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Cardio - Gupta > Patholology of Heart Disease I > Flashcards

Patholology of Heart Disease I Flashcards

1
Q

*Heart Failure (4 components)

A

Steps of Congestive Heart Failure

  1. Heart doesn’t pump blood efficiently
  2. Blood Circulates through body slower
  3. pressure in the heart increases
  4. heart can’t pump enough oxygen and nutrients to meet its needs
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2
Q

*Left Heart Failure

• Signs and Symptoms

A

When the Left Ventricle Fails

Signs/Symptoms:
• Difficulty Breathing (Pulomonary Edema)
• Short of Breath when LYING DOWN (orthapnea) or during activity

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3
Q

*Pulmonary Edema

• Why is this seen in CHF? Steps?

A
  1. Heart Fails to Pump Adequately
  2. Increased end-diastolic ventricular volume
  3. Increased end-diastolic pressure
  4. Increased Venous Pressure
  5. Hydrostatic Pressure Forces Fluid into Body Tissues
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4
Q

*Hemosiderin Laden Macrophages

• cause?

A
  • Alveolar Septa become thickened and fibrotic and capillaries burst
  • RBCs escape into the alveolar space and macrophages eat RBCs => heart failure cells
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5
Q

*Right Heart Failure

• Signs and Symptoms

A

Failure of the Right Ventricle

Signs/Symptoms:
• Fluid collection in the FEET that may progress to ASCITES

• this is where we see PITTING EDEMA

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6
Q

*Pitting Edema

• Mostly Associated with what heart pathology?

A

• Pitting Edema Results from RIGHT sided heart failure because IVC isn’t pumping blood up into the atria the way that it should due to inefficient pumping of the left ventricle

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7
Q

*Frank-Starling Mechanism

• What is it?

A

Increased End Diastolic Volumes (from HTN) lead to increased MYOCARDIAL STRETCHING, more stretching leads to increased force of contraction

***This INCREASES cardiac output

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8
Q

*Myocardial Structural Changes

• What Happens?

A

Myocardium must undergo hypertrophy because it can’t divide. Myocytes enlarge and increased the number of sarcomeres by adding them in parallel or by adding in series to existing sarcomeres.

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9
Q

*Concentric Hypertrophy

  • What happens?
  • When is this seen?
A

• HYPERTENSION, aortic coarctation, valvular stenosis

• Venticular wall increases in thickness while chamber is much less affected. This is caused by high pressures that cause hypertrophy by adding sacromeres in parallel.

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10
Q

*Eccentric Hypertrophy

  • Some causes?
  • What Happens?
A

Causes: Aortic/Mitral Regurgitation, area opposite of infarct, ventricular septal defect

  • New sarcomeres are added to the end of exisiting sarcomeres to incease muslce cell length
  • Ventricle will be about to hold a larger Volume
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11
Q

*cor pulmonale

A

• Any problem with pulmonary function that leads to Right Sided Heart Failure

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12
Q

*Congestive Hepatomegaly

A

Happens as a result of right sided heart failure because of fluid back up from the right atria to the right ventricle. Ultimately IVC backs up

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13
Q

*Tamponade

A

Severe symptom of RSHF and is usually only present when RSHF is secondary to LSHF

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14
Q

*Ascites

• what causes it?

A

• Fluid build up in the abdomin from the congestion in the IVC from RIGHT sided heart failure

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15
Q

*Ansarca

• What is it?

A

Systemic Subcutaneous Swelling that results from right sided heart failure

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16
Q

What 3 things may cause “Failure of the pump”?

A
  • Systolic Dysfunction
  • Diastolic Dysfunction
  • Valve Dysfunction
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17
Q

What factor may cause the pump to fail via diastolic dysfunction?

• Why?

A

Hypertension - prevents the pump from emptying properly

*HTN causes increased afterload pressure which decreases the amount of fluid that escapes from the ventricles and into the aorta - with increased afterload the heart must work Harder leading to hypertrophy

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18
Q

What factors may cause the pump to fail via Diastolic Dysfunction?

