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What is Cor pulmonale?
- Right ventricular hypertrophy due to pulmonary hypertension secondary to disorders of the lungs or pulmonary vessels
- ie - COPD, Chronic lung disease (cystic fibrosis, bronchiectasis, interstitial fibrosis, Recurrent thromboemboli
Acute cor pulmonale
abrupt onset of right ventricular dilatation due to a massive pulmonary embolism
Left sided heart failure
- Results in pulmonary edema
- Hemosiderin laden macrophages (heart-failure cells) in lungs
Right sided heart failure
- Usually results from left-sided failure
- Chronic passive congestion in liver (nutmeg liver)
- Jugular vein distension
- Peripheral edema
The most common congenital heart defect recognized in clinical practice; initially is non-cyanotic with left to right shunting of blood; in late stages flow is reversed
Tetralogy of Fallot
- Important cause of cyanosis at birth!
- Ventricular septal defect
- Pulmonary artery stenosis
- Right ventricular hypertrophy’
- Dextroposition of the aorta
Left to right shunts
- (not associated with cyanosis-most common type of shunt)
- Ventricular septal defect (most common)
- Atrial-septal defect
- Patent ductus arteriosus
- Atrioventricular septal defect
Right to left shunts
- Tetralogy of Fallot
- Transposition of the great arteries
- Persistent truncus arteriosis
Obstructive congenital defects
- Coarctation (narrowing) of the aorta
- Pulmonary artery stenosis/atresia
- Aortic valve stenosis/atresia
inflammation of heart muscle; most cases are of viral origin; can be of autoimmune origin such as seen in SLE
- multifactorial disease of large and medium sized arteries that is characterized by the accumulation of lipids, fibrosis, and calcification of the arterial walls
- Risk factors: Advancing age, Sex (males) until menopause—then equal, Hereditary, Diet rich in lipids, Hypertension
- Pathologic changes: Fatty streaks and Intimal thickening, Atheromatous plaques, Progressive narrowing to complete occlusion of the arterial lumen
- intermittent attacks of chest pain
- Stable (exercise induced)
- Prinzmetal (at rest, due to coronary vasospasms)
- Unstable (at rest, lasts longer)
What are the two main etiological classifications of hypertension?
- Essential (primary) –no apparent cause—90% of all cases
- Secondary—due to identifiable cause such as renal, endocrine, of coarctation of aorta
What are the two pathological classifications of hypertension?
- Benign---stable elevation of Blood pressure over many years Characterized by hyaline arteriolosclerosis, thickening of elastic lamina; reduced size of vessel lumen; increased rigidity of vessel wall
- Malignant—rare; rapid rise in blood pressure; young adults Characterized by fibrinoid necrosis of vessel wall; severe renal damage
What are the primary (multifactorial) causes of hypertension?
- Genetic predisposition
- Socio-economic status
- Dietary factors (alcohol, salt, caffeine, obesity)
- Hormonal (abnormal renin-angiotensin-aldosterone pathway)
What are the causes of secondary hypertension?
- Renal disease
- Adrenal disorders ( pheochromocytoma, Cushings, Conn’s)
- Other endocrine disorders
- Cardiovascular abnormalities
- Drugs ( BCP, steroids)
- Pregnancy (pre-eclampsia)
- Leading cause of death in US
- Transmural infarcts are the most common type characterized by coagulation necrosis
- Due to occlusion of one of the coronary arteries by a thrombus at the site of a ruptured atherosclerotic plaque
What is the timetable/breakdown following a MI?
- 6-12 hours increased creatine kinase, troponin, and myoglobin
- 12-24 hours pale area
- 24-72 hours neutrophils
- >72 hours neutrophils replaced by macrophages,
- Resorption of necrotic muscle tissue and formation of granulation tissue. Scarring within six weeks
Myocardial infact complications include?
- Arrhythmias--most common
- Left ventricular failure
- Cardiogenic shock
- Mural thrombi
- Rupture of the heart wall or septum
- Inflammation of heart muscle
- Due to infection, immune mediated reaction, or unknown (Sarcoidosis)
- Heart disease resulting from primary abnormality of myocardium
- Excludes damage from extrinsic factors
What are the 3 types of cardiomyopathy?
- Dilated: combination of dilatation and hypertrophy of all chambers, Ineffective contraction of heart muscles
- Hypertrophic: Affects mostly left ventricle and septum, Wall is substantially thicker, Ventricular outflow obstruction
- Restrictive: Impaired ventricular filling during diastole, Stiff inelastic ventricle; contractile function is normal, Can be caused by amyloid deposition
What are 3 types of endocarditis?
- Acute endocarditis—massive destruction of valves and heart failure; Staph aureus, Subacute –Strep viridans, less severe
- Sterile endocarditis---Nonbacterial thrombotic endocarditis (marantic) characterized by deposition of small sterile fibrin thrombi on previously normal valves
- Libman-Sacks endocarditis--- SLE
- Abnormal immune response to streptococci
- Children 5-15
- Aschoff bodies
- Group A beta hemolytic strep
- Abnormalities of heart valves—prone to calcification and infection
- Pancarditis—may present with endocarditis, myocarditis, or pericarditis
What is the most common primary tumor of the heart?
Cardiac myxoma (typically in the left atrium)