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CVS Pathology I Flashcards

1
Q

Congestive heart failure involves an interplay of what 2 factors?

A

1) Inability of the heart to maintain sufficient CO to support body functions
2) Recruitment of compensatory mechanisms to maintain cardiac reserve

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2
Q

Heart failure is characterized by?

A

1) Diminished cardiac output (forward failure)

2) Damming back of blood to the venous system (backward failure)

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3
Q

According to the Frank Starling Mechanism, the stroke volume increases in response to…

A

increased (end diastolic volume) volume of blood filling the heart

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4
Q

Compensatory mechanisms in CHF

A

Frank Starling mechanism, Myocardial hypertrophy (with or without dilation), Activation of the neurohumoral system

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5
Q

In the heart, pressure overload causes _____ while Volume overload causes ______

A

muscle hypertrophy; chamber dilation

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6
Q

Name 2 important things to take note in the histology of the hypertrophic heart

A

thickness of the myocardium & box-type nuclei (enlarged)

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7
Q

(T/F) CHF almost always presents with tachycardia.

A

True

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8
Q

3 systems activated in the neurohumoral compensatory response in CHF

A

NE/Epinephrine, Renin-Angiotensin-Aldosterone System, Release of atrial-natriuretic peptide

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9
Q

Release of atrial natriuretic peptide (ANP) causes sodium and water _______ therefore causing ______

A

retention; edema

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10
Q

What is the role of the RAA system in the compensatory system of CHF?

A

RAA activation causes tubular reabsorption of sodium and water –> increased blood volume –> increased venous return –> increased volume to L ventricle –> augment failing heart

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11
Q

Pressure overload causes what kind of hypertrophy?

A

Concentric

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12
Q

Give examples of pathological states with pressure overload

A

systemic hypertension, pulmonary hypertension

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13
Q

Give examples of pathological states with volume overload

A

aortic/mitral regurgitation, shunting anomalies

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14
Q

(T/F) A 25 YO male’s heart was determined to weigh 350 grams. His heart is considered enlarged.

A

False. Normal for males: 300-350 grams; Females 250-300 grams

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15
Q

Give the basis for myocardial contractile failure

A

1) Death of myocytes/loss of vital pump elements
2) Overworked, fatigued cardiac muscles
3) Altered gene expression with prolonged hemodynamic overload
4) Re-expression of pattern of protein synthesis similar to fetal cardiac development

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16
Q

Give functional modifications in the heart in heart failure after neurohumoral stimulation

A

Increased inotropy; Increased HR; Vasoconstriction; Na and water retention

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17
Q

Give structural modifications in the heart in heart failure after neurohumoral stimulation

A

Hypertrophy, Increased nonmuscular tissue, Increased expression of adult cardiac genes

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18
Q

Give the end results of functional & structural modifications in the heart in heart failure after neurohumoral stimulation

A

1) Increased energy demand
2) Altered loading conditions
3) Altered vascular/diastolic properties
4) Proarrhythmogenic effect

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19
Q

Give some anatomic, biochemical and ultrastructural changes in the heart in CHF

A

1) Pathologic hypertrophy
2) Increased protein synthesis
3) Altered gene expression
4) Synthesis of abnormal proteins
5) Fibrosis
6) Decrease calcium
7) Microciculatory spasm (further ischemia)
8) Apoptosis

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20
Q

Mechanisms of cardiac dysfunction in CHF

A

Pump failure, Obstruction of flow, Regurgitant flow, Disorders of cardiac conduction, Disruption of normal circulatory continuity

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21
Q

Examples of diseases that cause myocardial dysfunction

A

IHD, Dilated cardiomyopathy

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22
Q

Examples of diseases that cause ventricular pressure overload

A

HTN, Aortic stenosis, Pulmonary embolism, cor pulmonale,

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23
Q

Examples of diseases that cause ventricular volume overload

A

Aortic/mitral regurgitation, high output state (pregnancy, anemia, thyrotoxicosis)

24
Q

Examples of diseases that cause restrictive disease

A

pathological tachycardia, heart block

25
Q

Examples of diseases that cause conduction system failure

A

AMI, Arrythmia

26
Q

Examples of diseases that cause valvular failure

A

endocarditis, Rheumatic heart disease, calcific aortic stenosis, Pulmonary stenosis, tricuspid atresia

