wk 5- cardiac pathology

Question 1

right side of the heart does what

Answer 1

weaker ventricle, pumping poorly oxygenated blood into pulmonary artery (circuit)

Question 2

left side of the heart does what

Answer 2

stronger ventricle, enters aorta our major artery. pumps oxygenated blood into systemic circuit to the body downstream

Question 3

what is the difference between angina and myocardial infarction

Answer 3

angina caused by transient ischaemia, no necrosis occurs, loss of blood supply but blood is restored

myocardial infarction caused by acute ischaemia, necrosis occurs in the myocardium

Question 4

describe the inflammation and repair that occurs following a myocardial infarction

Answer 4

acute inflammation
healing through organisation because it is a permanent organ. granulation tissue and the 3 components.

Question 5

what 5 complications can occur following an MI

Answer 5

1. thrombus
2. embolus
3. aneurysm
4. arrhythmia
5. further heart failure and disease

Question 6

list the causes of left sided heart failure

Answer 6

1. ischaemic heart disease
2. systemic hypertension
3. aortic/mitral valve disease

Question 7

list the causes of right sided heart failure

Answer 7

1. left side failing first

Question 8

describe backward effects of left sided heart failure and what symptoms they cause

Answer 8

pulmonary congestion
pulmonary oedema
reduced venous return from pulmonary circuit

symptoms: dyspnea

Question 9

describe backward effects of right sided heart failure and what symptoms they cause

Answer 9

congestion and oedema in the systemic venous circuit leading to peripheral oedema

Question 10

describe forward effects of heart failure, what compensatory mechanisms are triggered from a reduction in cardiac output

Answer 10

cardiac ouput goes down, kidney activates RAAS.
renin angiotensin aldosterone system
angio- vasoconstrictor increasing vascular resistance
aldo- increase sodium uptake increasing blood volume

Question 11

list some common causes and possible consequences of endocarditis

Answer 11

inflammation of the inner lining of the heart

causes: necrosis, bacterial infection, trauma all these can lead to inflammation

consequences: stenosis or incompetence

Question 12

list some common causes and possible consequences of pericarditis

Answer 12

inflammation of the outer sack of the heart

causes: intrinsic heart disease, disease in lungs, pleura, medistinum, generalised disorders, aging

consequences: heart failure (acute or chronic)

Question 13

stenosis

Answer 13

valve does not open properly

Question 14

incompetence

Answer 14

valve does not close properly

Question 15

hypertension

Answer 15

increased blood pressure

Question 16

systemic hypertension is caused by

Answer 16

cardiac output and systemic vascular resistance

Question 17

congestive heart failure

Answer 17

heart increases in size to meet demands of maintaining blood pressure and cardiac output

Question 18

what is a major risk factor for atherosclerosis

Answer 18

aging

Question 19

what are the impacts of age on cardiovascular system

Answer 19

increase in ischaemic heart disease and heart failure with age. heart valves can become calcified with age also.

Question 20

main risk factors for atherosclerosis 6

Answer 20

diabetes
increasing age
being male
smoking
systemic hypertension
hyperlipidaemia (increased LDL, decreased HDL)

Question 21

what is atherosclerosis and what vascular pathology does it cause

Answer 21

a chronic inflammatory process within the wall of an artery.

1.predisposes you towards formation of an aneurysm, thrombus and embolus.
aneurysm can rupture
thrombus/embolus can cause infarctions
2. increases resistance of blood flow and reduces the supply to tissues

Question 22

how does atherosclerosis contribute to systemic hypertension? 3

Answer 22

1. reducing vessel contractility
2. increasing resistance of blood flow
   3.injure kidneys and increase RAAS which increases systemic hypertension (increased blood volume and vascular resistance)

Question 23

how does systemic hypertension lead to atherosclerosis

Answer 23

increases the chance of endothelial injury due to the turbulent blood flow.

Question 24

how can large aneurysms place greater stress on the heart?

