Cardiovascular Diseases 2 Flashcards
Sterling’s hypothesis
Volume of blood in the chamber is proportional to the contractile ability of the heart in that chamber
What are the 3 causes of increased cardiac workload?
Hypertension, vascular disease or MI
What is the result of increased cardiac work?
Increased stress- hypertrophy and/or dilation= cardiac dysfunction
What are the 2 main results of left sided heart failure that have effects throughout the body?
Low output
congestion
What are the effects of low output resulting from left ventricular heart failure
pre-renal azotremia (high N2content in blood)
Salt and fluid retention (renin-angiotensin activation/natriuretic peptides)
Brain-irritability, decreased attention, stupor>coma
What are the effects of congestion, resulting from left ventricular heart failure?
Lungs: pulmonary congestion and oedema. Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, blood tinged sputum, cyanosis, increased pulmonary wedge pressure
Causes of right sided heart failure
Left heart failure
Cor pulmonale
What is cor pulmonale
Abnormal enlargement of the right side of the heart as a result of lung disease or pulmonary blood vessels
Organs/areas affected by right sided heart failure
Liver and spleen
Kidneys
Pleura/pericardium
Peripheral tissues
What are the effects of right sided heart failure on the liver and spleen
Passive congestion (nutmeg liver)
Congestive splenomegaly
Ascites
Autopsy findings of cardiac heart failure
Cardiomegaly, chamber dilation, hypertrophy of myocardial fibres, BOXCAR nuclei, pulmonary/peripheral oedema
What are BOXCAR nuclei?
Rectangular nuclei in hypertrophied myocytes
Valvular opening problems
Stenosis
Valvular closing problems
Regurgitation
70% valvular heard disease is made up of what 2?
Aortic and mitral stenosis
Causes of aortic stenosis
Senile-old age
Rheumatic heart disease
Causes of mitral stenosis
Rheumatic heart disease
Rheumatic heart disease follows what infection?
Group A strep
Effects of rheumatic heart disease
Pancarditis:
1) endocarditis
2) myocarditis
3) pericarditis
5 acute effects of rheumatic heart disease
Inflammation Asschoff bodies (nodules) Anitschlcow cells (enlarged macrophages with asschoff bodies) Pancarditis Vegetations on chordae tendinae
3 chronic effects of rheumatic heart disease
Thickened valves
Commisural fusion
Thick, short chordae tendinae
Left ventricular hypertrophy but no hypertension
Aortic stenosis
Calcification of the mitral skeleton, usually a result of regurgitation, but sometimes stenosis
Mitral annular calcification
What mitral valve dysfunction is more common in females than males?
Mitral annular calcification
mitral valve prolapse
Causes of aortic regurgitation
Syphilis
Rheumatoid arthritis
Marfan’s syndrome
Causes of mitral regurgitation
Mitral valve prolapse Infectious Fen Phen (anti obesity drug) Weakness in papillary muscles/chordae tendinae Mitral annular calcification
Myxomatous (pathological weakening of tissue) degeneration of mitral valve. Associated with connective tissue disorders.
Mitral valve prolapse
Usually asymptomatic, mid-systolic ‘click’, holocystolic murmur if regurg present, occasional chest pain, dyspnoea
Mitral valve prolapse
Effects of mitral valve prolapse
97% no significant effects
3% infective endocarditis, mitral insufficiency, arrythmias, sudden death
Which congential heart defects may not be evident until adult life?
Coarctation of the aorta and ASD
Give 4 examples of left to right shunt congenital heart defects
VSD
ASD
Atrioventricular septal defect
Patent ductus arteriosus
Give 5 examples of right to left shunt congenital heart defects
Tetralogy of fallot Transposition of the great arteries Truncus arteriosus Total anomalous pulmonary venous connection Tricuspid atresia
Gene abnormalities account for what percentage of CHDs
10%
What are the most common genetic defects in CHDs
Trisomies
Mutations of single genes (TBX5 for ASD and VSD, NKX2.5 for ASD)
Deletion of a specific region of chromosome 22
Environmental factors that can result in CHDs
Rubella
Teratogens
Name of the gap between the 2 parts of the septum primum
ostium secundum
The septum secundum grows on what side of the septum primum?
The right side
The border of the septum secundum delineates what foramen?
Foramen ovale
In the development of the aorticopulmonary system of the heart, the septum divides what 2 parts of the heart into the spiralling aorta and pulmonary artery?
bulbis cordis
Truncus
Does ASDs include a patent forament ovale?
NO
What are the 3 types of ASD
Secundum (90%)
Primum (5%)
Sinus venosus (5%)
A type of ASD with a defective fossa ovalis
Secundum
A type of ASD next to AV valves,mitral cleft
Primum
A type of ASD next to superior vena cava, anomalous pulmonary veins draining to SVC on right atrium
Sinus venosus
Most common CHD
VSD
The majority of VSD involve with septum
Membranous
If msucular septum is involved in VSD, what appearance can this have?
Multiple holes ‘swiss cheese septum’
What can be the result of a large VSD?
Pulomary hypertension
What happens both initially and evenutally in patent ductus arteriosus?
Left to right shunt, possibly reverse shunt as pulmonary hypertension approaches systemic pressure.
What treatment is given to keep the ductus arteriosus patent?
Protstaglandin E1
Continuous harsh, machinery like murmur
Patent ductus arteriosus
More than 30% patients with Atrioventricular septal defect have what other medical condition?
Down’s syndrome
Atrioventricular septal defect is associated with what part of the heart?
AV valves
What does complete atrioventricular septal defect mean?
All 4 chambers freely communicate
What are the 4 characteristics of tetralogy of fallot?
Pulomonary stenosis
VSD
Right ventricular hypertrophy
Over-riding aorta
Abnormal formation of truncal and aortopulmonary septa, needs a shunt for survival
Transposition of great artereis
What classes as an unstable shunt for transposition of the great arteries- the majority
PDA or PFO
What calsses as stable shunt for transposition of the great arteries- the minority
VSD
In transposition of the great arteries, which ventricular wall is thicker?
Right
What is the prognosis for transposition of the great arteries?
Fatal in the first few months unless surgically repaired
Developmental failure of separation of truncus arteriosus and associated VSD
Truncus arteriosus
Produces systemic cyanosis as well as increased pulmonary blood flow
Truncus arteriosus
pulmonary veins do not go into LA but into L.innominate vein or coronary sinus
total anomalous pulmonary venous connection
Name 3 obstrucive congenital heard diseases
Coarctation of the aorta
Pulmonary stenosis/atresia
Aortic stenosis/atresia
Is coarcation of the aorta more common in males or females?
Males, common in turner’s syndrome
Which is more serious, preductal coarctation of the aorta or post ductal ?
Preductal
What other heart defects present with pulmonary stenosis/atresia
If 100% stenosed, hypoplastic RV with ASD.
What are the 3 types of aortic stenosis/atresia
Valvular
Subvalvular
Supra-valvular
