Pathophysiology Review PDF

Pathophysiology Review Cardiomyopathies A heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and that are due to a variety of causes that frequently...

Pathophysiology Review Cardiomyopathies A heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and that are due to a variety of causes that frequently are genetic. Cardiomyopathies either are confined to the heart or are part of generalized systemic disorders, often leading to cardiovascular death or progressive heart failure–related disability. Primary Cardiomyopathy Secondary Cardiomyopathy Genetic. Acquired -Hypertrophic. - Myocarditis -Arrhythmogenic right ventricular -Left ventricular noncompaction cardiomyopathy - Inherited conduction system disorders -Ion channelopathies  Mixed cardiomyopathy. -Dilated cardiomyopathy -Restrictive cardiomyopathy Peripartum cardiomyopathy Stress cardiomyopathy Alcoholic cardiomyopathy Treatment of Cardiomyopathy Treatment depends on the type of: -Medication -Implanted pacemakers -Defibrillators -Ventricular assist devices -Ablation The goal of treatment is often symptom relief, and some patients may eventually require a heart transplant. Example of Hypertrophic Cardiac Myopathy: An Athlete What is valvular regurgitation? Cardiac valve leaflets, or cusp, are floppy and fail shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure. Where is the best location to place the stethoscope? Mitral valves stenosis is characterized by an early diastolic opening snap that is the loudest close to the left lower sternal border. This is followed by a low-pitched decrescendo rumbling diastolic murmur, which is heard best when the bell of the stethoscope at the apex at end- expiration when the patient is in the left lateral decubitus position. CHF -The heart is not pumping efficiently. The kidneys are getting less blood flow; therefore, holding on to sodium and water. What does renin-angiotensin-aldosterone mechanism cause? -Increase sodium and water retention. Heart Failure#1 HF occurs when the heart does not pump efficiently and does not deliver enough oxygen to meet your body’s needs. Dietary goal is to reduce the amount of work your heart needs to do. Examples: Low sodium diet and light exercise. Heart Failure #2 Systolic dysfunction—impaired ejection of blood from the heart during systole. Diastolic dysfunction—impaired filling of the heart during diastole. Heart Failure #3 Right-sided-Pulmonary edema, weight gain, congestion of viscera, jugular vein distention Left-sided-Decreased cardiac output, elevated pulmonary venous pressure. Note: Pitting edema ankles/feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. Circulatory Shock Diagnosis: involves a combination of symptoms, physical examination, and laboratory tests. Key indicators include a decrease pulse pressure (the difference between systolic and diastolic blood pressure) or a high shock index. Pathophysiology: Failure of the circulatory system to supply adequate blood flow, resulting in insufficient oxygen delivery to the body’s cells and tissues. - It can occur due to various factors, including severe bleeding, infections, allergic reactions, or cardiac failure. Clinical manifestations: Weakness fast heart rate, Fast breathing, Sweating, Anxiety and Increase Thirst. Treatment: depends on the underlying cause. Priorities include establishing an open airway, ensuring sufficient breathing. - Stopping ongoing bleeding (which may cause surgery or embolization) and administering intravenous fluids (IV) such as Ringer’s lactate or packed red blood cells. - Maintaining normal body temperature is also crucial. In some cases, vasopressors may be useful. Hypovolemic Shock Pathophysiology -this type may result from severe bleeding, vomiting, diarrhea, dehydration, or pancreatitis. Sepsis and Septic Shock Pathophysiology -Septic shock is characterized by dangerously low blood pressure. (SHOCK). Lungs, kidney, heart and brain typically receive too little blood. -Septic shock is the most severe stage of SEPSIS which occurs when the immune system has an extreme response to an infection. -fast heart rate, low blood pressure, fever, hypothermia (low body temperature), shaking, chills, warm, clammy, sweaty skin, confusion or disorientation and hyperventilation (rapid breathing). Treatment: treat people with life threatening sepsis within 1 hour (GOLDEN HOUR); antibiotics, intravenous fluids and blood pressure support. Obstructive Shock Circulatory shock that results from mechanical obstruction of the flow of blood through the central circulation Causes: dissecting aortic aneurysm, cardiac tamponade, pneumothorax, atrial myxoma, and evisceration of abdominal contents into the thoracic cavity. NOTES: what does dissecting aortic aneurysm sound/feel like?? Tearing or ripping type pain in the chest or back. Chronic Obstructive Airway Disease -Inflammation and fibrosis of the bronchial wall -Hypertrophy of the submucosal glands -Hypersecretion of mucus Loss of elastic