Cardiac 3 Shea

Question 1

• Rare, but when they occur can result in serious problems
• Usually benign and are pedunculated (have a stalk for easy removal from wall of LA or wall of valve)

Answer 1

Primary Cardiac Tumors

Question 2

What are the 3 types of cardiac tumors and which age groups are they most common in?

Answer 2

• Cardiac Myxomas (adults)
• Rhabdomyomas (Kids)
• Metastatic Tumors

Question 3

The most common primary tumor (35 - 50%)

Answer 3

Cardiac Myxomas

Question 4

• Most Cardiac Myxomas arise from where?
• What %?

Answer 4

• Left Atrium (75%)
• But, can occur in any chamber of heart or on a valve

Question 5

• Glistening, gelatinous, polypoid mass (5 - 6cm)
• Short stalk
• Sometimes is sufficiently mobile, obstructing the mitral valve orifice (moves up and down causing conduction issue)
• What allows the motion to occur?

Answer 5

• Cardiac Myxomas
• Stalk

Question 6

Over 1/2 of patients w/ myxomas of the LA have clinical evidence of what?

Answer 6

Mitral Valve Dysfunction

Question 7

1/3 of patients w/ cardiac myxomas of the LA or LV die from what?

Answer 7

Embolization of tumor to the brain

(piece breaks off bc/ it is so soft)

Question 8

What is the surgical success rate of cardiac myxomas.

Answer 8

Surgical removal is successful in most cases

Question 9

The most common primary cardiac tumor in infants and children

Answer 9

Rhabdomyomas

Question 10

Forms nodular masses in the myocardium

Answer 10

Rhabdomyomas

Question 11

Almost all rhabdomyomas are multiple and involve which 2 heart chambers?

Answer 11

Left and Right Ventricles

Question 12

1/3 of cases of rhabdomyomas occur where?

Answer 12

Atria

Question 13

• In 1/2 of cases, the tumor mass projects into the cardiac chamber
• Grossly, are pale gray masses up to several cm

Answer 13

Rhabdomyomas

Question 14

Which 3 types of cancer metastasize to the heart most often?

Answer 14

• lung cancer
• breast cancer
• GI tract cancers

Question 15

Which 3 other cancers can metastasize to the heart, but less often than the other 3?

Answer 15

• Lymphomas
• Leukemias
• Malignant Melanomas

Question 16

Metastatic cancers of the myocardium can result in manifestations of ____.

Answer 16

Restrictive Cardiomyopathy

Question 17

What is the #1 cause of sudden cardiac death?

Answer 17

Cardiac Arryhthmias

Question 18

What % of patients do not survive their first MI?

Answer 18

25%

Question 19

Atherosclerosis of the coronaries which presents as myocardial ischemia owing to a slowly progressive narrowing by atherosclerosis or a sudden occlusion due to a thrombus

Answer 19

Coronary Artery Disease

Question 20

Chronic progressive ischemia of Coronary Artery Disease results in hypoperfusion of the myocardium and slowly evolving _____.

Answer 20

Pump failure (CHF)

Question 21

Acute coronary thrombosis is more common where?

Answer 21

Arteries already narrowed by atherosclerosis

Question 22

What are the main killers?

• 1 A:
• 1 B:
• 2:

Answer 22

• 1 A: CAD (coronary artery disease)
• 1 B: Stroke
• 2: Cancer

Question 23

Complete blockage of LAD

Answer 23

Widow Maker

Question 24

The heart and the brain have what type of circulation?

Answer 24

Collateral Circulation

Question 25

What does the sudden occlusion of a major coronary artery cause and does location of occusion differ?

Answer 25

Yes, MI

Question 26

An anterior wall infarct is typically caused by occlusion of which vessel?

Answer 26

Left Anterior Descending coronary artery (LAD)

Question 27

An infarct of the _**lateral wall** of the left ventricle_ is usually caused by occlusion of which vessel?

Answer 27

Left Circumflex coronary artery

Question 28

An infarct of the _right ventricle_ and _**posterior wall** of the left ventricle_ is usually caused by occlusion of which vessel?

