Flashcards in CV lecture 2- CHF, CHD, IHD, Cardiomyopathies, and Myocarditis Deck (71):
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.
T/F: CHF may be due to pathologic conditions inside or outside the heart.
what are the compensatory mechanism for CHF?
1) Myocardial hypertrophy
2) Frank- starling mechanism- Ventricle dilation
3) Physiologic "neurohumoral" mechanisms- NE and renin-aldosterone
what are the "physiological compensatory mechanisms" for CHF?
increased heart rate
increased intravascular volume
re-distribution of blood flow
what are the causes of LEFT SIDE heart failure?
1. Ischemic heart disease
5. Valvular disease
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
what symptoms are seen during Left ventricular failure caused by CHF?
Orthopnea (shortness of breath)
what neurological condition results from a left and/or right ventricular failure?
CHF due to left ventricular failure eventually leads to ______________
right ventricular failure
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)
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
what is the rate of congenital heart disease in the US?
6-8/1,000 live births in US
what are the causes of congenital heart disease?
1) Environmental factors
2) Chromosomal abnormalities
**90% are unknown and likely multifactorial **
what are the forms of congenital heart disease?
Cyanotic and noncyanotic forms
___________ is the 2nd most common congenital heart malformation
Atrial septal defect (ASD)
_____________ is the most common of cardiac malformations
Ventricular septal defects (VSD's)
what is the prevalence of Ventricular septal defects?
4/1000 live births
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
what are the 2 types of CYANOTIC congenital heart disease?
1) Tertiary of Fallot
2) transposition of great arteries
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
what occurs during a Transposition of the great arteries?
Right ventricle empties into the aorta
Left ventricle empties into pulmonary artery
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
ischemic heart disease is primarily caused by what?
due to coronary artery atherosclerosis (coronary artery disease)
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
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
Coronary artery thrombosis
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)
name the Clinical Types of Ischemic Heart Disease:
(theres 4 kinds)
Chronic IHD with CHF
Sudden cardiac death
_____________ is defined as intermittent chest pain caused by transient, reversible myocardial ischemia
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
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
_______________ is due to necrosis of cardiac muscle caused by ischemia
Acute myocardial infarction
(“heart attack”, MI)
Acute myocardial infarctions can be the result of acute __________________ secondary to atherosclerosis
coronary artery thrombosis
how many myocardial infarctions occur per-year? how many people die?
- 1.5 million MI’s annually in US
- one-third die
Severe ischemia lasting longer than ______________ will cause irreversible myocyte injury and cell death
myocardial ischemia may also lead to may lead to ventricular __________
name the clinical manifestations of myocardial infarctions
Shortness of breath
low grade fever
what types of tests can be used to diagnose MI's?
B) elevated serum proteins from damaged cardiac myocytes
- troponins T and I
- myocardial-specific isoform of creatine kinase (CK-MB)]
T/F: MI’s less than 24 hours old are usually not grossly apparent at autopsy
less than 12 hours old
At 12-24 hours, infarcted area appears what color?
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
treatments for myocardial infarctions may result in __________ injury
what CARDIAC complications can arise from a myocardial infarction?
3) Mural thrombus
4) Mitral valve regurgitation
_________ thrombi develop on the lining of the heart chamber
Mural thrombi can lead to left-sided _______
what causes Mitral valve regurgitation?
papillary muscle dysfunction
what condition is defined as "Progressive heart failure due to ischemic myocardial damage"
Chronic Ischemic Heart Disease
Arrhythmias, CHF and subsequent MI’s as a result of _____________________ lead to many deaths
Chronic Ischemic Heart Disease
what is the most common cause of sudden cardiac death?
accounts for 80-90% of all SCD's
ischemic heart disease
what are PRIMARY cardiomyopathies?
disease primarily or solely confined to the heart muscle
secondary cardiomyopathies are defined as what?
myocardium is destroyed because it is involved in part of a systemic disorder
what are the 3 functional patterns of Cardiomyopathies?
Dilated Cardiomyopathies may be May caused by what?
May be primary or secondary
may be genetic or acquired
about ____% of dilated cardiomyopathies are genetically linked
what are the characteristics of DILATED cardiomyopathies?
- Dilation of all 4 chambers
- Poor ventricular contractility
- Nonspecific histology with fibrosis and myocyte hypertrophy
____________ Cardiomyopathy is a primary, genetic cardiomyopathy
T/F: hypertrophic cardiomyopathy is inhereted in a autosomal recessive pattern
its autosomal dominant
name the characteristics and histology of HYPERTROPHIC cardiomyopathy:
- Stiff ventricles prevent adequate filling (diastolic dysfunction)
- Histology: myocyte disarray with fibrosis
_______________ occurs when the wall of the ventricles becomes stiffer with impaired filling during diastole
RESTRICTIVE cardiomyopathy can be __________ or __________ to systemic conditions that affect the myocardium
idiopathic or secondary
what systemic conditions cause restrictive cardiomyopathy?
"too much protein, iron, granules" + radiation
Myocarditis can be caused by what 4 agents?
1) Pyogenic bacteria
which type of myocarditis has the following characteristics:
interstitial mononuclear inflammatory cells with myocyte necrosis (Coxsackie A and B)
___________ are seen in individual myocytes or interstitium with adjacent inflammation during this form of myocarditis
give an example of parasitic myocarditis:
(found in south america)
____________ myocarditis is characterized by:
- often caused by drugs
- perivascular inflammation with eosinophils
hypersensitivity induced myocarditis
__________ cardiomyopathy is a disorder of sarcomeric proteins
what 3 proteins are dysfunctional during hypertrophic cardiomyopothy disorders?
myosin binding protein C
what are the non-infectious causes of myocarditis?
Non infectious causes include:
what % of dilated cardiomyopathies are due to genetics?
hereditary basis in 20-50% of cases
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)