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Systems Pathology Final > Heart Pt. 1 > Flashcards

Heart Pt. 1 Flashcards

1
Q

What is the function of the circulatory system?

A

Provide nutrients, remove waste

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2
Q

What is the most common mechanism of heart disease?

A

Contractile (pump) failure

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3
Q

What are the mechanisms of heart disease?

A

Pump failure, obstruction of flow, regurgitant flow, shunted flow, dysfunction cardiac conduction, ruptured vessels or heart walls

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4
Q

What is the most common cause of congestive heart failure?

A

Decreased cardiac output

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5
Q

How many Americans are affected by heart failure?

A

5 million

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6
Q

What conditions are associated with increased tissue demands which can lead to heart failure?

A

Hyperthyroidism, severe anemia, fistula, “high-output failure”

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7
Q

What are the causes of decreased cardiac output?

A

Systolic dysfunction, diastolic dysfunction, valvular dysfunction

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8
Q

What are the risks for systolic dysfunction?

A

CAD, systemic hypertension, decreased pH (shock)

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9
Q

What causes systolic dysfunction?

A

Weak contraction

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10
Q

What causes diastolic dysfunction?

A

Failure to relax which inhibits filling

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11
Q

What gender is more likely to develop diastolic dysfunction?

A

Females

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12
Q

What conditions are associated with diastolic dysfunction?

A

Myocardial fibrosis, amyloidosis, left-sided hypertrophy, pericardial tamponade

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13
Q

What conditions are associated valvular dysfunction?

A

Stenosis, endocarditis

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14
Q

What occurs due to insufficient output of the heart resulting in forward failure?

A

Hypoxia

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15
Q

What is backward failure of the heart?

A

Venous congestion, increased venous volume and pressure

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16
Q

Forward and backward failure of the heart affects what organs?

A

Virtually every one

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17
Q

Do forward and backward heart failure tend to occur independently?

A

No, usually together

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18
Q

How do forward and backward heart failure change the heart?

A

Lead to myocardial adaptations

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19
Q

What is the Frank-Starling mechanism of compensated heart failure?

A

Increased stretch leading to stronger contraction

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20
Q

What is the benefit of Frank-Starling mechanism of compensated heart failure?

A

Increased cardiac output

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21
Q

What is the cost of Frank-Starling mechanism of compensated heart failure?

A

Increased oxygen and tension

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22
Q

How does norepinephrine affect the heart?

A

Increased heart rate and contractility

Stimulation of renin-angiotension system therefore increasing blood pressure

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23
Q

How does ANP affect the heart?

A

Vasodilation (balances NE and leads to diuresis)

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24
Q

What two substances make up the neurohumoral mechanisms of compensated heart failure?

A

Norepinephrine and ANP

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25
Q

What are the three mechanisms of compensated heart failure?

A

Frank-Starling mechanism, neurohumoral mechanisms, cardiac hypertrophy

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26
Q

Physiologic cardiac hypertrophy is seen among what type of individuals?

A

Top athletes

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27
Q

Which kind of cardiac hypertrophy is the “good kind”?

A

Physiological

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28
Q

What changes to the size of the heart can result from overload and increased oxygen consumption?

A

Cardiac hypertrophy

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29
Q

What occurs with transposition of the great arteries?

A

Arteries connect to the wrong ventricles

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30
Q

In transposition of the great arteries, the aorta connects to what ventricle?

A

Right

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31
Q

In transposition of the great arteries, the pulmonary artery connects to which ventricle?

A

Left

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32
Q

What is a visual sign of transposition of the great arteries that is seen after birth in 1:4,000 births?

A

Postnatal cyanosis

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33
Q

What is the prognosis for transposition of the great arteries?

A

Poor, lethal in less than one month

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34
Q

What treatment can be used for transposition of the great arteries to increase the life expectancy slightly?

A

Shunting

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35
Q

What usually abnormal defects can actually benefit patients with transposition of the great arteries by enabling more blood movement?

A

Patent ductus arteriosus, ventricular septal defect

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36
Q

What gender is more likely to suffer from aortic coarctation?

