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Cardiovascular Part II L Pham
Terms in this set (72)
Right ventricular failure
Cor pulmonale means?
Left-sided heart failure
The causes of this heart failure include ischemic heart disease especially myocardial infarction, hypertension, aortic and mitral valvular disease, and amyloidosis.
What is the earliest and significant symptom of left-sided heart failure?
Right-sided heart failure
The causes of this heart failure is left-sided heart failure, left-sided lesions, pulmonary hypertension often causes by chronic lung disease (cor pulmonate), and patients with emphysema.
What are the two types of right sided heart failure?
Tiredness, breathlessness, and development of edema
What are some signs and symptoms of CHF?
Which common side of the heart will lead to hypertrophy?
Congestive Heart Failure
Heart chamber cannot expand and fill sufficiently during diastole, failure of left, right, or both ventricles, and major impact on organ systems other than heart.
Compensatory response: Ventricles will try to enlarge to contract more efficiently, constriction of arterioles to redistribute blood flow, activation of sympathetic and renin-angiotensin systems etc., dean desensitization of cardiac muscle to sympathetic stimulation.
- pulmonary congestion of edema
- blood backing up in pulmonary circulation
- pleural effusion with hydrothorax
What are the clinical manifestations of the lung in left-sided heart failure?
- reduction in renal perfusion
- activates renin-angiotensin-aldosterone system - retain water and salt
What are the clinical manifestations of the kidney in left-sided heart failure?
What is the earliest and most significant symptom of left-sided heart failure?
Right-Sided Heart Failure
If there is raised pressure in inferior vena cava reflected back into liver's venous system and the liver becomes tender, enlarged, palpable congested liver ("nutmeg"), which heart failure is this seen in?
- NUTMEG LIVER
- left sided heart failure
What are the two most common causes of right-sided heart failure?
Ischemic heart disease
Most common cardiac disease and leading cause of death in the Western world and main cause is atherosclerotic narrowing of coronary arteries with partial or complete interruption of arterial blood flow to the myocardium.
Diminished blood volume
Diminished oxygen carrying capacity
What results from ischemic heart disease?
Main cause of ischemic heart disease and formation stimulated by presence of atherosclerotic plaque.
Episodic chest pain, inadequate oxygenation of myocardium upon demand for increased work (exercise) which causes at least one stenosis of >50% of the lumen in a main coronary artery and the high grade stenosis limits flow but modifiable by drugs, and repeated episodes of impaired blood flow.
1. Prinzmetal angina
2. Stable Angina
3. Unstable Angina
What are the 3 types of angina pectoris?
Angina pectoris that has intermittent chest pain AT REST caused by coronary artery spasm and response to vasodilators.
Most common type of angina pectoris that takes place causing pain precipitated by exertion relieved by rest or by vasodilators (ex. Nitroglycerine), severe narrowing of atherosclerotic coronary vessels, and can experience referred pain-radiate down left arm or pain to left jaw.
Unstable Angina (Crescendo angina)
Type of angina pectoris that is prolonged or recurrent pain AT REST and causes fissuring of plaques, sudden onset, and increases in frequency and severity. It's often indicative of imminent Myocardial Infarction (usually caused by potential of the plaque fissure and thrombosis, total thrombotic occlusion of a vessel, and myocardial infarction or death secondary to ventricular arrhythmia)
This ischemic heart disease causes coagulative necrosis caused by coronary artery occlusion, most important cause of morbidity from ischemic heart disease and one of the leading causes of death in the western world, serious of progressive changes (gross and micro), neutrophils, macrophages, and fibroblasts, release of myocardial enzymes and other proteins into blood.
A myocardial infarction pattern known as ST elevation myocardial infarction (STEMI), involves one segment of the left ventricular wall (ex. regional instead of circumferential), and caused by nearly always thrombus formation on a complicated atheromatous plaque, complete, persistent occlusion of arterial branch to that area - full thickness infarct.
Subendocardial (regional and circumferential)
A myocardial infarction pattern that is known as non-ST election infarct (NSTEMI); there is a subendocardial zone with region at the end of the arterial perfusion zone that is failed to be perfused (necrosis) of the interior 1/3 of the left ventricle wall.
