Arrhythmias, SCD, HTN, Cardiac Valve Dz, Cardiomyopathy, Pericardial Dz, Cardiac Tumors, Transplantation Flashcards Preview

Cardiovascular Exam I > Arrhythmias, SCD, HTN, Cardiac Valve Dz, Cardiomyopathy, Pericardial Dz, Cardiac Tumors, Transplantation > Flashcards

Flashcards in Arrhythmias, SCD, HTN, Cardiac Valve Dz, Cardiomyopathy, Pericardial Dz, Cardiac Tumors, Transplantation Deck (81)
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1

Ischemic injury is the most common cause of rhythm disorders including sick sinus syndrome, afib, and heart block. What is sick sinus syndrome?

Bradycardia d/t SA node damage

2

Condition in which myocytes depolarize independently and sporadically (atrial dilation) with variable transmission through AV node; auscultated as irregularly irregular rhythm

Atrial fibrillation

3

Heart block occurs as a result of dysfunctional ___ node


What are the 3 degrees of heart block?

AV

3 degrees of heart block:

First degree = prolonged PR interval

Second degree = intermittent transmission

Third degree = complete failure

4

Arrhythmias may result from abnormalities in ____ junction structure or spatial relationship, such as those that occur in IHD, dilated cardiomyopathies, myocyte hypertrophy, inflammation (myocarditis or sarcoid), amyloid, etc

Gap

5

Most hereditary conditions resulting in arrhythmia are _____ inheritance. Primary electrical disorders are dx through genetic testing. ______ are diseases associated with mutations in genes that are required for normal ion channel function, often associated with skeletal m. disorders and diabetes

Autosomal dominant; channelopathies

6

Most common inherited arrhythmogenic disease

Long QT syndrome

[associated with gene defects in KCNQ1, KCNH2, SCN5A, CAV3; results in LOF of K+ channel or GOF of Na channel or caveolin]

7

4 inherited arrhythmogenic diseases

Long QT syndrome (most common)

Short QT syndrome (GOF in K+ channel)

Brugada syndrome (LOF in Na or Ca channel)

CPVT syndrome (GOF or LOF in diastolic Ca release)

8

Sudden cardiac death is due to a fatal _____ most often arising from ischemia-induced myocardial irritability; it may occur without symptoms or within 1-24 hours of symptom onset. 80-90% of successively resuscitated pts show ____ on ECG

arrhythmia; Nothing!

80-90% show no lab or ECG changes

9

_______ precipitates sudden cardiac death in 80-90% of cases

CAD — usually with >75% stenosis of one or more of the 3 main coronary arteries

Unfortunately, SCD may be the first manifestation of IHD; healed remote MIs are seen in about 40%

10

CAD is the most common cause of sudden cardiac death. What are some other possible causes?

Cardiomyopathy, myocarditis, congenital abnormalities of conduction system, myocardial hypertrophy

11

Describe changes in the heart with left-sided hypertensive disease

Pressure overload —> left ventricular hypertrophy (concentric thickening)

Diastolic dysfunction can result in left atrial enlargement, which may lead to afib

May lead to CHF

Risk factor for SCD!

12

Describe right-sided hypertensive disease

Isolated right-sided hypertensive heart disease arises in the setting of pulmonary hypertension

Acute cor pulmonale may arise from a large pulmonary embolus —> marked dilation of RV without hypertrophy


[remember most common cause of pulmonary HTN is LEFT-sided heart dz]

13

Diseases predisposing to cor pulmonale include diseases of pulmonary parenchyma, diseases of pulmonary vessels, disorders affecting chest movement, and disorders inducing pulmonary arterial constriction. What are some associated diseases of the pulmonary parenchyma?

COPD
Diffuse pulmonary interstitial fibrosis
Pneumoconiosis
Cystic fibrosis
Bronchiectasis

14

Diseases predisposing to cor pulmonale include diseases of pulmonary parenchyma, diseases of pulmonary vessels, disorders affecting chest movement, and disorders inducing pulmonary arterial constriction. What are some associated diseases of the pulmonary vessels?

Recurrent PE
Primary pulm HTN
Extensive pulmonary arteritis
Drug, toxin, radiation-induced obstruction
Extensive pulmonary tumor microembolism

15

Diseases predisposing to cor pulmonale include diseases of pulmonary parenchyma, diseases of pulmonary vessels, disorders affecting chest movement, and disorders inducing pulmonary arterial constriction. What are some associated disorders affecting chest movement?

