Hypoplasia

Less cells making up that tissue. Cells never grew. Or the cells grew, but shrank and grew smaller over time. Either one in relationship to cells means hypoplasia

Atrophy

grew (matured) reached full size, but then shrunk. As aging occurs tissues atrophy. Some atrophy normal: embryo or fetus during course of development, aging, chronic ischemia,

Atrophy is not always abnormal

Metaplasia

Metaplasia: (Greek- meta: beyond/away; plasia: form/molding) Cell differentiation that grow away from a form normal for that specific area, a particular design shift typically caused by insult, infection and are more resistant

Dysplasia

Abnormality in differentiation and in proliferation. Would mean that the cells have changed in a normal differential line, but are abnormally changed in reproduction. (cluster of cancer cells, for example)

Neoplasms

Benign Neoplasm

Benign Neoplasm/ Tumor – a local occurring event. Surrounded by absolutely normal developing cells. Doesn’t invade tissue. Just nudges it out of the way. May continue indefinitely, or may grow to a certain point and stop. Usually has a well-defined border and is very localized

Malignant Neoplasm

Malignant – (evil; wicked in latin) Not cohesive. Doesn’t nudge other tissue – it invades other tissue.

            What malignant growth is (and all that it is) is that somewhere in the developmental pattern, cells began to randomly/acceleratedly/exacerbatedly reproduce. Rather than continuing the normal rate of reproduction, they began to acceleratedly reproduce. The younger this is in cell development, the worse it’s going to be. Their growth is rapid and aggressive.

            Metastasis – (away from a position in latin) The malignant cells may go out and recruit other cells to grow nutty, too.

Common sites of Metastasis

Lungs, Bone, Liver

Immune system and Cell Reproduction

Something has influenced the reproductive part of the cell.

On a daily basis the reproduction of a cell can be compromised. By this morning, we may have been up against cancer many times in one day. What changes is when a person’s immune system is compromised and can’t fight the destructive nature of the crazy reproductions.

~oma

"generally" means a neoplasm that's benign.

(several exceptions: carcinoma, sarcoma, lymphoma, adenocarcinoma)

Adenoma

Benign growth in gladular tissue

(aden is glands)

Carcinoma

Malignant.

Origination of the tumor was epithelial cells.

Adenocarcinoma

malignancy in epithelial cells in the gland. Sometimes we can tell the epithelial cells that it arose from.

Fibroma

Benign. Arose from fibrous tissue

Osteoma

Benign. Arose from bone tissue.

Sarcoma

it arose from the supporting tissue. Sar reflects malignant.  Example – osteosarcoma – malignant growth in bone tissue.

Fibrosarcoma

Malignant growth in fibrous tissue

Lymphomas

neoplasms arising from lymphoid tissue, usually malignant, lymphoma synonymous with malignant lymhoma.

SIGNS of Heart Disease

Edema – typically it’s peripheral edema. Swelling caused by the accumulation of interstitial fluids.

Pulse - rate, rhythm, force, amplitude, quality= good indicator of Stroke Volume – volume of blood being pumped out of LV with each contraction 70 ml (ejection fraction)

Blood Pressure - 120/80 normal

SYMPTOMS of Heart Disease

Angina – Chest pain. The heart muscles hurt. Heart is 100% aerobic, so if oxygen can’t get to the heart due to blocked passages, it hurts.

Orthopnea/Dyspnea – Difficulty in breathing while laying down.

Palpitations – being aware of your heart beating. What makes you aware of your heart beating, are changes in its rate, force, rhythm, skipping a beat, whatever.

Define Stroke Volume

The volume of blood ejected by each ventricle per beat.

  Residual ventricular volume at end of systole is referred to as the end-systolic volume.

Korotkoff Sounds

Onset of turbulent flow is heard as first Korotkoff sound and correlates with systolic pressure.

Reductions in cuff pressure produce characteristic alterations in the sound as flow increases through the arterial lumen until the sound disappears - abrupt muffling or disappearance of sound correlates with diastolic pressure.

When is BP hypertensive?

Systolic: greater than 140

Diastolic: greater than 90

Calculation of Pulse Pressure

Pulse pressure is difference between systolic and diastolic pressure. If you have a pressure of 105/90, pulse pressure is 15. It is influenced by peripheral resistance and stroke volume. Greatest resistance to blood flow is in smaller arteries and arterioles.

Explain Gallop Rhythm

Additional heart sounds, typically in the manifestations of heart disease the appearance of these sounds is referred to as gallop rhythm

3rd and 4th heart sounds

S3- Ventricular gallop. Really is a rapid filling of the ventricle. Hearing blood rushing into the ventricle and filling it up very quickly. A normal sound you hear in children. Not normal in adults.