27
Q

Examples of diseases that cause cardiac malformation

A

VSD< ASD, PDA, tetralogy of fallot, Coarctation of the aorta

28
Q

What are the most frequent clinical conditions associated with CHF

A

MI and valvular disease

29
Q

Iatrogenic causes of CHF

A

Drugs: cocaine, doxyrubicin, radiation

30
Q

Clinical conditions associated with CHF

A

Previous MI, CAD, HTN, Arrythmia, Heart valve disease, cardiomyopathy, congenital heart disease, alcohol and drug abuse

31
Q

DIfferntiate systolic vs diastolic dysfunction in terms of its main pathology

A

Systolic: problem during contraction; Diastolic: failure of muscle to relax

32
Q

Types of CHF in terms of anatomic location

A

1) Left-sided HF (Failure of LV)
2) Right-sided HF (Failure of RV)
3) Combined or biventricular

33
Q

What is the most common cause of heart failure?

A

Systolic dysfunction

34
Q

Give diseases that cause systolic dysfunction

A

IHD, hypertensive heart disease, dilated cardiomyopathy

35
Q

(T/F) Most systolic dysfunction affects the right ventricle

A

False. Left ventricle

36
Q

(T/F) You find s/s of pulmonary edema and congestion in systolic dysfunction

37
Q

Give causes of diastolic dysfunction in CHF

A

massive LV hypertrophy, amyloidosis, constructive myocarditis, myocardial fibrosis

38
Q

(T/F) In diastolic dysfunction the ejection fraction is decreased

A

False. The ejection fraction is normal

39
Q

Give an important clinical manifestation in left sided heart failure

40
Q

Effect of left sided heart failure on the brain

A

Hypoxic encephalitis

41
Q

Effect of left sided heart failure on the kidneys

A

Release of Renin = edema

42
Q

Effect of left sided heart failure on the lungs

A

acute congestion and edema; Chronic passive congestion

43
Q

Histologically, how do you differentiate acute vs passive congestion of the lung?

A

Acute = no heart failure cells; Chronic = (+) heart failure cells

44
Q

Give the clinical features of left-sided heart failure

A

Dyspnea, orthopnea, Paroxysmal Nocturnal Dyspnea, Increased HR, caridomegaly, Blood tinged sputum, cyanosis, elevated pulmonary wedge pressure, rales, cough, edema

45
Q

Give causes of right-sided heart failure

A

PE, Intrinsic lung disease (COPD, cystic fibrosis), Pulmonary HTN, kyphoscoliosis, pneumoconiosis, schistosomiasis

46
Q

Give the liver morphology in right-sided heart failure

A

Congestive hepatomegaly, nutmeg liver, centrilobular necrosis, sclerosis

47
Q

Give the spleen morphology in right-sided heart failure

A

congestive splenomegaly

48
Q

Give the heart morphology in right-sided heart failure

A

RV dilatation and hypertrophy

49
Q

Give the kidney morphology in right-sided heart failure

A

congestion

50
Q

Give the brain morphology in right-sided heart failure

A

hypoxic encepalopathy

51
Q

Clinical features of right-sided heart failure

A

Splanchic congestion (hepatosplenomegaly), hepatojugular reflex, Jugular venous distention, dependent edema, transudative effusions, cyanosis

52
Q

Give causes of high output failure

A

anemia, hyperthyroidism, high fever, shunts between the artery and veins

53
Q

What is the underlying physiological problem in high output heart failure

A

decreased systemic vascular resistance d/t arterio-venous shunting or peripheral vasodilation

54
Q

Which is more common, high or low output heart failure?

55
Q

Give the major criteria in the diagnosis of CHF

A

PND, Neck vein distention, rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased venous pressure & (+) hepatojugular reflux

56
Q

What are the minor criteria in the diagnosis of CHF

A

Extremity edema, night cough, dyspnea on exertion, hepatomegaly, pleural effusion, vital capacity reduced by 1/3 & tachycardia

57
Q

Weight loss of >4.5 kg over 5 days treatment is a (major/minor/both) criteria for diagnosis of CHF

Pathology (7 decks)

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