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System Pathology I -- Roecker > Exam 3: The Heart > Flashcards

Exam 3: The Heart Flashcards

1
Q

What is the first organ system to develop in utero?

A

cardiovascular system

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2
Q

What is the leading cause of death in the U.S.? Give some statistics.

A

Heart Disease

  • 1 in every 4 deaths = ~ 1 death per minute
  • 1/3 of all “premature” deaths (younger than 75)
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3
Q

How many people each year in the U.S. have CHF? How many are hospitalized? How many die from it?

A

5 million have CHF
1 million are hospitalized with CHF
300,000 die from CHF

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4
Q

What are the six categories for the pathophysiological mechanisms ass. with “heart disease”?

A
  1. Pump Failure (“contractile failure” or “systolic dysfunction”)
  2. Obstructed Flow
  3. Regurgitant Flow
  4. Shunted Flow
  5. Disordered Cardiac Conduction
  6. Rupture of the Heart Wall or Major Vessel
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5
Q

What is the most common mechanism of heart failure?

A

Pump failure (contractile failure or systolic dysfunction)–> they myocytes contract too weakly and chambers are unable to completely empty

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6
Q

What is the results of the Pump failure mechanism for heart disease?

A

reduced Stroke Vol. and reduced Cardiac Output

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7
Q

What may cause the Obstructed Flow mechanism for heart disease? Why is this bad?

A
  • cardiac valve stenosis
  • systemic HTN

heart must pump harder to overcome it, therefore works harder

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8
Q

What mechanism of cause is it when the cardiac valves do not seal properly? Why is this an issue?

A

Regurgitant Flow –> allows blood to travel against direction of flow and requires heart to pump same unit of blood, increasing workload on heart

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9
Q

What is the MC reason for Regurgitant Flow?

A

cardiac valvular disease

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10
Q

What heart failure mechanism is it when blood is inappropriately diverted from one region of the heart to another? What does this result in?

A

Shunted Flow–> results in overloading cardiac tissue by increasing pressure/blood volume w/in that region receiving the shunted blood

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11
Q

Disordered Cardiac Conduction mechanism for heart failure may causes what?

A

cardiac arrythmias–> which may cause heart palpitations, or produce lethal sudden cardiac death if arrhythmia is prolonged/sustained

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12
Q

What may cause the Rupture of the Heart Wall or Major Vessel mechanisms for heart failure?

A

severe elevations in cardiac pressure or external trauma —> result in a “loss of circulatory continuity” and heart quickly fails

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13
Q

When does Heart Failure (CHF) occur?

A

when cardiac dysfunction causes insufficient cardiac output and the heart fails to meet body’s metabolic requirementes

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14
Q

What form of heart failure initially involves sufficient cardiac output, but elevated filling pressures are required to achieve this level of CO?

A

compensated heart failure

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15
Q

What form of heart failure occurs when the heart failure occurs due to an increased tissue demand? How common is this?

A

High-output heart failure

small minority of heart failure cases and is secondary to conditions

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16
Q

What conditions may High-output heart failure be secondary to?

A
  • Hyperthyroidism
  • severe anemia
  • large AV fistula
  • Paget Disease (occasionally)
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17
Q

What three things may heart failure occur due to?

A
  1. Systolic dysfunction
  2. Diastolic dysfunction
  3. Valvular dysfunction
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18
Q

What cause of heart failure is due to the result of inadequate myocardial contraction? What is this form frequently a result of?

A

Systolic dysfunction

HTN or CAD (an ischemia heart disease)

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19
Q

What is the reduced cardiac output from systolic dysfunction sometimes referred to as?

A

“forward failure”

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20
Q

What cause of heart failure is due to the results of inadequate cardiac relaxation and inadequate filling of cardiac chambers?

A

Diastolic dysfunction

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21
Q

What are common causes of Diastolic dysfunction?