A

Males

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37
Q

Those with what genetic condition are more likely to have aortic coarctation?

A

Turner syndrome

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38
Q

How is the aortic valve changed with aortic coarctation?

A

> 50% have bicuspid aortic valve instead of the usual three cusps

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39
Q

Where do we seen aortic coarctation in infants (pre-ductal)?

A

Proximal to a patent ductus arteriosus

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40
Q

What is common with an adult form of aortic coarctation?

A

Infolding near the ligamentum arteriosum (asymptomatic)

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41
Q

What are some of the features of aortic coarctation?

A

Upper extremity hypertension, weak lower extremity pulses, lower extremity vascular claudication and cyanosis, systolic murmurs/thrills

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42
Q

What is a coarctation?

A

Congenital narrowing

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43
Q

Increased consumption of what gas can lead to cardiac hypertrophy?

A

O2

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44
Q

What conditions can result from chronic increased cardiac pressure?

A

Hypertension, valvular stenosis

45
Q

Physiologic cardiac hypertrophy can lead to the formation of what vascular structures?

A

Capillary beds

46
Q

What is the most common cause of left-side heart failure?

A

Ischemic heart disease (CAD)

47
Q

What are all the causes for left-sided heart failure?

A

IHD/CAD, hypertension, valve disorders (mitral and aortic), primary myocardial disease (amyloidosis)

48
Q

How are the heart chambers affected in left-sided heart failure?

A

Left ventricular hypertrophy, possible dilation of left atria, atrial fibrillation, atrial thrombi (stroke)

49
Q

How can left-sided heart failure affect the pulmonary system?

A

Decreased cardiac output leads to pulmonary edema

50
Q

What are signs and symptoms of left-sided heart failure?

A

Dyspnea, rales, orthopnea, cough

51
Q

How is heart rate affected by left-sided heart failure?

A

Tachycardia (Over 100bpm)

52
Q

Right-sided heart failure most commonly results from what prior condition?

A

Left-sided heart failure (backward failure)

53
Q

What is the condition involved with pulmonary hypertension and isolated right-sided heart failure?

A

Cor pulmonale

54
Q

What valves can be impaired in right-sided heart failure?

A

Pulmonary or tricuspid

55
Q

Peripheral congestion and edema are seen in what vascular structures during right-sided heart failure?

A

Systemic and portal veins

56
Q

During heart failure of which side do we see more pulmonary congestion and involvement?

A

Left-sided (minimal involved with right-sided)

57
Q

What are some clinical features seen with right-sided heart failure?

A

Ascites and hepatosplenomegaly

58
Q

What is a big risk for congenital heart disease?

A

Prematurtity

59
Q

What vessels and structures are primarily affected by congenital heart disease?

A

Cardiac walls and great vessels: superior and inferior vena cavae, pulmonary artery, pulmonary vein, and aorta

60
Q

What condition makes up 30% of birth defects?

A

Congenital heart disease

61
Q

How frequent is congenital heart disease?

A

8:1,000

62
Q

What is the genetic component to congenital heart disease?

A

Trisomy involvement (13, 18, and 21), polygenic

63
Q

What environmental factors can increase risk for congenital heart disease?

A

Teratogens, maternal diabetes, infection

64
Q

What is the cause of 90% of congenital heart disease cases?

A

Idiopathic in nature

65
Q

Over half of congenital heart disease cases involve which septal defects?

A

Ventricular and atrial septal defects

66
Q

What other less common defects can be associated with congenital heart disease?

A

Pulmonary valve stenosis, patent ductus arteriosus, tetralogy of fallot, coarctation of aorta

67
Q

What is the most common shunting path of congenital heart disease?

A

Left-to-right

68
Q

What occurs with right-to-left shunts in congenital heart disease?

A

Blood bypasses lungs

69
Q

What defects can result from right-to-left shunts in congenital heart disease?

A

Tetralogy of Fallot, transposition of great arteries

70
Q

What visible sign can be seen in a baby with right-to-left shunts in congenital heart disease?

