Goljan Rapid Review Of Path Heart Disorder

Front 1

List 3 causes of Right and Left ventricular hypertrophy

Back 1

1. sustained pressure increases wall stress

2. contraction against an increased resistance (afterload)

3. volume overload (increased preload)

Front 2

Sustanined pressure can increase the wall stress of hte right and left ventricles causing hypertrophy. What affects does this have on the sarcomeres

Back 2

causes duplication of the sarcomeres, duplicates causes parallel thick muscles and duplication in series lengthens muscle

Front 3

T/F contraction against an increase resistance (after-load) produces concentric thickening of the ventricular wall

Back 3

true- new sarcomeres duplicate in parallel to the long axes of the cells

Front 4

list the 2 common causes of left ventricular hypertrophy

Back 4

1. essential hypertension (most common)

2. aortic stenosis

Front 5

list the 2 common causes of right ventricular hypertrophy

Back 5

1. pulmonary hypertension

2. pulmonary artery stenosis

Front 6

T/ F volume overload (increased preload) causes constriction and hypotrophy of the ventricular wall

Back 6

False- volume overload (increased preload) causes DILATION and HYPERtrophy of the ventricular wall

Front 7

list 2 causes of eccentric hypertrophy of left ventricles

Back 7

1. mitral valve or aortic valve regugitation

2. left to right shunting of blood (ventricular septal defect) which causes more blood to return to the left side of he heart

Front 8

what causes eccentric hypertrophy of the right ventricle

Back 8

tricuspid valve of pulmonary valve regurgitation

Front 9

list 3 consequences of ventricular hypertrophy

Back 9

1. left or right sideded heart failure

2. angina (mostly LVH)

3. S4 heart sound ( correlated with the atrial contraction in late diastole and by blood entering a noncomplaint ventricle)

Front 10

Definition:

the heart fails when it is unable to eject blood delivered to it by the venous system

Back 10

congestive heart failure

Front 11

list the types of CHF

Back 11

1. left sided heart failure- most common

2. right sides heart failure

3. biventricular heart failure

4. high output heart failure

Front 12

why is it said that left sided heart failure is a forward failure

Back 12

1. left side of the heart can not eject blood into the aorta

2. increase in let ventricular end-diastolic volume and pressure

3. backup of blood into the lugs causes pulmonary edema

Front 13

in LHF, the decrease in ventricular contraction, noncompliance of the ventricles and increased workload causes what effects

Back 13

1. decreased ventricular contraction (systolic dysfunction) causes ischemia and myocardial fibrosis, myocarditis, cardiomyopathy

2. noncompliant ventricles (diastolic dysfunction) restricts filling of the ventricle and causes concentric LVH and infiltration of muscle with amyloid, iron or glycogen

Front 14

what is the difference between systolic dysfunction and diastolic dysfunction

Back 14

1. systolic dysfunction- low ejection fraction (<40%)

2. diastolic dysfunction-hight EF and an S4 gallop due to increased resistance to filling in late diastole so there is an increase in left atrial pressure (there could be a normal EF)

EF=stroke volume/ LV end-diastolic volume , normal 55%-80%

Front 15

what is the gross and microscopic findings of LHF

Back 15

1. lungs are congested and exude a frothy pink transudate (edema)

2. alveolar macrophages contain hemosiderin ( heart failure cells)

Front 16

what are the differences on clinical exam of pt with LHF vs RHF

Back 16

left sided heart failure
1. dyspnea- can not inspire
2. pulmonary edema-bibasilar inspiratory crackles
3.*** Left side S3 heart sound- first finding in LHF
4. mitral valve regurgitation
5. paroxysmal noctural dyspnea

right sided heart failure
1. prominent jugular veins
2. right sides S3 sound due to volume overload
3. tricuspid valve regurgitation
4. painful hepatomegaly
5. dependent pitting edema and ascites

Front 17

the pulmonary edema in LHF will show what finding on chest radiograph

Back 17

congestion in upper lobes and alveolar infiltrates

Front 18

why is a left sided S3 heart sound heard in LHF and when is this sound heard on exam