A
  • Left Ventricular Hypertrophy
  • Fibrosis
  • Amyloidosis
  • Constrictive Pericarditis
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19
Q

What are some factors that may cause failure of the pump via valve dysfunction?

A
  • Endocarditis
  • Fluid or Pressure Overload
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20
Q

What cause acute heart failure?

• Chronic?

A

Acute: Myocardial Infarction

Chronic: Slow Overload and Loss of Myocardium

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21
Q

What causes the majority of cases of heart failure?

• Px for all cases of Heart Failure?

A

Most Cases:
• Ischemic Heart Disease of Hypertension

All Heart Failure:

• Progressive with a Poor Px.

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22
Q

Differentitate Between:

• systolic dysfunction

• diastolic dysfunction

• causes of each??

A

systolic dysfunction:
*VENTRICLES enlarge BUT can’t pump all of the blood back out
*Leads to increased end systolic volume

diastolic dysfunction:

*ventricles pump all the blood out but can’t FILL PROPERLY DURING DIASTOLE
*Leads to a decreased end diastolic volume

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23
Q

What are 3 common symptoms of Heart Failure and What causes these symptoms?

A

• Shortness of Breath, Weakness, Swelling

Cause:

  • Decreased Cardiac Output =>
  • Increased Pressure in Capillary BVs =>
  • H2O leaking out into tissues (such as Lungs and Legs)
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24
Q

What 3 major ways does our heart try to compensate in heart failure?

A
  • Frank-Starling Mechanism
  • Activation of Neurohumoral Systems
  • Mycocardial Structural Changes (including augmenting muscle mass)
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25
Q

T or F: in Right Heart Failure we tend to see more Pulmonary symptoms.

A

False, more PULMONARY symptoms are seen in LEFT SIDED HEART FAILURE. SYSTEMIC symptoms (pitting edema) is seen in right sided heart failure

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26
Q

What is a major problem of the Frank-Starling mechanism in heart failure?

A

• The dilated ventricle can COMPENSATE to increase cadiac output HOWEVER this increased the oxygen demand on tissue that is already ischemic

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27
Q

What are the Neurohumoral Compensation Mechanisms used in heart failure?
• how do they work?

A

(NOR)EPINEPHRINE
• Increased HR, Increased Contractibility, Increased TPR

Renin-Angiotensin-Aldosterone System
• Increased Electrolyte retention causing increased water retention => Increased Filling Pressure

Atrial Naturetic Peptide
• Balances renin-angiontensin-aldosterone system through diuresis and smooth muscle relaxation

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28
Q

T or F: Cardiac Myocytes can proliferate to adapt to increased workloads.

A

False, they don’t.

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29
Q

If myocytes can’t proliferate then how do they aid in COMPENSATION?

A

HYPERTROPHY/increasing the number of sacromeres

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30
Q

What does compensated heart failure always lead to?

A

DEcompensated Heart Failure - no amount of stretching can take place to meet the needs of the body

31
Q

What deteremines the method by which your heart muscle rearranges to compensate for increased work load?

Specific Type of Hypertrophy?

A

Determinate = Pressure vs. Volume

With Pressure increases:
• sarcomeres are added in Parallel = concentric hypertrophy

With Volume increases:

• Sarcomeres add in Series

32
Q

Pathophysiologic Processes That cause PRESSURE overload?

A
  • Increased Afterload
  • Concentric Hypertrophy
  • Fibrosis
33
Q

Pathophysiologic Processes that cause Volume Overload?

A
  • Increased PRELOAD
  • Eccentric Hypertrophy
  • ECM Degradation
34
Q

Why is valvular Regurgitation associated Regurgitation at Mitral and Aortic Valves?

A

Distention of Left Ventricle Pulls leaflets appart preventing proper valve closure and fluid can flow retrograde

35
Q

What is shown here?

