Exam 3: Heart Flashcards
1 cause of death in US
Heart disease
Heart disease MC due to
Contractile failure
CHF MC due to
Low cardiac output
Systolic dysfunction
Weak contraction
Diastolic dysfunction
Failed relaxation
Valvular dysfunction
Failure to effectively seal
Forward failure
Insufficient output
Backward failure
Congestion
Forward failure is almost always accompanied by
Backward failure
Forward failure impacts
Virtually every organ
3 adaptations to heart failure
Frank-starling law mechanism
Neurohumoral mechanisms
Structural changes
Frank-starling law
Increase stretch = stronger contraction
Benefit and cost of frank-starling law
Benefit: increase output
Cost: increase O2 and tension
Neurohumoral mechanisms
NE = increase HR and increase contractility
ANP = diuresis and vasodilation
Structural changes
Cardiac hypertrophy
Cost of structural changes
Increase O2 consumption
Pathological cardiac hypertrophy
Concentric hypertrophy
Increase pressure
Physiologic cardiac hypertrophy
Eccentric hypertrophy
Increase volume
Increase capillary density
Athlete’s heart can be used to describe
Sarah
Orthopnea
Dyspnea when lying down
L side heart failure causes L ventricle to
Hypertrophy
L side heart failure causes gradual decrease in ____ and therefore ____
cardiac output
Pulmonary edema
Signs of L side heart failure
Cough
Rales
Orthopnea
Tachycardia
R side heart failure MC from
L sided failure
R side heart failure causes minimal
Pulmonary congestion
R side heart failure causes peripheral congestion, including
Pitting edema
Ascites
Hepatosplenomegaly
30% of all birth defects
Congenital heart disease
As embryo…R atrium communicates with L atrium via
Foramen ovale
As embryo… L pulmonary artery joins aorta at
Ductus arteriosus
___ closes at birth and ____ closes 1-2 days after birth
FO
DA
Risks for congenital heart disease
Prematurity Trisomies Teratogens Maternal diabetes Fetal infection
90% of congenital heart disease are
Idiopathic
Isolated R side heart failure is from
Pulmonary HTN
Pulmonary HTN can be due to
Lung pathology
Valve disorder
Left to right shunt
R side heart failure coming from something in lungs causing pulmonary HTN
Cor pulmonale
Over half of congenital heart disease is due to
Septal defects
VSD or ASD
R to L shunt
Blood bypass lungs —> cyanosis
R to L shunt can be due to
Tetralogy of fallot
Transposition of great arteries
MC shunt
L to R
42% of malformations and 30% isolated
VSD
10% malformations
ASD
MC asymptomatic and spontaneous closure is rare
ASD
7% malformations and 90% isolated
PDA
VSD may spontaneously
Close
1 cause of congenital heart disease
VSD
Obstructed flow can be due to
Valve stenosis
Aortic coarctation
4 malformations of tetralogy of fallot
VSD
RV outflow obstruction
Overriding aorta
RV Hypertrophy
MC congenital heart disease to cause cyanosis
Tetralogy of fallot
“Boot shaped” heart and polycythemia describe
Tetralogy of fallot
Irregular connections in transposition of great arteries
RV -> aorta
LV -> pulmonary A
Transposition of great arteries separates ___ and is incompatible with postnatal life
Pulmonary and systemic circulation
Aortic coarctation MC in
Males
Turner syndrome
Types of aortic coarctation
Infantile
Adult
Infantile aortic coarctation
Pre-ductal
Proximal to PDA
Adult aortic coarctation
Post-ductal
Near ligamentum arteriosum
MC asymptomatic
Variable features of aortic coarctation
Upper extremity HTN
HA
Low blood to LE
Systolic murmurs
More than half of aortic coarctation have
Bicuspid aortic valve
More severe aortic coarctation
Infantile
Ischemia causes ___ in 1-2 min and ___ in 20-40 min
Dysfunction
Infarction
90% of IHD cases
CAD
Left anterior descending artery aka
Anterior interventricular Artery
“Widow maker”
MC artery involved in IHD
Left anterior descending Artery
Progression of IHD
Fatty streaks
Atheroma
Significant luminal stenosis
Thrombosis
4 types of cardiac syndromes
- Angina pectoris
- Acute MI
- Sudden cardiac death (SCD)
- Chronic IHD
Angina Pectoris occurs due to myocardial ischemia (____ occlusion)
70%
Angina pectoris causes pain in
Substernal pain
Jaw
Let arm
Back
Shoulders
Stable angina
Episodic and exertional
Relieved with rest and vasodilators
Variant angina
Vasospasm at rest
Responds to vasodilators
Unstable angina
Increase intensity Increase frequency Increase duration Provoked by less exertion >90% occlusion
> 70% occlusion aka
Critical stenosis
> 70% occlusion observed in
Stable angina
> 90% occlusion observed in
Unstable angina
Angina pectoris in females is less ____ and many have no ____
Predictable
Angina
Symptoms of angina in females
Nausea Dizziness Back pain Lower chest or epigastric pain Dyspnea Fatigue
MI causes
Myocardial necrosis
____ of MIs are lethal
1/3
90% of MI cases are due to
Acute coronary thrombosis
Risks for MI
HTN Smoking CHF DM Males Age 40-60 Postmenopausal females Sickle cell Stress
Reperfusion injures due to MI can cause
Endothelial swelling -> block capillaries
Treatment for MI
CPR Defibrillation Vasodilator meds Angioplasty Stent CABG
Symptoms of MI
Crushing pain with intense pressure
-unrelieved by “nitro”
Thready pulse
Nausea
Sweaty
Dyspnea
In community, MI’s __ lethal, in hospital, ___ lethal
30%
7%
Diagnosis for MI
Troponins
CK-MB
Myoglobin
Most sensitive and specific cardiac marker
Troponin
Progressive failure secondary to ischemia damage, including past MI and long term CAD
Chronic ischemic heart disease
Chronic ischemia HD has a ___ prognosis
Poor
Order of cardiac conduction system
SA node
AV node
Bundle of His
Purkinje Fibers
___ begins electrical impulse
SA node
Sudden cardiac death MC from
Ischemic injury (CAD)
Sustained arrhythmia causing death that is unexpected and sudden
Sudden cardiac death
Commotio cordis
SCD from precordial trauma
Commotio cordis causes no
Tissue damage
Commotio cordis MC in
Adolescent males
15 yo
Commotio cordis has a ___ prognosis
Poor
