1 – Introduction and Heart Failure Flashcards
3 layers of the heart:
-pericardium
-myocardium
-endocardium
Pericardium: epidcardium
o Parietal and visceral pericardium
Thin layer of mesothelium and connective tissue
Pericardial space contains small amounts of clear lubricant fluid
Myocardium: heart muscle
o Striated, connected by intercalated disks
o Lots of mitochondria
Endocardium: atria, ventricles, valves
- Endothelium (superficial)
- Basal lamina
- Sub-endothelial connective tissue
*Purkinje fibres
AV valves
- Attached to papillary muscles by chordae tendinea
Postmortem examination of the heart
- Check in situ (relative size)
Most important compensatory mechanisms of the heart:
- Activation of neurohumoral systems (NE/RAA
- Cardiac dilation and hypertrophy
- Activation of neurohumoral systems (NE/RAA)
o Vascular redistribution of blood
o Increase HR
o Increase in blood volume
o *all leads to atrial natriuretic peptide secretion (counter mechanism)
o Cardiac dilation
Increased stroke (blood) volume
Myocardial fibers stretch=increase contractile force
* Limit to stretch (too far=decrease tension)
Chronic dilation through addition of sarcomeres (lengthening of myocytes)
*acute overload=dilation, chronic overload=hypertrophy
o Myocardial hypertrophy
Greater contractility and ejection force
* Pump more blood (volume overload)
* Pump at a higher pressure (pressure overload)
Due to sustained increase in cardiac workload OR due to trophic signals (ex. hyperthyroidism)
*reversible if workload demand is corrected
Eccentric hypertrophy:
- Accompanied by dilation
- *thin wall and distended ventricle
Concentric hypertrophy:
- Reduced volume of ventricular chamber
- *thick wall and reduced ventricular space
Cellular stages in cardiac hypertrophy:
- Initiation
- Compensation
- Deterioration
- Initiation
a. Increase cell size (sarcomeres/mitochondria)
- Compensation
a. Stable hyperfunction with no clinical signs