Glossary of 11 - Pathology: Heart 1

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The base of the Heart faces __1__ and to the __2__
1. Superiorly
2. Right
Apex points __1__ and __2__
Left and Down
Base consists primarily of the ____
Left Atrium, part of RA and Proximal part of Great Vessels
The Apex consists of the _____
left ventricle
Female heart Weight = 1
Male weight = 2
female = 250-300 g
male = 300-350
Right side of heart contains this type of blood

Left contains this kind of blood
Right = venous

Left = Arterial
Tricuspid and Bicuspid valves each has something that the Pulmonary and Aortic Valves don't have. What is it?
Papillary Muscles

*all have Chordae Tendinae
Layer of Heart that has fat in it
2 classifications of Endocardium
1. Mural Endocardium = lining the cardiac chambers

2. Valvular = covering the valves
_______arrangement of myocytes is essential for the transmission of electrical impulses through the myocardium, and a synchronized contraction of cardiac chambers
2 surfaces of Pericardial Sac
Epicardium = lining the heart itself

Pericardium = surface facing the Epicardium
Occur at the ends of myocytes and maintain cell to cell cohesion
Intercalated Disks
Present at the intercalated disks and are low-resistence paths between cells that allow for rapid electrical spread of action potentials
Gap Junctions
Contractile unit of a Myocardial cell
Thick filaments of Sarcomere

Thin filaments of Sarcomere

Separates sarcomeres
Z line
Position of Myocardial nuclei

centrally located
Most common disturbance caused by MI
Electrical disturbance
Cell membrane of Myocardiocyte
Site of storage and release of Ca+ for excitation-contraction coupling
Sarcoplasmic Reticulum
Strength of contraction depends on...
initial length of cardiac myocytes

*max strength = 2.2 microns, anything longer causes weaker contractions
Troponin that is the Calcium binding regulatory protein
Troponin C
What do blood vessels in the Valves usually represent?
Angiogenesis due to BACTERIAL INFECTION = Valvular Endocarditis

*usually Valves contain no blood vessels
Effects of aging on the Heart Chambers
Left Atrial DILATION

Left Ventricle cavity reduction
Effects of aging on Valves
1. Dystrophic Calcification
2. Fibrosis
3. focal thickenings
Effect of aging on Coronary Arteries
4 effects of aging on the Myocardium

Brown Atrophy
Basophilic Degeneration
Explain Senile Amyloidosis
Amyloid is derived from proteins in blood -> gets deposited in myocardium but not removed -> builds up so much that myocytes can't contract/conduct well
3 Effects of aging on the Aorta
Dilation and Elongation
Elastic fragmentation
5 Mechanisms of Heart Failure

*What is most common?
1. Pump Failure****
2. Flow obstruction
3. Regurgitation of blood
4. Electric conduction disorders
5. rupture of circulatory system
are cJUN and cFOS oncogenic or Tumor suppressors?
Those with Hypertrophic Myocytes have these genes activated
Embryonic genes
-Beta-myosin heavy chain
-Skeletal alpha-actin

*allow for increased muscle activity
Consequences of Hypertrophy

increased demand for O2 -> relative ischemia -> death of myocytes -> fibrosis -> weakness of myocardium
What is Forward Heart Failure?
ischemia due to reduced Systolic output
What is Backward Failure?
congestion due to inadequate emptying of the heart chambers (stagnation of blood)
4 causes of Left Sided Heart Failure
1. Ischemic Heart Disease
2. Hypertension
3. Aortic/Mitral valve diseases
4. Myocarditis
Left Atrial Dilation due to LV failure can result in these 3 things (sequential)
Atrial Fibrilation -> blood is shoved about and can coagulate to form Thrombi -> Thrombi detach and form Emboli
2 syndromes that may have Congenital Heart Disease
Down Syndrome

DiGeorge Syndrome
Environmental causes of CHD's
Most likely cause of CHD's
Multifactorial effects of several genes, maternal, and environmental factors
Most common CHD
Ventricular Septal Defect (VSD)
Most common Cyanotic CHD
Tetralogy of Fallot
Most common type of Atrial Septal Defect
ASD secundum (ASD 2)
ASD 2 is a defect in the _______
Foramen Ovale
ASD Primum is adjacent to the _______ and is associated with deformities of the _____
AV valves

Mitral valve
ASD Sinus Venosus is located at the entry level of the __1__ into the __2__
1. Superior Vena Cava
2. Right Atrium
ASD-1 results embryonically from a defect in ______ development
Endocardial Cushion (associated with Down Syndrome)
Ventricular Septal Defect usually involves this part of ventricle
Membranous part of Septum (90%)

*muscular part = 10%
Large VSD's are usually in this part of ventricle

*small in Muscular part
Explain VSD
1. Left to Right shunt at first
2. With increased blood going from LV to RV to Lungs, Pulmonary HTN develops
3. Pulmonary HTN results in late Right to Left shunt
4. Mixing of RV blood into LV = LATE CYANOSIS
Reversal of the shunt from L-R to R-L is called?
Eisenmenger Syndrome
What is the Ductus Arteriosus?
In fetus allows venous blood to bypass the lungs (R->L shunt)

RV -> Pulmonary Artery -> Aorta
Patent Ductus Arteriosus is associated with _______
Congenital Rubella Syndrome
This closes PDA

This keeps PDA open

If the shunt reverses, unoxygenated blood enters the Aorta below the ______ resulting in Cyanosis in the _______
Subclavian Artery

Lower extremities
PDA presents with this type of murmur
Tetralogy of Fallot pathogenesis
1. Pulmonary Stenosis
2. RVH
3. Overiding Aorta
4. VSD
Tetralogy of Fallot Symptoms depend on the severity of _________
Pulmonary Stenosis
-Severe stenosis increases __1__ shunting and causes __2__
1. Right to Left
2. Cyanosis
Tetralogy of Fallot:
-Cyanosis occurs: 1
-compensatory __2__
1. soon after birth
2. polycythemia (high RBC's)
3. Clubbing of fingers/toes
4. Retarded growth
Explain Transposition of Great Vessels
Aorta receives blood from right side of heart

Lungs receive blood from left side of heart
What is required for compatibility of life with Transposition?
In Transposition, which has greater compatibility with life?
Two forms of Coarctation of the Aorta

Explain Infantile Coartation of Aorta
- Aortic arch and Ascending Aorta are markedly narrowed
- Ductus Arteriosus turns into PDA
-PDA serves as conduit for blood flow below the narrowing
-Head and Upper extremities are hypoxic
-Lower extremeties are Cyanotic
-High Mortality RATE
Explain Adult Coarctation of Aorta
-narrowing is opposite the Ductus Arteriosus which closes
-Hypertension in Upper Extremities and Head
-Notching of Ribs
-Low pressure in the Legs
-Symptomatic in ADULTHOOD
CHD's that cause Early Cyanosis (Blue Babies)
3 T's:
Tetralogy of Fallot
Transposition of Vessels
Truncus Arteriosus
Infantile Coarctation of the Aorta is associated with.....
Turner's Syndrome

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