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Pathology - Exam 1 > Cardiovascular II > Flashcards

Cardiovascular II Flashcards

1
Q

What are the 6 principle mechanisms of heart disease?

A 
Failure at the pump
Flow obstruction
Shunted flow
"Leaky" flow (bad valves)
Canduction disordes
Rupture of heart/major vessel
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2
Q

Congestive Heart Failure definition

A

Failure of the heart to pump an adequate amount of blood to supply the metabolic requirements of the organs

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3
Q

Is Congestive heart failure due to pathologic conditions inside or outside of the heart?

A

It may be due to either

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4
Q

What are the compensatory mechanisms of congestive heart failure?

A

The heart can compensate to try and keep pace for a short time via:

  • Activation of neurohumoral systems
  • Frank-Starling Mechanism
  • Myocardial Hypertrophy
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5
Q

Activation of neurohumoral mechanisms

A

The body releases NE to increase HR and contractility

The renin-angiotensin system is activated to retain water and salt to increase circulatory volume

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6
Q

Frank-Starling Mechanism

A

Increased end diastolic filling to stretch cardiac muscle fibers, which cause the fibers to contract more forcefully and increase CO
Eventually, they cannot keep up

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7
Q

Myocardial hypertrophy

A

Increase in muscle fiber size, resulting in increased thickness of the ventricular wall, but without increase in the size of the lumen

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8
Q

Why do compensatory mechanisms fail?

A

Due to increase oxygen requirements of the myocardium, but without increased capillary support - resulting in susceptibility to ischemia

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9
Q

How will decompensated muscle look compared to normal?

A

It will have larger nuclei and not as many fibers

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10
Q

What are some causes of left-sided heart failure? (Etiology)

A 
Ischemic heart disease (IHD)
Hypertension
Myocarditis
Cardiomyopathy
Valvular disease
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11
Q

What are some causes of right-sided heart failure?

A

Left-sided heart failure - subsequent pulmonary congestion leads to an increased arterial pressure
Pulmonary hypertension
Valve disease
Septal defects with left-to-right shunts

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12
Q

What are some manifestations of Congestive heart failure from Left ventricular failure

A
  • Pulmonary edema and congestion, resulting in dyspnea
  • Chronic cough
  • Orthopnea (can’t breathe laying down)
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13
Q

What are some manifestations of Congestive heart failure from Right and/or Left ventricular failure?

A

Cerebral hypoxia

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14
Q

What are some manifestations of Congestive heart failure from Right ventricular failure?

A

Congestion of the liver (nutmeg liver) and spleen

Edema (pitting) of subcutaneous tissues, particularly in the lower extremities

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15
Q

What are the two forms of Congenital heart disease?

A

Cyanotic

Noncyanotic

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16
Q

What are some causes of Congenital heart disease?

A

Environmental factors
Chromosomal abnormalities
90% are unknown and likely multifactorial

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17
Q

What are the Noncyanotic forms of congenital heart disease

A

Atrial Septal Defect - allows shunting between atria
Ventricular Septal Defect - allows shunting between ventricles
Patent ductus arteriosus - connects aorta and pulmonary artery, should close a few days after birth

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18
Q

What are the cyanotic forms of congenital heart disease?

A

Tetralogy of Fallot

Transposition of the great arteries

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19
Q

What are the 4 anomalies of the Tetralogy of Fallot?

A

1) Ventricular septal defect
2) Narrowing of right ventricular outflow
3) Overriding of the aorta over ventricular septal defect
4) Right ventricular hypertrophy

20
Q

Transposition of the great arteries

A

The right ventricle empties into the aorta

The left ventricle empties into the pulmonary artery

21
Q

Ischemic Heart Disease

A

Refers to a group of related disorders that are all characterized by an imbalance between myocardial blood supply and myocardial oxygen demand (ischemia)
Primarily due to atherosclerosis
Leading cause of death in the US

22
Q

What is the pathogenesis of Ischemic Heart Disease?

A

Coronary artery atherosclerosis (>75%)
Coronary artery thrombosis
Other factors:
-Increased myocardial oxygen demand (Hypertension)
-Decreased blood volume (hypotension)
-Decreased oxygen (pneumonia)
-Decreased oxygen-carrying capacity (anemia)

23
Q

What are the different types of Ischemic Heart disease?

