cardio 2 Flashcards
what is CHF
failure of the heart to pump enough blood for the metabolic requirements of the organs.
CHF may be due to conditions inside or outside the heart
T/F?
TRUE
how does the body/heart compensate for CHF
- myocardial hypertrophy- cells get bigger but require more oxygen
- ventricular dilation
- physiological mechanisms- increased heart rate, increased catecholoamines, increase intravascular volume
causes of CHF
- ischemic heart disease.
- hypertension
- myocarditis
- cardiomyopathy
- valvular disease
manifestations of CHF
- right ventricular failure
- left ventricular failure
- left and/or right ventricular failure
right ventricular failure leads to what
- Congestion of liver (zonal or “nutmeg” pattern) and spleen
- Edema of subcutaneous tissue (feet and ankles)
left ventricular failure leads to what
pulmonary edema
left and/or right ventricular failure leads to what
- Cerebral hypoxia
T/F CHF due to left ventricular failure eventually leads to right ventricular failure
TRUE
what is congenital heart disease (defect)
Congenital heart defect (CHD) or congenital heart anomaly[2] is a defect in the structure of the heart and great vessels that is present at birth. Many types of heart defects exist, most of which either obstruct blood flow in the heart or vessels near it, or cause blood to flow through the heart in an abnormal pattern.
CHD may be caused what what two factors
environmental or genetics (chromosome abnormality)
two forms of CHD
cyanotic and noncyanotic
noncyanotic examples
A. Atrial septal defect – allows shunting between the atria
B. Ventricular septal defect – allows shunting between the ventricles
C. Patent ductus arteriosus – this should close within a few days after birth and connects the aorta and pulmonary artery
cyanotic exmaples
- tetralogy of fallout four anomalies 1) ventricular septal
defect, 2) narrowing of right ventricular outflow, 3) overriding of the aorta over VSD and 4) right ventricular hypertrophy - Transposition of the great arteries
Ishemic heart disease pathogenesis
- Narrowing of coronary arteries (usually at least 75%) by atherosclerosis (more than 90% of IHD)
- Coronary artery thrombosis initiated by fissure in the fibrous cap of an atherosclerotic plaque.
- other- hypotension, increased myocardial oxygen demand, decrease blood volume, reduced oxygen carrying capacity (anemia), reduced oxygenation (pneumonia, CHF),
3 types of IHD
- angina pectoralis
- acute myocardial infarction
- chronic IHD with CHF
- sudden cardiac death
angina pectoralis
“chest pain” of several minutes duration usually associated with exercise or emotional stress and relieved by rest. No myocardial necrosis occurs. In unstable angina, the episodes of chest pain become more frequent and the pain becomes more severe.
Acute Myocardial Infarction clinical presentation
chest pain, shortness of breath, nausea/vomiting, diaphoresis, low grade fever.
diagnosis of acute myocardial infarction
1) ECG changes
2) Elevation of serum enzymes (creatine kinase; CK-MB) and troponin derived from necrotic myocytes.
Pathology of acute myocardial infarction
coagulation necrosis (few hours), neutrophil infiltration (few days), granulation tissue (1 week), scar formation (wks-mos).
treatment of acute myocardial infarction
- placement of stents to open the coronary arteries clogged by atherosclerotic plaques
- coronary artery by-pass grafts (CABG),
- clot destroying drugs like tPA
risk of all of these treatements is?
reperfusion injury
primary cardiomyopathy
disease is soley confined to the heart muscles
secondary cardiomyopathy
the heart is involved as part of a multi-system disorder
The three morphologic patterns of cardiomyopathy:
- dilated,
- hypertrophic
- restrictive
dilated cardiomyopathy is a _______ group of cardiac diseases
heterogenous
dilated cardiomyopathy can be genetic or acquired and primary or secondary T/F??
TRUE
dilated cardiomyopathy characteristics
b. dilation of all 4 heart chambers
c. histology shows variable fibrosis and myocyte hypertrophy
d. poor ventricular contractility (systolic dysfunction)
Hypertrophic cardiomyopathy is a ___ and ____ cardiomyopathy
(a primary, genetic cardiomyopathy)
T/F hypertrophic cardiomyopathy can be primary or secodary and genetic or acquired?
FALSE
hypertrophic cardiomyopathy is a disorder of
disorder of sarcomeric proteins (myosin, myosin binding protein C, troponin T)
what happens in hypertrophic cardiomyopathy?
inappropriate (spontaneous) myocardial hypertrophy, asymmetric hypertrophy which is greater in the interventricular septum than the left ventricular free wall and often obstructs the left ventricular outflow tract.
hypertrophic cardiomyopathy inheritance…
inherited as autosomal dominant with variable expression
disarray of cardiac myocytes and fibrosis is associated with which cardiomyopathy?
hypertrophic
T/F Restrictive cardiomyopathy can be idiopathic or associated with other conditions that happen to affect the myocardium, such as radiation fibrosis, amyloidosis, hemochromatosis, and sarcoidosis
TRUE
what area of heart is most affected in restrictive cardiomyopathy?
decrease in ventricular compliance (wall is stiffer), resulting in impaired ventricular filling during diastole
MYOCARDITIS is what
inflammation involving the myocardium
most common cause of myocarditis is what
viral infections
what viruses cause myocarditis
Coxsackie A and B, other Enteroviruses
T/F Myocarditis cant be caused by bacterial, fungal and parasitic organisms.
false, they can.
T/F non- infectious agents can also cause myocarditis
toxins, hypersensitivity reactions and auto immune disorders.
produces a lymphocytic infiltrate with foci of necrosis
viral pathology
causes abscesses
pyogenic bacteria pathology
infect individual myocytes or are in interstitial areas with surrounding inflammatory cells
parasites pathology
causes a perivascular inflammatory infiltrate with many eosinophils.
hypersensitivity pathology
