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gen-path 2 > CV lecture 2- CHF, CHD, IHD, Cardiomyopathies, and Myocarditis > Flashcards

CV lecture 2- CHF, CHD, IHD, Cardiomyopathies, and Myocarditis Flashcards

1
Q

what is the definition of congestive heart failure (CHF)?

A

CHF is failure of the heart to pump an adequate amount of blood to supply the metabolic requirements of the organs.

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2
Q

T/F: CHF may be due to pathologic conditions inside or outside the heart.

A

true

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3
Q

what are the compensatory mechanism for CHF?

A

1) Myocardial hypertrophy
2) Frank- starling mechanism- Ventricle dilation
3) Physiologic “neurohumoral” mechanisms- NE and renin-aldosterone

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4
Q

what are the “physiological compensatory mechanisms” for CHF?

A

increased heart rate
increased intravascular volume
re-distribution of blood flow
increased catecholamines

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5
Q

what are the causes of LEFT SIDE heart failure?

A
  1. Ischemic heart disease
  2. Hypertension
  3. Myocarditis
  4. Cardiomyopathy
  5. Valvular disease
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6
Q

what manifestation of CHF is characterized by:

  • Congestion of liver (zonal or “nutmeg” pattern) and spleen
  • Edema of subcutaneous tissue (feet and ankles)
A

Right Ventricular failure

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7
Q

what symptoms are seen during Left ventricular failure caused by CHF?

A

pulmonary edema
Chronic cough
Orthopnea (shortness of breath)

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8
Q

what neurological condition results from a left and/or right ventricular failure?

A

Cerebral hypoxia

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9
Q

CHF due to left ventricular failure eventually leads to ______________

A

right ventricular failure

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10
Q

what occurs during the Frank-Starling mechanism? (a CHF compensatory mechanism)

A
  • increased end-diastolic filling volume stretches cardiac muscle fibers.
  • At first the fibers contract more forcefully, increasing cardiac output (compensated heart failure)
  • eventually they cannot keep up (decompensated heart failure)
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11
Q

what are the causes of RIGHT SIDE 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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12
Q

what is the rate of congenital heart disease in the US?

A

6-8/1,000 live births in US

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13
Q

what are the causes of congenital heart disease?

A

1) Environmental factors
2) Chromosomal abnormalities

**90% are unknown and likely multifactorial **

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14
Q

what are the forms of congenital heart disease?

A

Cyanotic and noncyanotic forms

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15
Q

___________ is the 2nd most common congenital heart malformation

A

Atrial septal defect (ASD)

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16
Q

_____________ is the most common of cardiac malformations

A

Ventricular septal defects (VSD’s)

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17
Q

what is the prevalence of Ventricular septal defects?

A

4/1000 live births

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18
Q

what structure connects the aorta and pulmonary artery at birth? when does this structure normally close?

A

ductus arteriosus (if it doesn’t close…. PDA)

normally closes within a few days of birth

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19
Q

what are the 2 types of CYANOTIC congenital heart disease?

A

1) Tertiary of Fallot

2) transposition of great arteries

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20
Q

what 4 anomalies make up the Tertiary of Fallot?

A

1) Ventricular septal defect
2) Narrowed right ventricular outflow
3) Overriding of the aorta over the VSD
4) Right ventricular hypertrophy

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21
Q

what occurs during a Transposition of the great arteries?

A

Right ventricle empties into the aorta

Left ventricle empties into pulmonary artery

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22
Q

what is Ischemic Heart Disease (IHD)?

A

Refers to a group of related disorders that are all characterized by an imbalance between myocardial blood supply and myocardial oxygen demand

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23
Q

ischemic heart disease is primarily caused by what?

A

due to coronary artery atherosclerosis (coronary artery disease)

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24
Q

IHD is the leading cause of death in the united states…… how many people does it kill?

