Cardiovascular pathophysiology

Question 1

what are congenital heart conditions

Answer 1

= a range of developmental defects that affect heart function. They can be apparent before birth, but it can takes from weeks to years to detect it. There is genetic linkage, but it can also be caused by maternal illness or exposure to toxins as a foetus.

Question 2

what is meant by systemic circulation

Answer 2

the circuit of vessels supplying oxygenated blood to and returning deoxygenated blood from the tissues of the body

Question 3

what is meant by pulmonary circulation

Answer 3

the system of blood vessels that forms a closed circuit between the heart and the lungs

Question 4

what is meant by acyanotic

Answer 4

a heart defect that affects the normal flow of blood

Question 5

how do we label the seriousness of a heart defect

Answer 5

very small defects are hydrodynamically irrelevant. This is because there is high resistance compared to the route the blood is meant to take, so blood is encouraged to take the usual route. Some blood will still leak out of the defect, but it isn’t a huge issue.
However, large defects are dangerous because a left to right shunt can cause volume overload. This can cause pulmonary hypotension and reverse the flow of blood, causing issues with oxygen saturation.

Question 6

what does stenosis mean

Answer 6

the narrowing of a gap

Question 7

what is meant by hypertrophy regarding the heart

Answer 7

the enlargement or thickening of the walls of the heart. usually due to the heart becoming more strong

Question 8

what is fatigue

Answer 8

a feeling of constant tiredness or weakness

Question 9

what is tachypnoea

Answer 9

rapid breathing

Question 10

what is dyspnoea?

Answer 10

difficulty breathing, shortness of breathe, breathlessness

Question 11

what is exercise intolerance

Answer 11

the reduced ability of the heart to perform activities that involve demanding movement of your body

Question 12

what is efficacy?

Answer 12

the ability to produce a desired or intended result.

Question 13

name some inflammatory heart conditions

Answer 13

– endocarditis, myocarditis, and pericarditis. They are conditions associated with infection, cancer, and autoimmune diseases.

Question 14

what is an autoimmune disease

Answer 14

where the immune system attacks the body. it happens when the body’s natural defense system can’t tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells

Question 15

define heart failure

Answer 15

where the heart is unable to supply the body with enough blood

Question 16

what is necrosis

Answer 16

the death of body tissue. It occurs when too little blood flows to the tissue.

Question 17

what is meant by cardiac tamponade

Answer 17

where there is restricted space for the heart to operate. it happens when extra fluid builds up in the space around the heart. This fluid puts pressure on the heart and prevents it from pumping well.

Question 18

what is hypotension

Answer 18

low blood pressure

Question 19

what is atherosclerosis

Answer 19

It is where the volume of blood that can flow in a curtain area is restricted due to damage to the epithelium caused by plaque build-up. This causes blockage of the artery and a loss of elasticity of the artery wall. There is usually also an accumulation of inflammatory, immune, and smooth muscle cells present in an area where there is blockage. There is a genetic linkage, however it can also be caused by diabetes, smoking, advanced age, and hyperlipidaemia. Atherosclerosis can begin to develop in childhood due to increased BMI, cholesterol, and low density lipoprotein levels.

Question 20

what is a high density lipoprotein

Answer 20

= something that helps clear away excess cholesterol in the blood and take it to the liver to be processed.

Question 21

what is a low density lipoprotein

Answer 21

something that carries plaque forming lipids such as cholesterol into the wall of damaged blood vessels.

Question 22

what is hyperlipidaemia

Answer 22

also called high cholesterol. means your blood has too many lipids (fats) in it. These can add up and lead to blockages in your blood vessels. This is why high cholesterol can put you at risk for a stroke or heart attack.

Question 23

what is a negative risk factor

Answer 23

something that contributes to a disease

Question 24

what is a positive risk factor

Answer 24

something that prevents a disease

Question 25

what is a thrombus

Answer 25

a blood clot. It is caused by the rupture of a plaque, the erosion of a cap, or a dysfunctional endothelium that causes vasoconstriction.

Question 26

what is meant by ischemia

Answer 26

an inadequate blood supply leading to a shortage of oxygen in a tissue.

Question 27

what is an arrhythmia

Answer 27

abnormalities of the electrical system of the heart that disrupts the way the heart functions. This can be due to problems with impulse formation, impulse conduction, or both. There is also a spectrum of severity- it can cause death in some and others live their life without knowing they have an arrhythmia.

