Hemodynamics (lab)

Question 1

Causes and Effects of LEFT CHF

Answer 1

Causes:

• Ischemic & non ischemic cardiomyopathy
• HTN
• Valve disease (e.g.aortic/mitral)

Effects

• Lungs: Edema
• Heart: R Ventricle hypertrophy and failure if chronic
• Hypoperfusion of organs: *Kidneys - reduced perfusion
• Brain - hypoxic encephalopathy

Question 2

Causes of RIGHT CHF

Answer 2

Causes:

• Left CHF (induces right CHF - this is a tricky one**)
• Congenital heart disease
• Any disease that effects lungs. COPD, PE, Pulmonary HT. Etc

Question 3

What are the Effects of Right CHF

Answer 3

Effects:

• Venous Congestion/Increased Hydrostatic Forces
• Liver congestion (nutmeg liver)
• Spleen congestion
• Peripheral edema

Question 4

What are the gross and histologic features of a HEART in a pt with CHF

Answer 4

Gross findings:

• Increased heart weight (i.e. Cardiomegaly)
• Ventricular Hypertrophy

Histologic findings:

• Cardiac Hypertrophy (bigger cells but not more: trophy=bigger)
• Cardiac Hyperplasia (more cells, but not bigger

Question 5

What are the features of a LUNG in a pt with CHF

Answer 5

• Vascular congestion of the alveolar septal blood vessels
• Intravascular congestion and associated intraalveolar leakage of blood/hemorrhage - ACUTE
• This looks like brown spots on a histo slide, because macrophages are ingesting the RBC’s to try and clean up the congestion.
• Iron laden macrophages in alveoli = Heart failure cells

Question 6

What are the features of a LIVER in a pt with CHF

Answer 6

• Hepatomegaly
• Centrilobular congestion (referred to as “nutmeg” liver) - indicates difficulty draining blood into the hepatic vein and then the IVC
• c/w R CHF
• Centrilobular necrosis - hepatocytes that are missing nuclei

Question 7

What are the features of a SPLEEN in a pt with CHF

Answer 7

Splenomegaly

Question 8

What are risk factors for PE?

Answer 8

• immobility
• upper respiratory tract infection
• cancer (hyper coagulability)

Question 9

How do you differentiate between acute and chronic PE?

Answer 9

Acute: tissue is still present, there is no cavitation, wbc nuclei are intact, macrophages

Chronic: loss of tissue, scarring, recanalization, fibroblasts

Question 10

Describe the pathophysiological changes seen in blood vessels and myocardium associated with hypertension

Answer 10

• myocardiac hypertrophy
• arteriolosclerotic damage of blood vessels
• focal aneurism formation

Question 11

What’s the difference between infarct and hemorrhage?

Answer 11

Infarct: reduced or absent blood flow leading to hypoxic ischemic injury, dead tissue, pale

Hemorrhage: blood escapes out from a breached blood vessel wall

Question 12

Symptoms of a massive pulmonary embolism?

Answer 12

• acute obstruction of pulmonary arteries
• acute hypoxia with or without chest pain
• death

Question 13

Symptoms of a small pulmonary embolism?

Answer 13

• asymptomatic if pulmonary emboli are small and few in number
• progressive hypoxia with or without chest pain