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Flashcards in Cardiac Deck (220):
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EKG of stable angina would show

ST depression (subendocardial ischemia)

3

EKG of stable angina would show

ST depression (subendocardial ischemia)

4

EKG of Prinzmetal Angina would show

ST elevation (transmural ischemia)

5

Most common artery causing an MI

Left anterior descending (LAD)

6

LAD supplies

Apex, anterior left ventricle, one third of the anterior right ventricle, anterior 2/3 of the intraventricular septum

7

Right coronary a. supplies

remaining 2/3 of anterior right ventricle, posterior right ventricle, posterior half of left ventricle, posterior 1/3 of interventricular septum

8

Left circumflex a. supplies

lateral wall of the LV

9

Cardiac enzymes elevated in MI

Troponin I, CK-MB

10

After an MI, Troponin I peaks at

24 hours

11

After an MI, Troponin I begins to rise at

2-4 hours

12

After an MI, Troponin I returns to baseline by

7-10 days

13

After an MI, CK-MB peaks at

24 hours

14

After an MI, CK-MB begins to rise at

4-6 hours

15

After an MI, CK-MB returns to baseline by

72 hours

16

CK-MB help detect

re-infarction that occurs days after an initial MI

17

Contraction band necrosis is seen after

returned blood/Ca2+ entry into dead myocytes after MI followed by angioplasty, causes contraction

18

Reperfusion injury results from

returning of O2 to irreversibly damaged myocytes resulting in the generation of free radicals

19

Key events seen 4-24 hours after MI

Coagulative necrosis --> arrhythmia

20

Key events seen 1-3 days after MI

Neutrophil infiltration of acute inflammation --> fibrinous pericarditis

21

Key events seen 4-7 days after MI

Macrophage infiltration of acute inflammation --> rupture of ventricle wall

22

Key events seen 1-3 weeks after MI

Granulation tissue (emerging red border)

23

Key events seen Months after MI

Fibrosis --> aneurysm, mural thrombus, Dressler Syndrome

24

Scarring after MI contains primarily

Type I collagen

25

Sudden cardiac death is typically due to

severe atherosclerosis

26

LSHF causes edema in the _________ causing

lungs, PND, orthopnea, crackles

27

Heart failure cells are

hemosiderin-laden macrophages

28

Heart failure cells are seen with what condition/s

LSHF

29

Nutmeg Liver is seen with what condition/s

RSHF

30

Nutmeg Liver is due to congestion of

central veins of the liver

31

What congenital heart defect results typically from fetal EtOH syndrome?

Ventricular Septal Defects

32

Eisenmenger Syndrome

late-stage VSD; R->L Shunt; RV hypertrophy, cyanosis, polycythemia, clubbing

33

What congenital heart defect may be associated w/ Down's Syndrome?

Atrial Septal Defect

34

What PE finding is associated w/ Atrial Septal Defect?

Split S2 (due to high BV in RA and delayed closure of pulmonic valve)

35

Significant risk involved w/ Atrial Septal Defect?

paradoxical embolus

36

What congenital heart defect may be associated w/ Congenital Rubella?

Patent Ductus Arteriosus (PDA)

37

What PE finding is associated w/ Patent Ductus Arteriosus (PDA)?

holosystolic machine-like murmur

38

Patent Ductus Arteriosus (PDA) + pHTN resulting in Eisenmenger Syndrome would have what PE finding?

Cyanosis of the LE

39

Treatment for Patent Ductus Arteriosus (PDA)?

Indomethacin (decreases PGE)

40

4 Key findings w/ Tetralogy of Fallot

P: Pulmonary stenosis R: RV hypertrophy O: Overriding aorta V: VSD

41

Clinical presentation of Tetralogy of Fallot

cyanotic baby, relieved by squatting

42

Key X-ray finding of Tetralogy of Fallot

boot-shaped heart

43

What congenital heart defect may be associated w/ maternal diabetes?

Transposition of great vessels

44

Treatment for Transposition of great vessels

PGE

45

Tricuspid Atresia is almost always seen in association w/

ASD and an aplastic RV

46

Location of an infantile Coarctation of the Aorta

distal to arch, proximal to PDA

47

Key PE finding of infantile Coarctation of the Aorta

LE cyanosis

48

What congenital heart defect may be associated w/ Turner's Syndrome?

infantile Coarctation of the Aorta

49

Key PE finding of adult Coarctation of the Aorta

UE HTN and LE hypotension

50

Key X-ray finding of adult Coarctation of the Aorta

Notching of the ribs due to collateral circulation

51

Diagnosis of Acute Rheumatic Fever first involves establishing

evidence of a previous GAS infection w/ high ASO or DNase B titers

52

Acute Rheumatic Fever results from

molecular mimicry from M proteins produced by a previous GAS infection (pharyngitis) 2-3 weeks prior

53

JONES criteria for Acute Rheumatic Fever findings

Migratory polyarthritis, pancarditis, nodules, erythema marginatum, Syndenham chorea

54

Pancarditis due to Acute Rheumatic Fever

Endocarditis: vegetations on mitral valve -> mitral regurgitation Myocarditis: Aschoff bodies w/ Anitschkow cells Pericarditis: friction rub

55

Chronic Rheumatic Valvular Disease affects which valves

Mitral stenosis (thickening of chord tendineae) and occasionally Aortic valve stenosis (fusion of commissures)

56

Bicuspid aortic valve increases risk of ________?

