patho unit3
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- describe cardogenic shock sequelae to IHD
- loss of ventricle muscle consequence of large MI or dysrhythmias that decrease CO below level required to perfuse the tissues adequately (vulnarable to hypoxia)
- be able to describe some of the causes of the 3 forms of shock.
- Cardiogenic shock examples are most common cause is LV failure due to MI (> 40% of myocardium lost) thrombi, drugs, arrhythmias and MI are other causes. Hypovolemic shock= caused by massive bleeding, burns, dehydration. Vascular shock=toxic shock, sepsis, anaphylactic.
- a cause usually identified in primary hypertension?
- a complex interaction between genetics factors and enviornmental factors, there is no known cause identified in 90-95% of all cases , it is widely believed to be a defect in BP control systems and gentetic defects in the control system at some point.
- what is progressive shock?
- when BP remains low (compensatory mechanisms fail), reflexive mechanisms (RAA) or therapy begins in vital organs and the response is not megative feedback but positive feedback.
- be able to describe 3 functional cardiomyopathies.
- dialated=ventricles "outward" ventricular failure. Hyperthropic=ventricle hypertrophy "inward", outflow (genetic, asymptamatic), Restrictive=stiffened ventricular walls (muscle calcifies, steal-like)
- what are 3 areas that genetics may affect in hypertension?
- involves a defect in the kidney's sodium excretion mechanisms, defect may be centered in the membranes of arterial smooth muscle, and an exaggerated responsiveness on the part of the autonomic system so that it's constriction inputs to systemic arterials are excessive.
- LAD stands for?
- left anterior descending artery(AKA widow maker)40-50%
- what is meant by sclerosis?
- most arterial disease involves changes in the vessel wall that reduces it's elascticity and flexibility.
- how do obstructive lung disease tend to cause hypoventilation? examples
- due to increased fluid/mucusproduction, then reduced expiration (hard to remove) (ex's= chronic bronchitis,most common, Pulmonary emphysema, Small airway disease=nonfunctional, Chronic airway obstruction CAO/COPD, Cystic fibrosis.
- what is the prescipitating event in atherosclerosis?
- widely accepted as injury to endothelium, and accepted most common causes this is hypertension. Inflammation is now widely accepted as a possible presciitating event.
- what is vegetation?
- the basic lesion is the build-up of a large, easily fragmented infective mass (thrombus with masses of bacteria.
- give 2 factors that affect heart rate or contractility
- cronotropes and ionotropes
- CX stands for ?
- Circumflex artery between the LA and LV 15-20%
- what is coronary artery disase? what happens if the obstruction is severe enough?
- the cardiac result of the progression of systemic atherosclerosis. It si possible that the dynamics of blood flow in coronary vessels is such that they are nore suspecdtible to atherosclerosis thatn other vessels. if the obstruction is severe or prolonged (IHD) will develop
- describe aneurysms/rupture sequelae to IHD
- less pumping more turbulance, if rupture occurs it causes blood to fill the pericardial sac, compression caused by pressure form distended sac impedes filling of the ventricles and death ensues
- in CHF understand 2 clinical signs and organs affected by hear dysfunction
- the essential problem of the hearts inability to clear itself of the blood delivered to it and the compartively long time over which signs and symptoms develop, organs affected are the spleen and liver, (enlarged)
- is IHD always fatal?
- not always fatal, all sequelaes lead to CHF
- what is a chronotrope?
- acts as a cardiac rate acelerator (epenephrine and sympathertic nervous system)
- describe healing of infarcted tissue sequelae to IHD
- SCAR tissue less pumping
- what is non progressive shock?
- reflexive mechanisms return BP to normal, normal blood flow.
- what are the minor risk factors of atherosclerosis?
- obesity, lack of exercise, alcohol, etc.
- describe/give examples of restrictive lung disease
- defects with the thoracic wall; trauma=broken ribs, pneumothorax, musculart dystrophies, massive pulmonary edema.
- what are the 5 respiration steps?
- Ventilation(breathing), Gas exchange at alveoli, Gas transport in blood, Gas exchange in tissues, Cellular use of gases.
- what are 3 forms of shock and where so they affect blood flow?
- Cardiogenic shock=loss of CO. Vascular shock=loss of TPR. Hypovolemic shock=loss of plasma volume.
- what is myocarditis and its primary cause?
- inflammatory change in the myocardium, mostly viral, can be mild or up to heart failure, usually followed by a complete recoverey.
- what happens to blood pressure (and then CO and flow) in shock?
- shock will occur if BP drops such that CO or blood flows to tissues stops. P=pressue=F=flow X R=resistance=systemic blood flow. MAP=mean arterial pressue= CO X TPR=total periphrial resistance.
- what probably causes secondary hypertension?
- malfunctions of the kidney's or RAA activating system.
- what does ARDS stand for?
- Acute Respiratory Distress Syndrome, characterized by damage to pulmonary capillaries following some injurious event (often pneumonia)
- what is the goal of compensation of shock?
- to restore BP
- describe the pathogenesis of atherosclerosis.
- if endothelium is loss, heal, and heal but macrophages accumulate, then early signs such as presence of fatty streaks and in vessels (age 10) and new fatty streaks form (ages 10-30) , becomming plaque=macrophages appear in fatty streaks and accumulate fat.
