Clinical Pathophysiology Chapter 10 Review

Most cases of myocarditis in the US are viral in origin. What are the most common pathogens responsible?

Coxsackieviruses A and B, echovirus

In most cases of chronic cardiac decompensation, patients present with ___________________________

biventricular CHF encompassing the clinical syndromes of both right sided and left sided heart failure

What type of valvular heart disease is a common degenerative age-related lesion?

calcific aortic stenosis - valve fibroblasts and valve mitral fibroblasts decrease and calcic is building up during this most common congenital disease is bicuspid aortic valve stenosis is failure of a valve to open completely, obstructing forward flow, and insufficiency results from a failure of a valve to close completely thereby allowing regurgitation (backflow of blood)

List the classifications of vascular tumors

capillary hemangioma, lymphangioma, and glomus tumor are benign vascular tumors angiosarcoma is a malignant tumor hemangioendotheliomas are low grade malignant tumors

Define systolic dysfunction

cardiac muscle contracts weakly and the chambers cannot empty properly, usually a consequence of ischemic heart disease or hypertension

What event happens during ventricle systole?

opening of semilunar valves (pulmonary on the right and aortic on the left)

What is the SA node?

pacemaker of the heart

Describe Eisenmenger Syndrome

prolonged left to right shunting with volume and pressure overloads eventually causes pulmonary hypertension and secondarily right sided pressure that exceed those on the left, at the point reversal of blood flow occurs with resultant right to left shunting, and development of cyanosis such reversal of flow and shunting of unoxygenated blood into the systemic circulation is called Eisenmenger Syndrome

Formation of thrombi and emboli arising from these thrombi account for the common and the most serious complications following __________________

prosthetic valve implantation

What is the cardiac cycle?

rhythmic pumping of heart that is broken into two parts: systole: ventricle of heart contracts diastole: ventricle of heart relaxes

What are clinical manifestations of right ventricular failure?

right atrial and ventricular dilation, hypertrophy, congestive hepatomegaly, congestive splenomegaly, peripheral edema, pleural effusion, ascites

What usually causes right sided heart failure?

right sided is usually a consequence of left sided heart failure, pressure increase in pulmonary circulation inevitably produces an increased burden on the right side of the heart

Carcinoid tumors elaborate bioactive products that can cause cardiac lesions. What are these products?

serotonin, kallikrein, bradykini, histamine, prostaglandins, and tachykinins p and K lesions are usually located on the right heart valves on endocardium

What are two intracellular bacteria that kill the host cell through rapid replication and lysis?

shigella and e.coli

Name the two categories of hypertensive heart disease

systemic (left sided) hypertensive heart disease pulmonary (right sided) heart disease - cor pulmonale

Most cases of congestive heart failure are due to _______________

systolic dysfunction

What are the most common causes of left sided heart failure?

the most common cause of left sided is ischemic heart disease, systemic hypertension, mitral or aortic valve disease, and primary diseases of the myocardium

Endomyocardial catheter biopsy is the only reliable means of diagnosing ______________

transplantation rejection in transplanted hearts

Congenital hypertrophic cardiomyopathy can result from the mutation of the gene encoding _______________

troponin T, troponin I, a-tropomyosin, myosin-binding protein, B-myosin heavy chain

What is currently the best biochemical indicator of a myocardial infarction?

troponin t there are multiple indicators, this is just the best one

Describe bacillary angiomatosis

typically found in AIDS patients and caused by Bartonella henselae

Calcific aortic valve stenosis causes _______________ to flow

obstruction

Describe mitral valve prolapse and its primary form

one or both valves are enlarged

Fevers, murmurs, embolic phenomena, and the ultrasonographic findings suggest the diagnosis of _______________

bacterial endocarditis

At what age of the embryo's life does the heart begin to pump blood?

22nd day of gestation

Cardiovascular disease accounts for what percent of all deaths in the United States?

40%

What percentage of cases will an angiography reveal a thrombus occulting the coronary artery after the onset of infarction?

90% within 4 hours

What is an adaptive response of the heart to systemic hypertensive heart disease?

hypertrophy

What are three mechanisms the cardiovascular system uses to compensate for reduced myocardial contractility or increased hemodynamics burden?

