Cardio Pathology Part 1 Flashcards
How is dominance of the heart defined?
Defined due to the preference of the posterior descending artery
What happens as the heart ages?
There is a reduction in compliance and elasticity
What can happen to the mitral valve as the heart ages?
Become fibrous which will cause a buckling prolapse during systole leading to atrial dilation and arrhythmia
What do calcific deposits on the valves cause?
Aortic stenosis
How do the chambers of the heart change with age?
- Left ventricle cavity size reduced (esp in HTN)
- Atrial dilation
What atherosclerotic changes occur with age?
- Significant stenosis (MI, aortic dissection)
What epicardial and myocardial changes occur with age?
- Increase in epicardial fat
- Lipofuscin accumulates
- Basophilic degeneration
- Myocyte loss
- Amyloid deposition (transthyretin)
What are the two types of pump failure in cardiovascular dysfunction?
- Inadequate contraction (systole)
- Inadequate filling (diastole)
What does flow obstruction cause?
- Increase in resistance pressure (HTN, valve stenosis)
- Decreased blood flow (atherosclerosis; cardiac ischemia)
What causes regurgitant flow?
- Incompetent valve (valvular disease)
What causes shunted flow?
- Congenital disease (VSD, PDA)
- After MI
What can cause cardiac conduction abnormalities?
- Ischemic injury (infarction, direct nodal injury, dilated dysfunction)
- Heritable arrhythmias
What can cause vessel rupture?
- Aortic dissection
- Trauma (car crash from hitting chest on steering wheel)
What is a good approximation of heart weight?
- 0.5% of BW
What is the definition of dilation?
Enlarged chamber size
What is the definition of hypertrophy?
- Increase in muscle mass or thickening of heart muscle (due to cardiomyocyte size or length)
What is cardiomegaly?
- Abnormal enlargement of the heart (increase in weight or size)
What are some causes of hypertrophy or dilation? What causes this?
- HTN, Vascular disease, and MI
- Caused by increased cardiac work
What causes congestive heart failure?
- A pump failure which causes inadequate blood supply to the body
- Either a systolic dysfunction or a diastolic dysfunction)
What are some causes of systolic dysfunction?
- Decreased ejection fraction
- Ischemic injury
- Dilated cardiomyopathy
- Valve regurgitation
What are some causes of diastolic dysfunction?
- Will have normal EF but lower total volume due to less filling
- HTN
- Aortic stenosis
- Hypertrophic cardiomyopathy
- Fibrosis
- Restrictive cardiomyopathy
What are some primary causes of left sided CHF?
- MI
- HTN
- Left-sided valve disease
- Primary myocardial disease
What are the clinical effects of left sided CHF?
- Pulmonary congestion/edema
- Decreased tissue perfusion (decreased cerebral perfusion and decreased renal perfusion, azotemia)
What is seen on CXR in a patient with left sided CHF?
- Kerley B lines (like in pneumonia)
What is seen histologically in a patient with left sided CHF?
- Hemosiderin-laden macrophages
What is the most common cause of right sided CHF?
- Left sided failure
Why is left sided heart failure the number one cause of right sided failure?
- Increase in pulmonary pressure causes the right side to fail
What is isolated right heart failure called?
- Cor Pulmonale
What are some causes of pulmonary HTN?
- Parenchymal lung diseases (most common)
- Lung thromboemboli
- Primary pulmonary HTN (Rare)
What are some clinical effects due to venous congestion?
- Hepatosplenomegaly
- Distended jugular veins
- Effusions of peritoneal, pleural, and pericardial spaces
- Edema (esp ankles)
- Nutmeg liver
What are some causes of congenital heart disease?
- Sporadic genetic mutations (common)
- Environmental toxins (fetal alcohol syndrome)
What is the most common congenital heart defect in those with down syndrome?
- Atrioventricular or ventricular septal defects
What is the most common congenital heart defect in those with marfan syndrome?
- Aortic aneurysm/dissection
What is the mnemonic for DiGeorge Syndrome?
- CATCH-22
What are the most common congenital heart defects in those with DiGeorge syndrome?
- Conotruncal heart abnormalities
- ASD
- VSD
What is the most common congenital heart defect in those with Turner’s syndrome?
- Coarctation of the aorta
What are the most common congenital heart defects in those with Patau’s or Edward’s syndromes?
- PDA
- VSD
- ASD
What are the two types of cardiac shunts?
- L to R
- R to L
What causes a left to right cardiac shunt?
- High pressure in the left heart and lower pressure in the right heart
- Could also be seen in aorta to pulmonary trunk due to PDA
What does a person with a left to right shunt present with clinically? Why?
- Asymptomatically with no cyanosis
- This is due to the higher pressure side being oxygenated
What are the different defects that cause a left to right shunt?
- ASD
- VSD
- PDA
What causes a right to left cardiac shunt?
- When blood bypasses the pulmonary circulation
What does a person with a right to left shunt present with clinically?
- Symptomatic with cyanosis
What are the different defects that cause a right to left shunt?
- Tetralogy of Fallot
- Transposition of the great vessels
- Tricuspid atresia
What can arise if there is a shunt reversal in a normally left to right shunt?
- Paradoxical embolus
How do an ASD and VSD specifically cause a left to right shunt?
- They increase the right ventricular and pulmonary outflow volumes
How does a PDA specifically cause a left to right shunt?
- Increases pulmonary blood flow, pulmonary pressure, and HTN