Heart Flashcards
Stable angina
chest pain with exertion
ST depression
What heat problem can be caused by hypertension causes left heart failure?
concentric left ventricular hypertrophy
Heart wall becomes thicker - more difficult to supply oxygen – longstanding hypertension leads to ischemia and eventual left heart failure
What is dilated cardiomyopathy?
heart chambers dilate strech walls and less efficient at contracting –> left ventricular dilated cardiomyopathy leads to lower ejection fraction and left heart failure
What is restrictive cardiomyopathy?
can’t fill the heart appropriately so can’t pump blood appropriately –> leads to left heart failure
What is the major consequence of left sided heart failure?
pulmonary hypertension/congestion
What symptoms are associated with pulmonary congestion secondary to left heart failure?
Pulmonary edema with dypsnea
Orthopnea
Crackles
Paroxysmal nocturnal dyspnea
What is paroxysmal nocturnal dyspnea? What causes it?
Dyspnea when you lay flat over period of hours
with orthopnea dyspnea occurs in minutes
Describe the consequence of microvessel hemmorage secondary to pulmonary hypertension
capillaries rupture > blood leaks into alveoli > macrophages enter alveoli to consume blood > iron from heme accumulates in macrophages (hemosiderin laden macrophages aka heart-failure cells)
What heart problem can cause activation of RAAS? What is the consequence?
left heart failure resulting in decreased forward perfusion
leads to to less renal blood flow and activation of juxtoglomerular apparatus, which triggers renin release from juxtoglomerular cells, which then leads to ATII and aldosterone ==> sodium/water reabsoption, increased blood volume and constriction of peripheral arterioles ==> hypertension ==> concentric LV hypertrophy and further left ventricular ischemia/worsening of congestive heart failure
What is most common cause of right heart failure?
left heart failure due to back up of blood into pulmonary circuit and back up of blood into right heart
What is the consequence of left to right shunting (left ventricular to right ventricular)
right heart failure - because more blood is pumping into right heart.
can be caused by ventricular septal defect
What is the pathophysiology leading to right heart failure from left to right ventricular shunt?
left to right shunt can result in equalization of pressure between left and right ventricals
right ventrical exhibits pressure induced hypertrophy
left ventrical exhibits volume hypertrophy
Describe the consequence of patent ductus arteriosis
ductus arteriosus connects pulmonary artery (containing deoxygenated blood) with the aorta. When opening persists the higher pressure in the aorta will shunt blood to the pulmonary circuit.
Because of the high pressure, pulmonary HTN will arise preventing blood from flowing from pulmonary artery
if pressure is high enough the blood will be sent back to aorta (descending branch) and cause cyanosis of lower extremities
describe the pathophysiology of atrioventricular septal defect
tbd
What is a consequence of chronic pulmonary disease?
hypoxia of pulmonary vessels causes them to constrict
What is core polmonoly?
right heart failure due to chronic long hypoxia and vascular constriction leading to increased pulmonary pressure and strain on right ventrical
Name the clinical consequences of hepatosplenomegaly
JVD
painful hepatosplenomegaly ==> cardiac cirrosis (cardogenic hepatic cerrosis)
increased hydrostatic pressure in lower extremities ==> dependent pitting edema
What congenital defect is associated with fetal alcohol syndrome?
ventricular septal defect (most common septal defect!)
What problem is vaused by ventricular septal defect?
left to right shunt
what will eventually happen from a left to right shunt?
Blood will initially flow from LV to RV during systole, increased ejection fraction of RV into pulmonary circuit cases pulmonary hypertension. Eventually pressure in right ventrical builds up so high that left to right shunt is reversed to form right to left shunt
What is the consequence of reversed left to right shunting secondary to ventricular septal defect?
Cyanosis - from right to left shunt secondary to pulmonary hypertension causes deoxygenated blood to be pumped into systemic circuit
What is Eisenmenger syndrome?
