Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
54 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What are the two main way sin which heart diseases are classified? |
1. Anatomical compartment
2. Etiology (cause)
|
Anatomical compartment Etiology |
|
|
What are some examples of diseases for the following congenital cardiac structural abnormalities? |
Left to right shunts: ventricular septal defects, atrial septal defects, patent ductus arteriosus Right to left shunts: tetralogy of Fallot, transporition of great arteries Obstructive: coarctation (narrowing) of aorta |
Left to right shunts? Right to left shunts? Obstruction? |
|
|
Define atherosclerosis. |
Atherosclerosis is a degenerative and inflammatory disease involving the intima of large and medium sized arteries, causing thickening and loss of elasticity of arteries. |
Atherosclerosis is a d__________ and i____________ d_______ involving the i______ of large and medium sized a______, causing t_________ and loss of e________ of arteries. |
|
|
What is the pathogenesis of atherosclerosis? |
There is focal accumulation of lipid-rich material in the innermost layer of the vessel wall. This is known as an atheromatous plaque. The cells react by fibroplasia, which results in the narrowing of the lumen. Chronic endothelial injury results in increased permeability of the vessels, leukocyte adhesion, lipoprotein accumulation, monocyte migration into the intima, and macrophage activation. There is also platelet aggregation, smooth muscle cell proliferation (due to cytokines and growth factors), extracellular matrix synthesis (e.g. collagen) and lipid accumulation. |
There is f_____ a_____________ of l____-rich material in the i__________ layer of the vessel wall. This is known as an a_______________ p_____. The cells react by f__________, which results in the n__________ of the lumen. Chronic endothelial injury results in increased p__________ of the vessels, l__________ a__________, l__________ a__________, m__________ m__________ into the i_____, and m__________ a__________. There is also p______ a__________, s_____ m_____ c_____ p__________ (due to c_______ and g_____ f_______), e__________ m_____ s_______ (e.g. c_______) and l_____ a__________. |
|
|
What is present in an advanced atherosclerotic plaque? |
Necrotic centre - consists of cell debris, cholesterol crystal, cholestrol esters and calcium Fibrous cap - consists of proliferating smooth muscle cells, collagen, extracellular and intracellular lipids. If this cap ruptures, there will be thrombosis |
N_______ c_______ - consists of cell debris, cholesterol crystal, cholestrol esters and calcium F_______ c__ - consists of proliferating smooth muscle cells, collagen, extracellular and intracellular lipids. If this cap ruptures, there will be thrombosis |
|
|
What are the fixed risk factors that may lead to atherosclerosis formation? |
Age Gender (premenopausal females are protected) Family history Race (uncommon in China, Japan and Africa) |
|
|
|
What are the modifiable risk factors that may lead to atherosclerosis formation? |
Hyperlipidemia HTN Diabetes mellitus Cigarette smoking Obesity Sedentary lifestyle |
|
|
|
What are the consequences of atherosclerosis? |
1. Vessel thickening → narrowed lumen → poor tissue perfusion → ischemia 2. Loss of elasticity → predisposition to aneurysm formation, rupture and hemorrhage 3. Endothelial changes → predisposition to thrombosis |
1. Vessel thickening → ... 2. Loss of elasticity → ... 3. Endothelial changes → ... |
|
|
What are the clinical effects of atherosclerosis on:
|
Aorta: aneurysm Coronary arteries: IHD Cerebral arteries: cerebrovascular damage (occlude vessels, hemorrhage into brain) Common iliac/femoral arteries: peripheral vascular disease (ischemic lower limbs) |
|
|
|
Define ischemic heart diseaes (IHD). |
Ischemic heart disease is a spectrum of diseases characterised by reduced blood supply to the heart muscle, usually due to coronary artery disease. |
Ischemic heart disease is a s________ of d________ characterised by r_______ b_____ s______ to the heart muscle, usually due to c________ a______ d______ |
|
|
What are the four classical patterns of ischemic heart disease? |
|
|
|
|
Describe the processes that result in reduced coronary blood flow. |
Reduced coronary blood flow is the result of atheromatous plaque formation, which occlude the coronary arterial lumen. There are several types that can form, but the most dangerous is the unstable plaque. Sudden acute plaque changes can cause the plaque to rupture, leading to thrombosis. |
|
|
|
What processes can increase myocardial demand? |
|
|
|
|
What processes can reduce the availability of oxygen in the blood? |
|
|
|
|
What are the various causes of ischemic heart disease? |
|
|
|
|
What is angina pectoris? |
Angina pectoris refers to episodic chest pain on exertion, caused by transient ischemia of the myocardium (usually the result of stenosis of the coronary arteries). It can usually be relieved by rest or vasodilators (e.g. GTN). |
|
|
|
What are the types of angina pectoris? |
Stable angina: pain with fixed levels of exercise Unstable angina: increasing frequency of pain and longer duration, requires less effort to induce. Results from acute plaque changes and/or arterial spasm Prinzmetal's variant angina: unpredictable, at rest. Results from coronary artery spasm |
|
|
|
Define myocardial infarction. |
