CV pathology

HTN

BP > or equal to 140/90

- 2 separate occasions

- 2 weeks apart

PVR

diameter of a blood vessel

viscosity of blood

SBP

correlates with SV and aortic compliance

SV

determinants of ____

- preload

- afterload

- contractility of the heart

aortic compliance

determined by elasticity

- decreases with age

preload; contractility

causes of increased SBP

- increase in ____

- increase in _____

- decrease in compliance of the aorta

afterload

causes of decreased SBP

- decrease in preload

- decrease in contractility

- increase in _____

DBP

correlates with aortic blood volume

- during diastole

depends on:

- tonicity of smooth muscle in PVR

- blood viscosity

- heart rate

vasoconstriction; HR

causes of increases DBP

- _____ of PVR arterioles

- increase in blood viscosity

- increase in ____

vasodilation

causes of decreased DBP

- _____ of PVR arterioles

- severe anemia

- decrease in HR

increases

narrowing of the arterioles ____ PVR

SV; SBP

excess sodium increases plasma volume which increases ____ and ____

it also increases arteriolar vasoconstriction by having increased sodium in smooth muscles --> increases calcium mediated contraction and DBP

primary HTN

high blood pressure that has no known secondary cause

- 85% of cases

- genetically reduced sodium excretion (causes increased SBP and DBP)

- other factors: obesity, stress, smoking, increased Na+ intake, and lack of exercise

secondary HTN

15% of cases

Most common causes: drugs and renal/vascular causes

- pathology dependent on cause

2ndary HTN causes:

- adrenal diseases

- aortic disease

- drugs

- endocrine: thyroid

- pregnancy

- renal disease

- CNS

LVH

_____ is the most common complication of HTN

- high BP in aorta, left ventricle has to overcome

complications

_____ of HTN

- LVH

- MI (most common cause of death)

- atherosclerosis

- aneurysm

- cerebral infarcts

- retinopathy

urgency

hypertensive _____

- goal: stop organ damage

- symptoms: headache, SOB, nosebleeds, asymptomatic

emergency

hypertensive _____

- end organ damage

- results in: stroke, kidney failure, or MI

atherosclerosis

result of endothelial injury to muscular and elastic arteries

- leads to development of raised, yellow plaques that contain WBCs, foam cells, smooth muscle cells, and necrotic debris

risk factors

atherosclerosis ____ ____

- HTN

- diabetes

- smoking

- increased LDL

- C. pneumoniae infection

ischemic heart disease

interruption of arterial flow

- partial

- complete

- oxygen supply and demand imbalance

MOST COMMON: atherosclerotic narrowing of a vessel

- thrombosis

- vasospasm

LAD

"widow maker"

- anterior LV

- anterior 2/3 ventricular septum

- apex

RCA

posterobasal LV wall

posterior 1/3 ventricular septum

RV

AV and SA nodes

MI

most common cause of death in adults in the US

- atheromatous plaque ruptures

- necrotic tissue/subendothelial tissue exposed

- platelets swarm the area

- thrombus: held together by fibrin

unstable angina

chest pain at rest

- multiple atherosclerotic vessels

- disruption of plaques

chronic angina

AKA: stable angina

- exercise (activity) induced chest pain

- 10-20% develop unstable angina/MI within a year

- decreased coronary flow --> subendocardial ischemia

- muscle hypertrophy ---> subendocardial ischemia

chronic

causes of _____ angina

- MOST COMMON: atherosclerosis

- AV stenosis

- HTN with LVH

- cardiomyopathy

- cocaine

concentric hypertrophy

Pressure overload

increased wall thickness and expand cross sectional area of myocytes

dilated hypertrophy

volume overload

increased ventricular diameter and cell length and width increase

LVH

most common cause: HTN and L sided valvular disease

RVH

causes:

- LVF

- chronic lung disease

- mitral valve disease

- congenital heart disease (L --> R shunt)

cardiomyopathy

disease of the heart muscle

- noninflammatory

- no association with: HTN, congenital heart issues, valvular disease, coronary artery stenosis

manifestations

cardiomyopathy ____

- unexplained ventricular dysfunction

- HF usually unresponsive to digitalis

- ventricular enlargement

- ventricular arrythmia

dilated cardiomyopathy

MOST COMMON cardiomyopathy

- Four chamber hypertrophy and dilation (biventricular failure)

- unknown etiology

- alcoholism

- thiamine deficiency

- prior myocarditis

restrictive cardiomyopathy

infiltrative process

- stiffening of myocardium

- interferes with pumping

- amlyoidosis (deposition of amyloid in organs)

- biventricular failure

hypertrophic cardiomyopathy

genetic inheritance (autosomal dominant)

- hypertrophy of all walls

- asymmetric septal hypertrophy

muscles fibers are disoriented, tangled, and hypertrophied

L ventricular outflow obstruction leading to syncope or suden death

myocarditis

inflammation of the heart muscle

- biventricular heart failure

- young without comorbidities

- most common cause: viral

- chagas disease (sleeping sickness)

- diffuse myocardial degeneration

- necrosis with inflammatory infiltrate

infective endocarditis

infection of endothelial surface of the heart (innermost)

- mostly affects valves

- acute or subacute

- fevers/chills, new or changing murmur, cutaneous lesions

pathology:

- bacteremia (bacteria in blood)

- adhere to valves

- grow onto valves

endothelial damage

immune complex deposition (damage to valves and kidneys)

common cause: heroin use (IV)

rheumatic fever

ages 5-15

- around 20 days after infection

- group A strep causes

antibody mediated

mimicry- Abs cross react with human tissues

symptoms:

