(4) Heart failure, congenital & ischemic disease (Martin) Flashcards
What is the number 1 worldwide cause of mortality?
Cardiovascular disease (CAD, stroke, and peripheral vascular disease)
Define: (in relation to the heart)
Hypertrophy=
Dilation =
Cardiomegaly=
Hypertrophy= increase in ventricular thickness
Dilation = enlarged chamber size
Cardiomegaly= increased cardiac weight
Where is atrial natriuretic peptide (ANP) found?
What is ANP’s significance?
ANP is found in storage granules within atrial myocytes of the myocardium
ANP promotes arterial vasodilation and stimulates renal salt and water elimination (natriuresis & diuresis)
What are the three types of heart damage?
Collagen = mitral prolapse
Nodular calcification = calcific aortic stenosis
Fibrotic thickening = rheumatic heart disease
Significance of lipofucin?
Yellow-brown pigment granules composed of residues of lysosomal digestion
They are considered the “wear and tear” pigments
Significance of basophilic degeneration?
As the myocardium looses material, it gets replaced by basophilic deposits
What is congestive heart failure (CHF)?
Occurs when the heart is unable to pump blood at a rate to meet peripheral demand OR can only do so with increasing filliing pressure
What can cause CHF?
Loss of myocardial contractile function (systolic function)
Loss of ability to fill the ventricles during diastole (diastolic dysfunction)
When does cardiac hypertrophy occur?
- Sustained pressure or volume overload (systemic HTN or aortic stenosis)
- Sustained trophic signals (Beta-adrenergic stimulation)
What is the best way to measure hypertrophy?
Heart weight
Is there an increase in the blood supply with a hypertrophic heart?
NO!
Hypertrophy of myocytes isn’t accompanied by a matching increase in blood supply, despite the increase in energy demand
Hypertrophied hearts are vulnerable to…
Ischemia-related decompensation
What is a major histologic marker for left sided heart failure?
HEART FAILURE CELLS
Hemosiderin-laden macrophages
Make this association RIGHT NOW…
Heart failure cells only occur with…
LEFT sided heart failure
What is the most common cause of Right sided heart failure?
Left-sided heart failure
What would cause an isolated right sided heart failure?
Pulmonary hypertension
Left sided heart failure is most commonly due to…
Ischemic heart disease, systemic hypertension, mitral or aortic valve disease
The most common genetic cause of congenital heart disease is…
Trisomy 21 (Down syndrome)
What is the most common congenital cardiac malformation?
Ventricular septal defect
What is the most common form of ventricular septal defects?
Left-to-Right Shunts
What are the common forms of left to right shunts?
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent ductus arteriosus (PDA)
What does left-to-right shunting cause?
Volume overload on the right side which can lead to…
- Pulmonary hypertension
- Right heart failure
- Paradoxical embolization
What is a PFO?
Patent foramen ovale
Most of the time, it permanently closes by 2y/o
What is this an example of?
VSD membranous type
What is the clinical sign of a patent ductus arteriosus (PDA)?
Harsh, machinery-like murmur
What is a common presentation for the teralogy of fallot (TOF)?
Squatting
Cyanosis
Clubbing
Syncope
What are the four cardinal features of tetralogy of fallot?
- VSD
- Pulmonary stenosis
- Aorta overrides the VSD
- RV hypertrophy
*Heart is enlarged and “boot shaped” because of RIGHT ventricular hypertrophy
Transposition of the great vessels (TGA)
Discuss
Incompatible with life after birth unless a shunt is present for mixing of blood
*With TGA, pt gets two separate systemic and pulmonary circulations
Coarctation of the aorta is highly associated with?
Turner Syndrome
Major clinical manifestations of Coarctation of the aorta WITH a PDA?
Cyanosis in the lower half of the body
What are the major clinical manifestations of aortic coarctation WITHOUT a PDA?
Murmurs throughout systole
Usually asymptomatic
HTN upper extremities and hypotension in lower extremities
NOTCHING on undersurface of ribs
What causes ischemic heart disease?
Results from insufficient perfusion to meet the metabolic demands of the myocardium
*Blood to the myocardium is supplied by the coronary arteries, so any disruption of coronary flow may result in ischemia
What is angina pectoris?
Transient, often recurrent chest pain induced by myocardial ischemia insufficient to induce myocardial infarction
What are the three clinical varients of angina pectoris?
Stable angina
Prinzmetal variant angina
Unstable (or “crescendo”) angina
What are the sx of stable angina?
“Squeezing” or burning sensation
Relieved by rest or vasodilators
Induced by physical activity or stress
What is prinzmetal variant angina?
Episodic coronary artery spasm
Relieved with vasodilators
Unrelated to physical activity HR or BP
What is unstable/crescendo angina?
Frank pain that increases in frequency, duration and severity at progressively lower levels of physical activity
Usually rupture of atherosclerotic plaque which causes
How can you tell that a heart is experiencing irreversible injury?
Increase in lactate, decrease in ATP
What is the most common coronary vessel associated with infarct?
LAD
Describe the appearance of:
An Old MI
Necrotic tissue
Cardiac rupture
An Old MI = White reveals scarring
Necrosis = yellowish appearance
Cardiac rupture = blackish
What are the tests you’d perform to confirm an MI?
CK-MB
Troponin I and T (cTnI and CTnT) *most sensitive and specific
What is the most common complication of MI?
Arrhythmia
Time to elevation of CKMB, cTnT and cTnl?
3 to 12 hours
CKMB and cTnL peak at?
24 hours
CKMB returns to normal levels at?
48-72 hours
cTnl returns to normal levels after?
5-10 days
cTnT returns to normal levels after?
5-14 days
