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Pathology II > Heart Dis-Ease > Flashcards

Heart Dis-Ease Flashcards

1
Q

Major sources of cardiac pain

A
  1. Myocardial Ischemia

2. Pericarditis

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2
Q

Circulatory Failure is associated with

A

an inability to maintain adequate blood flow to the tissues

  1. Acute Heart Failure
  2. Chronic Heart Failure
  3. Compensatory mechanisms
  4. Decompensation
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3
Q

Contributing factors to circulatory failure

A
  1. Insufficient cardiac output (heart failure)

2. Marked reductions in circulating blood volume (hemorrhage, acute dehydration, septic shock)

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4
Q

Acute Heart Failure: Course

A

Rapidly progressive; associated with medical emergencies

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5
Q

Acute Heart Failure: Causes

A

infarcts, aortic/ventricular rupture, cardiac arrest, large emboli

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6
Q

Chronic (Congestive) Heart Failure (CHF): onset is preceded by

A
  1. Myocardial hypertrophy

2. Compensatory response to increased workload in a compromised heart

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7
Q

CHF: Populations

A
  1. 5 million affected each year

2. 2% at 50 => 10% at 80

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8
Q

CHF: Prognosis

A
  1. Recurrent with poor prognosis

2. 300,000 deaths due to CHF

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9
Q

CHF: General Features

A
  1. Congestion
  2. Pooling of blood in veins
  3. Reduced/Low arterial flow
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10
Q

CHF Underlying causes

A
  1. Myocardial dysfunction
  2. Impaired ventricular filling
  3. Increased cardiac workload
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11
Q

CHF: Myocardial dysfunction: General features

A
  1. Most common
  2. Ischemic and Non-ischemic
  3. Conduction disturbances
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12
Q

CHF: Impaired ventricular filling: associated with

A
  1. Increased cardiac stiffness (diastolic dysfunction
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13
Q

CHF: Impaired ventricular filling: Causes

A
  1. L. ventricular hypertrophy
  2. amyloid
  3. pericardial fibrosis
  4. rigidity
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14
Q

CHF: Increased cardiac workload: synonyms

A
  1. hypertenstion
  2. valve lesions
  3. high output failure
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15
Q

Compensatory mechanisms: definition

A

Mechanisms that are activated in order to maintain adequate blood flow. They may initially maintain cardiac output at adequate levels, but they also contribute signs of heart failure and other deleterious effects

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16
Q

Compensatory mechanisms: types

A
  1. Ventricular dilatation
  2. Myofiber hypertrophy
  3. Neurohumoral mechanism activation
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17
Q

Ventricular dilatation: Mechanism

A

improves contraction by stretching the myofibers according the the Frank Starling mechanism

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18
Q

Myofiber hypertrophy: Mechanism

A

increased myocardial mass augments contractile forces

19
Q

The 3 types of Nuerohumoral mechanisms

A
  1. Increased sympathetic nerve activity
  2. Activate the renin-angiotensin-aldosterone system
  3. Secretion of atrial natriuretic peptide
20
Q

Neurohumoral mechanism: Sympathetic activity

A
  1. serves to increase heart rate
  2. augment ventricular contraction
  3. activate vasomotor responses
21
Q

Neurohumoral mechanism: Renin-Angiotensin-Aldosterone

A
  1. Promote retention of Na and Water

2. Expand the circulating blood volume

22
Q

Decompensation: Definition

A

associated with a decreased ability to maintain minimum levels of output.

