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53 Cards in this Set
- Front
- Back
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heart failure definition |
inability of the heart to pump blood at a rate that is adequate for the body's needs |
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mortality of HF |
>50% in less than 5 years |
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Starling's Law |
the heart will pump whatever volume of blood is brought to it - stroke volume is related to the preload |
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congestive heart failure (CHF) |
cardiogenic (myocardial weakness), high output, thyroid toxicosis, reduced return |
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heart failure categories |
systolic dysfunction and diastolic dysfunction |
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systolic dysfxn |
more common, myocardial contractile function deteriorates |
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diastolic dysfxn |
chamber cannot relax, expand or fill during diastole (ejection fraction is preserved) |
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causes of left sided HF |
ischemic heart disease, hypertension, aortic/mitral valve disease, non ischemic myocardial dz |
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primary sign of LHF |
pulmonary edema |
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right-sided heart failure main associations |
LHF, mitral stenosis, cor pulmonale |
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cor pulmonale |
pure RHF due to pulmonary hypertension (intrinsic lung dz) |
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dilation of the heart |
LHF & RHF |
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pulmonary edema & congestion |
LHF |
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pleural effusions |
LHF & RHF |
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renal failure |
LHF & RHF |
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congestion of liver |
RHF |
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splenic congestion |
RHF |
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ascites |
RHF |
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pitting edema |
RHF |
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cardiac hypertrophy |
precedes HF, incr. rate of protein synthesis, # of sarcomeres and mitochondria |
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pressure (concentric) hypertrophy |
HTN, AS; increased thickness (parallel) of wall, normal to reduced cavity diameter |
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dilation (eccentric) hypertrophy |
AR/MR, serial hypertrophy |
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normal heart weight |
300 grams |
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600 grams |
ischemic HD, pulmonary hypertension |
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800 grams |
HTN, AS, MR, dilated cardiomyopathy |
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1000 grams |
chronic AR, hypertrophic cardiomyopathy |
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hypertrophy histology |
"box-car" nuclei |
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clinical features of myocardial disease |
arrhythmias, pain, rapid cardiac enlargement, rapid CHF onset, sudden death |
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Cardiomyopathy definition |
Heart disease with NO coronary artery disease, valvular HD, hypertensive HD, ischemic HD, or congenital abnormalities |
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Dilated cardiomyopathy (DCM) |
cardiac dilation, CHF, arrhythmias
no longer has "V" shape on X-ray |
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Hypertrophic cardiomyopathy (HCM) |
myocardial hypertrophy with or w/o outflow obstruction |
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restrictive cardiomyopathy |
amyloidosis, endocardial fibroelastosis, endomyocardial fibrosis, sarcoidosis dilated LA on X-ray |
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Arrhythmogenic right ventricular cardiomyopathy |
RHF, rhythm disturbances, thinned RV wall due to myocyte loss w/ fatty infiltration & interstitial fibrosis rare! |
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Naxos syndrome |
arrhythmogenic right vent. cardiomyopathy + hyperkeratosis of plantar palmar skin surfaces plakoglobin gene mutations |
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Dilated Cardiomyopathy |
progressive hypertrophy, dilation & contractile dysfunction |
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DCM causes |
genetic (most AD), alcohol/cobalt toxicity, myocarditis (viral nucleic acids in myocytes), pregnancy-assoc., idiopathic |
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DCM heart |
>600 grams, dilated chambers, mural thrombi, clear coronary arteries, hypertrophied fibers w/ stretched, large nuclei and interstitial fibrosis |
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DCM clinical features |
20-50 y/o, progressive CHF, ejection fraction <25% at end, death due to HF, arrhythmia or embolism 25% 5 year survival |
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Hypertrophic cardiomyopathy |
massive myocardial hypertrophy, abnormal diastolic filling (can't relax), intermittent left ventricular outflow obstruction, asymmetric septal hypertrophy, myofiber disarray |
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HCM is a... |
diastolic problem!! |
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HCM causes |
genetics!! (>1/2 are familial, AD) proteins of sarcomeres are mutated (B-myosin heavy chain, cardiac troponin T, alpha-tropomyosin, myosin-binding protein C) |
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HCM clinical features |
reduced chamber size, reduced stroke volume, harsh systolic ejection murmur, focal ischemia, anginal pain, A-fib, emboli, endocarditis, sudden death |
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Restrictive cardiomyopathy |
decrease in ventricular compliance resulting in impaired ventricular filling during diastole heart normal size, usually not dilated |
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Secondary cardiomyopathy |
most present as dilated cardiomyopathy alcoholic, metabolic (thyroid, K+, glycogen storage, nutritional, hemochromatosis), connective tissue diseases, neuromuscular dz, toxicities, mucopolysaccharidoses, leukemia |
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drugs causing secondary CM |
anthracyclines (doxorubicin and daunorubicin), dose dependent |
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infectious myocarditis |
viral, chlamydia, rickettsial (vasculitis), fungal and protozoan, Bacterial |
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viral myocarditis |
coxsackie A, B, ECHO, influenza, polio, HIV present w/ interstitial lymphocytes and isolated cell degeneration |
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bacterial myocarditis |
borrelia burgdorferi, Corynebacterium diphtheriae |
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fungal/protozoan myocarditis |
toxoplasmosis, Chagas disease |
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Hypersensitivity Myocarditis |
eosinophilic infiltrate |
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giant cell myocarditis |
giant cells, very poor prognosis, generally younger patients |
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Carcinoid heart disease |
functional neuroendocrine tumor secreting serotonin, 5-hydroxtryptophane, bradykinin, histamine most right side, plaque-like thickenings, fusion of tricuspid leaflets |
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Leutic (syphilis) HD |
obliterative endarteritis, aneurysm of thoracic aorta, tree barking, narrowing of ostia of coronary arteries, severe ASVD at aorta root, dilation of aorta valve ring, marked LVH |