Frank-Starling mechanism, activation of neurohumoral systems (release of epinephrine and other chemicals), myocardial structural changes (increase in myocyte hypertrophy and fibrosis)

Name the bacterial agents in the low virulence HACEK group of oral cavity commensals associated with infective endocarditis?

Haemophilus, actinobacillus, cardiobacterium, eikenella, kingella

Describe endocarditis of systemic lupus erthematosus

Libman-sacks disease endocarditis that occurs in SLE and in antiphospholipid syndrome, presumably due to immune complex deposition

Describe myocardial infarction as well as the clinical features of a class MI

MI also referred to as a "heart attack" is necrosis of heart muscle resulting from ischemia, severe crushing chest pain radiating to the neck, jaw, epigastrium, or left arm, weak or rapid pulse, diaphoresis, nausea, dyspnea, myoglobin, cardiac troponins T and I, creatine kinase, and lactate dehydrogenase found in blood

Describe nonbacterial thrombotic endocarditis

Marantic endocarditis

Describe the 3 types of congenital atrial septal defects

Ostium Secundum ASDs account for 90% of ASDs: smooth walled defects near the foramen ovale usually without other associated cardiac abnormality (most common) Ostium Primum ASDs accounts for 5% of ADSs: occurs in the lowest part of the atrial septum and can be associated with mitral and tricuspid valve abnormalities Sinus Venosus ASDs accounts for 5% of ASDs: located high in the atrial septum and often are associated with anomalous drainage of the pulmonary veins into the right atrium or superior vena cava

Describe course of impulse travel through the cardiac conduction system

SA node impulse-> AV node impulse -> AV bundle impulse (bundle of his) -> purkinje fibers impulse

What protozoan, also associated with Chagas disease, causes myocarditis in most those infected with it?

Trypanosoma cruzi

Describe the mechanism of cardiac cell contraction

action potential induced by pacemaker cells in SA and AV nodes action potentials travel between sarcomeres

Describe the two types of infective endocarditis and the most common bacteria associated with each

acute endocarditis: happens quickly, caused by highly virulent organisms (staphylococcus aureus) typically seeding a previously normal valve to produce necrotizing subacute endocarditis: fast, but not as fast, typically caused by moderate to low virulence organisms (streptococcus viridians) seeding an abnormal or previously injured valve

Describe rheumatic fever

acute inflammatory disease that occurs in children after group A beta-hemolytic streptococcal (not staphococcal) usually pharyngitis

Describe Tetralogy of Fallot

cardinal features: right ventricular outflow tract obstruction (pulmonary stenosis), right hypertrophy, VSD, overriding of the VSD by the aorta, the hemodynamic consequences of tetralogy fallot are right-to-left shunting, decreased pulmonary blood flow, and increased aortic volumes the clinical severity largely depends on the degree of the pulmonary outflow obstruction

What are clinical manifestations of left ventricular failure?

cardiomegaly, tachycardia, a third heart sound (S3), fine rales at the lung bases, pulmonary congestion and edema, left atrial dilation, atrial fibrillation, decreased renal perfusion

What is the etiology of serious pericarditis?

cause is usually unknown, it is characteristically non-bacterial

Describe infantile coarctation

characterized by circumferential narrowing of the aortic segment between left subclavian artery and the ductus arterioisus

Chronic cor pulmonale is a result of what specific factors?

chronic right ventricular pressure overload

Myocyte hypertrophy increase the content of contractile proteins at the expense of what?

compliance, impairing diastolic filling while increasing oxygen demand

Name some causes of acquired valvular heart disease?

degeneration - calcification inflammatory processes - rheumatic heart disease infection - infective endocarditis changes secondary to myocardial disease

Describe ischemic heart disease and list clinical manifestations

diagnose by listening to any heart that has abnormal rhythm (dysrhythmia) caused by myocardial ischemia clinical manifestations include angina pectoris, acute myocardial infarction, chronic IHD with CHF, and sudden cardiac death

What are the three main functional and pathologic patterns of cardiomyopathies?

dilated, hypertrophic, restrictive

What is usually the the earliest and most significant symptom of left sided heart failure?

dyspnea

What is seen microscopically in the acute phase of of rheumatic fever?

