Pathology Flashcards
1
Q
What is the most common acquired heart disease in children and young adults?
A
Acute Rheumatic fever
2
Q
What is the causative agent for Acute rheumatic fever?
A
Group A β-hemolytic Streptococcus.
3
Q
What is the criteria used in diagnosing acute rheumatic fever?
A
Jones criteria
4
Q
What is the Jones criteria for Acute Rheumatic fever?
A
Evidence of Group A streptococcus infection
- elevated or rising ASO titer
- Throat culture
- Rapid antigen test
AND
Two major manifestations OR one major and two minor manifestations.
5
Q
What are the MAJOR manifestations of Acute Rheumatic fever?
A
P- Polyarthritis
E - Erythema marginatum (type of skin rash)
C - Carditis
S - Sydenham’s chorea (uncontrollable movements)
S - Subcutaneous nodules
” PECSS Major”
6
Q
What are the MINOR manifestations of Acute rheumatic fever?
A
P - Prolonged PR interval on ECG.
E - Elevated ESR or CRP
A - Arthralgia
F - Fever
7
Q
What is the most important protein in the causation of ARF and where is it located?
A
M protein in Group A strep
8
Q
What is the term given to the inflammation of all layers of the heart?
A
Pancarditis
9
Q
What is the main histological feature for ARF carditis?
A
Aschoff nodule which contains the pathognomonic cell called the Anitschkow cell
10
Q
What is the most common valve associated with Chronic rheumatic heart disease?
A
Mitral valve
11
Q
What is Infective endocarditis?
A
A microbial infection of heart valves or endocardium covering wall of heart
12
Q
What are Congenital Heart Diseases?
A
Congenital heart diseases are abnormalities of the heart or great vessels that are present at birth.
13
Q
What are the most common Congenital Heart diseases?
A
Ventricular septal defect
Atrial septal defect
14
Q
Which genetic abnormalities are associated with Congenital Heart diseases?
A
Trysomy 21
Trisomy 13&18
Turner’s syndrome
22q11.2 deletion syndrome ( DiGeorge syndrome )
15
Q
What are other causes of Congenital Heart diseases?
A
- Congenital rubella infection
- Teratogens
- Maternal diabetes, and genetic factors
16
Q
When do most congenital heart abnormalities occur ?
A
First 8 weeks of Pregnancy ( Embryogenesis)
17
Q
When does the formation of the heart structure and great vessels occur?
A
Weeks 1-4
18
Q
When does the formation of valves and completion of septa dividing right from left heart occur?
A
Weeks 4-8
19
Q
True or False? A left to right Arteriovenous shunt can result in left ventricular hypertrophy.
A
FALSE!! Left to right shunt results in RIGHT ventricular hypertrophy .
20
Q
What are the disorders associated with Left to Right AV shunts?
A
*Atrial septal defects (ASDs),
* Ventricular septal defects (VSDs),
*Patent ductus arteriosus (PDA)
* Atrioventricular septal defect (AVSD)
21
Q
What is the name given to the late onset of cyanosis seen in Left to right shunts?
A
Eisenmenger syndrome
22
Q
What is an Atrial Spetal Defect?
A
This is a defect in the interatrial septum ( septum separating right and left atria)
23
Q
At what age does 50% of Atrial septal defect close?
A
By age 5.
24
Q
What is Ventricular Septal Defect ( Hole in the heart)?
A
This is a defect in the ventricular septum.
25
What are the main types of Ventricular septal defects?
* Perimembranous - most common type
* Muscular
26
What is Atrioventricular Septal defects?
* This is a defect of the septum at the atrioventricular junction.
It involves the lower atrial septum and upper ventricular membranous septum
* Disrupts the tricuspid and mitral valves.
27
Which diseases is associated with hearing" Machinery- like murmurs"?
Patent Ductus Arteriosus
28
What is the most common cause of Patent Ductus Arteriosus?
PDA occurs when there is a failure of the ductus arteriosus to close and may be as a result of HYPOXIA.
29
What are the most common causes of Right to Left venous shunts?
