Cor Pulmonale refers to conditions in which there is dysfunction of the right side of the heart as a result of pulmonary disease, where pulmonary hypertension develops, leading the the failure of the right side of the heart
NOTE: Right sided failure that is the result of left sided failure is NOT Cor Pulmonlae
2. Pulmonary hypertension causes an increased workload on the right ventricle
3. Hypertrophy of the right ventricle as a result in increased work load and the increased pressure that needs to be generated to overcome the increased pulmonary pressures
4. Failure of the right ventricle
1. Alveolar hypoxia/acedemia that will lead to vasoconstriciton
2. Emphysema, intersitital lung disease, and pulmonary thromboembolism
3 . Increased blood viscocity that is associated with sickle cell disease and polycythemia vera
Actue Cor Pulmonale is mainly associated with right ventricular dilation
REMEMBER: Acute Cor Pulmonale is mainly associated with a pulmonary embolism
1. Chronic Cough
2. Shortness of breathe and easy fatigueability
3. Pitting edema of the ankles and legs
Non pitting edema will not hold an indentation after pressure is applied to it, and non pitting edema is mainly associated with disorders of the lymphatics and it responsive to diuretic therapy
2. Mitirial valve disease
3. Congential Heart Disease
The kindeys in a person that suffers from malignant hypertension will develop petichiae, giving them the appearance that they have been bitten numerous times by fleas
REMEMBER: Malignant hypertension is defined as a diastolic pressure that remains above 110 mmHg
2. Hypertrophic Cardopmyopathies
3. Restrictive Cardiomyopathies
REMEMBER: NONE of these conditons will present with chest pain
REMEMBER: NO CHEST PAIN!
3. Coxsacheivirus Infection
4. Cocaine Use
5. Doxarubincin Use
REMEMBER: Dilated cardiomyopathies will present with a decreased ejection fraction due to the dilation of all 4 cardiac chambers. It IS NOT associated with chest pain.
REMEMBER: NO CHEST PAIN
REMEMBER: This disease is the result of defective beta myosin heavy chain, leasing to hypertophy of the heart because it will need to work harder to pump blood through the body.
The heart will hypertophy and will eventually fail if this condition is not treated.
Result in a decreased ejection fractions
Classic patient is a young adult who suddenly collapses while playing a sport
Present with a banana shaped heart
REMEMBER: This will cause S4
REMEMBER: This disease does NOT present with chest pain. RESTricitive indicates that there is a problem at REST (Diastole), AKA the heart does not fill appropriately due to the loss of compliance.
Antibodies will be formed to the M protein, the virulence factor of the strep pyogenes bacteria.
The antibodies will clear the infeciton from the throat, but then will attack the myocardial cells of the heart, causing granolomatous inflammation and the formaton of Aschoff bodies
REMEMBER: Because this disease is the result of soluable antibody complexes, it is classified as a type 2 hypersensitivity reaction
REMEMBER: The soluable antibodies that were developed for the M protein of strep pyogenes will attack the myocardial cells of the heart. This will result in the formaiton to Aschoff bodies and damage to the heart tissues
REMEMBER: These are formed via a type 2 hypersensitivity reaction
Rheumatic heart disease occurs not as a result of a strep pyogenes infection, but as a result of rheumatic fever, when the immune system will attack the myocardium AND the valves.
<3 Disease (myocarditis) Nodule formation Erythema Marginatum Sydenham Chorea/Sore Throat/Strep infection REMEMBER: Females are more likely to present with Chorea than males
REMEMBER: Strep Pyogenes is a gram positive, bacitracin sensitive (differentiating factor from GBS), beta hemolytic catalase negative organism.
It is associated with the formation of Rheumatic Fever via a type 2 hypersensitivity reaction.
