Pathb2: Heart I Hf

Front 1

Left: Concentric hypertrophy due to pressure overload (HTN, aortic stenosis), parallel sarcomeres
Right: Eccentric hypertrophy due to volume overload (MV or AV regurg, series sarcomeres

Back 1

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Front 2

heart failure cells due to pulmonary edema, alveolar macrophages consume extravasated RBCs=>hemosiderein laden marcophages, consequence of LHF with pulmonary congesition and edema

Back 2

-

Front 3

heart disease US morlatlity

Back 3

40% of US deaths, 50% greater mortality than all forms of cancer combined

Front 4

weight and ventricular thickness of normal heart

Back 4

weight=250-350 grams, RV=.3-.5 cm, LV=1.3-1.5 cm

Front 5

Describe the distribution of blood supply to the heart

Back 5

1. LAD=apex, ant 2/3 of septum, anterior wall of LV 2. LCA-laterall wall of LV 3. RCA=posterior 1/3 of septum, posterior basal wall of LV, RV free wall, flow occurs during diastole

Front 6

which region/ layer of the heart is most vulnerable to ischemia

Back 6

subendocardium

Front 7

define CHF

Back 7

inability of the heart to pump blood at a rate to meet the needs of active tissues or can only do so form an elevated filling pressure, leading discharge Dx in pts over 65, 1 millino admissinon/yr, 50,000 death, 1 yr mortality =45%

Front 8

three general mechanisms of CHF

Back 8

1. abnormal load presented to heart 2. impaired ventricular filling 3. obstruction due to valve stenosis

Front 9

Causes of systolic dysfunction leading to heart failure

Back 9

IHD, pressure or volume overload, dilated cardiomyopathy

Front 10

causes of diastolic dysfxn leadint to HF

Back 10

Massive LVH, amyloidosis, fibrosis, constrictive pericarditis

Front 11

Describe the rapidly occuring compensation for HF

Back 11

1. Frank-Starling-increase preload dilation 2. Activation of neurohormonal systems (NE/epi, Renin/Ang/ alodosteronse)

Front 12

Hypertrophy is a compensation to HF. Expalin the two patterns of hypertrophy and what causes them

Back 12

1. Concentric hypertrophy-caused by pressure overload, sacomeres are parallel (HTN, aortic stenosis) 2. Eccentric hypertrophy- cause by volume overload (mitral or aortic regurg), sarcomeres in series

Front 13

how does sustained cardiac hypertrophy lead to cardiac failure

Back 13

increased myocyte size=decreased capillary density, increased oxygen demand, altered gene expression, myocyte apotosis

Front 14

5 causes of LHF

Back 14

IHD, HTN, Aortic/Mitral valve diseae, Cardiomyopathies, Myocarditis

Front 15

What are the clinical effects of LHF on the heart

Back 15

LVH and dilation=mitral insufficiency, secondary enlargement of LA= afib, murual thrombis, S3, S4

Front 16

what are the clinical effects of LHF on the lung

Back 16

edema, congestion, heart failure cells, dysnpnea, PND, orthopena, crackles

Front 17

what are heart failure cells

Back 17

LHF leads to pulmonary congestion and extravasation of RBCs. Alveolar macs eat the RBCs and retain the iron=hemosiderin laden macrophages

Front 18

What are the clinical effects of LHF on the kidney

Back 18

decreased perfusion=renin/AngII/aldosteron activation=increased volume and TPR, moderate azotemia if perfusion deficit is severe

Front 19

what are the clinical effects of LHF on the brain

Back 19

erebral hypoxia, encephalopathy

Front 20

the effects of RHF are mainly due to

Back 20

engorgement of systemic and portal venous systems

Front 21

the effects of LHF are primarly due to

Back 21

progressive damming of blood within the pulmonary ciruclation and diminished peripheral blood pressure and flow

Front 22

primary cause of RHF

Back 22

secondary to LHF (others include pulmonary HTN, primary myocaridal disease, tricuspid/ pulmonary valve disoders

Front 23

clinical effects of RHF on the heart

Back 23

RV hypertrophy and dilation, fxnl TV regurg, S3, S4

Front 24

clinical effects of RHF on the lungs

Back 24

pleural effusion, atelectasis

Front 25

clinical effects of RHF on the kidney

Back 25

venous congestion, flud retention, severe azotemia

Front 26

clinical effects of RHF on the liver

Back 26

elevated portal pressue= congestion=nutmeg liver, HSM, cardiac cirrosis, ascites,

Front 27

clinical effects of RHF on the brain

Back 27

venous congestion, hypoxic encephalopathy

Front 28

clinical effects of RHF on the peripheral body

Back 28

peripheral (ankle, sacral) edema progressing to generalized massive anasarca, JVD, congestion of mucus membranes, liver congestion

Front 29

nutmeg liver is a characteristic sign of

Back 29

RHF, liver congestion due to increased portal pressure

Front 30

compare the azotemia caused by LHF and RHF

Back 30

RHF is worse- severe venous congestion of kidneys=cannot remove metabolites, LHF=less severe, poor perfusion=lack of nutrients

Front 31

___hypertensive heart diseases Causes LHF and ___ causes RHF

Back 31

systemic HTN=LHF, pulmonary HTN=RHF

Front 32

heart morphology associated with systemic HTN

Back 32

concentric LVH (pressure overload, parallel sarcomeres), no dilation (until failure),

Front 33

define cor pulmonale

Back 33

RVH and/or dilation and failure secondary to pulmonary HTN (accute=PE, dilation w/o hypertrophy; chronic=primary or secondary HTN due to chronic lung disease)

Front 34

how does chronic lung disease lead to pulmonary hypertenisive lung disease (cor pulmonale) and reventually RVH/RHF

Back 34

lung disease= hypoxia= vasonconstriction=increased afterload=RVH=RHF