Lecture 10- CHF 9/13

Question 1

6 principal mechanisms of heart disease

Answer 1

1. failure of pump
2. flow obstruction
3. shunted flow
4. bad valves
5. conduction disorders
6. rupture of heart/vessel

Question 2

… is the failure to pump an adequaye amt of blood to supply the metabolic needs of the organs

Answer 2

Congestive heart failure

Question 3

CHF affects nearly … people in the US and annually contributes to … deaths

Answer 3

5 million

300,000

Question 4

2 neurohumoral systems that are compensatory mechanisms of CHF

Answer 4

1. release of NE w/ increased HR and contractility

2. renin-angiotensin system with water/salt retention

Question 5

Compensatory mechanism of CHF where increased end diastolic filling volume increases stretch in cardiac fibers. At first the fibers contract more forcefully (compensated), increasing CO but eventually cannot keep up (decompensated)

Answer 5

Frank-starling

Question 6

Compensatory mechanism of CHF where there is an increase in muscle fiber size resulting in increased thickness of the ventricular wall but without increase in size of lumen

Answer 6

myocardial hypertrophy

Question 7

Compensatory mechanisms of CHF usually fail because with heart working harder, there are great oxygen requirements w/o an increased capillary supply resulting in…

Answer 7

susceptibility to ischemia

Question 8

5 causes of left sided heart failure

Answer 8

1. IHD
2. HTN
3. valvular dz
4. myocarditis
5. cardiomyopathy

Question 9

4 causes of right sided heart failure

Answer 9

1. left sided failure (b/c of pulm congestion)
2. pulmonary HTN
3. valve dz
4. septal defects (L–>R shunts)

Question 10

L. ventricular failure clinical manifestations (3)

Answer 10

1. pulmonary edema/conges. resulting in dyspnea
2. chronic cough
3. orthopnea/ SOB

Question 11

L. and R. ventricular failure clinical manifestation

Answer 11

cerebral hypoxia

Question 12

R. sided failure clinical manifestations (2)

Answer 12

1. liver congestion (nutmeg liver) and spleen

2. edema of subcutaneous tissues especially lower extremities

Question 13

Congenital heart disease occurs in … out of … live births in the US

Answer 13

6-8 out of 1000

Question 14

3 causes of congenital heart disease

Answer 14

1. environmental (congenital rubella, maternal diabetes)
2. chromosomal abnorm.
3. 90% are unknown and multifactorial

Question 15

3 most common forms of noncyanotic congenital HD

Answer 15

1. VSD (most common)
2. ASD (2nd most common)
3. PDA

Question 16

A VSD occurs in … out of every …. live births

Answer 16

4/1000

Question 17

2 most common forms of cyanotic congenital HD

Answer 17

1. Tetralogy of fallot

2. transposition of the great arteries

Question 18

What are the 4 abnormalities in tetralogy of fallot

Answer 18

1. overriding aorta
2. narrowed RV outflow
3. RV hypertrophy
4. VSD

Question 19

… is leading cause of death in US (500k annually)

Answer 19

IHD

Question 20

90% of IHD is due to…

Answer 20

coronary atherosclerosis (coronary artery dz)

Question 21

There are … MI’s annually and … are fatal

Answer 21

1.5 million

one-third

Question 22

During an MI, severe ischemia lasting longer than…. minutes will cause irreversible myocyte injury and death

Answer 22

20-40

Question 23

3 types of cardiomyopathies

Answer 23

dilated (most commom)
hypertrophic
restrictive

Question 24

dilated cardiomyopathy can be… , …. or acquired

Answer 24

secondary

genetic

Question 25

… cardiomyopathy involves dilation of all 4 chambers, poor ventricular contractility and nonspecific histologiy w/ fibrosis and myocyte hypertrophy

Answer 25

dilated

Question 26

… cardiomyopathy is a primary, genetic cardiomyopathy where there is a missense point mutation in one of several sarcomeric gene loci.

There are stiff ventricles which prevent adequate filling (diastolic dysfxn) and the histology will show myocyte dissarray w/ fibrosis

Answer 26

hypertrophic

Question 27

…. cardiomyopathy is when the walls of the ventricles become stiffer with impaired filling during diastole, can be idiopathic or secondary to systemic conditions that affect the myocardium– radiation-induced fibrosis, amyloidosis, hemochromatosis, sarcoidosis

Answer 27

restrictive

Question 28

viruses that cause myocarditis

Answer 28

coxsackie a and b