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1. heart pathology; heart failure

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1. heart pathology; heart failure

  1. 1. Heart  OBJECTIVES  Normal  Effects of Aging on the Heart  Pathology Heart Failure Left-sided heart failure Right-sided heart failure  Congenital Heart Disease  Ischemic Heart Disease  Hypertensive Heart Disease 1 Dr. Krishna Tadepalli, MD, www.mletips.com
  2. 2. Heart  OBJECTIVES  Valvular diseases  Valvular degeneration caused by calcification  Myxomatous degeneration of the Mitral valve (Mitral valve Prolapse- MVP)  Rheumatic fever and rheumatic heart disease (RHD)  Infective endocarditis (IE)  Non-infected vegetations  Complications of artificial valves 2 Dr. Krishna Tadepalli, MD, www.mletips.com
  3. 3. Heart OBJECTIVES Carcinoid heart disease Cardiomypathies Myocarditis Pericardial disease Tumors of the heart Cardiac transplantation 3 Dr. Krishna Tadepalli, MD, www.mletips.com
  4. 4. Heart -Normal  Weight Male - 325 gm. Female - 275 gm.  Systole- ventricular contraction  Diastole- ventricular relaxation  Thickness Thickness (cm) LV RV Normal 1.5 0.5 Hypertrophy >2 >0.7 4 Dr. Krishna Tadepalli, MD, www.mletips.com
  5. 5. Heart -Normal  Normal  Hypertrophy = pressure overload  Dilation= volume overload 5 Dr. Krishna Tadepalli, MD, www.mletips.com
  6. 6. Heart -Normal  Normal  Histology  Specific Atrial Granules  Atrial Natriuretic Peptide (ANP )  Intercalated disks with Gap junctions  Clinical significance  Clinical significance  Arrhythmias  Arrhythmias  Due to electromechanical dysfunction  Due to electromechanical dysfunction  Due to Abnormal distribution of gap junctions  Due to Abnormal distribution of gap junctions 6 Dr. Krishna Tadepalli, MD, www.mletips.com
  7. 7. Heart -Normal  Normal = Blood Supply 1. Left anterior descending (LAD) 2. Left circumflex (LCX) arteries 3. Right coronary artery (RCA)  Clinical significance  Clinical significance  Most susceptible cardiac tissue to ischemic damage  Most susceptible cardiac tissue to ischemic damage Sub- endocardial myocardium Sub- endocardial myocardium  Cardiac chamber involved irrespective of specific vessel  Cardiac chamber involved irrespective of specific vessel 7 occlusion  Left Ventricle occlusion  Left Ventricle Dr. Krishna Tadepalli, MD, www.mletips.com
  8. 8. Heart -Normal  Normal = Effects of Aging on the Heart  Lambl excrescences = calcifications on aortic or Mitral valves  Atherosclerotic plaque  Clinical significance  Clinical significance  Lambl excrescences = confuse with stenosis  Lambl excrescences = confuse with stenosis 8 Dr. Krishna Tadepalli, MD, www.mletips.com
  9. 9. Heart - Pathology Heart Failure  Cardiomegaly = increased size of heart  Congestive Heart failure (CHF)  Failure to pump blood = systolic dysfunction  Compensatory hypertrophy & dilation  Types = LVF, RVF Cardiac hypertrophy 2 times the size (Left Ventricle) 3 times 4 times Condition pulmonary HTN & IHD Systemic HTN, AS, MR, DCM AR or HOCM 9 Dr. Krishna Tadepalli, MD, www.mletips.com
  10. 10. Heart - Pathology  Congestive Heart failure (CHF) Compensatory hypertrophy 10 Dr. Krishna Tadepalli, MD, www.mletips.com
  11. 11. Heart - Pathology LVF  Causes = IHD, HTN, Valvular ( Aortic, Mitral) and Myocardial diseases  Pathology & Clinical features are due to Pulmonary pooling of blood Decrease in systemic arterial flow  Morphology  Heart LV- hypertrophy LA enlargement → Atrial fibrillation→ Thrombus formation → Embolic stroke  Lungs = Dyspnea  Earliest and the cardinal congestion and edema-heavy, wet lungs Kerley's B lines on x-ray Siderophages or Heart failure cells 11 Dr. Krishna Tadepalli, MD, www.mletips.com
  12. 12. Heart - Pathology  Morphology  Kidneys = prerenal azotemia  Brain =Hypoxic encephalopathy What are these cells ? 12 Dr. Krishna Tadepalli, MD, www.mletips.com
  13. 13. Heart - Pathology RVF  Causes MCC= left-sided heart failure Rare =Pure right-sided heart failure ( seen in Pulmonary HTN & Cor pulmonale)  Morphology Liver and Portal System = nutmeg congestive hepatomegaly centrilobular necrosis cardiac sclerosis or cardiac cirrhosis Congestive splenomegaly Bowel - Chronic edema Ascites Kidneys- Congestion→ peripheral edema →azotemia Brain –like in LVF 13 Dr. Krishna Tadepalli, MD, www.mletips.com
  14. 14. Heart - Pathology  Clinically  Atelectasis due to Pleural and Pericardial effusions  Subcutaneous Tissue edema =Hallmark Dependent pitting edema Aanasarca -generalized massive edema 14 Dr. Krishna Tadepalli, MD, www.mletips.com
  15. 15. Heart – quick review  Sub-endocardial myocardium (adjacent to the ventricular cavities) - most susceptible to ischemic damage  Lambl excrescences – Due to aging  Selective up-regulation or re-expression of embryonic/fetal forms of contractile proteins in Hypertrophy- β-myosin heavy chain, ANP, Collagen  Compensatory changes in Hypertrophy  Pressure overload – Hypertrophy  Volume overload – Dilation & Hypertrophy 15 Dr. Krishna Tadepalli, MD, www.mletips.com
  16. 16. Heart – quick review  Left-sided heart failure  MCC - – IHD, HTN  Lungs in LHF – heavy & wet  Earliest and the cardinal complaint - Dyspnea  Orthopnea &Paroxysmal nocturnal Dyspnea (PND) – Severe forms of Dyspnea  Renal effects are counteracted by – ANP  Right-sided heart failure  MCC- left-sided heart failure  Liver in RHF Nut Meg Liver (congestive hepatomegaly) centrilobular necrosis cardiac sclerosis or cardiac cirrhosis  Hallmark of RHF - Subcutaneous Tissue edema 16 Dr. Krishna Tadepalli, MD, www.mletips.com

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