EXAM 2 PATHOPHISIOLOGY – CV, Resp, Musculoskeletal_STUDY GUIDE

EXAM 2 PATHOPHISIOLOGY – CV, Resp, Musculoskeletal 1. Discuss pathophysiology of coronary artery disease (CAD).  Coronary Arteries: Supply blood to the heart o Atherosclerosis – plaque formation on artery walls  P ...

EXAM 2 PATHOPHISIOLOGY – CV, Resp, Musculoskeletal 1. Discuss pathophysiology of coronary artery disease (CAD).  Coronary Arteries: Supply blood to the heart o Atherosclerosis – plaque formation on artery walls  Plaque formation starts forming in early adulthood  Usually forms in the bigger vessels  Coronary artery beds, aorta, carotids, vertebral, renal, femoral  Protrudes into lumen, partially or completely obstructing blood flow  Leading factor in cardiovascular disease  Fibrotic plaques become calcified, hemorrhagic, ulcerated, or thrombosed  Injury of Endothelial cells in tunica intima- inflammatory process begins  LDL cholesterol invades tunica intima layer  Macrophages “eat up” LDL & die (foam cells)  Foam cells accumulate; build fatty layers (fatty streaks)  Smooth muscle cells of tunica media migrate to fatty streaks  Form fibrous cap (collagen & elastin) over fatty streaks and lays down calcium deposits (PLAQUE structure)  Process repeats, artery becomes stiff, plaque narrows lumen & decreases blood flow (less O2 to tissue) Acute Coronary Disease  Plaque is a problem (atherosclerosis)  Unstable plaque – ruptured and thrombus  Stable plaque – obstructs blood flow  Plaque vulnerability to rupture: size of lipid core; lack of stabilizing smooth muscle cells; presence of inflammation; stability and thickness of fibrous caps 2. Describe the pathophysiology of the different types of angina. CHRONIC STABLE ANGINA: Predictable  Imbalance between blood flow and the metabolic demands of myocardium  Physical exertion, emotional stress, exposure to cold o Steady constricting, squeezing, or suffocating sensation o Increases in intensity at onset and end of episode o Relieved with rest and nitroglycerin o Delay of more than 5-10 minutes for relief is a sign of more severe ischemia! PRINZMENTAL ANGINA (variant angina):  Coronary artery Spasm  Happens at rest; usually at night UNSTABLE ANGINA:  Acute coronary syndrome May occur more frequently, occur more easily at rest, feel more severe, or last longer 3. Compare acute and chronic coronary syndromes. Unstable Angina • Ischemia (lack of blood flow) to cause symptoms, no signs of heart damage (Can also occur at rest) Non-ST-Elevation Myocardial Infarction (NSTEMI) • Ischemia severe to cause symptoms and raise cardiac markers (labs) ST-Elevation Myocardial Infarction (STEMI) • Ischemia severe to cause symptoms, raise cardiac markers (labs), and result in EKG changes (ST-elevation) • Necrosis of myocardial tissue 4. D escribe the pathophysiology of the pericardial disorders. - Acute Pericarditis Pericardial inflammation lasting less than 2 weeks o Inflammatory response  Causes: viral (majority), bacterial (Rheumatic fever), connective tissue diseases, post-MI, post cardiac surgery, neoplasms  Clinical manifestations: chest pain (worse with inspiration and coughing; decreases when sitting up and leaning forward); ausculatory pericardial friction rub (leathery sound); EKG changes; fever  Disease severity varies self-limiting to death o Complications: pericardial effusion and cardiac tamponade - Pericardial Effusion  Pericardial inflammation lasting less than 2 weeks  Inflammatory response  Causes: viral (majority), bacterial (Rheumatic fever), connective tissue diseases, post-MI, post cardiac surgery, neoplasms  Clinical manifestations: chest pain (worse with inspiration and coughing; decreases when sitting up and leaning forward); ausculatory pericardial friction rub (leathery sound); EKG changes; fever  Disease severity varies self-limiting to death  Complications: pericardial effusion and cardiac tamponade 5. Explain the pathophysiology of different types of valvular disorders. *Function of the heart valves are meant to promote unidirectional flow of blood through the chambers of the heart Valvular Heart Disease – dysfunction that can result from:  Congenital defects  Trauma  Ischemia  Degenerative  Inflammation Stenosis RegurgitationoNarrowing of valve orifice oDoes not OPEN properly oNot enough blood flows through the valve Mitral Valve Stenosis  Caused by Rheumatic fever  Impair filling of left ventricle  Leads to blood pooling in left atrium and thrombus formation o Distortion of valve o Does not CLOSE properly o Blood flows backwards Mitral Valve Regurgitation and Prolapse  Blood leaks back into left atrium  Leads to impairment of left ventricle, ↑ in atrial pressure, and pulmonary congestion  Mitral Valve Prolapse: floppy mitral valve – balloons back into left atrium during systole  With and without regurgitation