Aortic stenosis

57

Aortic stenosis may arise as a complication of

Chronic Rheumatic Valvular Disease (fusion + mitral stenosis)

58

Key finding of Aortic Stenosis on PE exam?

systolic ejection click followed by a crescendo-decrescendo murmur

59

Typical presentation of pts w/ Aortic Stenosis?

angina, syncope w/ exercise

60

Lab findings w/ Aortic Stenosis?

Schistocytes due to Microangiopathic hemolytic anemia

61

What heart condition may result from Syphilitic aneurysm?

Aortic Regurgitation

62

Aortic Regurgitation most commonly arises as a result of

aortic root dilatation

63

Key finding of Aortic Regurgitation on PE exam?

Early, blowing diastolic murmur + Hyperdynamic circulation

64

Describe the Early, blowing diastolic murmur + Hyperdynamic circulation Sx w/ aortic regurg.

Bounding pulses, pulsatile nail bed, head bobbing

65

What heart condition may result from Marfan's or Ehler-Danlos?

Mitral Valve Prolapse

66

Key finding of Mitral Valve Prolapse on PE exam?

Mid-systolic click ( +/- regurgitation murmur)

67

Key finding of Mitral Regurgitation on PE exam?

holosystolic “blowing” murmur

68

Key finding of Mitral Stenosis on PE exam?

opening snap, followed by a diastolic rumble

69

What heart condition may result from Acute Rheumatic Fever?

Mitral Regurgitation

70

What heart condition may result from Chronic Rheumatic Valvular Disease?

Mitral Stenosis

71

Most likely etiologic agent causing endocarditis in a previously injured heart (acute rheumatic fever)?

Strep viridans

72

Most likely etiologic agent causing endocarditis in a IV drug user?

S. aureus

73

Most likely etiologic agent causing endocarditis in a pt w/ a prosthetic valve?

Staph epidermidis

74

Strep bovis is associated w/

Endocarditis w/ underlying colorectal carcinoma

75

Presentation of pt w/ endocarditis?

Fever, murmur, janeway lesion, osler nodules, anemia of chronic disease (microcytic)

76

What heart condition is associated w/ SLE?

Libman-Sacks Endocarditis

77

Biopsy finding of valve in Libman-Sacks Endocarditis would show?

vegetations on BOTH SIDES of valves

78

Nonbacterial Thrombotic Endocarditis arises due to

hypercoagulable state affecting mitral valve

79

Dilated Cardiomyopathy leads to

biventricular CHF

80

Causes of Dilated Cardiomyopathy

Genetic mutation, Coxsackie A or B virus, EtOH use, doxorubicin, cocaine, pregnancy

81

Genetic mutations in the sarcomere proteins causes?

Hypertrophic Cardiomyopathy

82

Most common cause of sudden death in young athletes?

Hypertrophic Cardiomyopathy

83

Key pathology findings w/ Hypertrophic Cardiomyopathy

myofiber hypertrophy w/ disarray

84

Common causes of Restrictive Cardiomyopathy?

Amyloidosis, sarcoidosis, hemochromatosis, endocardial fibroelastosis (children), Loeffler Syndrome

85

Key finding on EKG of Restrictive Cardiomyopathy?

low-voltage EKG w/ diminished QRS

86

Myxoma originates from

mesenchymal tissue

87

Myxoma is most common in what pt population

adults

88

Myxoma features and location

pedunculated tumor in L. atrium

89

Presentation of pt w/ myxoma tumor?

Syncope due to tumore blocking mitral valve

90

Myxoma pathology

ground substance - gelatinous appearance

91

Rhabdomyoma originates from

cardiac muscle (skeletal)

92

Rhabdomyoma is most common in what pt population

children

93

Rhabdomyoma is associated w/ what disease?

Tuberous Sclerosis

94

Rhabdomyoma arises typically in the

ventricle

95

Most common metastasis to the heart?

