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general path > Congestive heart failure and other heart conditions > Flashcards

Congestive heart failure and other heart conditions Flashcards

1
Q

what are the size perinciple mechanisms of heart disease

A 
Failure of the pump
Flow obstruction
Shunted flow
Leaky flow (bad valves
Conduction disorder
Rupture of heart/major vessel
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2
Q

what is congestive heart failure

A

Failure to pump an adequate amount of blood to supply the metabolic requirements of the organs

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3
Q

how many people are affected by congestive heart failure

A

5 million in the US annually

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4
Q

how many people die from Congestive heart failure

A

300k

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5
Q

what may cause the heart to go into congestive heart failure

A

direct pathologic conditions of the heart

Peripheral problems

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6
Q

what are the compensatory mechanisms of congestive heart failure

A

Activate neurohumoral systems
Frank-starling mechanism
Myocardial hypertrophy

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7
Q

what are the neurohumoral systems that can compensate for congestive heart failure

A

release NE

activate renin-angiotensin system

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8
Q

what does release of NE do to compensate for conestive heart failure

A

Increase heart rate and contractility

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9
Q

what does the renin-angiotensin system do to stop congestive heart failure

A

retain water/salt retention (to increase circulatory volume)

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10
Q

what is the frank-starling mechanism

A

Increased End-diastolic filling volume stretch cardiac muscle fibers

  • first contract more forcefully increasing cardiac output (compensated heart failure)
  • eventually cannot keep up (decompensated heart fialure
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11
Q

what is the result of myocardial hypertrophy to compensate for congestive heart failure

A

increase in muscle fiber size

incerased thickness of wall without an increase in size of lumen

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12
Q

why do compensatory mechanisms fail

A

Increase O2 requirements of myocardium without increased capillary supply
=ischemia

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13
Q

what are the causes of left-sided heart failure

A 
Ischemic heart disease (IDH)
hypertension
myocarditis
Cardiomyopathy
valvular disease
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14
Q

causes of Right sided heart fialure

A

Left sided heart failure
Pulmonary hypertension
Valve disease
septal defects with left to right shunts

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15
Q

how can left sided heart failure lead to Right sided heart failure

A

pulmonary congestion leads to increased pulmonary arterial pressure
= backing up of the system

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16
Q

what does left ventricular failure lead to

A

Pulmonary edema and congestion leading to dyspnea
Chronic cough
Orthopnea

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17
Q

what does Right and or left ventricular failure lead to

A

Cerebral hypoxia

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18
Q

what does Right ventricular failure lead to

A

Congestion of liver (nutmeg) and spleen

Edema (pitting of sucutaneous tissues, especially lower extremities

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19
Q

what is dyspnea

A

fluid leaking out of the alveoli leading to shortened breath

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20
Q

how common is congenital heart disease

A

6-8/1000 live birth in US

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21
Q

causes of congenital heart disease

A

envirnomental factors (congenital rubella, materal diabetes)
Chromosomal abnormalities
90% unknown

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22
Q

what does Congenital hear disease include

A

Shunts (abnromal comm between chambers
Abnormal connectivons between chambers and BV
Absence of normal connection

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23
Q

what does the Cyanotic congenital heart disease tend to ahve

A

Shunting of poorly oxygenated systemic venous return to systemic arterial circulation
- skips the lungs

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24
Q

what are the noncyanotic forms of congenital heart disease

A

atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent ductus Arteriosus (PDA)

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25
Q

what is the second most common congenital malformation

A

Atrial septal defect

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26
Q

what is the most common cardiac malformation

A

Ventricular septal defect

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27
Q

what is a patent ductus arteriosus

A

Connects aorta and pulmonary artery

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28
Q

how long does a patent ductus arteriosus hang around

A

Closes within a few days after birth

- can persist though and fuck people up

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29
Q

what are examples of Cyanotic forms of congenital heart disease

A

Tetralogy of fallot

Transposition of the great arteries

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30
Q

what are the anomalies associated with tetralogy of fallot

A

Ventricular septal defect
Narrowing of right ventricular outflow
Overriding of aorta over Ventricular Septal defect
Right ventricular hypertrophy

