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CVM II > Cardiac Path I > Flashcards

Cardiac Path I Flashcards

(51 cards)

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1
Q

What changes are found in the myocardium and chambers of an aging heart?

A

Decreased LV size
Increase epcardial fat
lipofuscin and basophilic degeneration
Fewer myocytes,increased collagenfibers - reduced contractility and compliance

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2
Q

What changes are found in the valves of an aging heart?

A

Aortic and mitral valve annular calcification - stenosis
Fibrous thickening
Mitral valve degeneration - MVP -> increase LA size
Lambl excrescences - bumps

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3
Q

What changes are found in the vasculature of an aging heart?

A

Coronary atherosclerosis

Stiffening aorta - loss of elastic tissue

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4
Q

When does CHF occur? How many people are effected?

A

Occurs when the heart is unable to pump blood at a rate to meet peripheral demand, or can only do so with increased filling pressure
2% of US population

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5
Q

When the body is not getting the oxygen demand, what does the heart initially do to compensate?

A

Frank-starling mechanism
Myocardial hypertrophy
Activation on neurohumoral systems

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6
Q

When do cardiac myocytes become hypertrophic?

A

When there is sustained pressure or volume overload
or
Sustained trophic signals - b-adrenergic

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7
Q

What happens to myocytes in the setting of pressure overload?

A

Myocytes become thicker, LV wall thickness increases

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8
Q

What happens to myocytes in the setting of volume overload?

A

Myocytes elongate, and ventricular dilation is seen

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9
Q

Why is the hypertrophied heart vulnerable to ischemia-related decompensation?

A

because the hypertrophy of myocytes isnt accompanied by a matching increase in blood supply

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10
Q

What is the best measurement of hypertophied heart?

A

weight, not size or length

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11
Q

What is cardiac dysfunction characterized by?

A

Heart failure (systolic/diastolic)
Arrhythmias
Neurohumoral stimulation

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12
Q

What are the causes of LEFT sided HF?

A

Myocardial ischemia
HTN
Left-sided valve disease
Primary myocardial disease

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13
Q

What are the symptoms of LEFT sided HF?

A

Hypertension
Pulmonary congestion/edema/HTN
Atrial fib, stasis, thrombus if LV dysfunction->LA dilation
Reduced renal perfusion - prerenal azotemia
Hypoxic encephalopathy due to reduced CNS perfusion

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14
Q

What is the most common cause of RIGHT sided HF?

A

left-sided failure

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15
Q

What causes isolated RIGHT sided HF?

A

From any cause of pulmonary HTN

  • lung disease
  • Primary pulmonary HTN
  • Pulmonary vasoconstriction
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16
Q

In primary RIGHT - sided HF, what will manifest

A 
Pulmonary congestion is minimal 
Venous system is markedly congested 
- nutmeg liver/hepatomegaly
- Splenomegaly 
- Effusions
- Edema
- Renal congestion
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17
Q

What can ischemia of the heart result in

A

Myocardial infarction
Angina pectoris
Chronic ischemic heart disease, with HF
SCD - arrhythmias

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18
Q

What are more than 90% of IHD secondary to?

A

atherosclerosis

causing chronic vascular occlusion, acute plaque changes leading to thrombus

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19
Q

What are some causes of IHD?

A

Atherosclerosis, increased myocardial demand, hypoxia due to anemia, lung disease, etc

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20
Q

What is Agnina pectoris?

A

Transient, often recurrent chest pain induced by myocardial ischemia insufficient to induce myocardial infarction

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21
Q

What is stable angina?

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A

Stenotic occlusion of coronary artery
Squeezing or burning sensation
Exercise induced
Relieved by rest or vasodilators

22
Q

What is Prinzmetal variant angina?

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A

Episodic coronary artery spasm
Symptoms unrelated to exertion
Relieved with vasodilators

23
Q

What is unstable (crescendo) angina?

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A

Pain, increasing in frequency, duration and severity, eventually at rest
Usually rupture of plaque, w partial thrombus
50% may have myocardial necrosis

24
Q

What are most MIs caused by? What are the other causes?

