cardiovascular diseases 2 Flashcards
what 3 factors contribute to increasing cardiac work load
pressure overload-hypertension
pressure and volume overload- valvular disease.
Regional dysfunction with volume overload- MI
what coping mechanism does the hurt used when the cardiac output or work exceeds the limit.
ventricular hypertrophy
what coping mechanism does the heart use when hypertrophy fails to lower cardiac work/ouput
dilates- predisposes you to heart failure
Cardiac dysfunction is characterised by
heart failure
arrhythmia’s
neurohumoral stimulation
what is hypertrophy and dilation characterised by
decreased heart size and mass, increased protein synthesis, induction of immediate-early genes, induction of feral gene program, abnormal proteins, fibrosis, inadequate vasculature.
what happens to the kidneys in LHS heart failure (systemic heart failure)
not enough blood to the kidneys
pre-renal azotaemia- increase urea in blood.
salt and fluid retention- due to RAS.
renin aldosterone activation
natriuretric peptides-produced by atria to stop salt and water retention (oppose RAS)
Symptoms in the brain due to LHS heart failure
irratability, decreased attention, stuporacoma.
what effects does LHS heart failure have upon the lungs
pulmonary congestion and oedema.
blood is dumped back into the pulmonary circulation as LHS is blocked.
symptoms of LHS heart failure upon the lungs
pulmonary hypertension dyspnea (shortness of breath), orthopnea (shortness of breath when lying down but relieve by sitting up), paroxysymal nocturnal dyspnea (shortness of breath when lying down which in no relieved by sitting up) blood in sputum cyanosis elevated pulmonary pressure
what causes right sided heart failure
dumping blood into the peripheries
symptoms and sizes of right sided heart failure
– Liver and spleen- symptoms due to blood being duped back into the venous system via the superior and inferior vena cava as no space in right atrium to take blood in so affects hepatic portal circulation.
• Congestive splenomegaly
• Ascites
– Kidneys – Pleura/Pericardium • Pleural and pericardial effusions • Transudates – Peripheral tissues.
what is nutmeg liver and which heart failure is it a sign of
right hand side heart failure.
• Passive congestion.
dark at the peripheries as they are not perfused by the hepatic artery, and pale at the peripheries, as blood supply reaches here because of hepatic portal vein
what does regurgitation mean,
what type of valve problem is it
blood flows back
Closing problems
what does stenosis mean, what type of valve problems is it.
narrowing
opening problem of the valve
on which side do most valavular diseases occur, left or right
left
main causes of aortic stenosis
calcification of a deformed valve, rheumatic heart disease
main causes of mitral stenosis
rheumatic heart disease
what infection is followed by rheumatic heart failure
group A strep infection
pathogenesis of rheumatic heart disease
- Strep A induces a immune reaction and antibodies are produced
- Antibodies cross attack tissue glycoproteins in the heart as the antigens are similar.
- Results in vegetation’s, myocardial Ashchoff body and fibrous pericarditis were 2 layers of pericardium stick together due to fibrous exudate which forms between them.
symptoms of acute rheumatic heart disease
Inflammation
- Aschoff bodies
- Anitschkow cells- macrophages increased size of nuclei
- Pancarditis- inflammation of the whole heart.
- Vegetations on chordae tendinae at leaflet junction
symptoms of chronic rheumatic heart disease
Thickened valves
commisural fusion
thick, short, chord tendinae
consequences of aortic stenosis
increased ventricular pressure, hypertrophy, dilatation and then angina, syncope, arrthymia and heart failure
main cause of aortic stenosis
calcium deposits
Mitral annular calcifications lead to stenosis or regugitations
regurgitations, however stenosis is still possible
what 3 conditions cause aortic regurgitation
- Syphilis
- Rheumatoid Arthritis
- Marfan
Can infections cause aortic valve regurgitation
YES -endocarditis
Can infections cause mitral valve regurgitation
YES
what drug causes mitral valve regurgitation
Fen Phen
what type of tissue disorders is mitral valve prolapse associated with
connective
what machine easily detects mitral valve prolapse
echocariogram.
clinical features of mitral valve prolapse
• Usually asymptomatic • Mid-systolic “click” • Holosystolic murmur if regurg. present • Occasional chest pain, dyspnea % Infective endocarditis, mitral insufficiency, arrythmias, sudden death
what stage of development do congenital heart defects occur in
faulty embryogenesis (week 3-8)
what chromosome is important in cardiac development
chromosome 22.
normal embryogenesis of the heart
- 1 atria initially
- Septum develops at the roof of atria and then descends- septum primum
- Goes to endocardial cushion recedes back
- the septum secundum (the second septum ) then begins to grow down on the right hand side of the septum primum
- from the beginning, the septum has semilunar shape and its border delineates oval foramen - the foramen ovale
- as the ostium secundum and oval foramen lie in different levels, the blood may pass from the right atrium into the left atrium in the fetal period
- Through the oval foramen into the gap between both septae and through the ostium secundum
what rote does foetal blood take upon entering the heart
• in foetal development as 02 blood comes form placenta the blood doesn’t need to go to the lungs so it goes RA-LA via foramen ovale and then to LV and the body.
what 2 structures does the aorticopulmnary septum separate
- This septum divides bulbus cordis and truncus into 2 main arterial trunks: aorta and pulmonary artery
- It has spiral path that results in final topographical relations of both vessels that are known from the anatomy
Do left to right shunts cause cyanosis
No
Do right to left shunts cause cyanosis
Yes
what is the major consequence of a left to right shunt
pulmonary hypertension
what is a major consequence of a right to left shunt
pulmonary embolism, venous emboli.
how many types of atrial septal defects are there
3 types
secumdum
primum
sinus venosus
what is the most common CHD defect
ventricular septal defect.
which septum is usually affected muscular of mucosal for Ventricular septal defect
mucosal
patent ductus arterious is associated with which other defect problems
although rare
VSD, coarctation of aorta, pulmonary or aortic stenosis
define atrioventricular septal defects
all 4 chambers are freely communicate with each other.
tetralogy of falloffs consists of
– 1) VSD, large
– 2) OBSTRUCTION to RV outflow- smaller pulmonary artery.
– 3) Aorta OVERRIDES the VSD- enlarged aorta.
– 4) RVH
define TGA ((TRANSPOSITION of GREAT ARTERIES)-
Aorta and pulmonary artery connect to the wrong chambers.
• Abnormal formation of truncal and aortopulmonary septa
what defect is needed in order to survive a transposition of the great vessels
shunt – Patent ductus arterious or Patent foramen ovale
define truncus arterious
Developmental failure of separation of truncus arteriosus- into aorta and pulmonary artery.
what septal defect is truncus arteries associated with
VSD- ventricular septal defect.
what types of shunts do tricuspid atresia need for survival
ASD, VSD, or PDA for survival
right to left shunt.
define Total Anomalous Pulmonary Venous Connection (TAPVC)
• PULMONARY VEINS do NOT go into LA, but into L. innominate v. or coronary sinus
3 types of obstructive CHD
- COARCTATION of aorta
- Pulmonary stenosis/atresia
- Aortic stenosis/atresia
in what gender is coarctation of the aorta more common
males
3 forms of aortic stenosis
- VALVULAR
- If severe, hypoplastic LV→fatal
- SUB-valvular (subaortic- below aortic valve leaflet)
- Aortic wall THICK BELOW cusps
- SUPRA-valvular- ( above aortic valve leaflet)
- Aortic wall THICK ABOVE cusps in ascending aorta
names of conditions starting with T have what kind of shunt present
right to left shunt
names of conditions starting with d have what kind of shunt present
left to right shunt.