A
  • myocardial fibrosis
  • cardiac amyloidosis
  • advanced concentric cardiac hypertrophy
  • constrictive pericarditis
  • secondary to pericardial tamponade
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22
Q

What cause of heart failure occurs following any valvular injury? What are causes of this?

A 
Valvular Dysfunction
Causes:
- age-related calcific stensosi
- infectious endocarditis
- Libman-Sacks endocarditis from Lupus
- Rheumatic Fever
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23
Q

What will “forward failure” due to systolic dysfunction result in?

A

an increase in “end-diastolic” volume and pressure and elevated venous blood volume and pressure—-> known as “backward failure”

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24
Q

Our cardiovascular system will attempt to adapt during early stages of heart failure from reduced myocardial contractility (systolic dysfunction). What are the 3 mechanisms of Compensated Heart Failure?

A
  1. Frank-Starling Mechanism
  2. Neurohumoral Activation
  3. Myocardial Structural Changes
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25
Q

What is it known as when we are able to maintain adequate cardiac output and tissue perfusion during hear failure?

A

compensated heart failure (3 mechanisms of it)

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26
Q

What is the Frank-Starling Mechanism of Compensated Heart Failure?

A

when increased end-diastolic volumes dilate the heart by stretching ind. myocystes—> causes increased systolic contraction and increased CO

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27
Q

What is the Neurohumoral Activation mechanism of Compensated Heart Failure?

A

ANS signals release of NE–> which increases HR and cardiac contractility to increase CO

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28
Q

What is the Myocardial Structural Changes mechanisms for Compensated Heart Failure?

A

overloading the cardiac myocytes stimulates increased sarcomere growth–> increasing thickness of myocytes –> causing concentric hypertrophy (primarily isolated to LV wall)

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29
Q

When pressure is overloading the heart, what type of cardiac hypertrophy is it most likely to cause? In what situations will this occur?

A

concentric cardiac hypertrophy

in times of prolonged systemic HTN or valvular stenosis

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30
Q

What is concentric cardiac hypertrophy?

A

= a pathological cardiac adaptation ass. with increased cardiovascular morbidity and mortality

sarcomeres are added “parallel to long axis of myocyte” which thickens cardiac muscle cells and grows INWARD to narrow iintraventricular space

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31
Q

What type of cardiac hypertrophy occurs in times of overloading the heart and is a NORMAL physiological response to high levels of endurance exercise?

A

eccentric cardiac hypertrophy

causes sarcomeres to be added “in series” with existing sarcomeres–> lengthening cardiac muscle cells–> producing a proportional increase in size of heart–> and an increase in intraventricular volume

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32
Q

T/F. Eccentric Cardiac Hypertrophy causes intraventricular obstruction, just like concentric cardiac hypertrophy.

A

False- Eccentric Cardiac hypertrophy does NOT cause intraventricular obstruction

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33
Q

What is Eccentric cardiac hypertrophy sometimes referred to as? What are some benefits of it?

A

“athlete’s heart” or “physiological hypertrophy”

  • increase cardiac efficiency
  • bradycardia
  • increase in myocardial capillary density
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34
Q

What do the benifits of compensated heart failure come as a cost to?

A

at a cost of increased oxygen consumption –> and overtime the three mechanisms of compensated heart failure begin to fail

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35
Q

What is it called when the mechanisms of compensated heart failure begin fail and the failing heart no longer can perfuse the body’s tissues?

A

Decompensated heart failure (cardiac decompensation)

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36
Q

What is the most common form of heart failure?

A

Left-Sided Heart failure

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37
Q

What is Left-Sided Heart Failure most likely to arise from?

A
  • ischemic heart disease (CAD)
  • systemic HTN
  • aortic or mitral valve disease
  • various cardiomyopathies
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38
Q

What kind of heart failure involves inadequate tissue perfusion and elevated “back-pressure” w/in the pulmonary circulation?

A

Left-sided heart failure

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39
Q

What will the “backward failure” of Left-sided heart failure produce?