A

Cyanosis (“dusky blue”)

71
Q

What condition is associated with left-to-right shunts in congenital heart disease?

A

Pulmonary hypertension

72
Q

What defects are seen with left-to-right shunts in congenital heart disease?

A

Atrial septal defects (patent foramen ovale)
Ventricular septal defects
Patent ductus arteriosus

73
Q

What defects are seen with obstruction of flow in congenital heart disease?

A

Valvular stenosis, aortic coarctation

74
Q

What type of septal defects is most commonly asymptomatic until adulthood?

A

Atrial septal defect

75
Q

Is which septal defects is spontaneous closure rare?

A

Atrial septal defect

76
Q

What is the most common structural abnormality of septal defects?

A

Ventricular septal defect

77
Q

What type of septal defect may spontaneously close?

A

Ventricular septal defect

78
Q

A patent ductus arteriosus is associated with what type of shunt?

A

Left-to-right

79
Q

What is the most common type of congenital heart disease to cause cyanosis?

A

Tetralogy of Fallot

80
Q

What are the four features of tetralogy of Fallot?

A

Large ventricular septal defect
Valve stenosis with right ventricular outflow obstruction
Overriding aorta between ventricles
Right ventricular hypertrophy

81
Q

A “boot-shaped” heart seen on X-ray is associated with what cardiac condition?

A

Tetralogy of Fallot

82
Q

Tetralogy of Fallot presents risk of what type of blockage?

A

Systemic emboli

83
Q

What is the treatment for aortic coarctation?

A

Balloon dilation, surgical resection, vascular graft

84
Q

How long does it take for dysfunction to arise in ischemic heart disease? Necrosis?

A

Dysfunction: 1-2 minutes
Necrosis: 20-40 minutes

85
Q

What condition mkaes up 90% of all ischemic heart disease cases?

A

Coronary artery disease (CAD)

86
Q

What is the leading cause of death in the U.S.?

A

IHD

87
Q

CAD, pneumonia, CO poisoning, and A-V fistula can all lead to what cardiac disease?

A

IHD

88
Q

What condition is a result of myocardial ischemia that involves the occlusion of coronary arteries?

A

Acute coronary syndrome (ACS)

89
Q

Is acute coronary syndrome a serious matter?

A

Yes, medical emergency

90
Q

What is angina pectoris?

A

Chest pain of cardiac origin involving ischemia of the heart but no cellular death

91
Q

Is angina pectoris the same as a myocardial infarction?

A

NO; angina pectoris does not involve necrosis

92
Q

Chronic IHD can lead to what condition?

A

Congestive heart failure

93
Q

What is SCD?

A

Sudden cardiac death

94
Q

What are the features of coronary atherosclerosis?

A

Inflammation, thrombosis, vasoconstriction

95
Q

What happens to the diameter of the coronary arteries during coronary atherosclerosis?

A

Decreased diameter

96
Q

How much vessel occlusion does it take to present angina pectoris?

A

Over 70%

97
Q

Where do we see referred pain in angina pectoris?

A

Jaw, left arm, back shoulders

98
Q

What is the most common type of angina pectoris?

A

Stable angina (typical angina)

99
Q

How can stable angina be relieved?

A

With rest and vasodilators

100
Q

What vasodilator can be used to relieve typical angina pectoris?

A

Nitroglycerin

101
Q

What is the unique type of angina pectoris?

A

Variant angina (Prinzmetal angina)

102
Q

What occurs at rest with variant angina pectoris?

A

Vasospasms

103
Q

Which forms of angina pectoris respond to vasodilators?

A

Both

104
Q

What are the other names for unstable angina?

A

Crescendo angina or pre-infarction angina

105
Q

What provokes unstable angina?

A

Decreased exertion

106
Q

How much coronary artery occlusion do we see when unstable angina is presented?

A

90%

107
Q

What is the cause of unstable angina?

A

Plaque disruption, thrombosis, embolization, vasospasm

108
Q

What is different with angina pectoris in females?

A

Less predicable symptoms that tend to resemble menstrual symptoms like nausea, dizziness, and back pain

Systems Pathology Final (2 decks)

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