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Clinical Pathology > Cardiovascular Diseases- Heart Failure, Common Valvular Disease and common Congenital Heart Diseases > Flashcards

Cardiovascular Diseases- Heart Failure, Common Valvular Disease and common Congenital Heart Diseases Flashcards

1
Q

What are the main causes of left sided heart failure?

A
  • Hypertension (pressure overload)
  • Valvular disease (pressure/volume overload)
  • MI - dysfunction with volume overload
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2
Q

What happens to the left side of the heart with left sided heart failure?

A

Increased wall/cell stretch and cardiac work results in hypertrophy and dilatation, causing cardiac dysfunction

(LOW OUTPUT - effects on subsequent organs)

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3
Q

What are the signs/symptoms of left sided heart failure?

CONGESTION

A
  • Pulmonary congestion and oedema
  • heart failure cells
  • dyspnea, orthopnea
  • paroxysmal nocturnal dyspnea (PND)
  • blood tingled sputum
  • cyanosis
  • increased pulmonary capillary wedge pressure (2-15 mmHg)
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4
Q

What is the cause of right sided heart failure?

A

Left sided heart failure

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5
Q

What does right sided heart failure cause?

A

Cor pulmonale (abnormal enlargement of right side of heart)

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6
Q

What are the signs and symptoms of right sided heart failure

A
  • Splenomegaly and hepatomegaly
  • ascites - accumulation of fluid in abdominal cavity
  • oedema - periphery
  • PLEURAL AND PERICARDIAL EFFUSION
  • cyanosis
  • Distention of jugular veins
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7
Q

What does heart failure present with at autopsy?

A

Cardiomegaly - enlargement of heart

  • Dilatation of chambers
  • hypertrophy of cardiac fibres with BOXCAR nuclei
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8
Q

What are the compensatory mechanisms of coronary heart failure?

A

RAAS - sodium and water retention

Adrenal medulla release of catecholamines (increases HR and therefore cardiac output)

Hypertrophy

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9
Q

What are the two major types of valvular heart disease?

A
  • Stenosis (opening)

- regurgitation/incompetence

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10
Q

Where do most valvular heart diseases occur?

A

Left side (70% of valvular heart disease)

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11
Q

What is the main cause of aortic stenosis?

A

Calcification of deformed valve

but can be caused by rheumatic heart disease

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12
Q

Whats the main cause of mitral stenosis

A

Rheumatic heart disease

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13
Q

What infection is rheumatic heart disease usually caused by?

A

Group A strep infection

Causes endocarditis, myocarditis and pericarditis

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14
Q

What is endocarditis and how is it characterised?

A

Inflammation of endocardium, usually involving heart valves

  • vegetations (lesions; mass of platelets, fibrin and microorganisms)
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15
Q

What are the macrophages in necrotic regions of rheumatic heart disease?

A

Anitschkow cells

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16
Q

What are the necrotic regions called

A

Aschoff bodies

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17
Q

What are the macroscopic signs of rheumatic heart disease?

A

Thickened valves (aortic and mitral)

Fusion of valves

Thick short chordae tendinae

18
Q

What is the main cause oaf aortic stenosis?

A

Calcification of aortic valve

19
Q

What can happen to the heart with chronic aortic stenosis?

A

Cardiac decompensation
Angina
Heart failure

20
Q

What are the major causes of atrial valve regurgitation?

A

Rheumatic heart disease (stops valve opening and closing)

Infections e.g. endocarditis

Other conditions e.g. syphilis, marfans

21
Q

What is the major cause of mitral valve regurgitation??

A

Mitral valve prolapse

22
Q

What is mitral vale prolapse also known as

A

Myxomatous degeneration of the mitral valve - ‘floppy valve’ - occurs more in females

23
Q

What are the clinical features of mitral valve prolapse?

A

Usually asymptomatic

Mid-systolic click

If regurgitation present, holosystolic murmur

Sometimes chest pain, dyspnea

24
Q

How do congenital heart defects usually arise and what weeks?

A

Faulty embryogenesis (weeks 3-8)

25
Q

What are the main causes of congenital heart defects?

A

Genetic e.g. trisomy 21, 13, 15, 18 (only 10%)

Environmental e.g. rubella, teratogens

26
Q

What are the characteristics of Left to right shunt congenital defects?

A
  • All have ‘D’ in their name
  • not cyanotic
  • Pulmonary hypertension - significant pulmonary hypertrophy is irreversible (worst case scenario)
27
Q

What are the characteristics of right to left shunt congenital heart defects?

A
  • All have T in their name
  • cyanotic
  • Venous emboli become systemic - paradoxical
28
Q

What is ASD?

A

Atrial septal defect - malformation of atrial septum

  • NOT DUE TO PATENT FORAMEN OVALE
  • Left to right shunt
29
Q

What are the three types of ASD and where do they occur?

A

Secundum - defective fossa ovale (most common)

Primum - next to AV valves, mitral cleft

Sinus venous - SVC with anomalous pulmonary veins draining to SVC or RA

30
Q

What are the characteristics of Ventricular septal defects?

A
  • Most common
  • Occur in muscular or membranous (~90%) regions for he septa
  • muscular involve holes - ‘swiss cheese’
  • small holes usually close off, large can lead to pulmonary hypertension
31
Q

What is the cause of patent ductus arteriosus?

A

Closure failure of the DA between the pulmonary artery to atria, resulting in L to right shunt (usually)

32
Q

What is the clinical features of a PDA?

A

Continuous harsh, machinery-like murmur

33
Q

What is the clinical feature of atrioventricular septal defect

A

Partial or complete communication between all 4 chambers

  • 1/3 people with AVSD have down syndrome
34
Q

What are the four features of tetralogy of fallot?

A
  • Overriding aorta
  • VS defect
  • Pulmonary stenosis
  • Right ventricular hypertension
35
Q

What happens with transposition of the great arteries?

A

Aorta drains the right ventricle, the pulmonary artery drains the left ventricle

36
Q

With transposition of great arteries, when is postnatal life at all possible?

A

Patent ductus arteriosus

VSD

37
Q

What is truncus arteriosis and what is its clinical features?

A

Failure of truncus arteriosis to separate (common artery)

VSD

blood mixes at VSD

cyanosis and increased pulmonary flow (RVH)

38
Q

What is tricuspid atresia?

A

Absent tricuspid valve - requires a VSD, ASD or PDA

39
Q

What is total anomalous pulmonary venous connection?

A

Where the pulmonary veins are not connected to the LA (usually SVC)

ASD present (required for life)

40
Q

What is coarticulation of aorta?

A

Narrowing of aorta

Infantile form serious, especially if proximal to patent ductus aerteriosus

Clinical Pathology (50 decks)

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