Tetralogy of Fallot ( TOF )
Transposition of the Great Arteries (TGA)
To the lefTT to the lefTT.
30
What are the four cardinal features associated with Tetralogy of Fallot?
* Pulmonary Stenosis - Obstruction of the outflow from the right ventricle.
* Ventricular Septal Defect (VSD)
* Aorta that overrides the VSD
* Right ventricular hypertrophy.
31
What is Dextrocardia?
This is an abnormality of position , opposite rotation of the heart with apex pointing to the right side.
32
What is the term given to an abnormal morphology usually with thickening and modularity of leaflets or cusps of valves?
Dysplasia
33
What is the term given to a reduction in the circumference of a valve orifice and may occur with an otherwise normal valve with a dysplastic valve?
Stenosis
34
What is Atresia?
This is complete occlusion of valve orifice due to poor or no development of valve apparatus.
35
Fill in th blanks. " In 95% of cases, Primary hypertension is ______ or ________."
Essential or Idiopathic
36
What are the causes of Secondary Hypertension?
* primary renal disease, renal artery narrowing (renovascular hypertension), or adrenal disorders
37
What are examples of accelerated hypertension?
Severe hypertension
Renal failure
Retinal haemorrhage / exudates.
38
Which hypertensive vascular disease is associated with small arteries and arterioles?
Hyaline arteriosclerosis( Benign)
Hyperplastic arteriosclerosis ( Malignant)
39
What are the morphological features found in Benign nephrosclerosis?
Bilateral changes
Mild decrease in size
Diffuse, fine granularity of cortical surface area
40
What are the clinical features of Left-sided heart failure?
Increased Dyspnoea on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Pulmonary oedema
Cough
haemoptysis
Respiratory tract infections.
41
What are the clinical features of Right sided heart failure?
Elevated venous pressure
Tender hepatomegaly
Oedema
42
What is shock?
A state of generalized inadequate tissue perfusion or a state in which there is severe circulatory impairment such that the metabolic needs of the tissues/organs of the body are not met.
note: it's systemic hypoperfusion (basic definition)
43
True or False? Shock is normally accompanied with Hypertension.
FALSE!! It is usually accompanied by HYPOTENSION.
44
What are the types of shock?
* Cardiogenic shock
* Obstructive shock
* Hypovolemic shock
* Distributive shock: septic shock, anaphylactic shock, neurogenic shock
45
What is the most common type of shock?
Hypovolaemic Shock
46
What is HYpovalemic shock?
Hypovolemic shock results from low cardiac output due to loss of blood or plasma volume (e.g., resulting from hemorrhage or fluid loss from severe burns).
47
What are the clinical manifestations of Hypovalemic shock?
* Pallor (especially in cases of haemorrhage)
* cyanosis
* Sweating (in the early stage)
* Tachycardia
* Hypotension
* Cardiac dysrrhythmias
* Tachypnea
* Oliguria ( urinary output less than 400 ml per day or less than 20 ml per hour)
* Circulatory collapse/shock
48
True or False? Cardio-vascular collapse/shock occurs with blood/fluid loss >40%
TRUE!!
49
What is the management for a Hypovalemic shock?
Fluid (crystalloid +/- blood) & correction deranged electrolytes - important in the resuscitation of patients .
50
What are the three types of Distributive shock ?
Anaphylactic shock
Neurogenic shock
Septic shock
51
What is the main pathophysiology in Distributive shock?
The problem is not loss of blood , but excessive dilation of blood vessels or decreased vascular resistance causing the blood to be improperly distributed.
52
What is the cause of Septic shock?
Gram -negative bacteria or endotoxic release. May also be due to Gram -positive bacteria.
53
Fill in the blanks. " _________ are an important component of atherosclerotic plaques.
Lipids
54
What are the other components in the formation of atherosclerotic plaques?
Macrophages, Cytotoxic factors and inflammatory agents
55
Fill in the blanks. " Atheroscelorosis in peripheral arteries gives rise to _______ and in the carotid or cerebral arteries gives rise to _________which may cause a __________."
