Heart I Flashcards
Cardiac Dysfunction Mechanisms (6)
Pump Failure Flow Obstruction Regurgitant Flow Shunted Flow Conduction Disorders Heart/Major Vessel Rupture
Congestive Heart Failure
Description and Compensatory Mechanisms (3)
heart unable to pump blood at rate sufficient to meet metabolic demands of tissues
Frank Starling (enhanced contractility/SV) Hypertrophy Neurohumoral Responses (NE, ANP, RAAS)
Left Sided Heart Failure
Causes (4) and Presentation (5)
Ischemia, HTN, Valve or Myocardial Disease
Pulmonary congestion (cough) Paroxysmal Nocturnal Dyspnea Atrial Fibrillation Prerenal Azotemia Hypoxic Encephalopathy
Systolic vs. Diastolic Failure
Functional and Clinical Differences
Systolic is decreased ejection fraction that causes poor perfusion
Diastolic is from a stiff left ventricle and causes pulmonary edema
Secondary Right Sided Heart Failure Cause
Due to left sided heart failure from pulmonary congestion
Primary Right Sided Heart Failure
Causes (3) and Complications (5)
Primary Pulmonary HTN
Parenchymal Lung Disease
Pulmonary Vasoconstriction
Nutmeg Liver Splenomegaly Renomegaly Effusions Extremity Edema
Atrial Septal Defects
Anatomy and Complications
Defect in septum secundum causing L to R shunt
Usually asymptomatic until adulthood
Ventricular Septal Defects
Anatomy and Complications (4)
In membranous interventricular septum
Symptoms present in children
Right ventricle hypertrophy
Pulmonary HTN
Cyanosis
Patent Ductus Arteriosus
Complications (2) and Treatment
Causes machinery-like murmur
Hypoxia in infants
Prostaglandin E
Patent Foramen Ovale
Complications (2)
Paradoxical embolism
Transient right sided pressure increases
Tetralogy of Fallot
Anatomy (5) and Symptoms (2)
VSD Subpulmonary Stenosis Aorta Overrides VSD Right Ventricle Hypertrophy Boot Shaped Heart
Infant cyanosis
Squatting
Transposition of Great Vessels
Anatomy (3)
Switched systemic and pulmonary circulations
VSD and PDA often present
Aorta Coarctation
Associated Condition and Presentation (5)
Turner Syndrome
Systolic Murmur
Lower body cyanosis (if with PDA)
UE HTN, LE hypotension and LE claudication (no PDA)
Pulmonary Stenosis and Atresia
Complications (3)
Right ventricle hypertrophy
Pulmonary A. dilation
Hypoplastic right ventricle
Aortic Stenosis and Atresia
Complications (2)
Hypoplastic left heart syndrome
Williams-Beuren Syndrome
Ischemic Heart Disease
Main, Complications (4) and Epidemiology
Coronary atherosclerosis (CAD)
Myocardial Infarction
Angina
Heart failure
Sudden Cardiac Death
Leading cause of death in US
Angina Pectoris Definition
Stable, Prinzmetal, Unstable
(Descriptions and Symptoms)
Paroxysmal recurrent CP without myocyte necrosis
Stable: stenotic Coronary A occlusion
Activity induced pain relieved by rest
Prinzmetal: Episodic pain spasms relieved by vasodilators
Unstable: Progressive frequency, duration and severity
Plaque rupture induced, leads to MI
Myocardial Infarction
Pathogenesis, Necrosis Progression and Timeline
Most start with atheromatous Coronary A. occlusion
Necrosis distal to occlusion starts in subendocardium
Half thickness necrosis within 2-3 hours, transmural within 6
Infarction Anatomy
LAD (3), RCA (3) and LCX (1) Areas Affected
LAD: Apex, Anterior LV, Anterior Septum
RCA: RV wall, Posterior LV, Posterior Septum
LCX: Lateral LV
Infarction Histology Features 4 hours (1), 12 hours (3), Days (3), Weeks (2)
4-12 hours: Coagulative necrosis starts
12-24 Hours: Nucleus pyknosis, hypereosinophilia, neutrophils infiltrate
1-3 Days: Nuclei and striations lost, neutrophils infiltrate
7-14 Days: Macrophages infiltrate, Tissue granulation
Reperfusion
Procedures (4), Effects (2) and Injury (4)
Thrombolysis, Angioplasty, Stents and CABG
Salvages reversibly damaged cells
Contraction bands in irreversibly damaged cells
Reperfusion injury caused by oxidative stress, Ca2+ overload and inflammatory cells and results in hemorrhage
MI Biomarkers
Timeline (4) and Usefulness
Troponin T: Rises hours 3-12 and peaks at 12-48
Troponin I: Rises 3-12 hours and peaks at 24
CK-MB: Rises 3-12 hours and peaks at 24
Troponins are the most cardiac specific and useful
Myoglobin increases first but is less specific
MI Symptoms (4) and Complications (6)
CP >30 minutes
Dsypnea
Diaphoresis
N/V
Arrhythmia Contractile Dysfunction Fibrinous Pericarditis Myocardial Rupture Infarct Expansion Ventricle Aneurysm