Thickening of the Chordae tendenae
REMEMBERL The aortic valve is the secondly most afffected valve followed by the tricuspid valve. The aortic valve is almost never affected in this disease
REMEMBER: C reactive protein is made in the liver. It is most likely associated with the induction of IL6, which will then increase the C reactive protein
REMEMBER: C reactive protein is made in the liver
REMEMBER: disease that are associated with increased IL6 and therefore increased C reactive protein are Arthritis, Acute Inflammation, Atherosclerosis, Alzheimers, Aging, Diabetes, and Cancer
While Impetigo Contagiosum is caused by strep pyogenes, it is more likely to cause post strep glomerulonephritis (hematuria, htn, and oliguria) and not rhematic fever
Presents as a midsytolic click
More common in females
REMEMBER: Mitirial Valve prolapse is also a common condition in people that suffer from Marfans syndrome
Murmur is heard in the 5th intercostal space on the midclavicular line
REMEMBER: Strep Viridians is a gram postive, alpha hemolytic, non-optochin sensitive (differentiation from strep pneumo) organism that like to attack damaged hearts
REMEMBER: Marfans syndrome is a autosomal dominant conditon that commonly affects males. It is a result of a defect in fibrillin, which causes problems with the formaiton of connective tissues. These individuals are also at a high rish of disseciton of the ascending aorta.
REMEMBER: This defect occurs in the septum that separates the right and the left atrium. Originally, it is a left to right shunt, meaning that blood will flow from the left atrium to the right atrium. Because the blood in the left atrium is oxygenated, there are typically no clinical symptoms of this disease until the shunt becomes a Right to Left shunt as a result of right sided hypertrophy and therefore an increase in the right sided pressure. Once this occurs, patients will present with right sided failure symptoms, pulmonary edema, and arrythmias
A hole opens between then right and the left atrium, allowing blood to be shunted from the left atrium to the right atrium. Originally, this is classified as a left to right shunt, because the pressure gradients force the blood to move from the high pressure left atrium to the low pressure right atrium. As the right atrium is continuously overloaded with fluid, it will begin to hypertrophy, and the pressure will rise, causing the shunt to convert to a right to left shunt. This will allow blood to bypass the pulmonary circulation, and will also cause an overload of the left side of the heart, resulting in pulmonary edema, cyanosis, and arrythimas to develop.
REMEMBER: Normally, emboli will be filtered out in the lungs, but a defect will allow the emboli to bypass the lung and therefore not be filtered from the circulation.
REMEMBER: VSD is the formation of a hole in the septum that separates the left and the right ventricles. Orginally, because the ventricles are almost at equal pressures, there is a slight left to right shunt, but this does not cause clinical significance. Over time, if the pressure on the right side increases, the shunt may change into a right to left shunt, and therefore cyanosis may develop in the patient
REMEMBER: You will also hear fixed splitting of S2
REMEMBER: In utero, the ductus arteriosus allows blood to bypass the lungs, by having blood pass into the aorta from the pulmonary arteries. When the baby is born, the pressures will change and the blood will shunt from the aorta into the pulmonary arteries. As time goes on though, the pulmonary resistance will increase and obstructive pulmonary disease will cause the blood to reverse flow and travel from the pulmonary arteries into the aorta
A comminicating branch between then aorta and the pulmonry arteries that fails to close after birth.
REMEMBER: Once Eisenmengers develops, it is irreversible, as the pulmonary hyperpension is too severe.
REMEMBER: This is classically and right to left shunt, while the other septal defects are left to right shunts at firts.
Hypertrophy of the Right Ventricle
REMEMBER: The degree of stenosis and the degree the aorta overrides the circulation is the factor that determines the severity of the disease.
REMEMBER: This shape is caused by the hypertrophy of the right ventricle
This is primarily due to the lack of oxygen at high levels. It has been postulated that the ocygen concentration in the first few breathes of air inhibti PGE2 and thefore promote the closure of the ductus arteriosus. Low oxygen in the air however will not inhibit PGE2 and therefore will not promote the closure.
VSD, PDA, ASD, Coarciton are all diseases that are associated with late onset Eisenmengers
Tetrology of Fallot, Transposition of the Great Vessels, total Anomalous Pulmonary Return, and Tricupid Atresia are all associteed with childhood onset