CHF, Congenital Heart Disease, IHD, Cardiomyopathies, Myocarditis

Question 1

CHF is…

Answer 1

the failure of the heart to pump an adequate amount of blood to supply the metabolic requirements of the organs

Comes from blood backing up (congesting) the liver, abdomen, lower extremities, and lungs

Question 2

CHF may be due to pathologic conditions….

Answer 2

inside (directly related) or outside (peripheral problems like hypertension) to the heart

Question 3

3 compensatory mechanisms for CHF

Answer 3

1. Myocardial hypertrophy
2. Ventricular dilation
3. physiologic mechanisms (inc HR, intravascular volume, and catecholamines (E and NE), along with redistribution of BF,

Question 4

What is myocardial hypertrophy

Answer 4

• a compensatory mechanism for CHF
• it’s a thickening of the heart muscle (myocardium) which results in a decrease in size of the chamber of the heart, including the left and right ventricles.
• it helps initially, but the larger muscle fibers require more oxygen from the capillaries, which typically is not available

Question 5

Etiology or the cause of CHF

Answer 5

ischemic heart disease
hypertension
myocarditis - inflammation of the heart (usually a virus)
cardiomyopathy - heart muscle damage
valvular disease - a damaged valve causes heart to work harder to keep blood flowing as it should

Question 6

Manifestations of CHF are:

Answer 6

1. Right ventricular failure - liver, lungs, feet, ankles
2. Left ventricular failure - pulmonary edema
3. left and/or right ventricular failure
4. CHF due to left ventricular failure eventually leading to right ventricular failure

Question 7

What does right ventricular failure look like and where does it occur?

Answer 7

• congestion of the LIVER (a “nutmeg” pattern) and SPLEEN

- edema of the FEET and ANKLES

Question 8

What does left ventricular failure cause?

Answer 8

pulmonary edema - abnormal buildup of fluid in the lungs

Question 9

Left and/or right ventricular failure can cause..

Answer 9

cerebral hypoxia - not enough O2 to brain

Question 10

What can cause congenital heart disease?

Answer 10

chromosomal anomalies or environmental factors

Question 11

Congenital heart disease affects how many births in the US out of 1000?

Answer 11

6-8

Question 12

Congenital heart disease is divided into:

Answer 12

cyanotic and noncyanotic forms

Question 13

Examples of noncyanotic congenital heart disease:

Answer 13

1. Atrial septal defect - doesnt allow shunting between atria
2. Ventricular septal defect - doesnt allow shunting between Vs
3. Patent/Open ductus arteriosus - this should (but doesnt) close within a few days of birth and connects the aorta to the pulmonary artery (bypasses the lungs)

Question 14

Examples of cyanotic congenital heart disease

Answer 14

Tetralogy of Fallout (low O2 levels in blood):
1. ventricular septal defect (VSD) - hole between R/L Vs
2. narrowing of R ventricular outflow
3. overriding of the aorta over VSD
4. R ventricular hypertrophy - thickened wall of RV
Transposition of great arteries
-RV empties into aorta and LV into pulmonary artery

Question 15

Ischemic heart Disease (IHD) is..

Answer 15

imbalance between the hearts blood supply and the hearts o2 demand (ischemia)

Question 16

What’s the leading cause of death in the US?

Answer 16

Ischemic heart disease –> 500,000/year

Question 17

Pathology of IHD

Answer 17

1. narrowing of coronary arteries (usually at least 75%) by atherosclerosis –> gradual narrowing may lead to opening of collateral arteries (90% of IHD is due to coronary artery atherosclerosis)
2. coronary artery thrombosis initiated by fissure in the fibrous cap of an atherosclerotic plaque
3. increased myocardial oxygen demand (hypertension), diminished blood volume (hypotension/shock), reduced oxygenation (pneumonia, CHF), reduced oxygen carrying capacity (anemia)

Question 18

4 types of IHD

Answer 18

1. Angina pectoris
2. acute MI
3. Chronic IHD with CHF
4. Sudden cardiac death

Question 19

Describe stable angina

Answer 19

“chest pain” of several minutes duration usually associated with exercise or emotional stress and relieved by rest

-No myocardial necrosis occurs

Question 20

Describe unstable angina

Answer 20

episodes of chest pain become more frequent and the pain becomes more severe

-this usually precedes MI

Question 21

What causes acute myocardial infarction?

