Cardiovascular 2 Flashcards
**Define Congestive Heart Failure.
Heart is unable to pump blood at a rate required by the tissues of the body or does so at an elevated filling pressure. Either can have systolic dysfunction (progressive deterioration of contractile function) or diastolic dysfunction (reduced ability to accommodate ventricular blood volume). Heart failure is caused by any condition which reduces the efficiency of the myocardium through damage or overloading. The general effect is one of reduced cardiac output and increased strain on the heart.
**What are the characteristic functional changes in CHF?
1.) Decreased cardiac output (or forward failure)
OR
2.) Damming of blood returning to the heart (backward failure) (i.e. failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall i.e. ventricular systolic function normal but heart can’t deal with augmentation of blood volume).
**CHF can be divided into left sided heart failure and right sided heart failure. What are the major causes of left sided heart failure?
- Ischemic Heart disease
- Hypertension
- Aortic and mitral valve disease
- Myocardial disease
**CHF can be divided into left sided heart failure and right sided heart failure. What are the signs/symptoms/effects of left sided heart failure and what do the effects of LHF result from?
The effects of LHF result from damming of the blood in the pulmonary circulation and decreased peripheral blood pressure and flow.
The effects on the lungs are (backward failure):
- pulmonary congestion, edema, microhemorrage
Signs
- dyspnea on exertion, orthopnea (SOB when lying flat), paroxysmal nocturnal dyspnea, cough
The effects on the kidneys and brain (forward failure):
- decreased perfusion
Signs
- retention of salt, water and nitrogenous waste, irritability, loss of attention, coma
**CHF can be divided into left sided heart failure and right sided heart failure. What are the signs/symptoms/effects of right sided heart failure and what do the effects of RHF result from?
The effects of RHF result from damming of blood in the systemic and portal venous system; decreased peripheral blood pressure and flow
The effects on the Liver and portal system:
- congestion of the portal system
Signs
- liver congestion, to necrosis and sclerosis - enlarged, painful; bowel edema; ascites; pleural and pericardial effusions; hydrostatic pitting edema of subcutaneous tissues
The effects on the kidney and brain
- decreased perfusion
Signs
- retention of salt, water and nitrogenous waste; irritability, loss of attention, coma
**CHF can be divided into left sided heart failure and right sided heart failure. What are the major causes of right sided heart failure?
- left sided heart failure
- chronic cor pulmonale
What is Valvular heart disease?
Disease of the heart valves leading to either stenosis of valves, regurgitation or both. Stenosis means failure of the valve to open completely thereby impeding forward flow. Regurgitation means failure of the valve to close completely thereby allowing reversed blood flow. May be isolate (1 valve) or combined (2 valves). Can be congenital or acquired.
What can cause acquired stenosis (valvular disease)?
Mitral Valve
- post-inflammatory scarring (rheumatic heart disease)
Aortic Valve
- calcification of a congenitally deformed valve; post-inflammatory scarring (rheumatic heart disease)
What can cause acquired regurgitation (valvular disease)?
Mitral Valve
- rheumatic disease; infective endocarditis; mitral valve prolapse; rupture of papillary muscle of chordate; papillary muscle dysfunction; LV enlargement; calcification of mitral valve ring
Aortic Valve
- rheumatic heart disease; infective endocarditis; degenerative aortic dilation; inflammatory disorders of the aorta (syphilis. ankylosing spondylitis, rheumatoid arthritis); defects of connective tissue (e.g. Marfan’s syndrome)
What is calcific aortic stenosis?
It is the most common valvular abnomality with 90% of cases being non-rheumatic. It is due to calcification arising from age-related wear and tear of the valve. It is an active process of inflammation, lipid accumulation, and calcification.
What are the clinical features of calcific aortic stenosis?
Outflow obstruction leads to increasing pressure gradient across valve. The consequences are
- murmur; hypertrophy, eventually heart failure, angina (may occur without coronary heart disease); syncope (loss of consciousness).
The onset of symptoms carries a poor prognosis i.e. angina 50% 5 year survival; heart failure 50% 2 year survival
What is bicuspid calcific aortic stenosis?
Cause of aortic stenosis; a congenital bicuspid valve (30-40% of cases); aortic valve is usually three-leafed; Calcification of a bicuspid valve appears earlier (40’s and 50’s). Once calcified it will follow the same course as calcific aortic stenosis in a normal valve (i.e. murmur, hypertophy of LV, angina, syncope).
What is infective endocarditis?
Infection and inflammatory destruction of heart valves or endocardium. Severity and rate of progression are dependent on virulence of the organism and presence or absence of underlying disease. Most cases are bacterial. May be single or multiple valve involvement. Key components include:
- Vegetations (i.e. abnormal growth - fibrin, platelets, cellular blood elements and organisms)
- Destruction of valvular tissue
- Extension to adjacent tissues
- Distal embolization (septic infarction)
What are the clinical features of infective endocarditis?
- Depends on virulence*
- fever, chills, weakness, murmurs, signs and symptoms of heart failure, renal dysfunction
Define aneurysm.
Localized abnormal dilation of the wall of a blood vessel. A true aneurysm is bounded by all wall components. A false aneurysm is bounded or contained only by partial wall components and extravascular connective tissues (basically forms hematoma between outer layers).