Atherosclerosis in peripheral arteries gives rise to PERIPHERAL VASCULAR DISEASES and in the carotid or cerebral arteries to CEREBROVASCULAR disease which may cause a STROKE.
56
What are the risk factors for Ischaemic heart diseases?
Smoking
Hypertension
Serum LDL
Diabetes Mellitus (DM)
Obesity
Fibrinogen
Lipoprotein a
Homocysteine
57
True or False? Lipids are classified as sterols.
TRUE!!
58
What are Eicosanoids?
These are multiple lipid based signaling molecules that has effects on blood coagulation bronchial and vascular contractility , reproduction .
59
Where are Sphingolipids used?
In the Central nervous system and blood group substances.
60
Vitamin E is mainly used for?
Neural function and as an antioxidant .
61
Vitamin K is used for?
Activation of clotting factors
62
Fill in the blanks. " Cholesterol serves as precursors for the synthesis for ________, _______ & __________."
Steroid hormones, Vitamin D and Bile acids
63
What maintains the cholesterol balance?
The liver- where in excess it is secreted by the liver directly , into bile or by conversion into bile acids.
64
What is the name given to small surface invaginations that serve as binding sites for receptors and signalling molecules?
Caveolae
65
What are the two substances that form a Caveolae or lipid raft?
Cholesterol and Sphingomyelin
66
How is a constant concentration of cholesterol in plasma membrane maintained?
This is achieved by the transcription of genes encoding enzymes involved in cholesterol synthesis
67
What are phytosterols?
These are Plant sterols that act in the intestines to lower cholesterol absorption.
68
What are the two types of Phytosterols?
* Delta5-phytosterols ( eg beta-sitosterol )
* 5 alpha-reduced phytosterols (stanols)
69
What is the basic structure of Fatty acids?
RCOOH
70
True or False? Saturated Fatty acids are mostly ANIMAL derived while UNSATURATED fatty acids are mainly PLANT derived.
TRUE!!
71
What is the main dietary fat?
Triglycerides - a concentrated form of metabolic energy.
72
What is the name of the enzyme which hydrolyses triglycerides in the gut?
Lipoprotein lipase.
73
True orFalse? Monoglycerides undergo re-esterification in enterocytes and subsequent incorporation into chylomicrons.
TRUE!!
74
Where are the major sites of endogenous triglyceride synthesis?
The liver and Adipose tissue
75
Fill in the blanks. " Fatty acids are mobilised from adipose tissue by the action of__________."
Hormone sensitive lipase (HSL)
76
Hormone sensitive lipase (HSL) is activated by ?
Glucagon and Adrenaline
77
Hormone sensitive lipase (HSL) is inhibited by?
Insulin
78
True or False? Phospholipids contain a Hydrophilic (phosphate group ) and a hydrophobic (fatty acid ) domains
TRUE!!
79
What is the shape of HDL?
Discoidal
80
What is the shape of Lipoproteins?
They are Generally spherical
81
Which Chylomicron remnant is anti-atherogenic?
HDL
82
Majority of chylomicron remnants is said to be?
Pro-atherogenic - VLDL, IDL, LDL, Lp(a)
83
What are the functions of apolipoproteins?
1. Serving a structural role
2. Acting as ligands for lipoprotein receptors
3. Guiding the formation of lipoproteins
4. Serving as activators or inhibitors of enzymes involved in the metabolism of lipoproteins.
84
Chylomicrons are made by?
The intestines
85
What is the largest and most buoyant class of Lipoproteins?
Chylomicrons
86
What is the major chylomicron protein?
APO B-48
87
True or False? Chylomicron remnants are enriched with cholesterol and are pro-atherogenic.
TRUE!!
88
What are Chylomicron remnants?
These are smaller particles caused by the removal of triglycerides from chylomicrons by peripheral tissues.
89
What is the major protein of Very low density lipoproteins (VLDL)?
Apo B-100
90
What are the proteins found in VLDL?
apo B-100
apo C-1
apo c-II
apo c- III
apo E
apo-A
91
True or False? VLDL particles are LARGER than Chylomicrons.
