Ch12-Heart

Ch12-Heart - HEART THE HEART Normal Pathology Heart...

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HEART
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THE HEART Normal Pathology Heart Failure: L, R Heart Disease Congenital : L R shunts, R L shunts, Obstrustive Ischemic : Angina, Infarction, Chronic Ischemia, Sudden Death Hypertensive : Left sided, Right sided Valvular : AS, MVP, Rheumatic, Infective, Non-Infective, Carcinoid, Artificial Valves Cardiomyopathy : Dilated, Hypertrophic, Restrictive, Myocarditis, Other Pericardium : Effusions, Pericarditis Tumors : Primary, Effects of Other Primaries Transplants
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NORMAL Features 6000 L/day 250-300 grams 40% of all deaths (2x cancer) Wall thickness ~ pressure (i.e., a wall is only as thick as it has to be) LV=1.5 cm RV= 0.5 cm Atria =.2 cm Systole/Diastole Starling’s Law
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TERMS CARDIOMEGALY DILATATION, any chamber, or all HYPERTROPHY, and chamber, or all
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STRIATIONS NUCLEUS DISCS SARCOLEMMA SARC. RETIC. MITOCHONDRIA ENDOTHELIUM FIBROBLASTS GLYCOGEN A.N.P.
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S.A. Node AV Node Bundle of HIS L. Bundle, R. Bundle
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Anterior Lateral Posterior Septal
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VALVES AV: TRICUSPID MITRAL SEMILUNAR: PULMONIC AORTIC
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Sigmoid-shaped ventricular septum Decreased left ventricular cavity size Increased left atrial cavity size Chambers Buckling of mitral leaflets toward the left atrium Fibrous thickening of leaflets Mitral valve annular calcific deposits Aortic valve calcific deposits Valves Atherosclerotic plaque Calcific deposits Increased cross-sectional luminal area Tortuosity Epicardial Coronary Arteries Amyloid deposits Basophilic degeneration Lipofuscin deposition Brown atrophy Increased subepicardial fat Increased mass Myocardium CARDIAC AGING
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CARDIAC AGING Atherosclerotic plaque Elastic fragmentation and collagen accumulation Sinotubular junction calcific deposits Elongated (tortuous) thoracic aorta Dilated ascending aorta with rightward shift Aorta
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BROWN ATROPHY, HEART LIPOFUCSIN
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Pathologic Pump Possibilities Primary myocardial failure (MYOPATHY) Obstruction to flow (VALVE) Regurgitant flow (VALVE) Conduction disorders (CONDUCTION SYSTEM) Failure to contain blood (WALL INTEGRITY)
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CHF DEFINITION TRIAD 1) TACHYCARDIA 2) DYSPNEA 3) EDEMA FAILURE of Frank Starling mechanism HUMORAL FACTORS Catecholamines (nor-epinephrine) Renin Angiotension Aldosterone Atrial Natriuretic Polypeptide (ANP) HYPERTROPHY and DILATATION
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HYPERTROPHY PRESSURE OVERLOAD (CONCENTRIC) VOLUME OVERLOAD (CHF) LVH, RVH, atrial, etc. 2X normal weight ischemia 3X normal weight HTN >3X normal weight MYOPATHY, aortic regurgitation
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CHF: Autopsy Findings Cardiomegaly Chamber Dilatation Hypertrophy of myocardial fibers, BOXCAR nuclei
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Left Sided Failure Low output vs. congestion Lungs pulmonary congestion and edema heart failure cells Kidneys pre-renal azotemia salt and fluid retention renin-aldosterone activation natriuretic peptides Brain: Irritability, decreased attention, stupor coma
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Ch12-Heart - HEART THE HEART Normal Pathology Heart...

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