Overview of Heart Disease

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Questions and Answers

Which of the following is NOT a direct consequence of elevated back-pressures within the pulmonary circulation in the context of left-sided heart failure?

  • Myocardial hypertrophy (correct)
  • Pulmonary congestion
  • Pulmonary edema
  • Pleural effusion

In chronic left-sided heart failure, what is the primary mechanism underlying the formation of heart failure cells?

  • Direct breakdown of red blood cells in alveolar spaces due to the presence of cytotoxic substances
  • Breakdown of red blood cells by macrophages, leading to the formation of hemosiderin-laden macrophages (correct)
  • Direct leakage of red blood cells from capillaries into alveolar spaces due to increased hydrostatic pressure
  • Accumulation of white blood cells in alveolar spaces in response to inflammation

Which of the following is NOT a characteristic microscopic finding in the lungs of patients with acute left-sided heart failure?

  • Perivascular and interstitial transudates
  • Presence of numerous neutrophils in the alveolar spaces (correct)
  • Accumulation of edema fluid within alveolar spaces
  • Alveolar septal edema

How does the supine position contribute to orthopnea in patients with left-sided heart failure?

<p>It elevates the diaphragm, making it harder for the lungs to expand (A)</p> Signup and view all the answers

Which of the following valvular conditions can cause left-sided heart failure WITHOUT leading to left ventricular hypertrophy?

<p>Mitral stenosis (D)</p> Signup and view all the answers

The development of left atrial enlargement and an increased risk of atrial fibrillation in patients with left-sided heart failure is primarily attributed to:

<p>Increased blood flow through the left atrium due to the back-pressure from the lungs (D)</p> Signup and view all the answers

Which of the following statements correctly describes the histological features of myocyte hypertrophy in left-sided heart failure?

<p>Increased size of individual myocytes with interstitial fibrosis (B)</p> Signup and view all the answers

Which of the following clinical manifestations is characteristic of left-sided heart failure but NOT right-sided heart failure?

<p>Dyspnea on exertion (D)</p> Signup and view all the answers

What specific pattern, seen in a cut section of the liver, is characteristic of right-sided heart failure?

<p>Centrilobular congestion surrounded by pale, noncongested parenchyma (A)</p> Signup and view all the answers

What type of heart failure is typically associated with an enlarged spleen due to vascular congestion?

<p>Right-sided heart failure (B)</p> Signup and view all the answers

How does right-sided heart failure affect the morphology of the liver in long-standing cases?

<p>It can lead to the formation of cardiac cirrhosis due to fibrosis in the central areas of the liver. (B)</p> Signup and view all the answers

What is the primary cause of the increased burden on the right side of the heart in right-sided heart failure?

<p>Increased blood pressure in the pulmonary circulation (A)</p> Signup and view all the answers

What is the primary difference between the morphological effects of left-sided and right-sided heart failure on the liver?

<p>Left-sided heart failure causes congestion in the peripheral areas of the liver lobule, while right-sided heart failure causes congestion in the central areas. (D)</p> Signup and view all the answers

Which of the following is NOT a common feature of right-sided heart failure?

<p>Decreased cardiac output due to left ventricular hypertrophy (B)</p> Signup and view all the answers

What is the primary clinical consequence of chronic passive congestion and edema in the bowel wall associated with right-sided heart failure?

<p>Impaired absorption of nutrients and medications (A)</p> Signup and view all the answers

What condition is often referred to as cor pulmonale and is a primary cause of isolated right-sided heart failure?

<p>Pulmonary hypertension (B)</p> Signup and view all the answers

Which of the following is NOT a typical clinical manifestation of pure right-sided heart failure?

<p>Pulmonary edema (C)</p> Signup and view all the answers

How does right-sided heart failure contribute to the development of ascites?

<p>Increased hydrostatic pressure in the peritoneal cavity (A)</p> Signup and view all the answers

What is the primary reason why patients with right-sided heart failure may develop pitting edema in their feet and lower legs?

<p>Increased hydrostatic pressure in the capillaries of the lower extremities (C)</p> Signup and view all the answers

Which of the following statements accurately describes the difference between left-sided and right-sided heart failure in terms of clinical presentation?

