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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
Q

3 morphologic patterns of cardiomyopathy

A

dilated (most common form)
hypertrophic
restrictive

26
Q

histology of dilated cardiomyopathy shows ____ and _____; characterized by _____

A

variable fibrosis; myocyte hypertrophy; poor ventricular contractility (systolic dysfunction)

27
Q

hypertrophic cardiomyopathy is a disorder of _____, inherited as _____ with variable expression

A

sarcomeric proteins (myosin, myosin binding protein C, troponin T); autosomal dominant

28
Q

characteristic histology of hypertrophic cardiomyopathy is disarray of _____ and _____

A

cardiac myocytes; fibrosis

29
Q

restrictive cardiomyopathy characterized by _____ , resulting in _____ during diastole

A

decrease in ventricular compliance (wall is stiffer); impaired ventricular filling

30
Q

most common cause of myocarditis in the US is _____

A

viral infection (coxsackie A and B, other enteroviruses)

31
Q

myocarditis can also be caused by ____, ____, and ____ organisms

A

bacterial; fungal; parasitic

32
Q

non-infectious causes of myocarditis include:

A

toxins, hypersensitivity rxns, and autoimmune disorders

33
Q

clinical manifestations of L vent. failure

A
  1. pulmonary edema and congestion, resulting in dyspnea
  2. chronic cough
  3. orthopnea
34
Q

clinical manifestations of L and/or R vent. failure

A

cerebral hypoxia

35
Q

clinical manifestations of R vent. failure

A
  • congestion of liver (zonal or nutmeg pattern) and spleen

- edema (pitting) of subcutaneous tissues, particularly lower extremities

36
Q

most common of cardiac malformations; 4/1000 live births

A

VSD

37
Q

2nd most common congenital malformation

A

ASD

38
Q

intermittent chest pain caused by transient, reversible myocardial ischemia

A

angina pectoris

39
Q

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)

A

stable angina

40
Q

increasing frequency of chest pain with minimal/no exertion. Longer lasting than stable angina. Often precedes more serious ischemia or MI

A

unstable angina

41
Q

heterogeneous group of cardiac diseases which may be primary or secondary, genetic or acquired

A

dilated cardiomyopathy

42
Q

restrictive cardiomyopathy can be idiopathic or associated with other conditions that happen to affect the myocardium such as:

A

radiation fibrosis, amyloidosis, hemochromatosis, and sarcoidosis

43
Q

viral infection of myocarditis produces a ______ with foci of necrosis

A

lymphocytic infiltrate

44
Q

pyogenic bacteria of myocarditis cause _____

A

abscesses

45
Q

parasites (trypanosomes in chagas disease) infect _____ or are in _____ with surrounding _____

A

individual myocytes; interstitial areas; inflammatory cells

46
Q

hypersensitivity in myocarditis (usually to drugs) causes a _____ with many _____

A

perivascular inflammatory infiltrate; eosinophils

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