pathology of Heart Failure, Hypertension, Anuerysms And Neoplsia

Question 1

1- define cardiac failure?
2- what will It result in?

Answer 1

1- failure of the heart to pump sufficient blood and deliver sufficient nutrients to satisfy metabolic demands
2- results in under perfusion which may cause fluid retention and increased blood volume

Question 2

acute heart failure?

Answer 2

rapid onset of symptoms, often with definable cause eg- MI

Question 3

chronic failure?

Answer 3

slow onset of symptoms, associated with, for example, ischaemic or valvular heart disease

Question 4

acute-on-chronic heart failure?

Answer 4

chronic failure becomes decompensated by an acute event

Question 5

systolic failure?

Answer 5

• failure of the pump to move blood into systole
• reduced ejection fraction
• reduced ventricular contraction

Question 6

causes of systolic failure?

Answer 6

• myocardial ischamia
• MI
• myocardial scarring
• myocarditis
• drugs
• muscular disorders (DMD)

Question 7

effects of systolic failure?

Answer 7

• reduced cardiac output
• feedback to atria and right side of heart
• pulmonary oedema
• peripheral oedema

Question 8

treatment of systolic failure?

Answer 8

support

Question 9

diastolic failure?

Answer 9

• failure of ventricular wall to relax
• • restrictive, stiff ventricle
• reduced ventricular filling leads to reduced blood for systole
• elevated end diastolic pressure

Question 10

causes of diastolic failure?

Answer 10

• scarring plus most causes of systolic
• infiltrative disease (amyloid)

Question 11

effect of diastolic failure?

Answer 11

• none
• pulmonary and peripheral oedema
• response to excersise
• • tachycardia and pulmonary acute oedema

Question 12

treatment of diastolic failure?

Answer 12

reduce AV conduction

Question 13

what are some of the causes of left and right ventricular failure?

Answer 13

• coronary heart disease
• hypertension
• cardiomyopathy
• drugs
• toxins
• endocrine
• nutritional deficiency
• infiltrative
• other

Question 14

examples of cardiomyopathy causes?

Answer 14

• familial/genetic
• non familial/ non genetic can be acquired

Question 15

examples of drugs?

Answer 15

beta blockers
calcium antagonists
antiarryhtmics
cytotoxic agents

Question 16

examples of toxins?

Answer 16

alcohol
medication
cocaine
trace elements

Question 17

examples of endocrine causes?

Answer 17

diabetes
hyper/hypo thyroidism
cushings syndrome
adrenal insufficiency
excessive growth hormone

Question 18

examples of nutritional causes?

Answer 18

deficiency of thiamine
obesity

Question 19

examples of infiltrative causes?

Answer 19

sarcoids
amyloidosis
connective tissue disease

Question 20

examples of other causes?

Answer 20

HIV
peripartum cardiomyopathy
end stage renal failure

Question 21

describe the clinical effects of left ventricular failure?

Answer 21

build up of fluid in lungs
- blockage of blood
- can cause a build up of frothy fluid made of proteins leaking out

Question 22

describe the clinical effects of right ventricular failure?

Answer 22

pitting oedema
congested ‘nutmeg’ liver

Question 23

what organ is most effected right ventricular failure and describe the pathway?

Answer 23

liver
backlog of blood … IVC … hepatic vein… liver
patient may come in complaining of a sore side.

Question 24

2 main causes of left ventricular failure?

Answer 24

hypertensive and ischameic heart failure

Question 25

what will left ventricular failure cause?

Answer 25

- pulmonary oedema with associated symptoms - leads to pulmonary hypertension and eventually right ventricular failure

Question 26

what is combined left and right ventricular failure called?

Answer 26

congestive cardiac failure

Question 27

common causes of right ventricular failure?

Answer 27

- secondary to left ventricular failure - related to intrinsic lung disease - cor pulmonale due to pulmonary hypertension - primary pulmonary hypertension

Question 28

what are they key features of the clinical examination in patients with heart failure?

Answer 28

- Appearance -alertness, nutritional status, weight - Pulse rate -rhythm, and character - Blood pressure -systolic, diastolic, pulse pressure - Fluid overload -jugular venous pressure - Peripheral oedema -(ankles and sacrum), hepatomegaly, ascites - Respiratory rate, crackles, effusion (transudate) - Apex displacement, gallop rhythm, third heart sound, flow murmurs suggesting valvular dysfunction

Question 29

forward failure?

Answer 29

- Reduced perfusion of tissues - Tends to be more associated with advanced failure - problem with blood flowing out the heart

Question 30

backwards failure?