- what are some enviornmental factors in hypertension?
- obesity, inadequate exercise, stress that increases epinephrine, smoking, etc.
- RCA stands for?
- Right coronry artery between RA and RV 30-40%
- give 3 causes of hypoperfusion
- Heart failure=decreased flow to pulmonary capillaries, pulmonary edema. Thromboembolism. Reduced ventilation=(hypoventilation creates a V/Q mismatch.
- what are the vessels most frequently involved in atherosclerosis?
- abdominal aorta and common illiacs, coronaries, femoral an popliteal, internal cartoids, and cerebral.
- descrobe arrhythmia sequelae to IHD
- damage to the conducting system
- explain 2 modes of therapy for hypetension. Identify some drugs that could be used.
- reduction of unfavorable enviornmental factors and drugs like , diuretics, beta blockers, ACE inhibitors and calcium channel blockers.
- explain the 3 factors that combine to dertermine BP
- CO blood pumped into circulation. Degree of smooth muscle constriction in arterioles (TPR). Plasma volume (fills vascular spaces)
- what is the patogenesis of promary shock?
- decrease BP, decreased cerebral blood flow leads to a breif loss of consciousness (syncope/fainting)
- what is the purpose of the respiratory system?
- to deliver oxygen to blood, and remove carbon dioxide from blood.
- what are 2 consequences of prolonged hypertension?
- arteriosclerosis (loss of vessel elasticity), loss of stretching, constricts lumen of arterioles increasing BP and predisposes to the charteristic pathology of athersclerosis which leads to increased incidence of stroke and heart attack.
- describe 3 signs of IHD
- typical angina pectoris= (oxygen demand > oxygen perfusion), it is a sign of myocardial ischemia, Acute MI = occurs when atheroma is disrupted an occludes a vessel, Sudden cardiac death (but does not have to have MI along with it)
- what is a variose vein?
- superfical leg veinss become dialated and assume a more twisted pattern, the irregular bulging of the varices limits complete valve closure and allows some backflow, valve function is compromised, adding to the volume and pressure load the wall must resist , veins in the rectum and anal cannal are called hemmaroids.
- describe throbosis sequelae to IHD
- less pumping more turbulane, triggered by activating factors released form injured myocardial tissues forms over the site of injury or were blood pools in weakly contracting chambers , CO decreased by injury and pt's immobility
- describe two things that will result in respiratory distress
- hypoperfusion of the blood=decreased pulmonary capillary flow, or inability of gases to be exchanged. Inadequate air flow to alveoli (hypoventilation)
- what is the conducting zone?
- zone for air passage
- what is chronic heart failuire?
- heart failure is added burden on the heart over a period of time.
- what are the major risk factors of atherosclerosis?
- hypertension/hemodynamic stress, hyperlipidemia/hypercholersterolemia, genetics, smoking, diabetes mellitus, and age and gender (to about age 60)
- what are 3 characteristic signs of respiratory distress?
- cough: productive (sputum) vs. nonproductive. Dyspena: (obstructive or decreased compliance). Cyanosis: blood has a lot of deoxygenated hemoglobin V/Q=ventilation/perfusion
- what should therapy in compenstated shock do? What haplpens if it is unsuccessful?
- dependant on eliminating the root cause (more easily done if hypovolemic) howerver even with appropriate if decrease BP and decreased blood flow to tissues = hypoxia, esp. affeted are the lungs, kidneys (uremia), and liver. Major therapy is increased flud volume, body responds increased BP, and drugs=increased heart rate=epinepherine
- describe the pathogenesis of bronchial asthma
- Triggering event--> IgE(most cells reaction)-->Parasympathetic stimulation-->Release of chemical mediators-->Mucosal swelling, bronchoconstriction,mucous hypersecretion--> Dyspenia, wheezing
- what is an inotrope?
- affects controctility, Hypoia and certain toxins decrease myocardial contractility and are called negative inotropes. Other factors such as digitalis or it's derivatives will increase contractility are known as positive inotropes. In addition the increased sympathetic stimultion and epinephrine are positive inotropes.
- what is actue heart failure?
- a few seconds to a few days (33% fatality)
- what are 3 effects of CHF give etiology for each.
- myocardial weakness=pumping activity decreased (ex:ischemia related to atherosclerosis, thrombosis in coronary arteries and MI. Pumping restrictions= pumping activity (ex: arrythmias, internal obstruction). Increased afterload= blood pooling in chambers and vessels leading to heart.
- what are 2 factors that lead to ishemia, sudden or gradual.
- extent of occulusion and Location-55-70% of CAD is in the left ventricle.
- what is infective endocarditis?
- if untreated (fatal), even with aggressive antibiotic therapy, morttality range of 30-35%. fungi and richettsiae also caouse endocarditis. 2 patterns of the disease are subactie-(IE) has mortality rate 5-10% and, Acute (IE) is 60-80%
- describe 3 sequelaes of atherosclerosis.
- 1) arterial stenosis=reduces volume of blood downstream, slower wound healing, impaired brain function, chest pain, failure of heart to meet demand, 2) thrombosis and embolism, 3) aneurysm
- occurs in the lungs between alveoli pulmonary capillaries, gases cant get in or out
- exchange of gases
- what is the respiratory zone?
- zone for gas exchange