Term
| CV disease is the number __ cause of death worldwide. |
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Definition
|
|
Term
| In the US, CV disease accounts for nearly __% of all postnatal deaths. |
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Definition
|
|
Term
| It is estimated that what proportion of Americans have some type of CV disease? |
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Definition
|
|
Term
| What percentage of heart disease deaths are "premature?" |
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Definition
|
|
Term
| What is the average heart weight in males and females? |
|
Definition
| 250-300 gm in females, 300-350 gm in males |
|
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Term
| What is the avg thickness of the free wall of the right ventricle? The left ventricle? |
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Definition
|
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Term
| Greater heart weight or ventricular thickness indicates... |
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Definition
|
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Term
| Enlarged heart chamber size implies... |
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Definition
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Term
| Increase in cardiac weight, size, or both is termed... |
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Definition
|
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Term
| Myocardium is composed primarily of a collection of specialized muscle cells called... |
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Definition
|
|
Term
| How are ventricular myocytes arranged? |
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Definition
| circumferentially in a spiral orientation |
|
|
Term
| What filaments are found in cardiac sarcomeres? |
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Definition
|
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Term
| Sarcomeres contain regulatory proteins such as... |
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Definition
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Term
| How does moderate ventricular dilation during diastole affect the extent of sarcomere shortening and the force of contraction? |
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Definition
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Term
| How do the size and arrangement of atrial myocytes differ from ventricular myocytes? |
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Definition
| Smaller and arranged more haphazardly |
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Term
| Some atrial cells have electron-dense granules in their cytoplasm. What are they called and what do they contain? |
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Definition
| specific atrial granules, atrial natriuretic peptide |
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Term
| Functional integration of cardiac myocytes is mediated by... |
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Definition
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Term
| Within intercalated discs, what structures facilitate synchronous myocyte contraction through electrical coupling? |
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Definition
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Term
| Abnormalities in the spatial distribution of gap junctions and their respective proteins in heart disease could contribute to... |
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Definition
| arrhythmia and heart failure |
|
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Term
| What are the flaps of cardiac valves called? |
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Definition
|
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Term
| What are the layers of the valves? |
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Definition
| fribrosa, spongiosa, ventricularis or atrialis, endothelial covering |
|
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Term
| Describe the valve fibrosa layer. |
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Definition
| dense collagenous core close to outflow surface and continuous with valvular supporting structures |
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Term
| Describe the valve spongiosa layer. |
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Definition
| A central core of loose connective tissue |
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Term
| Which valve layer is below the inflow surface and is rich in elastin? |
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Definition
| Ventricularis or atrialis |
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Term
| What forms the covering of the heart valves? |
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Definition
|
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Term
| What substance is responsible for mechanical integrity of the valve? |
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Definition
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Term
| The valve is populated throughout by which cells? What do they do? |
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Definition
| interstitial cells, continuously repair the ECM |
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Term
| In contrast to semilumar valves, the competence of the AV valves depends on not only the leaflets and their attachments, but also on... |
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Definition
| tendinous connections to the papillary muscles of the ventricular wall |
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Term
| Describe blood supply of heart valves. |
