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Patho Ch. 23
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Undergraduate 4
04/11/2012

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Term
arteriosclerosis
Definition
hardening and thickening of walls of arterioles
usually caused by elevated BP and aging
Term
atherosclerosis
Definition
depositis of yellowing plaques (atheromas) containing cholesterol, other lipoid material, and lipophages are formed within the intima of large and medium-sized arteries
Term
monckeberg's sclerosis
Definition
affects muscular wall of medium-sized arteries involving deposition of calcium salts
Term
hypertension
Definition
abnormal elevation of systolic and/or diastolic blood pressure
Term
primary hypertension
Definition
89-95%
hypertension with no known cause
malignant hypertension is severe form of primary with chronic kidney disease often being cause
Term
secondary hypertension
Definition
caused by altered hemodynamics associated with primary disease, such as atherosclerosis
Term
isolated systolic hypertension
Definition
elevated systolic blood pressure accompained by normal diastolic blood pressure
manifestation of increased cardiac output and/or rigidity of the aorta
Term
orthostatic (postural) hypotension
Definition
decrease in both systolic and diastolic arterial blood pressure upon standing
Term
characteristics of orthostatic (postural) hypotension
Definition
dizziness, blurring or loss of vision, syncope
Term
What causes acute orthostatic (postural) hypotension?
Definition
when normal regulatory mechanisms are sluggish as result of anatomic variation, drug action, starvation, prolonged immobility, exhaustion, etc.
Term
What causes chronic orthostatic (postural) hypotension?
Definition
may be secondary (results from endocrine disorders, metabolic disorders, or diseases of nervous system) or idiopathic (no known initial cause; affects men more than women between ages of 40 and 70)
Term
stable angina perctoris
Definition
characterized by crushing chest pain that occurs during exertion or excitement and is relieved by rest or with use of nitroglycerin
Term
unstable angina pectoris
Definition
intermediate coronary syndrome or pre-infarction anging
Term
prinzmetal angina
Definition
chest pain due to transmural ischemia of myocardim occuring at rest
Term
spastic constriction
Definition
triggered by exposure to wind or cold, excessive intake of caffeine or nicotine, anxiety, or physical exertion
Term
occlusion
Definition
characteristically a progressive and irreversible occurrence that is associated with later stages of SHD
Term
angina
Definition
temporary and reversible ischemia
Term
infarction
Definition
more sustained and extensive oxygen deprivation
Term
myocardial infarction
Definition
ischemic death of myocardial tissue associated with obstruction of a coronary vessel
thrombosis is ultimately linked with vessel occlusion
Term
intramural infarc
Definition
contained within the myocardium
Term
trasmural infarct
Definition
involves endocardium, myocardium, and epicardium
Term
subendocaridal infarct
Definition
limited to inner half of myocardium
Term
cardiogenic shock
Definition
profound left ventricular dysfunction
Term
congestive heart failure
Definition
state of circulatory congestion produced by myocardial dysfunction, associated with abnormal retention of water and sodium
Term
ventricular aneurysm
Definition
when large section of ventricular muscle is replaced by scar tissue, section does not contract with rest of ventricle; outpouching (aneurysm) of ventricle during systole, which diminishes myocardial pumping efficiency
Term
endocarditis
Definition
inflammation of the inner lining of the heart, including the membrane over the valves
Term
What does stenosis cause?
Definition
a decrease in flow through the valve, with an increased work demand on the heart chamber in front of the diseased valve
Term
What's an incompetent (regurgitant) valve do?
Definition
permits blood flow to continue while the valve is closed
work demands of both the heart chamber in front and that in back of the vavle are increased
Term
aortic valvular stenosis
Definition
causes resistance to ejection of blood into the aorta, so work demands on left ventricle are increased and volume of blood ejected into systemic circulation decreases
most common: rheumatic fever and congenital heart defects
Term
incompetent aortic valve
Definition
allows blood to return to left ventricle during diastole
may result from conditions that cause scarring of valve leaflets or from enlargement of vavle orifice to extent that valve leaflets no longer meet
Term
What's mitral valve stenosis almost always associated with?
