1. Congenital Defect:
    right to left shunt
    • non-oxygenated blood away from the pulmonary circuit and into the systemic circulation
    • reducing the oxygen saturation of the aterial blood
    • causing immediate cyanosis
  2. cynosis
    bluish discoloration of the skin due to accumilation of reduced hemoglogin in capillary beds and seen most readily around lips and nail beds
  3. Congenital Defects:
    Left to right shunt
    • divert oxygenated blood from the systemic circulation
    • depriving the systemic tissues of oxygen
    • excess blood flowing throught the pulmonary circulation produces a pulmonary hypertension
  4. Congenital Defects:
    Obstruction disorders
    physical barriers to blood flow and generally do not cause cyanosis
  5. Atherosclerosis
    a slow progressive disease of the large elastic and large and medium sized muscular arteries characterized by the formation of atherosclerotic plaques
  6. Non-alterable factors of Atherosclerosis
    • age (increase with age)
    • sex (male, until menopause)
    • race (caucasion)
    • genetic predisposition
  7. Major risk factors for atherosclerosis
    • smoking
    • hyperlipidemia
    • hypertension
    • diabetes mellitus
  8. Minor risk factors for atherosclerosis
    • physical activity
    • stress
    • behavior patterens
    • obesity
    • long term oral contraceptive use

  9. chylomicrons
    • primarily transports dietary triglycerides
    • in the body for 2 hours after you eat
  10. beta lipoproteins
    • low density lipoprotein
    • LDL
    • bad cholesterol
  11. pre-beta lipoprotein
    • very low density lipoprotein
    • VLDL
    • triglycerides- to the liver
  12. alpha lipoprotein
    • high denisty lipoprotein
    • more cholestrole than triglycerides
    • good cholesterol
  13. Receptor pathway
    Liver cells have specific cell surface receptors that bind to LDL, and removes it by excreting it through the bile
  14. Phagocytic (receptor independent) pathway
    cells of macrphages contain modified LDL, can not excrete through the bile, so the HDL helps to excrete it through the bile
  15. xanthomas
    • form when high levels of phagocitic cells for cholesterol
    • little bumps on the skin, expression of hyperlipidemia
  16. Sign of hyperlipidemia: Familial hyperlipidemia
    dietary excess
    excessive caloric intake, excessive dietary cholesterol, and saturated fatty acids
  17. Fatty streaks
    • fatty yellow streaks on the inner surface of vessels
    • they are the fist sign of atherosclerosis
  18. Atherosclerotic plaques
    • multifocal asymmetric elevations of the vessel linning
    • will induce thrombosis
  19. fibrous plaques
    • hard
    • formed by larde amount of collagen
  20. atheromatous
    • soft
    • made with abundant lipid material
  21. LDL/ HDL ratio
    • > 4:1 high
    • <1:4:1 border
    • <3:1 good
  22. Ischemis Heart Disease
    • results from an imbalance between the metabolic demand of the heart for oxygen and the amount available
    • decrease Oxygen in the heart
  23. Reasons for low availability of Oxygen to the heart (ischemic heart disease) is
    • decrease coronary flow (atherosclerosis)
    • increased metabolic demand (tachycardia{infections/ exersice} pregnacies)
    • decreased saturated hemoglobin (anemia, hemoglobinopathy, carboxyhemoglobin, right to left shunts)
  24. Types of Ischemic Heart Disease
    • angina pectoris
    • myocardial infarction
    • sudden cardiac death
  25. ischemic Heart Disease
    -Angina pectoris
    • symptoms: Chest discomfort or neck, left jaw, left shoulder, left arm
    • Stable: predicable, like when you work out or do physical labor and you know you will have chest pain
    • Unstable: first time you have the attack
  26. Ischemic Heart Disease
    -myocardial infarction
    • 60% deaths related to IHD
    • exclusion of blood flow due to the athersclerosis and thrombus ( most common location is left anterior descending coronary artery)
    • risk is dependent on the material of the plaque not the size
  27. Complications of myocardial infarcts
    • cardiac arrhythmias 90%
    • left ventricualr dysfunction
    • mural thrombosis/ embolization
    • ruputre
    • ventricular aneurysm
  28. Laboratory result for myocardial infarction
    • CPK- during the first 24 hours
    • Troponin- serum when muscle necrosis
    • Myoglobin- serum LDH which persist for 7-12 days
  29. Modes for interventino for myocardial infarction
    • thrombolytic theraby- clot busting drug