Answer 21

necrosis of cardiac muscle caused by ischemia

-usually follows unstable angina

Question 22

Clinical presentation of MI

Answer 22

chest pain
shortness of breath
nausea/vomitting
diaphoresis - non-stop sweating
low-grade fever

Question 23

What kind of test is done in regards to MI?

What does the test look at?

Answer 23

EKG

Test looks to see if there is elevation of serum enzymes (CREATINE KINASE) and TROPONIN derived from necrotic myocytes

Question 24

Describe the pathology of MI

Answer 24

coagulation occurs (few hours)
neutrophil infiltration (few days)
granulation tissue (1 week)
scar formation (weeks-months)

Question 25

What are some treatments done to mediate MI and what do you need to be worried about from the treatments?

Answer 25

Placement of stents to open the coronary arteries clogged by the atherosclerotic plaques Coronary artery by-pass grafts Clot-busting drugs such as tissue plasminogen activator (TPA) Reperfusion injury is a risk of these treatments (tissue damage caused when blood supply returns to tissue after a period of ischemia or lack of oxygen

Question 26

What is reperfusion injury and when could it occur?

Answer 26

a risk of these treatments (tissue damage caused when blood supply returns to tissue after a period of ischemia or lack of oxygen when treating MI

Question 27

List complications that can come from MI (7)

Answer 27

``` arrhythmia and sudden death CHF/shock mural thrombus/emboli myocardial rupture mitral valve regurgitation ventricular aneurysm chronic ischemic heart disease ```

Question 28

what condition is it when you have progressive cardiac decompensation following acute MI? It can also be secondary to smaller ischemic events, with an eventual mechanical pump

Answer 28

chronic IHD with CHF

Question 29

T of F: sudden cardiac death may occur in individuals with or without a previous history of IHD?

Answer 29

True

Question 30

Describe sudden cardiac death

Answer 30

sudden onset of ischemia-induced cardiac arrythmia (improper beating of the heart) with or without myocardial necrosis/infarction

Question 31

What kind of classification of cardiomyopathy is described when the heart is involved as part of a multi-system disorder?

Answer 31

Secondary cardiomyopathy

Question 32

What kind of classification of cardiomyopathy is described when the disease is solely or predominately confined to the heart muscle?

Answer 32

Primary cardiomyopathy

Question 33

3 morphologic patterns of cardiomyopathy

Answer 33

dilated - all 4 heart chambers hypertrophic restrictive

Question 34

How can dilated cardiomyopathy come about?

Answer 34

- primary or secondarily - genetic (20-50% of cases) - or acquired

Question 35

What is associated with dilated cardiomyopathy?

Answer 35

poor ventricular contractility (systolic dysfunction)

Question 36

How can hypertrophic cardiomyopathy come about?

Answer 36

``` primarily genetic (inherited as autosomal dominant with variable expression) ```

Question 37

What is hypertrophic cardiomyopathy?

Answer 37

a disorder of sarcomeric proteins (myosin, myosin binding protein C, troponin T)

Question 38

What occurs during spontaneous myocardial hypertrophy?

Answer 38

This is under the hypertrophic cardiomyopathy asymmetric hypertrophy is greater in the interventricular septum than the left ventricular free wall and oftern obstructs the LV outflow tract

Question 39

What is restrictive cardiomyopathy?

Answer 39

a decrease in ventricular compliance (wall is stiffer), resulting in impaired ventricular filling during diastole

Question 40

What is the most common cause of myocarditis (inflammation involving the myocardium) in the US?

Answer 40

viral infection (it can also be caused by bacteria, fungus, and parasites) -non-infectious causes include toxins, hypersensitivity reactions and auto-immune disorders

Question 41

Pathology of myocarditis? List a common cause of myocarditis and then what this can cause

Answer 41

- viral infection produces a lymphocytic infiltrate with foci of necrosis - pyogenic bacteria causes abscesses - parasites infect individual myocytes or are in interstitial areas with surrounding inflammatory cells - hypersensitivity (usually to drugs) causes a perivascular inflammatory infiltrate with many eosinophils