- migratory polyathritis

- carditis

- subcutaneous nodules

- erythema marginatum (C-shaped rash)

- sydenham chorea (involuntary movements)

mitral valve prolapse

most frequent valvular issue

- seen commonly in young women

- associated with Marfan, ehler-danlos, klinefelter syndromes

- usually benign and symptomatic

- myxoid degeneration of valve

- stretchign of posterior leaflet

- floppy cusp (parachute)

- during systole: prolapse into atrium, midsystolic click

mitral valve stenosis

most likely due to rheumatic heart disease

- F > M

- MV orifice narrows

- LA dilates and hypertrophies

symptoms:

- dyspnea and hemoptysis

- A fib

- pulmonary HTN

- dysphagia

- murmur: opening snap with early diastolic rumble

mitral valve regurgitation

incompetent closure of MV

- retrograde flow into LA

causes:

- rheumatic heart disease

- mitral valve prolapse

- infectious endocarditis

- papillary muscle damage

- left ventricular dilation (stretches valvular ring)

aortic valve stenosis

most common valve lesion in adults in the US

- calcifications

- congenital tricuspid aortic valve

- rheumatic heart disease (valve commissure fusion)

- LV outflow obstruction

- LVH

- CO decreased with exercise

angina with exercise

syncope with exercise

hemolytic anemia

murmur

aortic valve regurgitation

Incompetent valve allows blood to flow back into LV from Aorta during Diastole

Left ventricular failure

tricuspid regurgitation

Backflow of blood through incompetent tricuspid valve into RA

Causes:

- rheumatic heart disease (with mitral and aortic)

- carcinoid syndrome

- infective endocarditis in IVDA

- pulmonary HTN

- dilated cardiomyopathy

- RV MI

Symptoms:

- pulsating liver

- pitting edema

- ascites

- JVD

- murmur

pulmonary

the _____ valve is the most common cause of congenital malformation

- rarely rheumatic heart disease

- carcinoid syndrome

pulmonary valve regurgitation

stretching of valve ring

RVH (volume overload)

murmur

pulmonary valve stenosis

association with:

- CHF

- carcinoid

RVH

murmur: systolic ejection

aneurysm

stretch/dilation of arterial wall (can occur in veins)

diameter > 50% normal

Plaque formation

stretching of tunica media

false aneurysm

rupture of vessel wall

true aneurysm

dilation of vessel wall

thrombosis

intravascular mass attached to vessel wall

- injury to endothelium

- blood stasis

- hypercoaguable

embolism

detached mass (clot on the move)

- blood clots

- fat

- gas

- amniotic fluid

- tumor

heart failure

complex syndrome resulting from functional or structural impairment of ventricular filling or ejection of blood into the circulation

most common type: left-sided (lung symptoms)

most common cause of RHF: left-sided (systemic symptoms)

myxoma

most common primary cardiac tumor

- usually adults

- L atrium is most common

- benign

rhabdomyoma

most common primary heart tumor in infants and children

- association with tuberous sclerosis

- blood filled, arises from cardiac myocytes

metastatic tumors

more common than primary

- most common site: pericardium

ductus arteriosus

between pulmonary artery and aorta

- patent in fetus due to low O2 tension and prostaglandins

2-8

ductus arteriosus closes ___ to ___ weeks after birth and becomes the ligamentum arteriosum

24

foramen ovale closes in less than ____ hours

- between the R and L atria

patent ductus arteriosus

left to right shunt

associated with:

- congenital rubella

- respiratory distress syndrome

- transposition of great vessels

- tetralogy of fallot

manifestations:

- pulmonary HTN

- RVH

- reversal of blood flow

- late cyanosis

- murmur

congenital heart disease

most common heart disease in kids

increased incidence in premature newborns

no identifiable cause for most cases

Known causes:

- genetic-environmental

- primary genetic

- environmental

maternal risk factors:

- > 45 y/o

- previous child with congenital heart defect

- poorly controlled DM

- EtOH

- congenital infection

- ASA

- SLE

- phenytoin

atrial septal defect

F > M

most common congenital heart disease in adults

several anatomic variations

left to right shunt

most common cause: patent foramen ovale

associated with: fetal alcohol syndrome and down syndrome

ventricular septal defect

most common congenital heart disease

left to right shunt

most common defect: within intraventricular septum

Small: may close in 30-50% of cases

Large: pulmonary HTN and RHF

tetralogy of fallot

a congenital malformation of the heart involving four distinct defects

R to L shunt

- narrowing of pulmonary valve

- thickening of wall of right ventricle

- displacement of aorta over ventricular septal defect

- ventricular septal defect opening between the L and R ventricles

Tet-fits (hypoxemia due to crying, fever, anemia)

transposition of the great vessels

right to left shunt

due to abnormal embryonic development of septa

aorta arises from R ventricle

pulmonary artery from L ventricle

atria are normal

compensatory anomaly: keep PDA

congenital coarctation

narrowing of the aorta

extensive collaterals formed

dilation of intercostals

HTN in upper extremities and cerebrals

notching on ribs

if severe --> CHF

acquired coarctation

more common in children

constriction of the aorta distal to the ligamental arteriosum

blood flow proximally increases

blood flow distally decreases

associated with bicuspid AV valve

BP in UEs increased

aortic dilation

cerebral BF increases (increased risk for berry aneurysms)

decreased renal BF (RAA kicks in --> HTN)

leg claudication