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SP16- Gen Path Exam 1 > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

1
Q

What is congestive heart failure?

A

failure to pump an adequate amount of blood to supply the metabolic requirements of the organs

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2
Q

True or False: Congestive Heart failure may be due to pathologic conditions related to the heart or due to peripheral problems.

A

True

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3
Q

In most cases of congestive heart failure, what is the problem?

A

the heart cannot keep pace with the metabolic demands of the tissues

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4
Q

What are the compensatory mechanisms of congestive heart failure?

A
  1. Activation of neurohumoral systems (Norepi, Epi, Renin-angiotensin)
  2. Frank-Starling mechanism (increased EDV stretching)
  3. Myocardial hypertrophy
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5
Q

Describe the Frank-Starling Mechanism.

A

increased EDV stretches the cardiac muscle fibers

  • AT FIRST…the fibers contract more forcefully and increase cardiac output (compensated heart failure)
  • EVENTUALLY… the fibers cannot keep up, they hypertrophy, stack on top of each other, and give up (decompensated heart failure)
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6
Q

What is myocardial hypertrophy?

A

increase in muscle fiber SIZE = increased thickness of ventricular wall WITHOUT an increase in the size of the lumen

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7
Q

Why do compensatory mechanisms usually fail?

A

due to increased oxygen requirements of myocardium without increased capillary supply (susceptibility to ischemia)

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8
Q

What are the causes of left-side heart failure?

A
  • ischemic heart disease
  • hypertension
  • myocarditis
  • cardiomyopathy
  • valvular disease
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9
Q

What are the causes of right-side heart failure?

A
  • LEFT SIDED HEART FAILURE (pulmonary congestion leads to increased pulmonary arterial pressure)
  • Pulmonary Hypertension
  • Valve Disease
  • Septal Defects with left-to-right shunts
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10
Q

Pulmonary edema and congestion, orthopnea (trouble breathing while lying down), and/or chronic cough are signs for _______ ________ failure.

A

left ventricular

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11
Q

True or False: Cerebral hypoxia is a manifestation for right ventricular failure only.

A

False: left OR right ventricular failure

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12
Q

How might a “Right Ventricular Failure” manifest in the liver?

A

Congestion of the liver (or spleen) would results in a “nutmeg liver”

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13
Q

Edema (pitting) of subcutaneous tissues in lower extremities would be potential manifestation of _______ _______ failure.

A

right ventricular

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14
Q

How do right and left ventricular failures differ in their manifestation of edema?

A

Right–> LOWER extremity pitting
Left –> PULMONARY

left = lungs, right = run

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15
Q

In a picture of a “nutmeg” liver, which hepatocytes are vital? (bright red or orange)

A

orange

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16
Q

Compression of subcutaneous tissue that remains indented is a clinical presentation of edema, also known as ______. If its in the ankle, which side of the heart was affected?

A

pitting
right

remember, Run (legs) = Right Ventricular

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17
Q

True or False: Congenital Heart Disease is very common in the US.

A

False: only ~6 per 1,000 live births

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18
Q

______ % of congenital heart diseases are of unknown cause.

A

90

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19
Q

What are the two forms of Congenital Heart Disease?

A

cyanotic (blue)

non-cyanotic (pink)

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20
Q

What are two possible causes of Congenital Heart Disease?

A
  1. Environmental Factors (i.e. maternal diabetes, rubella, etc)
  2. Chromosomal Abnormalities
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21
Q

Congenital Heart Disease patients may have ______ connections, _____, or _______ connections.

A
  • absence of normal
  • shunts
  • abnormal
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22
Q

True or False: ASD is the most common form of Noncyanotic Congenital Heart Disease.

A

False, MOST surgeries are due to ASD but VSD is the most common!

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23
Q

True or False: Surgery of VSD is extremely common.

A

False, most VSD will resolve spontaneously even though it is the MOST COMMON congenital heart defect from birth

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24
Q

ASD and VSD are of what form of Congenital Heart Disease?

