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BHP Exam 2 > Cardiovascular 2 &3 > Flashcards

Cardiovascular 2 &3 Flashcards

(106 cards)

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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
What is angina pectoris?
episodic chest pain
26
Angina pectoris source of pain?
inadequate oxygenation of myocardium when exercising
27
Underlying causes of angina pectoris? (2)
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
28
3 Types of angina pectoris?
1. prinzmetal 2. stable 3. unstable/CRESCENDO
29
Prinzmetal angina is what? Caused by?
intermitted pain at rest, vasospasm
30
Stable angina is what? Caused by?
Pain upon exertion, caused by atherosclerotic narrowing of coronary vessels
31
Unstable angina is what? Caused by?
Prolonged/recurrent pain at rest, caused by fissuring of plaques
32
unstable angina is indicative of what?
imminent MI
33
Eccentric vs. Concentric plaques - whats the diff
Eccentric - rich in lipid, one segment of wall, improved by drugs Concentric - rich in collagen, entire wall, drugs don't help
34
Main cause of ischemic heart disease?
Thrombosis
35
MI leads to what kind of necrosis?
coagulative necrosis
36
MI releases what into blood?
myocardial enzymes b/c of altered membrane permeability of necrotic cells
37
Two patterns of MI?
1. regional/transmural infarction - full thickness of wall | 2. subendocardial infarction - interior 1/3 of left ventricular wall
38
Transmural MI occurs in what % of MI cases
90%
39
Cause of transmural MI?
nearly always thrombus, complete occlusion
40
Subendocardial MI what % of MI cases?
10%
41
Cause of subendocardial MI?
general hypoperfusion of main coronary arteries
42
MI extent and distribution depends on what?
which coronary artery branch is occluded
43
Vast majority of infarcts affect which regions of heart?
Left ventricle and septal region
44
End result of MI? Time span?
replacement of necrotic scar with collagenous scar, takes 6-8 weeks
45
Tissue changes 6h post-MI?
vascular congestion at perimeter of lesion
46
Tissue changes 12h post-MI?
PMNs arrive
47
Tissue changes 24h post-MI?
pale and swelling muscle becomes pinker, loses striation and nuclei (coagulative necrosis) PMNs invade
48
Tissue changes 3d post-MI?
yellow | Macrophages arrive, eat debris
49
7d post-MI?
yellow inside red fibroblasts grow into region vessels grow into region
50
Sudden cardiac death - symptoms?
often none
51
Sudden cardiac death usually due to?
ventricular fibrillation
52
Sudden cardiac death v-fib usually arises from what?
thrombotic events destroy muscle, disturb normal rhythm
53
Short-term complications of MI typically occur within..?
two weeks
54
6 short-term complications of MI?
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
4 long-term complications of MI?
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
Rheumatic fever is what?
Multisystem inflammatory disorder with cardiac manifestations and sequellae.
57
What usually precedes rheumatic fever?
streptococcal tonsilitis or pharyngitis, esp. group A beta-hemolytic strep
58
Most important target organ of rheumatic fever?
Heart
59
What are aschoff's nodules?
classic lesions of rheumatic fever, focal interstitial myocardial inflammation
60
what do aschoff's nodules result in?
chronic scarring of heart valves
61
Major manifestations of RF?
1. carditis 2. polyarthritis 3. skin rashes 4. neurological symptoms
62
Minor manifestations of RF?
1. polysynovitis 2. arthralgia 3. raised ESR or C-reactive protein 4. prolonged PR on ECG 5. FEver
63
What is Jones' criteria for diagnosing RF?
1. 2 major 2. 1 major & 2 minor & Raised anti-strep antibody 3. positive throat culture for group A beta-hemolytic strep
64
Most frequently involved valve in RF?
mitral
65
Least frequently involved valve in RF?
pulmonary
66
Cause of pancarditis?
RF
67
3 components of pancarditis?
1. rheumatic pericarditis 2. rheumatic myocarditis 3. rheumatic endocarditis aschoff's nodules, fibrous, and edema everywhere
68
Two main types of heart valve defects
1. stenosis - narrowing/failure to open | 2. incompetence - failure to close