S4- You hear when there is an increases in ventricle resistance to atrial filling. In other words, when something is going on in the ventricle that is interfering with the atrium’s ability to fill. If the ventricle can’t get rid of all its blood, the atrium can’t dump the whole of it’s blood. The atrium grows bigger.

Kussmaul's Sign

Normally, when you breathe in, there's a slight fall in your jugular venous pressure (which reflects function of rt. side of heart). It's when pressure in chest falls and gives blood a push up to right side of heart.

A Kussmaul's sign is when you breathe in and venous blood increases. This reflects an impediment of blood return to the heart. Something on the rt side is interfering w/ blood flow (heart isn't emptying properly) making pressure increase.

Correlation of 1st and 2nd Heart Sounds

First Sound: AV valves closing

Second Sound: Semilunar valves closing

1st and 2nd heart sounds are correlated with the closure of the AV valves and then the semilunar valves.

first sound is ventricular systoli: when the heart valves are getting smaller and smaller. AV valves getting smaller on first sound

second sound ventrical has contracted and closed. Semilunar valves have opened, due to backwash of blood closing them. There is no more pressure pushing the blood out the aorta.

Abnormal would be pulmonary valve closing before the aortic.

Extra Cardiac Sounds

Normally you don’t hear valves open or close. Typically means there is a pathology there if it can be heard. Hearing this valve open or close is an extra cardiac sound

Friction rub – a fibropurulent exudate in the cardiac cavity would cause a sound you don’t normally hear.

How is pulse pressure influenced by stroke volume and peripheral resistance?

Narrow pulse pressure indicates a low stroke volume, high peripheral resistance, or both

Falling BP and narrowing pulse pressure is ominous sign of LV dysfunction

4 major determinants of myocardial oxygen demand

Heart Rate

Contractile Force

Muscle Mass

Ventricle Wall Tension

Define & Explain Cardiac Ischemia

If a lack of oxygen to the heart is transient (reversible state of inadequate blood flow), patient is suffering from an Ischemic attack.

Can lead to necrosis of tissue. LV most suseptible.

Development of Atherosclerotic Lesions

 the build up of plaque, lipids, fibrous tissue build up in arteries and narrows the lumen of the artery, very slowly. It prevents the arteries from dilating.

Most likely to develop at curve or branch.

until vessel is ^ 75% occluded – pt. probably fine

Risk Factors for Atherosclerosis

Age: rare for complete occlusion under age 40

Race: Blacks more likely than whites

Family: May be genetic. May be environmental

Sex: Females relatively immune until after menopause. More likely than males after meno.

VLDL, LDL, HDL

 VLDL: very low density lipoproteins, majority of material is triglycerides

LDL: low density lipoproteins; least amount of proteins, greatest amount to cholesterol. Increasing LDLs increases coronary artery disease

HDL: high density lipoproteins; largest part of molecule is protein. Want these #s high.

Total cholesterol should be below 180

Other Risk Factors

Smoking: not about how long you've smoked, but how many per day.

Diabetes: Type I more than Type II greater risk  of vessel insult in injury.

Obesity: Sedentary lifestyle and bad diet can create a lot of plaque and occlusion of blood vessels.

Explain the relationship of hypertension to coronary atherosclerosis and give risk factor of development

Leading cause of death in the US; 25% of the population. Greater risk in Blacks. Elevation in systemic blood pressure leads to cardiac workload increases, then ventricle hypertrophies, and cardiac dilation and failure. Vascular flow is disrupted to brain and kidneys leading to renal failure or cerebrovascular rupture

Explain the relationship between ischemia, anaerobic metabolism and a decrease in pH

The lack of oxygen (ischemia)forces the myocardium to shift from aerobic metabolism to anaerobic.

Anaerobic = less efficient means of energy production, phosphate reduced. Lactic acid is produced which reduces cellular pH

Explain T wave and ST segment changes associated with ischemia

Very pronounced QRS complex

Elevated ST segment

T wave - inverted

Over time ST changes and T wave changes tend to revert, evidence of old MI in LV is a pronounced Q wave

Transmural: involves the full thickness of the myocardial tissue

Subendocardial: limited to half of myocardium thickness

Within first 24 hrs. MI looks like a bruise. in 24 hrs. repair has begun. Inflammation activates coagulation factor - fibrous net; very fragile. keep pt. calm. Repair complete in 3 days.

Define & Explain Congestive Heart Failure

Circulatory congestion produced by myocardial dysfunction. Location of congestion depends on which part of heart was affected in MI.

