Cardiovascular Diseases 2 Flashcards
What is the pathogenesis of LSHF?
1) Hypertension, valvular disease & MI lead to inc cardiac work by pressure or vol overload
2) Leads to inc wall stress
3) Leads to cell stretch
4) Leads to hypertrophy &/or dilation- inc heart size&mass, fibrosis, abnormal proteins, inadequate vasculature
5) Results in cardiac dysfunction-HF, arrhythmias, neurohumoral stimulation
What can LSHF affect?
- Kidneys= Na&fluid retention
- Brain=irritability, dec attention, stupor,coma
- Lungs=pulmonary congestion & oedema, heart failure cells
How would congestive left heart failure present?
- Dyspnoea
- Orthopnoea
- PND
- Blood tinged sputum
- Cyanosis
- Elevated pulmonary pressure
What are the signs & symptoms of right sided heart failure?
- Liver & spleen= passive congestion, nutmeg liver, ascites, congestive splenomegaly
- Kidneys
- Pleura/pericardium- transudates, pleural & pericardial effusions
- Peripheral tissues= elevated peripheral venous pressure
- Fatigue
- Oedema
- Cyanosis
How does RSHF occur?
- Result of left heart failure
- Cor Pulmonale
What are features of chronic heart failure?
- Cardiomegaly
- Chamber dilatation
- Hypertrophy of myocardial fibres
What are the 2 types of valvular heart disease?
- Opening problems: Stenosis
- Closing problems: Regurgitation or incompetence
What are the main causes of aortic & mitral stenosis?
- A= calcification of a deformed valve, rheumatic HD
- M= Rheumatic HD
What is rheumatic heart disease?
- Hypersensitivity reaction
- Follows a group A strep infection
- Antibodies directed against M proteins of strep
- Cross reaction for pharynx to heart cells by CD4+ T cells producing cytokines that activate macrophages
- Leads to pancarditis: endo/myo/pericarditis
What are signs of acute & chronic valvular HD?
- Acute= inflammation, Aschoff bodies, anitschkow cells, pancarditis, vegetation on chordae tendinae at leaflet junctions
- Chronic= thickened valves, commissary fusion, which, short chordae tendinae
Describe aortic stenosis
- x2 gradient pressure
- left V hypertrophy (no hypertension)
- Ischaemia
- Cardiac decompensation
- Angina
- CHF
What is mitral annular calcification?
- Calcification of mitral skeleton
- No dysfunction
- Regurgitation but stenosis possible
What are the main causes of aortic & mitral regurgitations?
- A= rheumatic, infectious, aortic dilatations (syphilis, RA, marfan)
- M= mitral valve prolapse, infectious, fen-phen, papillary muscles, calcification of mitral ring
What is a mitral valve prolapse associated with?
- Connective tissue disorders (floppy valve)
- Myxomatous degeneration of mitral valve
- Mid-systolic click
Name some cardiac congenital malformations
- V/A septal defect
- Pulmonary stenosis
- Patent ductus arteriosus
- Atrioventricular septal defect
- ALL ABOVE L–>R SHUNT= pulmonary hypertension
- Transposition of great arteries
- Truncus arteriosus
- Tricuspid atresia
- ALL ABOVE R–>L SHUNT= cyanosis, venous emboli become systemic
What environmental factors can affect the heart?
- Rubella
- Teratogens
Describe atrial septal defects
- Not patent foramen oval
- Asymptomatic till adulthood
- Secundum-90%, defective fossa ovalis
- Primum-next to AV valve, mitral cleft
- Sinus venosus: next to SVC
Describe ventricular septal defects
- Most common CHD defect
- Tetralogy of ballot
- 90% involve membranous septum
- Muscular septum invloved= multiple holes
- Large progress to pulmonary hypertension
Describe a patent ductus arteriosus
- 90% isolated
- Associated with VSD, coarctation of aorta, pulmonary/aortic stenosis
- Continuous harsh machinery-like murmur
Describe AVSD
- Defective, inadequate AV valves
- Partial/complete= all 4 chambers communicating freely
- 1/3rd have Down’s syndrome
What is tetralogy of fallot?
1) large VSD
2) Obstruction to RV outflow
3) Aorta overrides VSD
4) RVH
- Survival depends on severity of subpulmonic stenosis
What is transposition of the great arteries?
- Abnormal formation of truncal & aortopulmonary septa
- Shunt needed for survival
- PDA or PFO= unstable shunt
- RV>LV in thickness
What is a truncus arteriosis?
- Developmental failure of separation of truncus arteriosus
- Associated VSD
- Systemic cyanosis & inc pulmonary blood flow
What is tricuspid atresia?
- Hypoplastic RV
- High mortality
- Shunt needed ASD, VSD, PDA
What is a total anomalous pulmonary venous connection?
- Pulmonary veins do not go into LA but into L innominate vein or coronary sinus
- Hypoplastic LA
What are the main types of obstructive CHD?
- Coarctation of aorta
- Pulmonary/aortic stenosis/atresia
What are the types of aortic stenosis/atresia?
- Valvular: severe hypoplastic LV= fatal
- Subvalvular: aortic wall thick below cusps
- Supravalvular: aortic wall thick above cusps in ascending aorta
What happens to the renin aldosterone/ADH system in patients with heart failure?
Renin-Increase
ADH-inappropriately high causing hyponatraemia