Back 18

occurs in early diastole- intesity of sound increases with expiration

caused by blood entering a volume overloaded left ventricle

*** this S3 heart sound is the first cardiac finding in LHF

Front 19

in LHF, the mitral valve regurgitates blood, why and where is the murmur best heart

Back 19

mitral valve regurgitates blood bc it is caused by stretching of the valve ring which causes a problem closing the mitral valve during systole.

blood entering the Left Atrium during systole produces a pansystolic murmur that increases in intensity on expiration

murmur best heard at the apex

Front 20

what is paroxysmal noctural dyspnea and why does it occur in LHF

Back 20

choking sensation at night due to increased venous return to the failed left side of the heart

blood backs up in the lungs producing pulmonary edema

relieved by standing on placing pillow under head (pillow orthopnea) to increase the effects of gravity on reducing venous return to the heart

Front 21

why is right sided heart failure considered a backward failure

Back 21

right side of the heart cannot pump blood from the venous system to the lungs

blood accumulated in the venous system which leads to increase in venous hydrostatic pressure

Front 22

RHF can be caused by what 4 pathogenesis

Back 22

1. decreased contraction- right ventricular infarction

2. noncompliant right ventricle - RVH

3. increase afterload- LHF

4. increase preload- tricuspid valve regurgitation

Front 23

in Right sided heart failure, what causes the prominence of the jugular veins

Back 23

increase in the venous hydrostatic pressure

Front 24

in right sided heart failure what causes the Right S3 heart sound

Back 24

due to volume overload in the ventricle which increases in intensity with inspiration

Front 25

In right sided heart failure what causes the tricuspid valve regurgitation and where is it best heard

Back 25

caused by stretching of the valve ring which causes problem closing the tricuspid valve during systole.

blood entering the right atrium during systole produces a pansystolic murmur that increases with inspiration

murmurs best heard on left parasternal border

Front 26

why is there painful hepatomegaly in RHF

Back 26

passive liver congestion due to back up of venous blood in the central veins

Front 27

what kind of edema is seen in RHF and why

Back 27

dependent pitting edema and ascites caused by the increase in venous hydrostatic pressure

Front 28

Defintion:

Form of heart failure in which cardiac output is increased compared with values for the normal resting state

Back 28

high output heart failure

Front 29

high output heart failure can be caused by what 4 condition

Back 29

1. increase in stroke volume- hyperthyroidism

2. decrease blood viscosity- severe anemia

3. vasodilation of peripheral resistance arterioles- thiamine deficiency, early phase of endotoxic shock

4. arteriovenous fistulas-bc AV communications bypass the mircocirculation which increases venous return to the heart- trauma from knife wound or surgical shunt from hemodialysis

Front 30

Definition:

Imbalance between myocardial O2 demand and supply from the coronary arteries

Back 30

ischemic heart disease

Front 31

when doe coronary vessels fill

Back 31

diastole

Front 32

what is the effect of tachycardia on the coronary artery blood flow

Back 32

1. Tachycardia (>180bpm) decreases filling time, leading to ischemia.

2. decreases diastole which decreases filling of coronary arteries

Front 33

which coronary artery accounts for about 50% of the coronary artery thomboses

Back 33

left anterior descending coronary artery

Front 34

the LAD supplies which portions of the heart

Back 34

1. Anterior portion of the left ventricle

2. Anterior two thirds of the interventricular septum

Front 35

the right coronary artery supplies which portions of the heart

Back 35

1. Posteroinferior part of the left ventricle

2. Posterior one third of the interventricular septum

3. Right ventricle

4. Posteromedial papillary muscle in left ventricle

5. Both atrioventricular and sinoatrial nodes

Front 36

which coronary artery Supplies the lateral wall of the left ventricle and
Accounts for 15% to 20% of coronary artery thromboses

Back 36

left cicumflex coronary artery

Front 37

what are the 4 types of ischemic heart disease

Back 37

1. Angina pectoris (most common type)

2. Chronic ischemic heart disease

3. Sudden cardiac death

4. Myocardial infarction

Front 38

what risk factors are associated with ischemic heart disease

Back 38

1. Age- Men 45 years old and up, women 55 years old and up

2. Family history of premature coronary artery disease or stroke

3. Lipid abnormalities- Low-density lipoprotein above 160 mg/dL or High-density lipoprotein below 35 mg/dL

4 Smoking tobacco,

5. hypertension

6. diabetes mellitus

Front 39

what is angina pectoris-

Back 39

chest pain or discomfort due to coronary heart disease.