A
  • increased pressure w/in pulmonary veins
  • pulmonary edema
  • pleural effusion
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40
Q

What are some clinical features of Left-sided Heart failure?

A
  • exertional dyspnea
  • dyspnea at rest or while sleeping
  • orthopnea
  • chronic coughing due to pulmonary edema or irritation
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41
Q

What are some more advanced features of Left-sided heart failure?

A
  • massive concentric hypertorphy of LV wall
  • tachycardia (>100 bpm)
  • rales (“crackles”)
  • bilateral pitting edema of ankles or sacral region
  • systemic cyanosis
  • fatigability
42
Q

What may the severe reductions in CO of Left-sided heart failure cause that deals with the CNS?

A

severe hypoperfusion to the CNS –> may cause “Hypoxic Encephalopathy”

43
Q

How does Hypoxic Encephalopathy due to severe reduced CO from Left-Sided heart failure manifest?

A
  • irritability
  • reduced cognitive fxning
  • stupor
  • coma
  • death
44
Q

What may be present upon biopsy of someone with advanced or chronic Left-sided heart failure?

A

“heart failure cells” (aka hemosiderin-containing macrophages)
–> due to high elevations in pulmonary vascular pressure that cause small areas of hemorrhage

45
Q

What is Right-Sided Heart failure most likely to develop from? Why?

A

following left-sided heart failure–> due to increased pressure w/in pulmonary circulation–> causing right-sided overloading

(therefore all causes of Left-sided heart failure may cause Right-sided)

46
Q

How do we describe the situation when left-sided heart failure causes right-sided heart failure?

A

Biventricular CHF

recall it is when left-sided heart failure causes right-sided heart failure

47
Q

What is Biventricular CHF a representation of?

A

decompensated heart failure (aka cardiac decompensation) that is affecting both sides of the heart

(more advanced stages of heart failure)

48
Q

What form of right-sided heart failure is much less common than left-sided heart failure causing it, and develops following pathologies that effect the lungs or cause pulmonary HTN?

A

Isolated right-sided heart failure (aka pure right-sided heart failure)

49
Q

What conditions can cause Isolated Right-sided heart failure?

A
  • pathologies of lungs
  • pulmonary HTN causes
  • pulmonary or tricuspid valve disease
  • left-to-right shunt
50
Q

What describes the altered structure and function of the right ventricle that develops following a disorder affecting the pulmonary system?

A

Cor pulmonale

51
Q

What does Cor pulmonale involve?

A

right-sided ventricular hypertrophy and dilation that are limited to the right ventricle and right atrium

52
Q

What is the common link b/w pulmonary pathologies and right-sided heart failure?

A

pulmonary HTN

53
Q

What are conditions that may cause increased pulmonary blood pressure and therefore Cor pulmonale?

A
  • cystic fibrosis
  • recurrent pulmonary emboli
  • conditions causing pulmonary fibrosis (i.e. silicosis)
54
Q

What are clinical features of Pure Right-sided heart failure?

A
  • systemic venous congestion
  • peripheral pitting edema
  • hepatic congestion
  • hepatomegaly
  • splenomegaly
  • ascites
  • jugular venous distention
55
Q

T/F. Pure right-sided heart failure is likely to involve pulmonary edema or respiratory symptoms.

A

False – it is unlikely to (it is NOT the same as left-sided heart failure)

56
Q

What are the three categories/ main groups of Congenital Heart Disease?

A
  1. Left-to-Right Cardiac Shunts
  2. Right-to-left cardiac shunts –
  3. obstructed blood flow (aortic coarctation)
57
Q

What are abnormalities of the heart or great vessels that are present at birth considered?

A

congenital heart diseases

58
Q

What percent of newborns are affected by congenital heart disease? What percent of all birth defects do cardiac malformations represent?

A

1% all newborns have congenital heart disease

30% of all birth defects are cardiac abnormalities

59
Q

T/F. Congenital heart disease commonly results from faulty embryogenesis, but more (90%) cases are idiopathic.