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Definition
| Mostly diffusion, scant blood vessels limited to the proximal portions |
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Term
| What are the 3 main types of pathologic damage to cardiac valves? |
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Definition
| damage to collagen, nodular calcification, fibrotic thickening |
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Term
| How does the AV node serve as a kind of gatekeeper? |
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Definition
| Delays transmission of excitatory signal from atria to ventricles to coordinate proper contractions. |
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Term
| The bundle of His courses from where to where? |
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Definition
| from the right atrium to the summit of the ventricular septum |
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Term
| What controls the rate of firing of the SA node? |
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Definition
| The autonomic nervous system |
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Term
| To meet their energy needs, cardiac myocytes rely almost exclusively on... |
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Definition
| oxidative phosphorylation |
|
|
Term
| Cardiac myocytes have abundant numbers of which organelles? |
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Definition
|
|
Term
| Myocytes are extremely vulnerable to... |
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Definition
|
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Term
| What are the coronary arteries running along the external surface of the heart? |
|
Definition
| epicardial coronary arteries |
|
|
Term
| What are intramural arteries? |
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Definition
| Coronary arteries penetrating the myocardium |
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Term
| What are the 3 major epicardial coronary arteries? |
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Definition
| Left anterior descending, left circumflex, right coronary artery |
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Term
| Branches of the LAD are called... |
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Definition
| "diagonal" and "septal perforators" |
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|
Term
| "Obtuse marginals" are branches of which artery? |
|
Definition
| Left circumflex coronary artery |
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|
Term
| Most coronary arterial blood flow to the myocardium occurs during ventricular... |
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Definition
|
|
Term
| Aging can affect which CV structures? |
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Definition
| pericardium, cardiac chambers, valves, coronary arteries, conduction system, myocardium and aorta |
|
|
Term
| What happens to epicardial fat with age? |
|
Definition
| It increases, especially over the anterior surface of right ventricle and in the atrial septum |
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|
Term
| With aging, a reduction in the size of which cavity can occur? |
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Definition
|
|
Term
| What is a sigmoid shaped ventricular septum? When does this occur? |
|
Definition
| bulging of the basal ventricular septum into the ventricular outflow tract, occurs with aging |
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Term
| The mitral annulus and aortic valve can undergo what sort of changes with again? |
|
Definition
| calcification, sometimes leading to aortic stenosis, and fibrotic thickening |
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Term
| When the mitral valve develops fibrous thickening, what happens to its actions? |
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Definition
| Tends to buckle back toward the left atrium during systole, simulating a prolapsing mitral valve |
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Term
| What are the small filiform processes that develop on the closure lines of aortic and mitral valves in older people, probably from the organization of small thrombi? |
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Definition
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Term
| In what population do you see myocardium with fewer myocytes, increased collagenized connective tissue and sometimes deposition of amyloid? |
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Definition
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Term
| Extensive _________ deposits in a small, atrophied heart is called brown atrophy. |
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Definition
|
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Term
| What is it called when cardiac myocytes have an accumulation of a gray-blue byproduct of glycogen metabolism? |
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Definition
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|
Term
| Brown atrophy often accompanies ___________, as seen in terminal cancer. |
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Definition
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Term
| What are the 6 principle mechanisms from which CV dysfunction results? |
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Definition
| failure of the pump, obstruction to flow, regurgitant flow, shunted flow, disorders of cardiac conduction, rupture of the heart or a major vessel |
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Term
| The pathogenesis of many congenital heart defects involves an underlying genetic abnormality whose expression is modified by what sort of factors? |
