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Chapter 12- The Heart Flashcards

1
Q

What is the number one cause of worldwide mortality?

A

Cardiovascular disease

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2
Q

What is myocardium?

A

Heart muscle

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3
Q

What are the phases of heart pumping?

A

Contraction (systole) and relaxation (diastole)

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4
Q

What are the contractile components of the heart?

A

Sarcomeres

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5
Q

What is ANP secreted in response to?

A

Increased blood volume in the heart

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6
Q

What are the names for the components of AV and semilunar valves?

A

AV- leaflets

Semilunar- cusps

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7
Q

What is the pacemaker of the heart?

A

The SA node

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8
Q

Where do the conducting components of the heart lie?

A

SA node- junction if the right atrial appendage and SVC

AV node- right atrium (along septum)

Bundle of His- through the septum

Purkinje network- divisions into the right and left ventricles

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9
Q

What is the division of the Purkinje network called?

A

Arborization

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10
Q

When does blood flow to the myocardium occur?

A

Diastole

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11
Q

What are the supply vessels of the heart for each area?

A

Anterior

  • Right coronary, right marginal
  • Left coronary, left anterior descending, left marginal

Left posterior- left circumflex

Right posterior- posterior left ventricular branch

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12
Q

What are the effects of aging on the heart?

A

Sigmoid septum

Valve sclerosis and degenerative changes

Decreased myocytes and increased fibrosis

Aortic stiffness

Atherosclerosis

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13
Q

What are the causes of cardiac pathophysiology?

A

Pump failure

Flow obstruction

Regurgitant flow

Shunted flow

Abnormal conduction

Rupture of heart or major vessels

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14
Q

What is congestive heart failure?

A

End stage heart disease

Heart is unable to maintain output

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15
Q

What is forward failure vs backward failure?

A

Forward- trouble getting blood out (reduced CO and tissue perfusion)

Backward- blood pooling

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16
Q

What is the most common cause of CHF?

A

Systolic dysfunction

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17
Q

When is diastolic dysfunction seen as he cause of CHF?

A

Women over 65

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18
Q

What are two compensatory mechanisms for CHF?

A
  1. Frank-Starling mechanism (heart dilated with increased filling and enhances contraction)
  2. Myocardial hypertrophy
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19
Q

What are the three types of cardiac hypertrophy?

A
  1. Pressure overload- hypertension or stenosis (concentric increased in wall thickness)
  2. Volume overload- valvular insufficiency or ventricular dilation (no thickened wall, just bigger)
  3. Physiologic- exercise, increased mitochondria and angiogenesis
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20
Q

What are the characteristics of left sided heart failure?

A

Systolic failure

Left ventricle is hypertrophied and dilated

Secondary left atrium dilation (A-fib)

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21
Q

How does left sided heart failure manifest?

A

Pulmonary congestion and edema

Left atrial dilation

Decreased atrial perfusion (salt and water retention)

Hypoxic encephalopathy

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22
Q

What is the most common cause of right sided heart failure?

A

Left sided heart failure

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23
Q

What is right sided heart failure infrequently isolated as?

A

Cor pulmonale (alterations in structure and function due to pulmonary disorders)

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24
Q

What are the characteristics of right side heart failure?

A

Edema

Hepatomegaly with centrilobar congestion (nutmeg liver)