Kyphoscoliosis
Marked obesity (OSA, pickwickian syndrome)
Neuromuscular dz

16

Diseases predisposing to cor pulmonale include diseases of pulmonary parenchyma, diseases of pulmonary vessels, disorders affecting chest movement, and disorders inducing pulmonary arterial constriction. What are some associated diseases inducing pulmonary arterial constriction?

Metabolic acidosis
Hypoxemia
Chronic altitude sickness
Obstruction of major airways

17

What is the difference between valvular stenosis and valvular insufficiency?

Stenosis = valve doesn’t OPEN completely; occurs chronically, impeding FORWARD flow

Insufficiency = valve doesn’t CLOSE completely; may occur acutely or chronically, allowing REVERSED flow

18

Chronic stenosis may cause _____ overload hypertrophy —> CHF

Chronic insufficiency may cause ____ overload hypertrophy —> CHF

Pressure

Volume

19

Virtually the ONLY cause of mitral stenosis

Postinflammatory scarring d/t rheumatic heart disease

20

Causes of mitral regurgitation

***Abnormalities of leaflets and commissures***: postinflammatory scarring, infective endocarditis, mitral valve prolapse, drugs (fen-phen)

Abnormalities of tensor apparatus: rupture of papillary muscle, papillary muscle dysfunction/fibrosis, rupture of chordae tendinae

Abnormalities of LV and/or annulus: LV enlargement (myocarditis, dilated cardiomyopathy), calcification of mitral ring

21

Causes of aortic stenosis

Postinflammatory scarring (rheumatic heart disease)

Senile calcific aortic stenosis

Calcification of congenitally deformed valve

22

Causes of aortic regurgitation

***Abnormalities of leaflets and commissures***: postinflammatory scarring (RHD)

Abnormalities of tensor apparatus: degenerative aortic dilatation, SYPHILITIC AORTITIS, ankylosing spondylitis, rheumatoid arthritis, MARFAN

23

Most common valve abnormality and commonly associated comorbidities

Calcific aortic stenosis — “wear and tear” phenomenon associated with chronic HTN, hyperlipidemia, and inflammation

24

With calcific aortic stenosis, ____ valves will show an accelerated course. Affected valves contain ____-like cells which deposit substance that creates mounded calcifications in cusps which prevent complete opening of the valve

Bicuspid; osteoblast (deposit osteoid like substance that ossifies)

25

Symptoms and clinical features of calcific aortic stenosis

Angina, CHF, or syncope

Increased pressure causes LVH

Most pts with aortic stenosis will die within 5 years of developing angina, within 3 years of developing syncope, and within 2 years of CHF onset

26

Mitral annular calcification involves calcific deposits in the fibrous annulus. It normally does NOT affect valve function. However, nodules may becomes sites for ______ formation or _____ _____. It is most common in females > males, > 60 yrs, and with pts who have ________

Thrombus; infective endocarditis; mitral valve prolapse

27

Most bicuspid aortic valves are prone to calcification. Patients can remain relatively asymptomatic until stenosis reaches a critical point when _____ rapidly ensues. The dense white nodules of calcification are present on both valve surfaces

CHF


[while bicuspid aortic valves are especially susceptible, an aortic valve does not need to be bicuspid to calcify. Sometimes in older adults, a normal aortic valve will undergo calcification = “senile calcific aortic stenosis”]

28

Mitral valve prolapse often occurs in those with ____ syndrome or as a complication of other cuases of regurgitation like dilated hypertrophy. On auscultation, a _____ may be noted

Marfan; mid-systolic click

29

Mitral valve prolapse occurs when valve leaflets prolapse into the ____ during systole. It affects 2-3% of adults in the US with a female predominance. Leaflets become thickened and rubbery due to disorganized ______ deposits, aka ______ degeneration, and elastic fiber disruption

LA; proteoglycan; myxomatous

30

Symptoms and complications associated with mitral valve prolapse

Most are asymptomatic but a minority may experience pain mimicking angina and/or dyspnea

Serious (but rare) complications may include:
Infective endocarditis
Mitral insufficiency
Thromboembolism
Arrhythmias