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Definition
| environmental or maternal |
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Term
| Each year in the US, CHF affects nearly how many individuals? It is the primary or contributing cause of death in how many? |
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Definition
|
|
Term
| What is the leading discharge diagnosis in patients over 65? |
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Definition
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Term
| What occurs when the heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the tissues or can do so only at an elevated filling pressure? |
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Definition
|
|
Term
| How does CHF most often develop? |
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Definition
|
|
Term
| What can cause CHF to appear suddenly? |
|
Definition
| Acute hemodynamic stresses |
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Term
| What are the 3 most important mechanisms by which arterial pressure and perfusion of vital organs is maintained when cardiac function is impaired or the work load increased? |
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Definition
| The Frank-Starling mechanism, myocardial adaptations, activation of neurohumoral systems |
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|
Term
| What is the Frank-Starling mechanism? |
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Definition
| Increased filling volumes dilate the heart and thereby increase functional cross-bridge formation within the sarcomeres, enhancing contractility |
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Term
| What is the name for the collective molecular, cellular and structural changes that occur as a response to injury or changes in loading conditions of the heart? |
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Definition
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|
Term
| What is the compensatory response of the myocardium to increased mechanical work? What does it often precede? |
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Definition
| hypertrophy, heart failure |
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Term
| What are the 3 main neurohumoral systems activated when cardiac function is impaired or work load is increased? |
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Definition
| 1- release of norepi from cardiac nerves of the ANS, 2 - activation of the renin-angiotensin-aldosterone system, 3 - release of atrial natriuretic peptide |
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Term
| Most frequently, heart failure results from progressive deterioration of myocardial contractile function, termed... |
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Definition
|
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Term
| Which type of cardiac dysfunction may be caused by ischemic injury, pressure or volume overload due to valvular disease or hypertension, or dilated cardiomyopathy? |
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Definition
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|
Term
| Diastolic dysfunction can occur due to... |
|
Definition
| massive left ventricular hypertrophy, myocardial fibrosis, deposition of amyloid or constrictive pericarditis. |
|
|
Term
| What is diastolic dysfunction? |
|
Definition
| Inability of the heart chambers to expand and fill sufficiently during diastole. |
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|
Term
| Increased mechanical work causes myocytes to... |
|
Definition
| increase in size (hypertrophy) |
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|
Term
| Hypertrophy is dependent on increased _____________, which enables the assembly of additional ___________. |
|
Definition
| protein synthesis, sarcomeres |
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|
Term
| Hypertrophic myocytes have which features? |
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Definition
| Increased numbers of mitochondria, enlarged nuclei |
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Term
| Enlarged nuclei of hypertrophic myocytes appears to be due to increases in DNA _______, resulting from replication without cell division. |
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Definition
|
|
Term
| In response to increases in pressure (hypertension or aortic stenosis), ventricles develop... |
|
Definition
| pressure-overload hypertrophy |
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|
Term
| What type of hypertrophy causes a concentric increase in wall thickness? |
|
Definition
| pressure-overload hypertrophy |
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|
Term
| In pressure overload, in what arrangement are new sarcomeres assembled? |
|
Definition
| in parallel to long axis of cells |
|
|
Term
| Ventricular dilation is a characteristic of what type of hypertrophy? |
|
Definition
| Volume-overload hypertrophy |
|
|
Term
| In which type of hypertrophy are new sarcomeres assembled in series to the existing sarcomeres? |
|
Definition
| volume-overload hypertrophy |
|
|
Term
| Describe the wall thickness found in volume-overload hypertrophy. |
|
Definition
| may be increased, normal or decreased. |
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|
Term
| In volume-overloaded hearts, what is the best measure of hypertrophy? |
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Definition
|
|
Term
| In pts with aortic regurgitation or hypertrophic cardiomyopathy, heart weights can be how much? |
|
Definition
| 3 to 4x greater than normal |
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|
Term
| The supply of oxygen and nutrients to the hypertrophied heart is more tenuous than normal because the increase in myocyte size is not accompanied by... |
