[05.18] Heart Failure, Ischemic, and Hypertensive Heart Disease V2.3.pdf

Failure of the pump

What is a principal mechanism of cardiovascular dysfunction that involves cardiac muscle contracting weakly or relaxing insufficiently

Systolic problem

What type of problem results when cardiac muscle contracts weakly and chambers cannot empty properly

Diastolic problem

What type of problem results when muscles cannot relax sufficiently to permit ventricular filling

Obstruction to flow

What principal mechanism of cardiovascular dysfunction involves lesions that impede forward blood flow

Atherosclerotic plaque

What is an example of a lesion that obstructs blood flow through a vessel

Failure of valve to open completely

What causes stenosis

A systolic problem

Stenosis is considered what type of problem

Regurgitant flow

What principal mechanism of cardiovascular dysfunction involves part of the output from each contraction flowing backward

Insufficiency or incompetence

What is another term for regurgitation

Failure of a valve to close completely

What causes regurgitant flow

Increase in volume workload

What is the result of regurgitant flow to the chambers

Left ventricle

Which chamber experiences high pressure in aortic regurgitation

Left atrium and left ventricle

Which chambers experience high pressure in mitral regurgitation

Shunted flow

What principal mechanism of cardiovascular dysfunction involves blood diverted from one part of the heart to another

Congenital or acquired defects

What can cause shunted flow

Myocardial infarction (MI)

What is an example of an acquired defect causing shunted flow

Patent ductus arteriosus (PDA)

What is an example of shunted flow occurring between blood vessels

Disorders of cardiac conduction

What principal mechanism of cardiovascular dysfunction involves uncoordinated generation of impulses

Atrial fibrillation (AFib or AF), Ventricular fibrillation (VFib or VF)

What are examples of disorders of cardiac conduction

Nonuniform and inefficient contractions of the muscular walls

What can disorders of cardiac conduction lead to

Myocardial irritability and/or conduction disturbances

What in individuals who suffered from MI can lead to potentially fatal arrhythmias

Rupture of the heart or a major vessel

What principal mechanism of cardiovascular dysfunction leads to massive bleeding

Free-wall rupture

What type of rupture occurs most frequently 2-4 days after MI

Coagulative necrosis, Neutrophilic infiltration, Lysis of the myocardial connective tissue

What three events, when weakening an infected myocardium, can lead to rupture

Heart failure

What occurs when the heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the tissues

Frank-Starling Mechanism, Myocardial adaptations, Activation of neurohumoral systems

What are the three physiological mechanisms that maintain arterial pressure and perfusion of vital organs when cardiac function is impaired

Increased filling volumes dilate the heart and increase functional cross-bridge formation

What is the process in the Frank-Starling Mechanism

Enhances contractility and stroke volume

What is the result of the Frank-Starling Mechanism

Sarcomeres

What is the basic contractile unit of the muscle

Actin

What is the thin filament of the sarcomere

Myosin

What is the thick filament of the sarcomere

acTHIN

What mnemonic helps recall that actin is the thin filament

Cardiac hypertrophy

What adaptation often precedes heart failure as a compensatory response to increased mechanical workload

Maladaptive

What does hypertrophy become beyond a certain point

Heart failure, arrhythmias, and sudden death

What can maladaptive hypertrophy lead to

Norepinephrine

What substance is released by adrenergic cardiac nerves of the autonomic nervous system to increase heart rate, myocardial contractility, and vascular resistance

Adrenal medulla

Where are catecholamines synthesized from

Zona Glomerulosa

What layer of the adrenal cortex produces mineralocorticoids, such as aldosterone

Renin-Angiotensin-Aldosterone System (RAAS)

What neurohumoral system is activated to maintain arterial pressure

Retention of sodium and water

What is the effect of aldosterone produced by the RAAS

Atrial Natriuretic Peptide (ANP)

What hormone is released to counterbalance RAAS

Diuresis and vascular smooth muscle relaxation

What are the effects of ANP

Natriuresis

What is the term for the excretion of sodium in the urine

Diuresis

What is the term for the excretion of urine

Forward failure

What characteristic of heart failure involves decreased cardiac output and tissue perfusion of the vital organs

Backward failure

What characteristic of heart failure involves pooling of blood in the venous system

Pulmonary edema, peripheral edema

What are two possible results of backward failure

Pooling or backflow of blood into the pulmonary circulation

What happens when left-sided heart failure occurs (LSHF)

Progressive deterioration of myocardial contractile function

What causes Systolic Dysfunction

Ischemic injury, Pressure/volume overload, Dilated cardiomyopathy

What are three factors contributing to systolic dysfunction

Inability of the heart chamber to expand and fill sufficiently during diastole

What causes Diastolic Dysfunction

Massive left ventricular (LV) hypertrophy, Myocardial fibrosis, Deposition of amyloid, Constrictive pericarditis

What four conditions can cause diastolic dysfunction

Cor bovinum

What term refers to the patient’s heart being the size of a cow’s heart due to massive LV hypertrophy