FALSE!!! VLDL particles are SMALLER than chylomicrons
92
How are Intermediate density lipoproteins (IDL) produced?
They are produced during the conversion of VLDL to LDL .
* they are VLDL remnants
93
What are the structural component of IDL?
Cholesteryl esters
apo B-100
apo - E
94
Fill in the blanks. " __________ represents the end products of VLDL catabolism ."
Low density lipoproteins (LDL)
95
What is the major cholesterol - containing lipoprotein?
Low - density lipoprotein( LDL)
96
What is the main component in LDL?
Apo B-100
97
True or False? Small dense LDL are more pro-atherogenic than large LDL.
TRUE!!
98
True or False? Large LDL particles have a decreased affinity for the LDL receptor resulting in a prolonged retention time in the circulation .
FALSE!! Small dense LDL
have a decreased affinity for the LDL receptor.
99
Fill in the blanks. "Small Dense LDL are more susceptible to _______ which could result I an enhanced uptake by macrophages."
Oxidation
100
Which lipoprotein is the smallest and most dense?
HDL
101
Which lipoprotein has anti-oxidant , anti-inflammatory , anti- apoptotic properties which also contribute to its ability to inhibit atherosclerosis?
HDL
102
Which lipoprotein is considered a risk factor for Cardiovascular diseases?
High Lp(a) - cut off 300 mg/dL
103
What is the major structural protein of HDL?
Apolipoprotein A- I
104
Where is Apolipoprotein A- I synthesised?
In the liver
105
What is the name of the enzyme that converts free cholesterol into cholesteryl ester ?
Lecithin cholesterol acyltransferase(LCAT)
106
What is an activator of the enzyme,e Lecithin cholesterol acyltransferase(LCAT)?
Apolipoprotein A-1
107
Which apolipoprotein may play a role in regulating food intake?
Apolipoprotein A -IV
108
Which apolipoprotein is an activator of LPL mediated lipolysis and thereby plays an important role in the metabolism of triglyceride rich lipoproteins?
Apolipoprotein A- V
109
Which Apolipoprotein is the major structural proton of chylomicrons and chylomicron remnants?
Apo B-48
110
Apolipoprotein B-100 is the major structural component in what lipoproteins?
VLDL
IDL
LDL
111
Where is Apolipoprotein C synthesised?
In the liver
112
Fill in the blanks. " __________ is a co-factor for lipoprotein lipase (LPL) and thus stimulates triglyceride hydrolysis."
Apo C-II
113
What is the most common isoform of Apolipoprotein E?
Apo E- 3
114
Patients who are homozygous for Apo- E2 can develop what disease?
Familial Dysbetalipoproteinemia
115
Which Apolipoprotein is associated with an increased risk of Alzheimer's disease and an increased risk of atherosclerosis?
Apo E4
116
What is the process by which the LDL receptor uptakes LDL, Chylomicron remnants and IDL?
Endocytosis
117
True or False? Ischaemic Heart diseases are a collection of Syndromes.
TRUE!!
118
What are the cardiac syndromes which can cause clinical presentations associated with IScahemic Heart disease?
* Angina Pectoris (stable/unstable)
*Chronic IHD with heart failure
*Myocardial infarction
*Sudden cardiac death
119
What are the causes of Ischaemic Heart Disease?
* Atherosclerotic coronary artery disease (~90%)
* Vasospasm
*Vasculitis
*Embolism (plaque, thrombus, tissue, foreign body)
*Coronary artery dissection
120
What are the aggravating factors of Ischaemic Heart Disease?
* Increased cardiac demand.
* Hypertrophy (e.g. hypertensive heart disease)
* Decreased perfusion e.g. low systemic blood pressure
* Hypoxaemia e.g. COPD, anaemia
*Increased heart rate: Increased demand and decreased diastolic filling
121
Fill in the blanks. " Ischaemic heart disease is a late manifestation of ___________."
Atherosclerotic coronary artery disease.
122
True or False? Clinically, acute plaque change manifests as Acute Coronary Syndrome (ACS).
TRUE!!
123
What are the intrinsic factors of the atheromatous plaque
?
