Oct. 28, 2019

Question 1

What disease precedes the development of RHEUMATIC HEART DISEASE (RHD)?

Answer 1

RHEUMATIC FEVER (RF)

Question 2

What is RF?

Answer 2

An immune-mediated, multi-system, inflm disease

Question 3

What is a result of immune based destruction?

Answer 3

Causes inflm

Question 4

“When there is inflm, there is always..?

Answer 4

…some degree of tissue damage.”

Question 5

What age population is usually affected by RF?

Answer 5

Usually children (~3% 5-15 yr olds)

Question 6

Overview of how RF is dev?

Answer 6

• 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

Question 7

What form of AUTO-IMMUNITY is RF an example of?

Answer 7

MOL MIMICRY

Question 8

What is RHD?

Answer 8

An inflm disease of the HEART, immune mediated inflm of VALVES, MYOCARDIUM, and PERICARDIUM

Question 9

What is meant by the term “self-limiting disease”?

Answer 9

Referring to a disease that doesn’t necessarily require interventions to treat, will run its course and be gone

Question 10

The self-limiting, ACUTE form of RHD requires:

Answer 10

Monitoring

Question 11

If RHD is CHRONIC, this will result in:

Answer 11

Severe CARDIAC damage

Question 12

One word to describe the diagnosing process for RHD?

Answer 12

Fuckin’ complex (oops that was two words ;P)

Question 13

What is one important mnft of RHD?

Answer 13

Inflm in the HEART

Question 14

What does inflm in the HEART result in?

Answer 14

(lots of problems, but in this case) dec CO

Question 15

Diagnostic tests for RHD?

Answer 15

• CBC and differential
• CRP
• ESR
• Serology
• Echo

Question 16

What is ESR?

Answer 16

ERYTHROCYTE SEDIMENTATION RATE, measures the rate at which RBCs settle

Question 17

What may cause the ESR to be shorter?

Answer 17

If there are many PROTEINS present, the RBCs will settle faster

Question 18

5 Tx for RHD?

Answer 18

1) Antibiotics (for the strep)
2) Anti-inflms
3) Immunosuppressants
4) Rest
5) Tx of complications that arise

Question 19

Which antibiotics would you give for RDH?

Answer 19

• Penicillin

- Erythromycin

Question 20

What would you give for immunosuppressant in RDH? Why?

Answer 20

Steroids, this will suppress the IR, inflm, and pain

Question 21

What is the benefit of rest for Tx of RHD? How long for bedrest is suggested?

Answer 21

This will dec the CARDIAC workload, suggested bedrest for 4-5 weeks

Question 22

CONGESTIVE HEART FAILURE (CHF) is not:

Answer 22

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

Question 23

CHF is a __________ of inadeq CARDIAC Fx

Answer 23

Syndrome

Question 24

6 things that *usually cause CHF:

Answer 24

1) MI
2) VALVE DISEASE
3) CARDIOMYOPATHY
4) Uncontrolled HTN
5) CAD
6) Risk factors (see Porth pg 626)

Question 25

How long after an MI could CHF occur?

Answer 25

May occur w/in hours, but individual may also live for months or years after

Question 26

In a normal HEART, CO can inc up to 5x its normal amount, this is referred to as..?

Answer 26

…CARDIAC RESERVE

Question 27

How is CARDIAC RESERVE impacted by CHF?

Answer 27

Very minimal CAR RES

Question 28

Where does failure usually take place first? Why here?

Answer 28

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

Question 29

When a chamber is unable to eject it’s B sufficiently, this causes:

Answer 29

RESIDUAL VOLUME

Question 30

If there is RES VOL in the Vs, how might this affect the As?

Answer 30

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

Question 31

If there is dec output in the RV, what effect will this have on the LA?

Answer 31

The LA will not receive the total PULMONARY RETURN = PULM CONGESTION = PULM EDEMA

Question 32

How is HYDROSTATIC PRESSURE affected by PULM CONGEST?

Answer 32

PULM CONGEST = large inc in HP (remeber this is the “push” pressure) = PULM EDEMA

Question 33

What happens when the RV pumps against resistance?

Answer 33

HYPERTROPHY, and inc RES VOL

Question 34

T or F:

R side failure usually precedes L side failure

Answer 34

F, other way around

Question 35

What circuit does L side failure damage? Why?

Answer 35

The PULM CIRCUIT, because failure to pump into the SYSTEMIC CIRCUIT = PULM EDEMA
Remember, L side affects Lungs: L:L

Question 36

What circuit does R side failure damage? Why?

Answer 36

The SYST CIRCUIT, because failure to pump into the PULM CIRC = CONGEST in SYST CIRC = PERIPHERAL EDEMA followed by distention of abdominal organs

Question 37

What is COMPENSATORY HF (COM HF)?

Answer 37

This is when the HEART is failing, but there are no obvious mnfts because the COMPENSATORY MECHANISMS are triggered

Question 38

3 COMP MECHs:

Answer 38

1) V DILATION
2) SNS
3) RAAS

Question 39

Overview of the COMP MECH of V DILATION:

Answer 39

More muscle stretch = more vol in chambers = inc PRELOAD = inc recoil = inc CO

Question 40

Downfall of V DIL? Why?

Answer 40

• Cannot be used longterm because the HEART will then lode its contractility
• Inc ATP demand
• Overstretching

Question 41

The COMP MECH aim of the SNS is to..?

Answer 41

…inc CO

Question 42

Through what 3 processes does the SNS inc CO?

Answer 42

1) TACHYCARDIA
2) VASOCON
3) Inc contractility

Question 43

Downfall of SNS? Why?

Answer 43

• Inc CO = inc workload for the HEART
• Inc ATP demand
• Advances failure

Question 44

How is RAAS triggered?

Answer 44

Dec CO = dec RENAL perfusion = RAAS triggered

Question 45

What does RAAS cause?

Answer 45

• VASOCON

- Releases ADH + ALDOSTERONE = inc B VOL = inc PRELOAD = inc recoil = inc CO