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Pathology > Heart Disorders > Flashcards

Heart Disorders Flashcards

1
Q

Causes of concentric right ventricular hypertrophy due to increased afterload

A
  1. Pulmonary hypertension

2. Pulmonary valve stenosis

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2
Q

Increased afterload produces

A

Sarcomere duplication parallel to long axis, i.e., concentric ventricular hypertrophy

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3
Q

Increased preload produces

A

Sarcomere duplication in series, i.e., eccentric hypertrophy of the ventricular wall

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4
Q

Causes of eccentric hypertrophy of the left ventricle due to increased preload

A
  1. Mitral valve or aortic valve regurgitation

2. Left-to-right shunting of blood (e.g., ventricular septal defect)

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5
Q

Causes of eccentric hypertrophy of the right ventricle due to increased preload

A

Tricuspid valve and pulmonic valve regurgitation

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6
Q

Why is angina pectoris with exercise observed in pts with left ventricular hypertrophy?

A

In the normal left ventricle, the subendocardium receives the least amount of blood from the coronary arteries. Therefore, if the muscle is concentrically thickened, angina may occur with exercise, because the muscle wall is so thick that the subendocardial tissue receives dangerously low levels of O2, causing chest pain.

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7
Q

With exercise, the heart rate…, which…the time for diastole and the filling of the coronary arteries.

A

Increases; decreases

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8
Q

Heart sound commonly present in either LVH or RVH

A

S4 – abnormal heart sound that correlates with atrial contraction in late diastole; produces an atrial gallop

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9
Q

Cause of an S4 heart sound

A

Caused by blood entering a noncompliant ventricle (i.e., there is a problem in filling the ventricle). A noncompliant ventricle is present in concentric hypertrophy involving either the LV or RV. A noncompliant ventricle is also present in left- or right-sided eccentric hypertrophy because the ventricles are volume overloaded and resist receiving more blood in late diastole.

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10
Q

Examples of a noncompliant ventricle producing an S4 heart sound

A
  1. Concentric LVH in essential HTN or AV stenosis
  2. Concentric RVH in PH or PV stenosis
  3. Volume overload in MV or TV regurgitation
  4. Volume overload in AV or PV regurgitation
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11
Q

Pathologic heart sound commonly present in either left- or right-sided eccentric hypertrophy

A

S3 heart sound. Due to blood entering a volume overloaded chamber in early diastole.

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12
Q

Examples of volume overloaded ventricles producing an S3 heart sound

A
  1. Volume overload in MV or TV regurgitation

2. Volume overload in AV or PV regurgitation

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13
Q

Most common cause of hospital admission for persons > 65 yrs old

A

Congestive heart failure

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14
Q

Left-sided heart failure causes…

A

An increase in LVEDV and LV end-diastolic pressure.

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15
Q

Increased LVEDV and LVEDP (i.e., hydrostatic pressure) leads to…

A

A backup of blood into the lungs, producing pulmonary edema.

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16
Q

What defines systolic heart failure (SHF)?

A

Decreased LV contraction.

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17
Q

What is the most common type of left-sided heart failure?

A

Systolic heart failure.

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18
Q

Causes of systolic heart failure

A
  1. Ischemia, due to coronary artery atherosclerosis (most common cause)
  2. Post-myocardial infarction (MI), myocarditis, and dilated cardiomyopathy
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19
Q

What defines diastolic heart failure (DHF)?

A

A noncompliant LV with impaired relaxation.

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20
Q

Causes of diastolic heart failure

A
  1. Concentric LVH due to essential HTN is the most common cause
  2. Other causes include AV stenosis, hypertrophic cardiomyopathy, and restrictive cardiomyopathy (amyloidosis or glycogenosis)
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21
Q

Systolic heart failure is characterized by…

A

A low ejection fraction (EF

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22
Q

Ejection fraction (EF) =

A

Stroke volume (SV) / Left ventricular end-diastolic volume (LVEDV)

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23
Q

Normal ejection fraction value ranges from…

A

55-80%

24
Q

Diastolic heart failure is characterized by…

A

A normal EF (>60%) at rest. In addition, there is usually an S4 atrial gallop due to increased resistance to filling in late diastole. There is also an increase in left atrial and left ventricular end-diastolic pressure.

25
Q

When does pulmonary congestion typically occur in diastolic heart failure?

A

Pulmonary congestion commonly occurs when the heart cannot meet the metabolic demands of peripheral tissue (e.g., when the pt exercises) at which point the EF is decreased.

26
Q

Gross and microscopic findings in left-sided heart failure

A
  1. Lungs are heavy, congested, and exude a frothy pink transudate (edema) on the cut surface or in the airways
  2. Alveoli are filled with a pink-staining fluid and alveolar macrophages often contain hemosiderin (“heart failure” cells)
27
Q

What happens in cardiac asthma?

A

Peribronchiolar edema narrows the airway and produces expiratory wheezing

28
Q

Inspiratory crackles (rales) are due to…

A

Air expanding alveoli filled with fluid.

29
Q

What causes rust-colored sputum in pts with left-sided heart failure?

A

Presence of hemosiderin in alveolar macrophages (heart failure cells)

30
Q

Chest radiograph findings in left-sided heart failure

A
  1. Congestion in the upper lobes (early finding)
  2. Perihilar congestion (“bat-wing configuration” or “angel-wing configuration
  3. Fluffy alveolar infiltrates
  4. Kerley lines (septal edema)
  5. Air bronchograms (air visible in the bronchus or small airways because fluid surrounds the airways)
31
Q

How does left-sided heart failure produce functional MV regurgitation?