Congestive splenomegaly

Renal congestion

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25
What is the pharmacological treatment for CHF?
Diuretics (relieve fluid overload) Beta blockers (lower adrenergic tone)
26
When does most congenital heart disease occur?
Week 3-8
27
What are common congenital heart diseases?
Single gene mutations DiGeorge Down Environmental factors Lesions (obstructions and shunts
28
Left to right shunts result in what?
Right sided volume and pressure overload Pulmonary hypertension
29
What is Eisenmenger syndrome?
Pulmonary pressure increases so much a left shunt occurs (overcorrects the left to right shunt)
30
What are the types of left to right shunts and their characteristics?
1. Atrial septal defects- adults, increased distendability of the right ventricle, murmur 2. Ventricular septal defects- membranous septum near aortic valve, right ventricular hypertrophy and pulmonary hypertension 3. Patent ductus arteriosus- distal to left subclavian artery, ligamentum arteriosum failed to close (aorta and pulmonary artery)
31
What is the most common CHD overall?
Ventricular septal defects
32
What are the types of atrial septal defects?
1. Primum- adjacent to mitral and tricuspid valves 2. Secondum (90%)- deficient septum secondum formation near atrial septum Sinus venosus- near SVC entrance
33
What is patent foramen ovale?
Defective sealing of fossa ovalis flap
34
What is associated with right to left shunts?
Tetralogy of Fallot and transposition of great arteries
35
What is tetralogy of Fallot?
VSD Pulmonary stenosis with right ventricular outflow obstruction Overriding aorta Right ventricular hypertrophy
36
What are the “colours” of the two kinds of shunts?
Left to right- pink Right to left- blue (cyanotic- skips lungs)
37
What is TGA?
The aorta arises from the right ventricle Pulmonary artery arises from the left ventricle
38
What does post natal development with TGA depend on?
Mixing of outgoing blood (some defect- VSD, PDA, ASD or patent foramen ovale)
39
What do obstructive lesions within the heart give rise to?
Ventricular hypertrophy without cyanosis
40
What are the different types of obstructive lesions within the heart?
1. Coarctation (constriction) of the aorta- left ventricle hypertrophy 2. Pulmonary stenosis and atresia- right ventricle hypertrophy 3. Aortic stenosis and atresia
41
What are the forms of aorta coarctation?
1. Infantile- narrowing proximal to PDA, right to left shunting 2. Adult- narrowing opposite the (closed) ligamentum arteriosum
42
What are the types of aortic stenosis and atresia?
Valvular Hypoplastic left heart syndrome Subaortic stenosis- ring of fibrous tissue below the cusps Supraventricular aortic stenosis- elastin gene mutation
43
What causes ischemic heart disease?
Reduced coronary blood flow (atherosclerosis, vasospasm, thrombosis) Increased myocardial demand (tachycardia and hypertrophy) Hypoxia
44
What syndromes are associated with ischemic heart disease?
Angina pectoris- chest pain Myocardial infarction- cell death (vascular occlusion) Chronic ischemic heart disease- progressive heart failure Sudden cardiac death- lethal arrhythmia
45
What are the types of angina pectoris?
1. Stable- occurs with exertion, diminishes with rest 2. Prinzmetal- vasospasm 3. Unstable/crescendo- occurs with successively lesser amounts of exertion
46
What causes most myocardial infarctions?
Atherosclerotic plaques
47
When is complete necrosis seen in myocardial infarction?
After 6hrs of severe ischemia
48
What do the morphological features of acute MI depend on?
Location, severity, rate of obstruction development Size of vascular bed perfused by obstructed vessels Occlusion duration Metabolic and oxygen needs of the myocardium Extent of collateral blood vessels Presence, site and severity of coronary arterial spasm Heart rate, cardiac rhythm, blood oxygenation
49
What are the different locations of MIs and how do they affect the heart?
1. Transmural- epicardium vessel occlusion, full thickness of wall involved 2. Subendocardial/nontransmural- subendocardium is least perfused, involves inner third of ventricle wall 3. Multifocal microinfarction- involves smaller, intramural vessels
50
What are the gross changes associated with MIs and when do they occur?
4-12hrs- only see histo 12-24hrs- pale, cyanotic 1-3 days- yellow, defined lesions 3-7 days- dead myocytes are ingested 7-10 days- granulation tissue >2wks- scar
51
How does reperfusion affect MIs?
Restores viability but remains poorly contractile Contraction band necrosis Additional injury (inflammation)
52
What are the clinical features of MIs?
Chest pain, nausea, diaphoresis, dyspnea ECG changes CK-MB and troponin markers increase Nearly all transmural affect the left ventricle
53
When do half of all deaths due to MIs occur?
Within the first hour
54
What is the treatment for MIs?
Anticoags, oxygen, beta blockers, ACE inhibitors, fibrinolytics Angioplasty, stenting, surgical bypass
55
What are the complications of MIs?
