pathology Flashcards
definition of pulmonary hypertension
and d/t
mean pulmonary artery pressure equal to or above 25 mmHg at rest
- Due to increased pulmonary vascular resistance (>30-50% of pulmonary arterial tree is occluded)
persistent systolic BP more than 130 mm HG and/or diastolic BP more than 80 mm HG
hypertension
is the following systemic or pulmonary hypertension?
Elevated systolic and/or diastolic blood pressure
- Measured on 3 separate occasions
- Excess salt with low potassium intake, chronic inflammation, low magnesium, chronic stress or anxiety, insulin resistance, renal hormone imbalance, obesity, arteriosclerosis
- Complications include chronic renal failure, retinopathy, aneurysm ruptures, congestive heart failure
- High pressure causes chronic damage and can affect any organ sensitive to minor vascular damage
- Most are asymptomatic for a long period of time
- Very high pressure can cause dizziness, blurry vision, and headaches
systemic
which is more common systolic or diastolic CHF?
systolic CHF - MORE common
which type of CHF:
Lung disease leads to right ventricular failure initially followed by left-sided failure
- Due to left-sided CHF, left-sided lesions (mitral stenosis), pulmonary hypertension, cardiomyopathy and diffuse myocarditis, tricuspid or pulmonary valvular disease
- Renal hypoxia (fluid retention, pitting edema), pleural effusion and ascites, enlarged and congested liver and spleen, neck venous distension
Right-sided CHF “Blue bloater”
which type of CHF:
Caused by ischemic heart disease (i.e. MI), hypertension, aortic and mitral valvular disease, cardiomyopathy, myocarditis
- Dyspnea and orthopnea due to pulmonary congestion and edema, pleural effusion with hydrothorax, reduced renal perfusion and therefore water and salt retention, cerebral anoxia
Left-sided CHF “Pink puffer”
what type of ischemic heart disease?
Episodic chest pain due to insufficient oxygen supply to the myocardium
- Pain or discomfort in jaw, back, epigastrium, shoulders, or neck
o Dyspnea, nausea, or diaphoresis may occur during an attack
angina pectoris
match: stable,unstable Prinzmetal’s angina pectoris to the following
1.
- Severe narrowing of the coronary arteries
- Occurs during exertion and relieved by rest or nitroglycerin
- Unpredictable → can occur at rest or sleep
- Nitroglycerin DOES NOT bring relief
- Caused by vasospasm
- Can occur at rest
- Nitroglycerin brings relief
- stable
- unstable
- prinzmetal’s
- No acute event unless an asymptomatic myocardial infarction occurred earlier
- Slowly proceeds to congestive heart failure
- Small areas of scar tissue are found in the heart as a result of numerous small, subclinical Mis
Chronic Ischemic Heart Disease
- Coagulation necrosis of the myocardium due to ischemia
- Caused by decreased or complete cessation of blood flow to a portion of the myocardium
- Blockage of the left anterior descending (LAD) coronary artery is the leading cause of a myocardial infarction
Myocardial Infarction
subendocardial or transmural myocardial infarction:
Myocardial necrosis is limited to the inner 1/3 of the heart wall generally a result of a partial coronary occlusion or an occlusion within the heart’s vascular tree
- Sudden crushing chest pain (radiating into neck, jaw, left arm, back, or shoulders), nausea, vomiting, dyspnea, feeling of impending doom, palpitations, cyanosis
- Complications:
o Arrthythmias
o Myocardial rupture – within 4-10 days after an MI; can cause blood to enter the pericardial sac, cardiac tamponade, and death
o Mural thrombosis – a thrombus may form over the infarct and can lead to an embolism
o Ventricular aneurysm (dilation of the ventricle)
o Ruptured papillary muscle
Subendocardial
transmural or subendocardial MI
Myocardial necrosis that spans the endocardium to pericardium usually results from an occlusion in the proximal portion of a coronary artery
transmural
which valvular disease:
- Generally congenital but can be a result of rheumatic disease
- Aortic valve becomes calcified that causes outflow to be obstructed leading to left ventricular hypertrophy
- Most commonly due to calcification of a congenitally bicuspid aortic valve
- Chest pain, syncope, dyspnea on exertion, palpable chest thrill/heave