* Thin fibrous cap
* ↑ lipid and foam cells
* Few smooth muscle cells
* ↑ inflammatory cells increased MMPs 🡪 ↓ collagen
124
What are factors extrinsic to plaque?
* Adrenergic stimulation
* Blood pressure control
* Vasospasm
* Platelet reactivity
* Emotional stress
125
What are the symptoms of a Myocardial Infarction?
* Central crushing chest pain, prolonged
* Weak, rapid pulse
* Diaphoresis / sweating
* Shortness of breath
* Asymptomatic
126
What are the biochemical abnormalities associated with a MI?
Increase in Tropinin- I and T
127
What are the ECG abnormalities associated with a Myocardial infarction?
ST segment elevation
128
If there is an infarction present on the Right ventricle, posterior wall of left ventricle or in the posterior septum. Which artery is occluded?
Right coronary artery
129
If the Left Anterior Descending coronary artery is occluded if there is an infarction present where on the heart?
In the Anterior wall of left ventricle OR anterior septum
130
If there is an infarction in the Lateral wall of left ventricle which artery is occluded?
Left Circumflex coronary artery
131
If there is occlusion of the artery for less than two minutes (<2) what is the outcome/ impact on myocardium ?
Loss of cell function
132
If there is occlusion of the artery for less than two minutes (<20)what is the outcome/ impact on myocardium ?
Reversible cell injury
133
If there is occlusion of the artery for 20-40 minutes what is the outcome/ impact on myocardium ?
Irreversible cell injury
134
What are the impacts on the myocardium after a myocardial infarction?
* Electrical instability
* Electrolyte disturbances
* Damage to conduction system
* Tissue necrosis
135
What is the most common pattern of a Myocardial Infarction?
Transmural (Full thickness)
136
What are the features of a sub-endocardial infarction?
* Inner 1/3 of ventricular wall (furthest away from source).
* May extend outside arterial distribution pattern.
137
When does a sub-nedocardial MI occur?
* Acute plaque change with subtotoal occlusion
OR
* Low perfusion pressure with non-critical stenosis
138
Which pattern of a Myocardial infarction involves small intramural vessels?
Multifocal microinfarction
139
Fill in the blanks. " A multifocal micro infarction can be caused by ______ or ________."
* Endogenous catecholoamines- ex from a pheochromocytoma
* Drugs such as cocaine, ephedrine
140
What is the major primary prevention of a MI?
Risk factor modification: Atherosclerosis
141
Which drugs can help the treatment myocardial infarction?
* Aspirin prophylaxis; anti-platelet agents
* Anticoagulation
* Beta blockers
* ACE inhibitors
* Statins
142
What are surgical treatments of a Myocardial infarction?
*Thrombolysis:
- Fibrinolytic therapy
- Percutaneaous transluminal coronary angioplasty (stents)
*Coronary artery by-pass grafting (CABG)
*Left ventricular assist devices
* Implantable defibrillators and pacemakers
143
Which pattern of a myocardial infarction Begins approximately 30 minutes after complete occlusion?
Transmural
144
True or False? The right ventricle is MORE common in a Transmural MI than the left ventricle.
FALSE!!Left ventricle involvement more common than right.
145
True or False? Diabetes Mellitus is a major risk factor for Periperl vascular diseases?
FALSE!! It is a MINOR factor.
146
What are the major risk factors for Peripheral Vascular Disease?
Hypertension
Hypercholesterolemia
Cigarette Smoking
147
What are the minor risk factors for Peripheral vascular diseases?
Obesity
Diabetes Mellitus *
Hypertriglyceridemia
Sedentary lifestyle
Stress
Family history
148
What are the surgical treatments for Critical limb ischaemia?
* Angiography indicated
* Percutaneous Transluminal
* Angioplasty (PTA)
* Bypass Surgery
* Amputation
149
What is the most common bypass to be used in Peripheral Vascular diseases?
The most common bypass is the Fem-Pop bypass
150
What are the clinical features of Chronic occlusion seen in Peripheral Vascular diseases?
