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Cardiac Pathology Heart Failure, Ischemic Heart Disease and more

Cardiac Pathology Heart Failure, Ischemic Heart Disease and more. Cardiac Pathology Outline. Blood Vessels Heart I Heart II. Cardiac Pathology Outline. Blood Vessels Heart I Heart Failure Ischemic Heart Disease Hypertensive Heart Disease Congenital Heart Disease.

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Cardiac Pathology Heart Failure, Ischemic Heart Disease and more

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  1. Cardiac Pathology Heart Failure, Ischemic Heart Disease and more

  2. Cardiac Pathology Outline • Blood Vessels • Heart I • Heart II

  3. Cardiac Pathology Outline • Blood Vessels • Heart I • Heart Failure • Ischemic Heart Disease • Hypertensive Heart Disease • Congenital Heart Disease

  4. Cardiac Pathology Outline • Blood Vessels • Heart I • Heart Failure

  5. Heart failure Definition It is the pathophysiological process in which the heart as a pump is unable to meet the metabolic requirements of the tissue for oxygen and substrates despite venous return to the heart being normal or increased

  6. Preload Factors effecting heart pump effectiveness • Preload can be defined as the initial stretching of the cardiac myocytes prior to contraction.  • Preload, therefore, is related to the sarcomere length. • Preload is also related to the volume of blood in ventricles at the end of diastole • Depends on venous return • Depends on compliance

  7. Afterload • Force needed to eject blood into circulation • Arterial B/P, pulmonary artery pressure • Valvular disease increases afterload

  8. Heart Failure • End point of many heart diseases • Common! • 5 million affected each year • 300,000 fatalities • Heart can’t pump blood fast enough to meet the needs of the body • The heart can’t fill with enough blood or • The heart doesn’t have enough force

  9. Heart Failure • System responds to failure by • Releasing hormones (e.g., norepinephrine) • Frank-Starling mechanism • Hypertrophy • Initially, this works • Eventually, it doesn’t • Myocytes degenerate • Heart needs more oxygen • Myocardium becomes vulnerable to ischemia

  10. Heart Failure • Heart failure develops over time • Can affect right side of heart or both sides • Right-side heart failure occurs if the heart can't pump enough blood to the lungs to pick up oxygen. • Left-side heart failure occurs if the heart can't pump enough blood to the rest of the body. • Also known as Congestive Heart Failure

  11. Heart Failure (AKA-congestive heart failure) • Pathophysiology • Cardiac compensatory mechanisms • Tachycardia • Ventricular dilation-Starling’s law • Myocardial hypertrophy • Hypoxia leads to decreased contractility

  12. R L

  13. cyanosis pulmonary edema hepatomegaly Clinical consequences of left and right heart failure splenomegaly ascites peripheral edema

  14. Left Heart Failure • Left ventricle fails; blood backs up in lungs • Most Common Causes • Ischemic heart disease (IHD) • Systemic hypertension • Mitral or aortic valve disease • Primary heart diseases • Heart changes • LV hypertrophy, dilation • LA may be enlarged too (risk of atrial fibrillation)

  15. Left Heart Failure • Dyspnea (shortness of breath) • Orthopnea, paroxysmal nocturnal dyspnea too • Enlarged heart, increased heart rate, fine rales at lung bases • Later: mitral regurgitation, systolic murmur • If atrium is big, “irregularly irregular” heartbeat

  16. Right Heart Failure • Right-side heart failure may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck. • Right-side and left-side heart failure also may cause shortness of breath and fatigue • Leading cause of heart failure is due to diseases that damage the heart • Diabetes • High blood pressure • Coronary heart disease

  17. Right Heart Failure • Right ventricle fails; blood backs up in body • Most Common Causes • Left heart failure • Lung disease (“cor pulmonale”) • Failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart • Caused by long term hypoxia, ie. chronic bronchitis or obesity • Some congenital heart diseases • Heart changes • Right ventricular hypertrophy, dilation • Right atrial enlargement

  18. Right Heart Failure • Peripheral edema • Big, congested liver (“nutmeg liver”) • Big spleen • Most chronic cases of heart failure are bilateral

  19. Cardiomegaly/ventricular remodeling occurs as heart overworked> changes in size, shape, and function of heart after injury to left ventricle. Injury due to acute myocardial infarction or due to causes that inc. pressure or volume overload as in Heart failure

