Heart

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

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

3. Heart OBJECTIVES Carcinoid heart disease Cardiomypathies Myocarditis Pericardial disease Tumors of the heart Cardiac transplantation

4. Heart -Normal Weight Male - 325 gm. Female - 275 gm. Systole- ventricular contraction Diastole- ventricular relaxation Thickness

5. Heart -Normal Normal Hypertrophy = pressure overload Dilation= volume overload

6. Heart -Normal Normal ? Histology Specific Atrial Granules ? Atrial Natriuretic Peptide (ANP ) Intercalated disks with Gap junctions

7. Heart -Normal Normal = Blood Supply Left anterior descending (LAD) Left circumflex (LCX) arteries Right coronary artery (RCA)

8. Heart -Normal Normal = Effects of Aging on the Heart Lambl excrescences = calcifications on aortic or Mitral valves Atherosclerotic plaque

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

10. Heart - Pathology Congestive Heart failure (CHF) ?Compensatory hypertrophy

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

12. Heart - Pathology Morphology Kidneys = prerenal azotemia Brain =Hypoxic encephalopathy

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

14. Heart - Pathology Clinically Atelectasis due to Pleural and Pericardial effusions Subcutaneous Tissue edema =Hallmark Dependent pitting edema Aanasarca -generalized massive edema

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- �-myosin heavy chain, ANP, Collagen Compensatory changes in Hypertrophy Pressure overload � Hypertrophy Volume overload � Dilation & Hypertrophy

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

17. Heart - Pathology Congenital Heart Disease MC type of heart disease among children Etiology and Pathogenesis Multifactorial = majority of cases Developmental Trisomy 21 (Down syndrome) MC known genetic cause Endocardial cushion defects (AVSD) & ASD Di -George syndrome with TOF Environment= infection (congenital rubella) or teratogens

18. Heart - Pathology Congenital Heart Disease Clinical Features Malformations causing left-to-right shunt right-to-left shunt obstruction