fibrinoid necrosis, ashcoff bodies, anitschkow cells - "caterpillar cells"

Which of the following is the most common cardiac disease encountered in patients who have rheumatoid arthritis?

fibrinous pericarditis often progresses to adhesive pericardial fibrosis, adhesive pericardial fibrosis is the most common heart disease found in patients who have longstanding rheumatoid arthritis

The most common location of atrial septal defects is in the _____________

fossa ovalis, the original site of the foramen secundum

Define congestive heart failure and what it is caused by

generally defined as heart failure, occurs when the heart cannot generate sufficient output to meet the metabolic demands of the tissues, caused by many conditions that damage cardiac muscle such as: coronary artery disease, heart attack, cardiomyopathy, and other conditions that overwork the heart (high blood pressure, valve disease, thyroid disease, kidney heart disease, diabetes, or heart defects present at birth) myocytes in heart hypertrophy and increase in fibrosis

Cardiac output

heart rate x stroke volume x volume of blood being pumped by the heart per minute

The central circulation contains blood that is in what?

heart, lungs (pulmonary blood vessels)

Does compensated heart failure usually lead to decompensated heart failure?

in compensated heart failure, the dilated ventricle is able to maintain cardiac output via the frank starling mechanism, this ventricular dilation comes at the expense of increased wall tension and amplifies the oxygen requirements of the myocardium, eventually the muscle fails and is longer able to propel sufficient blood to meet needs of tissues and the patients develops decompensated heart failures

Describe the Frank-Starling mechanism

increased end-diastolic filling volumes dilate the heart and cause increase cardiac myofiber stretching, these lengthened fibers contract more forcibly, thereby increasing cardiac output the larger the stretch of the muscle - the more force it gives

Describe blood flow vena cava

inferior vena cava: carries deoxygenated blood from the lower half of the body to the right atrium of the heart clinical significance: blockage of inferior vena cava is associated with DVT (blood clot) superior vena cava: receives from from upper limbs, eyes, and neck, behind the lower border of the first right costal cartilage clinical significance: obstruction can lead to enlarged veins in the head and neck and may also cause breathlessness cough, chest pain, and difficulty swallowing

Describe angina pectoris and the variants

intermittent chest pain caused by transient, reversible myocardial ischemia, the pain is a consequence of the ischemia-induced release of adenosine, bradykinin, and other molecules that stimulate the autonomic afferents typical or stable angina: prinzmetal or variant angina: unstable angina:

List 5 manifestations of arrhythmia

irregular rhythm can start in any cell in the heart tachycardia (fast heart rate), bradycardia (slow heart rate), irregular rhythm with normal ventricular contraction, chaotic depolarization without functional ventricular contraction (ventricular fibrillation), no electrical activity at all (asystole)

What is the most common cause of sudden death in adults?

ischemic heart disease caused by thrombotic occlusion of atherosclerotic coronary arteries, atherosclerotic coronary heart disease

Describe the two periods of ventricular systole

isovolumetric contraction period: AV and semilunar valves are closed, ventricles begin to contract, ventricular muscle initially shortens only a little, but intraventricular pressure rises sharply ventricular ejection period: AV valves are closed and semilunar valves are open, pressure in left and right ventricle exceeds pressures in aorta and pulmonary artery, ejection is rapid at first, slowing down as systole progresses

What are two types of prosthetic heart valves?

mechanical valves: rigid, synthetic bioprosthetic valves: chemically fixed animal tissue

Rheumatic endocarditis is still the most common cause of _____________

mitral stenosis (accounting for 99% of all cases)

Define diastolic dysfunction

muscle cannot relax sufficiently to permit ventricular filling, such as massive left ventricular hypertrophy, myocardial fibrosis, amyloid deposition, or constrictive pericarditis

Describe the Jones criteria

used to diagnose rheumatic fever the constellation of findings to diagnose rheumatic fever, erythema marginatum - skin rash, Sydenham chorea - purposeless movement, carditis, subcutaneous nodules and/or migratory large joint polyarthritis Duke criteria: describes infective endocarditis

___________________ is the most common cause of death within the first few hours after coronary artery occulusion

ventricular fibrillation