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DMD 5247 > Bikman - Heart Path > Flashcards

Bikman - Heart Path Flashcards

1
Q

What is heart failure? Early and final stages?

A

Heart cannot pump blood sufficient to meet body’s needs. Generally occurs on one side.

Early stages, compensations can occur:

  • Catecholamines
  • Frank-Starling mechanism
  • Hypertrophy

Eventually:
- Ischemia

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2
Q

What is the Frank-Starling mechanism?

A

The more time the heart has to fill, the stronger it will contract

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3
Q

Where does R heart failure manifest?

A

Below the heart

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4
Q

Where does LHF (left heart failure) manifest?

A

Above the heart

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5
Q

What are some common causes of LHF?

A
  • Systemic hypertension
  • Mitral or aortic valve disease
  • Primary heart diseases
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6
Q

What are some heart changes observed in LHF?

A
  • LV hypertrophy**
  • LV dilation
  • LA may be enlarged
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7
Q

What are some consequences of LHF?

A
  • Dyspnea - hard time breathing
  • Orthopnea - hard time breathing in certain positions
  • Enlarged heart, increased HR
  • Rales - fluid accumulating in lung space
  • Mitral regurgitation, systolic murmur
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8
Q

What are some common causes of RHF (right heart failure)?

A
  • Cor Pulmonale ( HF due to lung failure)

- Some congenital heart diseases

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9
Q

What are some heart changes observed in RHF?

A
  • RV hypertrophy
  • RV dilation
  • RA may be enlarged
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10
Q

What are some consequences of RHF?

A
  • Peripheral edema
  • Hepatomegaly
  • Splenomegaly
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11
Q

Outline the series of events that cause cor pulmonale.

A

HF due to lung failure, causing RHF.
RV enlargement due to pulmonary hypertension (from primary lung disorder).

There is less O2 in the alveolar capillaries, causing alveolar constriction. The R side of the heart has to do more work since the alveoli constriction increases pressure.

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12
Q

What are the 3 categories of congenital heart disease and what diseases fall under each category.

A

Left to right (L2R)

  • ASD
  • VSD
  • PDA

Right to left (R2L)

  • Tetralogy of Fallot
  • Transposition of great arteries

Coactation
- Aortic coarctation

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13
Q

Atrial Septal Defect (ASD)

A

Too much blood going to the lungs

  • May cause pulmonary hypertension
  • Sending too much blood to the lungs
  • Mixing of oxygenated and deoxygenated blood
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14
Q

Ventricular Septal Defect (VSD)

A

Too much blood going to the lungs

  • Most common
  • Most close spontaneously
  • Size and location matters
  • The higher towards the base the defect is, the more problematic it will be with mixing of blood
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15
Q

Patent Ductus Arteriosus (PDA)

A

Too much blood going to the lungs

  • Allows flow from PA to aorta in the fetus
  • Generally closes by day 2 of life
  • Size matters
  • Moving blood from the aorta and into the pulmonary arteries
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16
Q

Tetralogy of Fallot

A

Most common cause of cyanotic congenital heart disease.

  1. VSD
  2. Pulmonary stenosis
  3. Overriding aorta
  4. RV hypertrophy

All 4 of these phenomena happen together

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17
Q

Transposition of great arteries

A

Requires atrial or ventricular shunt to live.

Embryonic lethal in absence of shunt

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18
Q

Coarctation

A

Aortic coarctation.

  • Narrowing of aorta
  • Causes cyanosis and low BP systematically
  • Size of blockage matters
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19
Q

What is Ischemic Heart Disease and what are the 4 conditions associated with it? How is the coronary artery blood flow reduced?

A

Usually a result of reduced coronary artery blood flow.
Myocardial perfusion can’t meet demand.
- By thrombus
- Critical stenosis

  1. Angina pectoris
  2. Acute MI
  3. Chronic IHD
  4. Sudden cardiac death
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20
Q

What is Angina Pectoris and what are the three types?

A

Ischemic heart disease.
Intermittent chest pain.

  1. Stable
    - Most common
    - Pain on exertion
    - Fixed narrowing of CA
  2. Prinzmetal (variant)
    - Pain at rest
    - CA spasm
  3. Unstable (pre-infarction)
21
Q

What is acute MI and what are clinical features?

A

Ischemic heart disease.
Necrosis of myocardium from ischemia.

  • Affects 1.5M/year.
  • Mostly due to CA thrombosis <20-30min
  • Prompt reperfusion can salvage myocardium

Clinical Features:

  • Severe, crushing chest pain
  • Not relieved by nitroglycerin
  • Sweating, nausea
22
Q

Elevation of what molecule precedes acute MI and why?

A

CK-MB increases within 2-4hrs, returns to normal within 72 hours.

Cardiomyocytes have a lot of CK-MB, so if they are damaged, CK-MB spills out of cells.

23
Q

What gross changes may be absorbed with acute MI?

A
  • Mottling - coagulation necrosis
  • Mottling - coagulation necrosis; neutrophils come in
  • Yellow infarct center - Neutrophils die, macrophages come to eat dead cells
  • Yellow center, red borders - granulation tissue
  • Scar - collagen
24
Q

What are the two types of acute MI?