Answer 28

Right Coronary Artery

Question 29

Where do most occlusions of the heart occur? 1. 2. 3.

Answer 29

1. **LAD** (over 50%) 2. **RCA** (30 - 40%) 3. **Left Circumflex Artery** (10 - 20%)

Question 30

What are the 2 types of MIs and which is worst?

Answer 30

* **Transmural** (infarction that involves full thickness of myocardium -Epicardium/Myocardium/Endocardium) = WORST * **Subendocardial** Infarction (better bc/ only involves inner 1/2 of heart)

Question 31

**Pathology of CAD** * The coronaries involved by atherosclerosis are transformed into rigid, heavily calcified cylinders that can be palpated beneath the \_\_\_\_.

Answer 31

Epicardium

Question 32

Pathology of CAD * On cross section, the lumina are narrowed due to the prominent fibrotic plaques and atheromas. The wall contains deposits of which 2 things?

Answer 32

* Calcium salts * Cholesterol clefts

Question 33

* Rapid, sudden occlusion of a coronary artery * 80 - 90% of transmural infarcts are caused by what?

Answer 33

MI * thrombosis of a coronary artery

Question 34

Apart from thrombosis of a coronary artery, what are 2 other causes of a transmural infarct?

Answer 34

* Ulceration of an embolized atherosclerotic plaque * Prolonged vasospasm

Question 35

What is the cause of sudden cardiac death? What % die from MI? What % survive after MI?

Answer 35

* In **25%** of cases = death * 75% survive * Most cases: **major cardiac arrhythmias** (V. fib) or * complete heart block * pump failure

Question 36

Among the 75% of patients who survive the onset of an MI, most develop signs of which 2 things?

Answer 36

* HF * Cardiogenic Shock

Question 37

Of the 75% who survive MI, what develops as a result of inadequate perfusion of tissue by blood from the failing heart?

Answer 37

Multisystemic major organ failure

Question 38

What is the most dangerous result of an MI?

Answer 38

Consequences of cerebral ischemia. May lead to: * Permanent mental injury * Loss of CNS functions

Question 39

What 2 organs are we most concerned about keeping perfused w/ an MI?

Answer 39

* **Kidneys** (or else they will go into Acute Tubular Necrosis \*ATN\* which is reversible if the heart tissue is taken care of) Otherwise, pt will go anuric/anuresis which means the patient cannot pass urine * **Brain,** have pt take anticoagulants to dissolve baby clots so they don't go to brain

Question 40

What is the gold standard test?

Answer 40

Troponin

Question 41

* How long can the kidneys take until they reach ATN (acute tubular necrosis)? * How long can the brain last as ischemic?

Answer 41

* 20 mins * minutes, then more minutes = death

Question 43

A transmural MI usually involves which parts of the heart?

Answer 43

* **Free wall of LV** And/Or * **Interventricular septum**

Question 44

A _subendocardial_ or _intramural_ MI is usually located where?

Answer 44

Usually concentric around the subendocardial layer of the LV

Question 45

How much blood in the pericardial sac will cause heart to stop?

Answer 45

350 - 375 CCs

Question 46

If a pt has a transmural MI, they are more at risk for which 3 things?

Answer 46

* LV rupture * Aneurysm of ventricle * Mural thrombi which can embolize

Question 47

Heart disease resulting from a primary abnormality in the myocardium (myocytes)

Answer 47

Cardiomyopathy

Question 48

In response to injury, if a heart has cardiomyopathy, which 2 things will it undergo?

Answer 48

* Dilatation * Hypertrophy

Question 49

**Cardiomyopathy:** Long standing pressure changes results in \_\_\_\_. Long standing volume changes results in \_\_\_\_.

Answer 49

* Hypertrophy * Dilation

Question 50

* What are the 3 types of cardiomyopathies? * Which is most common?

Answer 50

* Dilated is **#1** * Hypertrophic * Restrictive Usually a combination of _Dilated and Hypertrophic_

Question 51

Which side of the heart is involved w/ cardiomypathy?

Answer 51

Left, right side is NOT involved