Ventricular rupture (free wall most common) Papillary muscle rupture Aneurysm Mural thrombus Arrhythmia Pericarditis CHF Infarct expansion
56
Chronic ischemic heart disease is associated with what?
Arrhythmias
57
What is sudden cardiac death most commonly due to?
Lethal arrhythmia (V-fib)
58
What is the most common cause of sudden cardiac death?
Ischemic heart disease
59
What are the types of hypertensive heart disease?
1. Systemic (left side) | 2. Pulmonary (right side) or cor pulmonale
60
What is the cause and characteristics of systemic hypertension?
Due to chronic elevated pressures Concentric left ventricle hypertrophy (no other causes) Impaired diastolic filling, increases oxygen demand Fibrosis reduces compliance
61
What is the cause of pulmonary hypertension?
Lung diseases cause pulmonary vascular hypertension (most often due to left sided heart failure)
62
What is the difference between acute and chronic pulmonary hypertension?
Acute- after passive PE, only see dilation Chronic- right ventricular pressure overload, hypertrophy
63
What can cause valvular disease?
1. Stenosis (failure to open) 2. Insufficiency (failure to close, regurgitation) 3. Functional regurgitation (abnormality in cable support structure)
64
What are the major functional valvular lesions and their causes?
Aortic stenosis- calcification and stenosis Aortic insufficiency- dilation of ascending aorta Mitral stenosis- rheumatic heart disease Mitral insufficiency- myxomatous degeneration (prolapse)
65
What are the characteristics of calcification aortic valve stenosis?
Nodular, calcific, subendothelial masses on valve outflow Valve fibrosis Spares free edge of cusps Compensatory, concentric left ventricle hypertrophy
66
What are the characteristics of mitral annular calcification?
Calcific deposits in the fibrous annulus Stenosis- poor leaflet movement over bulky deposits Impingement on conducting pathways
67
What are the characteristics of mitral valve prolapse?
Myxamatous degeneration Enlarged leaflets, floppy Chordae tendinae occasionaly rupture Thrombosis behind ballooning cusps
68
Mitral valve prolapse shows high frequency in what disease?
Marfan syndrome
69
What is rheumatic fever and heart disease?
Acute inflammation due to GAS infection, often in children Cardiac Ags cross react with strep Abs or T cells
70
What is the only cause of acquired mitral valve stenosis?
Rheumatic fever/heart disease
71
What are the phases of rheumatic fever?
Acute- Aschoff bodies, fibrinous vegetations along cusp free edge, modules of mixed mononuclear cells with necrosis Chronic- diffuse fibrinous thickening (fishmouth/buttonhole stenoses)
72
What are the characteristics of vegetations seen in rheumatic fever/heart disease?
Verrucous Small, warty Along lines of closure
73
What is the diagnosis of rheumatic fever based on?
Skin rash (erythema marginatum) Migratory polyarthritis of joints Carditis Subcutaneous nodules Syndenham chorea (involuntary movements)
74
What are the clinical implications of rheumatic fever?
Left atrial hypertrophy and enlargement and mural thrombi A-fib CHF with pulmonary congestion Increased risk of infective endocarditis
75
What are the characteristics of infective endocarditis?
Microbial infections of valves leading to friable vegetations
76
What are the characteristics of the vegetations seen in infective endocarditis?
Large, irregular masses Can extend into chordae Friable
77
What are the types of infective endocarditis and their characteristics?
Acute- highly virulent organisms seed normal valves Subacute- low virulence organisms seed an abnormal or injured valve (smaller)
78
What are the two forms of noninfectious vegetations?
1. Nonbacterial thrombotic endocarditis | 2. Endocarditis of SLE (Libman Sacks)
79
What are the characteristics of vegetations seen with nonbacterial thrombotic endocarditis?
Small, bland Sterile- fibrin and platelet thrombi At line of closure Can embolize
80
What can cause nonbacterial thrombotic endocarditis?
Cancer Prolonged debilitating illness with DIC
81
What are the characteristics of Libman Sacks vegetations?
Small-medium On either side of the leaflet
82
What are the characteristics of carcinoid heart disease?
Release bioactive products Extensive metastatic spread Thickening of pulmonary and tricuspid valves (rarely involves left heart)
83
What complications are associated with prosthetic valves?
Thromboembolic complications Infective endocarditis Structural deterioration Occlusion Hemolysis Paravalvular leak (poor healing)
84
What are cardiomyopathies?
Principle cardiac dysfunctions Mechanical and/or electrical
85
What are the three types of cardiomyopathies and their characteristics?
1. Dilated- progressive cardiac dilation and contractile dysfunction 2. Hypertrophic- genetic disorder resulting in poorly compliant left ventricle (asymmetrically enlarged) 3. Reactive- reduction in ventricular compliance, impaired ventricular filling
86
What are the pathways of dilated cardiomyopathy?
