Cardiovascular Pathology Pt. 2

Question 1

Heart Failure - Definition

Answer 1

Unable to pump enough blood to meet body’s demand. A weak heart or it cannot overcome increased blood pressure. Not a disease but a complex of symptoms.
Main types of failure:
Systolic heart failure: can’t pump with enough force (pump problem).
Diastolic heart failure: can’t fill with enough blood (filling problem).

Question 2

Heart Failure - Classification

Answer 2

1. Left or Right (according to the heart side)
2. High or Low output (according to the blood volume pumped)
3. Acute or Chronic

Question 3

Heart Failure - Consequences

Answer 3

Critical reduction of the ejection fraction of the heart.

Beating harder or faster → OK in early stage → can become overworked → needing more O2 → cell death ↓stroke volume.

Question 3

Heart Failure - Consequences

Answer 3

Critical reduction of the ejection fraction of the heart.

Beating harder or faster → OK in early stage → can become overworked → needing more O2 → cell death ↓stroke volume.

Question 4

Left Sided Heart Failure - Description and Cause

Answer 4

Most common.
Left ventricle not efficiently pumping blood out → Blood stays in lungs, congestion.
Cause:
- Arterial hypertension
- Valve disease
- Ischemic heart disease
- Myocardial infarction
- Arrhythmia

Question 5

Left Heart Failure - Concequences

Answer 5

• Pulmonary edema
• Pleura effusion
• Dyspnea, tachypnoea, orthopnea
• Reduced exercise capacity
• Can lead to right heart failure => Global failure

Question 6

Right Heart Failure - Description and Cause

Answer 6

Right ventricle not efficiently pumping blood to lungs → Blood can flow back to body, congestion (feet or abdomen).
Causes:
- Valve failure
- Left heart failure with pulmonary edema
- Pulmonary diseases with pulmonary arterial hypertension

Question 7

Right Heart Failure - Consequences

Answer 7

• Leg edema
• Nocturia
• Liver edema
• Ascites (accumulation of fluid in abdominal cavity)
• Nausea/loss of appetite

Question 8

Global Heart Failure - Description and Cause

Answer 8

Limited pump function of both ventricles.

Usually stems from left side failure. Left to right heart failure.

Question 9

Heart Failure - Consequences and Diagnosis

Answer 9

Consequences: 
- Reduction of the physical capacity
- Risk of cardiovascular fail
- Reduced blood flow to visceral organs
Diagnosis
• Medical history
• Echocardiogram
• Blood tests

Question 10

Heart Failure - Classification according to New York Heart Association

Answer 10

I. No dyspnea/symptoms
II. Mild dyspnea during ordinary activity
III. Marked limitation during ordinary activity
IV. Severe limitations, Dyspnea at rest

Question 11

Heart Failure - Risk Factors

Answer 11

• Arterial hypertension
• Diabetes mellitus
• Smoking
• Abuse of alcohol
• Overweight
• Physical inactivity

Question 12

Heart Failure - Treatment

Answer 12

• Underlying cause
• Medication
• Exercise
• Education
• Nutrition
Heart Transplant - LAST RESORT

Question 13

Disturbances in Cardiac Rhythm

Answer 13

Can originate from normal conduction pathway: SA node, AV node.
Can originate from outside pathway: where myocardium is irritable (depolarization of conduction pathway).
Can arise from atria or ventricle.

Question 14

Pacemaker/Internal Defibrillator

Answer 14

Stimulate the heart with electrical impulses to maintain or restore a normal heart rhythm and enhance the cardiac function.

• Sinus node dysfunction
• Acquired Atrioventricular(AV) block
• After acute phase of myocardial infarction
• Hypertrophic cardiomyopathy

Question 15

Cardiac Valve Disease - Stenosis vs Regurgitation

Answer 15

Restriction of valve opening (stenosis) or of valve closing (regurgitation)
• 1) obstruction of flow → ↑ pressure
• 2) inadequate valve closure → volume overloading

Question 16

Aortic Valve Stenosis

Answer 16

Most common, narrowed opening.
↑ Pressure overloading left ventricle → left ventricle hypertrophy →difficulties pumping blood to rest of body.
Creates a afterload problem.