Question 28

what is bradycardia

Answer 28

= abnormally slow heart rhythm

Question 29

what is tachycardia

Answer 29

abnormally fast heart rhythms

Question 30

TELL ME ABOUT THE 4 COMMON CONGENITAL LESIONS (20)

Answer 30

Atrial septal defects – this is where there is a left to right atrial shunt, so blood is able to go from the left atrium into the right. This means that oxygenated blood from the systemic circulation system into the pulmonary circulation system. So, it doesn’t cause issues with oxygenation as the blood is recirculating the lungs. Ventricular septal defects – this is where there is a left to right ventricular shunt due to an opening in the interventricular septum. This means that oxygenated blood from the systemic system enters the pulmonary circulation system, so it doesn’t cause issues with oxygenation. Patient ductus arteriosus – this happens when the ductus arteriosus fails to close before birth. This can cause a left to right shunt if the hole remains open. This causes volume overload to the pulmonary circulation system and can lead to ventricular dilation or heart failure. Congenital valve stenosis- this is where there is a narrowing of the opening of the valve, so it reduces the amount of blood that can get into the systemic circulation system. It can occur in wither the aortic valve or the pulmonary valve. It causes fatigue and hypertrophy of the subsequent ventricle affected.

Question 31

common congenital lesions - what is an atrial septal defect

Answer 31

this is where there is a left to right atrial shunt, so blood is able to go from the left atrium into the right. This means that oxygenated blood from the systemic circulation system into the pulmonary circulation system. So, it doesn’t cause issues with oxygenation as the blood is recirculating the lungs.

Question 32

common congenital lesions - what is a ventricular septal defect

Answer 32

this is where there is a left to right ventricular shunt due to an opening in the interventricular septum. This means that oxygenated blood from the systemic system enters the pulmonary circulation system, so it doesn’t cause issues with oxygenation.

Question 33

common congenital lesions - patent ductus arteriosus

Answer 33

– this happens when the ductus arteriosus fails to close before birth. This can cause a left to right shunt if the hole remains open. This causes volume overload to the pulmonary circulation system and can lead to ventricular dilation or heart failure.

Question 34

common congenital lesions - congenital valve stenosis !!

Answer 34

- this is where there is a narrowing of the opening of the valve, so it reduces the amount of blood that can get into the systemic circulation system. It can occur in wither the aortic valve or the pulmonary valve. It causes fatigue and hypertrophy of the subsequent ventricle affected.

Question 35

TELL ME ABOUT THE 4 HEART CONDITIONS ACQUIRED IN CHILDHOOD

Answer 35

Dilated cardiomyopathy – there is genetic linkage however it can also be caused by viral infection sin children. It is where the heart muscle weakens and stretches. As the ventricles stretch, they aren’t able to pump blood as efficiently, so eventually the heart won’t be able to pump enough blood to the body. Arrythmias, blood clots, leaky valves, lung congestion, and heart failure occur from the heart stretching. Endocarditis – it is the infection of the heart valves. The infection spreads through the bloodstream, and it damages the valves. This can cause the valves to become leaky or narrow, both reduce blood flow through the heart and into the body. If the condition becomes severe it can lead to heart failure and the valve will need to be replaced Myocarditis – it is the necrosis and inflammation of the myocardium, usually caused by the body trying to fight a viral infection. The inflammation can reduce the heart’s ability to pump blood effectively, and it interferes with the heart’s rhythm. Pericarditis – where the pericardium becomes infected. This increases the amount of fluid that surrounds he heart and causes there to be restricted space for the heart to function. This can cause cardiac arrest as there is increased pressure external to the heart limiting how it functions.

Question 36

heart conditions aquired in childhood - dilated cardiomyopathy

Answer 36

Dilated cardiomyopathy – there is genetic linkage however it can also be caused by viral infection sin children. It is where the heart muscle weakens and stretches. As the ventricles stretch, they aren’t able to pump blood as efficiently, so eventually the heart won’t be able to pump enough blood to the body. Arrythmias, blood clots, leaky valves, lung congestion, and heart failure occur from the heart stretching.

Question 37

heart conditions aquired in childhood- endocarditis

Answer 37

it is the infection of the heart valves. The infection spreads through the bloodstream, and it damages the valves. This can cause the valves to become leaky or narrow, both reduce blood flow through the heart and into the body. If the condition becomes severe it can lead to heart failure and the valve will need to be replaced

Question 38

heart conditions aquired in childhood - myocarditis

Answer 38

– it is the necrosis and inflammation of the myocardium, usually caused by the body trying to fight a viral infection. The inflammation can reduce the heart’s ability to pump blood effectively, and it interferes with the heart’s rhythm.

Question 39

heart conditions aquired in childhood - pericarditis

Answer 39

where the pericardium becomes infected. This increases the amount of fluid that surrounds he heart and causes there to be restricted space for the heart to function. This can cause cardiac arrest as there is increased pressure external to the heart limiting how it functions.