Answer 30

- problem with blood flowing back to the heart - Due to increased venous pressures - Dominated by fluid retention and tissue congestion

Question 31

what is B-natiuretic protein?

Answer 31

- BNP is one of of the natriuretic peptide hormone family, produced by ventricular muscle. - It is a stress response protein that increases in heart failure.

Question 32

what will B-natiuretic protein act on?

Answer 32

Acts on the ANP receptor but with relatively lower affinity but longer half life than other natriuretic proteins.

Question 33

what effects can B-natriuretic protein bring about?

Answer 33

Vessel dilatation Reduced load on heart Changes in glomerular filtration Inhibits renin secretion Decrease aldosterone Natriuresis Reduction in blood pressure

Question 34

what is hypertension a major risk factor for?

Answer 34

- Cardiovascular disease - Ischaemic heart disease - Accelerated atherosclerosis - Alzheimer type dementia

Question 35

what are the different categories of blood pressure?

Answer 35

1- Optimal 120/80 mm Hg ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg 2- Hypertension high blood pressure is considered to be 140/90mmHg or higher (or 150/90mmHg or higher if you're over the age of 80) 3- Isolated systolic hypertension >130/<80 mm Hg – commonest in >65 year old

Question 36

what is B-natriuretic protein a good biomarker for?

Answer 36

ventricular stress the stress response protein that is a good biomarker for cardiac failure.

Question 37

how can hypertension cause atherosclerosis?

Answer 37

- High blood pressure can damage blood vessels - fats (like LDL) can accumulate in these damaged areas - the process of atherosclerosis will occur

Question 38

how are coronary arteries subject to atherosclerosis due to hypertension?

Answer 38

they pressures in the coronary arteries are very high and they are subject to a lot of turbulence

Question 39

describe the end organ effects of systemic hypertension?

Answer 39

primary = sow changes in vessels and heart with chronic end organ dysfunction (tends to be less severe but will develop over time) accelerated = rapid changes in vessels with acute end organ dysfunction (medical emergency- causing damage over a short period of time)

Question 40

what end organs are most commonly effected in systemic hypertension?

Answer 40

brain heart kidneys arteries eyes

Question 41

3 effects on the kidney due to systemic hypertension?

Answer 41

1- Nephrosclerosis= - Drop-out’ of nephrons due to vascular narrowing - Proteinuria - Haematuria 2- Chronic renal failure 3- Acute renal failure can be associated with accelerated and severe hypertension

Question 42

how can you get proteinuria due to systemic hypertension?

Answer 42

by loosing glomerular integrity you will loose the full nephron = proteinuria (low level)

Question 43

3 effects on blood vessels of systemic hypertension?

Answer 43

1- Acceleration of atherosclerosis 2- Intimal proliferation and hyalinisation of arteries and arterioles 3- Accelerated and severe hypertension – fibrinoid necrosis

Question 44

effects on the brain of systemic hypertension?

Answer 44

- Atherosclerosis - Ischaemia and TIA - Infarct - Haemorrhage

Question 45

effects on the eyes due to systemic hypertension?

Answer 45

hypertensive retinopathy

Question 46

what are the causes of pulmonary hypertension?

Answer 46

- Increased pulmonary vascular resistance - Diffuse lung disease, for example COPD - Elevated left atrial pressure e.g. left ventricular failure, mitral valve stenosis - Recurrent pulmonary emboli - Primary pulmonary hypertension (unknown cause) - genetics - Left-right shunts e.g. ASD, VSD

Question 47

what are the different types of aneurysms that can be caused by systemic hypertension?

Answer 47

1- Aortic and other arteries: - Atherosclerosis - Hypertension 2- Berry aneurysm - Congenital 3- Dissecting aneurysm - Thoracic aorta, Marfan’s 4- Mycotic aneurysm - Infective endocarditis

Question 48

describe the relationship between neoplasia and the heart?

Answer 48

Rare - most often metastatic eg melanoma or small cell undifferentiated lung cancer Primary benign – atrial myxoma Primary malignant – angiosarcoma, rhabdomyosarcoma…….

Question 49

what is thrombosis? what are its risk factors?

Answer 49

1- local coagulation or clotting of the blood in part of the circulatory system. 2- smoking Diabetes Hypertension High cholesterol Obesity Familial

Question 50

biomarker for cardiac failure?

Answer 50

BNP

Question 51

what is an aneurysm?

Answer 51

Abnormal swelling in the wall of a blood vessel. The vessel wall become weakened and cannot maintain the tension to accommodate for the pressure.