pathology of Heart Failure, Hypertension, Anuerysms And Neoplsia Flashcards
1- define cardiac failure?
2- what will It result in?
1- failure of the heart to pump sufficient blood and deliver sufficient nutrients to satisfy metabolic demands
2- results in under perfusion which may cause fluid retention and increased blood volume
acute heart failure?
rapid onset of symptoms, often with definable cause eg- MI
chronic failure?
slow onset of symptoms, associated with, for example, ischaemic or valvular heart disease
acute-on-chronic heart failure?
chronic failure becomes decompensated by an acute event
systolic failure?
- failure of the pump to move blood into systole
- reduced ejection fraction
- reduced ventricular contraction
causes of systolic failure?
- myocardial ischamia
- MI
- myocardial scarring
- myocarditis
- drugs
- muscular disorders (DMD)
effects of systolic failure?
- reduced cardiac output
- feedback to atria and right side of heart
- pulmonary oedema
- peripheral oedema
treatment of systolic failure?
support
diastolic failure?
- failure of ventricular wall to relax
- restrictive, stiff ventricle
- reduced ventricular filling leads to reduced blood for systole
- elevated end diastolic pressure
causes of diastolic failure?
- scarring plus most causes of systolic
- infiltrative disease (amyloid)
effect of diastolic failure?
- none
- pulmonary and peripheral oedema
- response to excersise
- tachycardia and pulmonary acute oedema
treatment of diastolic failure?
reduce AV conduction
what are some of the causes of left and right ventricular failure?
- coronary heart disease
- hypertension
- cardiomyopathy
- drugs
- toxins
- endocrine
- nutritional deficiency
- infiltrative
- other
examples of cardiomyopathy causes?
- familial/genetic
- non familial/ non genetic can be acquired
examples of drugs?
beta blockers
calcium antagonists
antiarryhtmics
cytotoxic agents
examples of toxins?
alcohol
medication
cocaine
trace elements
examples of endocrine causes?
diabetes
hyper/hypo thyroidism
cushings syndrome
adrenal insufficiency
excessive growth hormone
examples of nutritional causes?
deficiency of thiamine
obesity
examples of infiltrative causes?
sarcoids
amyloidosis
connective tissue disease
examples of other causes?
HIV
peripartum cardiomyopathy
end stage renal failure
describe the clinical effects of left ventricular failure?
build up of fluid in lungs
- blockage of blood
- can cause a build up of frothy fluid made of proteins leaking out
describe the clinical effects of right ventricular failure?
pitting oedema
congested ‘nutmeg’ liver
what organ is most effected right ventricular failure and describe the pathway?
liver
backlog of blood … IVC … hepatic vein… liver
patient may come in complaining of a sore side.
2 main causes of left ventricular failure?
hypertensive and ischameic heart failure
what will left ventricular failure cause?
- pulmonary oedema with associated symptoms
- leads to pulmonary hypertension and eventually right ventricular failure
what is combined left and right ventricular failure called?
congestive cardiac failure
common causes of right ventricular failure?
- secondary to left ventricular failure
- related to intrinsic lung disease
- cor pulmonale due to pulmonary hypertension
- primary pulmonary hypertension
what are they key features of the clinical examination in patients with heart failure?
- Appearance -alertness, nutritional status, weight
- Pulse rate -rhythm, and character
- Blood pressure -systolic, diastolic, pulse pressure
- Fluid overload -jugular venous pressure
- Peripheral oedema -(ankles and sacrum),
hepatomegaly, ascites - Respiratory rate, crackles, effusion (transudate)
- Apex displacement, gallop rhythm, third heart sound, flow murmurs suggesting valvular dysfunction
forward failure?
- Reduced perfusion of tissues
- Tends to be more associated with advanced failure
- problem with blood flowing out the heart
backwards failure?
- problem with blood flowing back to the heart
- Due to increased venous pressures
- Dominated by fluid retention and tissue congestion
what is B-natiuretic protein?
