Test 2 - RU Heart Flashcards
chronic inflammatory response in the walls of arteries
atherosclerosis
inflammatory disease of blood vessels
vasculitides
S/S of vasculitides
fever, malgias, athralgais
ischemia, thrombus formation
M/C arteritis after 50 yrs
involves medium and small arteries
granulomatous formation is T cell mediated
giant cell arteritis
ocular disturbances and weakened upper extremity pulse
takayasu arteritis
typically involves small and medium arteries, especially renal vessels
autoimmune
affects young adults
transmural inflammation of the arterial wall
nodular formation causes segmental weakening resulting in rupture
polyarteritis nodosa (PAN)
autoimmune
acute necrotizing granulomas in respiratory tract
renal disease - “crescentic glomerulonephritis”
wegener’s granulomatosis
onset before age 35
affects heavy smokers
involves segmental thrombosing and inflammation of medium and small arteries
thromboangiitis obliterans “buerger disease”
localized, abnormal dilation of a blood vessel wall or wall of the heart
aneurism
true vs false aneurism
true: involves all layers: atherosclerotic, symphilitis, congenital vascular aneurism, left vascular aneurism (MI)
false: leak in the vessel wall leading to a hematoma (PAN)
blood enters the vessel wall and forms a hematoma resulting in a dissection of the layers of the wall
usually caused by atherosclerosis and cyctic median necrosis
dissection
affects mainly men 50+
mostly results from atherosclerosis
abdominal aorta - below renal artery but above the bifercation
obstruction, shock, aneuris, embolism
abdominal aortic aneurism
typically men between 40-60 with history of hypertension
thoracic aorta
S/S: aortic valve insufficiency, difficulting breathing, encroachment of mediastinal structures
syphilitic (leutic) and aortic dissection
benign, malformation of the endothelial cells lining blood vessels
majority are superficial, occuring in the head, neck and liver
hemangioma
located in skin, sub-cutaneous tissue and mucus membranes of oral cavities and lips
capillary hemangioma
juvenile : strawberry patch seen in new borns
cavernous : large, often located in the brain or brainstem
most often seen in AIDS patients
karposi sarcoma
malignant endothelial neoplasm
most common primary malignancy of the heart
angiosarcoma
most frequently occurring cardiac tumor and is found most often in adults; benign
myxoma of the left atrium
most common in infants and young children
notable for its association with tuberous sclerosis; benign
rhabdomyoma
5 principles of cardiac dysfunction
- failure of the pump - muscle contracts weakly, incomplete emptying of chambers, insufficient ventricular filling
- obstruction of flow: incomplete valve opening, increased ventricular pressure
- flow regurgitation: insufficient closure of the valve casuing blood to flow backwards
- disorders of conduction: due to heart-block or arhythmeas
- disruption of the continuity of the circulatory system
group of syndromes caused by myocardial ischemia
ischemic heart disease
acute heart attack
myocardial infarction
severe chest pain (stable, prinzmetal, and unstable)
angina pectoris
unstable angina, MI, sudden death
acute coronary syndromes
blood supply to the heart is interrupted
myocardial infarction
transmural MI involves ischemic necrosis of the full thickness of the _______
ventricular wall
morphologic changes of MI
4hrs
4-24 hrs
1-3 days
3-7
>7
4hrs - no gross damage
4-24hrs - collagen necrosis
1-3 days - necrosis with inflammation (neutrophilic infiltrate)
3-7 days - dying neutrophils and necrosis
>7 days - necrosed myocardium is replaced with connective tissue (fibrosis)
consequences of MI
contractile dysfunction
arrhythmias
pericarditis
ventricular anurism
myocardial rupture
usually caused by significant coronary occlusion
congenital, structural coronary arterial abnormalities
aortic valve stenosis
mitral valve prolapse
dialted or hypertrophic cardiomyopathy
pulmonary hypertension
sudden cardiac death
hear tis large and heavy due to left ventricular hypertrophy and dilation
myocardial hypertrophy found with ischemic cardiomyopathy
chronic ischemic heart disease
sustained diastolic blood pressure > 90mmHg
or
sustained systolic blood pressure > 140mmHg
hypertension
priamary vs secondary hypertension
primary: abnormality in the rennin-angiotensin system resulting in an increase in blood volume, increase in peripheral resistance
secondary: often caused by renal disease, caused by adrenohyperfunction (cushing syn), caused by pregnancy, stress, and cardiovascular pathology
found in elderly patients without hypertension
leakage of plasma components across vascular wall
increase in extra-cellular matrix production by smooth muscle cells
hyaline deposition
hyaline atherosclerosis
acute or rapid elevation in blood pressure
narrowing of the arteriole lumen due to a concentric laminated thickening (onion skin)
smooth muscle cells thicken and replicate the basement membrane
results in fibrinoid deposition and acutre necrosis of the vessel
hyperplastic atherosclerosis
hypertension retinopathy
1
2
3
4
1 - generalized narrowing of the arterioles
2 - grade 1 + focal arteriole spasms
3 - grade 2 + flame shpaed hemorrhages, cotton wool spots and hard waxy exudates
4 - grade 3 + optic disc edema
inflammation of the endothelial and subendothelial tissues
endocarditis
autoimmune
occurs after strep infections
produces Macculm plaques - subendocardial thickening from regurgitation, left atrium
changes usually occur in mitral valve
leaflet thickening
commissural fusion
shortening and thickening of cordea tendenea
rheumatic valvulitis
autoimmune
involves the mitral and tricuspid valves
small vegetations on both sides of valves
found in fibrinoid necrosis
liebman - sacks (SLE)
caused by highly virulent bacteria: strep aureus / viridans
commonly involves aortic or pulmonary valves
devastating destruction of the valves
acute INFECTIVE endocarditis
caused by low virulence bacteria: alpha hemolytic Streptococci - S. milleri, S. Mutans and S. salivarus, S. bovis. Staphylococcus aureus or E.coli.
