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CVS Pathology I Flashcards

1
Q

Congestive heart failure involves an interplay of what 2 factors?

A

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

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2
Q

Heart failure is characterized by?

A

1) Diminished cardiac output (forward failure)

2) Damming back of blood to the venous system (backward failure)

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3
Q

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

A

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

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4
Q

Compensatory mechanisms in CHF

A

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

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5
Q

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

A

muscle hypertrophy; chamber dilation

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6
Q

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

A

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

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7
Q

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

A

True

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8
Q

3 systems activated in the neurohumoral compensatory response in CHF

A

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

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9
Q

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

A

retention; edema

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10
Q

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

A

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

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11
Q

Pressure overload causes what kind of hypertrophy?

A

Concentric

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12
Q

Give examples of pathological states with pressure overload

A

systemic hypertension, pulmonary hypertension

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13
Q

Give examples of pathological states with volume overload

A

aortic/mitral regurgitation, shunting anomalies

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14
Q

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

A

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

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15
Q

Give the basis for myocardial contractile failure

A

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

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16
Q

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

A

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

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17
Q

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

A

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

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18
Q

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

A

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

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19
Q

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

A

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

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20
Q

Mechanisms of cardiac dysfunction in CHF

A

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

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21
Q

Examples of diseases that cause myocardial dysfunction

A

IHD, Dilated cardiomyopathy

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22
Q

Examples of diseases that cause ventricular pressure overload

A

HTN, Aortic stenosis, Pulmonary embolism, cor pulmonale,

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23
Q

Examples of diseases that cause ventricular volume overload

A

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

24
Q

Examples of diseases that cause restrictive disease

A

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

Pathology (7 decks)

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