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BHP Exam 2 > Cardiovascular 2 &3 > Flashcards

Cardiovascular 2 &3 Flashcards

1
Q

Causes of left ventricular hypertrophy? (2)

A
  1. Htn

2. Aortic or Mitral valvular disease

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2
Q

Causes of right ventricular hypertrophy (4)

A
  1. Left ventricular failure
  2. Chronic lung disease
  3. Mitral valve disease
  4. Congenital left-to-right shunt
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3
Q

Another name for right ventricular failure?

A

cor pulmonale

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4
Q

What 2 things can lead to right ventricular failure?

A
  1. RIght ventricular hypertrophy

2. Dilation secondary to lung disease OR disease of pulmonary vasculature like pulmonary Htn or emphysema.

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5
Q

Two main causes of heart failure?

A
  1. Demand extra work of heart (htn, valvular disease)

2. Damaged heart muscle (ischemia)

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6
Q

Congestive heart failure (CHF) from failure of what structures in the heart?

A

Left or Right ventricles or both.

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7
Q

Signs and symptoms of CHF?

A

Tiredness, development of edema

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8
Q

Compensatory responses to CHF? (4)

A
  1. Ventricles enlarge and contract more forcefully
  2. Constriction of arterioles to redistribute blood
  3. Sympathetic and renin-angiotensin systems
  4. Desensitization of cardiac muscle to sympathetic stimulation
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9
Q

Left-sided heart failure causes (4)?

A
  1. ischemic heart disease/MI
  2. Hypertension
  3. Aortic/mitral valvular disease
  4. Myocardial disease
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10
Q

Left-sided heart failure clinical manifestations in the lung?

A

dyspnea and orthopnea, pleural effusion and hydrothorax

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11
Q

Left-sided heart failure clinical manifestations in the kidney?

A

reduction of renal perfusion, water & salt retained

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12
Q

Left-sided heart failure clinical manifestations in the Brain?

A

cerebral anoxia (infrequent)

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13
Q

What organs does left-sided heart failure affect most?

A

Kidney, Lung, Brain

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14
Q

What causes pulmonary edema in left-sided heart failure?

A

left atrium dilation leads to increased pressure in pulmonary capillaries

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15
Q

Right sided heart failure - most common cause?

A

Left sided heart failure lol

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16
Q

Right-sided hear failure causes (3)

A
  1. Left-sided heart failure/lesions
  2. Pulmonary htn
  3. Cardiomyopathy or myocarditis
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17
Q

Right-sided heart failure clinical manifestations? (6)

A
  1. Neck veins distended
  2. Subcutaneous peripheral edema (pitting edema on ankles)
  3. Transudation of fluid in interstitial tissues
  4. Lung-pleural effusion, ascites, hydrothorax
  5. Kidney - hypoxia
    6 .Liver - congested, enlarged
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18
Q

Biventricular failure usually comes from?

A

left-to-right involvement or chronic left-sided heart failure

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19
Q

What is the most common cardiac disease and leading cause of death in western world?

A

Ischemic/coronary heart disease

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20
Q

Main cause of ischemic heart disease?

A

Atherosclerotic narrowing of coronary arteries

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21
Q

Acute manifestations of ischemic heart disease?

A

Unstable angina, MI, cardiac death

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22
Q

Chronic manifestations of ischemic heart disease?

A

stable angina, cardiac failure

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23
Q

Which ventricle is more prone to ischemic heart disease? Why?

A

Left, because it is larger and demands more oxygen

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24
Q

Ischemic heart disease clinical manifestations? (4)

A
  1. can be silent
  2. angina pectoris
  3. MI
  4. chronic ischemic heart disease
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25
Q

What is angina pectoris?

A

episodic chest pain

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26
Q

Angina pectoris source of pain?

A

inadequate oxygenation of myocardium when exercising

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27
Q

Underlying causes of angina pectoris? (2)

A
  1. at least one stenosis of more than half of lumen of coronary artery
  2. Repeated episodes of impaired blood flow leads to fine fibrosis of myocardium
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28
Q

3 Types of angina pectoris?

A
  1. prinzmetal
  2. stable
  3. unstable/CRESCENDO
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29
Q

Prinzmetal angina is what? Caused by?

A

intermitted pain at rest, vasospasm

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30
Q

Stable angina is what? Caused by?

A

Pain upon exertion, caused by atherosclerotic narrowing of coronary vessels

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31
Q

Unstable angina is what? Caused by?

A

Prolonged/recurrent pain at rest, caused by fissuring of plaques

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32
Q

unstable angina is indicative of what?

A

imminent MI

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33
Q

Eccentric vs. Concentric plaques - whats the diff

A

Eccentric - rich in lipid, one segment of wall, improved by drugs
Concentric - rich in collagen, entire wall, drugs don’t help

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34
Q

Main cause of ischemic heart disease?