lung fibers -Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse Alveolar tissue - Decreases the surface area for gas exchange Causes of Chronic Obstructive Airway Disease -Chronic bronchitis -Emphysema -Bronchiectasis -Cystic fibrosis COPD(Chronic Obstructive Pulmonary disease) Types of Chronic Obstructive Pulmonary Disease Emphysema -Enlargement of air spaces and destruction of lung tissue thus causes shortness of breath. - In people with emphysema, the air sacs in the lungs (alveoli) are damaged. -Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. The damaged alveoli don't work correctly, and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Chronic Obstructive Bronchitis -Obstruction of small airways -Most people with emphysema also have chronic bronchitis. -Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough. -Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD.  Treatment may slow the progression of COPD, but it can’t reverse the damage. Diet - Diet does not affect the respiratory tract other than via allergic reactions. Disorders of Blood flow Diseases of the Arterial System Dyslipidemia: is a condition of imbalance (triglycerides, phospholipids, and cholesterol) in the blood. Atherosclerosis : is a progressive disease characterized by formation of fibrofatty plaques in the intima of large- and medium-sized vessels. Disorders of Systemic Arterial Blood Flow Vasculitis: is an inflammation of the is a progressive disease characterized by formation of fibrofatty plaques in the intima of large- and medium-sized vessels blood vessel wall, resulting in tissue injury and necrosis. Dyslipidemia Triglycerides - Used in energy metabolism Phospholipids - Important structural constituents of lipoproteins, blood clotting components, the myelin sheath, and cell membranes Cholesterol -Chemical activity similar to other lipid substances Hyperlipidemia -Elevated levels of one or all of the above Classification of Lipoproteins Very–low-density lipoprotein (VLDL) -Carries large amounts of triglycerides -Derived from the calories we consume Intermediate-density lipoprotein (IDL) Low-density lipoprotein (LDL) -Main carrier of cholesterol -Often referred to as the “bad” cholesterol, high LDL levels contribute to the buildup of plaque in artery walls, increasing the risk of heart attacks High-density lipoprotein (HDL) -50% protein -Known as the “good” cholesterol; HDL helps remove LDL from the bloodstream. Example: Fish, avocado Disorders of Blood pressure -Blood pressure must be closely regulated throughout the body to ensure adequate perfusion of body tissues and to prevent damage to blood vessels. -Low blood pressure- tissues don’t receive sufficient blood flow to ensure delivery of nutrients and oxygen and removal of cellular wastes -High blood pressure- can damage endothelial tissue, increasing the likelihood of both atherosclerotic vascular disease and vascular rupture. Hypertension -Sustained condition of elevation of the blood pressure within the arterial circuit. -Etiology and pathogenesis -Clinical manifestations -Diagnosis and treatment Signs and Symptoms of Hypertension -Hypertension Headache -Dizziness -Vomiting -Nausea -Chest pain -Confusion -Anxiety -Nosebleeds -Buzzing in the ears -Difficulty breathing -Abnormal heart rhythm -Blurred vision or other vision changes Risk Factors for Hypertension -Age -Gender and race -Family history and genetics -Dietary factors -Tobacco -Alcohol consumption -Obesity Secondary Hypertension -Elevation of blood pressure that results from some other disorder, such as kidney disease. Causes of Secondary Hypertension Cushing disease or syndrome: Exposure to high cortisol levels for a long time. Hypertension in Pregnancy -Preeclampsia—eclampsia -Chronic hypertension -Chronic hypertension with superimposed preeclampsia -Gestational hypertension: Happens on during pregnancy; typically diagnosed after 20 weeks of pregnancy. HTN goes away after you give birth. MUST BE CONTROLLED Orthostatic Hypotension (Postural Hypotension) - “Sustained reduction in systolic pressure of at least 20 mmHg or more or diastolic blood pressure of 10 mm Hg within 3 minutes of standing or head-up tilt on a tilt table to at least 60 degrees”. Atherosclerosis -a progressive disease characterized by formation of fibrofatty plaques in the intima of large- and medium-sized vessels. Mechanisms of Development of Atherosclerosis Types of lesions associated with atherosclerosis Fatty streaks - Thin, flat yellow intimal discolorations that progressively enlarge Fibrous atheromatous plaque - The accumulation of intracellular and extracellular lipids, proliferation of vascular smooth muscle cells, and formation of scar tissue Complicated lesion - Contains hemorrhage, ulceration, and scar tissue deposits. Major Risk Factors for Atherosclerosis -Hypercholesterolemia -Cigarette smoking -Hypertension -Family history of premature CHD in a first-degree relative -Age (men ≥45 years; women ≥55 years) -HDL cholesterol