Cardiovascular Diseases 1 Flashcards
Name the three types of primary cardiomyopathy
dilated, hypertrophic and restrictive
What is the most common CM and accounts for 25% of heart failure?
dilated cardiomyopathy
Describe hearts of dilated CM
big heart with thin walls
Describe hearts of hypertrophic CM
big heart with thick walls
Which CM is mostly inherited and involves mutations for genes encoding sarcomere proteins?
hypertrophic CM
All CM may have – origins
familial
What happens to heart tissue during restrictive CM
replace cardiac tissue = lose contractile ability
What does functional classification focus on?
systolic and diastolic functions change
What is dilated CM associated with?
bi-ventricular dilation (or dilated L and squished R) and contractile dysfunction
Name three possible results of dilated CM
enlarged heart (cardiomegaly), systolic dysfunction and signs of congestive heart failure
describe the wall thickness of dilated CM
normal (but enlarged chambers)
What is systolic failure?
bad CO (pumping out blood)
What is hypertrophic CM associated with?
L ventricle hypertrophy and thickened interventricular septum
Describe the wall thickness of hypertrophic CM
thick walls (but similar chamber size)
Why is hypertrophic CM asymptomatic for many years?
late contractile (diastole) dysfunction
What are potential consequences of hypertrophic CM?
arrhythmia (irregular heart beat), myocardial ischemia (chest pain), or sudden death
Which CM is least common in western countries?
restrictive CM
What is associated with restrictive CM?
diastolic dysfunction and sometimes endocardial scarring of ventricles
Where does dilation occur in restrictive CM?
bi-atrial then left ventricle
Describe walls in restrictive CM
very rigid ventricular walls –> bad diastolic filling (atria can’t empty)
in Amyloidosis: the atria are markedly dilated and the – , normally smooth, has yellow-brown amyloid deposits that give texture to the surface
left atrial endocardium
inflammation of myocardium
myocarditis
What causes myocarditis?
infections, autoimmunity or toxins
Consequences of myocarditis
arrhythmia, chest pain and sudden death (similar to hypertrophic CM) + fever
How is myocarditis classified?
by type of inflammatory response
What is the most common myocarditis?
lymphocytic
What is the origin of lymphocytic myocarditis?
infectious
What is the most common mode of lymphocytic myocarditis?
viruses
example of bacterial lymphocytic myocarditis
Lyme disease
example of parasitic lymphocytic myocarditis
Chagas diseases
What kind of treatment could you give a person infected with lymphocytic myocarditis?
antiviral or antibacterial
Which myocarditis affects young adults with congestive heart failure and arrhythmias?
giant cell
What kind of treatment would you give a person infected with giant cell myocarditis?
immunosuppressant and/or transplantation
Which myocarditis is associated with allergy?
eosinophilic
The inability of the heart to supply adequate oxygenated blood to meet body’s metabolic needs
congestive heart failure
What are causes of abnormal myocardial structure and function?
increase in hemodynamic burden or reduction in myocardial oxygen
Describe dysfunction of congestive heart failure
usually both systolic and diastolic
Define systolic dysfunction
dilated ventricles and decreased contractility
define diastolic dysfunction
normal contractility but decreased myocardial compliance (can’t relax)
What are consequences of systolic dysfunction?
reduced CO and ejection fraction
What are consequences of diastolic dysfunction?
increased diastolic pressure but CO can be normal
What is the purpose of adaptive mechanisms?
maintain adequate pumping functions, CO, and adequate perfusion of vital organs
Which adaptive mechanism is activated rapidly but continues over a long period of time?
peripheral mechanisms
Describe the Frank-Starling relationship
stretch cardiac tissue –> stronger contractions
How can you expand volume/stretch cardiac tissue/increase resting muscle length?
retain sodium = retain water = increase preload
What kind of adaptive mechanism is the Frank-Starling relationship?
short term
What kind of adaptive mechanism is the activation of neurohumoral system?
short term
name the two neurohumoral systems
adrenergic
renin-angiotensin-aldosterone
What’s the function of the adrenergic system?
increases contractility or contraction velocity and heart rate (maintain/improve CO)
What’s the function of renin-angiotensin-aldosterone system?
helps maintain arterial pressure and tissue perfusion and increases preload
give examples of long term adaptive mechanisms
heart chamber dilation
myocardial remodeling/hypertrophy
increased radius of (L) ventricle requires – to generate the same pressure which increases the demand of the heart
greater wall tension
What does chronic volume overload lead to?
dilated LV
What does chronic pressure overload and high wall tension lead to?
pathological myocardial remodeling (fibrosis in damaged areas)
According to the Law of Laplace, in order to reduce wall tension – increases
wall thickness
How do you increase wall thickness?
increase size of individual myocytes and increase overall muscle mass
Give examples of hemodynamic consequences of adaptive changes
decreased ejection fraction and CO
increased EDV and EDP
blood redistribution
edema
In moderate LV dysfunction compare CO during rest and exercise
normal and unable to increase CO
In severe heart failure how is CO affected?
decreased
less blood to skeletal muscles –>
anaerobic metabolism and fatigue
less blood to kidneys –>
Na and nitrogen retention
less blood to liver
liver dysfunction
Left sided edema show symptoms –
secondary to pulmonary congestion
generalized fluid accumulation characterizes –
right sided edema
ischemic heart disease is a –
cause of left sided heart failure
valvular heart disease is a –
cause of left sided heart failure
cardiomyopathy causes –
left sided heart failure
myocarditis causes –
left sided heart failure
left sided heart failure causes –
right sided heart disease
pulmonary hypertension is a –
cause of right sided heart disease
pulmonary emboli is a –
cause of right sided heart disease
Precipitating factors that led the progression of congestive heart disease to heart failure
myocarditis myocardial ischemia arrhythmias pulmonary embolism inappropriate reduction of therapy stress
pulmonary edema is a symptom of –
left heart failure
a subjective feeling of not enough air or choking
dyspnea
difficulty in breathing while lying flat
orthopnea
sudden inability to breathe, awakening patient during night
paroxysmal nocturnal dyspnea
increased rate of respiration
tachypnea
indicating fluid in alveolar spaces
rales
gallop rhythm is a sign of –
left heart failure
congestion of organs like liver is a sign of –
right heart failure
edema of lower extremities is a sign of –
right heart failure
clubbing of fingers and cyanosis is a sign of –
right heart failure
jugular venous distention is a sign of –
right heart failure
increased jugular vein pressure (JVP) is a sign of –
right heart failure
what is pulmonary edema?
fluid moving into interstitial and alveolar spaces
Treat congestive heart failure: decrease preload by –
diuretics and angiotensin converting enzyme inhibitors
Treat congestive heart failure: improve contractility by –
cardiac glycosides and beta-blockers
Treat congestive heart failure: reduce afterload by –
vasodilators
Treat congestive heart failure: correct complicating causes like anemia by –
transfusion
Treat congestive heart failure: correct complicating causes like rhythm problems by –
medications
Treat congestive heart failure: correct complicating causes like heart block with –
pacemaker
Treat congestive heart failure: correct complicating causes like coronary heart disease by –
dilate or graft vessels
Treat congestive heart failure: diet by –
reduce sodium and caloric intake
Treat congestive heart failure: severe cardiomyopathies require –
heart transplant