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31
Q

what occures in transposition of the great arties for the cyanotic form of congenital heart disease

A

Right ventricle empties into the aorta

Left ventricule empties into pulmonary artery

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32
Q

what is ischemic heart disease

A

imbalance between myocardial blood and myocardial oxygen demand

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33
Q

what is the primary reason of Ischemic heart diesase

A

Primarily due to coronary artery atherosclerosis (Coronary artery disease)

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34
Q

how much does ISchemic heary disease kill

A

leading cause of death in US (500,000 annually)

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35
Q

what Happens to the Arteries that can lead to IHD

A

coronary artery atherosclerosis (greater the 75% narrowing)

coronary artery thrombosis

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36
Q

what outside of Arteries can lead to IDH

A

increased myocardial O2 demand (hypertension)
Decreased blood volume (hypotension/shock)
decreased Oxygenation (pneumonia)
decreased O2 carrying capacity (anemia)

37
Q

types of IHD

A

angina Pectoris
Acute myocardial infarction
Chronic IHD with CHF
Sudden cardiac death

38
Q

what is angina pectoris

A

Intermittent chest pain caused by transient, reversible myocardial ischemia

39
Q

when does stable angina occure

A

predictably at certain levels of exertion

40
Q

what pain is caused by stable angina

A

Crushing or squeezing substernal pain

- radiate down the left arm or jaw (referred)

41
Q

how is stable angina relieved

A

rest or sublingual nitroglycerin

- Vasodilator to increase coronary perfusion

42
Q

when does Unstable angina occur

A

increasing frequency with minimal/no exertion

- long lasting

43
Q

what pain is associated with unstable angina

A

Chest pain

44
Q

what does unstable angina precede

A

more serious ischemia of MI

45
Q

what happens to the myocardium in angina pectoris

A

No myocardial necrosis occurs

46
Q

other name for acute myocardial infarction

A

Heart attack

47
Q

what is the clinical presentation of acute myocardial infarction

A 
Chest pain
shortened breath
nausea/vom
diaphoresis
low grade fever
48
Q

what tests are done for acute myocardial infarction

A

ECG changes

Elevation of serum enzymes (creatine kinase;CK-MB) and troponin derived from necrotic myocytes

49
Q

what happens in Acute myocardial infarction

A 
Coagulation necrosis (few hours)
Neutrophil infiltration (few hats)
Granulation tissues (1 week)
scar formation (weeks to months)
50
Q

how does one treat acute myocardial infarction

A
  • Stents to open coronary arties clogged by atherosclerotic plaques
  • coronary artery by-pass grafts
  • clot busting dugs (tissue plasminogen activator)
51
Q

what is the risk associated with treating Acute myocardial infarction

A

reperfusion injury

52
Q

what are the complications associated with myocardial infarction

A 
Arrhythmia and sudden death
CHF/shock
Mural thrombus/emboli
Myocardial rupture
myocardial ruption
infarct expansion to involve right ventricle
Mitral valve regurgitation
Ventricular aneurysm
Chronic ischemic heart disease
53
Q

what is Chronic IHD with CHF

A

progressive cardiac decompensation following acute MI or smaller ischemic events
- eventual mechanical pump failure

54
Q

what is sudden cardiac death

A

sudden onset of ischemia-induced cardiac arrhythmia with or without myocardial necrosis (infarction)

55
Q

who tends to get sudden cardiac death

A

individuals with or without previous history of IHD

56
Q

how long does it take for severe ischemia to cause irreversible myocyte injury and cell death

A

20-40 minutes

57
Q

what can myocardial ischemia lead to besides fucking up muscles

A

Arrhythmias due to electrical instability

58
Q

how long does it take for markers of Ischemic heart disease to show necrosis

A

12-29 hours (problem cuz it takes 20-40 minutes to damage)