Answer 24

the pocket increases the workload of the heart as blood is diverted from its luminal flow

Question 25

what does the kidney do in response to hypotension

Answer 25

the kidneys activate RAAS - renin- angiotensin II- aldosterone system which: angiotensin II leads to vasoconstriction which increases vascular resistance aldosterone from the adrenal glands increases sodium and water reabsorption by the kidneys which increases blood volume these are also the forward effects of heart failure

Question 26

what do the kidneys do in response to systemic hypertension

Answer 26

activate RAAS as well and cause further hypertension

Question 27

explain the inflammatory and repair that occurs in the heart following a myocardial infarction

Answer 27

The infarcted tissue would stimulate the acute inflammatory response so there would be hyperaemia, oedema and the infiltration of the tissue by neutrophils. Hyperaemia increases hydrostatic pressure causing fluid to leak from the vessels into the damaged tissue. In addition, increased vascular permeability allows plasma proteins to also enter the damaged tissue hence the oedema is an exudate. Because the heart is a permanent tissue, the formation of granulation tissue would follow; macrophages will move into the necrotic tissue and continue to remove it along with the increasingly apoptotic population of neutrophils. Fibroblasts would migrate into the area and secrete collagen fibres to fill in the space once occupied by dead myocytes and new capillaries (angiogenesis) would sprout into the area to provide growth factors, oxygen and nutrients for the granulation tissue. Once the dead cells are removed and the tissue deficit filled with collagen, the macrophages and fibroblasts migrate away and the new capillaries regress (die of by apoptosis). As this is a case of organization as part of acute inflammation, the granulation tissue would mature into a collagen scar which contracts over time pulling the edges of parenchymal tissue together.

Question 28

what local effects can endocarditis have?

Answer 28

damage/scarring to the valves valve stenosis valave insufficiency/incompetence right side heart failure or global heart failure

Question 29

what are two types of valves diseases

Answer 29

stenosis insufficiency

Question 30

what is pericarditis

Answer 30

inflammation of the pericardium, the sack surrounding the heart

Question 31

what are the most common causes of pericarditis

Answer 31

infection, autoimmune disease, secondary cancer, spread of inflammatory response caused by myocardial infarction

Question 32

what is congestive heart failure

Answer 32

a clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricles to fill with or eject blood, thus resulting in congestion of blood trying to enter the failing ventricle and reducing the amount ejected with each contraction

Question 33

what are the forward effects of left and ride sided heart failure?

Answer 33

Aldosterone increases sodium and water reabsorption by the kidney  increasing blood volume Angiotensin II leads to vasoconstriction  increased vascular resistance. When the heart muscle is failing, the result is the maintenance of cardiac out and blood pressure within a normal range.

Question 34

what are the main causes of left sided heart failure

Answer 34

systemic hypertension, ischaemic heart disease, pericarditis and valve disease

Question 35

pathology that increases in incidence with age

Answer 35

atherosclerosis which increases the risk of heart failure, ischaemic heart disease and valve disease

Question 36

list causes of left and right sided heart failure separately

Answer 36

left- ischemic heart disease, valve disease, systemic hypertension right- left sided heart failure, pulomary hypertension, valve disease

Question 37

what are the forward effects of heart failure

Answer 37

decreased cardiac output leads to renal compensation through activation of RAAS this results in CO and BP often appearing normal

Question 38

what are the backwards effects of right vs left sided heart failure?

Answer 38

left- congestion, oedema in the lungs, dyspnea right- congestion and oedema in the venous system ???

Question 39

what symptoms would someone with right sided heart failure exhibit?

Answer 39

severe swelling of limbs, ascotes and distended jugular vein

Question 40

what symptoms would someone with left sided exhibit?

Answer 40

dyspnea, especiall when lying down, coughing up blood tinged fluid

Question 41

which organs are at risk of damage with right heart failure

Answer 41

organs with a large outflow into the inerior vena cava (liver and kidneys)

Question 42

what organs are at risk with left heart failure?

Answer 42

lungs