Oct. 28, 2019 Flashcards
What disease precedes the development of RHEUMATIC HEART DISEASE (RHD)?
RHEUMATIC FEVER (RF)
What is RF?
An immune-mediated, multi-system, inflm disease
What is a result of immune based destruction?
Causes inflm
“When there is inflm, there is always..?
…some degree of tissue damage.”
What age population is usually affected by RF?
Usually children (~3% 5-15 yr olds)
Overview of how RF is dev?
- First, individual contracts STREP THROAT
- Abs are produced to combat STREP
- Abs persist is the body, even after STREP is all gone
- 1-4 weeks later Abs target self Ags in the HEART, joints, CNS, and integument
What form of AUTO-IMMUNITY is RF an example of?
MOL MIMICRY
What is RHD?
An inflm disease of the HEART, immune mediated inflm of VALVES, MYOCARDIUM, and PERICARDIUM
What is meant by the term “self-limiting disease”?
Referring to a disease that doesn’t necessarily require interventions to treat, will run its course and be gone
The self-limiting, ACUTE form of RHD requires:
Monitoring
If RHD is CHRONIC, this will result in:
Severe CARDIAC damage
One word to describe the diagnosing process for RHD?
Fuckin’ complex (oops that was two words ;P)
What is one important mnft of RHD?
Inflm in the HEART
What does inflm in the HEART result in?
(lots of problems, but in this case) dec CO
Diagnostic tests for RHD?
- CBC and differential
- CRP
- ESR
- Serology
- Echo
What is ESR?
ERYTHROCYTE SEDIMENTATION RATE, measures the rate at which RBCs settle
What may cause the ESR to be shorter?
If there are many PROTEINS present, the RBCs will settle faster
5 Tx for RHD?
1) Antibiotics (for the strep)
2) Anti-inflms
3) Immunosuppressants
4) Rest
5) Tx of complications that arise
Which antibiotics would you give for RDH?
- Penicillin
- Erythromycin
What would you give for immunosuppressant in RDH? Why?
Steroids, this will suppress the IR, inflm, and pain
What is the benefit of rest for Tx of RHD? How long for bedrest is suggested?
This will dec the CARDIAC workload, suggested bedrest for 4-5 weeks
CONGESTIVE HEART FAILURE (CHF) is not:
Its not a disease, this is the failure of an organ. Granted, something has to lead to this failure, and that factor could very well be a disease
CHF is a __________ of inadeq CARDIAC Fx
Syndrome
6 things that *usually cause CHF:
1) MI
2) VALVE DISEASE
3) CARDIOMYOPATHY
4) Uncontrolled HTN
5) CAD
6) Risk factors (see Porth pg 626)
How long after an MI could CHF occur?
May occur w/in hours, but individual may also live for months or years after
In a normal HEART, CO can inc up to 5x its normal amount, this is referred to as..?
…CARDIAC RESERVE
How is CARDIAC RESERVE impacted by CHF?
Very minimal CAR RES
Where does failure usually take place first? Why here?
In the LV because this is where CO is produced, its the V that has to pump the hardest to keep blow to the systemic circuit
When a chamber is unable to eject it’s B sufficiently, this causes:
RESIDUAL VOLUME
If there is RES VOL in the Vs, how might this affect the As?
This results in an inc resistance for the As to pump against = As work harder = unable to fully eject because of RES VOL in Vs = RES VOL dev in As too
If there is dec output in the RV, what effect will this have on the LA?
The LA will not receive the total PULMONARY RETURN = PULM CONGESTION = PULM EDEMA
How is HYDROSTATIC PRESSURE affected by PULM CONGEST?
PULM CONGEST = large inc in HP (remeber this is the “push” pressure) = PULM EDEMA
What happens when the RV pumps against resistance?
HYPERTROPHY, and inc RES VOL
T or F:
R side failure usually precedes L side failure
F, other way around
What circuit does L side failure damage? Why?
The PULM CIRCUIT, because failure to pump into the SYSTEMIC CIRCUIT = PULM EDEMA
Remember, L side affects Lungs: L:L
What circuit does R side failure damage? Why?
The SYST CIRCUIT, because failure to pump into the PULM CIRC = CONGEST in SYST CIRC = PERIPHERAL EDEMA followed by distention of abdominal organs
What is COMPENSATORY HF (COM HF)?
This is when the HEART is failing, but there are no obvious mnfts because the COMPENSATORY MECHANISMS are triggered
3 COMP MECHs:
1) V DILATION
2) SNS
3) RAAS
Overview of the COMP MECH of V DILATION:
More muscle stretch = more vol in chambers = inc PRELOAD = inc recoil = inc CO
Downfall of V DIL? Why?
- Cannot be used longterm because the HEART will then lode its contractility
- Inc ATP demand
- Overstretching
The COMP MECH aim of the SNS is to..?
…inc CO
Through what 3 processes does the SNS inc CO?
1) TACHYCARDIA
2) VASOCON
3) Inc contractility
Downfall of SNS? Why?
- Inc CO = inc workload for the HEART
- Inc ATP demand
- Advances failure
How is RAAS triggered?
Dec CO = dec RENAL perfusion = RAAS triggered
What does RAAS cause?
- VASOCON
- Releases ADH + ALDOSTERONE = inc B VOL = inc PRELOAD = inc recoil = inc CO