What are 3 consequences?
consequence of large ventricular septal deftect (inital L>R shunt, pulmonary hypertension, reversal R>L shunt
Cyanosis
Right ventricular hypertrophy
Polythycemia
What causes polythycemia? What congenital syndrome is it associated with? Do you understand why?
Decreased oxygenated blood (hypoxemia) detected by peritubular capillary interstial cells in the kidney that release secrete erythropoietin and cause more RBC production
associated with Eisenmenger syndrome
Reversed ventricular septal defect ==> cyanosis
What is associated with patent ductus arteriousus?
Rubella
What is keeps the patent ductus arteriosus open?
PGE
What is treatment for patent ductus arteriosus?
Indomethacin ==> decreases PGE (which keeps it open)
What are the 4 probalems caused by terology of fallot?
Stenosis of RV outflow
Right ventricular hypertrophy
Ventricular septal defect
Aorder that overrides vent septal defect
Transposition of great arteries can be treated with what?
PGE
-transposition creates 2 independent circuits that do not mix
PGE maintains patent ductus arteriosus alowing mixing
Will still be cyanotic
What is tricupid atresia?
tricuspid valve fails to form
Coarctation of the aorta in the adult is associated with what finding on chest xray?
Notching of the ribs (from engorged blood vessels that arise because high pressure above the stenosis of the aorta causes colateral flow along intercostal arteries)
What causes acute rhumatic fever?
beta-hemolitic strep infection of the throat that arises as a complication of pharangitis
affects children 2-3 weeks after strep throat
Caused by molecular mimicry - bacterial M protein resembles human tissues
Which valve is affected by acute or recurring rhumatic fever?
mitral valve
complication is endocarditis
When aorta is involved in chronic rhumatic heart disease, what might arise?
fusion of the commisures (liks between the valve flaps - leads to less blood out
**always mitral valve stenosis in chronic rhumatic fever
What are the clinical featurees of aortic regurgitation?
LV dilation with eccentric (volume overload) hypertrophy
Eccentric hypertrophy: sarcomeres are added series (big hart)
Concentric hypertrophy: sarcomeres are added in parallel (thick heart)
What are the features of aortic valve stenosis (regarding systolic/diastolic)
increased systolic pressure (because of eccentric hypertrophy), decreased diastolic pressure
What change in the left ventrical can lead to mitral valve regurgitation?
left ventriculat dialation – pulls valve flaps apart
What is the difference between chronic vs acute rhumatic hart disease with regard to the mitral valve?
Chronic results in stenosis
Acute results in mitral regurgitation
What heart sounds would you hear from mitral valve stenosis?
opening snap followed by diastolic rumble
What consequences would chronic rhumatic heart disease cause?
stenosis prevent all the blood from the left atrium to be pumped into the left ventrical
causes volume to increase and results in dilation of the left ventrical
pulmonary congestion arises leading to pulmonary hypertension
atrial fibrulation
pulmonary hypertension caused by mitral valve stenosis and pulmonary HTN can cause right heart failure
What are the “tetra” of problems caused by Tetrology of fallot ?
Tetrology of fallot
- VSD
- Over-riding aorta
- Pulmonary stenosis – degree of pulmonic stenosis determines degree of cyanosis
a. Squatting increases preload - Right ventricular hypertrophy
Does blood return to the heart with inspiration or expiration?
Inspiration causes decrease in intrathoracic pressure -> increased blood return
Expiration increases inthathoracic pressure which decreases return
What is the most common cause of endocarditis?
S. viridans - only causes endocarditis in previously damaged tissue like valve stenosis or rhumatic heart disease
results in small vegitations that do not destroy the valves
Small vegitations of S. veridans on heart valves are low virulance themselves. How can these vegitations lead to infectious endocarditis?
damaged endocardial surface developes thombotic vegitations filled with platelets and fibrin.
Secondary transient baceriemia can bind to these and that’s how shit gets real.