*Claudication
*Rest pain
*Blistering/ulceration
*Gangrene
151
What is Leriche Syndrome?
Leriche Syndrome also commonly referred to as aortoiliac occlusive disease, is caused by severe atherosclerosis affecting the distal abdominal aorta, iliac arteries, and femoro-popliteal vessels.
152
What are the examinations to be done in suspected Peripheral diseases?
* Cardiac Examination
* Pulses
* Trophic changes
* Ankle brachial indices
153
What is the treatment for Claudication?
* Control of risk factors
* Burger's exercises
* Careful follow-up
154
Where is the LDL receptor located?
It is present in the liver.
155
True or False? A LOW number of LDL receptors is associated with HIGH plasma LDL levels BUT a HIGH number of LDL receptors in the liver is associated with LOW plasma LDL levels.
TRUE!!
156
True or False? Lipoproteinlipase (LPL) is synthesised in the liver.
FALSE!! It is synthesised in the heart, muscle and adipose tissue.
157
Fill in the blanks. " The enzyme lipoprotein lipase requires __________ as a co-factor."
APO C-II
158
What is the function of lipoprotein lipase(LPL)?
It hydrolyses triglycerides carried in the chylomicrons and VLDL to fatty acids.
159
Which apoproteins inhibit the activity of LPL?
Apo C-III and Apo A-II
160
What hormone stimulates LPL expression?
Insulin
161
Where is the enzyme Hepatic lipase located?
On the sinusoidal surface of liver cells
162
What is the function of Hepatic Lipase?
* It mediates the hydrolysis of triglycerides and phospholipids in IDL and LDL leading to smaller particles of LDL.
* It also mediates the hydrolysis of triglycerides and phospholipids in HDL resulting in smaller HDL particles.
163
What is the function of the Lecithin cholesterol acyltransferase (LCAT) ?
LCAT catalyses the synthesis of cholesterol esters in HDL by facilitating the transfer of a fatty acid from position 2 of lecithin to cholesterol.
164
Cholesterol in the intestinal lumen is primarily derived from ______.?
Bile
165
Fill in the blanks. " Chylomicrons are secreted into the lymph and delivered via the __________ to the circulation."
Thoracic duct
166
What is the primary determinant of the rate of VLDL synthesis?
The availability of triglycerides
167
In Type IIa dyslipidaemia what is the elevated lipoprotein?
LDL
168
What is the Gene involved in Type IIa dyslipidaemia (Familial Hypercholesterolemia )?
Auto-dom - defects in LDL receptor ApoB or PCSK9
169
What is the serum lipid pattern and electrophoretic change in Type IIa dyslipidaemia (Familial l Hypercholesterolemia)?
Serum lipid pattern - elevated cholesterol
Electrophoretic change - Incr beta band
170
The gene Auto recess -two mutant alleles of LPL etc is associated with which dyslipidaemias?
Type 1 ( Familial hyperchylomicronemia)
171
What is the serum lipid pattern in Diabetes and Obesity?
Increased triglycerides , Decreased HDL
172
What is the Serum lipid pattern in Alcohol excess ?
Increased triglycerides and HDL
173
What is the serum lipid pattern for Cholestasis?
Increased LDL , Increased total cholesterol
174
What is the serum lipid pattern of Hypothyroidism?
Increased LDL, Increased total cholesterol , increased triglycerides.
175
In nephrotic syndrome, what lipoprotein is lost in urines?
HDL
176
What is the cause of Nephrotic syndrome?
Due to a hepatic overproduction of apo B-100 as part of increased hepatic protein synthesis typical of the condition.
* Most likely hypercholesterolaemia or mixed hyoerlipidaemia
177
Which enzyme activity is reduced in Nephrotic syndrome?
HMG COA
178
True or False? Alcohol causes Hypertriglyceridaemia.
TRUE!!
179
Which drugs can raise plasma Tryglicerides. and lower HDL ?
Non-selective beta blockers ex propanolol & beta -1 selective beta blockers
180
Which drugs increases LDL , Triglycerides and HDL?
Glucocorticoids
181
How is HDL investigated?