Genetics Myocarditis Alcohol/toxins Peripartum cardiomyopathy Iron overload Supraphysiologic stress
87
At what age is dilated cardiomyopathy most common?
20-50 years
88
What types of supraphysiologic stress is associated with dilated cardiomyopathy?
Tachycardia, hypertension Excess catecholamines- contraction band necrosis Takotsubo cardiomyopathy- left ventricle contractile dysfunction following extreme stress
89
What tumour can cause increased catecholamines?
Pheochromocytomas
90
What causes death in dilated cardiomyopathies?
Progressive cardiac failure Arrhythmia
91
What does the heart look like in dilated cardiomyopathy?
Enlarged, heavy, flabby All chambers dilated Mural thrombi
92
What are the characteristics of arrhythmogenic right ventricular cardiomyopathy?
Right sided ventricular failure and arrhythmia Right ventricular wall severely thinned
93
What is the heart like in hypertrophic cardiomyopathies?
Thick walled, heavy, hypercontracting Asymmetrical hypertrophy (left side more enlarged) without dilation
94
What are the complications of hypertrophic cardiomyopathies?
Abnormal diastolic filling and intermittent ventricular outflow obstruction Reduced stroke volume Exertional dyspnea
95
What must hypertrophic cardiomyopathy be distinguished from?
Deposition and hypertensive diseases
96
What is the primary complication of reactive cardiomyopathy?
Impaired ventricular filling during diastole
97
What are the morphological features of reactive cardiomyopathy?
Ventricles normal or slightly enlarged No dilation Firm, noncompliant myocardium Bilateral dilation Patchy/diffuse interstitial fibrosis
98
What can cause reactive cardiomyopathy?
Idiopathic or radiation fibrosis Amyloidosis Sarcoidosis Metastatic tumours Inborn errors of metabolism
99
What causes myocarditis?
Infectious organisms and/or inflammatory processes
100
What is the most common cause of myocarditis?
Viruses (coxsackie A and B)
101
What are less common causes of myocarditis?
Lymphocytic (myocyte injury) Hypersensitivity Giant cell
102
What are the characteristics of myocarditis?
Hypertrophy Advanced- flabby, hemorrhagic lesions Acute- focal necrosis, interstitial inflammatory infiltrate
103
What are some other causes of cardiomyopathies?
Cardiotoxic drugs Amyloidosis (restrictive)
104
What is pericardial effusion?
Accumulation of fluid within the pericardial space (> the normal 50mL)
105
What is hemopericardium?
Accumulation of blood within the pericardial space
106
How does pericardial effusion affect the heart?
Slow accumulation- sac dilates to allow for extra fluid Rapid accumulation- can compress the heart, cardiac tamponade
107
What are the two types of pericarditis?
Acute Chronic/healed
108
What are the forms of pericarditis and their characteristics?
1. Serous- noninfectious inflammatory disease 2. Fibrinous and serofibrinous- fibrin may be lysed or organized, friction rub 3. Purulent/suppurative- active microbial infection, constrictive 4. Hemorrhagic- blood and fibrinous or suppurative effusion 5. Caseous- fibrocalcific, chronic constrictive, due to Tb
109
What is the most frequent type of acute pericarditis?
Fibrinous and serofibrinous
110
What is the difference between fibrinous and serofibrinous pericarditis?
Fibrinous- dry with fine granular roughening Serofibrinous- more intense inflammation, accumulation of yellow-brown turbid fluid
111
What are the characteristics of chronic/healed pericarditis?
Plaque-like fibrous thickenings of serosal membranes Often little/no effect on function
112
What are the forms of chronic pericarditis?
Adhesive mediastinopericarditis- strained systole Constrictive pericarditis- heart is encased in dense, fibrous or calcific scar
113
What heart diseases are associated with rheumatologic disorders?
Fibrinous pericarditis Granulomatous rheumatoid nodules Valvulitis
114
What are the types of primary cardiac tumours and their characteristics?
Myxomas- globular and hard or papillary and myxoid, ball valve obstruction, affect left atria Lipomas- left ventricle, right atrium or septum Papillary fibroelastoma- anemone-like lesions in valves Rhabdomyomas- valvular (outflow obstruction), spider cells (artifact), grey-white, small, usually multiple, may be considered hamartomas Angiosarcoma and rhabdomyosarcoma
115
What are the most common cardiac tumours in adults and children?
Adults- myxomas Children- rhabdomyomas
116
What are myxomas sometimes associated with?
Carney syndrome
117
What are rhabdomyomas sometimes associated with?
Tuberous sclerosis
118
How do non-cardiac neoplasms spread to the heart?
Metastasis- venous extension (kidney, liver) Circulating mediators
119
What are the complications associated with cardiac transplantation?
Cellular allograft rejection Ab mediated rejection Graft arteriosclerosis Opportunistic infections
120
What is the one and five year survival of cardiac transplantation?
1- 90% 5- 60%

Pathology (25 decks)

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