10/16 - Pathology of the Heart

Question 1

normal heart weights what percent of body weight? g in females and males

Answer 1

0.4% 0.5%

250-320 g in females
300-360 g in males

Question 2

what is increased heart weight or ventricular thickness

Answer 2

hypertrophy

Question 3

what is enlarged heart chambers

Answer 3

dilation

Question 4

what is increased heart weight or thickness or enlarged heart chambers

Answer 4

cardiomegaly

Question 5

what is main function of heart

Answer 5

pumping of blood

Question 6

how does pumping function of heart occur

Answer 6

1. coordinated contraction (during systole)
2. coordinated relaxation (during diastole) of cardiac myocytes of myocardium

Question 7

how is contraction achieved

Answer 7

shortening of serial contractile elements (sarcomeres) within parallel myofibrils

Question 8

what is the other function of heart instead of being primarily pump

Answer 8

endocrine function

Question 9

what are released from heart in response to increased stretch? what does this result in?

Answer 9

release protein hormones
1. promotes vasodilation
2. stimulate renal salt and water elimination

Question 10

what are the heart valves

Answer 10

4: tricuspid, pulmonary, mitral, and aortic

Question 11

what maintain unidirectional flow in heart

Answer 11

heart valves

Question 12

valve function depends on what

Answer 12

1. mobility
2. pliability
3. structural integrity

of AV vavlves of cusps of semilunar valives

Question 13

cardiac valves are lined by what

Answer 13

endothelium

Question 14

what is part of the conductin system

Answer 14

1. SA node pacemaker
2. AV node
3. AV bundle (bundle of His)
4. right and left bundle branch divisions

Question 15

what is at the junction of R atrial appendage and SVC

Answer 15

SA node

Question 16

what is located at right atrium along interatrial septum

Answer 16

AV node

Question 17

what connects the right atrium to the ventricular septum

Answer 17

AV bundle (bundle of His)

Question 18

what stimulates respective ventricles via further arborization into Purkinje network

Answer 18

right and left bundle branch divisions

Question 19

Cardiac myocytes rely almost exclusively on ___ for their energy needs

Answer 19

oxidative phosphorylation

Question 20

how does blood supply maintain energy

Answer 20

1. high density of mitchondria
2. constant supply of oxygenated blood

Question 21

is the myocardium extremely vulnerable to ischemia

Answer 21

yes

Question 22

nutrients and oxygen are delivered t the heart via what

Answer 22

coronary arteries with ostia immediately distal to aortic valve

Question 23

does the myocardium of mammals have very LOW or HIGH replicative potential after fetal and neonatal live

Answer 23

LOW

Question 24

myocardium of mammals average ___% cardiomyocytes turnover per year in adult humans

Answer 24

less than 1%

so has very low capacity of regeneration

Question 25

more forms of heart disease become more prevalent when

Answer 25

with each advancing decade

Question 26

the size of ___ is reduced in later life in heart

Answer 26

left ventricular capacity (particularly in base to apex dimension)

Question 27

reduced size of left ventricle is exacerbated by what

Answer 27

HT as basal ventricular septum protrudes into left ventricular outflow tract (so called sigmoid septum)

Question 28

compared to younger myocardium, an elderly heart as waht

Answer 28

1. Fewer myocytes 2. Deposition of extracellular amyloid that stiffens the heart

Question 29

what is a condition in which a heart cannot pump blood to adequately meet the metabolic demands of the peripheral tissues, or can do so only at elevated filling pressures

Answer 29

heart failure (CHF)

Question 30

what is the common end stage of many forms of chronic heart diseases

Answer 30

CHF

Question 31

are adaptive mechanisms capable of maintaining adequate cardiac capacity?

Answer 31

yes it can potentially maintain, but can ultimately be OVERWHELMED

Question 32

what is increased filling volume that dilates the heart and increases contractivity and stroke volume

Answer 32

Frank-Starling mechanisms

Question 33

what is the released of norepinephrine, activation of renin-angiotensin-aldoesterone? basically the kidneys are attemptin to help heart function

Answer 33

activation of neurohumoral system

Question 34

how can the heart be overwhelmed

Answer 34

1. Frank-Starling mech 2. acivation of neurohumoral system 3. myocardial adaptations

Question 35

heart failure can result from what

Answer 35

1. systolic dysufnction 2. diastolic dysfunction

Question 36

what is the deterioration of myocardial contractile dysfunction? examples?

Answer 36

systolic dysfunction e.g., HT, valvular disease

Question 37

what is the inability of heart chambers to expand? examples?

Answer 37

diastolic dysfunction e.g., myocardial fibrosis, amyloid deposition, constrictive pericarditis

Question 38

left sided heart failure = ___ failure

Answer 38

LUNG failure

Question 39

what is left sided heart failure most often caused by

Answer 39

1. Ishemic heart disease (IHD) (coronary a) 2. Hypertension (other artieries have HT) 3. Aortic and mitral valvular disease (heart) 4. primary myocardial disease (heart)

Question 40

clinical and morphologic effects of left sided CHF are consequence of what

Answer 40

1. Passive congestion (blood-backing up) in the pulmonary circulation 2. Stasis of blood in the left-sided chamber 3. Inadequate perfusion of down stream tissue leading to organ dysfunction

Question 41

what is the most commonly affeted organ in LHF

Answer 41

heavy wet lungs (pulmonary congestion)

Question 42

what does pulmonary congestion lead to

Answer 42

1. dyspnea 2. orthopenea 3. paoxysmal noctural dyspnea

Question 43

clinical signs of LS-CHF

Answer 43

1. dyspenea 2. orthopnea 3. pulmonary edema 4. pleural effuction 5. fatigue, tachycardia

Question 44

what is breathlesness

Answer 44

dyspnea

Question 45

what is dyspnea while lying down

Answer 45

orthopnea

Question 46

what is buildup of fluid in lungs

Answer 46

pulmonary edema

Question 47

what is buildup of fluid in tissues lining the lungs

Answer 47

pleural effusion

Question 48

what most commonly causes RIGHT sided heart fialure

Answer 48

left sided heart failure

Question 49

T/F: Any increase in pressure on the left side of the heart inevitably burdens the right side of the heart

Answer 49

TRUE

Question 50

in right sided heart failure, are clinical features the same as left sided CHF?

Answer 50

YES

Question 51

are isolated right sided CHF frequent? who does this occur in?

Answer 51

INFREQUENT! Occurs in patients with one of variety of disorders affecting the lungs; hence often called cor pulmonale

Question 52

what are clinical signs of RS-CHF

Answer 52

1. Systemic venous congestion 2. Soft tissue edema 3. Distended neck veins 4. Enlarged liver 5. Increased deep vein thromboses/pulmonary emboli

Question 53

what is the ISOLATED right side of the heat to fail due to lung pathology

Answer 53

Cord Pulmonale

Question 54

causes of cor pulmonale? most common cause?

Answer 54

1. Pulmonary hypertension (most common cause) 2. Scleroderma (damages lungs) 3. COPD 4. Cystic fibrosis 5. Severe bronchiectasis 6. Obstructive sleep apnea 7. Idiopathic

Question 55

CHF tx

Answer 55

1. focus on correcting underlying cause (valvular defect or inadequate cardiac perfusion) 2. salt restriction 3. pharmacological agents

Question 56

pharmacological agents for CHF tx

Answer 56

1. diuretics (reduce volume overload) 2. positive inotropes (increase cardiac contractibility) 3. ACE-inhibitors

Question 57

even if you treat CHF does it remains a serious cause of morbidity and mortality

Answer 57

yes