Lt Vent: Pulmonary Venous Congest (most common)

Right Ventricle: Systemic Venous Congestion

Failure of both: biventricular failure

Cardiogenic Shock

40% or more of left ventricular dysfunction after massive infarction. Leading cause of death of hospitalized patients with MI

Ventricular Septal Defects

You can potentially blow a hole through septum when there is ventricle septum involvement in MI. Tissue weakest/vulnerable when fibrinogen comes in. LV greatest pressure. Could spill into RV.

Common cardiac problem that children have. Birth defect (foramen ovale didn't close) NOT MI – surgically repaired

Tachycardia and bradycardia

and how they affect formula

Cardiac Output: heart rate x stroke volume

HR is primary determinant of CO (CO=HRXSV)

The most common side effect of MI: dysrhythmia

tachy= over 100; lowers CO by reducing vent. filling time and SV. Increase myocardial Oxy demand = ischemia. Reducing duration of diastole, compromising coronary oxy supply

brady= under 60; lowers CO by reducing frequency of ventricular ejection 

Define 1st, 2nd, 3rd Degree Heart Block

·         1^st degree: all impulses getting through AV node, but taking a bit longer

·         2^nd degree: still getting through, but taking even longer

Heart Block: A delay or interruption in the impuse between the atria and ventricle.

This complication occurs w/ posterior MI's

Bundle Branch Block

MI involving the bundle of His - means that impulses are reaching ventricles at different times.

Interruption of conduction in the bundle branches that prolongs ventricular depolarization times.

Two types of problems produced by disease values

AV & SA very fragile when diseased. One of two things happen: stenosis or regurgitation

Valvular Stenosis: valve orifice becomes restricted impeding forward flow

Valvular Regurgitation: valve leaflets fail to close securely, permitting backflow.

Mixed Lesion: stenosis/regurg appear together

Pure Lesion: one or the other appear alone

Mitral Regurgitation

Backflow

Permits retrograde blood flow from LV to LA - incomplete valve closure - during systole: LV ejects blood forward: aorta and backwards: LA

Aortic Stenosis

Stiff Valve

LV has to hypertrophy in order to generate enough pressure in order to overcome the stiff valve and maintain perfusion – okay for awhile, putting on muscle, but the inflexibility patient will do well until > than 50% occluded (blocked). Rule of thumb: then start to have serious problems: pulmonary edema. Prognosis: bad

Aortic Regurgitation

Reflux of blood from aorta into L ventricle during relaxation. Imposes severe volume load on L ventricle = hypertrophy

Used to be a result of syphilis

Tricuspid Valve Disease

Stenosis of tricuspid valve restricts blood flow from R atrium into R ventricle during diastole

Associated w/ mitral/aortic valve disease and rheumatic heart disease

R atrium dilates = systemic venous pressure elevation

P Wave is Bigger and Wider

Preload

preload: degree of myocardial fiber stretch immediately before contraction

the greater the stretch of myo fiber at end-diastole, the stronger teh force of contraction during systole

Afterload

The tension the myocardial fibers have to develop to contract and eject blood

Contractility

The change in the developed force of contraction that occur independent of changes in myocardial fiber length

Reduce myocardial contractility-> incr heart failure

MIs, cardiomyopathies

Cardiac Shock

results from profound L ventricle dysfunction, after a massive MI, usually involving more than 40% of ventricle.

Cardiac Index

The cardiac output in liters/minutes/square meter of body surface

CO/body surface area

Aprox. 3L/min/meters squared of body surface

Fusiform and Saccular Aneurism

True aneurysm resulting from the atrophy of the medial layer of the artery. Arterial wall dilates, but remains intact although distorted and composed primarily of fibrous tissue

Fusiform: uniform, circumferential dilation

Saccular: saclike outpouching connected to the arterial wall by narrow neck

These can be seen in Marfan's

Premature Beats

An activation of electrical conduction system from a site other than SA node

OR

SA node activated before a current has made it completely through the conduction system. (activated it and then turned around and activated it again)

Ventricular Fibrilation

Like a twitching eye or leg muscle. Not contracting. Just twitching

To stop it, we need to shock you to shut down the electric system. (turn off the switch) Since heart has autorhythmicity, it will start itself.

Patient has converted if it starts back up.

(when die from electrocution, they die from de/fibrilations)

Cardiac Shock

We have a heart so damaged, that we can't profuse tissue. It's becoming hypoxic from lack of O2.

Losing a % of LV means we can't retain CO. Hypotension - blood not getting back to lungs. Can't blow off enough CO2. Potassium UP when acidotic.

