9&10- Cardiac Pathology I

Question 1

leading discharge diagnosis in patients over 65 in US

Answer 1

CHF

Question 2

variable degrees of decreased CO and tissue perfusion as well as pooling of blood in the venous system which may cause pulmonary edema, peripheral edema or both

Answer 2

CHF defined

Question 3

two most common causes of HF

Answer 3

• coronary a disease

- high blood pressure

Question 4

ejection fraction of heart failure

Answer 4

below 45%

normal should be 50-70%

Question 5

how is systolic dysfunction different than diastolic dysfunction

Answer 5

• systolic dysfunction has a low EF

- diastolic dysfunction has a normal EF, but the total volume of blood being ejected is lower

Question 6

previous or current symptoms of heart failure in the context of n underlying structural heart problem, but managed with medical treatment: what stage CHF?

Answer 6

stage C

A- high risk
B- no symptoms
D- advanced need hospital

Question 7

what does b-type natriuretic peptide idnicate?

Answer 7

CHF

BNP > 100 pg/mL

Question 8

how does the kidney sense CHF?

Answer 8

activates RAAS because it senses it as a low volume state (give diuretics to treat)

Question 9

trouble breathing, lungs fill with fluid

Answer 9

left sided CHF

Question 10

VJD, splenohepatomegaly

Answer 10

right sided CHF

Question 11

what is biventricular CHF

Answer 11

left heart failure causes right sided failure

Question 12

heart failure cells

Answer 12

left sided CHF

Question 13

paroxysmal nocturnal dyspnea

Answer 13

left sided CHF

Question 14

what is the major cause of ischemic heart disease?

Answer 14

chronic atherosclerosis

Question 15

leading cause of death worldwide for men and women

Answer 15

ischemic heart disease

Question 16

due to an imbalance between the supply and demand of the heart for oxygenated blood

Answer 16

ischemix heart disease

Question 17

what is coronary artery disease?

Answer 17

reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries CAD

Question 18

major risk factor for atherosclerosis

Answer 18

cigarette smoking

Question 19

what level of obstruction is required for ischemia?

Answer 19

75% or greater for symptomatic ischemia

90% of the lumen can lead to inadequate coronary blood flow even at rest

Question 20

components of coronary plaque

Answer 20

necrotic grumous core

cholesterol clefts

foam cells

smooth muscle cells

Question 21

describe a vulnerable plaque

Answer 21

• soft w/ lipid filled core
• eccentric
• only 40-60% stenotic

Question 22

vulnerable –> rupture –>

Answer 22

thrombus –> MI

bleeding into plaque can accompany rupture

Question 23

ischemia v. infarction

Answer 23

ischemia is reversible and infarction is irreversible

Question 24

physical activity, emotional excitement, or any other increased cardiac worload results in an imbalance in coronary perfusion relative to demand. Relieved by rest or nitro

Answer 24

stable angina

most common form

Question 25

pattern of increasingly frequent pain precipitated by progressively lower levels of physical activity or at rest. Caused by disruption of a plque with partial thrombosis or embolization or vasospasm

Answer 25

unstable or crescendo angina warning that an acute MI may be imminent

Question 26

episodic myocardial ischemia caused by coronary artery spasm. Not retaled to activity, HR or BP. Responds promptly to vasodilators.

Answer 26

prinzmetal variant angina uncommon

Question 27

what is the ankle brachial pressure index?

Answer 27

value of greater than 1.3 is considered abnormal and suggeste calcification under 0.5 is sever arterial disease

Question 28

ST segment depression

Answer 28

ischemia

Question 29

ST segment elevation

Answer 29

MI

Question 30

if you do an angiogram 14 hrs after MI will you see stenosis

Answer 30

only 60% of time some occlusion resolve

Question 31

most common site for MI

Answer 31

LAD anterior wall of left ventricle near apex, anterior portion of ventricular septum and apex circumferentially

Question 32

when would you see a wavy fiber histo?

Answer 32

half hour to 4 hr post MI

Question 33

dark mottling is indicative of..

Answer 33

early coagulation necrosis, 12-24 hrs post MI

Question 34

yellow-tan infarct indicates ...

Answer 34

1-3 days post MI peak neutrophils

Question 35

when is risk of myocardial rupture greatest?

Answer 35

post MI 3-7 days

Question 36

overly ischemic tissue loses its ability to contract =

Answer 36

contractile dysfunction

Question 37

rupture of free wall of LV -->

Answer 37

cardiac tamponade

Question 38

rupture of papillary muscle -->

Answer 38

acute mitral valve incompetence

Question 39

rupture of ventricular septum -->

Answer 39

acutely acquired VSD

Question 40

what is dressler's syndrome?

Answer 40

autoimmune inflammatory rxn to myocardial neo-antigens formed as a result of the MI

Question 41

acute MI mortality for 30 days after discharge

Answer 41

16% 5% for every year after

Question 42

which graft is better for CABAG?

Answer 42

internal mammary a. because 90% are patent at 10 yr compared to saphenous (50%)