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Pathology II > Heart Disease > Flashcards

Heart Disease Flashcards

1
Q

What is a common kind of circulatory failure?

A

Chronic (congestive) heart failure (CHF)

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2
Q

With the onset of heart failure, __________________ are activated in order to maint adequate blood flow

A

Compensatory mechanisms

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3
Q

Ventricular dilation, myofiber hypertorphy and activation of neurohumoral mechanisms are examples of what

A

Compensatory mechanisms

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4
Q

__________ improves contraction by stretching the myofibers according to Frank Starling mechanisms

A

Ventricular dilation (compensatory mechanism)

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5
Q

_________ is associated with the heart’s decreased ability to maintain minimum levels of output and therapy may be required for cardiac survival

A

Decompensation

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6
Q

An increase in blood volume leads to what kind of hypertrophy of myocardium?

A

Left ventricular

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7
Q

Pathologic hypertrophy leads to ____________ while “physiologic” hypertrophy ____________

A

Anatomical and physiological changes that compromise cardiac function; seems to have little ill effect

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8
Q

What is the most common cause of CHF?

A

Left side ventricular failure

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9
Q

Causes of left side ventricular failure (3)

A

1 - Coronary heart disease (ischemic heart disease)
2 - Systemic HTN
3 - Aortic and mitral valve disease

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10
Q

Symptoms of left side ventricular failure (2)

A

1 - pulmonary congestion
2 - reduced output

Or, “backward failure” and “forward failure”

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11
Q

Symptoms of pulmonary congestion?

A
  • breathless when lying down
  • rusty sputum
  • pleural effusion

Pulmonary congestion, “backward failure”

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12
Q

Symptoms of reduced output?

A

Low cardiac output leads to

  • decreased arterial perfusion
  • systemic hypoxia

Reduced output, “forward failure”

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13
Q

_______ ___________ contributes to pulmonary HTN and RIGHT ventricular failure but develops in the absence of left ventricular failure.

A

Mitral stenosis

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14
Q

Outline the steps of left ventricular failure

A

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)

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15
Q

Outline the steps of RIGHT ventricular failure

A

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
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16
Q

_____________ is characterized by chronic congestion of systemic veins, systemic edema and cyanosis

A

RIGHT ventricular failure

Including: jugular veins, congestion and distension of liver

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17
Q

List contributing causes of RIGHT ventricular failure (2)

A
  • left heart failure (most common)

- diseases of lung and pulmonary arteries (because lung diseases restrict blood flow through lungs)

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18
Q

Disease of lung and pulmonary arteries can cause right ventricular failure. Examples include

A 
Chronic bronchitis
Emphysema
Silicosis
Cystic fibrosis
Severe kyphoscoliosis
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19
Q

Fullness of neck and abdomen (from subQ edema) and a nutmeg pattern on the liver suggests

A

RIGHT ventricular failure

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20
Q

What are the major heart diseases (4) that (nearly) all lead to CHF?

A

1 - Ischemic heart disease (most common)
2 - Systemic HTN heart disease
3 - Pulmonary HTN
4 - Congenital heart disease

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21
Q

What are the 4 variants of ischemic heart disease (IHD)?

A

1 - chronic ischemic heart disease
2 - angina pectoris
3 - myocardial infarction
4 - sudden cardiac death

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22
Q

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?

A

Chronic ischemic heart disease (CIHD)

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23
Q

What is the most common symptom of IHD that is characterized by pain of myocardial ischemia WITHOUT infarction (but still increased risk)?

A

Angina pectoris

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24
Q

Deep paroxysmal pain in precordial region that lasts <30 minutes and may be relieved by rest or administration of nitrites

A

“Angina”

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25
Q

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?

A

“Stable” angina

Provoked by increased HR and BP, usually relieved by rest and vasodilators

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26
Q

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.

A

“Unstable” angina

Random, unpredictable, NOT relieved by rest.

Note: Of the angina family, this is the MOST likely to contribute to infarction

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27
Q

A different kind of chest pain, not called “angina,” appears to be caused by coronary artery spasms. Does respond to vasodilators. What is it?