results in large irregular vegetations involving valves and cords
subacute bacterial endocarditis
seen in debilitated patients (cancer, sepsis, etc)
causes vegetations containing fibrin and platelts (thrombus) no bacteria
seen with: venous thrombosis, pulmonary embolism, hypercoagulability
non-bacterial thrombotic endocarditis (NBTE)
inflammation of myocardium
infections - viral coxsackie A
bacterial - diphtheria, lyme disease
immune - SLE, rheumatic
idopathic - sarcoidosis
myocarditis
deterioration of the heart
cardiomyopathy
acquired via alcoholism or pregnancy
hypertrophy followed by dilation, impairment of contractility, systolic dysfunction
enlarged heart
dialated cardiomyopathy (congestive carediomyopathy)
hypertrophy and fibrosis, impairment of compliance, diastolic dysfunction
hypertrophic (obstructive) cardiomyopathy
least common of cardiomyopathy
amyloidosis, sarcoidosis, radiatio, fibrosis
pericardial constriction, diastolic and systolic dysfunction
restrictive cardiomyopathy
inflammation of pericardium
pericarditis
fibrinous: bread and butter appearance
pericarditis
risk factors of CHD
preterm infants
genetic factors (trismony 13,15,18,21, turner syndrome)
enviromental factors (rubella, toxoplasma infections)
abnormal communication between chambers or vessels
direction of blood flow is dependent on pressure relationship between chambers
shunt
atrial septal defect (ASD)
ventricular septal defect (VSD)
patent ductus arteriosis (PDA)
atrioventricular septal defect (AVSD)
all part of ______ shunt: ___ cyanosis
left to right shunt
late cyanosis
tetralogy of fallout
transposition of greater vessels
tricuspid atresia
anomalies (connections)
all part of ______ shunt: ____ cyanosis
right to left shunt
early cyanosis
obstructive CHD
coarctiation of aorta
aortic valve stenosis and atresia
pulmonary valve stenosis and atresia
asymptomatic until adulthood
seen with volume hypertrophy of the ventricles
types:
secundum: most common, defect on fossa ovale
primum: occurs adjacent to atrioventricular valves (cleft mitral valve leaflet)
sinus venosus: near the entrance of the superior vena cava
atrial septal defect
L -> R shunt
most common congenital anomaly
usually closes by itself
types:
membranous: upper part of septum
muscular: lower part of septum
early - R to L shunt (no cyanosis)
right ventricle responds with hypertrophy
shunt shifts to L to R shunt with cyanosis
ventricular septal defect
connection between aorta and pulmonary artery
mostly asymptomatic
pulmonary hypertension which causes a reversal of the shunt to the R to L
machine like ‘harsh murmur’ can be heard
patent ductus arteriosus
R to L shunt
- ventricular septal defect
- pulmonary valve or subpulmonary valve stenosis
- overriding of the aorta over the ventricular septal defect
- right ventricular hypertrophy (heart becomes ‘boot shaped’)
child is born with cyanosis
tetralogy of fallot
R to L shunt
congenital anomaly where the aorta narrows where the ductus arteriosis inserts
infantile: aortic hypoplasia proximal to the patent ductus arteriosis
adult: rigid like folding the aorta opposite to the closed ductus arteriosis. higher blood pressure in the upper extrem than in lower extrem
coarctation of aorta
inability of the heart to pump blood at a rate commensurate with the demand of the tissues at normal pressure
heart failure
enhanced contractility with icnreased preload
heart failure
frank sterling mechanism
heart rate and contractility increased
heart failure
norepinephrine release
to increase blood volume
heart failure
activation of the renin-angiotensin-aldosterone system
pathophys of systolic failure vs diastolic failure
systolic - deterioration of myocardial contractility
diatole - inability of muscle to relax (decreased filling)
etiology: ischemic heart disease, angina, cardio myopathy, MI
results in decreased perfusion to the kidneys (prerenal azotemia) and brain hypoxic encephalopathy
left sided heart failure
blood backs up into the venous system
results in:
congestive hepatomegaly
centrilobar hemorrhagic necrosis
cardiac clerosis
portal hypertension
venous congestion in the brain
right sided heart failure