|
Definition
| a proportional increase in capillary numbers |
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|
Term
| Hypertrophy is often accompanied by the deposition of... |
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Definition
|
|
Term
| With prolonged hemodynamic overload, there may be a shift to a gene expression pattern resembling that seen during... |
|
Definition
| fetal cardiac development |
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|
Term
| At a functional level, cardiac hypertrophy is associated with heightened ___________ demands. |
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Definition
|
|
Term
| As a result of increases in wall tension, heart rate and contractility, the hypertrophied heart is vulnerable to... |
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Definition
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|
Term
| The molecular and cellular changes and hypertrophic hearts that initially mediate enhanced function may themselves contribute to the development of... |
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Definition
|
|
Term
| What are the 4 mechanisms by which the changes seen in hypertrophic hearts can lead to cardiac failure? |
|
Definition
| abnormal myocardial metabolism, alterations of intracellular handling of calcium ions, apoptosis of myocytes and reprogramming of gene expression |
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Term
| Reprogramming in gene expression seen in hypertrophic hearts appears to occur in part through changes in expression of... |
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Definition
|
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Term
|
Definition
| Small noncoding RNAs that inhibit the expression of proteins at the level of MRNA stability or translation |
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Term
| Cardiac hypertrophy is associated with a downregulation of ________ and upregulation of _______. |
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Definition
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|
Term
| At autopsy, the hearts of pts with CHF are generally... |
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Definition
| heavy, dilated, thin-walled, and have microscopic evidence of hypertrophy |
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Term
| In myocardial infarction, loss of pumping capacity due to myocyte death leads to... |
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Definition
| work-related hypertrophy of surrounding viable myocardium |
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Term
| Cardiomegaly is an independent risk factor for... |
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Definition
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|
Term
| What is associated with volume-load hypertrophy, increases in capillary density, decreases in resting HR and BP? What is the name given to these changes? |
|
Definition
| aerobic exercise, physiologic hypertrophy |
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|
Term
| Static exercise is associated with ________ hypertrophy and appears more likely to be associated with ________ changes. |
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Definition
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|
Term
| CHF is characterized by variable degrees of forward failure and backward failure. What are these? |
|
Definition
| forward: decreased cardiac output and tissue perfusion, backward: pooling of blood in the venous system |
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|
Term
| Backward failure may cause... |
|
Definition
| pulmonary edema and/or peripheral edema |
|
|
Term
| What are the 4 main causes of left-sided heart failure? |
|
Definition
| ischemic heart disease, hypertension, aortic and mitral valvular diseases, and myocardial diseases |
|
|
Term
| The morphologic and clinical effects of left-sided heart failure primarily results from...(3 things) |
|
Definition
| congestion of pulmonary circulation, stasis of blood in left side of heart, hypoperfusion |
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|
Term
| Except for failure caused by mitral valve stenosis or unusual restrictive cardiomyopathies, left-sided heart failure will produce a left-ventricle that is... |
|
Definition
| usually hypertrophied and often dilated |
|
|
Term
| Impaired left ventricular function has what effects on the left atrium and on the heart rhythm? |
|
Definition
| dilation of left atrium, increased risk of atrial fibrillation |
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|
Term
| Dilation of the left atrium, especially with atrial fibrillation, results in ________, particularly in the atrial _______. |
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Definition
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|
Term
| The atrial appendage is a common site of _______ formation in the setting of left-sided heart failure. |
|
Definition
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|
Term
| In left-sided heart failure, what are 3 main pulmonary changes seen? |
|
Definition
| 1- perivascular and interstitial edema, 2 - progressive edematous widening of alveolar septa, 3 - accumulation of edema fluid in the alveolar spaces |
|
|
Term
| What are heart failure cells? |
|
Definition
| Hemosiderin-laden macrophages resulting from phagocytosis of RBCs in the alveolar space (from pulmonary edema) |
|
|
Term
| What are the pulmonary symptoms of left-sided heart failure? |
|
Definition
| Cough, dyspnea, orthopnea, paroxysmal nocturnal dyspnea |
|
|
Term
| In left-sided heart failure, decreased cardiac output causes a decrease in renal perfusion, which leads to the activation of the... |