A

Non-cyanotic

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25
What does the Ductus Arteriosus connect?
Aorta | Pulmonary Artery
26
When should the Ductus Arteriosus close? What happens if it doesn't?
should close within a few days of birth | if NOT = VSD
27
What does VSD stand for?
Ventricular Septal Defect
28
What does ASD stand for?
Atrial Septal Defect
29
What causes ASD?
failure to close the Foramen Ovale = mixing of blood between the two atria
30
What are the two CYANOTIC forms of Congenital Heart Disease?
- Tetralogy of Fallot - Transposition of the Great Arteries (the "T" diseases look Turquoise)
31
What are the 4 anomalies associated with the Tetralogy of Fallot?
1. Ventricular Septal Defect (ASD) 2. Narrowed Right Ventricular Outflow to Pulmonary 3. Overriding aorta 4. Right Ventricular Hypertrophy ``` "IHOP" Interventricular septal defect Hypertrophy of right ventricle Overriding aorta Pulmonary stenosis ```
32
If there is a "transposition of the great arteries" where do the ventricles drain? What does this mean for the baby?
Right--> into the aorta (should drain into Pulmonary) Left --> into Pulmonary (should drain into the aorta) there is a shortage of oxygen flowing from the heart to the rest of the body and it cannot function
33
If the right ventricle pumps into the aorta, what kind of blood is being pumped out to the body?
De-oxygenated blood enters circulation...bad news
34
______ of the fingers or toes is often associated with a heart or lung disease that limits the amount of oxygen reaching the body.
Clubbing
35
What is Ischemic Heart Disease?
a group of related disorders that are all characterized by imbalance between myocardial blood supply and myocardial oxygen demand (ischemia)...DEMANDS ARE NOT BEING MET FOR THE HEART AND, THEREFORE, ANYWHERE ELSE!
36
90% of Ischemic Heart Diseases (IHD) are due to ____ _______.
Coronary Artery Atherosclerosis (Coronary Artery Disease)
37
What is the leading cause of death in the US (500,000 annually)?
Ischemia Heart Disease
38
Atherosclerosis or Thrombosis of which artery is associated with Ischemic Heart Disease?
Coronary Artery | aka: the artery that supplies the heart muscles
39
How much narrowing (atherosclerosis) must occur in order to cause IHD?
>75%
40
What are other contributing factors (other than thrombus or atherosclerosis) to Ischemic Heart Disease?
- increased myocardial oxygen demand (Hypertension) - decreased blood volume (hypotension/Shock) - decreased oxygenation (Pneumonia) - decreased Oxygen-carrying capacity (Anemia) ``` (the heart is in bad SHAPe when these happen) Shock Hypertension Anemia Pneumonia ```
41
What do streptokinase and TPA do when an embolism occludes an artery?
they try to break up the clot!
42
Name the four discussed types of Ischemic Heart Disease.
1. Angina Pectoris 2. Myocardial Infarction 3. Chronic IHD (ischemic) with CHF (congestive) 4. Sudden Cardiac Death
43
________: Intermittent chest pain caused by transient, reversible myocardial ischemia
angina pectoris
44
What is "stable" angina?
chest pain that occurs predictably at certain levels of exertion - crushing/squeezing - substernal pain - pain down left arm or jaw
45
Stable angina can be relieved by _____ or ______.
``` rest sublingual nitroglycerin (vasodilates to increase coronary perfusion) ```
46
What is "unstable" angina?
chest pain that increases in frequency during little to no exertion - longer lasting than stable - precedes serious ischemia or MI
47
_______: necrosis of cardiac muscle caused by ischemia.
Acute Myocardial Infarction ("heart attack")
48
What is the most common caused for heart attack?
an acute coronary artery thrombosis secondary to existing atherosclerosis
49
Of the 1.5 million heart attacks in the US annually, how often are they fatal?
1/3 are fatal (aka: 33% of the time)
50
Severe ischemia lasting longer than _______ will cause irreversible myocyte injury and cell death.
20-40 minutes
51
Myocardial ischemia contributes to _______ due to electrical instability/irritability.
arrhythmias
52
Arrhythmias may lead to __________.
ventricular fibrillation
53
What are the clinical manifestations of ischemic heart disease?
- chest pain - nausea/vomiting - diaphoresis (unusual sweating) - low grade fever - Shortness of Breath (SOB)
54
A common test for heart disease is the _____.
ECG
55
Chest Pain = Draw Blood... | Now, elevated levels of which serum proteins would indicate damaged cardiac myocytes?
Troponin T Troponin I CK-MB (Myocardial-Specific Isoform of Creatine Kinase) "T.I.C." (TIC-toc get to the doc)
56
How long must you wait in order to see infarcted areas on an autopsy?
12-24 hours after MI; before that, they won't be grossly apparent
57
After an MI, you wait 12 hours to look at the autopsy...what color is the infarcted area?
reddish-blue
58
Where does necrosis begin following coronary artery occlusion?
