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CHF Flashcards

1
Q

3 types of compensatory mechanisms of CHF

A
  1. activation of neurohumoral systems (release of NE, act of renin-angiotensin system)
  2. Frank-starling mechanism
  3. myocardial hypertrophy
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2
Q

compensatory mechanisms usually fail due to ____ _____ requirements of myocardium, but without increased ____ ____, resulting in susceptibility to _____

A

increased oxygen requirements
capillary supply
ischemia

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3
Q

causes of left sided heart failure

A
  1. ischemic heart disease (IHD)
  2. hypertension
  3. myocarditis
  4. cardiomyopathy
  5. valvular disease
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4
Q

causes of right sided heart failure

A
  1. left sided heart failure
  2. pulmonary hypertension
  3. valve disease
  4. septal defects with left to right shunts
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5
Q

causes of congenital heart diseases

A

environmental factors (congenital rubella, maternal diabetes)
chromosomal abnormalities
90% are unknown and likely multifactorial

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6
Q

3 types of noncyanotic congenital heart diseases

A
  1. atrial septal defect
  2. ventricular septal defect
  3. patent ductus arteriosus
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7
Q

2 types of cyanotic congenital heart diseases

A
  1. tetrology of fallot

2. transposition of the great arteries

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8
Q

4 anomalies of tetrology of fallot

A
  1. ventricular septal defect
  2. narrowed right ventricular outflow
  3. overriding of VSD by the aorta
  4. right ventricular hypertrophy
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9
Q

what occurs in transposition of the great arteries?

A

the R ventricle empties into the aorta and the L ventricle empties into the pulmonary artery

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10
Q

group of related disorders that are all characterized by imbalance between ____ and ____ (ischemia)

A

myocardial blood supply; myocardial oxygen demand

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11
Q

> 90% of IHD due to _____

A

coronary artery atherosclerosis

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12
Q

another cause of IHD is _____ due to fissure in the fibrous cap of an atherosclerotic plaque

A

coronary artery thrombosis

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13
Q

other factors that lead to IHD

A

increased myocardial oxygen demand (hypertension)
decreased blood volume (hypotension/shock)
decreased oxygenation (pneumonia)
decreased oxygen carrying capacity (anemia)

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14
Q

clinical types of IHD

A
  1. angina pectoris
  2. myocardial infarction
  3. chronic IHD with CHF
  4. sudden cardiac death
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15
Q

severe ischemia (as in MI) lasting longer than ____ will cause irreversibly myocyte injury and cell death

A

20-40 min

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16
Q

myocardial ischemia also contributes to _____, probably because ischemic regions cause _____ that may lead to _____

A

arrhythmias; electrical instability (irritability); ventricular fibrillation

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17
Q

clinical manifestations of MI

A

-chest pain, shortness of breath, diaphoresis (sweating), nausea/vomiting, low grade fever

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18
Q

diagnostic tests for acute MI include: ____ changes; elevation of ____ such as ____ and ____ derived from necrotic myocytes

A

ECG; serum enzymes; creatine kinase (CK-MB); troponin

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19
Q

tx of MI by placement of ____ to open the coronary arteries clogged by atherosclerotic plaques, ______, or _____ such as tissue plasminogen activator (TPA) or streptokinase

A

stents; coronary artery bypass grafts (CABGs); “clot busting” drugs

20
Q

____ is a risk of MI tx

A

reperfusion injury

21
Q

complications of MI

A
  1. arrhythmia and sudden death
  2. CHF/shock
  3. mural thrombus/emboli
  4. myocardial rupture
  5. mitral valve regurgitation
  6. ventricular aneurysm
  7. chronic IHD
22
Q

most common cause of sudden cardiac death is _____

A

IHD (80-90%)

23
Q

chronic IHD with CHF characterized by _____ following acute MI or secondary to smaller ischemic events, with eventual _____

A

progressive cardiac decompensation; mechanical pump failure

24
Q

sudden cardiac death occurs through sudden onset of _____ with or without _____; may occur in individuals with a without a previous history of IHD

A

ischemia-induced cardiac arrhythmia; myocardial necrosis (infarction)

25
3 morphologic patterns of cardiomyopathy
dilated (most common form) hypertrophic restrictive
26
histology of dilated cardiomyopathy shows ____ and _____; characterized by _____
variable fibrosis; myocyte hypertrophy; poor ventricular contractility (systolic dysfunction)
27
hypertrophic cardiomyopathy is a disorder of _____, inherited as _____ with variable expression
sarcomeric proteins (myosin, myosin binding protein C, troponin T); autosomal dominant
28
characteristic histology of hypertrophic cardiomyopathy is disarray of _____ and _____
cardiac myocytes; fibrosis
29
restrictive cardiomyopathy characterized by _____ , resulting in _____ during diastole
decrease in ventricular compliance (wall is stiffer); impaired ventricular filling
30
most common cause of myocarditis in the US is _____
viral infection (coxsackie A and B, other enteroviruses)
31
myocarditis can also be caused by ____, ____, and ____ organisms
bacterial; fungal; parasitic
32
non-infectious causes of myocarditis include:
toxins, hypersensitivity rxns, and autoimmune disorders
33
clinical manifestations of L vent. failure
1. pulmonary edema and congestion, resulting in dyspnea 2. chronic cough 3. orthopnea
34
clinical manifestations of L and/or R vent. failure
cerebral hypoxia
35
clinical manifestations of R vent. failure
- congestion of liver (zonal or nutmeg pattern) and spleen | - edema (pitting) of subcutaneous tissues, particularly lower extremities
36
most common of cardiac malformations; 4/1000 live births
VSD
37
2nd most common congenital malformation
ASD
38
intermittent chest pain caused by transient, reversible myocardial ischemia
angina pectoris
39
occurs predictably at certain levels of exertion; crushing or squeezing substernal pain that may radiate down the left arm or jaw (referred pain). Relieved by rest or sublingual nitroglycerin (vasodilator to increase coronary perfusion)
stable angina
40
increasing frequency of chest pain with minimal/no exertion. Longer lasting than stable angina. Often precedes more serious ischemia or MI
unstable angina
41
heterogeneous group of cardiac diseases which may be primary or secondary, genetic or acquired
dilated cardiomyopathy
42
restrictive cardiomyopathy can be idiopathic or associated with other conditions that happen to affect the myocardium such as:
radiation fibrosis, amyloidosis, hemochromatosis, and sarcoidosis
43
viral infection of myocarditis produces a ______ with foci of necrosis
lymphocytic infiltrate
44
pyogenic bacteria of myocarditis cause _____
abscesses
45
parasites (trypanosomes in chagas disease) infect _____ or are in _____ with surrounding _____
individual myocytes; interstitial areas; inflammatory cells
46
hypersensitivity in myocarditis (usually to drugs) causes a _____ with many _____
perivascular inflammatory infiltrate; eosinophils

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