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Pathology Exam 2 > Lecture 14 - Cardiovascular disease II > Flashcards

Lecture 14 - Cardiovascular disease II Flashcards

1
Q

what is the definition of congestive heart failure?

A

CHF is the failure of the heart to pump an adequate amount of blood to supply the metabolic requirements of the organs
*May be due to pathologic conditions inside or outside the heart

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2
Q

what are the 3 compensatory mechanisms the body uses in CHF

A
  1. Myocardial hypertrophy
  2. Ventricular dilation
  3. Physiologic mechanisms
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3
Q

one of the compensatory mechanisms of CHF is myocardial hypertrophy what are the effects of this?

A

helps initially, but the larger muscle fibers require more oxygen from the capillaries, which typically is not available

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4
Q

what are the physiologic mechanisms of congestive heart failure?

A
  • increased heart rate
  • increased intravascular volume
  • re-distribution of blood flow
  • increased catecholamines
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5
Q

what is the etiology (the cause, set of causes, or manner of causation of a disease or condition) of congestive heart failure?

A
  1. Ischemic heart disease
  2. Hypertension
  3. Myocarditis
  4. Cardiomyopathy
  5. Valvular disease
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6
Q

what are the 4 manifestations (failures) of CHF?

A
  1. Right ventricular failure
  2. Left ventricular failure
  3. Left and/or right ventricular failure
  4. CHF due to left ventricular failure eventually leads to right ventricular failure
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7
Q

what is the cause or manifestation of right ventricular failure?

A
  • congestion of liver (zonal or “nutmeg” pattern) and spleen

- edema or subcutaneous tissue (feet and ankles)

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8
Q

what is the cause/ manifestation of left ventricular failure?

A

pulmonary edema

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9
Q

what is the cause/ manifestation of left and/or right ventricular failure?

A

cerebral hypoxia

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10
Q

congenital heart disease may be caused by what two factors?

A

chromosomal anomalies or environmental factors

*In most cases a specific cause cannot be identified

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11
Q

in the US how many live births have congenital heart disease?

A

1-8 / 1000

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12
Q

congenital heart disease is divided into what two forms?

A

cyanotic
noncyanotic

*Congenital heart diseases include shunts (abnormal communications b/w chambers); abnormal connections b/w chambers and blood vessels; and absence of normal connections

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13
Q

Describe the cyanotic form of congenital heart disease

A

shunting of poorly-oxygenated systemic venous return to systemic arterial circulation, bypassing the lungs

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14
Q

what are 3 examples of noncyanotic congenital heart disease?

A

atrial septal defect
ventricular septal defect
patent ductus arteriosus

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15
Q

what is happening in an atrial septal defect?

A

allows shunting of blood between the atria

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16
Q

what is happening in ventricular septal defect?

A

allows shunting between the ventricles

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17
Q

patent ductus arteriosus should close within a few days after birth and it connects what two structures?

A

it connects the aorta and pulmonary artery

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18
Q

what are 2 examples of cyanotic congenital heart disease?

A

tetralogy of fallot

transposition of the great arteries

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19
Q

what are the four anomalies in tetraology of fallot?

A
  1. Ventricular septal defect
  2. Narrowing of right ventricular outflow
  3. Overriding of the aorta over VSD
  4. Right ventricular hypertrophy
20
Q

what is meant by transposition of the great arteries in cyanotic congenital heart disease?

A

the right ventricle empties into the aorta, the left ventricle empties into the pulmonary artery

21
Q

what is the pathogenesis of ischemic heart disease (IHD)

A
  • narrowing of coronary arteries (usually at least 75%) by atherosclerosis
  • Gradual narrowing may lead to opening of collateral arteries
  • coronary artery thrombosis initiated by fissure in the fibrous cap of an atherosclerotic plaque
22
Q

more than 90% of IHD is due to what?

A

coronary artery atherosclerosis

23
Q

what other factrs can lead to ischemic heart disease?

A
  • increase myocaridal oxygen demand (hypertension)
  • diminished blood volume (hypotenstion/shock)
  • reduced oxygenation (pneumonia, CHF)
  • Reduced oxygen carrying capacity (anemia)
24
Q

what are the different types of IHD (4 of of them - clinical presentation may include one or more)

A
  1. Angina pectoris
  2. Acute myocardial infarction
  3. Chronic IHD with CHF
  4. Sudden cardiac death
25
Q

what is the definition of angina pectoris?

