Lecture 17- Heart Pathology # 3
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90 terms
Terms | Definitions |
|---|---|
 Valvular Heat disease can be due to _____ or _________ | Stenosis Regurgitation (or both- a stiff valve with minimal opending may be stenotic but still incompetent) |
| obstructed forward flow;failure to open completely | stenosis |
| Regurgitation | insufficient closure allowing backflow |
| __________ prevents normal forward flow from the LV to the Aorta | Aortic Stenosis |
| What type of Mumur is assosiated with Aortic stenosis? | systolic |
| Aortic stenosis is a chronic process of _______ and _________ | calcification valve scarring |
| Results of aortic stenosis | -can be mild to severe -decrease cardiac output -diminish flow to coronary arteries |
| insufficiency or incompetence lead to leaking of blood backward from aorta to LV | aortic valve regurgitation |
| Type of murmur with aortic valve regurgitation | diastolic murmur |
| causes of aortic valve regurgitation | 1. intrinsic valve disease- endocarditis 2. disruption of supporting structure-papillary muscle or chordae tendonae |
| Valvular disease may involve one or several valves including | aortic, mitral, tricuspid, bicuspid |
| Systolic Murmurs | aortic stenosis pulmonic stenosis tricuspid regurgitation mitral regurgitation |
| Diastolic Murmurs | mitral stenosis tricuspid stenosis aortic regurgitation pumonic regurgitations |
| Valvular Symptoms are dependent on: | 1. valve involved or number of valves 2. severity of disease 3. Rapidity of development-acute or chronic 4. compensation mechanism |
| Most common cause of AS | calcific aortic stenosis |
| what causes calcific aortic stenosis | -wear and tear -aging -calcium buildup from: age, HTN, Hyperlipidemia, inflammation |
| With AS when there is ______% of valve constriction the area decreases from 4 cm to 0.5 cm | 70-80 |
| _____ ______ occurs as the heart works to overcome the pressure of stenotic aortic valve but ischemia is still common. | LV hypertrophy |
| As a result of the ischemia from AS patients develop... | syncope angina CHF |
| What is Rheumatic Valvular Disease | -acute immunologically mediated disease -occurs 2-3 weeks after a beta hemolytic strep infection -secondary heart inflammation occurs as a results of antibodies against the heart |
| What is occurs years after acute rheumatic valvular disease? | fibrotic mitral stenosis |
| What are the long term or chronic affects of mitral stenosis? | (in uncorrected) -Pulmonary HTN -right sided CHF -progressive symptoms |
| mitral valve | bicuspid |
| Longer Term concern with acute rheumatic fever | mitral stenosis |
| Symptoms of fever, pancarditis, arthritis | acute rheumatic fever |
| to be diagnosed with acute rheumatic fever one must display 2 of the five "jones critieria" | 1. carditis (myocarditis,pericarditis, endocarditis) 2. polyarthritis 3.subcutaneous nodules 4. skin rash 5. st. vitus dance (jerking movements) |
| Hemodynamic affects of pulmonary stenosis... | RV force blood across stenotic valve>RV Hypertrophy>pressure increase in RV, RA,SVC,>venous congestion |
| causes of calcium build up in aortic stenosis | age hyperlipidemia htn inflammation |
| 3 major groups of congenital malformations | -left to right shunts -right to left shunts (cyanotic heart dz) -obstructive malformations |
| What is a shunt? | 1. abnormal (malformed) communication b/t chambers or vessels 2. pressure differential to determine flow pattern |
| hypoxia and high co2 in the arterial blood leads to blueness or | cyanosis (children with cong. malf. tend to get this when feeding or crying) |
| Right to Left Shunts | result in cyanosis because pulmonary ciruclation is bypassed;deoxygenated blood is mixed with oxygenated blood |
| Left ot right shunts | -not assosiated with cyanosis early -increase pulmonary blood flow -expose right side of circuit to high pressure and high volume left side |
| adaptation assosiated with left to right shunts | RV Hypertrophy and pulmonary hypertension |
| obstructive lesions (or malformations) | -vascular flow is obstructed partially by narrow vessel or chamber or valve -hemodynamic derangement results -adaptive changes eventually irreversible |
| most common heart anomaly, most close during early childhood and are asymptomatic | ventricular septal defect |
| Larger Ventricular Septal Defects cause: | -chronic left to right shunting -pulmonary HTN -CHF -Reversal of Shunt (due so scarring and change of pressure left>right Cyanosis) |
| Why does VSD cause Pulmonary HTN? | increase volume and pressure on the right side casuses and adaptation adn thickening or hypertrophy |
| Eisenmenger's Syndrome | -progressive pathophysiology of chronic shunting -pulmonary HTN and increased pulmonary resistance -reversal of shunt now right to left (CYANOSIS) |
| Atrial Septal Defect | -asymptomatic until adulthood -initial left to right shunt |
| If ASD is not corrected... | pulmonary HTN develops due to high pressure and volume on right side> Eisenmengers (right to left CYANOSIS) |