A

Prinzmetal

Note: Of the angina family, this is the LEAST likely to contribute to infarction

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28
Q

What kind/symptom of IHD usually results from thrombotic occlusion of one or more atherosclerotic coronary artery segments?

A

Myocardial infarction

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29
Q

Where is a common location for myocardial infarction?

A

Left ventricle (95% of the time)

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30
Q

What kind of symptoms/lab findings will you see that would lead you to think myocardial infarction?

A
  • 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
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31
Q

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?

A

Systemic hypertensive heart disease

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32
Q

Why is the left ventricle enlarged in systemic hypertensive heart disease?

A

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.

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33
Q

What are the classifications of HTN?

A
  • 2˚ HTN
  • 1˚ or essential (idiopathic) HTN
  • Benign
  • Malignant
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34
Q

What is the most common classification of HTN?

A

1˚ / essential HTN (90-95% cases)

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35
Q

What is the most evil classification of HTN?

A

Malignant

36
Q

What causes malignant HTN?

A

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

37
Q

Why does 1˚ / essential HTN happen?

A

Don’t know. Likely family history, racial variations, lifestyle patterns, stress influence, obesity, alcohol, insufficient physical activity, likely excessive salt consumption

38
Q

__________________ 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

A

Pulmonary HTN (hypertension)

39
Q

_____ _______ is defined as RIGHT ventricular hypertrophy secondary to pulmonary HTN

A

Cor pulmonaie

40
Q

What is the most common heart disease under the age of 4?

A

Congenital heart disease

41
Q

What are contributing factors to congenital heart disease?

A
  • chromosomal abnormalities
  • familial patterns, Marfan’s, etc
  • environment: drugs, rubella/infectious disease, maternal diabetes/smoking/alcohol

** this is mostly just FYI **

42
Q

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?

A

Acyanotic shunts

43
Q

What type of congenital heart disease is symptomatic at birth because it promotes right to left shunting of blood?

A

Cyanotic shunts

44
Q

Which shunt promotes L to R flow, which allows for adequate O2 of systemic arterial blood?

A

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.

45
Q

Define and list the Tetralogy of Fallot (4)

A

Most common cause of neonatal cyanotic shunts

1 - interventricular septal defect
2 - overriding aorta
3 - pulmonary arterial stenosis
4 - RIGHT ventricular hypertrophy

46
Q

What is the inflammation and degeneration of endocardium and cardiac valves?

A

Endocarditis

47
Q

What kind of endocarditis gives rise to sterile valvular vegetations (fibrin, debris, other elements) which may become organized and deformed?

A

Non-bacterial (non-infectious) endocarditis

E.g. thrombotic endocarditis, rheumatic fever, systemic lupus erythematosus

48
Q

What kind of endocarditis can be caused by virtually any infectious agent including opportunistic infections?

A

Infectious endocarditis

49
Q

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?

A

Rheumatic fever (RF) which can lead to rheumatic heart disease

50
Q

The chronic phase of rheumatic fever is characterized by scarring and dysfxn of what

A

Cardiac valves

51
Q

In the chronic phase of rheumatic fever when there is scarring and dysfxn of cardiac valves, what characteristic feature will you see?

A
  • 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)
52
Q

What is a multisystemic autoimmune (AI) disorder with multiple autoantibodies

A

Systemic lupus erythematosus (SLE)

53
Q

What are the non-bacterial vegetations of cardiac valves associated with SLE?

A

Libman Sachs endocarditis

SLE, Systemic Lupus Erythematosus

54
Q

What valves are affected most often and are causes of heart failure and pulmonary congestion in most acquired valve disease?

A

Mitral (65-70%) and aortic (25%)

55
Q

The valve disease _______ _______ is most commonly caused by rheumatic fever. 2/3 patients are females.

A

Mitral stenosis

56
Q

The valve disease _______ _______ causes dilation and hypertrophy of left atrium, pulmonary hypertension and edema.

