Hemodynamics (lab) Flashcards
Causes and Effects of LEFT CHF
Causes:
- Ischemic & non ischemic cardiomyopathy
- HTN
- Valve disease (e.g.aortic/mitral)
Effects
- Lungs: Edema
- Heart: R Ventricle hypertrophy and failure if chronic
- Hypoperfusion of organs: *Kidneys - reduced perfusion
- Brain - hypoxic encephalopathy
Causes of RIGHT CHF
Causes:
- Left CHF (induces right CHF - this is a tricky one**)
- Congenital heart disease
- Any disease that effects lungs. COPD, PE, Pulmonary HT. Etc
What are the Effects of Right CHF
Effects:
- Venous Congestion/Increased Hydrostatic Forces
- Liver congestion (nutmeg liver)
- Spleen congestion
- Peripheral edema
What are the gross and histologic features of a HEART in a pt with CHF
Gross findings:
- Increased heart weight (i.e. Cardiomegaly)
- Ventricular Hypertrophy
Histologic findings:
- Cardiac Hypertrophy (bigger cells but not more: trophy=bigger)
- Cardiac Hyperplasia (more cells, but not bigger
What are the features of a LUNG in a pt with CHF
- Vascular congestion of the alveolar septal blood vessels
- Intravascular congestion and associated intraalveolar leakage of blood/hemorrhage - ACUTE
- This looks like brown spots on a histo slide, because macrophages are ingesting the RBC’s to try and clean up the congestion.
- Iron laden macrophages in alveoli = Heart failure cells
What are the features of a LIVER in a pt with CHF
- Hepatomegaly
- Centrilobular congestion (referred to as “nutmeg” liver) - indicates difficulty draining blood into the hepatic vein and then the IVC
- c/w R CHF
- Centrilobular necrosis - hepatocytes that are missing nuclei
What are the features of a SPLEEN in a pt with CHF
Splenomegaly
What are risk factors for PE?
- immobility
- upper respiratory tract infection
- cancer (hyper coagulability)
How do you differentiate between acute and chronic PE?
Acute: tissue is still present, there is no cavitation, wbc nuclei are intact, macrophages
Chronic: loss of tissue, scarring, recanalization, fibroblasts
Describe the pathophysiological changes seen in blood vessels and myocardium associated with hypertension
- myocardiac hypertrophy
- arteriolosclerotic damage of blood vessels
- focal aneurism formation
What’s the difference between infarct and hemorrhage?
Infarct: reduced or absent blood flow leading to hypoxic ischemic injury, dead tissue, pale
Hemorrhage: blood escapes out from a breached blood vessel wall
Symptoms of a massive pulmonary embolism?
- acute obstruction of pulmonary arteries
- acute hypoxia with or without chest pain
- death
Symptoms of a small pulmonary embolism?
- asymptomatic if pulmonary emboli are small and few in number
- progressive hypoxia with or without chest pain