69
Which valves are more frequent sites of endocarditis & thrombic vegetation formation?
left side valves
70
Valve collagen exposure can lead to two paths?
1. vegetation | 2. mechanical abnormality
71
Most cases of chronic valve scarring due to?
RF
72
Mitral stenosis can lead to...
pulmonary hypertension, left-side heart failure, atrial fibrillation and atrial thrombosis
73
Mitral stenosis caused by?
post-inflammatory scarring of valve tips, 50% have had RF
74
Causes of mitral valve incompetence
1. rheumatic heart disease 2. infarct 3. left ventricular dilation/annulus 4. infection 5. mitral valve prolapse
75
Result of mitral valve incompetence? (3)
1. left ventricular enlargement/giant left atrium 2. pulmonary edema if papillary muscle ruptures 3. end result --> left sided heart failure
76
Mitral valve prolapse aka?
floppy valve syndrome
77
most frequent valve lesion?
mitral valve prolapse
78
what is the parachute deformity of mitral prolapse?
posterior valve leaflet is soft and bulges upward during systole
79
Mitral valve prolapse complications?
mitral insufficiency, predisposition to infective endocarditis
80
Libman-sacks endocarditis associated with what condition?
systemic lupus
81
Clinical manifestations of libman sacks endocarditis?
vegetation on leaflets, high titers of anti-cardiolipin antibodies
82
Infective endocarditis manifestations (3)
1. infection of endocardium 2. vegetations 3. complications such as ulcers or chordae tendinae rupture
83
IE group 1 vs group 2
Group 1: low pathology, persistent infection in platelet mesh Group 2: pathogenic, directly invade valve, rapid destruction
84
Acute vs. Subacute IE
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
Main clinical effects of subacute IE (4)
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
What is the most important way to diagnose IE?
blood culture
87
Cardiomyopathy is abnormal cardiac function due to what?
abnormal cardiac function due to primary disease of myocardium, NOT htn, inflammation, ischemia etc.
88
Primary cardiomyopathy - cause?
no defined cause | idiopathic
89
Secondary cardiomyopathy - due to what?
underlying conditions such as diabetes, alcohol consumption
90
3 primary cardiomyopathy patterns?
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
What is ARVD?
right ventricle replaced with fat, causes cardiac death in childhood/adolescence
92
Myocarditis is what?
inflammation of myocardium
93
Myocarditis results in?
interstitial edema infiltration of lymphocytes & macrophages necrosis biventricular heart failure
94
Rubella during 1st semester of pregnancy increases incidence of what?
congenital heart defects
95
most shunts are in what direction?
left to right because of high left ventricular pressure
96
Atrial septal defect usually where?
level of fossa ovale incompletely closed (ostium secundum defect)
97
Ventricular septal defect - large and small location? prognosis?
large - muscular wall affected, leads to pulmonary htn, right sided heart failure, cyanosis small - confined to membranous area, can close spontaneously
98
Patent ductus arteriosus - connects what to what?
between aorta and pulmonary trunk
99
Patent ductus arteriosus leads to what if not closed?
pulmonary htn right ventricular hypertrophy reversal of blood flow late cyanosis
100
What is the tetralogy of Fallot?
1. VSD 2. overriding aorta - recieves blood from both ventricles 3. pulmonary valvular stenosis 4. right ventricular hypertrophy
101
Heart diseases without cyanosis?
1. aortic stenosis/coarctation | 2. left-to-right shunt (PDA, ASD, VSD)
102
Heart diseases WITH cyanosis?
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
What is hydropericardium?
accumulation of serous fluid in pericardial space
104
Hydropericardium most often caused by?
CHF, or hypoproteinemia diseases like chronic liver disease
105
Hemopericardium is what?
accumulation fo blood in pericardial sac
106
Hemopericardium caused by what?
traumatic perforation of heart/aorta associated with MI

BHP Exam 2 (6 decks)

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