Question 40

TELL ME ABOUT ATHEROSCLEROSIS (20)

Answer 40

It is where the volume of blood that can flow in a curtain area is restricted due to damage to the epithelium caused by plaque build-up. This causes blockage of the artery and a loss of elasticity of the artery wall. There is usually also an accumulation of inflammatory, immune, and smooth muscle cells present in an area where there is blockage. There is a genetic linkage, however it can also be caused by diabetes, smoking, advanced age, and hyperlipidaemia. Atherosclerosis can begin to develop in childhood due to increased BMI, cholesterol, and low density lipoprotein levels. Low density lipoprotein is a negative risk factor for atherosclerosis, as it contributes to the formation of plaques. This is because it carries cholesterol into the arterial wall, because it is a small enough molecule to pass across the endothelium easily. However, high density lipoprotein is a positive risk factor because it prevents the plaques from forming. This is because it can carry cholesterol, but it is too large to cross the endothelium, so it carries it to the liver instead to be processed. Stages of atheroma. Firstly, there is damage to the endothelium of a blood vessel. This could be due to smoking, bacteria, and cholesterol build up, which also causes inflammation. Then, lipids are brought to the damaged area but low density lipoproteins and it oxidises (further causing inflammation). This damages surrounding tissue and attracts macrophages, which take up the low density lipoproteins to become foam cells. finally, a fibrous cap forms because smooth muscle cells increase rapidly in number and lymphocytes are attracted to the area. Collagen and elastin fibres also accumulate, and the foam cells drop their lipid content. This is how a plaque forms. Eventually, the plaque will become unstable because it creates a turbulent flow of blood as it grows. The flow erodes the plaque and creates a thrombic system where a blood clot can develop. One reason the plaque can grow is due to blood vessels invading the plaque and these can bleed into the mass. This can cause severe complications if it is in one of the main blood vessels supplying the heart, or in one of the main arteries in the leg.

Question 41

WHAT ARE THE STAGES IN ATHEROSCLEROSIS OF PLAQUE FORMATION (20)

Answer 41

Firstly, there is damage to the endothelium of a blood vessel. This could be due to smoking, bacteria, and cholesterol build up, which also causes inflammation. Then, lipids are brought to the damaged area but low density lipoproteins and it oxidises (further causing inflammation). This damages surrounding tissue and attracts macrophages, which take up the low density lipoproteins to become foam cells. finally, a fibrous cap forms because smooth muscle cells increase rapidly in number and lymphocytes are attracted to the area. Collagen and elastin fibres also accumulate, and the foam cells drop their lipid content. This is how a plaque forms. Eventually, the plaque will become unstable because it creates a turbulent flow of blood as it grows. The flow erodes the plaque and creates a thrombic system where a blood clot can develop. One reason the plaque can grow is due to blood vessels invading the plaque and these can bleed into the mass. This can cause severe complications if it is in one of the main blood vessels supplying the heart, or in one of the main arteries in the leg.

Question 42

TELL ME ABOUT THE HEART CONDITIONS AQUIRED IN ADULTHOOD (20)

Answer 42

Firstly, angina pectoris is pain caused by reduced blood flow to the heart muscles. It can be caused by a stable atherosclerotic plaque, the rupture of a plaque, or intense vasospasm. Secondly, coronary artery stenosis is the narrowing or blockage of the coronary artery. This is usually due to an atherosclerotic plaque. Next, ischemia in the myocardium is where there is an inadequate amount of oxygen getting to the myocardium. This means that metabolic waste products cant be removed from the heart, and nutrients can’t get to the heart. Finally, coronary heart disease is where the coronary arteries cannot deliver enough oxygen-rich blood to the heart. This is due to a myocardial infraction, because a atherosclerotic plaque has caused a blood clot to develop, which blocks blood flow to the myocardium. The location of the blockage determines where the ischemic damage is. Myocardial infarctions can also cause arrythmias due to electrical instability of the contractions of the heart.

Question 43

heart conditions aquired in adulthood - angina pectoris

Answer 43

Firstly, angina pectoris is pain caused by reduced blood flow to the heart muscles. It can be caused by a stable atherosclerotic plaque, the rupture of a plaque, or intense vasospasm.

Question 44

heart conditions aquired in adulthood - coronary artery stenosis

Answer 44

Secondly, coronary artery stenosis is the narrowing or blockage of the coronary artery. This is usually due to an atherosclerotic plaque.

Question 45

heart conditions aquaired in adulthood - ischemia in the myocardium

Answer 45

next, ischemia in the myocardium is where there is an inadequate amount of oxygen getting to the myocardium. This means that metabolic waste products cant be removed from the heart, and nutrients can’t get to the heart.

Question 46

heart conditions aquired in adulthood - coronary heart disease

Answer 46

Finally, coronary heart disease is where the coronary arteries cannot deliver enough oxygen-rich blood to the heart. This is due to a myocardial infraction, because a atherosclerotic plaque has caused a blood clot to develop, which blocks blood flow to the myocardium. The location of the blockage determines where the ischemic damage is. Myocardial infarctions can also cause arrythmias due to electrical instability of the contractions of the heart.

Question 47

what is a myocardial infraction

Answer 47

where the supply of blood to the heart is suddenly blocked. also called a heart attack