  20. American Heart Assn-Media files Animations

  21. Hepatic blood flow

  22. “Nutmeg” liver Nutmeg

  23. Symptoms

  24. Cardiac Pathology Outline • Blood Vessels • Heart I • Heart Failure • Ischemic Heart Disease • Hypertensive Heart Disease • Congenital Heart Disease

  25. Ischemic Heart Disease • Myocardial perfusion can’t meet demand • Usually caused by decreased coronary artery blood flow (“coronary artery disease”) • Four syndromes: • angina pectoris • acute MI • chronic IHD • sudden cardiac death • http://www.youtube.com/watch?v=22bDs8teiZA

  26. Angina Pectoris • Intermittent chest pain caused by transient, reversible ischemia • Typical (stable) angina • pain on exertion • fixed narrowing of coronary artery • Prinzmetal (variant) angina • pain at rest • coronary artery spasm of unknown etiology • Unstable (pre-infarction) angina • increasing pain with less exertion • plaque disruption and thrombosis

  27. Myocardial Infarction • Necrosis of heart muscle caused by ischemia • 1.5 million people have MIs each year • Most due to acute coronary artery thrombosis • sudden plaque disruption • platelets adhere • coagulation cascade activated • thrombus occludes lumen within minutes • irreversible injury/cell death in 20-40 minutes • Prompt reperfusion can salvage myocardium

  28. https://www.youtube.com/watch?v=zeS-0au8ij4

  29. Morphologic Changes in Myocardial Infarction

  30. Acute Myocardial Infarction

  31. MI: day 1, day 3, day 7

  32. Myocardial Infarction • Clinical features • Severe, crushing chest pain ± radiation • Not relieved by nitroglycerin, rest • Sweating, nausea, dyspnea • Sometimes no symptoms • Laboratory evaluation • Troponins increase within 2-4 hours and remains elevated for a week. • CK/MB increases within 2-4 hours, returns to normal within 72 hours.

  33. Myocardial Infarction • Complications • Contractile dysfunction • Arrhythmias • Rupture of muscle • Chronic progressive heart failure • Prognosis • Depends on remaining function and perfusion • Overall 1 year mortality: 30% • 3-4% mortality per year thereafter

  34. Rupture of papillary muscle after MI

  35. Cardiac Pathology Outline • Blood Vessels • Heart I • Heart Failure • Congenital Heart Disease • Ischemic Heart Disease • Hypertensive Heart Disease

  36. Hypertensive Heart Disease • Can affect either L or R ventricle • Cor pulmonale is RV enlargement due to pulmonary hypertension caused by primary lung disorders • Result: myocyte hypertrophy • Reasons for heart failure in hypertension are poorly understood

  37. Left ventricular hypertrophy (L) and cor pulmonale (R)

  38. Drugs • Chronotropic • Alters heart rate • Ionotropic • Alters myocardial contractility • Digitalis is a positive ionotropic drug • Diuretics • Loop – reduces sodium reabsorption • Thiazide – increases sodium loss , water loss • ACE Inhibitors • Nitrates • Induces NO release by vessels = vasodilation

  39. Cardiac Pathology Outline • Blood Vessels • Heart I • Heart Failure • Ischemic Heart Disease • Hypertensive Heart Disease • Congenital Heart Disease

  40. Congenital Heart Disease • Abnormalities of heart/great vessels present from birth • Faulty embryogenesis, weeks 3-8 • Broad spectrum of severity • Cause unknown in 90% of cases

  41. Congenital Heart Disease • Left-to-right shunts • atrial septal defects • ventricular septal defects • Patent ductus arteriosus • Right-to-left shunts • tetralogy of fallot • transposition of the great arteries • Obstructions • aortic coarctation

  42. Atrial Septal Defects • Initially, left-to-right shunt (asymptomatic) • Eventually, pulmonary vessels may become constricted (“pulmonary hypertension”), leading to right-to-left shunt (“Eisenmenger syndrome”) • Surgical repair prevents irreversible pulmonary changes and heart failure

  43. Ventricular Septal Defects • Most common congenital cardiac anomaly • Most close spontaneously in childhood • Small VSD: asymptomatic • Large VSD: big left-to-right shunt, may become right-to-left

  44. Patent Ductus Arteriosus • Ductus: allows flow from PA to aorta • Closes spontaneously by day 1-2 of life • Small PDA: asymptomatic • Large PDA: shunt becomes right-to-left

  45. PDA

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