Definition
rheumatic fever
Term
mitral vavle regurgitation
Definition
permits blood flow from the left ventricle to the left atrium as result of incomplete valve closure
Term
automaticity
Definition
ability of certain cells of the conduction system to initiate an impulse or action potential
Term
ectopic packemaker
Definition
an excitable focus outside the normally functioning SA node
Term
sinus bradycardia
Definition
rate of less than 60 beats/min
P wave precedes each QRS
may be normal in well-trained athlete
Term
sinus tachycardia
Definition
increase in rate to 100-160 beats/min with origin in SA node
normal during exercise and in situations that incite sympathetic stimulation
Term
sinus arrhythmia
Definition
heart rate speeds up and then slows down in an irregular, but cylic, pattern
often associated with respiration and alterations in autonomic control
Term
sinus arrest
Definition
failure of the SA node to discharge and results in an irregular pulse
an escape of rhythm develops as another pacemaker takes over
sinus arrest may result in prolonged periods of asystole and often predisposes to other arrhythmias
causes include disease of the SA node, digitalis toxicity, and excess vagal tone
Term
sick sinus syndrome
Definition
condition of periods of bradycardia alternating wtih tachycardia
bradycardia is caused by disease of sinus node and tachycardia by paroxysmal atrial or junctional arrhythmias
Term
atrial premature contraction
Definition
can originate in atrial conduction pathways or in atrial muscle cells
contraction is transmitted to the ventricle as well as back to the SA node
retrograde transmission to the SA node often interrupts the timing of the next sinus beat so there is a pause between the two normally conducted beats
Term
atrial flutter
Definition
atrial rate of 160-350
there is a delay in conduction through the AV node, and the ventricle responds to every 2nd, 3rd, or 4th beat
Term
atrial fibrillation
Definition
atrial rate in excess of 350, usually 450-600 beats/min
conduction through AV node is totally disorganized
the peripheral pulse is grossly irregular
a pulse deficit can be observed
may be caused as result of left atrial distention due to mitral stenosis
Term
pulse deficit
Definition
difference between apical and peripheral pulses
Term
alterations in AV conduction
Definition
conduction defects are most commonly due to fibrosis or scar tissue in fibers of the conduction system
also can occur as result of digitalis toxicity
Term
heart block
Definition
occurs when conduction through the AV node is delayed or interrupted
may occur in the AV nodal fibers or in the AV bundle(bundle of His), which is continuous with the Purkinje conduction system that supplies the ventricles
affects P-R interval of ECG
Normal range: 0.12-.20 sec
Term
first-degree heart block
Definition
conduction through the AV pathway delayed
P-R interval is longer than 0.20 sec
Term
Second-degree block
Definition
one or more of atrial impulses are blocked
Term
Mobitz type I or Wenchkebach phenomenon (2nd degree block)
Definition
pregressive increase in P-R interval until the point where one P wave is totally blocked
Term
Mobitz type II block (2nd degree block)
Definition
sudden block in one or more atrial impulses without an antecedent prolongation of P-R interval
ventricular rate is irregular and reflects degree of block
significant because it often precedes complete heart block
Term
Third-degree or complete block
Definition
when conduction link between atria and ventricles is completely lost
atria continues to beat at a normal rate and ventricles develop their own rate, which is normally slow (30-40 beats/min)
complete heart block causes a decrease in cardiac output with possible periods of syncope (called Stokes-Adams attack)
Term
ventricular arrhythmias
Definition
more serious than those in atria
Term
premature ventricular contraction
Definition
caused by ventricular ectopic pacemake
ventricle is usually not able to repolarize sufficiently to response to next impulse that arises in SA node
Term
ventricular tachycardia
Definition
ventricular rate of 160-250
dangerous b/c causes reduction in diastolic filling time to point where cardiac output is severly diminised or nonexistent
leads to compromised coronary perfusion and predisposes to fibrillation
Term
ventricular fibrillation
Definition
fatal arrhythmia, unless interrupted by cardioversion
ventricle quivers, but doesn't contract, with cessation of cardiac output
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