Myocardial infarction refers to necrosis of the myocardium as a result of severe ischemia. |
|
|
|
What are the types of myocardial infarctions? |
Subendocardial infarct Transmural infarct |
|
|
|
What are the clinical features of diagnosis for acute myocardial infarction? |
Symptoms: severe, crushing chest pain ECG changes Elevated cardiac enzymes |
|
|
|
What are the possible complications of myocardial infarctions in the ventricles? |
LV failure will cause congestive heart failure Ruptured myocardium will cause cardiac tamponade Fibrosis and aneurysm Thrombus |
|
|
|
What are the possible complications of myocardial infarctions other than those in the ventricles? |
Arrhythmias: sudden cardiac death Pericarditis Ruptured papillary muscle will mean that the valves no longer work |
|
|
|
What are the causes of sudden cardiac death? |
Pronounced stenosis of one or more major arteries Acute plaque changes |
|
|
|
What is chronic ischemic heart disease? |
Chronic IHD results from the chronic atherosclerotic narrowing coronary arteries. There is a slow loss of myocardial fibres, together with generalised myocardial fibrosis. This results in insidious cardiac failure, finally causing death. |
|
|
|
Define hypertension. |
Hypertension refers to sustained blood pressure of 140/90 mmHg or above. |
|
|
|
What are the secondary causes of HTN? |
Renal Endocrine (adrenal tumours) Neurologic ( intracranial pressure) Aortic coarctation, atherosclerotic rigidity Labile (psychogenic, stress related) |
|
|
|
What are the clinicopathologic effects of HTN on blood vessels? |
1. Atherosclerosis
3. Aneurysm |
|
|
|
What are the clinicopathologic effects of HTN on the heart? |
Hypertensive heart disease
|
|
|
|
What are the clinicopathologic effects of HTN on the kidneys? |
|
|
|
|
What are the clinicopathologic effects of HTN on the CNS? |
|
|
|
|
What is heart failure? |
Heart failure is a clinical condition where impaired cardiac function renders the heart unable to maintain an output enough for the metabolic requirements of the body. |
|
|
|
What is congestive heart failure? |
Congestive heart failure is heart failure involving damage to both left and right ventricles. Fluid accumulates in the lungs, legs and/or abdominal cavity. Reduced flow of arterial blood from the heart, which in extreme cases results in peripheral circulatory failure (cardiogenic shock). |
|
|
|
What are the compensatory mechanisms in cardiac disease? |
|
|
|
|
What are the classification of heart failures? |
|
|
|
|
What are the causes of left heart failure? |
|
|
|
|
What is the main cause of right heart failure? |
RHF is usually secondary to left heart failure |
|
|
|
What is the main cause of pure right heart failure not involved with left heart failure? |
|
|
|
|
What are some causes of low output heart failure? |
Ischemic heart disease HTN Dilated cardiomyopathy Vavular disease Pericardial disease |
|
|
|
What are some causes of high output heart failure? |
Hyperthyroidism Anemia Pregnancy Arteriovenous fistula |
|
|
|
What is systolic failure? |
Systolic failure is where the heart is unable to contract normally and expel sufficient blood. This results in inadequate cardiac output - weakess, fatigue, reduced exercise tolerance |
|
|
|
What is diastolic failure? What are some causes? |
Diastolic failure is where the heart is unable to relax and fill normally. This results in raised filling pressures. Causes: constrictive pericarditis, hypertrophic cardiomyopathy, myocardial fibrosis |
|
|
|
What are the clinical effects of backward failure of the left ventricle? |
Pulmonary congestion and edema
|
|
|
|
What are the clinical effects of forward failure of the left ventricle? |
Poor systemic circulation: dizziness, confusion, cool extremities at rest Renal hypofusion: activation of the renin-angiotensin system, causing salt and water retention. May also cause acute tubular necrosis |
|
|
|
What are the clinical effects of right heart failure? |
Systemic venous congestion
|
|
|
|
What is valvular heart disease? |
Valvular heart disease involves regurgitation / incompetence (cannot close completely) of the valves, allowing reverse flow. It also involves stenosis (cannot open completely) that prevents forward flow. |
|
|
|
What are some examples of valvular heart disease? |
|
|
|
|
What is rheumatic heart disease? |
Rheumatic heart disease is an abnormal immune response to streptococcal pharyngitis, which may result in endocarditis, myocarditis and pericarditis. This will cause inflammation and damage to aortic and mitral valves, stenosis and regurgitation. |
|
|
|
What is infective endocarditis? |
Infective endocarditis results from the bacterial infection of structurally abnormal valves, causing valve damage and malfunction, ultimately resulting in systemic septic emboli. |
|
|
|
Why are prophylatic antibiotics required for dental procedures? |
Prevention of infective bacterial endocarditis, especially in pts with cyanotic heart disease (right to left shunts) and valvular disease / replacement. |
|
|
|
What are the causes and effects of mitral incompetence? |
Causes
Effects
|
|
|
|
What are the causes and effects of mitral stenosis? |
Cause: rheumatic heart disease Effects
|
|
|
|
What are the causes and effects of aortic incompetence? |
Causes:
Effects: (Volume overload)
|
|
|
|
What are the causes and effects of aortic stenosis? |
Causes:
Effects: (Volume overload)
|
|
|
|
What are the complications of infective endocarditis? |
Valvular damage
Septic emboli
|
|
