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Human Disease and Therapeutics > Cardiovascular Pathology > Flashcards

Cardiovascular Pathology Flashcards

1
Q

edema

A

too much extravascular fluid in the tissues
examples: pulmonary edema (interferes with gas exchange), edema with inflammation, hyperemia (leaky fluid from vessels usually due to vasodilation)

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2
Q

effusion

A

too much fluid in the body cavity

ex. ascites, pleural effusion, hydropcephalus

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3
Q

ascites

A

excess fluid in the peritoneal space usually due to liver failure, heart failure, or kidney disease

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4
Q

thrombi or emboli

A

clots or other material that block blood flow

usually from large vessels in the legs, can be from air, tumors, or amniotic fluid (but rare)

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5
Q

hypotension/shock

A

main causes: hypovolemia, arrhythmia/infarct, or septic shock (widespread infection with release of endotoxins with vasodilation as the body’s compensation)

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6
Q

body’s compensation for congestive heart failure

A

tachycardia, cardiac hypertrophy, increased stroke volume, increased catecholamine activity (leading to positive ionotropic effect), redistribution of blood flow (to kidneys and way from cutaneous vessels

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7
Q

causes of left sided heart failure

A

hypertension, ischemic heart disease

left-sided heart failure is more common

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8
Q

consequences of left sided heart failure

A
  • blood accumulates in the lungs (upstream)
  • pulmonary edema and breathing problems (orthopnea)
  • micro-leakages in the lungs
  • reduced blood perfusion to organs (kidney will interpret this as dehydration and retain fluid –> peripheral edema)
  • eventually critical organs will shut down.
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9
Q

causes of right sided heart failure

A

lung disease, as well as ischemia, hypertension, and valvular disease
right-sided heart failure is less common and usually associated with left-sided heart failure

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10
Q

consequences of right sided heart failure

A
  • hepatomegaly (blood pools around the central veins in the liver)
  • myocarditis
  • hyperemia (in the liver)
  • other systemic effects (venous blood backs up and forces fluid into the extravascular space –> edema)
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11
Q

cor pulmonale

A

pure right-sided heart failure

abnormal enlargement of the heart, usually due to a heart valve problem

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12
Q

transmural infarct (including symptoms and diagnostic criteria)

A

main cause - aneurysm in heart wall
full thickness (endo to epicardium)
mural thrombus often forms from MI or atrial fibrillation
more severe than subendocardial infarct
dx - correlates with STEMI (ST segment elevation myocardial infarct) on EKG.

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13
Q

Subendocardial infarct (including symptoms)

A

multifocal or diffuse areas of necrosis confined to inner 1/3-1/2 of LV wall
correlates with NSTEMI (non-ST segment elevation myocardial infarct) on EKG
less severe, but still potentially lethal.

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14
Q

symptoms of a myocardial infarct

A

retrosternal chest pain, dyspnea, diaphoresis, nausea/vomiting, palpitations, anxiety
can also be asymptomatic/present as sudden death
a mural infarct often forms

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15
Q

diagnostic criteria for MI

A
  • ischemic-type chest pain for >20 min.
  • acute EKG changes
  • rising, then falling serum biomarkers (troponin, CK)
  • documentation of infarct at autopsy
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16
Q

MI complications

A
  • no symptoms (10-20%)
  • pain radiating to left arm
  • sweating
  • elevated cardiac enzymes (CK-MB, troponin T, myoglobin, creatinine phosphate)
  • arrhythmias (ventricular arrhythmias cause most of the death following MI) - 70-90% of cases
  • congestive heart failure (60%)
  • pulmonary edema (60%)
  • pericarditis (50%)
  • mural thrombus (40%)
  • extension of the infarct
  • EKG/echocardiogram changes
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17
Q

stenosis

A

heart valve will not open; most common form is aortic valve stenosis

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18
Q

regurgitation

A

heart valve cannot close completely (less common than stenosis).

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19
Q

types of valvular heart disease (aortic stenosis)

A
  • rheumatic fever
  • infective endocarditis - dental related procedure usually strep or staph
  • pre-injured valve
  • senile calcified aortic stenosis (most common form)
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20
Q

Types of Infective Endocarditis

A
  • Libman-Sacks = endocarditis not associated with bacterial infection, but associated with autoimmune disorders such as SLE
  • infective form can be caused by intrinsic oral bacteria**
  • rheumatic form often involves mitral valve which became calcified at time of infection
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21
Q

Complications of Infective Endocarditis

A
  • very destructive
  • can cause thrombi
  • can destroy valvular tissue and cause perforations
  • very dangerous
  • splinter hemorrhages (from tiny blood clots that migrate from the inflamed heart to under the nails or other body parts)
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22
Q

aorta dissection

A

Blood forces a separation of wall layers of the aorta and may result in a rupture. Often associated with hypertension.

