Systems Path Heart

what happens when heart can't meet demands (MC) or increased tissue command occurs results in cognition "backing up" in pulmonary and systemic circulation

heart failure (CHF)

heart failure symptoms

dyspnea, fatigue, orthopnea, tachycardia

how does CHF occur?

increased tissue congestion and complications due to compensations

who gets CHF?

older individuals or those that have had MI (and other risks)

causes of CHF

history of MI, HTN, CAD

Systolic dysfunction (CHF) results in

weak contraction

diastolic dysfunction (CHF) results in

failed relaxation

valvular dysfunction (CHF) results in

failure to effectively seal

forward failure (CHF) results in

insufficient output

backward failure (CHF) results in

congestion

forward failure is almost always accompanied by what?

backward failure (impacts virtually every organ)

The greater the stretch, the stronger is the heart's contraction.

Result is increased output

Cost is increased O2 and tension

frank-starling law

which neurohumoral mechanism increases HR and contractility?

NE

which neurohumoral mechanism causes diuresis and vasodilation?

ANP

structural changes associated with compensated heart failure

cardiac hypertrophy

cost is increased O2 consumption

what type of cardiac hypertrophy is pathologic resulting in increased pressure (HTN/valve stenosis)

concentric hypertrophy

what type of cardiac hypertrophy is physiologic and causes increased volume, bradycardia, and increased capillary density

eccentric hypertrophy

causes of left sided heart failure

HTN, CAD, valve disorders, cardiomyopathies

effects of left-sided heart failure

left ventricle hypertrophies, gradual decreased cardiac output (causing pulmonary edema), cough, dyspnea, rales, orthopnea, tachycardia

left ventricle decreased output and hypertrophy, increased pulmonary HTN

left-sided heart failure

how does left-sided heart failure occur?

prior damage to left side of heart from MI/cardiomyopathies

who gets left-sided heart failure?

those with previous complications

causes of left-sided heart failure

history of CAD, HTN, cardiomyopathies and MI

what is the MC cause of right-sided heart failure?

left sided heart failure

what is right ventricle pump failure, MC from left heart failure but also from lung pathologies?

right-sided heart failure

how does someone get right-sided heart failure?

increase pressure in pulmonary circulation -> hypertrophy

who gets right-sided heart failure?

those with hx of left heart failure or lung pathologies

when heart is overloaded by increased pressure

hypertensive heart disease

types of hypertensive heart diseases

systemic and pulmonary

left ventricle overworked by increased HTN

systemic hypertensive heart disease

complications associated with systemic hypertensive heart disease

CHF, arrhythmia, stroke, renal failure

how does systemic hypertensive heart disease occur?

hypertrophy of left ventricle not accompanied by increased blood supply

who gets systemic hypertensive heart disease?

those with history of HTN (African Americans)

possible causes of systemic hypertensive heart disease

stress, high sodium, low physical activity, atherosclerosis

right sided heart disease due to a lung pathology causing right ventricular hypertrophy

pulmonary hypertensive heart disease

acute pulmonary hypertensive heart disease is associated with what?

large PE (saddle embolism) which obstructs pulmonary a.

chronic pulmonary hypertensive heart disease is associated with what?

prolonged lung pathology

what accounts for 30% of all birth defects ranging from mild to severe/lethal?

congenital heart disease

risks associated with congenital heart disease

prematurity, trisomies, teratogens, material diabetes, fetal infection

left-to-right shunts

VSD, ASD, PDA

right-to-left shunts

tetralogy of fallout, transposition of great arteries

examples of obstructed flow causing CHD

valve stenosis, aortic coarctation

MC congenital heart defect (left-to-right shunt in ventricles)

ventricular septal defect

how does VSD occur?

increased pressure on R side of heart and pulmonary circulation

2nd MC congenital heart defect (left to right shunt in atria)

atrial septal defect

congenital malformation involving four distinct heart defects (right to left shunt)

tetralogy of fallot

the defects associated with tetralogy of fallot

VSD, pulmonary valve stenosis, overriding aorta, R ventricular hypertrophy

tetralogy of fallot is the MC congenital heart disease to cause ________

cyanosis

tetralogy of fallot is characterized by a ______ - shaped heart

boot

how does tetralogy of fallot occur?

4 malformations -> deoxygenated blood to be pumped into circulation -> cyanosis

swapped aorta and pulmonary trunk which is "incompatible with postnatal life" if no intervention is done = cyanosis + death

transposition of the great arteries

with transposition of the great arteries, the right ventricle is connected ->

aorta

with transposition of the great arteries, left ventricle is connected ->

pulmonary artery

how does transposition of the great arteries occur?

