Heart Disease Flashcards
What is a common kind of circulatory failure?
Chronic (congestive) heart failure (CHF)
With the onset of heart failure, __________________ are activated in order to maint adequate blood flow
Compensatory mechanisms
Ventricular dilation, myofiber hypertorphy and activation of neurohumoral mechanisms are examples of what
Compensatory mechanisms
__________ improves contraction by stretching the myofibers according to Frank Starling mechanisms
Ventricular dilation (compensatory mechanism)
_________ is associated with the heart’s decreased ability to maintain minimum levels of output and therapy may be required for cardiac survival
Decompensation
An increase in blood volume leads to what kind of hypertrophy of myocardium?
Left ventricular
Pathologic hypertrophy leads to ____________ while “physiologic” hypertrophy ____________
Anatomical and physiological changes that compromise cardiac function; seems to have little ill effect
What is the most common cause of CHF?
Left side ventricular failure
Causes of left side ventricular failure (3)
1 - Coronary heart disease (ischemic heart disease)
2 - Systemic HTN
3 - Aortic and mitral valve disease
Symptoms of left side ventricular failure (2)
1 - pulmonary congestion
2 - reduced output
Or, “backward failure” and “forward failure”
Symptoms of pulmonary congestion?
- breathless when lying down
- rusty sputum
- pleural effusion
Pulmonary congestion, “backward failure”
Symptoms of reduced output?
Low cardiac output leads to
- decreased arterial perfusion
- systemic hypoxia
Reduced output, “forward failure”
_______ ___________ contributes to pulmonary HTN and RIGHT ventricular failure but develops in the absence of left ventricular failure.
Mitral stenosis
Outline the steps of left ventricular failure
Low output
Systemic hypoxia
Overfilling of left atrium leading to:
- pulmonary HTN and edema
Can also then lead to right ventricular failure (AKA combined failure)
Outline the steps of RIGHT ventricular failure
Overfilling right atrium
Increased central venous pressure
Overfilling systemic veins and capillaries
Chronic venous congestion, systemic edema with cyanosis leading to
- Reduced output to lungs
_____________ is characterized by chronic congestion of systemic veins, systemic edema and cyanosis
RIGHT ventricular failure
Including: jugular veins, congestion and distension of liver
List contributing causes of RIGHT ventricular failure (2)
- left heart failure (most common)
- diseases of lung and pulmonary arteries (because lung diseases restrict blood flow through lungs)
Disease of lung and pulmonary arteries can cause right ventricular failure. Examples include
Chronic bronchitis Emphysema Silicosis Cystic fibrosis Severe kyphoscoliosis
Fullness of neck and abdomen (from subQ edema) and a nutmeg pattern on the liver suggests
RIGHT ventricular failure
What are the major heart diseases (4) that (nearly) all lead to CHF?
1 - Ischemic heart disease (most common)
2 - Systemic HTN heart disease
3 - Pulmonary HTN
4 - Congenital heart disease
What are the 4 variants of ischemic heart disease (IHD)?
1 - chronic ischemic heart disease
2 - angina pectoris
3 - myocardial infarction
4 - sudden cardiac death
What type of ischemic heart disease (IHD) is characterized by progressive myocardial atrophy and fibrosis from artherosclerotic disease with fixed (stable plaques) coronary artery stenoses?
Chronic ischemic heart disease (CIHD)
What is the most common symptom of IHD that is characterized by pain of myocardial ischemia WITHOUT infarction (but still increased risk)?
Angina pectoris
Deep paroxysmal pain in precordial region that lasts <30 minutes and may be relieved by rest or administration of nitrites
“Angina”
Pt says they have pain when the climb stairs or when they are in cold weather; the pain stops when they sit down. They also say they have been having pain at work during a particularly stressful week. What might this be?
“Stable” angina
Provoked by increased HR and BP, usually relieved by rest and vasodilators
Pt says they randomly get attacks of pain no matter if they are climbing up stairs or sitting at their desk. When they sit down, the pain does not go away.
“Unstable” angina
Random, unpredictable, NOT relieved by rest.
Note: Of the angina family, this is the MOST likely to contribute to infarction
A different kind of chest pain, not called “angina,” appears to be caused by coronary artery spasms. Does respond to vasodilators. What is it?
Prinzmetal
Note: Of the angina family, this is the LEAST likely to contribute to infarction
What kind/symptom of IHD usually results from thrombotic occlusion of one or more atherosclerotic coronary artery segments?
Myocardial infarction
Where is a common location for myocardial infarction?