<p>Left-sided heart failure primarily manifests with respiratory symptoms while right-sided heart failure primarily manifests with systemic symptoms (B)</p> Signup and view all the answers

What is the primary difference between the effusions associated with uncomplicated right-sided heart failure and those associated with combined left and right-sided heart failure?

<p>The protein content of the effusion is significantly higher in combined left and right-sided heart failure (B)</p> Signup and view all the answers

Which of the following conditions would likely lead to concentric hypertrophy due to pressure overload?

<p>Aortic stenosis (C)</p> Signup and view all the answers

What is the primary mechanism by which cardiac myocytes adapt to increased workload?

<p>Production of new myofibrils (A)</p> Signup and view all the answers

Which of the following is a major consequence of the compensatory hypertrophy that occurs in response to cardiac workload?

<p>Increased risk of ischemic injury (B)</p> Signup and view all the answers

Which of the following is the LEAST reliable indicator of hypertrophy in a heart experiencing volume overload?

<p>Increased ventricular wall thickness (A)</p> Signup and view all the answers

Which of the following types of exercise is MOST likely to have a beneficial impact on cardiac hypertrophy?

<p>Marathons (B)</p> Signup and view all the answers

Which of the following is the MOST common cause of left-sided heart failure?

<p>Ischemic heart disease (C)</p> Signup and view all the answers

What is the primary mechanism by which atrial natriuretic peptide (ANP) helps to balance the renin-angiotensin-aldosterone system?

<p>Promoting diuresis and vasodilation (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of physiologic hypertrophy induced by aerobic exercise?

<p>Increased heart rate (C)</p> Signup and view all the answers

Which of the following is NOT a manifestation of left ventricular failure?

<p>Pulmonary hypertension (D)</p> Signup and view all the answers

What is the primary mechanism responsible for the development of atrial fibrillation in chronic left ventricular failure?

<p>Stretch-sensitive ion channels in the atrial wall (D)</p> Signup and view all the answers

Which of the following is a direct consequence of the reduced atrial contribution to ventricular filling in atrial fibrillation?

<p>Decreased stroke volume (C)</p> Signup and view all the answers

What is the primary mechanism by which angiotensin-converting enzyme (ACE) inhibitors benefit patients with heart failure?

<p>All of the above (D)</p> Signup and view all the answers

The activation of the renin-angiotensin-aldosterone (RAA) system in heart failure ultimately leads to:

<p>Increased preload and afterload (D)</p> Signup and view all the answers

Which of the following is NOT a common pharmacologic approach for the management of heart failure?

<p>Antibiotics to treat bacterial infections (B)</p> Signup and view all the answers

In severe heart failure, diminished cerebral perfusion can lead to:

<p>Hypoxic encephalopathy (B)</p> Signup and view all the answers

What kind of heart failure involves the inability of the heart to relax and fill adequately?

<p>Diastolic failure (C)</p> Signup and view all the answers

Which of the following is NOT a common cause of systolic heart failure?

<p>Diabetic neuropathy (C)</p> Signup and view all the answers

Which of the following is TRUE regarding heart failure with preserved ejection fraction?

<p>It is often characterized by an inability of the heart to relax and fill effectively. (C)</p> Signup and view all the answers

In the context of heart failure, what does the Frank-Starling mechanism refer to?

<p>The heart's ability to compensate for reduced contractility by increasing its stroke volume through dilation. (B)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the role of the neurohumoral system in heart failure?

<p>The neurohumoral system compensates for decreased cardiac function by increasing heart rate, contractility, and vascular resistance. (A)</p> Signup and view all the answers

What is the primary consequence of inadequate cardiac output in heart failure?

<p>Increased venous congestion. (C)</p> Signup and view all the answers

Which of the following best illustrates the concept of backward failure in heart failure?

<p>Increased fluid buildup in the lungs. (B)</p> Signup and view all the answers

Flashcards

Heart Failure

A condition where the heart can't pump enough blood to meet the body's needs.

Systolic Failure

Inability to eject blood due to poor myocardial contractile function.

Diastolic Failure

Inability of the heart to relax and fill properly, preserving ejection fraction.

Preserved Ejection Fraction

Occurs when heart failure is present but left ventricular ejection fraction is ≥50%.

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Forward Failure

Inadequate cardiac output leading to insufficient blood supply to tissues.

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Backward Failure

Increased congestion in the venous circulation due to heart failure.

