Cardio-Vascular Pathology Flashcards Preview

Year 3 - CR > Cardio-Vascular Pathology > Flashcards

Flashcards in Cardio-Vascular Pathology Deck (77)
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1

Define heart failure

Inability of the heart to pump blood at a rate commensurate with the requirements of the metabolising tissues

2

How does heart failure develop

Slowly
- cardiac hypertrophy

actue
- MI
- acute valve dysfunction

3

How common is heart failure

5 million in US
- commonest discharge diagnosis in under 65
- under 1 million hospitalised

4

What are the two types of heart failure

- Systolic dysfunction
- Diastolic dysfunction

5

Name the causes of systolic dysfunction

- Ischaemic heart disease
- pressure or volume overload such as systemic hypertension or aortic stenosis (AS)
- Cardiomyopathy

6

Name the causes of diastolic dysfunction

- Inability to reflex/fill
- amyloid deposition
- myocardial fibrosis
- constrictive pericarditis - after radiotherapy particularly for breast, TB, connective tissue disorders

7

How does amyloid deposition interfere with tissues function

- a collection of protein that are undigestible by the proteases therefore the protein when deposited in tissues interferes with the tissues function

8

What are the two consequences of heart failure

Forward
Backward

9

describe the forward and backward problem (consequence of heart failure)

Forward
- deliver the oxygen to the organs.
- The heart is not pumping out enough blood to satisfy the needs of the cells of the body. Thus, excess fluid retention and edema increase

backward
- hypoxic blood in the venous system
- One of the ventricles fails to pump out all of its blood that comes into it. Thus, the ventricular filling pressure and systemic or pulmonary edema increase.

10

Name mechanisms that are used to cope with heart failure

- frank-starling
- hypertrophy +/- chamber dilation
- activation of neurohormonal systems such as noradrenaline, RAAS and atrial natriuretic peptide
- may eventually be exceeded

11

What is the frank starling law

- this is the idea that increase in stretching of the heart causes an increase in contraction
- relation to EDV - as EDV increases this causes the heart muscle to stretch and increase in contraction to pump the EDV out

12

What are the consequences of heart failure

- Heart size/weight increase
- hypertrophy
- pressure overload - concentric hypertrophy
- volume overload - cavitary dilation maybe without thickening
- hypertrophy - can cause capillary decrease - increase in fibrous tissue - increase metabolic needs - vicious circle that leads to failure

13

Anything that does cause hypertrophy in the left ventricle is associated with...

Sudden death

14

Why do people who have left sided heart failure present the way they do

Main features are due to decreased peripheral pressure and damming of blood in the pulmonary circulation

15

What is the presentation of someone with left sided heart failure

- Lung congestion
- oedema
- accumulation of haemosiderin laden macros - leads to dyspneoa due to fluid build up on lungs, orthopnoea - fluid getting worse when you lie down, PND
- heart depends on cause - IDH, HT, Valves
- Brain and kidneys if severe suffer hypoxia (hypoxia - peripheral blood becomes hypoxic)

16

Describe what causes the symptoms of right sided heart failure

- Usually secondary to LVF
- primary association with severe pulmonary hypertension

17

What are the symptoms of right sided heart failure

Liver
- pure liver congested - nutmeg
- centrilobular necrossi and firbosis
- portal vein pressure increase - splenomegaly, ascities, kidneys and brain hypoxia, peripheral oedema
- biventricular - plus LVF

18

What is hypertension defined as

- systolic greater than 140mmHg
- diastolic greater than 90mmHg

19

What is hypertension as risk factor for

- IDH
- Cerebrovascular disease
- aortic dissection
- cardiac failure
- renal failure

20

Name the types of hypertension

- Primary/essential (95%)
- secondary
- benign or malignant/accelerated (5%)(has severe end organ damage)

21

Name the causes of secondary hypertension

Renal
- Chronic renal disease
- glomerulonephritis
- renal artery stenosis

Neurological
- stress including surgery
- psychogenic
- raised intracranial pressure

Cardiovascular
- coarctation of the aorta
- systemic vasculitis
- increased intravascular volume

Endocrine
- cushings
- conns
- exogenous hormones
- pheochromocytoma
- acromegaly
- thyroid disease
- pregnancy

22

How do you measure blood pressure

Cardiac output x peripheral resistance

23

What influences cardiac output

Blood volume
- sodium
- mineralocorticoids

cardiac factors
- heart rate
- contractility

24

What influences peripheral resistance

Constrictors
- angiotensin II
- catecholamines
- thromboxane
- leukotrienes
- endotheliin
- alpha adrenergic

Dilators
- prostaglandins
- NO
- Beta adrenergic

local factors
- autoregulation
- ionic (pH, hypoxia)

25

What do you see in the heart when someone has hypertension

- Left ventricular hypertrophy

26

What do you see in the vessels in someone who has hypertension

- atheroma
- aortic dissection,
- cerebrovascular haemorrhages,
- degenerative changes such as fibrointimal thickening

27

What do you see in the small vessels in someone who has hypertension

- hyaline arteriolosclerosis esp kidneys,
- hyperplastic arteriolosclerosis (onion-skinning)
- fibrinoid necrosis in accelerated

28

What is cor pulmonale

Heart disease as a consequence to lung disease

29

What is pulmonary hypertension

High blood pressure in the pulmonary circulation

30

What can cause pulmonary hypertension

- diseases of the lung parenchyma such as COPD, cystic fibrosis, diffuse interstitial fibrosis
- diseases of the pulmonary vessels such as recurrent, PEs, primary PH, severe vasculiits
- Disorders affecting chest movement such as kyphoscoliosis, neuromuscular disease
- disorders causing arterial constriction such as hypoxaemia, chronic altitude sickness