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Congestive heart failure and other heart conditions Flashcards

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1
Q

what are the size perinciple mechanisms of heart disease

A 
Failure of the pump
Flow obstruction
Shunted flow
Leaky flow (bad valves
Conduction disorder
Rupture of heart/major vessel
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2
Q

what is congestive heart failure

A

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

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3
Q

how many people are affected by congestive heart failure

A

5 million in the US annually

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4
Q

how many people die from Congestive heart failure

A

300k

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5
Q

what may cause the heart to go into congestive heart failure

A

direct pathologic conditions of the heart

Peripheral problems

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6
Q

what are the compensatory mechanisms of congestive heart failure

A

Activate neurohumoral systems
Frank-starling mechanism
Myocardial hypertrophy

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7
Q

what are the neurohumoral systems that can compensate for congestive heart failure

A

release NE

activate renin-angiotensin system

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8
Q

what does release of NE do to compensate for conestive heart failure

A

Increase heart rate and contractility

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9
Q

what does the renin-angiotensin system do to stop congestive heart failure

A

retain water/salt retention (to increase circulatory volume)

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10
Q

what is the frank-starling mechanism

A

Increased End-diastolic filling volume stretch cardiac muscle fibers

  • first contract more forcefully increasing cardiac output (compensated heart failure)
  • eventually cannot keep up (decompensated heart fialure
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11
Q

what is the result of myocardial hypertrophy to compensate for congestive heart failure

A

increase in muscle fiber size

incerased thickness of wall without an increase in size of lumen

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12
Q

why do compensatory mechanisms fail

A

Increase O2 requirements of myocardium without increased capillary supply
=ischemia

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13
Q

what are the causes of left-sided heart failure

A 
Ischemic heart disease (IDH)
hypertension
myocarditis
Cardiomyopathy
valvular disease
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14
Q

causes of Right sided heart fialure

A

Left sided heart failure
Pulmonary hypertension
Valve disease
septal defects with left to right shunts

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15
Q

how can left sided heart failure lead to Right sided heart failure

A

pulmonary congestion leads to increased pulmonary arterial pressure
= backing up of the system

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16
Q

what does left ventricular failure lead to

A

Pulmonary edema and congestion leading to dyspnea
Chronic cough
Orthopnea

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17
Q

what does Right and or left ventricular failure lead to

A

Cerebral hypoxia

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18
Q

what does Right ventricular failure lead to

A

Congestion of liver (nutmeg) and spleen

Edema (pitting of sucutaneous tissues, especially lower extremities

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19
Q

what is dyspnea

A

fluid leaking out of the alveoli leading to shortened breath

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20
Q

how common is congenital heart disease

A

6-8/1000 live birth in US

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21
Q

causes of congenital heart disease

A

envirnomental factors (congenital rubella, materal diabetes)
Chromosomal abnormalities
90% unknown

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22
Q

what does Congenital hear disease include

A

Shunts (abnromal comm between chambers
Abnormal connectivons between chambers and BV
Absence of normal connection

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23
Q

what does the Cyanotic congenital heart disease tend to ahve

A

Shunting of poorly oxygenated systemic venous return to systemic arterial circulation
- skips the lungs

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24
Q

what are the noncyanotic forms of congenital heart disease

A

atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent ductus Arteriosus (PDA)