A

True

60
Q

What category is the most common form of congenital heart disease? What will this increase blood flow to?

A

left-to-right cardiac shunts

increase blood flow to pulmonary circulation

61
Q

What are three examples of congenital cardiac defects that produce left-to-right shunting of blood?

A
  1. Atrial Septal Defect
  2. Ventricular Septal Defect
  3. Patent Ductus Arteriosus
62
Q

What is a congenital defect, a hole, in the septum that divides the two cardiac atria following abnormal embryonic development or a foramen ovale that did close?

A

atrial septal defect

63
Q

What is the term for a foramen ovale that did not close during the first year of life? What type of shunted blood flow does this cause?

A

Patent foramen ovale

left-to-right cardiac shunt

64
Q

What are some symptoms of an atrial septal defect? When does this typically appear?

A

may go unnoticed for decades and asymptomatic until mid-to-later adulthood

  • increase in pulmonary blood volume
  • increase pulmonary HTN
  • hear murmur
  • exertional dyspnea
65
Q

Which are more likely to spontaneously close, atrial septal defects or ventricular septal defects?

A

ventricular septal defects

66
Q

What is the MC congenital heart defect? What percentage does this represent?

A

Ventricular septal defect– 42% of all such malformations

67
Q

What is a congenital defect in the septum that divides the two cardiac ventricles that develops following abnormal embryonic development? Which way does the blood flow?

A

Ventricular septal defect–> left-to-right shunt

68
Q

How common is it for Ventricular septal defects to close during childhood?

A

about 1/2 close

69
Q

What percentage of ventricular septal defects occur in isolation?

A

30% in isolation; much more likely to occur in ass. with other cardiac malformations

70
Q

What are the clinical features associated with large Ventricular Septal Defects?

A
  • hypertrophy of right ventricular wall
  • dilation of pulmonary artery (to accommodate flow)
  • pulmonary HTN
  • exertional dyspnea
  • chest pain
  • reduced CO that may cause syncope
71
Q

In severe cases of a Ventricular septal defect, what may the dramatic increase in pulmonary blood pressure cause?

A

reverse flow of blood through VSD (causing a right-to-left- shunt) and systemic cyanosis will quickly onset

72
Q

What involves a failure of the ductus arteriosus to transform into the ligamentum arteriosum?

A

Patent Ductus Arteriosus

73
Q

How does a Patent Ductus arteriosus allow the blood to flow? What type of blood shunt is this considered?

A

from aorta to left pulmonary artery

left-to-right shunt

74
Q

What percentage of congenital defects are a Patent Ductus arteriosum? Do they commonly occur in isolation or associated with another defect?

A

7%

commonly occur (90%) in isolation

75
Q

What causes a “harsh” “machinery-like” murmur?

A

Patent ductus arteriosus

76
Q

Smaller Patent ductus arteriosus are typically asymptomatic, but what may larger ones cause?

A
  • increase in pulmonary blood pressure
  • cough
  • tachycardia
  • may contribute to congestive heart failure or arrhythmias
77
Q

What will congenital cardiac defects that produce a right-to-left shunt cause blood to bypass?

A

to bypass the pulmonary circulation and distribute deoxygenated blood to peripheral circulation

78
Q

What do right-to-left shunts characteristically cause at birth?

A

cyanosis at birth and widespread hypoxic tissue injury

79
Q

What are two examples of right-to-left shunts?

A
  1. Tetralogy of Fallot

2. Transposition of the Great Vessels

80
Q

What is the most common cause of cyanotic congenital heart disease?

A

Tetralogy of Fallot

81
Q

What are the four components of Tetralogy of Fallot?

A
  1. Large ventricular septal defect
  2. Overriding aorta (overriding VSD)
  3. Right ventricular outflow obstruction
  4. Hypertrophy of the right ventricular wall
82
Q

What type of shunt does the Tetralogy of Fallot create?