A
  1. Subendocardial infarction
    - Affects 1/3-1/2 of heart wall
    - Inner wall more affected because blood supply goes first to outer wall
  2. Transmural infarction
    - Affects more than 1/2 of heart wall
    - More serious
25
Chronic IHD
Ischemic heart disease. | Accumulation of small ischemic insult leads to mechanical failure.
26
Sudden Cardiac Death
Ischemia heart disease. | Often a result of a lethal arrhythmia without myocyte necrosis.
27
Hypertensive heart disease
Can affect L ventricle (systemic) or R ventricle (pulmonary) Cor pulmonale is RV enlargement due to pulmonary hypertension (from primary lung disorder)
28
Valvular stenosis
Failure to open
29
Valvular insufficiency/regurgitation
Failure to close
30
What conditions can valvular heart disease be the cause of?
- Murmurs - Angina - CHF - Fainting
31
What five conditions are associated with valvular heart disease?
1. Valvular stenosis - narrowing of valves - Aortic stenosis - Mitral stenosis 2. Valvular regurgitation - leakage of valves - Aortic regurgitation - Mitral regurgitation 3. Rheumatic valvular disease 4. Mitral valve prolapse syndrome 5. Infective endocarditis
32
What is aortic valve stenosis and what are its manifestations? Do we hear it during systole or diastole?
Stiffening and narrowing of the aortic valve. - Blood has difficulty exiting the heart - Prolonged ejection sound Clinical Manifestations: - Crescendo-decrescendo *systolic* heart sounds AKA heart murmur - Decrease in stroke volume - Increased LV pressure - Decreased systolic BP - Hypertrophy of LV
33
What is aortic regurgitation and what are its manifestations? Do we hear it during systole or diastole?
Failure of the aortic valve to properly close. - Blood leaks back into the ventricle after ventricular contraction Clinical Manifestations: - *Diastolic* murmur (blowing sound) of high pitch over the LV - Hypertrophy of LV - LV failure - Doppler echocardiography reveals blood flow back through aortic valve *Aortic valve is not completely closing shut, so the aortic blood is starting to push itself back into the LV which is why we hear it during diastole.
34
What is mitral stenosis and what are its manifestations? Do we hear it during systole or diastole?
Narrowing or stiffening of the mitral valve (L AV valve) - Turbulent blood flow during atrial filling and contraction ``` Clinical Manifestations: - Subtle crescendo *diastolic* murmur - Decreased blood flow from LA to LV - Increased LA pressure - Hypertrophy and dilation of LA - Atrial dysrhythmias (fibrillation) _ Increases pulmonary BP _ Pulmonary edema _ RHF ```
35
What is mitral regurgitation and what are its clinical manifestations? Does it occur during systole or diastole?
Failure of the mitral valve (L AV valve) to properly close - Blood passing into atrium from ventricle during contraction Clinical Manifestations: - *Systolic* murmur - Hypertrophied LV - LHF - Pulmonary hypertension and edema - Doppler echocardiography reveals blood flow back through mitral valve
36
What is Rheumatic Valvular Disease and how does it develop?
- Diffuse inflammatory disease caused by immune response to infection by the group A beta-hemolytic streptococci - Febrile illness - -- Inflammation of the joints, skin, NS, heart - Left untreated, rheumatic fever causes rheumatic heart disease Strep > Polyarthritis > Mitral Stenosis, LA enlargement
37
Mitral Valve Prolapse
Most patients are asymptomatic. Ballooning of mitral leaflets
38
The presence of what structure is indicative of RVD?
Aschoff bodies
39
Which genetic condition is associated with increased risk of valve prolapse?
Marfan's - insufficiency of collagen synthesis, too elastic
40
What is Infective Endocarditis?
Microbial invasion of heart valves, endocardium. Usually mitral and aortic valves.
41
What are the two types of infective endocarditis?
Splinter hemorrhages seen with both of these. 1. Acute - Highly virulent infection attacks normal valve - 50% patients die within weeks - Often requires surgery 2. Subacute - Low virulent infection colonizes abnormal valve - Long course, most recover
42
What are cardiomyopathies?
Diverse group of disorders in which myocardium dysfunctions.
43
What are the 3 types of cardiomyopathies?
1. Dilated cardiomyopathy - Congestive cardiomyopathy 2. Hypertrophic cardiomyopathy - Hypertension is a leading cause 3. Restrictive cardiomyopathy - Deposition of material in myocardium
44
What causes dilated cardiomyopathy?
Congestive cardiomyopathy. *Ventricle can't empty!* Causes: - Viral - Alcohol/toxin - Genetic abnormality 70% of patients dead in 5 years
45
What causes hypertrophic cardiomyopathy?
*Ventricle can't fill!* Causes: - Hypertension - Sarcomere mutation 4% of patients die each year Can be treated with drugs to relax ventricles
46
What causes restrictive cardiomyopathy?
Deposition of material in myocardium. *Heart wall is stiff; can't fill!* Causes: - Idiopathic - Amyloidosis or sarcoidosis (too much scar tissue) 70% patients dead in 5 years Insulin increases the amyloid accrual
47
What are the two disorders of pericardial disease?
1. Acute pericarditis - Causes severe chest pain that worsens with respiratory movements and with lying down - Dangers: Tamponade, chronic fibrosis 2. Pericardial effusion - Tamponade - Physically pressure compressing the heart
48
What is tamponade?
When the heart can't fill enough because pressure can't get low enough for that to happen
49
Are primary tumors common?
No. Most are benign. Malignant heart cancers are often metastasized from lung or lymphoma.

DMD 5247 (7 decks)

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