The "Zone of Perfusion"... the small area of myocardium beneath the endocardial surface in the center of the ischemic zone
59
Why is the zone of perfusion at such high risk?
the region depends entirely on the occluded vessel for blood supply
60
The zone of perfusion is at the ______.
apex
61
What is the treatment for heart attacks?
- placement of stents to open the coronary vessel affected by atherosclerosis - coronary artery by-pass grafts (CABG) - "clot busting drugs" (streptokinase)
62
True or False: Treatment for MI may result in reperfusion injury.
True (Timely reperfusion facilitates cardiomyocyte salvage and decreases cardiac morbidity and mortality. Reperfusion of an ischemic area MAY result, however, in paradoxical cardiomyocyte dysfunction: myocardial stunning, microvascular and endothelial injury, and irreversible cell damage or necrosis)
63
True or False: Arrythmia, Shock, Mural Thrombus, and Mitral Valve Regurgitation are all complications associated with MI.
True
64
What is Mural Thrombus?
(complication of MI) | -developing thrombus on the lining of the heart chamber that can lead to LEFT-side embolism
65
What is Mitral Valve Regurgitation?
(complication of MI) | -backflow due to papillary muscle dysfunction
66
______ rupture is a complication associated with MI.
myocardial
67
Infarct expansion can/will often move to involve the _____ ventricle.
right
68
A ________ is a complication that may occur after a heart attack. They usually arise from a patch of weakened tissue in a ventricular wall, which swells into a ______ filled with blood. This, in turn, may block the passageways leading out of the heart.
ventricular aneurysm | bubble (i.e.: the reason its termed an aneurysm)
69
What is Chronic Ischemic Heart Disease?
progressive heart failure due to ischemic myocardial damage | -usually: history of MI
70
What is the most common cause of "Sudden Cardiac Death?"
Ischemic Heart Disease (80-90%)
71
What are some causes of Sudden Cardiac Death in young patients?
- congenital coronary artery abnormalities - aortic valve stenosis - mitral valve prolapse - myocarditis - dilated or hypertrophic cardiomyopathy - pulmonary hypertension - myocardial hypertrophy
72
_____: disease of the heart muscle
Cardiomyopathy
73
What is the difference between primary and secondary cardiomyopathy?
Primary: confined to the heart muscle Secondary: involves the myocardium as part of a systemic condition
74
What are the three functional patterns of cardiomyopathy (in order of commonality)?
1. Dilated (90% of cases) 2. Hypertrophic 3. Restrictive
75
Of the three patterns of cardiomyopathy, two of them can be either primary or secondary. Which one can be Primary only?
Hypertrophic (autosomal dominant inheritance pattern, point mutation) "HAD 1" from birth....hypertrophic, autosomal dominant, primary
76
True or False: Dilated Cardiomyopathy can be either genetic or acquired.
True
77
True or False: Dilated Cardiomyopathy can only be of primary classification.
False: primary or secondary
78
Genetic acquirement of "Dilated Cardiomyopathy" is related to _____, _______, and ______.
alcoholism myocarditis (virus) pregnancy
79
How many chambers are affected by Dilated Cardiomyopathy?
all 4
80
Describe the histological findings of Dilated vs. Hypertrophic Cardiomyopathy.
Hypertrophic: MYOCYTE DISARRAY with fibrosis, looks like a messy, water-color painting Dilated: nonspecific with fibrosis and myocyte hypertrophy, looks "bubbly or fatty" due to large myocytes
81
What kind of dysfunction occurs with hypertrophic cardiomyopathy? Where is the mutation that causes dysfunction?
``` diastolic dysfunction (stiff ventricles prevent adequate filling) -point mutation in a sarcomeric gene loci = ventricle muscles don't work well ```
82
______ cardiomyopathy causes poor ventricular CONTRACTILITY; whereas, the other two cause diastolic dysfunction during filling.
Dilated contractility (systolic) --> dilated Hypertrophic and Restrictive --> filling up (diastole)
83
Restrictive cardiomyopathy causes ventricular stiffness and can be ideopathic or ________.
secondary to systemic conditions that affected the myocardium - radiation fibrosis - amyloidosis - hemochromatosis - sarcoidosis
84
What is myocarditis?
inflammation and damage of the heart muscle
85
True or False: Pyogenic bacteria could cause abscesses and myocarditis.
True
86
What is Coxsackie A and B Virus? Which heart disease is it related to?
``` related to MYOCARDITIS A = -cause flaccid paralysis -generalized myositis B = -spastic paralysis -focal muscle injury -degeneration of neuronal tissue ```
87
Which parasite is common in South America and causes myocarditis after trypanosomes invade individual myocytes or interstitium?
Chagas
88
True or False: Hypersensitivity to drugs cannot cause Myocarditis.
False; drug hypersensitivity can cause perivascular inflammation with eosinophils

SP16- Gen Path Exam 1 (10 decks)

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