A

“chest pain” of several minutes duration usually associated with exercise or emotional stress and relieved by rest

  • No myocardial necrosis occurs
  • In unstable angina, the episodes of chest pain become more frequent and the pain becomes more severe
26
Q

what is the clinical presentation of acute myocardial infarction?

A 
chest pain
shortness of breath
nausea/ vomiting
diaphoresis
low grade fever
27
Q

what are the 2 diagnostic tests for acute myocardial infarction?

A
  1. ECG changes

2. Elevation of serum enzymes (creatine kinase; CK-MB) and troponin derived from necrotic myocytes

28
Q

what is the pathology (what are the steps of formation) of acute myocardial infarction?

A
  1. coagulation necrosis (few hours)
  2. Neutrophil infiltration (few days)
  3. granulation tissue (1 week)
  4. scar formation (weeks - months)
29
Q

what methods are used to treat acute myocardial infarction?

A
  • Placement of stents to open the coronary arteries clogged by atherosclerotic plaques
  • Coronary artery by-pass grafts (CABG)
  • “clot-busting” drugs such as tissue plasminogen activator (TPA)
  • Reperfusion injury is a risk of these treatments however
30
Q

what are the 7 complications of myocardial infarction?

A
  1. arrhythmia and sudden death
  2. CHF/ shock
  3. mural thrombus/ emboli
  4. myocardial rupture
  5. mitral valve regurgitation
  6. ventricular aneurysm
  7. chronic ischemic heart disease
31
Q

what is chronic IHD with CHF?

A

Progressive cardiac decompensation following acute MI or secondary to smaller ischemic events, with eventual mechanical pump

32
Q

what is sudden cardiac death?

A

sudden onset of ischemia-induced cardiac arrhythmia with or without myocardial necrosis (infarction)
- This may occur in individuals with or without a previous history of IHD

33
Q

what is the difference between primary and secondary cardiomyopathy?

A
  • primary - the disease is solely or predominantly confined to the heart muscle
  • secondary - the heart is involved as part of a multi-system disorder
34
Q

what are the 3 morphologic patterns of cardiomyopathy?

A

dilated
hypertrophic
restrictive

35
Q

what is dilated cardiomyopathy?

A

heterogeneous group of cardiac diseases which may be primary or secondary, genetic or acquired

  • dilation of all 4 heart chambers
  • histology shows variable fibrosis and myocyte hypertrophy
  • poor ventricular contractility (systolic dysfunction)
36
Q

dilated cardiomyopathy has a hereditary basis in what percentage of cases?

A

20-50%

37
Q

what is hypertrophic cardiomyopathy?

A
  • A primary, genetic cardiomyopathy
  • disorder of sarcomeric proteins (myosin, myosin binding protein C, troponin T)
  • inherited as autosomal dominant with variable expression
  • inappropriate (spontaneous) myocardial hypertrophy, asymmetric hypertrophy which is greater in the interventricular septum than the left ventricular free wall and often obstructs the left ventricular outflow tract
  • characteristic histology is disarray of cardiac myocytes and fibrosis
38
Q

what is restrictive cardiomyopathy?

A
  • decrease in ventricular compliance (wall is stiffer), resulting in impaired ventricular filling during diastole
  • can be idiopathic or associated with other conditions that happen to affect the myocardium, such as radiation fibrosis, amyloidosis, hemochromatosis, and sarcoidosis
39
Q

what is the definition of myocarditis?

A

inflammation involving the myocardium

40
Q

what is the most common cause of myocarditis in the US?

A 
viral infection (coxsackle A and B, other Enteroviruses)
*It can also be caused by bacterial, fungal, and parasite organisms
41
Q

what are some non-infectious causes of myocarditis?

A

toxins, hypersensitivity reactions and auto-immune disorders

*In some cases the etiology is unknown

42
Q

in myocarditis, viral infection produces what?

A

lymphocytic infiltrate with foci of necrosis

43
Q

in myocarditis, pyogenic bacteria causes what?

A

abscesses

44
Q

parasites (such as trypanosomes in Chagas disease - found in south america) infect what?

A

individual myocytes or are in interstitial areas with surrounding inflammatory cells

45
Q

in myocarditis the hypersensitivity from the drugs causes what?

A

perivascular inflammatory infiltrate with many eosinophils

Pathology Exam 2 (8 decks)

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