Term
| What is the state in which the heart in unable to pump blood that is required or on at high pressures? |
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Definition
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Term
| What population is heart failure more common in? |
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Definition
People over 65
and African Americans |
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Term
| What happend with cardiac dysfunction that leads to elevated chamber pressures? |
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Definition
Right atrial pressure:ascites, congestive hepatomegaly, peripheral edema
Left atrial pressure: dyspnea, orthopnea, pulmonary edema and pleural effusions |
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Term
| What are the types of Congestive heart failure? |
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Definition
-acute and chronic
-right and left sided
-low output vs high
-systolic and diastolic
-forward and backward |
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Term
| What is systolic failure? |
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Definition
heart failure due to a defect in the expulsion of blood that is caused by an abnormality in systolic function
see EF <40%, dialated ventricle, lower contractility |
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Term
| What happend to the ventricle in systolic failure? |
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Definition
-hypertrophy, loss of myoctes, increased fibrosis, less efficient pump
-could get arrhythmias |
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Term
| What happens in diastolic heart failure? |
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Definition
-abnormal ventricular filling
-EF >50%, normal contraction, impaired filling
-caused by increase resistance to inflow |
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Term
| What are the neurohormonal/adaptive mechanisms? |
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Definition
1.carotid senses lower CO
2.Increase sympathetics
-increase contractility, HR, vasoconstriction, redistribute blood flow to vital organs
3. Activate RAA
4. Increase ADH
5. Release ANF
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Term
| What are the structural adaptive mechanisms? |
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Definition
| in heart failure for preload- decrease stroke volume, incomplete emptying, increase end-diastolic volume, increase stretch in fibers |
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Term
| What is compensated heart failure? |
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Definition
| when the ventricle dilates to maintain adequate output to meet the body's needs |
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Term
| How does hypertrophy develop? |
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Definition
-increase in wall stress due to LV dilatation or excess afterload
-myofiber hypertrophy and depostion of extracellular matrix
-increase contractile force to counteract elevated wall stress
-get wall stiffness/ ventricular compliance lower, retrograde trasnmission of pressure |
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Term
| What genes are involved in myocardial hypertrophy? |
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Definition
get re-expression or up-regulation of fetal proteins (B myosin heavy chain and ANF gene)
down regulate aMHC and switch to BMHC |
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Term
| What are the potential Adverse Effects of Adaptive Responses? |
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Definition
-increased HR
-increased diastolic volume
-increased venous return-pulmonary congestion and edema
-myocardial hypertrophy
-increase aldosterone and AGII |
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Term
| What are the clinical features of Left sided Heart Failure? |
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Definition
-get back-up in pulmonary and decrease in peripheral perfusion
-kidneys will try to increase renin-AG-ALD and ANF
-get brain hypoxia
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Term
| What causes Right sided Heart Failure? |
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Definition
-usually from left sided
-aka cor pulmonare from chronic pulmonary hypertension
-increase resistance and pressure overlaod to RV
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Term
| What are the characteristics of Right sided Heart Failure? |
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Definition
- liver congestion/fatty change/necrosis/ cardiac cirrhosis
-ascites, peripheral edema, congestive splenomegaly
-azotemia from renal congestion
-pleural and pericardial effusions can also occur |
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Term
| What is the common cause of ischemic heart disease? |
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Definition
reduced coronary blood flow due to ASO
aggrevated by factors that increase demand or reduce availability |
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Term
| What are the 4 associated syndromes for ischemic heart disease? |
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Definition
-myocardial infarction
-angina pectors
-chronic IHD with heart failure
-sudden cardiac death |
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Term
| What are the less OCmmon Causes of Ischemic Heart Disease? |
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Definition
-coronary emboli
-coronary trauma
-tertiary syphilis
-hypercoagulability of blood
-vasculitis |
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Term
| What is an important markers of ischemic disease risk? |
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Definition
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Term
| What happens in inflammation with ischemic heart disease? |
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Definition
| -release chemokines and get increase in expression of adhesion molecules from endothelial cells and leukocytes move into wall which release cytokines causing macrophages to release metalloproteinases |
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Term
| What characterizes stable angina? |
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Definition
-increased myocardial oxygen demand but supply short due to stenosis
-insufficient supply when increased demand is needed |
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Term
| How is stable angine relieved? |
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Definition
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Term
| When does Prinzemetal variant angina occur? |
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Definition
| at rest bc of coronary spasm in patients with severe coronary ASO |
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Term
| What happens to the ST segment in Prinzemetal angina? |
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Definition
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Term
| What does Prinzemetal responds to? |
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Definition
vasodilators
calcium channel blockers |
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Term
| What does unstable angina occur? |
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Definition
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Term
| What is the pathogenesis of a MI? |
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Definition
-90% atheromatous plaques
-10% other causes |
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Term
|
Definition
-block oxygen/stop aerobic glycolysis/ decrese ATP
-get anaerobic glycolysis/ get lactic acid
-decrease contractility/HF
-get ischemia/ coagulative ncrosis
-could get sudden death |
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Term
|
Definition
| infarct involving the full thickness of the myocardium |
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Term
| What are the clinical features of a MI? |
|
Definition
-chest pain
-dyspnea
-epigastric discomfort
-diaphoresis(lots of sweat)
-syncope |
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Term
|
Definition
-due to necrosis-cell membrane integrity bad
-leakage of intracellular protein
myoglobin
cardian tropins T and I
LDH
CK
isoenzymes
AST |
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Term
| What are the markers for acute MI? |
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Definition
cardaic troponin
MB fraction of creatine kinase (MB) |
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Term
| What is the first marker to exhibit rising levels after an MI? |
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Definition
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Term
| What marker is the most specific for cardiac muscle and are preferred to use? |
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Definition
Troponins I and T
elevate in 2-6 hrs
peak in 18-36
remain elevated longer (7-10 days) |
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Term
| Which LDH form is mainly in the myocardium? |
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Definition
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Term
T/F
Normally LDH2 levels are higher than those of other isoenzymes |
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Definition
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Term
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Definition
When LDH1 is greater than LDH2- strongly indicative of acute MI
can occur with hemolysis |
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Term
| What additional test can be done to dx MI? |
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Definition
-neutrophilic leukocytosis
-ECG (abnormal QRS or ST changes)
-ECG
-Radionuclide angiography
-Perfusion scintigraphy
-MRI |
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