Left ventricle (95% of the time)
What kind of symptoms/lab findings will you see that would lead you to think myocardial infarction?
- angina (50% of the time)
- pallor, anxiety, sweating, nausea, breathlessness (66%)
- ECG changes including altered rhythm and irregular cardiac cycle
- lab findings like increased enzymes CPK (creative kinase enzyme) and LDH (lactate dehydrogenase) and troponin levels (regulator of Calcium-mediated muscle contractions)
- female > male
High BP in systemic arterial circulation can damage walls of arteries, arterioles and left ventricle of the heart. What kind of heart disease is this?
Systemic hypertensive heart disease
Why is the left ventricle enlarged in systemic hypertensive heart disease?
Left ventricle responds to increased BP by hypertrophy. This is a compensatory mechanism. Eventually the hypertrophied muscle outgrows its O2 supply and angina and cardiac failure result.
What are the classifications of HTN?
- 2˚ HTN
- 1˚ or essential (idiopathic) HTN
- Benign
- Malignant
What is the most common classification of HTN?
1˚ / essential HTN (90-95% cases)
What is the most evil classification of HTN?
Malignant
What causes malignant HTN?
2˚ HTN most often due to renal failure that rapidly progresses with damage, necrosis and thrombosis of renal arteries and arterioles
Note: malignant HTN is when diastolic (not systolic) is over 120mmHg
Why does 1˚ / essential HTN happen?
Don’t know. Likely family history, racial variations, lifestyle patterns, stress influence, obesity, alcohol, insufficient physical activity, likely excessive salt consumption
__________________ is a common consequence of many conditions that affect the lung and heart. Long term results include RIGHT ventricular and atrial hypertrophy and dilation, hoarseness and chest pain
Pulmonary HTN (hypertension)
_____ _______ is defined as RIGHT ventricular hypertrophy secondary to pulmonary HTN
Cor pulmonaie
What is the most common heart disease under the age of 4?
Congenital heart disease
What are contributing factors to congenital heart disease?
- chromosomal abnormalities
- familial patterns, Marfan’s, etc
- environment: drugs, rubella/infectious disease, maternal diabetes/smoking/alcohol
** this is mostly just FYI **
What is the kind of congenital heart disease that is asymptomatic at birth because it promotes left to right shunting of blood, allowing for adequate oxygenation of systemic arterial blood?
Acyanotic shunts
What type of congenital heart disease is symptomatic at birth because it promotes right to left shunting of blood?
Cyanotic shunts
Which shunt promotes L to R flow, which allows for adequate O2 of systemic arterial blood?
Acynotic shunts (eventually the shunt is overpowered and flow ends up reversing, which is when you find out)
Contrast: Cyanotic shunts promote R to L flow, which is why there are symptoms at birth.
Define and list the Tetralogy of Fallot (4)
Most common cause of neonatal cyanotic shunts
1 - interventricular septal defect
2 - overriding aorta
3 - pulmonary arterial stenosis
4 - RIGHT ventricular hypertrophy
What is the inflammation and degeneration of endocardium and cardiac valves?
Endocarditis
What kind of endocarditis gives rise to sterile valvular vegetations (fibrin, debris, other elements) which may become organized and deformed?
Non-bacterial (non-infectious) endocarditis
E.g. thrombotic endocarditis, rheumatic fever, systemic lupus erythematosus
What kind of endocarditis can be caused by virtually any infectious agent including opportunistic infections?
Infectious endocarditis
What is an acute, systemic, posstreptococcal inflammatory disease (strep throat) that affects the joints, serosa, skin, CNS, blood vessels, and more, with the greatest effects on the heart valves?
Rheumatic fever (RF) which can lead to rheumatic heart disease
The chronic phase of rheumatic fever is characterized by scarring and dysfxn of what
Cardiac valves
In the chronic phase of rheumatic fever when there is scarring and dysfxn of cardiac valves, what characteristic feature will you see?
- Aschoff bodies which are small focal granulomas in the myocardium
- pancarditis which is inflammation of all layers of the heart (“bread and butter pericarditis” which causes friction rub and adhesions)
- valvular vegetations along lines of valve closures (most often on the left side of heart)
What is a multisystemic autoimmune (AI) disorder with multiple autoantibodies
Systemic lupus erythematosus (SLE)
What are the non-bacterial vegetations of cardiac valves associated with SLE?
Libman Sachs endocarditis
SLE, Systemic Lupus Erythematosus
What valves are affected most often and are causes of heart failure and pulmonary congestion in most acquired valve disease?