A

Thrombosis

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35
Q

MI leads to what kind of necrosis?

A

coagulative necrosis

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36
Q

MI releases what into blood?

A

myocardial enzymes b/c of altered membrane permeability of necrotic cells

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37
Q

Two patterns of MI?

A
  1. regional/transmural infarction - full thickness of wall

2. subendocardial infarction - interior 1/3 of left ventricular wall

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38
Q

Transmural MI occurs in what % of MI cases

A

90%

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39
Q

Cause of transmural MI?

A

nearly always thrombus, complete occlusion

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40
Q

Subendocardial MI what % of MI cases?

A

10%

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41
Q

Cause of subendocardial MI?

A

general hypoperfusion of main coronary arteries

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42
Q

MI extent and distribution depends on what?

A

which coronary artery branch is occluded

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43
Q

Vast majority of infarcts affect which regions of heart?

A

Left ventricle and septal region

44
Q

End result of MI? Time span?

A

replacement of necrotic scar with collagenous scar, takes 6-8 weeks

45
Q

Tissue changes 6h post-MI?

A

vascular congestion at perimeter of lesion

46
Q

Tissue changes 12h post-MI?

A

PMNs arrive

47
Q

Tissue changes 24h post-MI?

A

pale and swelling
muscle becomes pinker, loses striation and nuclei (coagulative necrosis)
PMNs invade

48
Q

Tissue changes 3d post-MI?

A

yellow

Macrophages arrive, eat debris

49
Q

7d post-MI?

A

yellow inside red
fibroblasts grow into region
vessels grow into region

50
Q

Sudden cardiac death - symptoms?

A

often none

51
Q

Sudden cardiac death usually due to?

A

ventricular fibrillation

52
Q

Sudden cardiac death v-fib usually arises from what?

A

thrombotic events destroy muscle, disturb normal rhythm

53
Q

Short-term complications of MI typically occur within..?

A

two weeks

54
Q

6 short-term complications of MI?

A
  1. further cardiac dysrhythmia when AV node is involved
  2. Left ventricular failure if large area of involvement
  3. rupture of ventricular wall
  4. papillary muscle dysfunction - from infarct/rupture
  5. Mural thrombus formation - inflamed endocardium
  6. acute pericarditis - inflammation over infarct
55
Q

4 long-term complications of MI?

A
  1. chronic left-heart failure
  2. ventricular aneurysm formation - gradual distention
  3. recurrent MI - underlying coronary artery insufficiency
  4. Dressler’s syndrome - immune-mediated pericarditis
56
Q

Rheumatic fever is what?

A

Multisystem inflammatory disorder with cardiac manifestations and sequellae.

57
Q

What usually precedes rheumatic fever?

A

streptococcal tonsilitis or pharyngitis, esp. group A beta-hemolytic strep

58
Q

Most important target organ of rheumatic fever?

A

Heart

59
Q

What are aschoff’s nodules?

A

classic lesions of rheumatic fever, focal interstitial myocardial inflammation

60
Q

what do aschoff’s nodules result in?

A

chronic scarring of heart valves

61
Q

Major manifestations of RF?

A
  1. carditis
  2. polyarthritis
  3. skin rashes
  4. neurological symptoms
62
Q

Minor manifestations of RF?

A
  1. polysynovitis
  2. arthralgia
  3. raised ESR or C-reactive protein
  4. prolonged PR on ECG
  5. FEver
63
Q

What is Jones’ criteria for diagnosing RF?

A
  1. 2 major
  2. 1 major & 2 minor & Raised anti-strep antibody
  3. positive throat culture for group A beta-hemolytic strep
64
Q

Most frequently involved valve in RF?

A

mitral

65
Q

Least frequently involved valve in RF?

A

pulmonary

66
Q

Cause of pancarditis?

A

RF

67
Q

3 components of pancarditis?

A
  1. rheumatic pericarditis
  2. rheumatic myocarditis
  3. rheumatic endocarditis
    aschoff’s nodules, fibrous, and edema everywhere
68
Q

Two main types of heart valve defects

A
  1. stenosis - narrowing/failure to open

2. incompetence - failure to close

69
Q

Which valves are more frequent sites of endocarditis & thrombic vegetation formation?

A

left side valves

70
Q

Valve collagen exposure can lead to two paths?

A
  1. vegetation

2. mechanical abnormality

71
Q

Most cases of chronic valve scarring due to?

A

RF

72
Q

Mitral stenosis can lead to…

A

pulmonary hypertension, left-side heart failure, atrial fibrillation and atrial thrombosis

73
Q

Mitral stenosis caused by?

