CP29 - Cardiovascular System 2 Flashcards
what are some common causes for left sided heart failure?
hypertension - pressure overload
valvular disease - pressure and/or volume overload
MI - regional dysfunction with volume overload
what is the pathogenesis of left sided heart failure?
one of the 3 common causes
cardiac workload increase
increase stresses on the wall of the heart
cause cell of the heart to stretch
hypertrophy of the heart and/or dilate
over a period of time, cardiac dysfunction
what are some effects of left sided heart failure on the rest of the body?
kidney - pre-renal azotemia (retention of nitrogen within the body), salt and fluid retention
brain - irritability, decreased attention, stupor (near unconscious) then coma
lungs
what can left sided heart failure cause to the lungs?
pulmonary congestion and oedema,
dyspnea orthopnea - shortness of breath when lying flat PND (paroxysmal Nocturnal Dyspnea) blood tinged sputum cyanosis elevated pulmonary 'WEDGE' pressure
what can cause right sided heart failure
left sided failure cor pulmonale (right sided heart failure caused by lungs disease)
what are some symptoms for right sided heart failure
liver & spleen - passive congestion, congestive splenomegaly, ascites
kidney - insufficient perfusion of kidneys
pleura/pericardium - both effusions, transudates (leaking of fluids out to the pleura/pericardium)
peripheral tissue - increase in peripheral venous pressure
what causes valvular heart disease
stenosis of any of the heart valvue
what can valvular heart disease lead to?
regurgitation of the heart valvue or incompetence or insufficiency
which 2 conditions cause 70% of all VHD?
aortic stenosis & mitral stenosis
what can cause aortic stenosis?
calcification of a deformed valve or rheumatic heart disease
what can cause mitral stenosis?
rheumatic heart disease
what can cause rheumatic heart disease?
group A strep infection
- endocarditis, myocarditis, pericarditis
how does rheumatic fever spread to the heart in a theoretical way
infection of group A step in the throat
haematonous spread to the hear through deposition on the coronary heart artery
then through the arteries it enters the heart chambers
what are the clinical findings of acute rheumatic fever>
inflammation of the heart valves
Aschoff bodies present
Antischkow cells present
pancarditis
vegetations on chordae tendinae at leaflet junction
what are Aschoff bodies ?
nodules of heart tissue characteristic to rheumatic fever
what are antischkow cells
enlarged macrophages present in the heart
what are some of the clinical features of chronic rheumatic fever?
thickened valves, commisural fusion, thick & short chordae tendinae
what are some of the clinical presentation for aortic stenosis?
2X gradient pressure
LVH (but no hypertension)
angina, CHF, ischaemia
what is stenosis ?
abnormal narrowing of a part of the body
what are the 2 major types of regurgitations
aortic regurgitations & mitral regurgitations
what are some of the common cause of aortic regurgitations
rheumatic fever, infections - endocarditis, aortic dilations
what are some of the common causes of mitral regurgitation
mitral valve prolapse, infections, calcification on the mitral ring (annulus)
what is regurgitation of the heart valve?
the heart valves are not closely adhered to each other leading to back flow of blood
what causes mitral valve prolapse?
myxomatous degeneration of the mitral valve - can be associated with connective tissue disorders
what can detect mitral valve prolapse?
esaily seen on echocardiogram
what are some clinical presentation for mitral valve prolapse
mid-systolic ‘click’, holosystolic murmur if regurg. present
occasional chest pain, dyspnea
what environmental factors can cause congenital defect of the heart?
rubella, teratogens (agents which can cause congenital defect)
what can happen systematically when L - R shunts happen?
no cyanosis, pulmonary hypertension,
SIGNIFICANT pulmonary hypertension is IRREVERSIBLE
what can happen systematically when R - L shunts happen?
cyanosis
what congenital conditions can cause L - R shunt?
ASD, VSD, AVSD (atrioventricular septum defect), PDA (Patent ductus arteriosus)
what causes arterial septum defect?
not patient foramen ovale
what causes ventricle septum defect?
ventricular septum defect leading to shunt from L - R
what condition does VSD associate with?
tetralogy of fallot
what causes Patent ductus arteriosus?
patent of ductus arteriosus - most of the times, isolated from other conditions
what other conditions does PDA associate with?
VSD, coarctation of aorta, pulmonary/aortic stenosis
what keeps the PDA open
prostaglandin E1
what is the cause of atrioventricular septum defects?
defective atrioventricular septum of the heart allowing blood to shunt form L - R
what does AVSD associate with?
defective, inadequate AV valves
what syndrome can have 1/3 of its cases to have AVSD?
Down syndrome
what are some of the conditions which can cause blood to shunt from R - L
Tetralogy of Fallot Transposition of great arteries Truncus arteriosus Total anomalous pulmonary venous connection Tricuspid atresia
T = R - L
what are the 3 major clinical features for tetralogy of fallot?
VSD, large,
obstruction to RV outflow
aorta overrides the VSD
RVH
what does TGA stands for?
Transposition of Great Arteries
what is the cause of TGA?
So Transposition of the Great Arteries means that the pulmonary artery is where the aorta should be, carrying red blood from the left ventricle to the lungs, and the aorta is where the pulmonary artery should be, carrying blue blood around the body.
how can TGA patients survival?
a shunt - PDA, VSD
what is the treatment for TGA?
surgical switching of the 2 vessels
what is truncus arteriolesis?
it is when there is only one valve for both aorta and pulmonary artery
what does truncus arteriosis associate with?
VSD,
what does truncus arteriosis cause/
produce systemic cyanosis and increased pulmonary blood flow
what are some examples of obstructive congestive heart disease?
coarctation of aorta, pulmonary stenosis/atresia,
aortic stenosis/atresia
what is coarctation on aorta?
it is a congenital localised constriction in the diameter of the aorta
where is the usual position for coarctation of the aorta occur
just distal to the ductus arteriosus
what is the serious/life threatening form of coarctation of aorta?
the coarctation of the aorta is proximal to the PDA