• Cause?

A

Left Ventriclular Hypertrophy = CONCENTRIC HYPERTROPHY caused by INCREASED PRESSURE

36
Q

T or F: the muscle tissue that developes as a result of left ventricular hypertrophy is usually ischemic

A

True - CAPILLARY BED DOES NOT increase in step with increased oxygen demand and the tissue is too thick for the blood to diffuse through

***additionally increased pressure in the aorta prevents the normal ischemic hyperemia that results during diastole of the normal heart

37
Q

If you want to measure the degree of hypertrophy in a heart that has failed due to volume overload, how would you go about it?

A

• Weighing the heart is the best way to do this

38
Q

What is displayed here?

• Cause?

A

Hypertrophy due to volume overload in the heart

39
Q

T or F: cadiac hypertrophy is a risk factor for sudden cardiac death

40
Q

What is the Number one Cause of RIGHT heart Failure?

A

LEFT heart failure

41
Q

What are some of the secondary and tertiary problems that Result from LEFT HEART failure?

A
  • Left Heart Failure
    • Decreased Cardiac Output
      • Activity Intolerance
      • Signs of Decreased Tissue Perfusion
    • Pulmonary Congestion
      • Impaired Gas Exchange
      • Pulmonary Edema

***Pulmonary congestion = LEFT side of the heart brings in blood from the pulmonary veins, failure to do so = LSHF***

42
Q

What are some of the manifestations for the tertiary side effects seen in LEFT HEART FAILURE?

  • Impaired Gas Exchange
  • Pulmonary Edema
A

Impaired Gas Exchange
• Cyanosis (and other signs of hypoxia)

Pulmonary Edema
• Cough with frothy sputum
• Orthopnea (fluid backs up in lungs when lying down)
• Paroxysmal Noctural Dyspnea

43
Q

What is a key sign of left heart failure?

A

FROTHY SPUTUM resulting from pulmonary Edema

44
Q

Secondary and Tertiary Causes of Right Heart Failure?

A
  • Right Heart Failure
    • Congestion of Peripheral Tissue
      • GI tract Congestion
      • Liver Congestion

***Makes sense b/c RIGHT atrium should be taking on fluid from the IVC (and svc) which is pulling blood out of the liver***

45
Q

What are some side effects of Liver and GI tract congestion caused by right sided heart failure?

A

GI TRACT: Anorexia, GI distress, Weight Loss

LIVER CONGESTION: Signs Related to Impaired Liver Function

46
Q

What are the most common causes of Left Sided Heart Failure?

A
  • Ischemic Heart Disease
  • Systemic Hypertension
  • Mitral or Aortic Valve Disease
  • Primary Diseases of the Myocardium (amyloidosis)
47
Q

What is typically the earliest sign of left sided heart failure?

A

Shortness of Breath

48
Q

On gross inspection what are some of the features you should see on a heart that has failed due to LEFT sided heart failure?

• Histologic Features?

A

Varies on the bases of underlying cause but most often:

  • Left Ventricle Hypertrophy is seen
  • Dilation may also be seen?

Histology:

• Myocytes hypertrophy wih interstitial fibrosis

49
Q

****What probably killed this person?

A

Left Sided Heart Failure secondary to a few MIs

• Notice Left wall hypertrophy and scarring

50
Q

****This tissue was taken from the left ventricle of someone who died of left sided heart failure.

• KEY histological features?

A

• Fibrosis causing widely spaced myocytes that separated so much communication via gap junctions wasn’t probably happening

51
Q

****What do you think the gross picture of this person’s left ventricle looks like?

• Based on what?

A

*Its probably huge because you can see that the myocytes on the right are way bigger than normal myocytes (left)

52
Q

****What features of this lung indicate that this person may have died of heart failure?

• which side of their heart was failing?

