Cardiovascular pathology 2

Question 1

Heart Failure/Congestive Cardiac Failure (CCF)

Definition

Answer 1

Inability of the heart to pump enough blood needed to meet the metabolic demands of the tissue

Question 2

Insidious effect =

Answer 2

chronic workload such as hypertension and valve diseases

Question 3

Sudden effect =

Answer 3

acute haemodynamic stress such as fluid overload and large MI

Question 4

Aetiology of heart failure

Answer 4

• Especially IHD and its causes

- Smoking, hypertension, diabetes

Question 5

Pathogenesis of heart failure

Answer 5

• Increased cardiac work = wall stress

- Wall stress causes cells to stretch = Hypertrophy/dilation

Question 6

Left sided heart failure clinical features

Answer 6

• Low cardiac output and hypoperfusion of tissues
• Pulmonary congestion causes pulmonary oedema and present of heart failure cells in alveoli
• Reduced kidney perfusion

Question 7

Right sided heart failure clinical features

Answer 7

• Engorgement of portal and systemic venous systems
• Congestive splenomegaly, ascites, congestion and oedema of bowel wall
• Pleural and pericardial effusions

Question 8

Valvular heart diseases

Answer 8

• Rheumatic heart disease - Aortic stenosis

- Disorders of valvular regurgitation

Question 9

Problems with valvular opening =

Answer 9

stenosis

Question 10

Acquired aortic stenosis (AS)

Answer 10

• Causes left ventricular hypertrophy (but no hypertension) and ischemia = cardiac decompensation, angina, CCF

Question 11

Calcific aortic stenosis

Answer 11

• Most common valvular abnormality
• Consequence of age-related wear/tear
• If valve is bicuspid (congenital) – becomes stenotic earlier
• May involve mitral valve too

Question 12

Acquired mitral stenosis (MS)

Answer 12

• Rheumatic heart disease
• Follows group A strep infection
• Diagnosis = Jones criteria
• Clinical features = mitral valve stenosis with infective endocarditis, Classical pancarditis

Question 13

Aortic regurgitation

Answer 13

• Failure of valve to close properly = backflow = volume overload of heart
• May be due to RA, syphilis, Marfan’s syndrome

Question 14

Mitral valve prolapse (MVP)

Answer 14

• Myxomatous degeneration of the mitral valve causing a “floppy valve”
• F>M
• Associated with connective tissue disorders e.g. Marfan’s
• Risk is sudden death from infective EC

Question 15

Congenital Heart Diseases definition

Answer 15

• Abnormalities of the heart and great vessels present from birth
• May not be evident until adult life

Question 16

Congenital Heart Diseases Aetiology

Answer 16

• Environmental factors = rubella, gestational diabetes of mother, teratogens
• Sporadic genetic abnormalities = Down’s syndrome, Turner Syndrome

Question 17

Congenital Heart Diseases pathogenesis

Answer 17

faulty embryogenesis of heart (weeks 3-8)

Question 18

Left to right shunts

Answer 18

• All have “D’s” in their name
• No cyanosis so live longer
• Pulmonary hypertension

Question 19

Atrial septal defect (ASD)

Answer 19

• Abnormal atrial septum allowing communication of blood between the two atria
• Secumdum ASD = most common, arises from septum secundum
• Other types = primum (next to AV valves), sinus venosus
• Asymptomatic until adulthood

Question 20

Ventricular septal defect (VSD)

Answer 20

• Most common CHD
• Often part of Tetralogy of Fallot
• 90% involve the membranous septum – 10% involve the muscular septum or lie under the infundibulum = “swiss cheese septum”
• Small ones often close spontaneously, large ones progress to pulmonary HT

Question 21

Right to left shunts

Answer 21

• All have “T’s” in their name

- Cause cyanosis as deoxygenated blood bypasses lungs = systemic circulation

Question 22

Tetralogy of Fallot

Answer 22

• Transposition of great arteries = truncus arteriosus,
• Total anomalous pulmonary venous connection,
• Tricuspid atresia (failure of formation of tricuspid valve)

Question 23

Tetralogy of Fallot Clinical features

Answer 23

• VSD
• Sub-pulmonary stenosis – blockage of outflow of RV
• Aorta overrides the VSD
• RVH

Question 24

Coarctation of aorta

Answer 24

• M>F (2:1)
• Females with Turner’s syndrome at risk
• Two forms = infantile and adult
• birth defect in which a part of the aorta is narrower than usual

Question 25

Infantile form =

Answer 25

• Proximal to PDA, low pressure allows shunting of deoxygenated blood through PDA into circulation = cyanosis in lower half of body

Question 26

Adult form =

Answer 26

• Closed ductus (no PDA), hypertension in upper extremities whilst hypotension in lower extremities and features of arterial insufficiency (claudication and coldness)