CV lecture 2- CHF, CHD, IHD, Cardiomyopathies, and Myocarditis Flashcards Preview

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Flashcards in CV lecture 2- CHF, CHD, IHD, Cardiomyopathies, and Myocarditis Deck (71):
1

what is the definition of congestive heart failure (CHF)?

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

2

T/F: CHF may be due to pathologic conditions inside or outside the heart.

true

3

what are the compensatory mechanism for CHF?

1) Myocardial hypertrophy

2) Frank- starling mechanism- Ventricle dilation

3) Physiologic "neurohumoral" mechanisms- NE and renin-aldosterone

4

what are the "physiological compensatory mechanisms" for CHF?

increased heart rate
increased intravascular volume
re-distribution of blood flow
increased catecholamines

5

what are the causes of LEFT SIDE heart failure?

1. Ischemic heart disease
2. Hypertension
3. Myocarditis
4. Cardiomyopathy
5. Valvular disease

6

what manifestation of CHF is characterized by:

- Congestion of liver (zonal or “nutmeg” pattern) and spleen

- Edema of subcutaneous tissue (feet and ankles)

Right Ventricular failure

7

what symptoms are seen during Left ventricular failure caused by CHF?

pulmonary edema
Chronic cough
Orthopnea (shortness of breath)

8

what neurological condition results from a left and/or right ventricular failure?

Cerebral hypoxia

9

CHF due to left ventricular failure eventually leads to ______________

right ventricular failure

10

what occurs during the Frank-Starling mechanism? (a CHF compensatory mechanism)

- increased end-diastolic filling volume stretches cardiac muscle fibers.

- At first the fibers contract more forcefully, increasing cardiac output (compensated heart failure)

- eventually they cannot keep up (decompensated heart failure)

11

what are the causes of RIGHT SIDE heart failure?

1) left-sided heart failure

2) pulmonary hypertension

3) valve disease

4) septal defects with left-to-right shunts

12

what is the rate of congenital heart disease in the US?

6-8/1,000 live births in US

13

what are the causes of congenital heart disease?

1) Environmental factors

2) Chromosomal abnormalities

**90% are unknown and likely multifactorial **

14

what are the forms of congenital heart disease?

Cyanotic and noncyanotic forms

15

___________ is the 2nd most common congenital heart malformation

Atrial septal defect (ASD)

16

_____________ is the most common of cardiac malformations

Ventricular septal defects (VSD's)

17

what is the prevalence of Ventricular septal defects?

4/1000 live births

18

what structure connects the aorta and pulmonary artery at birth? when does this structure normally close?

ductus arteriosus (if it doesn't close.... PDA)

normally closes within a few days of birth

19

what are the 2 types of CYANOTIC congenital heart disease?

1) Tertiary of Fallot
2) transposition of great arteries

20

what 4 anomalies make up the Tertiary of Fallot?

1) Ventricular septal defect
2) Narrowed right ventricular outflow
3) Overriding of the aorta over the VSD
4) Right ventricular hypertrophy

21

what occurs during a Transposition of the great arteries?

Right ventricle empties into the aorta

Left ventricle empties into pulmonary artery

22

what is Ischemic Heart Disease (IHD)?

Refers to a group of related disorders that are all characterized by an imbalance between myocardial blood supply and myocardial oxygen demand

23

ischemic heart disease is primarily caused by what?

due to coronary artery atherosclerosis (coronary artery disease)

24

IHD is the leading cause of death in the united states...... how many people does it kill?

Leading cause of death in US – 500,000 annually

25

coronary artery _________ and _________ both play a role in the pathogenesis of ischemic heart disease (IHD)

*****Coronary artery atherosclerosis (>75% narrowing)
- responsible for 90% of IHD cases

and

Coronary artery thrombosis

26

besides obstructions of the coronary artery, what other conditions can cause ischemic heart disease?

increased myocardial oxygen demand (hypertension)

decreased blood volume (hypotension/shock)

decreased oxygenation (pneumonia)

decreased oxygen-carrying capacity (anemia)

27

name the Clinical Types of Ischemic Heart Disease:

(theres 4 kinds)

Angina pectoris
Myocardial infarction
Chronic IHD with CHF
Sudden cardiac death

28

_____________ is defined as intermittent chest pain caused by transient, reversible myocardial ischemia

Angina pectoris

29

what are the characteristics of STABLE angina?

- occurs predictably at certain levels of exertion

- crushing or squeezing substernal pain that may radiate down the left arm or jaw (referred pain)

- Relieved by rest or sublingual nitroglycerin

30

what are the characteristics of UNSTABLE angina?

- increasing frequency of chest pain with minimal/no exertion

- Longer lasting than stable angina

- Often precedes more serious ischemia or MI

31

_______________ is due to necrosis of cardiac muscle caused by ischemia

Acute myocardial infarction

(“heart attack”, MI)

32

Acute myocardial infarctions can be the result of acute __________________ secondary to atherosclerosis

coronary artery thrombosis

33

how many myocardial infarctions occur per-year? how many people die?

