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BVetMed3 - Cardiovascular > Pathophysiology Of CV Disease > Flashcards

Pathophysiology Of CV Disease Flashcards

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1
Q

What is the difference between heart disease and heart failure?

A

A patient can have heart disease without showing outward signs (only seen with diagnostics)

Once they start to show inadequacy of CO or congestion - Heart failure.

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2
Q

What are the two broad types of heart failure?

A

Forward failure

Backward/congestive failure

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3
Q

What is forward failure?

A

Inadequacy of delivery into the arterial circulation

Seen as an acute drop in CO

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4
Q

What is backward/congestive failure?

A

Because of a chronic inadequacy of delivery of blood into the arterial circulation, fluid is retained which leads to congestion within the venous circulation.

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5
Q

How can forward and backward failure be broadly seen in patients?

A

Forward failure
—inadequate output at normal pressures
— inadequate output at abnormal pressures

Backwards failure
— Adequate output at abnormal pressures
— Inadequate output at abnormal pressures

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6
Q

What are five possible reasons for heart failure to occur?

A 
Pump failure
Volume overload 
Pressure overload 
Arrhythmias 
Diastolic heart failure
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7
Q

How are changes in pressure in the arterial circulation perceived?

A

Baroreceptors

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8
Q

What is usually the first step in the development of heart failure?]

How long does it take?

A

Baroreceptors sense underfilling of arterial circulation

Variable - Can take months/years or shorter

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9
Q

What is meant by the term ‘pump failure’?

A

Failure of systolic function of the myocardium.

Results in inadequate stroke volume and fall in CO

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10
Q

What condition can cause heart failure as a result of pump failure?

A

DCM

Failure of the myocardium leads to dilation of the heart and inadequacy of delivery into the arterial circulation

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11
Q

What is volume overload?

A

Heart chronically overworked because it is having to pump a greater volume of blood than normal.

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12
Q

What conditions can result in volume overload?

A

Valvular insufficiencies (mitral, aortic)

Shunting diseases e.g. VSD, PDA

Chronic anaemia (e.g. due to nutritional deficiencies)

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13
Q

What is mitral insufficiency?

A

Degeneration of the mitral valve which leads to the introduction of an insufficiency within the circulation

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14
Q

How does mitral insufficiency result in volume overload?

A

Total stroke volume=forward stroke volume+ regurgitation stroke volume

Systole causes blood to go to the aorta (normal) AND back into the atrium

This increases total stroke volume

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15
Q

What is pressure overload?

A

Diseases which chronically increase the pressure against which the ventricle has to pump.

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16
Q

What conditions can cause pressure overload?

A

Hypertension - systemic or pulmonary

Narrowing of the outflow tract - pulmonic or aortic stenosis
— can have congenital narrowing

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17
Q

How can arrhythmias result in syncope?

A

Sudden drop in HR = sudden drop in CO

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18
Q

How can arrhythmias compromise CO?

A

Low heart rates result in a drop in CO

Very high heart rates = diastole too short to allow adequate filling therefore SV and CO fall.

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19
Q

What is diastolic failure?

A

Inability of the heart to relax normally
— also something compressing heart and not allowing it to fill properly

Compromises filling and decreases CO

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20
Q

What conditions can cause diastolic failure?

A

HCM
DCM - myocardial fibrosis
Pericardial effusion

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21
Q

Which species is more likely to get HCM?

A

Cats

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22
Q

How can HCM lead to diastolic failure?

A

Hypertrophy leads to a very stiff myocardium which is difficult to fill.

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23
Q

What is the general progression of responses which are initiated by a drop in CO?

A

Autonomic response

Endocrine response

Hypertrophic response

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24
Q

What mechanisms increase blood volume?

