CVS Pathology I Flashcards Preview

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Flashcards in CVS Pathology I Deck (57):
1

Congestive heart failure involves an interplay of what 2 factors?

1) Inability of the heart to maintain sufficient CO to support body functions
2) Recruitment of compensatory mechanisms to maintain cardiac reserve

2

Heart failure is characterized by?

1) Diminished cardiac output (forward failure)
2) Damming back of blood to the venous system (backward failure)

3

According to the Frank Starling Mechanism, the stroke volume increases in response to...

increased (end diastolic volume) volume of blood filling the heart

4

Compensatory mechanisms in CHF

Frank Starling mechanism, Myocardial hypertrophy (with or without dilation), Activation of the neurohumoral system

5

In the heart, pressure overload causes _____ while Volume overload causes ______

muscle hypertrophy; chamber dilation

6

Name 2 important things to take note in the histology of the hypertrophic heart

thickness of the myocardium & box-type nuclei (enlarged)

7

(T/F) CHF almost always presents with tachycardia.

True

8

3 systems activated in the neurohumoral compensatory response in CHF

NE/Epinephrine, Renin-Angiotensin-Aldosterone System, Release of atrial-natriuretic peptide

9

Release of atrial natriuretic peptide (ANP) causes sodium and water _______ therefore causing ______

retention; edema

10

What is the role of the RAA system in the compensatory system of CHF?

RAA activation causes tubular reabsorption of sodium and water --> increased blood volume --> increased venous return --> increased volume to L ventricle --> augment failing heart

11

Pressure overload causes what kind of hypertrophy?

Concentric

12

Give examples of pathological states with pressure overload

systemic hypertension, pulmonary hypertension

13

Give examples of pathological states with volume overload

aortic/mitral regurgitation, shunting anomalies

14

(T/F) A 25 YO male's heart was determined to weigh 350 grams. His heart is considered enlarged.

False. Normal for males: 300-350 grams; Females 250-300 grams

15

Give the basis for myocardial contractile failure

1) Death of myocytes/loss of vital pump elements
2) Overworked, fatigued cardiac muscles
3) Altered gene expression with prolonged hemodynamic overload
4) Re-expression of pattern of protein synthesis similar to fetal cardiac development

16

Give functional modifications in the heart in heart failure after neurohumoral stimulation

Increased inotropy; Increased HR; Vasoconstriction; Na and water retention

17

Give structural modifications in the heart in heart failure after neurohumoral stimulation

Hypertrophy, Increased nonmuscular tissue, Increased expression of adult cardiac genes

18

Give the end results of functional & structural modifications in the heart in heart failure after neurohumoral stimulation

1) Increased energy demand
2) Altered loading conditions
3) Altered vascular/diastolic properties
4) Proarrhythmogenic effect

19

Give some anatomic, biochemical and ultrastructural changes in the heart in CHF

1) Pathologic hypertrophy
2) Increased protein synthesis
3) Altered gene expression
4) Synthesis of abnormal proteins
5) Fibrosis
6) Decrease calcium
7) Microciculatory spasm (further ischemia)
8) Apoptosis

20

Mechanisms of cardiac dysfunction in CHF

Pump failure, Obstruction of flow, Regurgitant flow, Disorders of cardiac conduction, Disruption of normal circulatory continuity

21

Examples of diseases that cause myocardial dysfunction

IHD, Dilated cardiomyopathy

22

Examples of diseases that cause ventricular pressure overload

HTN, Aortic stenosis, Pulmonary embolism, cor pulmonale,

23

Examples of diseases that cause ventricular volume overload

Aortic/mitral regurgitation, high output state (pregnancy, anemia, thyrotoxicosis)

24

Examples of diseases that cause restrictive disease

pathological tachycardia, heart block

25

Examples of diseases that cause conduction system failure

AMI, Arrythmia

26

Examples of diseases that cause valvular failure

endocarditis, Rheumatic heart disease, calcific aortic stenosis, Pulmonary stenosis, tricuspid atresia

27

Examples of diseases that cause cardiac malformation

VSD< ASD, PDA, tetralogy of fallot, Coarctation of the aorta

28

What are the most frequent clinical conditions associated with CHF

MI and valvular disease

29

Iatrogenic causes of CHF

Drugs: cocaine, doxyrubicin, radiation

30

Clinical conditions associated with CHF

Previous MI, CAD, HTN, Arrythmia, Heart valve disease, cardiomyopathy, congenital heart disease, alcohol and drug abuse

31

DIfferntiate systolic vs diastolic dysfunction in terms of its main pathology

Systolic: problem during contraction; Diastolic: failure of muscle to relax

32

Types of CHF in terms of anatomic location

1) Left-sided HF (Failure of LV)
2) Right-sided HF (Failure of RV)
3) Combined or biventricular

33

What is the most common cause of heart failure?

Systolic dysfunction

34

Give diseases that cause systolic dysfunction

IHD, hypertensive heart disease, dilated cardiomyopathy

35

(T/F) Most systolic dysfunction affects the right ventricle

False. Left ventricle

36

(T/F) You find s/s of pulmonary edema and congestion in systolic dysfunction

True

37

Give causes of diastolic dysfunction in CHF

massive LV hypertrophy, amyloidosis, constructive myocarditis, myocardial fibrosis

38

(T/F) In diastolic dysfunction the ejection fraction is decreased

False. The ejection fraction is normal

39

Give an important clinical manifestation in left sided heart failure

Edema

40

Effect of left sided heart failure on the brain

Hypoxic encephalitis

41

Effect of left sided heart failure on the kidneys

Release of Renin = edema

42

Effect of left sided heart failure on the lungs

acute congestion and edema; Chronic passive congestion

43

Histologically, how do you differentiate acute vs passive congestion of the lung?

Acute = no heart failure cells; Chronic = (+) heart failure cells

44

Give the clinical features of left-sided heart failure

Dyspnea, orthopnea, Paroxysmal Nocturnal Dyspnea, Increased HR, caridomegaly, Blood tinged sputum, cyanosis, elevated pulmonary wedge pressure, rales, cough, edema

45

Give causes of right-sided heart failure

PE, Intrinsic lung disease (COPD, cystic fibrosis), Pulmonary HTN, kyphoscoliosis, pneumoconiosis, schistosomiasis

46

Give the liver morphology in right-sided heart failure

Congestive hepatomegaly, nutmeg liver, centrilobular necrosis, sclerosis

47

Give the spleen morphology in right-sided heart failure

congestive splenomegaly

48

Give the heart morphology in right-sided heart failure

RV dilatation and hypertrophy

49

Give the kidney morphology in right-sided heart failure

congestion

50

Give the brain morphology in right-sided heart failure

hypoxic encepalopathy

51

Clinical features of right-sided heart failure

Splanchic congestion (hepatosplenomegaly), hepatojugular reflex, Jugular venous distention, dependent edema, transudative effusions, cyanosis

52

Give causes of high output failure

anemia, hyperthyroidism, high fever, shunts between the artery and veins

53

What is the underlying physiological problem in high output heart failure

decreased systemic vascular resistance d/t arterio-venous shunting or peripheral vasodilation

54

Which is more common, high or low output heart failure?

Low

55

Give the major criteria in the diagnosis of CHF

PND, Neck vein distention, rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased venous pressure & (+) hepatojugular reflux

56

What are the minor criteria in the diagnosis of CHF

Extremity edema, night cough, dyspnea on exertion, hepatomegaly, pleural effusion, vital capacity reduced by 1/3 & tachycardia

57

Weight loss of >4.5 kg over 5 days treatment is a (major/minor/both) criteria for diagnosis of CHF

both