Angina is a symptom myocardial ischemia. It occurs when the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen) as it needs. This usually happens because one or more of the heart's arteries (coronary blood vessels that supply blood to the heart muscle) is narrowed or blocked.

Front 40

Clinical findings:

Exercise-induced substernal chest pain lasting 30 seconds to 30 minutes

Relieved by resting or nitroglycerin

Stress test shows ST-segment depression.

a. stable angina
b. Prinzmetal's angina
c. unstable angina
d. myocardial infarction

Back 40

stable angina

Front 41

list 3 causes of stable angina

Back 41

1. Atherosclerotic coronary artery disease (most common)

2. Aortic stenosis with concentric LVH

3. Hypertrophic cardiomyopathy

Front 42

Pathogenesis
Subendocardial ischemia due to decreased coronary artery blood flow

a. stable angina
b. Prinzmetal's angina
c. unstable angina
d. myocardial infarction

Back 42

a. stable angina

Front 43

Pathogenesis:

Intermittent coronary artery vasospasm at rest

Vasoconstriction due to platelet thromboxane A2 or decrease in endothelin

a. stable angina
b. Prinzmetal's angina
c. unstable angina
d. myocardial infarction

Back 43

b. Prinzmetal's angina

Front 44

Clinical findings:

Stress test shows ST-segment elevation (transmural ischemia).

Responds to nitroglycerin and calcium-channel blocker (vasodilator)

a. stable angina
b. Prinzmetal's angina
c. unstable angina
d. myocardial infarction

Back 44

b. Prinzmetal's angina

Front 45

Pathogenesis:
Severe, fixed, multivessel atherosclerotic disease and
Disrupted plaques with or without platelet nonocclusive thrombi

Clinical findings
Frequent bouts of chest pain at rest or with minimal exertion and May progress to acute myocardial infarction

a. stable angina
b. Prinzmetal's angina
c. unstable angina
d. myocardial infarction

Back 45

c. unstable angina

Front 46

list 3 revascularization procedures for angina pectoris

Back 46

1. percutaneous transluminal coronary angioplasty (PTCA) and stenting- Balloon angioplasty dilates and ruptures the atheromatous plaque (Problem with restenosis)

2. Intracoronary stents- Decrease the rate of restenosis. Most common early complication is a localized dissection with thrombosis

3. Coronary artery bypass graft (CABG)- Used for multivessel coronary artery atherosclerosis

a. Internal mammary artery graft- Best graft patency after 10 years

b. Saphenous veins- "Arterialization" of the vessels, fibrosis, and occlusion common after 10 years

Front 47

Definition:

Progressive CHF resulting from long-term ischemic damage to myocardial tissue

Replacement of myocardial tissue with noncontractile scar tissue

Back 47

Chronic ischemic heart disease

Front 48

what is the cause of death in a sudden cardiac death

Back 48

Unexpected death within 1 hour after onset of symptoms

Pathogenesis:
Severe atherosclerotic coronary artery disease
Disrupted fibrous plaques
Absence of occlusive vessel thrombus (>80% of cases)

Cause of death is ventricular fibrillation.

Front 49

describe the common pathogenesis of a myocardial infarction

Back 49

Sequence:

1. Sudden disruption of an atheromatous plaque

2. Exposed subendothelial collagen or thrombogenic necrotic material

3. Platelet adhesion and eventual formation of a platelet thrombus

Front 50

list 4 less common causes of an MI

Back 50

1. Vasculitis (e.g., polyarteritis nodosa, Kawasaki disease)

2. Cocaine use

3. Embolization of plaque material

4. Thrombosis syndromes (e.g., antithrombin III deficiency, polycythemia)