A

a right-to-left shunt

blood goes from RV into exposed overriding aorta –> causes deoxygenated blood bypassing the lungs and be distributed to tissues of the body

83
Q

What will Tetralogy of Fallot cause an appearance of on a chest radiography?

A

“boot-shaped” appearance due to the hypertrophy of the right ventricular wall

84
Q

What involves the inappropriate attachment of the aorta to the right ventricle and the pulmonary artery to the left ventricle?

A

Transposition of the Great Arteries

85
Q

What type of blood shunt is the Transposition of the Great Arteries considered?

A

right-to-left shunt b/c the blood bypasses the lungs and deoxygenated blood is distributed to the body–> causing severe cyanosis

86
Q

What is the survival rate of someone with Transposition of the Great Arteries?

A

“incompatible with postnatal life” and needs emergency surgical correction, UNLESS a natural shunt exists

87
Q

What are the natural shunts that may improve prognosis of someone with Transposition of the Great Arteries?

A
  • ventricular septal defect
  • atrial septal defect
  • patent ductus arteriosus
88
Q

What other defect is present in about 30% of all cases of Transposition of the Great Arteries?

A

ventricular septal defects

but surgical correction w/in first month of life is still needed

89
Q

What part of term are infants with Transposition of the Great Arteries usually born? How does it manifest at birth?

A

born at term and will develop progressively worsening cyanosis that becomes obvious w/in a few hours after birth

90
Q

How do children born with Transposition of the Great Arteries along with a natural shunt manifest?

A

allows for mixing of oxygenated and deoxygenated blood

–> have features similar to CHF that only become evident w/in 3-6 wks after birth

91
Q

What is an example of a malformation that causes obstructed flow by a structural narrowing of inner aorta or an isolated “infolding” and represents about 5% of all congenital cardiac malformations ?

A

Aortic Coarctation (has two forms– Preductal or Postductal)

92
Q

Where is the area of narrowing associated with an Aortic Coarctation frequenlty located?

A

distal to left subclavian artery, near the ductus arteriosus/ligamentum arteriosum

93
Q

Does an Aortic Coarctation usually occur in isolation of with another malformation? What may that other malformation be?

A

can occur in isolation, but over 1/2 of all cases are associated with bicuspid aortic valve

94
Q

What are the two forms of Aortic Coarctation?

A
  1. Preductal (“infantile”) coarctation

2. Postductal (“adult”) coarctation

95
Q

Both types of Aortic Coarctation cause similar features, what are those features?

A

aortic narrowing creates pressure overloading the LV and also diverts greater blood volume to aortic branch vessels—> restricting flow to areas of body supplied by the thoracic aorta or branching arteries

96
Q

What type of Aortic Coarctation involves more severe narrowing and causes clinical features that are commonly recognized early in life, during infancy?

A

Preductal Coarctation

97
Q

What is a Preductal Coarctation accompanied by? How does this allow the blood to flow?

A

patent ductus arteriosus
–> blood now travels from pulmonary artery to thoracic aorta–> therefore may involve hypertrophy of the right ventricle

98
Q

What type of Aortic Coarctation involves smaller amounts of aortic narrowing and is much less severe and may remain asymptomatic throughout someone’s life and if features appear it is in adulthood?

A

Postductal Coarctation

99
Q

T/F. Postductal Coarctation is accompanied by a patent ductus arteriosus.

A

False- it is NOT (where as Preductal coarctation is)

100
Q

What are the features of Aortic Coarcatation?

A
  • HTN of upper extremities and head
  • HA
  • reduced lower extremity perfusion (cyanosis, cold legs, feet, vascular claudication)
  • dilated aortic branch vessels
  • cardiac murmur
  • palpable cardiac thrills
101
Q

What individuals are most likely to develop Aortic Coarctation?

A

males and inds with Turner Syndrome

System Pathology I -- Roecker (14 decks)

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