Question 17

Aortic Valve Regugitation

Answer 17

Inadequate closing.
Backflow of blood into ventricle.
Volume overloading left ventricle → dilation of ventricle → heart failure.

Question 18

Mitral Stenosis

Answer 18

infection (rheumatic fever)
→ calcium deposits → scarring mitral valve
- ↑ pressure left atrium – pulmonary veins
- ↓ blood flow
→ tired, dyspnea
Treatment: prevent fever.

Question 19

Mitral Valve Regurgitation

Answer 19

Mitral valve prolapse (degenerative)
Rupture of papillary fibers
Rheumatic fever
Trauma
Congenital heart defect
Cardiomyopathy (dilation heart muscle)

Question 20

Cardiac Valve Disease - Risk Factors and Diagnosis

Answer 20

Age
History of infections that can affect the heart
History of heart disease
High blood pressure – high cholesterol – diabetes
Congenital heart disease
Diagnosis: Echocardiogram.

Question 21

Cardiac Valve Disease - Symptoms

Answer 21

• At beginning often symptom-free
• Abnormal heart sound
• Fatigue
• Shortness of breath
• Swelling of your ankles and feel
• Dizziness
• Fainting
• Irregular heartbeat

Question 22

Cardiac Valve Disease - Complications and Treatment

Answer 22

Heart failure, stroke, blood clots, death.
• Healthy lifestyle changes + taking medications to treat symptoms
• Heart valve surgery
• Prevention rheumatic fever

Question 23

Cardiomyopathy - Descriptions and Types

Answer 23

Modification of cardiomyocytes, size of cardiac wall.
Heart muscle weakens and is unable to pump blood as well as it should.
Primary (inherited) vs Secondary (acquired)
- Dilated Cardiomyopathy
- Hypertonic Cardiomyopathy
- Restrictive Cardiomyopathy
- Arrhythmogenic right ventricular dysplasia (ARVD)

Question 24

Hypertrophic Cardiomyopathy

Answer 24

Diastolic dysfunction. Thickened left ventricular wall, thickened ventricular septum resulting in a small left ventricle. Can make it harder for the heart to pump blood.

Question 25

Dilated Cardiomyopathy

Answer 25

Enlargement of all cardiac chambers. Systolic dysfunction. Most common. Makes it harder for the heart to pump blood to the rest of the body.

Question 26

Restrictive Cardiomyopathy

Answer 26

Rigid ventricular walls, stiff muscle, results in decrease of expansion of the ventricular walls, decrease in blood volume of the ventricles. Diastolic dysfunction. Least common.

Question 27

Arrhythmogenic right ventricular dysplasia (ARVD)

Answer 27

Deposition of fatty tissue on right ventricle instead of muscle. The right ventricle is dilated and contracts poorly. Very rare, but it’s the leading cause of sudden death in young athletes.

Question 28

Cardiomyopathy - Cause and Symptoms

Answer 28

``` Cause: idiopathic, inherited, alcohol, coronary heart disease, cocaine use and viral infection. Symptoms: not present in early stages. - Shortness of breath - Tired - Swelling of the legs (heart failure) - Irregular heart beat - Fainting ```

Question 29

Cardiomyopathy - Diagnosis and Treatment

Answer 29

Presentation of symptoms - exclusion of other causes. Lifestyle changes (physical activity), medication or surgery (last resort).

Question 30

Pericardial Disease - Types

Answer 30

Inflammation of pericardium. - Acute pericarditis: inflammation - Pericardial effusion: extra fluid between layers. - Cardiac tamponade: medical emergency, quick increase in fluid in pericardial sac, compressing the heart → decrease in cardiac output and shock. - Constructive pericarditis: chronic scarring – thickening of pericardium.

Question 31

Pericardial Disease - Cause and Symptoms

Answer 31

Cause: Viral, bacterial, parasite infection, autoimmune disease, traumatic chest injury. Symptoms: Sharp chest pain (worse when coughing), dry cough, anxiety/fatigue, edema.

Question 32

Pericardial Disease - Diagnosis and Treatment

Answer 32