A

Angina Pectoris
Myocardial infarction
Chronic Ischemic Heart Disease with Congestive Heart Failure
Sudden Cardiac death

24
Q

Angina Pectoris

A

(Stable Angina)
“Chest Pain” of several minutes usually associated with exercise and emotional stress and relieved by rest
Caused by transient, reversible myocardial ischemia
No myocardial necrosis occurs

25
Q

Unstable Angina

A

Increasing frequency of chest pain with minimal/no exertion
Longer lasting than stable angina
Often preceded more serious ischemia or MI

26
Q

Acute Myocardial Infarction

A

Necrosis of cardiac muscle caused by ischemia
Severe ischemia lasting longer than 20-40 minutes will cause irreversible myocyte injury and cell death
Myocardial ischemia also contributes to arrhythmias, probably because ischemic regions cause electrical instability - may lead to ventricular fibrilation

27
Q

Acute Myocardial Infarction Clinical presentation

A 
Chest pain
Shortness of breathe
Nausea/vomiting
Diaphoresis
Low-grade fever
28
Q

Acute Myocardial Infarction PAthology

A 
Coagulation necrosis (few hours)
Neutrophil infiltration (few days)
Granulation tissue (1 week)
Scar formation (weeks-months)
29
Q

Acute Myocardial Infarction Tests

A

ECG

Elevated serum proteins from damages cardiac myocytes

30
Q

How does an MI look in an autopsy?

A

MI’s less than 12 hours old are not usually grossly apparent at autopsy
At 12-24 hours, infarcted areas appear reddish-blue

31
Q

Acute Myocardial Infarction Treatment

A

-Placement of stents to open coronary vessels affected by atherosclerosis
-Coronary artery by-pass grafts (CABG)
-“Clot-busting” drugs such as streptokinase
These may result in reperfusion injury

32
Q

If a patient survives an acute MI, what is commonly seen?

A

Scarring of the wall - but this can reduce contractibility, which can also be a problem

33
Q

Acute Myocardial Infarction Complications

A 
Arrhythmia and sudden death
CHF/shock
Mural thrombosis/embolism
Mitral valve regurgitation
Ventricular aneurysm
Chronic Ischemic Heart disease
34
Q

Chronic Ischemic Heart Disease with Congestive Heart Failure

A

Progressive heart failure due to ischemic myocardial damage
Patient usually has a history of MI
Arrhythmias, CHF and subsequent MI’s lead to many deaths

35
Q

What is the most common cause of sudden cardiac death?

A

Ischemic Heart Disease (80-90%)

36
Q

Sudden Cardiac Death

A

Sudden onset of ischemic arrhythmia with or without MI

May occur in individuals with or without a history of IHD

37
Q

What are the Classifications of Cardiomyopathies

A

Primary - disease primarily or solely confined to a heart muscle
Secondary - myocardium is involved as part of a systemic order

38
Q

What are the 3 functional/morphological patterns of Cardiomyopathy?

A

Dilated
Hypertrophic
Restrictive

39
Q

Dilated Cardiomyopathy

A

Can be primary or secondary, genetic, or acquired
Hereditary in 20-50% - related to alcoholism
Dilation of all 4 heart chambers
Histology shows variable fibrosis and myocyte hypertrophy
Poor ventricular contractility

40
Q

Hypertrophic Cardiomyopathy

A

Primary and Genetic
Autosomal dominant inheritance
Missense point mutation in one of several sarcomeric gene loci
Stiff ventricles prevent adequate filling

41
Q

Restrictive Cardiomyopathy

A

Wall of the ventricles becomes stiffer with impaired filling during diastole
Can be idopathic or secondary to systemic conditions that affect the myocardium

42
Q

What can cause Myocarditis?

A

Pyogenic bacteria
Viruses
Parasites
Hypersensitivity

43
Q

Myocarditis caused by Pyogenic Bacteria

A

Bacteria are usually from abscesses

44
Q

Myocarditis caused by Viruses

A

Interstitial mononuclear inflammatory cells with myocyte necrosis

45
Q

Myocarditis caused by Parasites

A

In individual myocytes or interstitium with adjacent inflammation

46
Q

Myocarditis caused by sensitivity

A

Often to drugs, causes a perivascular inflammatory infiltrate with many eosinophils

Pathology - Exam 1 (9 decks)

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