Cardiovascular System Pathologies Flashcards
What is hypertension?
Persistant elevation of diastolic, systolic, or both pressures
Hypertension
Why should blood be tested on two seperate occasions? How far apart should pressure be tested?
- To show sustained elevation of pressure
- Test two weeks apart
Cause of primary hypertension?
Secondary?
- Primary: Idiopathic
- Secondary: Identifiable cause
Pathogenesis
What is blood pressure related to?
(BP = CO x TPR)
Cardiac output
Total peripheral resistance
What are contributing factors to hypertension?
- Abnormal sodium transport
- Sympathetic nervous system stimulatin
- renin-angiotensin-aldosterone system
- Vasodilator deficiency
What are the pathological changes to early HTN
None
Pathological changes to late HTN
- End-organ damage
- CV system, brain, kidneys
- Acceleration of atherosclerosis dev.
- Death
Can hypertension be asymptomatic?
Yes
How is congenital heart defect defined?
Defect involving the heart or large vessels present at birth
In which trimester do congenital heart defects develop?
First trimester
Congenital heart defect causes
- Idiopathic
- Environmental
- Genetic
What is the clinical manifestation of congenital heart defects?
Variable depending on severity
What is the most common congenital heart disease?
Septal defects
What is a septum defect defined as?
Defect in the septum b/w left and right side of heart
Where does a defect occur in a atrial septal defect?
foramen ovale
What is more common atrial or ventricular septal defect?
Which is more serious?
Ventricular more common and more serious
Ventricular Septal Defect
Explain the difference in pressures b/w left and right heart chambers for a ventricular septal defect
Pressure in left heart chamber exceeds pressure in right heart chamber
Ventricular Septal Defect
What is a left-to-right shunt?
Blood flows from left to right side of heart
Ventricular septal defect?
What occurs due to the left-to-right shunt and blood flowing into right side of heart?
Overburdens right side leading to right ventricular hypertrophy
Ventricular Septal Defect
What happens to pulmonary arteries due to increased flow of blood?
Pulmonary hypertension
Ventricular septal defect
what happens after right ventricular hypertrophy and pulmonary hypertension occurs?
Increased pressure on right side of heart causing right-to-left shunt
Ventricular septal defect
What does the right-to-left shunt cause?
Deoxygenated blood flowing into left side of heart leading to cyanosis
Ventricular septal defect
Clinical manifestations to VSD?
- asymptomatic
- heart murmur
- cyanosis
Ventricular septal defect
Treatment of VSD
- Self-limiting
- surgery
What is Tetralogy of Fallot?
A complex congenital defect of the heart and major vessels
What is tetralogy of fallot the most common cause of?
- neonatal cardiac cyanosis
- 10% of congenital heart defects
What are the four abnormalities that make up tetralogy of fallot?
- Stenosis of pulmonary valve
- Ventricular septal defect
- Overriding of aorta
- Hypertrophy of right ventricle
Tetralogy of fallor
What does the stenosis of pulmonary artery cause?
- limit blood that can enter lungs
- Right ventricle needs to work harder
Tetralogy of fallot
What happens when RV pumps harder?
Blood shunted through septal defect into aorta and LV
Tetralogy of fallot
What occurs due to aorta overriding septum?
Deoxygenated blood goes into systemic circulation
Tetralogy of fallot
Clinical manifestations
- Cyanosis
- Heart murmur
- failure to thrive
Treatment and prognosis of tetralogy of fallot
- Treatment: Surgery
- Prognosis: Good
What is rheumatic fever?
- Systemic disease related to infection by group A streptococcal
Why is the incidence of rheumatic fever decreasing
- Antibiotics
- More effiecient treatment of bacterial infections
When does rheumatic fever usually occur?
- Around 2 weeks after acute strep throat
During rheumatic fever, antibodies produced by the immune system do what?
Antibodies developed in response to strep infection
- Attack self-antigens of heart, brain, kidneys, muscles, joints
Rheumatic heart disease occurs in 50% of rheumatic fever cases. What does this look like?
scarring and deformity of heart valves
Clinical manifestation of Rheumatic fever
- Sydenhams Chorea (St. Vitus Dance)
- SOB
- Nocturnal cough
- Subcutaneous nodules
- Erythema marginatum (50%)
Rheumatic Heart disease
What is Pancarditis
Involvement of all layers of heart
Rheumatic heart disease
Match the follow terms with the terms below:
* Endocarditis
* Myocarditis
* Pericarditis
Most common, common, rare
- Most common: Endocarditis
- Common: Myocarditis
- Rare: Pericarditis
Treatment of rheumatic fever?
- Antibiotics
- Anti-inflammatories
- corticosteroids
- CNS depressants
- Surgery
Prognosis of Rheumatic Fever
- 20% of cases will reoccur within 5 years
- May cause long term heart damage
- low mortality
What is endocarditis
Infection of endocardium, including heart valves
Where does damage occur most from endocarditis
Mitral valve
Who has a higher chance of getting right-sided endocarditis?
IV drug users
Endocarditis risk factors?
- Damaged valves
- Prosthetic heart valves
- IV drug users
- Immunocomprimised
Endocarditis
When infection occurs, what is the result?
Inflammation and destruction of endocardium and CT
What is the role of microorganisms in endocarditis?
Adhere to surface and release lytic enzymes that further erode valves
Endocarditis
What covers the defect in surface endocardium? What does this covering do?
- Fibrin and platelet thrombi
- attract more thrombogenic material
Endocarditis
What do the small wartlike vegetation structures that grow cause?
Verrucous endocarditis
Endocarditis
If valves rupture, what could occur?
Regurgitation
How quick can endocarditis develop?
Variable - insidously, over months, of immediately
Endocarditis
If infected vegetations break off, what could occur?
Septic emboli that can effect brain, kidneys, extermities
How does acute bacterial endocarditis present?
acute febrile illness of sudden onset
How does subacute bacterial endocarditis present?
mild temperature elevations that wax and wane
What is the prognosis for endocarditis?
- Fatal if untreated
- Poor prognosis in older people
What is myocarditis?
Chronic or acute inflammatory condition of muscular walls of heart
What is myocarditis also known as?
*
* Acquired inflammatory cardiomyopathy
What are the active, healing, and healed stages of myocarditis characterized by?
Inflammatory cells leading to interstitial edema, focal necrosis, fibrosis
Can ventricular arrythmias arise from myocarditis?
Yes
What are the medications used in myocardis
- antibiotics - bacteria infections
- cardiac medications - improve CO/reduce arrythmia
- Corticosteroids for patients w/ lupus carditis
What is pericarditis
Inflammation of the pericardium
Etiology of pericarditis
- Most often viral infections
- bacterial/fungal infections
- drugs
- autoimmune
- infarcts
- heart failure complications
Peridcarditis symptoms
- chest pain
- fever
- dyspnea
Pericarditis complications
- myocarditis
- cardiac tamponade
- heart failure
What is cardiomyopathy
- Group of conditions affecting heart muscles which impair contraction/relaxation
Cardiomyopathy classifications
- Primary
- Secondary
- Primary: genetic, mixed, confined to heart muscle
- Secondary: Systemic conditions affecting heart + other tissues
Which population does dilated cardiomyopathy mostly affect?
- Black men aged 40-60
Causes of dilated cardiomyopathy?
- 50% idiopathic
- obesity, alcohol, smoking, hypertension
Cause of hypertrophic cardiomyopathy
- Inherited chromosomal abnormality
What does hypertrophic cardiomyopathy commonly cause?
- cardiac death in young competitive athletes
Cause of restrictive cardiomyopathy?
- Result of myocardial fibrosis