59
Q

how long does ti take for MI’s to be grossly apparent at autopsy

A

12 hours then appears reddish blue in infarcted area

60
Q

what happens to areas distal to an occlusion

A

become necrotic over time

61
Q

how does heart muscle die for MI

A

little band near lumen never dies from O2 in the blood inside the heart
eventually goes from inside portion to the outside of heart

62
Q

why would reperfusion cause damage to the heart

A

blood now has lots of ROS and can kill cells and leads to scaring

63
Q

problem with scaring of the heart

A

less flexible,
shitty conduction
less strength

64
Q

what does rupture of the heart do

A

Sudden death

65
Q

who tends to get chronic ischemia heart disease

A

History of MI

66
Q

what tends to be the result of chronic ischemic heart disease

A

arrhythmias
CHF and sbubsequent MI’s
- many deaths

67
Q

what is the most common cause of sudden cardiac death

A

IHD

68
Q

who tends to be at risk of sudden cardiac death

A

Younger patients with cardiac problems(congenital coronary artery abnormalities, aorti valve stenosis, mitral valve prolapse, myocarditis, dilated or hypertrophic cardiomyopathy, pulmonary hypertension, myocardial hypertrophy)
- little damage to heart can cause rupture

69
Q

what is primary cardiomyopathy

A

Disease is sloely or predominantly confined to heart muscle

70
Q

what is secondary cardiomyopathy

A

heart is involeved as a multi-system disorder

71
Q

what are the 3 morphologic patterns of cardiomyopathy

A

dilated
Hypertrophic
restrictive/doesn’t beat well

72
Q

what can cause dilated cardiomyopathy

A

Primary
secondary
genetic
acquired-alcoholism, myocaritis, pregnancy

73
Q

commonness of genetic dilated cardiomyopathy

A

20-50% of cases

74
Q

what happens to the heart in dilated cardiomyopathy

A

dilation of all 4 chambers
fibrosis and mycocyte hypertrophy
poor ventricle contractility (systolic dysfuction)

75
Q

what are the causes of Hypertrophic cardiomyopathy

A

Primary

genetic

76
Q

where is the mutation that leads to hypertrophic cardiomyopathy

A

Missense point mutation in one of severeal sarcomeric gene loci
- myosin, myosin binding protein C
Troponin T

77
Q

what happens to the heart in hypertrophic cardiomyopathy

A

stiff ventricles prevent adequate filling (diastolic dysfunction)

78
Q

what is the histology associated with hypertrophic cardiomyopathy

A

myocyte disarray with fibrosis

79
Q

how is Hypertrophic cardiomyopathy inherited

A

Autosomal dominant with cvariable expression

80
Q

what parts of the heart does hypertrophic cardiomyopathy affect

A

greater in interventricular septum
less in left ventricular free wall
= obstructs left ventricular outflow

81
Q

what happens in restrictive cardiomyopathy

A

Wall of the ventricle becomes stiff with impaired filling during diastole

82
Q

when does restrictive cardiomyopathy occur

A

Idiopathic

Secondary to systemic conditions that affect myocardium

83
Q

what does restritive cardiomyopathy lead to

A
  • radiation-induced fibrosis
  • amyloidosis
  • hemochromatosis
  • sarcoidosis
84
Q

what viruses can cause myocarditis

A

(Coxsackie A and B)

85
Q

what does Virus induced Myocarditis lead to

A

Interstitial mononuclear inflammatory cells with myocyte necrosis

86
Q

what does pyogenic bacteria causing myocarditis lead to

A

Abscesses

87
Q

what do parasites cause in myocarditis

A

Individual myocyte or interstitium with adjacent inflammation

88
Q

what can cause hypersenitivity in myocarditis

A

Drugs

perivascular inflammation with eosinophils

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