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45 Cards in this Set
- Front
- Back
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What is congestive heart failure?
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Name derives from congestion/backup of blood in the lungs due to left cardiac failure
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Why do left heart failure cause right heart failure?
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The increased pulmonary venous pressure due to left cardiac failure causes increased afterload on the right ventricle, which eventually cannot work against the increased pressure and failure bocomes present
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Clinical symptoms of right heart failure?
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Increased jugular venous pressure (JVP)
Accumulation of fluid in abdomen (Ascites) Hepatic congestion (Portal hypertension and liver failure) Peripheral lower limb edema |
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What are the symptoms of forward failure in left cardiac failure?
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Weakness
Fatigue Dyspnea (decreased O2 to respiratory muscles) Dizziness/drowsyness (decreased O2 to brain) |
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Pathophysiology of orthopnea in heart failure
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In standing position gravity keeps blood pooled in veins of lower legs and abdominal cavity. When patient lies down this blood will be shifted towards to lungs, increasing the pulmonary pressure, and increasing the pulmonary edema
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What is paroxysmal nocturnal dyspnea?
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When lying down, blood shifts from peripheral venous pool and abdomen to lungs, increasing the pulmonary pressure and edema.
Also the decreased sympathetic stimulation of the heart causes bradycardia and the heart is not able to pump the blood out of the lungs, further increasing pulmonary edema |
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What is the treatment to increase the forward flow in heart failure?
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Increase ventricular contraction by Inotropes (digoxin, dopamine)
Decrease rate of contraction to increase the diastolic filling time by beta-blockers (propranolol) |
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What is the treatment to decrease the backup of blood in heart failure?
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Dilation of veins (nitrates)
Reduce extracellular volume (diuretics, ACE inhibitors) Dilate the arteries to decrease afterload (ACE inhibitors, hydralazine) |
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Explain the term "diastolic dysfunction" and under which conditions dous it occur?
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The heart is unable to relax, reducing the diastolic filling and cardiac output.
Occurs in cardiac hypertrophy and restrictive cardiomyopathy |
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Causes of left ventricular hypertrophy?
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Genetic hypertrophic cardiomyopathy
Increased afterload (hypertension) Aortic stenosis (pressure overload) |
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Causes of right ventricular hypertrophy?
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Pulmonary hypertension (left heart failure)
Pulmonary valve stenosis Pulmonary embolus Pulmonary fibrosis Chronic obstructive pulmonary disease |
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Treatment of cardiac hypertrophy
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Treating the diastolic dysfunction by increasing diastolic filling
Beta-blockers reduce the heart rate, increasing diastolic filling time Calcium-channel blockers (Causes heart muscle to relax, allowing for more filling time) |
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Causes of restrictive cardiomyopathy
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Infiltration of substances into heart muscle (amyloidosis, sarcoidosis, haemochromatosis, Pompe's disease)
Pericardial effusion Pericardial tamponade |
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Causes of cardiac dilatation
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Genetic
Drugs, alchohol Viral myocarditis Valve regurgitation (volume overload) |
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When can you hear S3 and S4 sounds in heart?
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S3 is typical for dilated heart, but can also be physiological in young patients
S4 is typical for hypertrophic heart |
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Causes of aortic stenosis
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Aging (senile calcification)
Congenital bicuspid aortic valve Rheumatic heart disease |
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Manifestations of aortic stenosis
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On physical examination:
Carotid upstroke Pulsus parvus et tardus (weak and delayed pulse in carotids) Left heart hypertrophy Dizziness, syncope Dyspnea Angina, ischemia of left ventricle |
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Causes of aortic regurgitation
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Ehler Danlos syndrome
Marfan's syndrome Syphilis |
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Manifestations of aortic regurgitation
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On physical examination:
Widened pulse pressure (reduced diastolic pressure) Corrigans pulse (throbbing carotid artery pulse) DeMussets sign (head bobbing with pulse) Heart failure synptoms |
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Causes of mitral stenosis
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Most often rheumatic fever
Less common due to congenital or endocarditis |
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Manifestations of mitral stenosis
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Left atrium dilatation
Atrial fibrilation due to streching of the wall Pulmonary hypertension (dyspnea) Opening snap on auscultation |
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Causes of mitral regurgitation
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Ventricular dilatation
Drugs, alchohol Mitral valve prolapse Endocarditis Rheumatic fever Ischemic heart disease Acute regurgitation: pappillary muscle rupture |
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Manifestations of mitral regurgitation
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Left ventricular dilatation
Pulmonary hypertension Dyspnea In acute regurgitation: Uncompensated In chronic regurgitation: Dilatation and forward flow problems (fatigue, dizziness) |
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How do you treat bradycardia?