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Frank-Starling Mechanism

Increased filling volume enhances myocardial contractility, improving output temporarily.

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Neurohumoral Activation

Activation of systems that increases heart rate, contractility, and fluid retention in heart failure.

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Atrial Natriuretic Peptide

A hormone that balances the renin-angiotensin-aldosterone system via diuresis and relaxation of blood vessels.

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Myocardial Hypertrophy

Enlargement of cardiac myocytes due to increased workload, resulting in increased muscle mass.

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Concentric Hypertrophy

Thickening of the ventricular wall with unchanged chamber size, often due to pressure overload.

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Eccentric Hypertrophy

Dilation of the ventricle with increased chamber size, commonly seen in volume overload.

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Ischemic Injury

Damage to heart tissue due to insufficient blood supply, often related to hypertrophy.

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Pathologic Hypertrophy

Cardiac hypertrophy associated with increased mortality, often leading to sudden cardiac death.

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Physiologic Hypertrophy

Heart muscle adaptation due to regular aerobic exercise, improving capillary density and reducing heart rate.

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Left-Sided Heart Failure

A condition where the left side of the heart fails to pump blood effectively, leading to fluid backup.

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Left-sided CHF

A condition characterized by diminished systemic perfusion and increased pulmonary back pressure.

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Left ventricular hypertrophy

Enlargement and thickening of the heart's left ventricle often seen in heart failure.

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Mitral insufficiency

A condition where the mitral valve does not close properly, leading to backflow into the left atrium.

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Atrial fibrillation

An irregular and often rapid heart rate that can occur in the context of heart failure.

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Pulmonary congestion

Swelling and fluid buildup in the lungs due to left-sided heart failure.

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Dyspnea

Shortness of breath; often the first symptom of left-sided heart failure.

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Orthopnea

Shortness of breath when lying flat, relieved by sitting or standing.

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Heart failure cells

Macrophages in the lungs that contain hemosiderin due to previous pulmonary edema episodes.

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Paroxysmal Nocturnal Dyspnea

A sudden episode of severe breathlessness at night, often waking patients.

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S3 Heart Sound

A third heart sound indicating rapid ventricular filling, typically heard in heart failure.

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Mitral Regurgitation

Backward flow of blood from the left ventricle to the left atrium due to valve dysfunction.

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Thrombus Formation

Blood clots that can develop due to stasis, particularly in the atrial appendage.

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Renin-Angiotensin-Aldosterone Axis

Hormonal system activated in response to decreased renal perfusion, increasing blood volume.

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Cerebral Perfusion Issues

Reduced blood flow to the brain causing symptoms like irritability and diminished cognition.

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ACE Inhibitors

Medications that help heart failure by lowering blood pressure and reducing fluid retention.

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Right-Sided Heart Failure

A condition where the right side cannot pump blood effectively due to increased pressure in the pulmonary circulation.

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Cor Pulmonale

Right-sided heart failure caused primarily by lung disorders.

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Pulmonary Hypertension

Increased pressure in the pulmonary arteries leading to right heart issues.

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Congestive Hepatomegaly

Enlargement of the liver due to congestion from right-sided heart failure.

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Nutmeg Liver

Liver appearance with dark central areas due to passive congestion.

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Congestive Splenomegaly

Enlargement of the spleen due to increased portal vein pressure.

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Cardiac Cirrhosis

Fibrosis of the liver due to long-standing right-sided heart failure.

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Bowel Wall Edema

Swelling in the bowel walls due to chronic passive congestion.

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Pleural Effusion

Fluid accumulation in the pleural space due to heart failure, often low protein.

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Pericardial Effusion

Fluid accumulation around the heart caused by systemic congestion from right-sided heart failure.

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Ascites

Fluid accumulation in the peritoneal cavity, resulting from hepatic congestion and portal hypertension.

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Pitting Edema

Swelling that leaves an indentation when pressed, common in lower limbs during right-sided heart failure.

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Biventricular CHF

Heart failure affecting both right and left sides, showing symptoms of both types.

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Study Notes

Overview of Heart Disease

  • A wide range of diseases affect the cardiovascular system
  • Pathophysiologic pathways leading to "broken" heart can be distilled to six mechanisms

Failure of the Pump

  • Most common mechanism
  • Cardiac muscle contracts weakly, chambers cannot empty properly
  • Called systolic dysfunction

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