A

Mitral regurgitation

57
Q

The valve disease _______ _______ _______ is the 2nd most common valvular disorder. Usually asymptomatic but potential symptoms include vague chest pain, decreased exercise tolerance.

A

Mitral valve prolapse (floppy mitral valve)

58
Q

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.

A

Aortic stenosis

59
Q

The valve disease _______ _______ occurs with dilation of aortic valve ring or degeneration of valve cusps (e.g. RF, endocarditis, AS, dissecting aneurysm or syphillis)

A

Aortic regurgitation

60
Q

The valves __________ and ________ are rarely affected by RF and may be slightly incompetent in healthy subjects.

A

Tricuspid and pulmonary

61
Q

Syphilitic heart disease is associated with what stage of syphilis?

A

Tertiary

62
Q

In syphilitic heart disease, the left ventricle hypertrophied 4x its normal size. What is the name of this?

A

Cor bovinum

63
Q

What is inflammation of the pericardium and what are contributing causes?

A

Pericarditis: infection, myocardial infarct, CT disorders, malignancy, radiation, idiopathic factors

64
Q

What kind of pericarditis is associated with invasive tumors and mild hypersensitivity disease and causes straw-colored abuminous fluid?

A

Serous pericarditis

65
Q

_________ pericarditis is characterized by shaggy fibrinous exudates on the pericardium caused by RF, SLE, cardiac surgery, trauma, myocardial infarction, irradiation, etc.

A

Fibrinous

66
Q

What kind of pericarditis is associated with pyogenic infections and accumulation of pus inside pericardium?

A

Suppurative pericarditis

67
Q

What kind of pericarditis is associated with TB?

A

Casseous pericarditis

68
Q

______ _________ are fluid accumulations within pericardium

A

Pericardial effusions

Normal contains 30-50ml but can increase to 100-300ml with this condition

69
Q

_______ is associated with transudates from CHF and hypoproteinemia

A

Hydropericardium

70
Q

_______ is associated with lymphatic obstruction resulting in a “milky” fluid accumulates that contains fats absorbed and transported by lymph from small intestine

A

Chylous pericardium

71
Q

______ is hemorrhage into pericardium.

A

Hemopericardium

Causes: thoracic trauma, ruptured aneurysms of heart or aorta, myocardial infarct, penetrating abscesses or tumors

72
Q

Constrictive pericarditis is associated with calcification scars that may become calcified. These are known as:

A

Concretio cordis

73
Q

“Heart muscle disease”

A

Cardiomyopathy

74
Q

Why does cardiomyopathy happen and what age group does it affect?

A

Don’t know; any age

75
Q

What kind of necrosis is seen with myocardial infarction?

A

Ischemic (Coagulation) necrosis

76
Q

_______ tissue is most poorly perfumed and most infarcts start out here as laminar infarcts.

A

Subendocardial

77
Q

Congenital narrowing of the aortic arch which restricts flow

A

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

78
Q

Other than symptoms associated with the heart, what other symptoms are present in the chronic phase of rheumatic fever?

A
  • migratory polyarthritis
  • syndeham’s chorea (worm-like movements)
  • subcutaneous nodules on extremities
  • erythema marginatum (spreading rash)
79
Q

Primary heart muscle disease of undetermined origin

A

Idiopathic Cardiomyopathy

80
Q

If anterior interventricular artery is occluded causing ischemia, what part of the heart is affected?

A

Anterior wall of L ventricle and adjacent septum

81
Q

If the right coronary artery is occluded causing ischemia, what part of the heart is affected?

A

Posterior wall of L ventricle and adjacent septum

82
Q

If the left circumflex artery is occluded and causes ischemia, what part of the heart is affected?

A

Lateral wall of L ventricle

83
Q

An abrupt onset of pulmonary hypertension due to sudden embolization, leading to right ventricular failure

A

Acute cor pulmonale

84
Q

Chronic pulmonary hypertension from COPD, emphysema or other pulmonary fibrosis/scarring, leading to right ventricular hypertrophy

A

Chronic cor pulmonale

85
Q

How does tertiary syphilis progress to heart disease?

A

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.

Pathology II (7 decks)

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