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A

atheromatous plaque

Other causes: embolus, vasospasm, ischemia secondary to vasculitis, shock, hematologic abnormalities

25
What is the clinical presentation of MI?
``` Prolonged chest pain (>30 min) Crushing, stabbing, squeezing, tightness Radiating down left arm or left jaw Diaphoresis Nausea 25% asymptomatic ```
26
How much time does complete deprivation of blood flow lead lead to irreversible myocardial injury?
20-30 min
27
What happens to ATP and Lactate levels in myocardial tissue during MI?
ATP levels are depleted | Lactate increases
28
What three arteries are mainly involved in MI? How frequently?
LAD (40-50%) RCA (30-40%) LCX (15-20%)
29
Describe Transmural MIs
Many MIs occur w/i the distribution of a single coronary a Fullthickness Atherosclerosis and acute plaque changes ST elevation
30
Describe non-transmural subendocardial infarct
may involve more territory than a single coronary Non-st elevation Causes: lysis of thrombosis, chronic atherosclerotic disease, global hypotension
31
Describe multifocal microinfarction
Small vessel microembolization, vasculitis, or vascular spasm (epi or cocaine) Can cause SCD non-transmural
32
What stain is used to look for myocardial tissue that has recently suffered MI?
Triphenyltetrazolium chloride - TTC Stains tissue containing lactate dehydrogenase red Lysed cells become yellow
33
Describe the morphologic changes that occur during an MI in the first 4 hours?
Grose: none Micro: none
34
Describe the morphologic changes that occur during an MI in the 4-24 hours?
Gross: dark mottling, pale-cyanotic arease Micro: coagulation necrosis, eventual PMN
35
Describe the morphologic changes that occur during an MI in 1-3 days ?
Gross: yellow-tan, mottling Micro: coagulation necrosis; many PMNs
36
Describe the morphologic changes that occur during an MI in the 7-10 days following?
Gross: yellow-tan, soft Micro: phagocytosis of dead cells/debris, granulation tissue
37
Describe the morphologic changes that occur during an MI in the 10-14 days following?
Gross: red-grey Micro: granulation tissue, new vessels, early collagen
38
Describe the morphologic changes that occur during an MI in the 2-8 wks following?
Gross: grey-white scar Micro: increased collagen
39
Describe the morphologic changes that occur during an MI in the 2 months following
Gross: complete scar Micro: Dense collagen
40
How is restoring blood flow to area of ischemia accomplished and what is the purpose? What can result
Thrombolysis, angioplasty and stent placement, CABG An attempt to limit infarct size by rescuing at risk myocardium Contraction band necrosis can occur due to Ca overload and hypertetanic contraction and reperfusion injury can result
41
Describe the levels of CK-MB and Troponin I after MI
Detectable in circulating blood 3-12 hrs after infarction Levels peak at 24 hours CKMB returns to normal in 48-72 hrs TI in 5-10 days
42
Half of MI-associated deaths occur w/i the first hour due to what?
arrhythmias - result frompermanent damage to conducting system, or from myocardial irritability following infarct
43
What are some complications of MI
Arrhythmia Contractile dysfunction Fibrinous pericarditis - Neutrophils coming in, friction rub, self limited Myocardial rupture - weakend wall; 2-4 days post papillary muscle rupture Infarct expansion Ventricular aneurysm - late complication SCD
44
What are the risk factors for myocardial rupture?
increase in age large transmural anterior MI First MI Absence of LV hypertrophy
45
What does rupture of the free wall of the heart cause?
pericardial tamonade
46
What does rupture of the septum cause?
L->R shunt with right sided volume overload
47
What disease commonly precipitate SCD?
Coronary artery disease
48
What is the minimum dx for Left-sided HTN disease?
Hx of HTN, left ventricular hypertrophy in thea bsence of other lesions (Valve stenosis, coarctation)
49
Isolated right-sided HTN HD arises in what setting?
pulmonary HTN
50
What may acute cor pulmonale arise from?
large pulmonary embolus
51
What may chronic cor pulmonale arise from?
chronic right venticular pressure overload- CHD or primary lung disease

CVM II (4 decks)

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