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3 Cards in this Set
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Blood pressure regulation Cardiac output vs stroke volume Heart failure is pathophysiology State in which heart, via an abnormality of cardiac functions fail to pump blood Common end point for cardiac disease Increased demand ie anemia, hypothyroidism Abrupt or gradual Systolic or diastolic dysfunction Common in older adults, diabetic patients and women Systolic dysfunction Systole is ejection phase Aortic and pulmonary valve open AV valves close Leads to inadequate myocardum pump dysfunction Causes CAD Valvular heart diseases Arrythmias lead to reduced pumping Infections and inflammation Congenital heart disease- Idiopathic cardiomyopathy Drugs Peripartum cardiomyopathy Diastolic dysfunction Period of ventricular filling AV valves open Diastolic dysfunction is inability to fill Causes Left ventricular hypertrophy Myocardial fibrosis Amyloid deposition Constrictive pericarditis Hypertrophic and restrictive cardiomyopathy Valvular heart disease ie aortic stenosis Effects of pump failure Increased end diastolic volume Increased end diastolic pressure Elevated venous pressure Forward failure - inadequate output Backwards failure - increased venous congestion Compensatory mechanism Frank starling mechanism Cardiac output increases or decreases in response Lead to compensated heart failure or decompensated heart failure Activation of neurohurmoral system Release of norepinephrine, renin angiotensin system Myocardial structural changes Cardiac myocytes adapt to increased workload by adding sarcomeres, Cardiac hypertrophy |
Left sided heart failure LV no longer pumps enough blood to body, blood build's up in pulmonary veins Causes IHD Systemic hypertendion Mitral and Aortic valve diseases Primary disease-of myocardion Morphology Heart Depends on underlying cause Areas of myocardial infarction Valvular deformities Endomycardial fibrosis in restrictive cardiomyopathy Left ventricular hypertrophy and dilatation Microscopic -, myocyte hypertrophy, interstitial fibrosis, areas of coagulative necrosis in MI Lungs Congestion and edema Olura effusion due to increased hydrostatic pressure Heavy and boggy Microscopic - Perivascular and interstitial transudate, alveolar septal edema, Heart failure cells - hemosiderin laden macrophages Clinical features Dyspnea on exertion Cough due to fluid transudation into air spaces Orthopnea- dyspnea when recumbent Paroxysmal nocturnal dyspnea Cardiomegaly Tachycardia Third heart sound S3 Fine rales at lung bases Papillary muscle displacements causing mitral valve regurgitation Atrial fibrillation as irregularly irregular sounds Stasis of blood due to atrial fibrillation Pre renal azotemia due to decreased renal perfusion Hypoxic encephalopathy Treatment Correct underlying cause Salt restrictions Pharmacologic agent's to reduce overload, increase contractility, reduce after load |
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Right sided heart failure RV too weak to pump blood to lungs Blood fills up in veins Consequence of Left sided heart failure Cor pulmonale is isolated Left side heart failure in patients with certain lung disorders Causes similar in Left sided heart failure Causes of Cor pulmonale Parenchyma lung diseases Pulmonary vasculature disorders Morphology Heart Myocardial hypertrophy and dilatation Bulging of ventricular septum Engorgement of systemic and portal venous sustem Liver and portal system Congestive hepatosplenonegaly Nutmegs liver LSHF present with centrilobular necrosis due to central hypoxia Elevated pressure in portal vein with congestive splenomegaly Severe congestion and edema can compromise absorption Pleural, Pericardial and peritoneal spaces Effusion in these space Pleural effusion more pronounced Ascites Are transudates with low protein system with no inflammatory cells Subcutaneous tissues Edema at feet, lower legs( Hallmark Presacral edema in clinically Ill patient Clinical features Pure right sided heart faiilur Congestive hepatosplenonegaly Ascites Venous congestion and hypoxia in kidney and brain Pleural effusion Patient may become cyanotic if it progress New York heart association Grade 1(,mild),2(mild), 3 (moderate),4(severe) Diagnosis/ Framingham diagnostic criteria Major Acute pulmonary edema Cardiomegaly Hepatojugular reflex |
Cardiac tumors Majority benign Primary Myxoma Fibroma Lipomas Papillary fibroelastoma Myxoma Most common Left atrium common Single Arise in atrial septa Mean age 50 years Histology- stellate, multinucleated myxoma cells admixed with endothelial smooth muscle cells Arise from mesenchymal Cells embedded in acid Rhabdomyoma More in children less than 1yr of age Obstruction of valvular orifice Associated with congenital heart disease- Clinical features Valvular obstruction Embolization Grey white masses Mixed population of cells:spider cells with numerous glycogen laden vacuoles Cardiac fibroma Common in children Present with heart failure or cyanosis , syncope or arrythmias, asymptomatic Discrete bulging mas Microscopic- bland fibroblast and collagen Papillary fibroelastoma Benign papillary growth of endocardium KRAS mutation Male than female Risk Damaged endothelial Microscopic- multiple branching friends of paucicellular avascular tissue |
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Cardiac effects of non cardiac neoplasm Metastasis Effects of circulating mediators Therapeutic mediators complications Metastasis From lung, breast, melanoma, leukemia and lymphomas, Occur by retrograde lymphatic spread Clinical features Associated with Pericardial spread Superior Vena cava symptom Effects of circulating mediators Non bacterial ylthrombotic Endocarditis Carcinoid heart disease Pheochromocytoma Myeloma Effects of treatment Dilated cardiomyopathy by doxorubicin Pericarditis by radiation treatment of breast cancer |
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