What is the #1 cause of death in the U.S
Heart Disease
What is the most common mechanism of heart disease
contractile (pump) failure
- Heart not pumping enough blood to supply the body
What is the most common cause of Heart Failure
Decreased cardiac output
- can also be caused by an increase in tissue demands
What causes decreased cardiac output
Systolic dysfunction, diastolic dysfunction and valvular dysfunction
Systolic dysfunction is when the heart will not relax which means it won’t fill enough
False, this is Diastolic Dysfunction
Systolic Dysfunction - is when there is weak contraction
Would pericardial tamponade cause diastolic or systolic dysfunction
Diastolic Dysfunction - it compresses the heart not allowing it to relax completely
______ occurs when the heart cannot generate sufficient output to meet the metabolic demands of the tissues
Congestive Heart Failure
Forward Failure (Insufficient output) is almost never combined with Backward Failure (Venous Congestion)
False, almost always combined
What is the adaptation in which the heart tissues will stretch in response to and increase in end diastolic volumes in order to increase contraction strength
Frank-Starling Mechanism
In the Frank-Starling Mechanism when in the patient said to be in “compensated heart failure”
When the dilated ventricle is able to maintain cardiac output
- this increases the oxygen demand of the heart muscles which it cannot keep up for a long time and will eventually lead to failure
What effect does norepinephrine have on heart rate
Increases HR,contractility and BP
What effect does the Renin-Angiotesin-Aldosterone System have on the heart
It initiates salt and water retention which increases vascular tone
What effect does ANP have on circulation
Vasodilation
Overload on the heart causes Cardiac Hyperplasia
False, Hypertrophy
Concentric Hypertrophy occurs when the ventricular wall thickness increases without an increase in size of the chamber
True
- Concentric is the bad kind - the walls grow in filling the ventricle
- this is a pathologic response
Eccentric Hypertrophy occurs when there is proportional dilation of the heart and a decrease in capillary denisity
False, Proportional dilation of heart and INCREASE in capillary density
- Cross section of ventricle remains the same
- this is a Physiologic Response
What are the most common causes of left sided heart failure
Ischemic Heart Disease (CAD)- Not enough blood to heart
Hypertension
Valve Disorders
Primary diseases of Myocardium (amyloidosis)
What occurs as a result of Left Sided Heart Failure
Decreased Cardiac Output and Pulmonary Edema
What are the symptoms associated with Left Sided Heart Failure
Dyspnea (shortness of breath) upon exertion, cough, Orthopnea (Dyspnea when recumbent), rales and tachycardia
Is right sided or left sided heart failure more common?
Left Sided
** Hardest working side fails first
Which sided heart failure will cause fluid back up into the lungs
Left
Right sided heart failure is usually the consequence of left sided heart failure
True
- left side causes fluid backup in the right side which puts stress on right side
What is the cause of Isolated right sided heart failure
Pulmonary Hypertension causing COR PULMONALE
In Isolated right sided heart failure does the problem typically originate in the lungs or in the heart
In the lungs/pulmonary Circulation (HTN)
Isolated right sided heart failure causes major pulmonary congestion
False, Minimal pulmonary Congestion
** Left sided heart failure causes Pulmonary Congestion
20% of birth defects are congenital heart disease, and prematurity increases risk
False, 30%
Which chromosomes are effected in Genetic Congenital Heart Disease
Trisomies 13, 18 and 21
in the embryological heart the right atrium communicates with the left atrium
True - through the Foramen Ovale
What percentage of congenital heart diseases are idiopathic?
90%
What is the most common congenital heart disease
Ventricular Heart Disease (42%)
- second most common @ 10% is Atrial Septal Defects
But together Septal Defects make up over half of Congenital Heart Disease Cases
What percent os congenital heart cases are caused by tetralogy of fallot
5%
What occurs in a congenital right to left shunt?
Blood bypasses the lungs and the baby’s appear “dusky blue” as a result of cyanosis
A Left to right Shunt occurs when blood bypasses the lungs
False, Left to Right means Left is forcing blood into Right/pulmonary circulation - causes right ventricular hypertrophy and Pulmonary Hypertension
Which type of shunt is most common, left to right or right to let
Left to right
* higher pressure coming from left forcing blood into right
What are the three main structural abnormalities in congenital heart failure
1) Right to Left Shunt
2) Left to right Shunt
3) Obstruction of Flow
ASD’s, VSD’s and PDA’s are examples of left to right shunts
True
What is the Most common cause of Cyanosis at birth
Tetralogy of Fallot
Tetralogy of fallot and transposition of the great arteries are examples of right to left or left to right shunts?
Right to Left
What are the 4 defects that make up tetralogy of fallot
1) Ventricular Septal Defect
2) Right Ventricular Outflow Obstruction
3) Overriding Aorta
4) Right Ventricular Hypertrophy
What condition is associated with the description of a “boot shaped heart”
Tetralogy of Fallot