Criteria for Cardiogenic Shock

Systolic less than 90

Urine less than 20 ml/hr

Decrease Blood Flow

Skin pale from Vasocongestion

Decrease Mental Function

Cardiac index less than 2.1 liters/min. (avg. CI is 2.8)

Varicose Veins

Dilation and elongation of veins. Most of the time they are cosmetic.

people on feet a lot are prone to it.

Thromboembolic Venous Disease
& 3 contributing factors

Embolis - any substance, a blood clot, a fat globule, air bubble, anything affecting blood flow.

Stasis of Blood Flow

Hypercoagulation

Endothelial Injury

Superficial Thrombophlebitis

Typically involves subcutaneous veins in the arm and limb.

If it's in the arms, most likely damage from IV

If it's in legs, probably vericose veins

Veins affected w/ Deep Vein Thrombosis

Popliteal

Superficial Femoral

Illiofemoral

Aneurisms

Fusiform and Saccular

Aneurysm is a localized dilation in the artery. The strongest, middle layer of the 3 layers has atrophied. Other two become thin from the pressure. If it perforates, it's fatal. May seep and that could be symptomatic.

Fusiform- both sides

Saccular - only 1 side

high incidence in Marfans

Usually seen in the abdomen (aorta)

COPD

Chronic Obstructive Pulmonary Disease

Generic term for a resistance to airflow in lungs.

Cystic Fibrosis

Genetic. Recessive. 1:2,000 births in white pop.

Problem w/ exocrine glands. Secretions are thick, viscous. In pancreas, liver, bronchioles.

Usual cause of death is infection. hard for antibiotics to reach areas of deep mucous.

Thoracic Cage Disorders

Lung tissue is fine - person dies because of pulmonary complications

includes:

pectus excavatum, pickwickian, pleural effusion, hemo pneumo and tension pneumothorax

Bronchiectasis

Usually in kids

Characterized by chronic dilation and inflammation of bronchi and bonchioles

Typically from an infection - secondary to cold, flu, measles, etc. Can be fatal

Cough up nasty, foul, multicolor sputum

Increase in sputum 200ml/day

Chronic bronchitis and role of goblet cells

Increase in hypertrophy of goblet cells

Major etiologic correlation - air pollution

Only way lungs has to deal with the stuff in there is to cough it up.

Asthma

3 reasons - bronchi spasms, increase in mucosal edema, Increase in amt. of mucus in air passages

3 Categories:

Allergic- in kids. spasm & increas in mucosal edema

Idiopathic- no clear cause. after age 40. precursor to chronic bronchitis and emphysema.

Mixed- some of both allergic and idiopathic

Pectus Excavatum

Kids born with lower part of sternum fused to the thoracic spine. Lungs can't move properly, but they are fine.

example of Thoracic cage disorder - lungs fine, but gasses can't exchange

Pickwickian Syndrome

Very obese people. Can't move their hugely heavy chest. Sleep a lot because they are retaining CO2. Also have sleep apnea.

An example of Thoracid Cage Disorder - lungs fine, but gasses can't exchange

Pleural Effusion

collection of fluid in cavity - may be transudates or exudates

Sleep Apnea

Not breathing during sleep and then suddenly gasps (due to high CO2 levels). Correlated w/ snoring, being overweight, and sleeping on back

Hemothorax

Pneumothorax

Tension Pneumothorax

Hemothorax -blood in thorax cavity (caused by trauma; knife wound or broken rib)

Pneumothorax - air in thorax cavity

Tension Pneumothorax - defect remains open during inspiration, closed during expiration, a lg. volume is collected in pleural space. Pressure builds up, so lung collapses. Emergency - treated w/ aspiration of air from cavity

Bacterial Pneumonia

Inflammation of the lungs. Consolidated area of infection. Exudate/ pus

Most common cause of pneumonia is a species of strep. The pneumonia vaccine is against strep.

Viral Pneumonia

No consolidation. Can't be seen on a chest X-ray. Can't be treated.

Dry air can lead to cracked mucous membranes so that more organisms can get into the system.

Aspriation Pneumonia

Lying on back and vomit - sucked into lungs.

Puts acid in lungs which kills lung tissue.

Microbes from mouth, throat, enter lungs to grow in the dead tissue.

Gangrenous lungh tissue w/ bacterial growth.

May develop bronicectasis from this.

Hypostatic Pneumonia

Occurs in lower base of lungs. Nursing home pts. Laying in same pos. for a long time.

After surgery, sit on side of bed, deep breath, dangle feet, aerate lower bases of lungs

When there is no deep breathing for a period of time, it can lead to infections.