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23
Q

complications of artificial valves

A
  • thrombosis/thromboembolism
  • hemorrhage (from anti-coagulant therapy)
  • infective endocarditis
  • deterioration (physical or biological)
  • non-structural dysfunction (anemia, tissue entrapment, etc.)
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24
Q

cardiac tamponade

A
  • compression of the heart from fluid accumulation which can reduce cardiac output and cause death
  • can cause: thrombi, increased risk of endocarditis, wears out valves, leaks (develop murmurs)
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25
Q

Arrhythmias

A
  • electrical problems in the heart
  • premature beats (usually not dangerous)
  • tachyarrhythmias (less common and more serious; ex. fibrillations)
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26
Q

symptoms of arrhythmias

A

palpitations, syncope, presyncope (light-headedness), sudden cardiac death (usually from ventricular arrhythmias related to atherosclerosis)

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27
Q

bradycardia

A

less than 60 bpm

related to impulse propagation problems such as conduction blocks.

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28
Q

tachycardia

A

more than 100 bpm

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29
Q

causes of conduction disturbance

A
  • ischemic heart disease and scarring
  • degenerative changes
  • anti-arrhythmic drugs
  • hyperkalemia
  • MI
  • trauma
  • congenital abnormalities
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30
Q

1st degree heart block

A

closed impulse propagation

usually aymptomatic

31
Q

2nd degree heart block

A

impulse propagation to ventricles sometimes fails and a pacemaker may be needed

32
Q

3rd degree heart block

A

no heart conduction

33
Q

ectopic beats

A

premature depolarization events (the beat originates from a site other than the SA node)
examples: atrial premature depolarization, ventricular premature depolarization, re-entrant arrhythmias

34
Q

tachyarrhythmias

A

rates usually >100 bpm

multiple ectopic foci firing too frequently –> circle/loop firing pattern

35
Q

atrial fibrillation

A

most common
causes ineffective atrial contractions
fairly common in older people (10% of people over 65)

36
Q

complications of atrial fibrillation

A
  • risk of thrombi or emboli (blood pools in the atria)
  • causes 25% of strokes
  • often seen in congestive heart failure, valvular disease, or hypertension
  • scarring (loss of myocytes and replacement with collagen and fibroblasts)
  • inefficient cardiac output
  • can lead to ventricular fibrillation
37
Q

ventricular fibrillation

A
  • less common, but more serious than atrial fibrillation

- very dangerous and often fatal

38
Q

sudden cardiac arrest

A
  • accounts for the majority of CV-related deaths in the US
  • usually due to coronary artery disease leading to ventricular fibrillation or tachycardia –> abrupt cessation of ventricular function
  • brain damage or death occurs within 4-6 minutes of sudden cardiac arrest
  • survival reduces 7-10% per minute without CPR or defibrillator.
  • fatal in 90% of cases
39
Q

essential hypertension

A
  • primary hypertension; it has no identifiable underlying cause
  • 95% of all hypertension
  • possible causes:
    > sodium retention and increased intravascular volume
    > narrowing of arteries and arterioles especially in the kidney –> disruption of the renin, angiotensin, aldosterone systems
40
Q

risk factors for essential hypertension

A

age, black, obesity, lack of exercise, high salt diet

41
Q

related problems of hypertension (essential or secondary)

A
  • increase in atherosclerosis
  • myocardial infarcts
  • aneurysm
  • heart failure
  • renal failure
  • hemorrhages (brain, retina)
42
Q

secondary hypertension

A

secondary to an underlying medical condition (such as congestive heart failure)
example: preclampsia - secondary hypertension associated with pregnancy and often connected to diabetes –> can lead to eclampsia and seizures.

43
Q

causes of secondary hypertension

A
  • endocrine (steroid, thyroid, pheochromocytoma)
  • drugs (stimulants)
  • pregnancy
  • renal failure
  • sleep apnea
  • renal artery stenosis
  • pain/stress
44
Q

hypertensive heart changes

A
  • malignant hypertension (sudden increase in BP, most common in african americans)
  • MI
  • stroke
  • peripheral vascular disease
  • hypertrophy of arteries and arterioles (but NOT capillaries)
  • increase in wall to lumen ratio of arteries
  • decrease in arterial density
  • aneurysms
  • heart failure
  • renal failure
  • hemorrhages
45
Q

definition of hyperlipidemia

A
  • risk factor for many atherosclerotic diseases
  • > 200 mg/dL
  • affects about 50% of adults in the US
46
Q

causes of hyperlipidemia

A
  • secondary causes are much more common than familial causes
  • type 2 diabetes
  • sedentary lifestyle
  • poor diet
  • obesity
  • heavy alcohol use
47
Q

HDLs

A
  • deliver lipids (cholesteryl esters) from the periphery to the liver
  • reverse cholesterol transport
  • anti-atherogenic
48
Q