A

RAAS - angiotensin II, aldosterone

ADH

Renal autoregulation of flow

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25
How does Angiotensin II increase blood volume?
Increases: — sympathetic activity — Tubular Sodium reabsorption and K+ excretion — aldosterone secretion from adrenal cortex — Arteriolar vasoconstriction to increase BP — ADH secretion from posterior pituitary
26
How does Aldosterone increase blood volume?
Increases tubular sodium (and chloride) reabsorption and potassium excretion Therefore water is retained
27
How can renal auto regulation of flow increase blood volume?
Decreased renal flow increases sodium retention
28
What mechanisms decrease blood volume?
Natriuretic peptides Renal autoregulation of flow
29
What are natriuretic peptides?
Peptides which induce natriuresis - the excretion of sodium from the kidneys
30
How can renal autoregulation of flow decrease blood volume?
Increased renal flow decreases sodium retention
31
What is the theme in cardiac disease?
Disease Adaptation Maladaptive response Heart failure
32
What effects does sympathetic stimulation have on the heart/circulating volume?
``` Positive chronotrope - increase HR Positive inotrope Positive luisitrope Vasoconstriction Stimulation of renin release and RAAS ```
33
How does the degree of sympathetic stimulation relate to survival?
Patients that survive longest have lowest concentrations of NAd. Inverse relationship between degree of sympathetic stimulation and survival Blocking NAd can improve survival - BETA BLOCKERS
34
What endocrine systems are involved in heart failure?
RAAS ADH Natriuretic peptides Local regulators of vascular tone (NO, Prostaglandins, Endothelin)
35
What is the function of endothelin?
Vasoconstriction
36
What cells secrete renin?
Juxtaglomerular cells
37
What are the advantages of the RAAS?
Increased circulating fluid volume -> increased preload -> increased CO by starling mechanism Increased systemic vascular resistance improves blood pressure
38
What are the disadvantages of the RAAS?
Long term stimulation results in excessive fluid retention — overfilling of the venous circulation leading to signs of congestion Excessive resistance to ventricular emptying Direct and indirect deleterious effects on the myocardium
39
How do the methods employed by Aldosterone and ADH to conserve water vary?
Aldosterone - retains SODIUM then passively retains water ADH - retains water WITHOUT retention of sodium — Therefore sodium concentration falls
40
When is ADH stimulated in heart failure?
Only in severe/late stages
41
What is the effect of ADH secretion in heart failure?
Hyponatraemia
42
When are natriuretic peptides released? How useful are they for patients and diagnostically?
When the myocardium is stretched Effects usually overwhelmed by volume retaining systems Increased levels associated with HF - BIOMARKER
43
What are the two types of hypertrophy?
Concentric | Eccentric
44
What type of hypertrophy is seen in Pressure overload?
Concentric e.g. Hypertension, Aortic stenosis
45
What type of hypertrophy is seen in volume overload?
Eccentric e.g. mitral regurgitation, shunting diseases (VSD, PDA)
46
How can you differentiate between concentric and eccentric hypertrophy?
Echocardiography
47
What are the consequences of pathological hypertrophy?
Increased myocardial oxygen demand may result in fibrosis and hypoxia of the myocardium
48
What is heart failure characterised by in the short, medium, and long term?
Short term - alteration in autonomic tone - increased sympathetic tone Mid - Endocrine systems Long - hypertrophy
49
What are the clinical signs of heart failure? What are their causes?
Tachycardia - increased sympathetics Poor peripheral perfusion - vasoconstriction Fluid retention - RAAS and ADH Signs of LCHF or RCHF
50
What is LCHF?
Diseases that result in increased filling pressures in the left side of the heart and retained fluid found in the PULMONARY CIRCULATION - Pulmonary oedema -> breathing problems
51
What is RCHF?
Diseases result in elevation in filling pressures in the right side of the heart and retained fluid found in SYSTEMIC veins - pleural effusion, ascites, peripheral oedema
52
What is the normal function of the vasculature ?
Distribute cellular metabolic substrates around the body (H2O, O2, glucose, triglycerides, a.a.) Remove cellular metabolic waste products (CO2, lactate) Maintain fluid homeostasis — balance between intravascular, extracellular and intracellular Primary haemostasis
53
What are the signs of vascular disease?
Underperfusion - vascular obstruction - complete or partial - Loss of function, ischaemia, necrosis Increased vascular permeability - oedema or haemorrhage Abnormal flow Abnormal pressures
54
Suggest what may cause increased hydrostatic pressures in vessels.
CHF | Venous occlusion
55
Suggest what may cause increased vascular permeability
Vasculitis
56
Suggest what may cause decreased oncotic pressures in vessels
Hypoproteinaemia / hypoalbuminaemia
57
Suggest what may cause decreased lymphatic drainage
Lymohoedema
58
What are the types of vascular disease?
Obstructive - thrombosis and embolism Degenerative Inflammatory - vasculitis Malformations - congenital and acquired
59
What is meant by the term ‘thromboembolism’?
Obstruction of a BV by a clot that has become dislodged from another site in the circulation
60
What needs to happen for a thromboembolism to occur?
One or more of the following: ``` Disturbance of: Flow Endothelial integrity Haemostasis Fibrinolysis ```
61
What can cause thromboembolism?
``` Cardiac disease Cushing’s (hyperadrenocorticism) Parasitic disease Protein losing nephropathy Neoplasia Auto-immune haemolytic anaemia ```

BVetMed3 - Cardiovascular (2 decks)

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