A

Stretching of the MV ring by the increased LVEDV causes MV regurgitation

32
Q

What is paroxysmal nocturnal dyspnea (PND)?

A

Choking sensation that occurs at night when the pt is supine.

33
Q

Describe the pathophysiology underlying PND

A

Without the effect of gravity, fluid from the interstitial space moves into the vascular compartment. This increases venous return to the right side of the heart and then to the failed left side of the heart. The failed left heart cannot handle the excess load and blood backs up into the lungs, producing dyspnea and pulmonary edema. Dyspnea is relieved by standing or placing pillows under the head (pillow orthopnea).

34
Q

Cardiac neurohormone secreted from the ventricles when they are volume overloaded

A

Brain natriuretic peptide (BNP)

35
Q

BNP is useful in:

A
  1. Diagnosing left-sided heart failure (increased)
  2. Excluding left-sided heart failure (normal)
  3. Predicting survival (remains high; bad prognostic sign)
36
Q

Why is atrial natriuretic peptide (ANP) also increased in left-sided heart failure?

A

Because of left atrial dilatation.

37
Q

Causes of increased RV afterload

A
  1. Left-sided heart failure (most common cause of right-sided heart failure)
  2. Pulmonary hypertension
  3. PV stenosis
  4. Saddle embolus
38
Q

Causes of decreased RV contraction

A
  1. RV infarction

2. Myocarditis

39
Q

Causes of RV noncompliance

A
  1. Restrictive cardiomyopathy (e.g., amyloidosis or glycogenosis)
  2. Concentric RVH
40
Q

Causes of increased RV preload

A
  1. TV/PV regurgitation

2. Left-to-right shunt

41
Q

Clinical findings in right-sided heart failure

A
  1. Prominence of internal jugular veins due to increased volume in venous system
  2. Functional TV regurgitation due to stretching of the TV ring from RV volume overload
  3. Right-sided S3 and S4 heart sounds due to RV volume overload
  4. Painful hepatomegaly due to centrilobular hemorrhagic necrosis
  5. Dependent pitting edema due to increase in venous hydrostatic pressure
  6. Cyanosis of the mucous membranes
42
Q

How does right-sided heart failure (RHF) cause cyanosis of mucous membranes?

A

Backup of blood in the venous system in RHF increases time available for peripheral tissue to extract O2, which decreases O2 saturation enough to produce cyanosis.

43
Q

What causes the marked increase in serum transaminase levels in pts with right-sided heart failure?

A

Systemic venous blood backs up into the hepatic veins and then into the central ventless, which expand with blood and cause hepatic cell necrosis in zone III hepatocytes.

44
Q

Abdominojugular reflux is a sign of right-sided heart failure. What is this sign/how is it elicited?

A

Compression of the congested liver in right-sided heart failure increases jugular neck vein distention.

45
Q

How is systolic heart failure (SHF) treated?

A

Treated with drugs that decrease the workload of the left ventricle, i.e., decrease afterload and preload. A first-line treatment for SHF is an ACE inhibitor or angiotensin II receptor inhibitor if the patient develops chronic cough. Diuretics (e.g., loop diuretics, aldosterone blockers) compliment ACE inhibitors by decreasing preload.

46
Q

How do ACE inhibitors work?

A

ACE inhibitors decrease afterload by decreasing angiotensin II levels (Angiotensin II normally constricts peripheral vascular resistance arterioles.) and decrease preload by decreasing aldosterone.

47
Q

How are beta blockers useful in treating systolic heart failure (SHF)?

A

Beta blockers decrease sympathetic tone, which reduces myocardial O2 consumption. It is considered first-line therapy for SHF.

48
Q

Because of its inotropic and vagotonic effects, digitalis may be useful in treating which pts?

A

Those with severe heart failure and atrial arrhythmias.

49
Q

How does hydralazine work?

A

It is a direct vasodilating drug that reduces systemic vascular resistance and pulmonary venous pressure.

50
Q

Therapeutic options for diastolic heart failure

A
  1. ACE inhibitor
  2. Beta blocker – decreases heart rate, which prolongs diastolic filling
  3. Diuretics must be used with caution because excessive diuresis may produce volume depletion and decrease the cardiac output
51
Q

What is high-output heart failure (HOF)?

A

HOF is a form of heart failure in which cardiac output is increased compared with values for the normal resting state.

52
Q

High-output heart failure may be due to…

A
  1. Increase in stroke volume (e.g., hyperthyroidism)
  2. Decrease in blood viscosity (e.g., severe anemia)
  3. Vasodilation of PVR-determining arterioles (e.g., thiamine deficiency)
  4. Arteriovenous fistula
53
Q

How does decreased blood viscosity produce high-output heart failure?

A

A decrease in blood viscosity decreases peripheral vascular resistance and thus increases venous return to the heart.

54
Q

Causes of concentric left ventricular hypertrophy due to increased afterload

A
  1. Essential hypertension
  2. Aortic valve stenosis
  3. Hypertrophic cardiomyopathy
55
Q

How do arteriovenous fistulae produce high-output heart failure?

A

Arteriovenous communications bypass the microcirculation, which increases venous return to the heart.

55
Q

Causes of arteriovenous fistulae

A
  1. Trauma from a knife wound (most common cause)
  2. Surgical shunt for hemodialysis
  3. Mosaic bone in Paget disease

Pathology (8 decks)

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