Heart Pathology Flashcards
heart failure
heart cannot pump blood sufficient to meet the body’s needs
early compensations of heart failure
catecholamines
frank-starling mechanism
hypertrophy
eventual outcome of heart failure
ischemia
where does blood pool with left heart failure
lungs
-pulmonary edema
cyanosis is another consequence of left heart failure
where does blood pool with right heart failure
periphery of the systemic circuit
-peripheral edema
hepatomegaly
splenomegaly
ascites
left heart failure common causes
systemic hypertension
mitral or aortic valve disease
primary heart disease(amyloidosis)
heart changes during left heart failure
left ventricular hypertrophy
left ventricular dilation
left atrium may be enlarged
consequences of left heart failure
dyspnea orthopnea enlarged heart increased heart rate rales mitral regurgitation systolic murmur
common causes of right heart failure
left heart failure
Cor Pulmonale
some congenital heart diseases
heart changes during right heart failure
right ventricular hypertrophy
right ventricular dilation
right atrium may be enlarged
consequences of right heart failure
peripheral edema
enlarged liver: hepatomegaly
enlarged spleen: splenomegaly
congenital heart disease
abnormalities at birth
cause is usually 90% unknown
3 classifications of congenital heart disease
left to right
right to left
coarctation
Left to right classification of congenital heart disease
ASD: atrial septal defect
VSD: ventricular septal defect
PDA: Patent ductus arteriosis
Atrial Septal Defect
may cause pulmonary hypertension
can be surgically repaired
Ventricular Septal Defect
most common
most close spontaneously
size and location matters
Patent Ductus Arteriosus
- in the fetus, allows flow from PA to aorta
- Generally closes by day 2 of life
- size matters
Right to left classification of congenital heart disease
tetralogy of fallot
transposition of great arteries
tetralogy of fallot
ventricular septal defect
pulmonary stenosis
overriding aorta
right ventricular hypertrophy
transposition of great arteries
embryonic lethal in the absence of shunt
coarctation
aortic coarctation
- narrowing of aorta
- causes cyanosis and low blood pressure systemically
- size matters
ischemic heart disease
myocardial perfusion can’t meet demand
usually a result of reduced coronary artery blood flow
4 syndromes of ischemic heart disease
- angina pectoris
- acute MI
- chronic IHD
- sudden cardiac death
stable angina pectoris
intermittent chest pain stable/chronic -most common -pain on exertion -fixed narrowing of coronary arteries
variant angina pectoris
pain at rest
coronary artery spasm
unstable/pre-infarction angina pectoris
- unpredictable pain
- plaque disruption and thrombosis
acute myocardial infarction
necrosis of myocardium from ischemia
- due to coronary artery thrombosis
- prompt reperfusion can salvage myocardium
clinical features of acute myocardial infarction
severe, crushing chest pain
not relieved by nitroglycerin
sweating, nausea
subendocardial infarction
affects only the inner 1/3-1/2 of the heart wall
-inner wall more affected because blood supply goes first to the outer wall
transmural infarction
- affects more than 1/2 of the heart wall
- more serious
chronic IHD
-accumulation of small ischemic insults leads to mechanical failure
sudden cardiac death
often a result of a lethal arrythmia without myocyte necrosis
hypertensive heart disease
- can affect the left or right ventricle
- cor pulmonale is right ventricle enlargement due to pulmonary hypertension
- PH from primary lung disorder
valvular heart disease can be caused by:
- murmurs
- angina
- CHF
- Fainting
forms of valvular heart disease
stenosis
insufficiency
stenosis
failure to open
insufficiency
failure to close
regurgitation
aortic valve stenosis
stiffening and narrowing of the aortic valve
- blood has difficulty exiting the heart
- prolonged ejection sound
clinical manifestations of aortic valve stenosis
crescendo-decrescendo systolic heart sound decrease in stroke volume increased left ventricular pressure decreased systolic blood pressure hypertrophy of the left ventricle
aortic regurgitation
- failure of the aortic valve to properly close
- blood leaks back into the ventricle after ventricular contraction
clinical manifestations of aortic regurgitation
- diastolic murmur(blowing sound) of high pitch over the left ventricle
- hypertrophy of the left ventricle
- left ventricular failure
- doppler echocardiography reveals blood flow back through the aortic valve
Mitral stenosis
narrowing or stiffening of the mitral valve (left AV valve)
blood flowing into the ventricle during diastole
clinical manifestations of mitral stenosis
- subtle crescendo diastolic murmur(rumbling)
- decreased blood flow from the left atrium to the left ventricle
- increased left atrial pressure
- hypertrophy and dilation of the left atrium
- atrial dysrhytmias(fibrillation)
- increases pulmonary blood pressure
- pulmonary edema
- right heart failure
mitral regurgitation
failure of the mitral valve(left AV valve) to properly close
blood passing into atrium from ventricle during contraction
clinical manifestations of mitral regurgitation
systolic murmur hypertrophied left ventricle left heart failure pulmonary hypertension and edema right heart failure doppler echocardiography reveals blood flow back though mitral valve
Rheumatic valvular disease
rheumatic fever
- diffuse inflammatory disease caused by immune response to infection by the group A Beta hemolytic streptococci
- Febrile illness: inflammation of the joints, skin, nervous system, and heart
- if left untreated, rheumatic fever causes rheumatic heart disease
mitral valve prolapse
ballooning of mitral leaflets
most patients are asymptomatic
infective endocarditis
microbial invasion of the heart valves, endocardium
usually mitral and aortic valves
Acute infective endocarditis
highly virulent infection attacks normal valve(e.g. S. aureus)
50% of patients die withing weeks
Often requires surgery
Subacute infective endocarditis
low virulent infection colonizes abnormal valve
long course, most recover
cardiomyopathies
diverse group of disorders in which myocardium dysfunctions
dilated cardiomyopathy
congestive cardiomyopathy
hypertrophic cardiomyopathy
hypertension is a leading cause
restrictive cardiomyopathy
deposition of material in myocardium
causes of dilated cardiomyopathy
viral
alcohol/toxin
genetic abnormality
causes of hypertrophic cardiomyopathy
hypertension
sarcomere mutation
ventricle can’t fill
causes of restrictive cardiomyopathy
deposition of material in myocardium
heart wall is stiff, can’t fill
idiopathic
amyloidosis or sarcoidosis
pericardial disease
disorders of the pericardium
- acute pericarditis
- pericardial effusion
acute pericarditis
causes severe chest pain that worsens with respiratory movements an with lying down
dangers: tamponade, chronic fibrosis
pericardial effusion
accumulation of fluid within the pericardium
-tamponade: physical pressure compresses heart
tumors
primary tumors are very uncommon
-most are benign
malignant heart cancers are often metastasized from lung or lymphoma
