Systemic pathology 400 (CV path 2) Flashcards
valvular disease
Any heart valve can become stenotic (narrowed) or incompetent/insufficient (doesn’t close properly)
what changes take place long before SSx appear when valves stenose?
Causes hemodynamic changes long before symptoms
do valvular insufficiencies occur simultaneously in multiple valves?
Most often valvular stenosis or insufficiency occurs in isolation in individual valves,
but multiple valvular disorders may coexist
mitral valve and valvular disease
Mitral regurgitation
Mitral stenosis
insufficiency vs stenosis
insufficiency means that your valve doesn’t fully close
stenosis means that your valve is narrowed and doesn’t open fully
opposite but related (?)
mitral regurgitation
incompetency (insufficiency) of the mitral valve (bicuspid) causing backflow (reflux) from the left ventricle into the left atrium
Mitral stenosis
narrowing of the mitral valve impeding blood flow from the left atrium to the left ventricle
valvular disease and AORTIC VALVE
Aortic regurgitation
Aortic stenosis
Aortic regurgitation
incompetency of the aortic valve causing backflow from the aorta into the left ventricle
Aortic stenosis
narrowing of the aortic valve obstructing blood flow from the left ventricle to the ascending aorta
valvular disease etiology / risk factors
rheumatic heart disease
endocarditis
congenital valvular disease
autoimmune disorders
valvular disease – pathogenesis
Abnormalities in valves causes back flow of blood
Back flow of blood overburdens chambers
Overburdening causes hypertrophy of chamber
also related to pathogenesis of valvular disease
HTN (hypertension)
decreased systemic bloodflow (as a result)
valvular disease clinic manifestations, SSx
Angina
Dyspnea
Heart failure
Arrhythmia
Palpitations
Heart murmur
valvular disase Dx, Tx, Px
Echocardiogram, auscultation
Tx:
Valve replacement, medication
Px:
Variable
ischemic heart disease
Major disorders of the heart due to insufficient blood supply
AKA coronary heart disease (CHD) or coronary artery disease (CAD)
—-> MI, angina, cardiac arrest
ischemic heart disease epidemiology
CAD/IHD is the leading cause of death globally
CAD is the most common cause/type of cardiovascular disease
ischemic heart disease pathogenesis
Ischemic heart disease that develops as a result of slowly progressive narrowing of the coronary arteries results in hypoperfusion of myocardium and slowly evolving pump failure (congestive heart failure)
ischemic heart disease pathogenesis 2
Ischemic heart disease can develop due to sudden occlusion of a major coronary artery resulting in an infarct
ischemic heart disease risk factors
Age
Gender
Family history
Ethnicity
Infection
Smoking
High cholesterol
HTN
Alcohol
ischemic heart disease risk factors 2
Diet
Obesity
Physical inactivity
Diabetes
Hormonal status
Medication
Excessive alcohol consumption
Stress
ischemic heart disease clinical manifestations
Variable – depending on rapidity and extent of blockage and which arteries are blocked
can ischemic heart disease be asymptomatic
yes
ischemic heart disease other clinical manifestations and SSx
Asymptomatic
Pain
Angina pectoris
Breathlessness (dyspnea)
Palpitations
Congestive heart failure
MI
Death
ischemic heart disease Dx, Tx
Echocardiogram
Stress test
Tx:
Meds
Surgery
Prevention***
angina pectoris
Type of CAD/IHD
Crushing chest pain, typically precipitated by exercise or strain and relieved by nitroglycerin (stable angina)
angina etymology
“strangling”
angina pectoris caused by
Caused by any condition that alters:
Blood supply to myocardium
Blood requirements of myocardium
(—>circulatory disorders, blood loss)
angina pectoris – pathogenesis
Narrowed or obstructed blood vessels limit blood supply to tissues
When the cardiac workload exceeds oxygen supply to myocardial tissue, ischemia occurs causing temporary chest pain
Chronic stable angina (type)
Classic exertional angina
Preceded by exercise or stress and relieved by rest or nitroglycerin
Predictable and consistent
Prinzmetal’s angina (vasospastic or variant angina) (type)
Symptoms similar to typical angina
Caused by coronary artery spasm
Usually occurs early morning; unrelated to exertion
Decubitus angina (resting angina) (type)
Atypical
Occurs at rest, worse when laying down (decubitus)
Reduced when sitting or standing
More prevalent in women
decubitus etymology
from Latin decumbere ‘lie down’, on the pattern of words such as accubitus ‘reclining at table’.
Unstable angina (progressive or crescendo angina)
Residual ischemia triggers angina
Unpredictable
Angina Pectoris, Dx, Tx
Dx:
History
Clinical manifestation
Angiogram
Tx:
Medications to treat symptoms or underlying conditions
MYOCARDIAL INFARCTION
Development of ischemia with resultant necrosis of myocardial tissue
MI is due to
Due to occlusion of a coronary artery
Anterior descending branch of left coronary artery (50%)
(LAD – LEFT ANTEIROR DESCENDING)
Right coronary artery (30-40%)
Left circumflex artery (15-20%)
Myocardial Infarction – risk factors
same as for CAD
Age
Gender
Family history
Ethnicity
Infection
Smoking
High cholesterol
HTN
Alcohol
Diet
Obesity
Physical inactivity
Diabetes
Hormonal status
Medication
Excessive alcohol consumption
Stress
MI – death occurs in what percentage of cases?
Death occurs in 25% of cases due to arrhythmia (ventricular fibrillation), heart block, pump failure, asystole (cardiac arrest)
can MI be asymptomatic?
Symptoms are variable but can be asymptomatic (rarely)
MI SSx
Can also include crushing pericardial pain, syncope, pallor, SOB, cold sweating, fatigue, referred pain (left arm), heartburn, nausea
syncope recall
temporary loss of consciousness caused by a fall in blood pressure.
Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery.
It is caused by a decrease in blood flow to the brain, typically from low blood pressure