1. heart pathology; heart failure

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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 Dr. Krishna Tadepalli, MD, www.mletips.com 1

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Transcript of 1. heart pathology; heart failure

Page 1: 1. heart pathology; heart failure

Heart Heart

OBJECTIVESNormal Effects of Aging on the HeartPathology

Heart Failure Left-sided heart failure Right-sided heart failure

Congenital Heart Disease Ischemic Heart Disease Hypertensive Heart Disease

OBJECTIVESNormal Effects of Aging on the HeartPathology

Heart Failure Left-sided heart failure Right-sided heart failure

Congenital Heart Disease Ischemic Heart Disease Hypertensive Heart Disease

Dr. Krishna Tadepalli, MD, www.mletips.com

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Page 2: 1. heart pathology; heart failure

Heart Heart

OBJECTIVESValvular 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 vegetationsComplications of artificial valves

OBJECTIVESValvular 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 vegetationsComplications of artificial valves

2Dr. Krishna Tadepalli, MD, www.mletips.com

Page 3: 1. heart pathology; heart failure

Heart Heart

OBJECTIVESCarcinoid heart disease CardiomypathiesMyocarditis Pericardial disease Tumors of the heart Cardiac transplantation

OBJECTIVESCarcinoid heart disease CardiomypathiesMyocarditis Pericardial disease Tumors of the heart Cardiac transplantation

3Dr. Krishna Tadepalli, MD, www.mletips.com

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Heart -NormalHeart -Normal

WeightMale - 325 gm.Female - 275 gm.

Systole- ventricular contractionDiastole- ventricular relaxationThickness

WeightMale - 325 gm.Female - 275 gm.

Systole- ventricular contractionDiastole- ventricular relaxationThickness

Thickness (cm) LV RV

Normal 1.5 0.5

Hypertrophy >2 >0.7

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Heart -NormalHeart -Normal

Normal

Hypertrophy = pressure overload

Dilation= volume overload

Normal

Hypertrophy = pressure overload

Dilation= volume overload

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Heart -NormalHeart -Normal

Normal HistologySpecific Atrial Granules Atrial Natriuretic Peptide

(ANP ) Intercalated disks with Gap junctions

Normal HistologySpecific Atrial Granules Atrial Natriuretic Peptide

(ANP ) Intercalated disks with Gap junctions

Clinical significance Arrhythmias

Due to electromechanical dysfunction Due to Abnormal distribution of gap junctions

Clinical significance Arrhythmias

Due to electromechanical dysfunction Due to Abnormal distribution of gap junctions

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Page 7: 1. heart pathology; heart failure

Heart -NormalHeart -Normal

Normal = Blood Supply

1. Left anterior descending (LAD)

2. Left circumflex (LCX) arteries

3. Right coronary artery (RCA)

Normal = Blood Supply

1. Left anterior descending (LAD)

2. Left circumflex (LCX) arteries

3. Right coronary artery (RCA)

Clinical significanceMost susceptible cardiac tissue to ischemic damage

Sub- endocardial myocardium Cardiac chamber involved irrespective of specific

vessel occlusion Left Ventricle

Clinical significanceMost susceptible cardiac tissue to ischemic damage

Sub- endocardial myocardium Cardiac chamber involved irrespective of specific

vessel occlusion Left Ventricle 7Dr. Krishna Tadepalli, MD, www.mletips.com

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Heart -NormalHeart -Normal

Normal = Effects of Aging on the Heart Lambl excrescences = calcifications on aortic or

Mitral valvesAtherosclerotic plaque

Normal = Effects of Aging on the Heart Lambl excrescences = calcifications on aortic or

Mitral valvesAtherosclerotic plaque

Clinical significanceLambl excrescences = confuse with stenosis

Clinical significanceLambl excrescences = confuse with stenosis

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Heart - Pathology 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

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

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Heart - PathologyHeart - Pathology

Congestive Heart failure (CHF) Compensatory hypertrophy

Congestive Heart failure (CHF) Compensatory hypertrophy

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Heart - PathologyHeart - PathologyLVF

Causes = IHD, HTN, Valvular ( Aortic, Mitral) and Myocardial diseases

Pathology & Clinical features are due to Pulmonary pooling of bloodDecrease in systemic arterial flow

MorphologyHeart

LV- hypertrophyLA enlargement → Atrial fibrillation→ Thrombus

formation → Embolic strokeLungs = Dyspnea Earliest and the cardinal

congestion and edema-heavy, wet lungsKerley's B lines on x-raySiderophages or Heart failure cells

LVFCauses = IHD, HTN, Valvular ( Aortic, Mitral) and

Myocardial diseasesPathology & Clinical features are due to

Pulmonary pooling of bloodDecrease in systemic arterial flow

MorphologyHeart

LV- hypertrophyLA enlargement → Atrial fibrillation→ Thrombus

formation → Embolic strokeLungs = Dyspnea Earliest and the cardinal

congestion and edema-heavy, wet lungsKerley's B lines on x-raySiderophages or Heart failure cells

Dr. Krishna Tadepalli, MD, www.mletips.com

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Heart - PathologyHeart - Pathology Morphology

Kidneys = prerenal azotemiaBrain =Hypoxic encephalopathy

MorphologyKidneys = prerenal azotemiaBrain =Hypoxic encephalopathy

What are these cells ?

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Heart - PathologyHeart - Pathology

RVFCauses

MCC= left-sided heart failureRare =Pure right-sided heart failure ( seen in Pulmonary

HTN & Cor pulmonale)Morphology

Liver and Portal System = nutmegcongestive hepatomegalycentrilobular necrosis cardiac sclerosis or cardiac cirrhosis

Congestive splenomegalyBowel - Chronic edema AscitesKidneys- Congestion→ peripheral edema →azotemiaBrain –like in LVF

RVFCauses

MCC= left-sided heart failureRare =Pure right-sided heart failure ( seen in Pulmonary

HTN & Cor pulmonale)Morphology

Liver and Portal System = nutmegcongestive hepatomegalycentrilobular necrosis cardiac sclerosis or cardiac cirrhosis

Congestive splenomegalyBowel - Chronic edema AscitesKidneys- Congestion→ peripheral edema →azotemiaBrain –like in LVF 13

Dr. Krishna Tadepalli, MD, www.mletips.com

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Heart - PathologyHeart - Pathology

Clinically Atelectasis due to Pleural and Pericardial effusions Subcutaneous Tissue edema =Hallmark

Dependent pitting edemaAanasarca -generalized massive edema

Clinically Atelectasis due to Pleural and Pericardial effusions Subcutaneous Tissue edema =Hallmark

Dependent pitting edemaAanasarca -generalized massive edema

14Dr. Krishna Tadepalli, MD, www.mletips.com

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Heart – quick reviewHeart – 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 HypertrophyPressure overload – HypertrophyVolume overload – Dilation & Hypertrophy

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 HypertrophyPressure overload – HypertrophyVolume overload – Dilation & Hypertrophy

15Dr. Krishna Tadepalli, MD, www.mletips.com

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Heart – quick reviewHeart – 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

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 edema16

Dr. Krishna Tadepalli, MD, www.mletips.com