04.16 - HTN, Related HD (Nichols) Flashcards
4 Major Types of Hypertrophic Heart Diseases
HTN Heart Disease, Hypertrophic Cardiomyopathy, Aortic Stenosis, Cor Pulmonale
3 Characteristics of HTN HD
Diastolic Dysfunction, Impaired Compliance and Ventricular Filling
4 major types of Hypertrophic Heart Diseases in order or prevalence
HTN Heart Disease, Hypertrophic Cardiomyopathy, Aortic Stenosis, Cor Pulmonale
Acute-on-Chronic Cor Pulmonale =
RV Dilatation + Hypertrophy
Age of presentation with Calcifications in Sinuses of Valsalva
Over 70
Age range for Bicuspid Aortic Stenosis
young and middle-aged adults
Age range for Degenerative Calcific Aortic Stenosis
> 70
Age range for Rheumatic Aortic Stenosis
young and middle-aged adults
Chronic Cor Pulmonale is characterized by
RV (and often R atrial) Hypertrophy
Criteria for Dx of HTN HD
LV Hypertrophy in absence of other CV pathology; Hx or pathologic evidence of HTN
Diastolic Dysfunction, Impaired compliance and Ventricular Filling are characteristic of
HTN HD
Dilation in HTN HD
Usually doesn’t occur until late in process
Do the same tx’s for atherosclerosis prevention work for calcific aortic stenosis
NO
Fibrosis is a feature of
HCM
Fibrosis of HCM can provide the anatomical substrate for
Reentrant Ventricular Tachycardia
How does rheumatic vavlulitis stenose the semilunar valve
Inflammation and fibrosis start at the commissure and moves inward
Hypertrophic CM is associated with asymmetric __
hypertrophy of septum
If aortic valve stenosis is due to previous rheumatic valvulitis, 95% of cases have simultaneous
mitral stenosis
In Acute Cor Pulmonale, the RV usually shows only
Dilation
In some cases of what are myocytes oriented in abnormal directions (not parallel)
HCM
Microscopic findings in HTN HD
Transverse diameter of myocytes is increased; Boxcar nuclei
Myocyte disarray is seen in many cases of
Hypertrophic CM
Normal LV thickness
1.2 - 1.4 cm
Normal Ventricular wall thickness
1.2 - 1.4 cm
Patient with Bicuspid stenosis probably present with
Sudden death
Possible Tx for HCOM
Surgical resection; Inject ethanol
Presentation of Calcifications in Sinuses of Valsalva
Dyspnea, Angina, or Sudden Death
Prevalence of HTN Heart Disease in HTN pts
60% of blacks, 30% of whites
Risk factors for Calcific Aortic Stenosis
Nearly same as atherosclerosis
RV in Chronic vs Acute Cor Pulmonale
Hypertrophy in Chronic, Dilatation in Acute
The myocardial fibrosis in HTN HD and other hypertrophic HD’s tends to be
Interstitial
Transverse diameter of myocytes is increased; Boxcar nuclei
Microscopic findings in HTN HD
Typical symptoms of compensated HTN HD
Usually asymptomatic
What causes obstruction of outflow in HCM
Asymmetrically hypertrophied upper septum bulging into outflow tract = HCOM
What drives Progressive Myocardial Fibrosis
Cytokines, TGF-Beta
What has stenosed the aorta in degenerative calcific aortic stenosis?
Formation of rocks in sinuses of valsalva
What is highlighted by trichome stain
Interstitial fibrosis in HCM
What proportion of Hypertrophic CM patients have HCOM
One Third
Which hypertrophic HD is a surgical emergency
Aortic Stenosis
Which hypertrophic HD occurs in RV
Chronic Cor Pulmonale
Which hypertrophic HD occurs in young
Hypertrophic CM
Which hypertrophic HD’s have murmurs
Aortic Stenosis, Hypertrophic CM sometimes
Which hypertrophic heart dieases is more prevalent in blacks
HTN HD
Which hypertrophic heart disease can be acute
Cor Pulmonale
Which hypertrophic heart disease doesn’t present with angina
Cor Pulmonale
