CVDII Flashcards
What is heart failure
Inadequate cardiac output. Cannot meet the metabolic demands of the body.
Major causes of heart failure
***MI
HTN
Vascular disease/valve damage
Cardiomyopathy- muscle heart disease
HF risk factors
Coronary heart disease HTN Cigarette obesity Diabetes
Heart failure causes
Congestion of blood flow, inability to increase cardiac output as needed.
What happens if left side of heart fails first?
Rt side keeps pumping fluid into lungs, but the left side of the heart can’t get rid of it. Causes back up in the pulmonary system
Pulmonary edema Causes tachypnea (rapid breathing) and cyanosis (body is hypoxic and turns blue)
What happens if the right side of heart fails first?
Blood backs up in systemic circulation.
Systemic circulation flows into right side. If right side can’t move blood, it stops there.
Causes peripheral edema. Hepatomegaly (enlargement of liver) and ascites (fluid problems. Excess venous pressure causes blood to leak into abdomen)
Common symptoms of heart failure
Fatigue, shortness of breath
Right side failure is most commonly caused by
Left side failure
3 compensatory mechanisms for HF
- Sympathetic nervous system activation (by baroreceptors in carotid)
- Compensatory vasoconstriction
- Myocardial hypertrophy
Cardiac arrhythmia
Irregularity in the hearts beating pattern due to pacemaker/SA node. Electrical conductivity problem in the heart.
Inefficient heart contractions, decreases CO, can be fatal.
Most common side effect of MI, but can also occur on its own and lead to heart failure.
What causes cardiac arrhythmia
Myocardial ischemia or MI ** Electrolyte imbalance (K+) Stress due to cortisol release Drugs (stimulants) Congenital defects in the myocardial electrical network
4 types of cardiac arrhythmia
- Tachycardia. Abnormally fast heart rate.
- Bradycardia. Abnormally slow heart rate.
- Flutter. Irregular or regular. Elevated rate.
- Fibrillation of atria or ventricles. Sporadic, quivering pattern. Inefficient pumping.
Atria vs ventricle fibrillation
Atria: too many p waves. Tx with meds, surgeries. No tx may lead to stroke.
Ventricle: Can quickly be fatal. Cause incomplete contraction and inefficient pumping.
Ischemic and non-ischemic forms of cardiomyopathy
Ischemic: Thrombus causes coronary heart disease.
Non-Ischemic:
- Toxic (alcohol abuse)
- Metabolic (Thyroid disease: elevated HR and hypertrophy. Amyloidosis: Amyloid accumulation in heart muscles due to autoimmune disease)
- Infectious (Post viral myocarditis. HIV, COVID)
3 types of cardiomyopathy
- Dilated
- Restrictive
- Hypertrophic
Dilated cardiomyopathy
- What is it
- Usually caused by what
Heart is enlarged due to heart trying to maintain CO.
- Walls are normal thickness
- Ventricular chamber is increased
- Contractility is decreased
More common out of the three types
Predominantly caused by ischemic damage to the heart due to MI. Results in myocardial degeneration bc ischemia.
What is cardiomyopathy
Myocardial degeneration that leads to heart failure.
Restrictive cardiomyopathy
- What is it?
- Primary causes
Normal sized heart that becomes more rigid. Results in reduced filling capacity because heart cannot initially expand to let more blood enter.
Amyloidosis- autoimmune disease that causes amyloid accumulation in heart muscles.
or idiopathic.
Hypertrophic cardiomyopathy
-What is it?
Larger than normal heart due to muscles getting larger.
- IV septum thicker than 1.5cm
- Reduced filling capacity because there is less space for blood due to increasing muscle size
- Normal capacity
Primarily an autosomal dominant genetic defect.
-AA men most affected
Most common cause of sudden cardiac death in young adults
Most common cause of sudden cardiac death in young adults
Hypertrophic cardiomyopathy
Difference between Hypertrophic and dilated cardiomyopathy
Dilated:
- Heart is enlarged due to trying to maintain CO.
- Walls are normal thickness.
- Decreased contractility. *
- Ventricular chamber is increased *
Hypertrophic:
- Larger than normal heart due to muscles getting larger.
- IV septum thicker than 1.5 cm.
- Normal contractility. *
- Reduced filling capacity. *
Two types of endocardial/valvular disease and what causes this
- Stenosis: Associated with narrowing of valve. It cannot completely open.
- Regurgitation: Valve cannot close completely.
Cause: Inflammation, scarring, calcification/ageing, congenital malformations.
Mitral valve regurgitation
Valve that is between left atrium and left ventricle. Instead of going from left ventricle to circulation, blood flows back into left atria.
Aortic valve stenosis
Aortic valve that doesn’t open or close completely. This increases the workload of the left ventricle. may lead to left ventricular hypertrophy and eventually HF.
Mitral valve prolapse
- What is it
- ocular associations
Degeneration of connective tissue (chordae/leaflets) in the valve.
- Valve leaflets balloon into left atrium during systole.
- May lead to mitral valve regurgitation.
Risk factor for bacterial endocarditis (infection) or thrombosis (clot)
Ocular associations: CRAO, BRAO, choroidal occlusion due to clot traveling.
Infective endocarditis
- What is it
- most common bacteria
- Predisposing risk factors
Colonization of endocardial structures due to pre-existing damage to the heart.
Strep, Staph
Rheumatic endocarditis/heart disease
Congenital valve defects
Rheumatic endocarditis/heart disease
Occurs in younger ppl: 5-15 years
Develops 1-5 weeks after infection. Must be exposed twice.
Type II hypersensitivity. Antibodies cross react with connective tissue antigens in the heart.
Pericardium
Sack that surrounds the heart. Outer covering. Holds the heart in place and assists with the regulation of blood pressure and HR. First line of defense against infection and inflammation.
Pericardial fluid
Cushion and lubricant
Acute pericarditis
Lasts less than 6 weeks
May be confused with MI
Leading cause: Neoplasm*
Chronic pericarditis
Lasts more than 6 months
Constrictive pericarditis. Increased scarring reduces movement and normal function of heart.
leading cause: Idiopathic* or TB
Systemic associations to pericarditis
Uremia* excess ammonia in the blood
Rheumatic fever
SLE
Ocular manifestation of infective endocarditis
Roth’s spot: red dot with white center.
Choroiditis
Endophthalmitis
Ocular manifestation of mitral valve prolapse
Mitral valve prolapse causes turbulence –> Coagulation –> Platelet emboli that travels to eye
Ocular manifestations of aortic stenosis
Associated with calcification of aortic valve. May break off and cause calcium emboli.