LV free wall is very thick, stiff, and rigid

What is the appearance of the LV in cor bovinum

Collagen deposition in the myocardium

What is myocardial fibrosis

Amyloid

What protein can be deposited in the heart and kidneys, causing diastolic dysfunction

Apple green birefringence

What is the appearance of amyloid under a polarizing microscope

Elongated appearance like pick-up-sticks

What is the appearance of amyloid fibrils under the electron microscope

Restrictive cardiomyopathy

What type of cardiomyopathy are myocardial fibrosis, deposition of amyloid, and constrictive pericarditis encountered in

Increased mechanical work due to pressure/volume overload, Trophic signals mediated through activation of beta-adrenergic receptors

What are the two causes of myocyte hypertrophy

Concentric increase in left ventricular wall thickness

What is the characteristic pattern of pressure-overload hypertrophy

Ventricular dilation

What is the characteristic of volume-overload hypertrophy

Heart weight

What is the best measure of hypertrophy in volume overload hearts

Box-shaped or squared

What is the shape of the hypertrophied nuclei, instead of elongated or ovoid

Boxcar nuclei

What term is used to describe the enlarged and squared nuclei in hypertrophied myocytes

Not accompanied by a proportional increase

What happens to capillary numbers relative to the increase in myocyte size in cardiac hypertrophy

Deposition of fibrous tissue

What accompanies hypertrophy, contributing to diastolic dysfunction

Fetal cardiac development

A shift in gene expression in prolonged hemodynamic overload resembles what developmental stage

Increased oxygen and nutrient consumption

What heightened metabolic demands are associated with cardiac hypertrophy

Wall tension, heart rate (HR), Contractility

What three factors increase, leading to heightened metabolic demands in cardiac hypertrophy

Imbalance between supply and demand

What occurs due to the disproportionate increase in capillary numbers in hypertrophy

Lysis and loss of myofibrillar contractile elements

What two regressive changes occur in myocardial fibers when the hypertrophy limit is reached

Myocyte death

What can occur in extreme cases of hypertrophy regression

Hypertension (pressure overload), Valvular diseases (pressure and/or volume overload), Myocardial infarction (regional dysfunction with volume overload)

What three causes lead to increased cardiac work and hypertrophy

Increased wall stress

Increased cardiac work leads to what, which causes cell stretch

Increased heart size and mass, Increased protein synthesis, Induction of immediate-early genes, Induction of fetal gene program, Abnormal proteins, Fibrosis, Inadequate vasculature

What seven changes characterize hypertrophy and/or dilation

Heart failure (systolic/diastolic), Arrhythmias, Neurohormonal stimulation

What three conditions characterize cardiac dysfunction resulting from hypertrophy and/or dilation

Ischemic heart disease, HPN, Aortic and mitral valvular disease, Myocardial disease

What are the four causes of Left-Sided Heart Failure (LSHF)

Congestion of the pulmonary circulation, Stasis of blood in the chambers of the left side of the heart, Hypoperfusion of tissues

What three factors primarily result in the morphologic and clinical effects of LSHF

LV hypertrophy with dilation, Myocyte hypertrophy with interstitial fibrosis, Impaired LV function

What are common morphologic manifestations in the heart in LSHF

LA dilation

What does impaired LV function induce, which increases the risk for atrial fibrillation

Pulmonary congestion and edema

What are morphologic findings in the lungs in LSHF

Heavy and wet

What is the gross feeling of the lungs in pulmonary congestion and edema

Hemosiderin-laden macrophages

What are "heart failure cells"

Red cells extravasate into the edema within the alveolar spaces

What event leads to the formation of heart failure cells

Previous episodes of pulmonary edema

What do heart failure cells signify

Tachycardia, Confusion, Restlessness, Fatigue, Cyanosis, Elevated pulmonary capillary wedge pressure

What are general symptoms of LSHF

Cough, Crackles, wheezes, Blood-tinged sputum, Tachypnea

What are symptoms of pulmonary congestion in LSHF

Exertional dyspnea

What is dyspnea caused by

Paroxysmal nocturnal dyspnea

What is severe dyspnea occurring at night, inducing a feeling of suffocation

Orthopnea

What is dyspnea when lying down, relieved by standing

Cerebral hypoperfusion

What advanced symptom of congestive heart failure can lead to hypoxic encephalopathy

Irritability, Loss of attention span, Restlessness

What are early symptoms of hypoxic encephalopathy

Diminished renal perfusion

What results from reduced ejection fraction, activating the RAAS

Salt and water retention with expansion of interstitial and intravascular fluid volume

What is the result of RAAS activation in LSHF

Prerenal azotemia (elevated blood urea nitrogen or BUN)

What may occur if kidney hypoperfusion becomes severe

Arrhythmia characterized by uncoordinated chaotic contraction of the atrium

What is AFib

Thrombosis and thromboembolic stroke

Stasis of blood in AFib increases the risk of what complications

Systolic failure

What type of failure is characterized by insufficient cardiac output due to pump failure, caused by disorders that damage or derange the contractile function of the LV

Diastolic failure

What type of failure has relatively preserved cardiac output at rest, but the LV is restricted in its ability to relax