23
Q

Decompensation: Circulatory disturbances are

A
  1. more severe
  2. progressive
  3. symptomatic
  4. supportive therapy is required if patient is to survive
24
Q

Decompensation: Therapeutic agents

A

Concerned with improving the unwanted effects of pulmonary congestion and fluid retention to improve Cardiac Output

  1. Diuretics, nitrates, ACE
  2. Digitalis to augment myocardial contraction
25
Q

Decompensation: Contributing factors

A
  1. Progressive deterioration
  2. Increased circulating blood volume
  3. Hypertrophy of myocardium
26
Q

Decompensation: Progressive deterioration

A

Progressive deterioration of the myocardium due to underlying disease

  1. Fibrosis
  2. Chronic ischemic atrophy
27
Q

Decompensation: Increased circulating blood volume

A
  1. Places an additional hemodynamic burden on the heart
  2. ultimately contributes to ventricular dilation and over-stretching
  3. decreased force of contraction (Frank Starling)
28
Q

Decompensation: Hypertrophy of Myocardium: Definition

A

Increased thickness of . ventricle and increased mass

29
Q

Decompensation: Hypertrophy of Myocardium: Pathologic changes lead to:

A

Anatomical and Physiological changes that compromise cardiac function

30
Q

Decompensation: Hypertrophy of myocardium: Pathological hypertrophy include

A
  1. Appearance of abnormal myosin
  2. myocardial fibrosis
  3. decresed capillary to myocyte ratio
  4. decreased sequestration of calcium
  5. diminished sympathetic function
  6. decreased beta-adrenergic r/c’s and depletion of catecholamines in sympathetic terminals
31
Q

Features of Heart Failure

A
  1. Left side (ventricular)

2. Right ventricular failure

32
Q

Heart Failure: Left Side: Etiology

A
  1. Coronary Heart Disease
  2. Systemic hypertension and its complications
  3. Aortic and mitral valve disease - stenosis/insufficiency
  4. Congenital conditions - septal defects, patent ductus arteriosus, aortic coarctation
  5. Cardiomyopathy
33
Q

Heart Failure: Manifestations

A
  1. Pulmonary congestion
  2. Reduced output
  3. Tachycardia - “weak pulse”
  4. “Poor circulation” with reduced tolerance to cold temperatures
34
Q

Heart Failure: Manifestations: Pulmonary Congestion: Cause

A

Congestion of the left ventricle contributes to elevated pulmonary venous pressure and pulmonary edema.

35
Q

Heart Failure: Manifestations: Pulmonary Congestion: Symptoms

A
  1. Dyspnea after rest or exercise

2. Othopnea

36
Q

Orthopnea: definition

A

feeling of being out of breath when lying flat, and improves when sitting up

37
Q

Heart Failure: Manifestations: Pulmonary Congestion: Paroxysmal nocturnal dyspnea: Cause

A

when edema fluids from the periphery are redistributed to the lungs wen the patient lies flat at night. Gives rise to rapidly progressive dyspnea which makes the patient sit up or lean out of the window to get “fresh air”

38
Q

Heart Failure: Manifestations: Pulmonary Congestion: Paroxysmal nocturnal dyspnea: other features

A
  1. Dyspnea and increased fatigue with mild exercise
  2. Pulmonary “Rales”
  3. Large volumes of frothy white sputum that may be tinged with blood (rusty sputum)
  4. Pleural effustion - severe may compress lungs
39
Q

Heart Failure: Manifestations: Reduced Output

A

Forward Failure

40
Q

Heart Failure: Manifestations: Reduced Output: Contributes to

A

low cardiac output contributes to decreased arterial perfusion and systemic hypoxia

41
Q

Heart Failure: Manifestations: Reduced Output: Renal ischemia activates…

A

activates vasopressor mechanisms and contributes to increased retention of fluids

  1. vasopressor mechanisms activated
  2. severe renal ischemia may cause tubular injury and renal failure
42
Q

Heart Failure: Manifestations: Reduced Output: Advanced stages

A

Organs may become hypoxic

CNS - anxiety, reduced attention span, restlessness, irritability, visual dimness

43
Q

Mitral stenosis contributes to pulmonary hypertension and right ventricular failure, BUT…

A

this develops in the absence of left ventricular failure.

Pathology II (3 decks)

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