What is most common cause of acute endocarditits in IV drug abusers?
S. aureas - high virulance - infects normal valves like the tri-cuspid valve (unlike S. veridans which needs already sick valve - more often aortic or mitral) and results in large vegitations that DESTROY valve hence name acute (again unlike S. viridans)
What causes endocarditis in prosthetic implants?
S. epidermitidis
What causes endocarditis in patients with underlying colorectal carcinoma?
S. bovis
What can give endocarditis with negative blood cultures?
HACEK organisms - bugs are particularly difficult to grow
What are the HACEK organisms?
hemophilus actinobacillus cardiobacterium eikenella kingella
What are the clinical features of endocarditis?
Fever
Murmur
Janeway lesions (complications of septic emboli from thromotic vegitations - erythemitous non-tender lesions
Osler nodes - painful lesions on fingers and toes
Slinter hemorrhage (fingers - not necessarily painful)
Anemia of chronic disease
What are the lab findings of endocarditis?
Microcytic anemia
hepsidein - traps iron (and other acute phase reactants released by liver)
Trans-esophogeal echo - useful for detecting lesions on valves
What is leibman sachs endocarditis? Which valve does it affect?
Sterile vegitation associated with SLE
Mitral valvue - vegitation on both sides
Dilated cardiomyopathy is results in systolic or diastolic dysfunction?
Systolic - dilation so can’t pump out as much blood
Complications are regurgitation becuase of valve stretching and arythmias (due to stretching of the conduction system)
What is the most common cause of cadiomypoathy
myocarditis from cockakie virus - lymphcytic ilfiltrates in myocardium
pts get chest pain, arythimia, sudden death
if they survive - dilated cardiomyopathy
Cardiomyopathy is usually idiopathic but what are other causes?
infection with coxackie virus
alcohol abuse - dilated cardiomypathy
drugs (doxyrubicin, cocaine = dilated cario)
pregnancy
What is most common cause of death among athletes?
ventricular arrythmias secondary to hypertrophic cardiomyopathy (diastolic dysfunction) – can also cause syncope because typically affects the septum and creates a ‘stenosis’ for aortic outflow
What is restrictive cardiomyopathy?
Decreased compliance of ventricular endocardium - restricts filling during diastole
What is formular for ejection fraction?
stroke volume?
blood flow in the aorta (Q)?
SV/end diastolic volume (LV)
SV=end diastolic volume - end systolic volume
Q=SV*HR
What are 5 causes of restrictive cardiomyopathy?
Amyloidosis Sarcoidosis Hemochromatosis (iron overload = toxic) Endocardial fibroelasotis (usually in children) Loeffler syndrome
What is endocardial fibroelastosis?
epicardium gets covered in fibrosis and thus is less compliant - ventricle can’t fill = diastolic dysfunction
usually in children
What is loeffler syndrome?
eosinic infiltrate in the wall of the heart that results in fibrosis of endocardium and myocardium - ventrical can’t fill = diastolic dysfunction
usually in children
What is the common clinical presentation of cardiomyopathy?
congestive heart failure - Low voltage EKG with diminished QRS amplitude
What is a myxoma?
benign mesenchymal proliferation with gelatinous appearance
Abundant ground substance on histolgy
Most common primary cardiac tumor in ADULTS
usually grows in left atrium and causes syncopy due to obstruction of mitral valve due to formation of a peduculated mass
What is Rhabdomyoma?
benign harmartoma of cardiac muscle
most common primary cardiac tumor in CHILDREN
arises in the ventricles (as oposed to myxoma which arises in the atrium) and is often associated with tuberous sclerosis (potatoe brain)
T/F metastatic cardiac tumor are more common than primary tumors
true
most common causes are breast/lung carcinoma, meanoma, lympoma
typically involves pericardium and results in pericardial effusion (fluid in pericardial sac that exerts pressure on heart)