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25
what is the second most common congenital malformation
Atrial septal defect
26
what is the most common cardiac malformation
Ventricular septal defect
27
what is a patent ductus arteriosus
Connects aorta and pulmonary artery
28
how long does a patent ductus arteriosus hang around
Closes within a few days after birth | - can persist though and fuck people up
29
what are examples of Cyanotic forms of congenital heart disease
Tetralogy of fallot | Transposition of the great arteries
30
what are the anomalies associated with tetralogy of fallot
Ventricular septal defect Narrowing of right ventricular outflow Overriding of aorta over Ventricular Septal defect Right ventricular hypertrophy
31
what occures in transposition of the great arties for the cyanotic form of congenital heart disease
Right ventricle empties into the aorta | Left ventricule empties into pulmonary artery
32
what is ischemic heart disease
imbalance between myocardial blood and myocardial oxygen demand
33
what is the primary reason of Ischemic heart diesase
Primarily due to coronary artery atherosclerosis (Coronary artery disease)
34
how much does ISchemic heary disease kill
leading cause of death in US (500,000 annually)
35
what Happens to the Arteries that can lead to IHD
coronary artery atherosclerosis (greater the 75% narrowing) | coronary artery thrombosis
36
what outside of Arteries can lead to IDH
increased myocardial O2 demand (hypertension) Decreased blood volume (hypotension/shock) decreased Oxygenation (pneumonia) decreased O2 carrying capacity (anemia)
37
types of IHD
angina Pectoris Acute myocardial infarction Chronic IHD with CHF Sudden cardiac death
38
what is angina pectoris
Intermittent chest pain caused by transient, reversible myocardial ischemia
39
when does stable angina occure
predictably at certain levels of exertion
40
what pain is caused by stable angina
Crushing or squeezing substernal pain | - radiate down the left arm or jaw (referred)
41
how is stable angina relieved
rest or sublingual nitroglycerin | - Vasodilator to increase coronary perfusion
42
when does Unstable angina occur
increasing frequency with minimal/no exertion | - long lasting
43
what pain is associated with unstable angina
Chest pain
44
what does unstable angina precede
more serious ischemia of MI
45
what happens to the myocardium in angina pectoris
No myocardial necrosis occurs
46
other name for acute myocardial infarction
Heart attack
47
what is the clinical presentation of acute myocardial infarction
``` Chest pain shortened breath nausea/vom diaphoresis low grade fever ```
48
what tests are done for acute myocardial infarction
ECG changes | Elevation of serum enzymes (creatine kinase;CK-MB) and troponin derived from necrotic myocytes
49
what happens in Acute myocardial infarction
``` Coagulation necrosis (few hours) Neutrophil infiltration (few hats) Granulation tissues (1 week) scar formation (weeks to months) ```
50
how does one treat acute myocardial infarction
- Stents to open coronary arties clogged by atherosclerotic plaques - coronary artery by-pass grafts - clot busting dugs (tissue plasminogen activator)
51
what is the risk associated with treating Acute myocardial infarction
reperfusion injury
52
what are the complications associated with myocardial infarction
``` Arrhythmia and sudden death CHF/shock Mural thrombus/emboli Myocardial rupture myocardial ruption infarct expansion to involve right ventricle Mitral valve regurgitation Ventricular aneurysm Chronic ischemic heart disease ```
53
what is Chronic IHD with CHF
progressive cardiac decompensation following acute MI or smaller ischemic events - eventual mechanical pump failure
54
what is sudden cardiac death
sudden onset of ischemia-induced cardiac arrhythmia with or without myocardial necrosis (infarction)
55
who tends to get sudden cardiac death
individuals with or without previous history of IHD
56
how long does it take for severe ischemia to cause irreversible myocyte injury and cell death
20-40 minutes
57
what can myocardial ischemia lead to besides fucking up muscles
Arrhythmias due to electrical instability
58
how long does it take for markers of Ischemic heart disease to show necrosis
12-29 hours (problem cuz it takes 20-40 minutes to damage)
59
how long does ti take for MI's to be grossly apparent at autopsy
12 hours then appears reddish blue in infarcted area
60
what happens to areas distal to an occlusion
become necrotic over time
61
how does heart muscle die for MI
little band near lumen never dies from O2 in the blood inside the heart eventually goes from inside portion to the outside of heart
62
why would reperfusion cause damage to the heart
blood now has lots of ROS and can kill cells and leads to scaring
63
problem with scaring of the heart
less flexible, shitty conduction less strength
64
what does rupture of the heart do
Sudden death
65
who tends to get chronic ischemia heart disease
History of MI
66
what tends to be the result of chronic ischemic heart disease
arrhythmias CHF and sbubsequent MI's - many deaths
67
what is the most common cause of sudden cardiac death
IHD
68
who tends to be at risk of sudden cardiac death
Younger patients with cardiac problems(congenital coronary artery abnormalities, aorti valve stenosis, mitral valve prolapse, myocarditis, dilated or hypertrophic cardiomyopathy, pulmonary hypertension, myocardial hypertrophy) - little damage to heart can cause rupture
69
what is primary cardiomyopathy
Disease is sloely or predominantly confined to heart muscle
70
what is secondary cardiomyopathy
heart is involeved as a multi-system disorder
71
what are the 3 morphologic patterns of cardiomyopathy
dilated Hypertrophic restrictive/doesn't beat well
72
what can cause dilated cardiomyopathy
Primary secondary genetic acquired-alcoholism, myocaritis, pregnancy
73
commonness of genetic dilated cardiomyopathy
20-50% of cases
74
what happens to the heart in dilated cardiomyopathy
dilation of all 4 chambers fibrosis and mycocyte hypertrophy poor ventricle contractility (systolic dysfuction)
75
what are the causes of Hypertrophic cardiomyopathy
Primary | genetic
76
where is the mutation that leads to hypertrophic cardiomyopathy
Missense point mutation in one of severeal sarcomeric gene loci - myosin, myosin binding protein C Troponin T
77
what happens to the heart in hypertrophic cardiomyopathy
stiff ventricles prevent adequate filling (diastolic dysfunction)
78
what is the histology associated with hypertrophic cardiomyopathy
myocyte disarray with fibrosis
79
how is Hypertrophic cardiomyopathy inherited
Autosomal dominant with cvariable expression
80
what parts of the heart does hypertrophic cardiomyopathy affect
greater in interventricular septum less in left ventricular free wall = obstructs left ventricular outflow
81
what happens in restrictive cardiomyopathy
Wall of the ventricle becomes stiff with impaired filling during diastole
82
when does restrictive cardiomyopathy occur
Idiopathic | Secondary to systemic conditions that affect myocardium
83
what does restritive cardiomyopathy lead to
- radiation-induced fibrosis - amyloidosis - hemochromatosis - sarcoidosis
84
what viruses can cause myocarditis
(Coxsackie A and B)
85
what does Virus induced Myocarditis lead to
Interstitial mononuclear inflammatory cells with myocyte necrosis
86
what does pyogenic bacteria causing myocarditis lead to
Abscesses
87
what do parasites cause in myocarditis
Individual myocyte or interstitium with adjacent inflammation
88
what can cause hypersenitivity in myocarditis
Drugs | perivascular inflammation with eosinophils

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