The cause is general hypo perfusion of the main coronary arteries, episode of modest hypertension critically reducing flow in arteries already affected by high-grade atherosclerotic stenosis, or lysis of the thrombus or a collateral supply to myocardium - endocardial zone infarct).
Left Anterior Descending a. (LAD)
Myocardial infarction extend and distribution depends upon which MAIN coronary artery branch that is occluded?
Left Ventricle & Septal region
Vast majority of infarcts for ischemic heart disease affect what two areas of the heart?
The end result of myocardial infarction is replacement of the necrotic area by collagenous _______.
Process from fiber necrosis to scar formation due to myocardial infarction takes how many weeks?
0 - 6 hrs
Progressive micro change of acute MI after 3 hours - vascular congestion at perimeter of lesion occur at what hours?
After 12 hours
Progressive micro change of acute MI - first neutrophils in viable tissue adjacent to the lesion occur at what hours?
12 - 24 hours
Progressive gross & micro change of acute MI - pale with blotchy discoloration and slight swelling; micro change with bright pink infarcted muscle with intracellular edema, and loss of striations and nuclei; neutrophils infiltrate lesion at what hours?
Ventricular fibrillation (arrhythmia)
Sudden cardiac death is usually due to what?
- tend to occur in first two weeks
- further episodes of cardiac dysrhythmia
- development of left ventricular failure
What are the short term complications of MI?
- Chronic intractable left heart failure
- ventricular aneurysm formation
- recurrent myocardial infarction
- Dressler's syndrome
What are the long term complications of MI?
Type of pericarditis, immune response to MI, symptoms include chest pain, fever, and can occur months after MI.
What is the most important target organ of rheumatic fever?
Caused by group A, beta-hemolytic strep produce antigens - antibodies developed by certain susceptible individuals (antistreptolyin O), multi system inflammatory disorder with major cardiac manifestations and sequellae
Nodules found in the heart of individuals with rheumatic fever, classic lesion with focal interstitial myocardial inflammation.
1. Fragmented collagen and fibrinoid material
2. Large cells (Anitschkow myocytes)
3. Occasional multinucleate giant cells (Aschoff cells)
Focal interstitial myocardial inflammation for Aschoff bodies is characterized by what 3 things?
Main morbidity of rheumatic fever is chronic scarring of _______________.
Which is the most frequently involved (1 in 50% of cases), affected by stenosis (fish-mouth buttonhole deformity, insufficiency, or both; mitral stenosis has diastolic pressure higher in the left atrium than left ventricle, only cause of stenosis) for rheumatic heart disease?
2 major OR 1 major and 2 minors PLUS raised anti-streptococcal antibody OR positive throat culture for group A beta-hemolytic streptococcus
What makes up Jone's Criteria?
What are the major manifestations of Rheumatic Fever?
Raised ESR or raised c-reactive protein
Prolonged pr-interval on ECG
What are the minor criteria for Rheumatic Fever?
Type of defect for disease of endocardium and valves that cause narrowing or abnormal rigidity of a valve and causes defect of heart valve.
Incompetence (insufficiency; regurgitation)
Type of defect for disease of endocardium and valves that cause failure of valve to completely close and causes defect of heart valve.
Valves on the LEFT or RIGHT side of the heart are much more frequently site of endocarditis and thrombotic vegetation formation than the other side?
nodules or irregular warty growths on leaflets (consequence of inflammatory disorders of heart valves with valve collagen exposed and thrombus deposition)
Consequence of inflammatory disorders of the heart valves with collagen exposed, inflammation, and thrombus on valve, organization and collagenous scarring, physical distortion of valve cusps are _____________ and ____________ abnormal.
What causes most cases of chronic scarring of valves?
Caused by post-inflammatory scarring of valve cusps, 50% of cases had rheumatic fever, valve cusps thickened and fusion of commissures, chordae tendineae or thickened and fused - funnel-shaped, narrow valve orifice with slit-like opening, failure of left atrium to empty into left ventricle through the stenosed valve etc., and atrial fibrillation is common complication causing left atrial thrombosis.
Mitral valve incompetence (Insufficiency)
results in regurgitation from left ventricle back into left atrium and causes post-inflammatory scarring, papillary muscle dysfunction after infarct, annulus, cusp destruction by infection, and mitral valve prolapse, and end result is left-sided heart failure.
left ventricular dilation with stretching of the mitral valve ring
Mitral Valve Prolapse (Myxomatous Degeneration)
Known as floppy valve syndrome - most frequent valvular lesion, most common cause of mitral valve surgery 7% of population, usually benign and asymptomatic, > females and usually young adulthood onset and some cases are familial.