It is measured by assessing cholesterol content after precipitation of APO b containing lipoproteins
182
Fill in the blanks. " LDL is mostly derived by ______."
Friedewald Formula
183
True or False? The lipoprotein electrophoresis on cellulose acetate paper, agarose and polyacrylamide assessment is QUANTITATIVE.
FALSE!! IT IS QUALITATIVE .
184
What is Backward failure?
Heart unable to accommodate venous return resulting in vascular congestion-pulmonary/hepatic
185
What is Forward failure?
* Heart unable to maintain adequate cardiac output.
* Low output failure-cool peripheries
186
What is the clinical features of a systolic dysfunction?
* Impaired myocardial contractile function.
* MI, myocarditis, Dilated Cardiomyopathy.
* Impaired stroke volume(EF)
* Symptoms of decreased cardiac function.
* Usually leads to low output heart failure.
187
What are the clinical features of Diastolic disfunction?
* Normal systolic function
* Impaired relaxation or compliance (increased stiffness and impaired filling)
* May be due to ischaemia of myocardium
( relaxation is an active process) or hypertrophy
* Increased filling pressures
* Leads to venous congestion
188
What are the causes of High output heart failure?
Thyrotoxicosis
Anaemia
Beri-beri
A-V fistula
Paget’s disease of bone
189
True or False? Heart failure is a diagnosis.
FALSE!! Heart failure is a SYNDROME
190
What are clinical features of Cardiac dysfunction?
* Decreased cardiac output
* Increased preload (LV dilatation)
* Activation of SNS-tachycardia
* Activation of RAAS-salt and water retention
191
What are the compensatory mechanism for Cardiac dysfunction?
Frank-Starling mechanism
Activation of Sympathetic system
Activation of RAAS system
Ventricular dilation and hypertrophy
Tahycardia
Reduced vagal activity
Vasopressin
Circulating catecholamines
Natriuretic peptides
192
What are the causes of Cardiac Dysfunction?
* Coronary artery disease (60-70%)
* Idiopathic (20%)(often DCM)
* Valvular
* HTN
* Alcohol
193
What are the symptoms of Low cardiac output?
* Fatigue, tiredness, mental cloudiness.
194
What are venous congestion symptoms of cardiac failure?
* Dyspnea, orthopnea, PND
* Cough
* Hemoptysis
* Peripheral oedema
* Tender liver
195
What are Investigations to be done to identify cardiac failure?
* Identify and treat precipitating causes.
* Blood work-U&E,CBC,Thyroid test,BNP,cardiac enzymes,ferritin
* ECG
* CXR
* Echocardiogram
* Nuclear imaging tests
196
What are. the functions of BNP- B type natriuretic peptide?
▪ Increases in the presence of LV dilatation and dysfunction.
▪ May be used as a screening test in patients with non-specific dyspnea.
▪ May be used as a prognostic marker.
197
What are the surgical procedures for treatment of cardiac failure?
* CABG(coronary artery bypass grafting) and angioplasties
* Valve surgeries
* Resynchronization therapy-
* Biventricular pacing to improve synchronicity of
contraction (MIRACLE) * ICD
* Primary and secondary prevention of sudden death(MADIT-1,MUST,MADIT-2)
* LVAD
* Cardiac Transplantation
198
What is Cardiomyopathy?
This is a cardiac condition with disorder in the myocardium not as a result of causes such as ischaemia, congenital,valvular ,pericardial and hypertension.
Primary- no known cause
Secondary- known cause
199
What are the types of Cardiac myopathy?
* Dilated
* Hypertrophic
* Restrictive
200
What is Dilated cardiomyopathy?
Dilated usually generalised hypokinesia of the Left ventricle
201
What is Hypertrophic cardiomyopathy?
Left ventricular hypertrophy- familial,genetic.
202
In which cardiomyopathy will the ECG present with giant T waves?
Hypertrophic cardiomyopathy
203
Which cardiomyopathy is caused by amyloid,haemochromatosis,eosinophili as,Fabry’s disease,glycogen deposition?
Restrictive cardiomyopathy
204