    • angioplasty- balloon/ stent
    • coronary bypass- for sever cases
  30. Ischemic heart disease
    - sudden cardiac death
    death quickly after the even
  31. Chronic Ischemic Heart Disease
    • slow
    • diffuse myocarial atrophy, spotty loss of myocardial cells, diffuse fibrosis, and possible scarring from previous infarcts
  32. stenosis in vascular disease
    • failure of a vlave to open
    • obstruction of forward flow
  33. insufficiency of vascular disease
    • inability of a valve to close
    • allows backward flow
  34. Rheumatic Heart Disease
    • inflammatory disease
    • streptococci (strep throat)
    • more common in children
    • Main sympotms (migratory polyarthritis and carditis)
  35. pericarditis
    • friction rub
    • bread and butter appearance
  36. myocarditis
    • inflammation of the myocardium
    • may lead to arrhythmias
  37. endocarditis
    • this is the most crippling and destructive aspect of the disease
    • occurs in the heart valves (primarily the MV)
  38. Rheumatic Heart Disease
    • cardiac failure
    • mural thrombosis and embolication
    • bacterial (infective) endocarditis
  39. Calcific Aortic Stenosis
    • no fusion of the valves
    • obstructs the flow through the valves
    • most often seen in elderly patients and may be a result of wear and tear
  40. Mitral Valve Prolapse
    • more frequent in your women
    • enlarged mitral leaflets
    • most patients are asymptomatic (severe is chordal rupture)
  41. Infective Endocarditis
    • vegetations
    • thrombi with embedded bacteria
  42. Infective Endocarditis
    -Acute endocarditis
    • Staph
    • seen in IV drug users or severe alcholoics
    • usually no underlying heart problems
    • high virulence
    • bulky vegitation
    • acute onset
    • high mortality
  43. Infective Endocarditis
    -Subacute Endocarditis
    • hearts usually have some underlying heart disease
    • usually occurs in the mitral valve and aortic valve
    • streptococcus viridans
    • low virulence
    • insidious onset
    • better prognoses
  44. Myocardial Heart Disease
    -Hypersensitive Heart Disease
    • (blood pressure >140/90)
    • cardiac volume output and the peripheral arteriolar resistance
    • in the absence of any other abnormality that might produce left ventricular hypertrophy (i.e. valve disease) this is the identifying hallmark of hypertension
    • heart failure, stroke, renovascular disease and or vascular complications
  45. Myocardial Heart Disease
    • most common in infants, pregnant women and immonosuppressed patients
    • viral
    • heart becomes flabby and soft
    • usually resolves in 6-8 weeks
  46. Myocardial Heart Disease
    • Dialated (congestive)
    • --dialation and hypertrophy of all the chamber of the heart
    • Hypertrophic (obstructive)
    • --usually a family history
    • --disproportional hypertrophy of the interventricular septum with myofiber disarray
    • --aortic outflow obstruction and mitral insufficiency
    • --angina, syncope, dyspnea
    • --obstruction of the left ventricular outflow tract
    • Restructive/ infiltrative
    • --restriction of ventricular filling
    • --stiffening of the muscle, not allowing it to dialte or contract
  47. Pericardial Disease
    • Acute
    • -irriation of the pericardium
    • -(serous, fibrinous, suppurative, hemorrahgic)
    • -prevent venous blood from reentering therefor decrease cardiac output (caridac tamponade)
    • Chronic
    • -adhesive or constructive (harden)
  48. Vascular Disease
    -Aortic Aneurysms
    • Abdominal- result from atherosclerotic weaking, leave until >5cm
    • Thoracic- more symptomatic
    • -Cystic medial necrosis- majority of the aneurysms (no known etiology)
    • -syphilis- near the arch or ascending aorta
  49. Vascular disease
    -Aortic dissection
    • tearing of the inner liner of the aorta (transverse tear)
    • hypertension is frequenlty an associated condition
    • retrograde dissection, rupture into the pericardial cavity and cardiac tamponade
  50. Vascular Disease
    -Peripheral vascular disease
    • atherosclerotic plaque
    • often as a complication of diabetes
    • eventual ulceration and gangrenous necrosis of the sking and underlying tissues
  51. Vascular Disease
    -Varicose veins
    • appartent with increasing age, especially females
    • gravitational effects
    • valve insufficiency
    • stasis dermatitis and chronic ulcerations (because not enough oxygen in the tissue)
Card Set
Cardio Pathology