- BNP is one of of the natriuretic peptide hormone family, produced by ventricular muscle.
- It is a stress response protein that increases in heart failure.
what will B-natiuretic protein act on?
Acts on the ANP receptor but with relatively lower affinity but longer half life than other natriuretic proteins.
what effects can B-natriuretic protein bring about?
Vessel dilatation
Reduced load on heart
Changes in glomerular filtration
Inhibits renin secretion
Decrease aldosterone
Natriuresis
Reduction in blood pressure
what is hypertension a major risk factor for?
- Cardiovascular disease
- Ischaemic heart disease
- Accelerated atherosclerosis
- Alzheimer type dementia
what are the different categories of blood pressure?
1- Optimal 120/80 mm Hg
idealblood pressure is usually considered to be between 90/60mmHg and 120/80mmHg
2- Hypertension high blood pressure is considered to be 140/90mmHg or higher (or 150/90mmHg or higher if you’re over the age of 80)
3- Isolated systolic hypertension >130/<80 mm Hg – commonest in >65 year old
what is B-natriuretic protein a good biomarker for?
ventricular stress
the stress response protein that is a good biomarker for cardiac failure.
how can hypertension cause atherosclerosis?
- High blood pressure can damage blood vessels
- fats (like LDL) can accumulate in these damaged areas
- the process of atherosclerosis will occur
how are coronary arteries subject to atherosclerosis due to hypertension?
they pressures in the coronary arteries are very high and they are subject to a lot of turbulence
describe the end organ effects of systemic hypertension?
primary = sow changes in vessels and heart with chronic end organ dysfunction (tends to be less severe but will develop over time)
accelerated = rapid changes in vessels with acute end organ dysfunction (medical emergency- causing damage over a short period of time)
what end organs are most commonly effected in systemic hypertension?
brain
heart
kidneys
arteries
eyes
3 effects on the kidney due to systemic hypertension?
1- Nephrosclerosis=
- Drop-out’ of nephrons due to vascular narrowing
- Proteinuria
- Haematuria
2- Chronic renal failure
3- Acute renal failure can be associated with accelerated and severe hypertension
how can you get proteinuria due to systemic hypertension?
by loosing glomerular integrity you will loose the full nephron
= proteinuria (low level)
3 effects on blood vessels of systemic hypertension?
1- Acceleration of atherosclerosis
2- Intimal proliferation and hyalinisation of arteries and arterioles
3- Accelerated and severe hypertension – fibrinoid necrosis
effects on the brain of systemic hypertension?
- Atherosclerosis
- Ischaemia and TIA
- Infarct
- Haemorrhage
effects on the eyes due to systemic hypertension?
hypertensive retinopathy
what are the causes of pulmonary hypertension?
- Increased pulmonary vascular resistance
- Diffuse lung disease, for example COPD
- Elevated left atrial pressure e.g. left ventricular failure, mitral valve stenosis
- Recurrent pulmonary emboli
- Primary pulmonary hypertension (unknown cause) - genetics
- Left-right shunts e.g. ASD, VSD
what are the different types of aneurysms that can be caused by systemic hypertension?
1- Aortic and other arteries:
- Atherosclerosis
- Hypertension
2- Berry aneurysm
- Congenital
3- Dissecting aneurysm
- Thoracic aorta, Marfan’s
4- Mycotic aneurysm
- Infective endocarditis
describe the relationship between neoplasia and the heart?
Rare - most often metastatic eg melanoma or small cell undifferentiated lung cancer
Primary benign – atrial myxoma
Primary malignant – angiosarcoma, rhabdomyosarcoma…….
what is thrombosis?
what are its risk factors?
1- local coagulation or clotting of the blood in part of the circulatory system.
2- smoking
Diabetes
Hypertension
High cholesterol
Obesity
Familial
biomarker for cardiac failure?
BNP
what is an aneurysm?
Abnormal swelling in the wall of a blood vessel.
The vessel wall become weakened and cannot maintain the tension to accommodate for the pressure.