A

post-inflammatory scarring of valve tips, 50% have had RF

74
Q

Causes of mitral valve incompetence

A
  1. rheumatic heart disease
  2. infarct
  3. left ventricular dilation/annulus
  4. infection
  5. mitral valve prolapse
75
Q

Result of mitral valve incompetence? (3)

A
  1. left ventricular enlargement/giant left atrium
  2. pulmonary edema if papillary muscle ruptures
  3. end result –> left sided heart failure
76
Q

Mitral valve prolapse aka?

A

floppy valve syndrome

77
Q

most frequent valve lesion?

A

mitral valve prolapse

78
Q

what is the parachute deformity of mitral prolapse?

A

posterior valve leaflet is soft and bulges upward during systole

79
Q

Mitral valve prolapse complications?

A

mitral insufficiency, predisposition to infective endocarditis

80
Q

Libman-sacks endocarditis associated with what condition?

A

systemic lupus

81
Q

Clinical manifestations of libman sacks endocarditis?

A

vegetation on leaflets, high titers of anti-cardiolipin antibodies

82
Q

Infective endocarditis manifestations (3)

A
  1. infection of endocardium
  2. vegetations
  3. complications such as ulcers or chordae tendinae rupture
83
Q

IE group 1 vs group 2

A

Group 1: low pathology, persistent infection in platelet mesh
Group 2: pathogenic, directly invade valve, rapid destruction

84
Q

Acute vs. Subacute IE

A

Acute: rapidly progressive, secondary to infection elsewhere, previously normal heart valve becomes infected and necroses–>heart failure.
Subacute: infection begins within structurally abnormal valves’ vegetation, gradual valve destruction–incompetence/failure, thrombus forms

85
Q

Main clinical effects of subacute IE (4)

A
  1. small emboli –> infarct many organs
  2. gradual destruction of valves –> incompetence & heart failure
  3. immune complexes against organisms –> skin petechiae, retinal microhemorrhages, glomerulonephritis
  4. Cytokine generation –> fever, anema, weight loss, splenomegaly
86
Q

What is the most important way to diagnose IE?

A

blood culture

87
Q

Cardiomyopathy is abnormal cardiac function due to what?

A

abnormal cardiac function due to primary disease of myocardium, NOT htn, inflammation, ischemia etc.

88
Q

Primary cardiomyopathy - cause?

A

no defined cause

idiopathic

89
Q

Secondary cardiomyopathy - due to what?

A

underlying conditions such as diabetes, alcohol consumption

90
Q

3 primary cardiomyopathy patterns?

A
  1. hypertrophic pattern - gene mutation, all wall thickened
  2. Dilated/congestive - dilated ventricles, walls stretched thin, poor contraction, ARVD
  3. Restrictive - infiltrative processes, stiffening
91
Q

What is ARVD?

A

right ventricle replaced with fat, causes cardiac death in childhood/adolescence

92
Q

Myocarditis is what?

A

inflammation of myocardium

93
Q

Myocarditis results in?

A

interstitial edema
infiltration of lymphocytes & macrophages
necrosis
biventricular heart failure

94
Q

Rubella during 1st semester of pregnancy increases incidence of what?

A

congenital heart defects

95
Q

most shunts are in what direction?

A

left to right because of high left ventricular pressure

96
Q

Atrial septal defect usually where?

A

level of fossa ovale incompletely closed (ostium secundum defect)

97
Q

Ventricular septal defect - large and small location? prognosis?

A

large - muscular wall affected, leads to pulmonary htn, right sided heart failure, cyanosis
small - confined to membranous area, can close spontaneously

98
Q

Patent ductus arteriosus - connects what to what?

A

between aorta and pulmonary trunk

99
Q

Patent ductus arteriosus leads to what if not closed?

A

pulmonary htn
right ventricular hypertrophy
reversal of blood flow
late cyanosis

100
Q

What is the tetralogy of Fallot?

A
  1. VSD
  2. overriding aorta - recieves blood from both ventricles
  3. pulmonary valvular stenosis
  4. right ventricular hypertrophy
101
Q

Heart diseases without cyanosis?

A
  1. aortic stenosis/coarctation

2. left-to-right shunt (PDA, ASD, VSD)

102
Q

Heart diseases WITH cyanosis?

A
  1. transposition of great vessels
  2. right-to-left shunt, tetralogy of Fallot
  3. disorders where left-to-right shunt reverses b/c higher pulmonary pressure
103
Q

What is hydropericardium?

A

accumulation of serous fluid in pericardial space

104
Q

Hydropericardium most often caused by?

A

CHF, or hypoproteinemia diseases like chronic liver disease

105
Q

Hemopericardium is what?

A

accumulation fo blood in pericardial sac

106
Q

Hemopericardium caused by what?

A

traumatic perforation of heart/aorta associated with MI

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