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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
Q

coronary artery _________ and _________ both play a role in the pathogenesis of ischemic heart disease (IHD)

A
  • **Coronary artery atherosclerosis (>75% narrowing)
  • responsible for 90% of IHD cases

and

Coronary artery thrombosis

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26
Q

besides obstructions of the coronary artery, what other conditions can cause ischemic heart disease?

A

increased myocardial oxygen demand (hypertension)

decreased blood volume (hypotension/shock)

decreased oxygenation (pneumonia)

decreased oxygen-carrying capacity (anemia)

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27
Q

name the Clinical Types of Ischemic Heart Disease:

theres 4 kinds

A

Angina pectoris
Myocardial infarction
Chronic IHD with CHF
Sudden cardiac death

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28
Q

_____________ is defined as intermittent chest pain caused by transient, reversible myocardial ischemia

A

Angina pectoris

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29
Q

what are the characteristics of STABLE angina?

A
  • 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
Q

what are the characteristics of UNSTABLE angina?

A
  • increasing frequency of chest pain with minimal/no exertion
  • Longer lasting than stable angina
  • Often precedes more serious ischemia or MI
31
Q

_______________ is due to necrosis of cardiac muscle caused by ischemia

A

Acute myocardial infarction

“heart attack”, MI

32
Q

Acute myocardial infarctions can be the result of acute __________________ secondary to atherosclerosis

A

coronary artery thrombosis

33
Q

how many myocardial infarctions occur per-year? how many people die?

A
  • 1.5 million MI’s annually in US

- one-third die

34
Q

Severe ischemia lasting longer than ______________ will cause irreversible myocyte injury and cell death

A

20-40 minutes

35
Q

myocardial ischemia may also lead to may lead to ventricular __________

A

fibrillation

36
Q

name the clinical manifestations of myocardial infarctions

A 
chest pain
Shortness of breath
nausea/vomiting
diaphoresis (sweating)
low grade fever
37
Q

what types of tests can be used to diagnose MI’s?

A

A) ECG

B) elevated serum proteins from damaged cardiac myocytes

  • troponins T and I
  • myocardial-specific isoform of creatine kinase (CK-MB)]
38
Q

T/F: MI’s less than 24 hours old are usually not grossly apparent at autopsy

A

FALSE

less than 12 hours old

39
Q

At 12-24 hours, infarcted area appears what color?

A

reddish-blue

40
Q

what are the possible treatment options for MI’s?

A

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
Q

treatments for myocardial infarctions may result in __________ injury

A

reperfusion

42
Q

what CARDIAC complications can arise from a myocardial infarction?

A

1) Arrhythmia
2) CHF/shock
3) Mural thrombus
4) Mitral valve regurgitation

43
Q

_________ thrombi develop on the lining of the heart chamber

A

mural

44
Q

Mural thrombi can lead to left-sided _______

A

embolism

45
Q

what causes Mitral valve regurgitation?

A

papillary muscle dysfunction

46
Q

what condition is defined as “Progressive heart failure due to ischemic myocardial damage”

A

Chronic Ischemic Heart Disease

47
Q

Arrhythmias, CHF and subsequent MI’s as a result of _____________________ lead to many deaths

A

Chronic Ischemic Heart Disease

48
Q

what is the most common cause of sudden cardiac death?

accounts for 80-90% of all SCD’s

A

IHD

ischemic heart disease

49
Q

what are PRIMARY cardiomyopathies?

A

disease primarily or solely confined to the heart muscle

50
Q

secondary cardiomyopathies are defined as what?

A

myocardium is destroyed because it is involved in part of a systemic disorder

51
Q

what are the 3 functional patterns of Cardiomyopathies?

A

1) Dilated
2) Hypertrophic
3) Restrictive

52
Q

Dilated Cardiomyopathies may be May caused by what?

A

May be primary or secondary

may be genetic or acquired

53
Q

about ____% of dilated cardiomyopathies are genetically linked

A

20%

54
Q

what are the characteristics of DILATED cardiomyopathies?

A
  • Dilation of all 4 chambers
  • Poor ventricular contractility
  • Nonspecific histology with fibrosis and myocyte hypertrophy
55
Q

____________ Cardiomyopathy is a primary, genetic cardiomyopathy

A

Hypertrophic Cardiomyopathy

56
Q

T/F: hypertrophic cardiomyopathy is inhereted in a autosomal recessive pattern

A

FALSE

its autosomal dominant

57
Q

name the characteristics and histology of HYPERTROPHIC cardiomyopathy:

A
  • Stiff ventricles prevent adequate filling (diastolic dysfunction)
  • Histology: myocyte disarray with fibrosis
58
Q

_______________ occurs when the wall of the ventricles becomes stiffer with impaired filling during diastole

A

Restrictive Cardiomyopathy

59
Q

RESTRICTIVE cardiomyopathy can be __________ or __________ to systemic conditions that affect the myocardium

A

idiopathic or secondary

60
Q

what systemic conditions cause restrictive cardiomyopathy?

A

radiation fibrosis
amyloidosis
hemochromatosis
sarcoidosis

“too much protein, iron, granules” + radiation

61
Q

Myocarditis can be caused by what 4 agents?

A

1) Pyogenic bacteria
2) Viruses
3) Parasites
4) Hypersensitivity

62
Q

which type of myocarditis has the following characteristics:

interstitial mononuclear inflammatory cells with myocyte necrosis (Coxsackie A and B)

A

viral myocarditis

63
Q

___________ are seen in individual myocytes or interstitium with adjacent inflammation during this form of myocarditis

A

parasites

64
Q

give an example of parasitic myocarditis:

A

Chagas disease

found in south america

65
Q

____________ myocarditis is characterized by:

  • often caused by drugs
  • perivascular inflammation with eosinophils
A

hypersensitivity induced myocarditis

66
Q

__________ cardiomyopathy is a disorder of sarcomeric proteins

A

HYPERtrophic

67
Q

what 3 proteins are dysfunctional during hypertrophic cardiomyopothy disorders?

A

myosin

myosin binding protein C

troponin T

68
Q

what are the non-infectious causes of myocarditis?

A

Non infectious causes include:
toxins
hypersensitivity reactions
auto-immune disorders

69
Q

what % of dilated cardiomyopathies are due to genetics?

A

hereditary basis in 20-50% of cases

70
Q

during hypertrophic cardiomyopathy, inappropriate (spontaneous) myocardial hypertrophy occurs more in what region of the heart?

A

greater in the interventricular septum

less in the left ventricular free wall

71
Q

what are the 3 examples of NON-cyanotic congenital heart disease?

A

1) Atrial septal defect (ASD)
2) Ventricular septal defect (VSD)
3) Patent ductus arteriosis

gen-path 2 (7 decks)

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