- Diamond shaped crescendo-decrescendo systolic murmur, which lasts throughout systole
o Best heard in the right upper sternal border
aortic stenosis
- Most common valvular disease = Narrowing of the mitral valve
- Main cause is Rheumatic fever
- Shortness of breath, fatigue, feet or leg swelling, heart palpitations, dizziness/fainting, chest discomfort
- Complications include pulmonary hypertension and edema, heart failure, cardiac hypertrophy, and atrial fibrillation
mitral stenosis
which valvular disease
- Inflammation of the endocardium
- Most of the damage is done to the valves (vegetations)
- Infective endocarditis due to bacterial and sometimes fungal infection of the endocardium
endocarditis
which valvular disease: acute or subacute endocarditis
- Staphylococcus aureus
- Often secondary to an infection elsewhere
- More virulent organisms
acute endocarditis
which valvular disease: acute or subacute endocarditis
Streptococcus viridans
- More common in patients with congenital heart disease or pre-existing valvular heart damage (i.e. rheumatic valvular disease)
- Less virulent organisms
subacute
which valvular disease:
Mitral valve leaflets are enlarged (protrude into the left atrium) and the chordae tendinae are elongated
- Mid-systolic click and sometimes a late systolic murmur (mitral regurgitation)
- Generally benign and asymptomatic but can result in mitral regurgitation
- Hyper-sympathetic syndrome, palpitations, orthostatic hypotension, fatigue, chest pain
- More susceptible to endocarditis
mitral valve prolapse
- Carcinoid syndrome occurs when a rare cancerous tumor called a carcinoid tumor/neuroendocrine cells that secrete high amount of serotonin into the bloodstream
- Carcinoid tumors occur most commonly in the gastrointestinal tract (SI) or lungs
- When carcinoid syndrome affect the heart, it most frequently causes tricuspid valve regurgitation
- Initial symptoms include fatigue and dyspnea
- Can result in pellagra
- Skin flushing, excessive diarrhea, right-sided heart disease, and bronchoconstriction
Carcinoid Heart Diseases
which valvular cdx:
- Sequelae of a Group A beta hemolytic Streptococcus pyrogens infection
- Strep Ab cross-react with the heart tissue (type II hypersensitivity reaction)
- Inflammation occurs in all 3 layers (endocarditis, myocarditis, pericarditis)
o Vegetations are found in the heart valves which is the ENDOCARDIUM
- Other symptoms include:
o Aschoff bodies (granulomatous inflammatory lesions)
o erythema marginatum (trunk/extremities)
o migratory polyarthritis
o fever
o subcutaneous nodules
o chorea
o malaise
o elevated ESR
Rheumatic Heart Disease
which type of cardiomyopathy:
- Most common cause of cardiomyopathy is characterized by dilation of all 4 chambers + thinning of muscular wall, systolic dysfunction, and right- & left-sided heart failure
- Most commonly due to chronic death of myocardial cells and lesser due to acute myocardial inflammation
- Fibrosis occurs in the left and right ventricles causing dyspnea on exertion and easy fatiguing
o Cough, edema (legs, ankles, feet), or even liver problems can occur which can cause ascites - Causes include viral infection, hypothyroidism, toxin exposure, post-partum, thiamine deficiency
dilated/conjestive
which type of cardiomyopathy
Stiffened and less compliant, but size of ventricle stay relatively the same
- Rigid ventricular walls (primarily the left) which causes decreased output -> diastolic HF
- Due to diffuse infiltration of hardening substances (ex. iron) or chronic inflammation
- Hypertrophy → fibrosis
- Dyspnea on exertion, edema, orthopnea, arrhythmias
restrictive
which type of cardiomyopathy
Significant ventricular hypertrophy not due to outflow obstruction such as aortic valve diseases or hypertension
- Anterior leaflet of mitral valve is misplaced
- Congenital, acquired, idiopathic forms
- Syncope and sudden death
hypertrophic
- Inflammation of the myocardium which can lead to chronic health issues and sudden death
- Bacterial infection can follow sepsis which causes neutrophil invasion
- Symptoms include: chest pain, palpitations, fever, CHF, fatigue, systolic murmur, dysnea
- Usually managed similar to HF
myocarditis