- 1.5 million MI’s annually in US

- one-third die

34

Severe ischemia lasting longer than ______________ will cause irreversible myocyte injury and cell death

20-40 minutes

35

myocardial ischemia may also lead to may lead to ventricular __________

fibrillation

36

name the clinical manifestations of myocardial infarctions

chest pain
Shortness of breath
nausea/vomiting
diaphoresis (sweating)
low grade fever

37

what types of tests can be used to diagnose MI's?

A) ECG

B) elevated serum proteins from damaged cardiac myocytes
- troponins T and I
- myocardial-specific isoform of creatine kinase (CK-MB)]

38

T/F: MI’s less than 24 hours old are usually not grossly apparent at autopsy

FALSE

less than 12 hours old

39

At 12-24 hours, infarcted area appears what color?

reddish-blue

40

what are the possible treatment options for MI's?

1) placement of stents to open coronary vessels affected by atherosclerosis

2) coronary artery by-pass grafts (CABG)

3) “clot-busting” drugs, such as streptokinase

41

treatments for myocardial infarctions may result in __________ injury

reperfusion

42

what CARDIAC complications can arise from a myocardial infarction?

1) Arrhythmia
2) CHF/shock
3) Mural thrombus
4) Mitral valve regurgitation

43

_________ thrombi develop on the lining of the heart chamber

mural

44

Mural thrombi can lead to left-sided _______

embolism

45

what causes Mitral valve regurgitation?

papillary muscle dysfunction

46

what condition is defined as "Progressive heart failure due to ischemic myocardial damage"

Chronic Ischemic Heart Disease

47

Arrhythmias, CHF and subsequent MI’s as a result of _____________________ lead to many deaths

Chronic Ischemic Heart Disease

48

what is the most common cause of sudden cardiac death?

accounts for 80-90% of all SCD's

IHD

ischemic heart disease

49

what are PRIMARY cardiomyopathies?

disease primarily or solely confined to the heart muscle

50

secondary cardiomyopathies are defined as what?

myocardium is destroyed because it is involved in part of a systemic disorder

51

what are the 3 functional patterns of Cardiomyopathies?

1) Dilated
2) Hypertrophic
3) Restrictive

52

Dilated Cardiomyopathies may be May caused by what?

May be primary or secondary

may be genetic or acquired

53

about ____% of dilated cardiomyopathies are genetically linked

20%

54

what are the characteristics of DILATED cardiomyopathies?

- Dilation of all 4 chambers

- Poor ventricular contractility

- Nonspecific histology with fibrosis and myocyte hypertrophy

55

____________ Cardiomyopathy is a primary, genetic cardiomyopathy

Hypertrophic Cardiomyopathy

56

T/F: hypertrophic cardiomyopathy is inhereted in a autosomal recessive pattern

FALSE

its autosomal dominant

57

name the characteristics and histology of HYPERTROPHIC cardiomyopathy:

- Stiff ventricles prevent adequate filling (diastolic dysfunction)

- Histology: myocyte disarray with fibrosis

58

_______________ occurs when the wall of the ventricles becomes stiffer with impaired filling during diastole

Restrictive Cardiomyopathy

59

RESTRICTIVE cardiomyopathy can be __________ or __________ to systemic conditions that affect the myocardium

idiopathic or secondary

60

what systemic conditions cause restrictive cardiomyopathy?

radiation fibrosis
amyloidosis
hemochromatosis
sarcoidosis

"too much protein, iron, granules" + radiation

61

Myocarditis can be caused by what 4 agents?

1) Pyogenic bacteria

2) Viruses

3) Parasites

4) Hypersensitivity

62

which type of myocarditis has the following characteristics:

interstitial mononuclear inflammatory cells with myocyte necrosis (Coxsackie A and B)

viral myocarditis

63

___________ are seen in individual myocytes or interstitium with adjacent inflammation during this form of myocarditis

parasites

64

give an example of parasitic myocarditis:

Chagas disease

(found in south america)

65

____________ myocarditis is characterized by:

- often caused by drugs

- perivascular inflammation with eosinophils

hypersensitivity induced myocarditis

66

__________ cardiomyopathy is a disorder of sarcomeric proteins

HYPERtrophic

67

what 3 proteins are dysfunctional during hypertrophic cardiomyopothy disorders?

myosin

myosin binding protein C

troponin T

68

what are the non-infectious causes of myocarditis?

Non infectious causes include:
toxins
hypersensitivity reactions
auto-immune disorders

69

what % of dilated cardiomyopathies are due to genetics?

hereditary basis in 20-50% of cases

70

during hypertrophic cardiomyopathy, inappropriate (spontaneous) myocardial hypertrophy occurs more in what region of the heart?

greater in the interventricular septum

(less in the left ventricular free wall)

71

what are the 3 examples of NON-cyanotic congenital heart disease?

1) Atrial septal defect (ASD)
2) Ventricular septal defect (VSD)
3) Patent ductus arteriosis