A

Leading cause of death in US – 500,000 annually

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25
coronary artery _________ and _________ both play a role in the pathogenesis of ischemic heart disease (IHD)
* ****Coronary artery atherosclerosis (>75% narrowing) - responsible for 90% of IHD cases and Coronary artery thrombosis
26
besides obstructions of the coronary artery, what other conditions can cause ischemic heart disease?
increased myocardial oxygen demand (hypertension) decreased blood volume (hypotension/shock) decreased oxygenation (pneumonia) decreased oxygen-carrying capacity (anemia)
27
name the Clinical Types of Ischemic Heart Disease: | theres 4 kinds
Angina pectoris Myocardial infarction Chronic IHD with CHF Sudden cardiac death
28
_____________ is defined as intermittent chest pain caused by transient, reversible myocardial ischemia
Angina pectoris
29
what are the characteristics of STABLE angina?
- 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
30
what are the characteristics of UNSTABLE angina?
- increasing frequency of chest pain with minimal/no exertion - Longer lasting than stable angina - Often precedes more serious ischemia or MI
31
_______________ is due to necrosis of cardiac muscle caused by ischemia
Acute myocardial infarction | “heart attack”, MI
32
Acute myocardial infarctions can be the result of acute __________________ secondary to atherosclerosis
coronary artery thrombosis
33
how many myocardial infarctions occur per-year? how many people die?
- 1.5 million MI’s annually in US | - one-third die
34
Severe ischemia lasting longer than ______________ will cause irreversible myocyte injury and cell death
20-40 minutes
35
myocardial ischemia may also lead to may lead to ventricular __________
fibrillation
36
name the clinical manifestations of myocardial infarctions
``` chest pain Shortness of breath nausea/vomiting diaphoresis (sweating) low grade fever ```
37
what types of tests can be used to diagnose MI's?
A) ECG B) elevated serum proteins from damaged cardiac myocytes - troponins T and I - myocardial-specific isoform of creatine kinase (CK-MB)]
38
T/F: MI’s less than 24 hours old are usually not grossly apparent at autopsy
FALSE less than 12 hours old
39
At 12-24 hours, infarcted area appears what color?
reddish-blue
40
what are the possible treatment options for MI's?
1) placement of stents to open coronary vessels affected by atherosclerosis 2) coronary artery by-pass grafts (CABG) 3) “clot-busting” drugs, such as streptokinase
41
treatments for myocardial infarctions may result in __________ injury
reperfusion
42
what CARDIAC complications can arise from a myocardial infarction?
1) Arrhythmia 2) CHF/shock 3) Mural thrombus 4) Mitral valve regurgitation
43
_________ thrombi develop on the lining of the heart chamber
mural
44
Mural thrombi can lead to left-sided _______
embolism
45
what causes Mitral valve regurgitation?
papillary muscle dysfunction
46
what condition is defined as "Progressive heart failure due to ischemic myocardial damage"
Chronic Ischemic Heart Disease
47
Arrhythmias, CHF and subsequent MI’s as a result of _____________________ lead to many deaths
Chronic Ischemic Heart Disease
48
what is the most common cause of sudden cardiac death? accounts for 80-90% of all SCD's
IHD ischemic heart disease
49
what are PRIMARY cardiomyopathies?
disease primarily or solely confined to the heart muscle
50
secondary cardiomyopathies are defined as what?
myocardium is destroyed because it is involved in part of a systemic disorder
51
what are the 3 functional patterns of Cardiomyopathies?
1) Dilated 2) Hypertrophic 3) Restrictive
52
Dilated Cardiomyopathies may be May caused by what?
May be primary or secondary may be genetic or acquired
53
about ____% of dilated cardiomyopathies are genetically linked
20%
54
what are the characteristics of DILATED cardiomyopathies?
- Dilation of all 4 chambers - Poor ventricular contractility - Nonspecific histology with fibrosis and myocyte hypertrophy
55
____________ Cardiomyopathy is a primary, genetic cardiomyopathy
Hypertrophic Cardiomyopathy
56
T/F: hypertrophic cardiomyopathy is inhereted in a autosomal recessive pattern
FALSE its autosomal dominant
57
name the characteristics and histology of HYPERTROPHIC cardiomyopathy:
- Stiff ventricles prevent adequate filling (diastolic dysfunction) - Histology: myocyte disarray with fibrosis
58
_______________ occurs when the wall of the ventricles becomes stiffer with impaired filling during diastole
Restrictive Cardiomyopathy
59
RESTRICTIVE cardiomyopathy can be __________ or __________ to systemic conditions that affect the myocardium
idiopathic or secondary
60
what systemic conditions cause restrictive cardiomyopathy?
radiation fibrosis amyloidosis hemochromatosis sarcoidosis "too much protein, iron, granules" + radiation
61
Myocarditis can be caused by what 4 agents?
1) Pyogenic bacteria 2) Viruses 3) Parasites 4) Hypersensitivity
62
which type of myocarditis has the following characteristics: interstitial mononuclear inflammatory cells with myocyte necrosis (Coxsackie A and B)
viral myocarditis
63
___________ are seen in individual myocytes or interstitium with adjacent inflammation during this form of myocarditis
parasites
64
give an example of parasitic myocarditis:
Chagas disease | found in south america
65
____________ myocarditis is characterized by: - often caused by drugs - perivascular inflammation with eosinophils
hypersensitivity induced myocarditis
66
__________ cardiomyopathy is a disorder of sarcomeric proteins
HYPERtrophic
67
what 3 proteins are dysfunctional during hypertrophic cardiomyopothy disorders?
myosin myosin binding protein C troponin T
68
what are the non-infectious causes of myocarditis?
Non infectious causes include: toxins hypersensitivity reactions auto-immune disorders
69
what % of dilated cardiomyopathies are due to genetics?
hereditary basis in 20-50% of cases
70
during hypertrophic cardiomyopathy, inappropriate (spontaneous) myocardial hypertrophy occurs more in what region of the heart?
greater in the interventricular septum | less in the left ventricular free wall
71
what are the 3 examples of NON-cyanotic congenital heart disease?
1) Atrial septal defect (ASD) 2) Ventricular septal defect (VSD) 3) Patent ductus arteriosis

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