LDLs and VLDLs

A
  • deliver cholesterol (LDL) and triglycerides (VLDL) from the liver to the periphery
  • atherogenic
49
Q

Chylomicrons

A
  • transport triglycerides from the gut to the liver

- triglycerides are also damaging

50
Q

optimal lipid values:

  1. total cholesterol
  2. LDL
  3. HDL
  4. triglycerides
A

total cholesterol = < 200 mg/dL
LDL = 70 - 130 mg/dL (based on other risk factors)
HDL = > 40 - 50 mg/dL
triglycerides = < 150 mg/dL

51
Q

definition of atherosclerosis

A
  • lipid deposits/plaques (atheromas) in the arteries that results in arteriosclerosis (hardening of the arteries)
  • leading cause of death from heart disease (causes 80% of heart disease)
52
Q

aortic and coronary artery atherosclerosis

A
  • fatty streaks and atheromas in vessel walls; can also have a connection with thrombi
  • vessel walls are hardened
  • inflammatory response causes fibrosis and eventual calcifications in the artery walls
53
Q

consequences of atherosclerosis

A
  • stenosis
    > stable angina (slow progression, caused by stenosis)
  • thrombus/embolus (fast progression)
    > can lead to infarcts, heart attacks, strokes, and death
  • rupture of the vessel –> causes a complicated lesion (thrombosis) and is the cause of most infarcts
54
Q

most common sites for atherosclerosis

A

aorta (most common site)
coronary arteries (most common cause of death, can cause angina, infarct, ischemic heart disease)
legs - femoral arter (can cause necrosis of the limb)
carotids/circle of Willis (can cause stroke)
kidney
lungs - pulmonary arteries

55
Q

risk factors for atherosclerosis

A

smoking, hypertension, diabetes, nephrosclerosis, post menopause

56
Q

sequence of developing atherosclerosis

A
  1. endothelial dysfunction (smoking, HTN, diabetes, inflammation, etc.)
  2. lipids deposit in the vessel wall intima
  3. inflammation (foamy macrophages)
  4. fibrosis in the smooth muscle (intimal layer)
  5. plaque rupture
  6. fibroatheroma with stenosis (angina and claudication)
  7. thrombosis (causes most infarcts/sudden deaths)
57
Q

at what percentage of stenosis is blood flow clinically impeded?

A

75%

58
Q

T/F

A

abrupt stenosis (thrombus or embolus) is most dangerous

59
Q

aorta (ascending) dissection

A

tear in the wall of the aorta

it’s related to hypertension

60
Q

most common cause of stroke

A 
cerebral infarct (usually from a thrombus)
other causes: hemorrhaging,
61
Q

symptoms of a stroke

A
  • numbness/paralysis on the contralateral side
  • symptoms for less than 24 hr = TIA
  • symptoms for more than 24 hr = brain damage
62
Q

Risk factors for atherosclerosis

A
  • age (males >45, females >55)
  • smoking
  • diabetes
  • hypertension
  • dyslipidemia
  • family history
  • lifestyles (obesity, inactivity, poor diet)
  • association with inflammatory diseases (such as perio dx…but not a clear causal relationship)
63
Q

T/F Ischemic heart disease causes 70% of heart disease deaths and 30% of total mortality in the US

A

True

64
Q

Causes of ischemic heart disease

A

coronary artery stenosis and atheromas

65
Q

differential diagnosis for ischemic heart disease

A
  • esophageal reflux disease (very frequent; to rule out - check EKG and cardiac enzyme level - troponin or creatine kinase)
  • pulmonary emboli
  • pericardial tamponade (pressure builds on the heart from fluid accumulation in the pericardial sac)
66
Q

define angina pectoris

A

paroxysmal attacks of chest pain; indicates myocardial ischemia

67
Q

stable angina (causes and consequences

A
  • caused by exertion; related to fixed coronary stenosis
  • most common type and easiest to manage
  • pain/pressure
68
Q

variant angina

A
  • occurs at rest

- brief and reversible

69
Q

unstable angina

A
  • most dangerous type; new or worsening angina
  • prolonged pain or pain at rest
  • usually due to acute plaque change (ex. thrombus)
70
Q

gross appearance of the heart following MI

A
  • pallor and hyperemia around infarct
  • central yellowing of vascular borders
  • (late) white fibrotic tissue (scarring)
71
Q

T/F Most infarcts are right sided

A

FALSE most are left sided

72
Q

Ludwig’s angina

A

neck infection sometimes from a mandibular molar that has the potential to block a pts airway

73
Q

pericarditis

A
  • swelling and irritation of the pericardium
  • associated with sharp, stabbing pain that’s usually acute in the chest, but can be chronic
  • causes: infection (coxsackie B virus) and inflammatory disorders (rheumatoid diseases)

Human Disease and Therapeutics (11 decks)

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