| ________ is a high pressure left to rigth shunt, with a loud systolic murmur | Patent Ductus arteriosis |
| Uncorrected PDA yeilds | Eisenmengers or a reversal of shunt with cyanosis due to pulmonary HTN |
| _____ is the most common cyanotic congenital heart disease; born with a right to left shung yielding a mixing of venous and arterial blood | tetralogy of fallot |
| What is are the hemodynamics of TOF? | -diminished pulmonary blood flow -large right to lefft shunt |
| Intervention for TOF | surgical |
| The _____ are protected in TOF ther is no _________ ________ | lungs pulmonary HTN |
| Tetrology of Fallot consists of: | 1.Pulmonary Stenosis 2. VSD 3. RV Hypertrophy 4. Overiding aorta |
| in_______ child presents with intermittent cyanosis | TOF |
| Presentation of Adult onset Coarctation (post-ductal) | -dichotomy of flow -high pressure and flow in upper extremeties and neck/head -low pressure adn diminished flwo is lower body/legs |
| Cyanosis to legs only is assosiated with........ | coarctation of the aorta due to decreased bloodflow to lower body |
| What is the cause of Coarctation | partial stenosis or narrowing of the aorta distal to to the take off of the subclavian and carotids |
| _________ a heart muscle disease | cardiomyopathy |
| _________ cardiomyopathy is confined to myocardium | primary |
| secondary cardiomyopathy | cardiac manifestation of sytemic illness |
| three causes of cardiomyopathies | myocarditis toxic idiopathic |
| Dilated Cardiomyopathy (DCM) | -progressive dilation of chambers -contractile dysfunction -systolic dysfunction -EF < 40% |
| Causes of Dilated Cardiomyopathy | Genetic, Myocarditis (coxsackie virus), adriamycin toxicity |
| Secondary causes of DCM | IHD Valvular heart disease HTN |
| Primary and Secondary DCM have the same symptoms of ______ _____ | systolic failure |
| ________% of dilated cardiomyopathy has genetic etiology which is ______ ________ | autosomal |
| Inherited DCM presents as _________ during ______ | progressive heart failure youth or young adulthood |
| Gene mutations in inherited DCM involve | sarcomere and cytoskeleton |
| _________ is a chemotherapy drug that causes DCM | Adriamycin |
| ETOH induced alcoholic cardiomyopathy (DCM) is from... | acetaldehyde which is a metabolite of alcohol that is toxic to the myocardium |
| Histological appearance of Dilated Cardiomyopathy | hypertrophy of myocyes with fibrosis in between; macro thin, large wall |
| Hypertrophic cardiomyopathy | -caused by heart beating against a high afterload -systolic function preserved -EF of 50-80% -Impairment of: compliance, diastolic fxn, difficult filling |
| Cause of hypertrophic cardiomyopathy | genetic, autosomal dominant (variable penetration) |
| What is the EF in Hypertrophic Cardiomyopathy | 50-80% |
| What is the EF is restrictive cardiomyopathy | 45-90% |
| Describe restrictive cardiomyopathy | *stiffened walls *restrict filling *decrease ventricular compliance *systolic fxn preserved |
| What are some of the causes of restrictive cardiomyopathy? | -Infiltrative DZ: amyloidosis, fibrosis, hemochromatosis -Radiation Fibrosis -Idiopathic |
| Clinically we confuse Restrictive Cardiomyopathy with _________ | Constrictive pericarditis |
| _________ is an infection or inflamation of myocardium | myocarditis |
| What is/are the most common cause(s) of myocarditis if the USA | -Viral inflections: *Coxsackie virus A/B *Enterovirus *CMV *HIV |
| What is Chagas DZ | variant form of myocarditis found is Central and South America caused by trypanosoma cruzi leads to arrhythmia and CHF |
| _____% of ppl with chagas dz die of fatal myocarditis (from arrhythmia or CHF) | 10 |
| ___% of people with chagas go thru a ___ ____ ____ ___ _____ followed by progressive CHF and lethal arrhythmia | 10 year immune mediate phases |
| What are symptom/signs of myocarditis | *fever *chest pain *fatigue *dyspnea *signs:arrhythmia |
| 3 outcomes of myocarditis | -minor symptoms and resolution -progressive CHF -lethal |
| inflammation of the pericardial sac | pericarditis (may present along with myocarditis) |
| Primary pericarditis is rare but is caused by ____ like______ | viruses coxsackie |
| Pericarditis is usually secondary to... | -AMI -Recent cardiac surgery -radiation to chest |
| Most common systemic cause of pericarditis: | uremia |
| blood or fluid in the pericaridal sac | pericardial effusion |
| Normally there is ______ mL of clear fluid in pericardial sac but pericardial inflammation results in effusions ______ | *30-50 mL *>50 mL |
| _______ pericadial effusions are usually the result of CHF | serous |
| Serosanguineous Pericardial Effusions are usually the result of... | *trauma *malignancy *rupture MI |
| __________ is a large amount of blood or fluid that constricts ventricular filling leading to diastolic dysfunction and decreased ventricular compliance | cardiac tamponade |
| in pericardial tamponade teh ventricle cannot fill which causes | diastolic dysfunction |
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