Systemic Effects of Cardiovascular Disease

Question 1

What does white tissue indicate on the heart?

Answer 1

Dead tissue

Question 2

What does a congestive lung indicate?

Answer 2

Pulmonary oedema

Question 3

How can liver congestion present?

Answer 3

• Increase in size - palpable

- Liver tenderness

Question 4

What is combined left and right ventricular failure often called?

Answer 4

Congestive cardiac failure

Question 5

What is Cor pulmonale?

Answer 5

Right sided heart failure as a result of disease of the lungs or the pulmonary blood vessels

Question 6

What would you hear upon clinical examination in an individual with HF?

Answer 6

• Crackles over lung
• Apex displacement
• Gallop rhythm
• Third heart sound
• Flow murmurs suggesting valvular dysfunction

Question 7

What does “forward failure” result in?

Answer 7

• Reduced perfusion of tissues

- Tends to be more associated with advanced failure

Question 8

What does “backward failure” result in?

Answer 8

• Due to increased venous pressures

- Dominated by fluid retention and tissue congestion

Question 9

What is hepatomegaly?

Answer 9

abnormal enlargement of the liver

Question 10

What are the types of renal diseases that can cause secondary hypertension?

Answer 10

• 75% are from intrinsic renal disease e.g Glomerulonephritis, polyarteritis nodosa, systemic sclerosis, chronic pyelonephritis or polycystic kidneys
• Approx. 25% are due to renovascular disease - most frequently atheromatous (e.g elderly cigarette smokers with peripheral vascular disease)

Question 11

What is the difference betweeen essential and malignant/accelerated hypertension?

Answer 11

• Essential
  Slow changes in vessels and heart with chronic end-organ dysfunction
• Malignant/accelerated
  Rapid changes in vessels with acute end-organ dysfunction (fibrin can form within a blood vessel)

Question 12

What are the typical ‘end-organs’?

Answer 12

Brain, heart, kidneys, arteries, eyes

Question 13

What is nephrosclerosis?

Answer 13

A progressive disease of the kidneys that results from sclerosis (hardening) of the small blood vessels in the kidneys.

• Associated with hypertension and diabetes.
• Proteinuria
• Haematuria
• Renal failure

Question 14

What can cause pulmonary hypertension?

Answer 14

• Increased pulmonary vascular resistance
• Diffuse lung disease, for example COPD
• Elevated left atrial pressure e.g L. ventricular failure, mitral valve stenosis
• Recurrent pulmonary emboli
• Primary pulmonary hypertension (unknown cause) - genetics
• Left-right shunts e.g. ASD, VSD

Question 15

What is systolic failure?

Answer 15

• Failure of pump to move blood in systole
• Reduced ejection fraction
• Reduced ventricular contraction

Question 16

What can cause systolic failure?

Answer 16

• Myocardial ischaemia
• Myocardial infarction
• Myocardial scarring
• Myocarditis
• Drugs e.g alcohol, anti-cancer cytotoxics, cocaine
• Muscular disorders eg DMD

Question 17

What are the effects of Systolic cardiac failure?

Answer 17

• Reduced CO
• Feedback to atria and right side of heart
• Pulmonary oedema then peripheral oedema

Question 18

What is diastolic cardiac failure?

Answer 18

• Failure of the ventricular wall to relax
• Restrictive, stiff ventricle
• Reduced ventricular filling leads to reduced blood for systole
• Elevated end diastolic pressure

Question 19

What can cause diastolic cardiac failure?

Answer 19

• Scarring plus most causes of systolic

- Infiltrative disease eg amyloid

Question 20

What are the effects of diastolic cardiac failure?

Answer 20

• Pulmonary and peripheral oedema

- Response to exercise (tachycardia and pulmonary acute oedema)

Question 21

How is diastolic failure treated?

Answer 21

Reduce AV conduction