A
  • You can see Sepatation through the lobed due to increased fluid volume in the lung lymphatics
  • LEFT sided heart failure from fluid backup from the pulmonary veins
53
Q

******What type of heart failure did this person die of?

A
  • Left sided heart failure
  • NOTE the fluid in the alveoli
54
Q

*****What is wrong here?

A

• Foamy Transcudate (prob LSHF)

55
Q

****What the problem here?

A

Macrophages are sitting in the center of an alveoli filled with transudate and they are filled with Hemosidering

56
Q

*****Prussian Blue Stain

A

Heart Failure Cells (hemosider laden macs) sitting in the center of an alveoli

57
Q

Right Sided Heart Failure

  • Most often secondary to?
  • Primary Causes?
A

RSHF

Often secondary to LSHF

Primary Causes:
• SEVERE PULMONARY HTN (cor pulmonale)
• Primary PULMONIC or TRICUSPID disease
• Congenital Heart Disease (L to R shunts w/ chronic pressure overload)

58
Q

*****RSHF

59
Q

What factor secondary to right atrial dysfunction causes most of the symptoms of RSHF?

A

Engorgement of SYSTEMIC and PORTAL venous systems causing EDEMA

60
Q

What is the typical gross appearance of a heart that has undergone RSHF?

A
  • HYPERTROPHY of the Right Ventricle (CHRONIC)
  • Sometimes ACUTE DILATION fo Left Ventricle
61
Q

*****What disease caused this gross appearance?

A

*Right Sided heart failure

• you can see the R and L ventricles are the same size

62
Q

*****Why is this person’s left venticle dialated?

A

• Right Sided Heart Failure has caused Left ventricular dialation

63
Q

What causes cor pulmonale?

A

ANY disease that causes the lungs to become less effective (e.g. Emphysema)

64
Q

What effects might RSHF lead to in:

  • Liver and Portal System
  • Pleural, Pericardial, and Peritoneal Spaces
  • Subcutaneous tissue
A

Liver and Portal
• CONGESTIVE HEPATOSPLENOMEGALY (any organs connected to the IVC = FUCKED

Pleural, Pericardial, and Peritoneal Spaces
• EFFUSION => Tamponade or Ascides (usually comes b/f tamp)

Subcutaneous tissue
• Anasarca (rare)

65
Q

*****what is this?

  • Process that has caused this?
  • Relation to RSHF?
A

NUTMEG liver = pooling of blood in the central veins due to lack of return of IVC to atria due to Right SIDED HEART FAILURE (most likely secondary to LEFT sided heart failure)

PASSIVE - RELATIVELY ACUTE CONGESTION

66
Q

*****What is this?

A

NUTMEG liver HISTO - notice blood pooling around its destination in the central vein as it travels from the portal triad

67
Q

In what area of liver lobules do you typically see the signs of RIGHT sided heart failure?

A

Typically seen in ZONE 3 - this is the least perfused area

68
Q

If LEFT sided heart failure was the primary cause of RSHR what would you expect to see in zone 3?

A

NECROSIS around the central vein because blood is just sitting there

69
Q

*****What was the primary problem in this person’s heart that caused this disease?

A

• Left Sided HF with secondary Right Sided HF has caused necrosis around the central vein

70
Q

• What is a primary risk factor the heart disease that caused this pathology?

A

• Central Lobular NECROSIS caused by LSHF that has caused RSHF

*Primary Risk Factors of LSHF

  • Ischemic Heart Disease
  • Systemic HTN
  • Mitral or Aortic Valve Disease
  • Amyloidosis (other primary disease of myocardium)
71
Q

*****What has caused this symptom?

72
Q

****What has caused this symptom?

73
Q

****What type(s) of heart failure have caused this?

A

RIGHT sided heart failure ONLY
• This is not necrosis its FIBROSIS and it is the result of CHRONIC RSHF whereas nutmeg liver is more acute and Necrosis is caused by LSHF + RSHF.

Cardio - Gupta (12 decks)

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