Interchondral ballooning or hooding valve-enlarged, thick, rubbery, characteristic systolic murmur with a mid-systolic click.
Tissue is thickened in __________ layer with deposition of myxomatous material (myxomatous degeneration) in mitral valve prolapse.
Type of endocarditis that causes systemic lupus erythematous, small vegetations on either or both surfaces of valve leaflets, and high titers of anti-cardiolipin antibodies.
- Infection of the endocardium especially heart valvular surfaces bacterial or fungal.
- large, soft, friable, easily detached vegetations that consists of fibrin intermeshed inflammatory cells, bacteria or fungal organisms
- complications include ulceration with perforation of valve cusps and rupture of chordae tendineae
Acute (Infective) Endocarditis
Infective endocarditis syndrome that is usually rapidly progressive and usually fatal with virulent organisms (staph aureus), secondary to elsewhere body infection, previously normal heart valve, bacteria proliferative in valve, and death can occur.
Subacute (Bacterial) endocarditis
Infective endocarditis syndrome that is structurally abnormal valves, poorly virulent (S. viridans), and proliferate slowly in thrombotic vegetations on the damaged valve surface - gradual valve destruction - thrombus formation potential for systemic embolization.
Clinical feature of IE where mitral valve is most frequently involved and tricuspid valve is involved > 50% of cases when IV drug abuser (staphylococcal infection).
Characterized by myocardial hypertrophy especially left ventricle
What is the most important characteristic of hypertrophic pattern for cardiomyopathy and myocarditis?
Increased volume of the ventricular chambers
What is the most important characteristic of dilated (congestive) pattern (MOST COMMON PATTERN) for cardiomyopathy and myocarditis?
- Rubella (first trimester of pregnancy)
- Chronic alcohol abuse
What two things increase incidence of congenital heart defect?
Atrial Septal Defect
Left to right shunt due to defect in interatrial septum, patent foramen ovale usually clinically insignificant, lesion usually located at level of fossa ovalis that is incompletely closed (aka osmium secundum defect), abnormal fixed opening in atrial septum, clinical manifestations usually delayed until adult life such as pulmonary hypertension and cyanosis late
LEFT to RIGHT shunt (*Can become right to left shunt and cyanosis seen late)
Abnormal shunting of blood between two sides of the heart due to high pressure on left side of the heart and there is no clinical cyanosis
RIGHT to LEFT shunt
Abnormal shunting of blood between two sides of the heart due to increase of blood resistance and blood bypasses into systemic circulation so clinical cyanosis develops (ex. Obstruction of right ventricle outflow or pulmonary hypertension)
Ventricular Septal Defect (VSD)
Left to right shunt due to defect in the interventricular septum, most common cardiac anomaly at birth, and vary greatly in size. Large defect involves muscular wall may head to pulmonary hypertension & eventual right-sided heart failure, increase risk for IE can be associated with Tetralogy of Fallot and late cyanosis can occur. Small defect usually confined to tiny membranous area (Maladie de Roger) and may close spontaneously.
Patent Ductus Arteriosis
Left to right shunt with persistent potency in fetal life, embryological connection between aorta and pulmonary trunk or left main pulmonary artery during intrauterine life important channel allowing oxygenated blood in placenta to bypass lungs, shortly after birth should close when lungs become aerated and expand. If not closed then leads to pulmonary hypertension, right ventricular hypertrophy, reversal of blood flow and late cyanosis.
Tetralogy of Fallot
Right to left shunt that is most common and important; can cluster in families, most common cause of cyanotic congenital heart disease, anteriosuperior displacement in infundibular septum, and features include VSD, right ventricular outflow tract obstruction (stenosis), overriding VSD by aorta, and right ventricular hypertrophy.
Disease of the pericardium that causes accumulation of serous transudate in pericardial space.
Disease of the pericardium that causes accumulation of blood in pericardial sac, usually caused by traumatic perforation of the heart or aorta by MYOCARDIAL RUPTURE associated with acute MI or aortic dissection and can cause cardiac tamponade.
Most common malignancy (ex. local extension of lung cancer)