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Beta-receptor antagonists (isoproterenol)
Pacemaker Anticholinergic drugs (atropine) |
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Why is myocardial infarction associated with ventricular tachycardia?
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Necrotic tissue has abnormal electrical properties, thus creating an reentrant circuit within the ventricals, which can result in an extremly fast ventricular heart rate (300bpm+)
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Types and characteristics of anginas
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Stable angina: pain only on exertion
Unstable angina: pain at rest. Highly associated with myocardial infarction Prinzmetals angina: Not due to occlusion of arteries, but due to vasospasm |
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What are the symptoms of acute myocardial infarction?
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Chest pain (unrelieved by rest)
Pain that radiate down left arm or to jaw Dyspnea Nausea/vomiting Fever Distress |
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Treatment of myocardial infarction
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Thrombolytis drugs (streptokinase, urokinase, tissue plasminogen activating factor)
Surgery (angioplasty with coronary stenting) Various (nitrates, statins, beta-blockers) |
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Etiology of infective and non-infective endocarditis
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Infective:
Streptococcus viridans Staphylococcus aureus Non.infective: hypercoagulability Systemic inflammatory diseases (lupus) IV drugs |
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Etiology and manifestations of fheumatic fever
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Etilogy
Group A streptococcus infection of upper respiratory tract Manifestations affects CNS, skin, joints and heart |
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Etiology of myocarditis
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Coxsackie B virus
Lupus, dermatomyositosis Drugs, radiation |
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Etiology of pericarditis
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Coxsackie B virus, TB, streptococci, staphylococci
Lupus, rheumatoid arthritis Radiation, malignancy |
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Signs and symptoms of constrictive pericarditis
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Kussmauls sign (rise in JVP during inspiration)
Pericardial effusion (hypotension, muffled heart sound, elevated JVP) |
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The 4 abnormalities in Tetralogy of Fallot
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Pulmonary valve stenosis, right ventricular hypertrophy, ventricular septal defect, biventricular aorta
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Apart from Tetralogy of Fallot, what cyanotic heart diseases exist?
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Transposition of the great arteries
Formation of two paralell circulations, instead of one continous |
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What is Eisenmenger syndrome
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The flow through a VSD causes increased pressure in the pulmonary circulation. Because the right ventricle have to pump both the blood from the right atrium as well as from the left ventricle, this will cause right ventricular hypertrophy. This will over time lead to such an increase in the right heart that blood starts flowing over to the left heart, causing cyanosis
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What electrolytic changes can be observed in the stimulation of a myecyte
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1. Na enters the cell (action potential)
2. Inflow of Ca and outflow of K (platau) 3. Continuation of K outflow after Ca inflow stops (repolarization) |
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Causes of bradycardia
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Sleep, common faint, increased age, beta-blockers, calcium channel blockers
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Systemic pathophysiological changes associated with heart failure
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Decreased output
Increased backup flow Activation of SNS RAAS activation Release of antidiuretic hormone Cytokine release Release of cardiac specific enzymes (troponin, CK) Cell death, fibrosis |
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Which factors induces the protein synthesis of contractile proteins associated with heart failure hypertrophy
And through which intracellular mediators do they act |
Angiotensin II, TNF-a, norepinephrine
acts through c-fos, c-jun, c-myc |
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What is believed to be the mediator of pain in angina?
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Adenosine
Blocking adenosine-receptors with aminophylline has shown to reduve pain |
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What are the three classical signs of pericardial tamponade (Becks triad)
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Muffled heart sounds
Hypetension Increased jugular venous pressure |
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Explain the timeline of changes in an ischemic heart cell from start of ischemia to death of cell
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10 sec: cells are ischemic
60 sec: functional changes, normal morphology 20 min: borderline cell still alive and can become normal if bloodflow is restored 60 min: cell is definetly dead and necrosis cannot be reversed by restoration of blood flow |
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What intracellular changes occur in myecytes during ischemia
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decreased ATP, decreased contractility, glycogenolysis, acidosis, extracellular hyperkalemia, lactic acidosis, edema, free radical formation
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What is a stunned heart
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Ischemic heart that is morphologically normal, but is functionally not able to contract
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