|
Definition
| renin-angiotensin-aldosterone system |
|
|
Term
| In LSHF, retention of salt and water can cause exacerbation of... |
|
Definition
|
|
Term
| In LSHF, if hypoperfusion of the kidney is severe, impaired excretion of nitrogenous products may cause... |
|
Definition
| azotemia (prerenal azotemia because of its vascular origin) |
|
|
Term
| In far advanced CHF, cerebral hypoxia can lead to... |
|
Definition
|
|
Term
| What are the symptoms of hypoxic encephalopathy? |
|
Definition
| Irritability, loss of attention span, restlessness, progressing to stupor and coma |
|
|
Term
| LSHF can be divided into... |
|
Definition
| systolic and diastolic failure |
|
|
Term
| Systolic failure is defined by... |
|
Definition
| insufficient cardiac output (pump failure) |
|
|
Term
| What has happened to the left ventricle to produce diastolic failure? |
|
Definition
| It is abnormally stiff or otherwise restricted in its ability to relax during diastole |
|
|
Term
| As a result of changes leading to diastolic failure, the heart is unable to... |
|
Definition
| respond to changes in demands of peripheral tissues (like during exercise) |
|
|
Term
| With diastolic failure, because the left ventricle cannot expand normally any increase in filling pressure is referred back to the pulmonary circulation, producing... |
|
Definition
| flash pulmonary edema/rapid onset pulmonary edema |
|
|
Term
| Diastolic failure is more common in... |
|
Definition
| patients over 65, women>men |
|
|
Term
| A reduction in the ability of the left ventricle to relax during diastole can be caused by... |
|
Definition
| mycardial fibrosis, infiltrative disorders, restrictive pericarditis |
|
|
Term
| Diastolic failure may occur in elderly patients with no know predisposing factors, possibly as an exaggeration of... |
|
Definition
| normal stiffening of the heart with age |
|
|
Term
| What are the risk factors for diastolic failure? |
|
Definition
| hypertension, DM, obesity, bilateral renal artery stenosis |
|
|
Term
| Most commonly, RSHF is caused by... |
|
Definition
|
|
Term
| The causes of RSHF include all those that cause... |
|
Definition
|
|
Term
| Pure RSHF is infrequent, usually occurs in pts with disorders that affect the ______. It is often referred to as... |
|
Definition
|
|
Term
| What can arise from diseases like primary pulmonary hypertension, recurrent pulmonary thromboembolism, or diseases that produce hypoxia with resultant pulmonary vasoconstriction? |
|
Definition
|
|
Term
| The common features of the diverse disorders that cause cor pulmonale is... |
|
Definition
|
|
Term
| Pulmonary hypertension has what effects on the heart? |
|
Definition
| hypertrophy and dilation of the right side of the heart |
|
|
Term
| The major effects of RSHF differ from those of LSHF in that pulmonary congestion is ________, whereas engorgement of the _________ and _________ systems may be pronounced. |
|
Definition
| minimal, systemic and portal venous systems |
|
|
Term
| As in LSHF, the morphology of RSHF, varies with ______. |
|
Definition
|
|
Term
| With isolated RSHF, the only morphological findings in the vast majority of cases are... |
|
Definition
| hypertrophy and dilation of the right atrium and ventricle |
|
|
Term
| In RSHF, congestion of the ________ and _______ vessels may produce pathological changes in the liver, _______, and gut. |
|
Definition
|
|
Term
| In RSHF, what happens to the liver? |
|
Definition
|
|
Term
| The characteristic appearance of hepatic lobules in _____-sided heart failure is called "_______ liver" |
|
Definition
|
|
Term
|
Definition
| Red-brown centrilobular discoloration and paler, sometimes fatty peripheral regions |
|
|
Term
| Some instances of RSHF, especially when paired with LSHF, affect the liver severely enough to produce severe central hypoxia, which produces... |
|
Definition
|
|
Term
| In long-standing severe RSHF, the centrolobular areas of the liver can become fibrotic, creating _______ sclerosis, and in extreme cases, _____ ______. |
|
Definition
| cardiac, cardiac cirrhosis |
|
|
Term
| Portal hypertension in RSHF affects the spleen and produces... |
|
Definition
|
|
Term
| Portal hypertension in _____-sided heart failure can contribute to chronic congestion and edema of the _____ wall, which can get so severe it interferes with absorption of nutrients. |
|
Definition
|
|
Term
| System venous congestion in RSHF can lead to accumulation of fluid in which spaces? |
|
Definition
| Pleural, pericardial, peritoneal |
|
|
Term
| Large pleural effusions can cause portions of the corresponding lung to be poorly inflated, called... |
|
Definition
|
|
Term
| With _____-sided heart failure, transudation of fluid into the peritoneal cavity may give rise to... |
|
Definition
|
|
Term
| Edema in the peripheral and dependent portions of the body is a hallmark of... |
|
Definition
| right sided heart failure |
|
|
Term
| Generalized massive edema, called _______, may also occur in _____-sided heart failure. |
|
Definition
|
|
Term
| Organs predominantly affected in RSHF include the.... |
|
Definition
|
|
Term
| Congestion of the kidneys is more marked with ____-sided heart failure than _____-sided heart failure, leading to greater... |
|
Definition
| right, left, fluid retention and peripheral edema and more pronounced azotemia |
|
|
Term
| In RSHF, venous congestion and hypoxia of the CNS can produce deficits of __________, essentially identical to those seen in LSHF |
|
Definition
|
|
Term
| What are the main 3 types of drugs used to treat CHF? |
|
Definition
| Drugs that relieve fluid overload (diuretics), block the renin-angiotensin-aldosterone system (ACE inhibitors) and drugs that lower adrenergic tone (beta blockers) |
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