``` Echocardiogram, x-ray, blood test. Treatment: depends on severity. Mild cases often spontaneous recovery. Medication: pain killers, corticosteroids, antibiotics. Surgery ```

Question 33

Aortic Disease - Aneurysm

Answer 33

Dilation arterial wall >150% Due to degeneration of connective tissue / inflammation. Often asymptomatic

Question 34

Aortic Disease - Aorta Dissection

Answer 34

Tear inner layer of aorta → blood entering aortic wall → possible rupture → often fatal. Acute stabbing chest pain, hypotension.

Question 35

Aortic Disease - Diagnosis and Treatment

Answer 35

CT-scan, MRI, chest X-ray. • Medication (prevent worsening: lower blood pressure) • Healthy lifestyle • Surgery (removal + reconstruction)

Question 36

Varicosis - Definition, Symptoms, Cause and Treatment

Answer 36

Venous valves not working, blood pools in veins → enlarged. Symptoms: leg edema, itchiness, spider veins. Cause: standing activity, obesity, age, pregnancy. Therapy: irreversible, compression socks, lymphatic drainage, activity, respiratory exercises.

Question 37

Thrombophlebitis, Deep Venous Thrombosis - Definition

Answer 37

Inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. Cause: prolonged immobility, traveling, pregnancy, inherited disorder, injury to vein, aging.

Question 38

Thrombophlebitis, Deep Venous Thrombosis - Diagnosis and Treatment

Answer 38

Ultrasound. Therapy: avoid sitting long walking and lying better than sitting, standing. Medication (blood thinners) Deep breaths Deep venous thrombosis - RED FLAG → pulmonary embolism

Question 39

Peripheral Arterial Occlusive Disease

Answer 39

Blockage of arteries to extremities. Pain due to low blood flow. Decrease or loss of peripheral pulse, cold extremity. Therapy: manage symptoms, fight cause, stop smoking, physical activity, nutrition.

Question 40

Physiotherapy Goals in Thoracic Surgery

Answer 40

* Respiratory physiotherapy. Prevent respiratory functional impairment (airway clearance, improve ventilation and efficiency of respiratory muscles) * Prevent circulatory impairment * Maintain or restore muscles strength and ROM * Reduce length of stay , health care cost

Question 41

Congenital Heart Disease - Definition and Classification

Answer 41

Most common defects involve: • the inside walls of the heart, • the valves of the heart, or • the large blood vessels that carry blood to and from the heart. Classification: According to the altered cardiac structure (Septum, valves, ventricle, atrium).

Question 42

Congenital Heart Disease - Atrial/Ventricular Septal Defect

Answer 42

Hole in the wall between the atria/ventricle, causing blood flow mixture (from the left to the right). It may close by it own.

Question 43

Congenital Heart Disease - Patent Ductus Arteriosus

Answer 43

Occurs when a connection between the pulmonary arteries and aorta does not close. Small openings may close on their own. Mixture of high and low oxygenated blood, from systemic to pulmonary circulation.

Question 44

Congenital Heart Disease - Tetralogy of Fallot

Answer 44

Most common. combination of four defects: 1. large ventricular septal defect 2. Overriding aorta (when aorta is located between the left and right ventricles and over the the septal defect). 3. Right ventricular hypertrophy (caused by the increased workload). 4. Pulmonary stenosis (narrowing of pulmonary valve). Surgical treatment.