Mitral (65-70%) and aortic (25%)
The valve disease _______ _______ is most commonly caused by rheumatic fever. 2/3 patients are females.
Mitral stenosis
The valve disease _______ _______ causes dilation and hypertrophy of left atrium, pulmonary hypertension and edema.
Mitral regurgitation
The valve disease _______ _______ _______ is the 2nd most common valvular disorder. Usually asymptomatic but potential symptoms include vague chest pain, decreased exercise tolerance.
Mitral valve prolapse (floppy mitral valve)
The valve disease _______ _______ is the most common valve abnormality. Reducing aortic aperture by 2/3+ contributes to left ventricular hypertrophy and complications. Calcification may extend into conducting tissue.
Aortic stenosis
The valve disease _______ _______ occurs with dilation of aortic valve ring or degeneration of valve cusps (e.g. RF, endocarditis, AS, dissecting aneurysm or syphillis)
Aortic regurgitation
The valves __________ and ________ are rarely affected by RF and may be slightly incompetent in healthy subjects.
Tricuspid and pulmonary
Syphilitic heart disease is associated with what stage of syphilis?
Tertiary
In syphilitic heart disease, the left ventricle hypertrophied 4x its normal size. What is the name of this?
Cor bovinum
What is inflammation of the pericardium and what are contributing causes?
Pericarditis: infection, myocardial infarct, CT disorders, malignancy, radiation, idiopathic factors
What kind of pericarditis is associated with invasive tumors and mild hypersensitivity disease and causes straw-colored abuminous fluid?
Serous pericarditis
_________ pericarditis is characterized by shaggy fibrinous exudates on the pericardium caused by RF, SLE, cardiac surgery, trauma, myocardial infarction, irradiation, etc.
Fibrinous
What kind of pericarditis is associated with pyogenic infections and accumulation of pus inside pericardium?
Suppurative pericarditis
What kind of pericarditis is associated with TB?
Casseous pericarditis
______ _________ are fluid accumulations within pericardium
Pericardial effusions
Normal contains 30-50ml but can increase to 100-300ml with this condition
_______ is associated with transudates from CHF and hypoproteinemia
Hydropericardium
_______ is associated with lymphatic obstruction resulting in a “milky” fluid accumulates that contains fats absorbed and transported by lymph from small intestine
Chylous pericardium
______ is hemorrhage into pericardium.
Hemopericardium
Causes: thoracic trauma, ruptured aneurysms of heart or aorta, myocardial infarct, penetrating abscesses or tumors
Constrictive pericarditis is associated with calcification scars that may become calcified. These are known as:
Concretio cordis
“Heart muscle disease”
Cardiomyopathy
Why does cardiomyopathy happen and what age group does it affect?
Don’t know; any age
What kind of necrosis is seen with myocardial infarction?
Ischemic (Coagulation) necrosis
_______ tissue is most poorly perfumed and most infarcts start out here as laminar infarcts.
Subendocardial
Congenital narrowing of the aortic arch which restricts flow
Coarctation
Called preductal/infantile coarctation if narrowing is severe and requires surgery early on
Called postductal/adult coarctation if narrowing is less severe and permits longer survival
Other than symptoms associated with the heart, what other symptoms are present in the chronic phase of rheumatic fever?
- migratory polyarthritis
- syndeham’s chorea (worm-like movements)
- subcutaneous nodules on extremities
- erythema marginatum (spreading rash)
Primary heart muscle disease of undetermined origin
Idiopathic Cardiomyopathy
If anterior interventricular artery is occluded causing ischemia, what part of the heart is affected?
Anterior wall of L ventricle and adjacent septum
If the right coronary artery is occluded causing ischemia, what part of the heart is affected?
Posterior wall of L ventricle and adjacent septum
If the left circumflex artery is occluded and causes ischemia, what part of the heart is affected?
Lateral wall of L ventricle
An abrupt onset of pulmonary hypertension due to sudden embolization, leading to right ventricular failure
Acute cor pulmonale
Chronic pulmonary hypertension from COPD, emphysema or other pulmonary fibrosis/scarring, leading to right ventricular hypertrophy
Chronic cor pulmonale
How does tertiary syphilis progress to heart disease?
It causes inflammation of primarily the ascending aorta (aortitis) which degenerates and scars the tunica media and causes “tree-braking” of the intima”. This causes dilation/aneurysm of the aorta and the media continues to degrade. Aneurysmal dilation of the proximal aorta will lead to left ventricular hypertrophy and aortic valvular insufficiency.