R ventricle pumps deoxygenated blood into systemic circulation

congenital narrowing of aorta

aortic coarctation

who is most likely to get an aortic coarctation?

males, turner syndrome

what type of aortic coarctation is associated with PDA and causes shunting of blood from pulmonary trunk to aorta

infantile (pre-ductal)

infantile aortic coarctation causes what?

cyanosis, hypoxia, R ventricular hypertrophy

what type of aortic coarctation is associated with the ligamentum arteriosum, MC asymptomatic, and causes increased BP in head/upper extremities but lower BP in lower extremities/kidneys

adult (post-ductal)

how does aortic coarctation occur?

narrowing restricts flow to lower extremities

group of conditions following ischemia

ischemic heart disease

ischemia to heart causes infarction after how long?

20-40 minutes

what is associated with 90% of IHD cases?

CAD

progression of IHD causes what?

fatty streaks, atheroma, luminal stenosis, thrombosis

acute cardiac syndromes (caused by sudden and significant ischemia)

angina pectoris, acute MI, sudden cardiac death, chronic IHD->CHF

(stable) cardiac chest pain that is a result of ischemia associated with a 70% occluded coronary artery with exertion substernal chest pain, back, jaw, left arm and shoulder pain which responds to rest and vasodilators

stable angina pectoris

how does stable angina pectoris occur?

slow growing atherosclerotic plaques causing stenosis

risk associated with developing angina pectoris (both types)

poor diet, ↓ exercise, dyslipidemia, smoking

(unstable) cardiac chest pain that is a result of ischemia associated with 90% occluded coronary artery with or without exertion, not improved by rest or vasodilating meds

unstable angina pectoris

how does unstable angina pectoris occur?

acute plaque disruption with significant and acute clotting of vessel

what is associated with angina pectoris in females?

nausea, dizziness, back pain, "discomfort" in lower chest/epigastric region, dyspnea and fatigue

myocardial cell death due to ischemia

myocardial infarction (MI)

how does someone get a MI?

acute plaque disruption with significant/acute clotting of vessel

artery MC involved in a MI

left anterior descending

risk associated with myocardial necrosis

HTN, smokin, CHF, diabetes, males age 40-60, postmenopausal females, sickle cell disease, amyloidosis

symptoms of MI

"crushing" pain, intense pressure, thready pulse, dyspnea, nausea, sweaty

cardiac markers

troponin, CK-MB, myoglobin

progressive heart failure, secondary to ischemic damage due to past MI or long-term CAD

chronic ischemic heart disease

sudden sustained arrhythmia leading to pump failure and death

sudden cardiac death (SCD)

MC cause of SCD

ischemic injury (CAD)

how does someone get SCD?

interruption of normal heart rhythm leading to systole or v-fib

who/why does someone get SCD?

Hx. of MI leading to fibrosis of heart, cardiomyopathies

chest wall trauma induced arrhythmia which causes SCD and is 50% lethal

commotion cordis

who does commotio cords occur in?

younger male athletes with underdeveloped chest

valvular heart diseases

stenosis, insufficiency, murmur

narrowing of heart valve, failure to open (calcification or fibrosis)

stenosis

failure of heart valve to close

insufficiency (aka regurgitation or incompetence)

turbulent flow through diseased valve

murmur

turbulence causing palpable vibration in heart

thrill

Mc cause of aortic valve stenosis

calcific aortic stenosis

symptoms of the early stages of calcific aortic stenosis

asymptomatic, murmur, decreased cardiac output

symptoms of late stages of calcific aortic stenosis

left ventricular hypertrophy, Ca+-> severe stenosis

who is most likely to get calcific aortic stenosis ?

70-80 or younger with bicuspid aortic valve

risks associated with calcific aortic stenosis

HTN, infection/inflammation, increased cholesterol, bicuspid aortic valve

inflammatory valve disease 2-3 weeks after group A beta hemolytic strep infection NOT active bacterial infection

rheumatic valve disease

how does rheumatic valve disease occur?

immune cross reactivity due to molecular mimicry causing left side valve damage (mitral) and potential valve fusion

who is most likely to get rheumatic valve disease?

5-15 + untreated strep throat

why would someone get rheumatic valve disease?

untreated group A beta hemolytic strep

symptoms of rheumatic valve disease

fever, carditis (children), migratory polyarthritis (adults), Sydenham's chorea, skin rash

skin rash associated with rheumatic fever

erythema marginatum