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MD3001 > pathology of Heart Failure, Hypertension, Anuerysms And Neoplsia > Flashcards

pathology of Heart Failure, Hypertension, Anuerysms And Neoplsia Flashcards

1
Q

1- define cardiac failure?
2- what will It result in?

A

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

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2
Q

acute heart failure?

A

rapid onset of symptoms, often with definable cause eg- MI

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3
Q

chronic failure?

A

slow onset of symptoms, associated with, for example, ischaemic or valvular heart disease

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4
Q

acute-on-chronic heart failure?

A

chronic failure becomes decompensated by an acute event

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5
Q

systolic failure?

A
  • failure of the pump to move blood into systole
  • reduced ejection fraction
  • reduced ventricular contraction
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6
Q

causes of systolic failure?

A
  • myocardial ischamia
  • MI
  • myocardial scarring
  • myocarditis
  • drugs
  • muscular disorders (DMD)
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7
Q

effects of systolic failure?

A
  • reduced cardiac output
  • feedback to atria and right side of heart
  • pulmonary oedema
  • peripheral oedema
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8
Q

treatment of systolic failure?

A

support

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9
Q

diastolic failure?

A
  • failure of ventricular wall to relax
    • restrictive, stiff ventricle
  • reduced ventricular filling leads to reduced blood for systole
  • elevated end diastolic pressure
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10
Q

causes of diastolic failure?

A
  • scarring plus most causes of systolic
  • infiltrative disease (amyloid)
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11
Q

effect of diastolic failure?

A
  • none
  • pulmonary and peripheral oedema
  • response to excersise
    • tachycardia and pulmonary acute oedema
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12
Q

treatment of diastolic failure?

A

reduce AV conduction

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13
Q

what are some of the causes of left and right ventricular failure?

A
  • coronary heart disease
  • hypertension
  • cardiomyopathy
  • drugs
  • toxins
  • endocrine
  • nutritional deficiency
  • infiltrative
  • other
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14
Q

examples of cardiomyopathy causes?

A
  • familial/genetic
  • non familial/ non genetic can be acquired
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15
Q

examples of drugs?

A

beta blockers
calcium antagonists
antiarryhtmics
cytotoxic agents

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16
Q

examples of toxins?

A

alcohol
medication
cocaine
trace elements

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17
Q

examples of endocrine causes?

A

diabetes
hyper/hypo thyroidism
cushings syndrome
adrenal insufficiency
excessive growth hormone

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18
Q

examples of nutritional causes?

A

deficiency of thiamine
obesity

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19
Q

examples of infiltrative causes?

A

sarcoids
amyloidosis
connective tissue disease

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20
Q

examples of other causes?

A

HIV
peripartum cardiomyopathy
end stage renal failure

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21
Q

describe the clinical effects of left ventricular failure?

A

build up of fluid in lungs
- blockage of blood
- can cause a build up of frothy fluid made of proteins leaking out

22
Q

describe the clinical effects of right ventricular failure?

A

pitting oedema
congested ‘nutmeg’ liver

23
Q

what organ is most effected right ventricular failure and describe the pathway?

A

liver
backlog of blood … IVC … hepatic vein… liver
patient may come in complaining of a sore side.

24
Q

2 main causes of left ventricular failure?

A

hypertensive and ischameic heart failure

25
Q

what will left ventricular failure cause?

A
  • pulmonary oedema with associated symptoms
  • leads to pulmonary hypertension and eventually right ventricular failure
26
Q

what is combined left and right ventricular failure called?

A

congestive cardiac failure

27
Q

common causes of right ventricular failure?

A
  • secondary to left ventricular failure
  • related to intrinsic lung disease
  • cor pulmonale due to pulmonary hypertension
  • primary pulmonary hypertension
28
Q

what are they key features of the clinical examination in patients with heart failure?

A
  • 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
29
Q

forward failure?

A
  • Reduced perfusion of tissues
  • Tends to be more associated with advanced failure
  • problem with blood flowing out the heart
30
Q

backwards failure?

A
  • problem with blood flowing back to the heart
  • Due to increased venous pressures
  • Dominated by fluid retention and tissue congestion
31
Q

what is B-natiuretic protein?

A
  • 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.
32
Q

what will B-natiuretic protein act on?

A

Acts on the ANP receptor but with relatively lower affinity but longer half life than other natriuretic proteins.

33
Q

what effects can B-natriuretic protein bring about?

A

Vessel dilatation
Reduced load on heart
Changes in glomerular filtration
Inhibits renin secretion
Decrease aldosterone
Natriuresis
Reduction in blood pressure

34
Q

what is hypertension a major risk factor for?

A
  • Cardiovascular disease
  • Ischaemic heart disease
  • Accelerated atherosclerosis
  • Alzheimer type dementia
35
Q

what are the different categories of blood pressure?

A

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

36
Q

what is B-natriuretic protein a good biomarker for?

A

ventricular stress
the stress response protein that is a good biomarker for cardiac failure.

37
Q

how can hypertension cause atherosclerosis?

A
  • High blood pressure can damage blood vessels
  • fats (like LDL) can accumulate in these damaged areas
  • the process of atherosclerosis will occur
38
Q

how are coronary arteries subject to atherosclerosis due to hypertension?

A

they pressures in the coronary arteries are very high and they are subject to a lot of turbulence

39
Q

describe the end organ effects of systemic hypertension?

A

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)

40
Q

what end organs are most commonly effected in systemic hypertension?

A

brain
heart
kidneys
arteries
eyes

41
Q

3 effects on the kidney due to systemic hypertension?

A

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

42
Q

how can you get proteinuria due to systemic hypertension?

A

by loosing glomerular integrity you will loose the full nephron
= proteinuria (low level)

43
Q

3 effects on blood vessels of systemic hypertension?

A

1- Acceleration of atherosclerosis

2- Intimal proliferation and hyalinisation of arteries and arterioles

3- Accelerated and severe hypertension – fibrinoid necrosis

44
Q

effects on the brain of systemic hypertension?

A
  • Atherosclerosis
  • Ischaemia and TIA
  • Infarct
  • Haemorrhage
45
Q

effects on the eyes due to systemic hypertension?

A

hypertensive retinopathy

46
Q

what are the causes of pulmonary hypertension?

A
  • 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
47
Q

what are the different types of aneurysms that can be caused by systemic hypertension?

A

1- Aortic and other arteries:
- Atherosclerosis
- Hypertension
2- Berry aneurysm
- Congenital
3- Dissecting aneurysm
- Thoracic aorta, Marfan’s
4- Mycotic aneurysm
- Infective endocarditis

48
Q

describe the relationship between neoplasia and the heart?

A

Rare - most often metastatic eg melanoma or small cell undifferentiated lung cancer

Primary benign – atrial myxoma

Primary malignant – angiosarcoma, rhabdomyosarcoma…….

49
Q

what is thrombosis?
what are its risk factors?

A

1- local coagulation or clotting of the blood in part of the circulatory system.
2- smoking
Diabetes
Hypertension
High cholesterol
Obesity
Familial

50
Q

biomarker for cardiac failure?

A

BNP

51
Q

what is an aneurysm?

A

Abnormal swelling in the wall of a blood vessel.
The vessel wall become weakened and cannot maintain the tension to accommodate for the pressure.

MD3001 (56 decks)

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