February 13th and 18th Lectures Flashcards
What disease are the following risk factors associated with? Acquired valvular heart disease, implantation of prosthetic heart valves, ventricular septal defects, male
Infective endocarditis
What are some casual agents of infective endocarditis?
Bacteria, viruses, fungi, rickettsiae, parasites
What are the 3 critical elements required for infective endocarditis?
- Endocardium must be prepared for colonization
- Blood-borne microorganisms must adhere
- Adherent organisms must proliferate and promote propagation of infective endocardial vegetation
What are some classic findings of Infective endocarditis?
Fever, cardiac murmur, petechial lesions of the skin, conjunctiva and oral mucosa
What are the two types of myocardial diseases (general)?
Myocarditis and Cardiomyopathy
Which type of myocardial disease is acute and stormy?
Myocarditis
What is the cause of myocarditis?
Inflammation, leukocyte infiltration and necrosis of cardiac muscle cells
Many causes- North America- viral
What condition can myocarditis progress to?
Dilated cardiomyopathy
What do most types of cardiomyopathy result from?
Underlying cardiovascular disorders or secondary to infections, toxins, etc.
What are the three types of cardiomyopathy?
Dilated, Hypertrophic, Restrictive
What type of cardiomyopathy fits these facts?
Ventricular dilation, diminished myocardial contractility, decrease ejection fraction, increased EDV
dilated cardiomyopathy
What are common symptoms of dilated cardiomyopathy?
Dyspnea, fatigue, pulmonary congestion
Is dilated cardiomyopathy inflammatory or non-inflammatory
Inflammatory
What are the two types of hypertrophic cardiomyopathy?
- Asymmetrical septal
2. Hypertensive or valvular hypertrophic
What type of cardiomyopathy is idiopathic, from an autosomal dominant inherited disorder
Asymmetrical septal hypertrophy cardiomyopathy
What is the cause of hypertensive cardiomyopathy?
Increased resistance to ventricular ejection
What happens with restrictive cardiomyopathy?
Myocardium becomes rigid and non-compliant
Ventricular filling is impeded- diastolic pressure is raised
What other heart problem does restrictive cardiomyopathy mimic clinically?
Constrictive pericarditis
What are the two types of pericardial diseases?
Pericardial effusion
Pericarditis
What is a pericardial effusion?
Any accumulation of fluid in pericardial cavity
What happens if pericardial effusion has enough fluid to compress the heart
Cardiac tamponade
What side the of the heart is affected first by cardiac tamponade?
Right side, decreased atrial fluid first
What is pulsus paradoxus?
Arterial BP during expiration is 10 mm Hg greater than inspiration (sign of cardiac tamponade)
What are the two types of pericarditis?
Acute and Chronic
What type of pericarditis is often idiopathic, has a sudden onset of severe chest pain, and has a friction rub?
Acute pericarditis
What happens with chronic pericarditis?
Fibrous scarring with some calcification of pericardium
Visceral and parietal layers adhere
Heart becomes encased in rigid shell
What is a general term that describes several types of cardiac dysfunction that result in inadequate tissue perfusion?
Heart failure
In systolic heart failure, what increases with decreased contractility or excess plasma volume?
Preload (LVEDV)
What is the increased afterload in systolic heart failure associated with?
Hypertension or aortic valvular disease
What is the name for cardiac muscle weakness due to hypertension induced hypertrophy?
Hypertensive hypertrophic cardiomyopathy
What does RAA do?
Increase PVR and plasma volume
increase afterload and preload further
Why is RAA activated?
Because there is a fall in CO
What is the only helpful hormone in response to systolic heart failure?
Natriuertic peptide, as it causes blood volume to decreases thereby decreasing afterload
helps to excrete salt
What are the three main pathways that mediate heart failture
Baroreceptors –> SNS activation
RAA activation –> fluid retention
ventricular wall tension –> hypertrophy
Are the following forward or backward effects of left ventricular heart failure?
DOE, orthopnea, cough, cyanosis
Backward effects
What are some forward effects of left sided ventricular heart failure?
Fatigue, oliguria, increased HR, confusion
What diseases can lead to right heart failure?
COPD, CF, ARDS (Acute respiratory distress syndrome)
Are the following forward or backward effects of Right sided heart failure?
Hepatomegaly, ascites, splenomegaly, anorexia, subcutaneous edema, JVD
Backward syndromes
Are the following forward or backwards effects of right sided heart failure? Fatigue, oliguira, increase HR, faint pulses, restlessness, confusion, anxiety
Forward effects
What do flow reduction in the systemic circuit lead to?
Ischemia –> hypoxia
What is a blood clot attached to a vessel?
Thrombus
What is a detached thrombus called?
Thromboembolus
What are threats of arterial thrombi?
- Occlusion of artery
2. Thromboembolus causing occlusion at distant site
What is a bolus of matter circulating in the bloodstream?
Embolus
What is an air embolism?
Undissolved air (caused from IVs a lot)
What is a sudden involuntary constriction of arterial smooth muscle that obstructs flow?
Vasospasm
What is phlebitis
Inflammation of the intima of a vein
What is valvular incompetence?
When intimal fold of venous valves are damaged
What can valvular incompetence cause?
Varicose veins and chronic venous insufficiency
What is a localized dilation of arterial wall?
Aneurysms
What is AVF (arteriovenous fistulas)?
Abnormal communication b/w arteries and veins
What is Buerger Disease? (AKA Thromboangilitis obliterals)
Type of arteritis
Inflammatory disease of peripheral arteries
Inflammatory lesions accompanied by thrombi and vasospams
Can occlude and obliterate small and medium arteries in feet and hands
In what disease do fingers look like the American flag?
Raynaud Syndrome
What is the difference between Raynaud Syndrome and Raynaud phenomenon
Syndrome- attack of vasospasms in small arteries, idiopathic
Phenomenon- secondary to systemic disease
What is a true aneurysm?
Where all three tunics are affected
Subdivided into saccular or fusiform
What is a false aneurysm
At least one tunic is not affected
What is a dissecting aneurysm?
Tear in arterial wall that creates blood flow channel
What are symptoms of dissecting aortic aneurysms?
Sudden, severe, tearing pain in back and abdomen
What is it called when an embolism lodges in a major artery?
Acute arterial occlusion
What are the 6 Ps?
Describe symptoms of acute arterial occlusion
Pallor, parasthesia, paralysis, pain, polar, pulseless
What is the difference between varicose veins and chronic venous insufficiency?
Varicose veins involve superficial veins while chronic venous insufficiency involves deep vein valvular incompetence
What conditions promote DVT (deep vein thrombosis) ?
Venous stasis
Venous endothelial damage
Hypercoagulable states
What is the difference between primary and secondary lymphedema?
Primary- due to congenital absence or decreased number of lymphatics
Secondary- surgical removal of lymph nodes or destruction of lymphatics
What is secondary hypertension?
Caused by altered hemodynamics associated with a primary disease (ex- kidney failure)
Do parasymp or sympathetic nervous systems cause vasoconstriction?
Sympathetic nervous system
What does angiotensin II do?
Causes remodeling of blood vessels and hypertrophy of myocardium.
What do mutation in gene for adducin lead to?
An increased risk of hypertension
How does inflammation play a role in primary hypertension?
Endothelial damage and tissue ischemia cause release of inflammatory cytokines- chronically there is vasoconstriction and vessel remodeling
What is the majority of the pathology of primary hypertension caused by?
Influence renal sodium excretions and shift pressure-natriuresis relationship
What is secondary chronic orthostatic hypotension caused by?
Endocrine disorders- metabolic disorders, diseases of CNS and PNS