Breast and Lung carcinoma, melanoma, and lymphoma

96

right ventricle measures

0.3 to 0.5 cm in thickness

97

left ventricle measures

1.3 to 1.5 cm in thickness

98

Papillary muscles attached to which valves

tricuspid valve and mitral valve

99

tricuspid valve and mitral valve close during

Systole

100

Purkinje fibers are located in which layer

myocardium

101

Pathway of conduction pathway in the heart

SA node -> AV -> intraventricular septum -> apex -> bundle of his to ventricular walls

102

End point of all serious heart disease

CHF

103

CHF results from

decreased ability to contract OR increased pressure SV load

104

CHF results in

forward failure (decreased CO) and/or backward failure (congestion of the venous system)

105

LSHF is due to

ischemic heart disease, HTN, aortic/mitral valvular disease, myocardial disease

106

What is the key pathological finding of pHTN due to LSHF?

perivascular cuffing, edema and widening of the intraalveolar septa

107

Clinical presentation of pt w/ pHTN due to LSHF?

dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea, productive cough (blood tinged, frothy)

108

LSHF effects on the kidney?

decreased perfusion causing tubular necrosis, RAAS activation

109

LSHF effects on the CNS?

decreased perfusion to the brain, encephalopathic changes

110

RSHF is due to

LSHF, Cor pulmonale, myocardial disease, or tricuspid/pulmonary valvular disease

111

RSHF effects on the liver?

congestion of central vein causing central lobular necrosis

112

Key pathological finding of RSHF effects on the liver?

Nutmeg liver

113

Chronic liver congestion due to RSHF results in

cardiac sclerosis - fibrosis of hepatic parenchyma

114

Pitting edema of RSHF is due to

increased hydrostatic pressure and decreased hepatic circulation - decreased removal of Aldo, decreased albumin production

115

Pleural effusion are seen w/ _____ sided HF?

Right

116

RSHF causes HSM, what deposits are found in the spleen?

Hemosiderin

117

leading cause of death in the U.S.?

Ischemic heart disease

118

Ischemic heart disease is defined as

increased O2 demand or decreased O2 supply

119

Causes of Ischemic heart disease

Stenosing coronary a. atherosclerosis, Platelet aggregation, vasospasm, vasculitides, hemodynamic derangement

120

Significant myocardial ischemia begins when the atherosclerotic lesion obstructs approximately

80-90% of lumen

121

Causes of MI include:

atherosclerosis, emboli, arteritis, cocaine abuse, trauma

122

Treatment for stable angina

Nitro

123

leading cause of death in the U.S. and industrialized nations

MI

124

Risk Factors for MI:

Age (40-65), Male, Smoking, Type A

125

Factors known to decrease risk of MI

exercise, diet, moderate EtOH consumption

126

Patient may initially become __________ before an MI

tachycardic

127

What % of MIs are due to causes other than atherosclerotic lesions + thrombus?

10% due to vasospam, mural thrombi, emboli, valvular vegetations, paradoxical emboli

128

MI size is dependent on

extent, severity, location, collateral circulation, metabolic demands

129

Most common type of MI

transmural (> 2.5, 4-10cm typically)

130

Transmural MI of LAD typically affects ___% of heart

40-50

131

Transmural MI of RCA typically affects ___% of heart

30-40

132

Transmural MI of LCA typically affects ___% of heart

15-20

133

Subendocardial MIs typically occur as a result of

drop in BP or systemic oxygen supply (not usually thrombosis)

134

Infarctions of what age are most prone to ventricular rupture

3-7 days

135

Fibrosis and scarring occurs how long after an MI

> 7 weeks

136

coagulation necrosis with edema, microscopic hemorrhage and the infiltration of segmented neutrophils occurs how long after an MI

4-12 hrs

137

Contraction band necrosis can be seen how long after an MI

18-24 hrs

138

At _____ there is florid coagulation necrosis with loss of nuclear structure and a very heavy infiltrate of segmented neutrophils

24-72 hours

139

At ______, necrotic myofiber begins to disintegrate. Macrophages infiltrate the area and phagocytize debris.

3-7 days

140

By _____ the infarction is well developed with necrosis in the center and fibrovascular response at the margins

10 days

141

Symptoms of MI

angina, squeezing, impending doom, radiating to left arm or jaw

142

Old cardiac markers

serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH) and MB isomer of creatine phosphokinase (CKMB).

143

Current cardiac markers

Troponin T (cTnT) and Troponin I (cTnI)

144

Course of cTnI after MI

rise 4-6 hrs, peaks 10-14h, drops 7-10d

145

Course of cTnT after MI

rise 4-6 hrs, peaks 10-14h, drops 10-14d

146

Course of CKMB after MI

rise 7-24h, peaks 20h, drops in 4d

147

Course of SGOT after MI

rise 8h, peaks 18-36h, drops 3-4d

148

Course of LDH after MI

rise 6-12h, peak 3-6d, drops 2weeks

149

Normally LDH1 is _________ than LDH2, but after an MI

lower than; after an MI LDH1 rises above LDH2

150

LDH of myocardium

LDH1

151

Course of myoglobin after MI

rise 0-2h, 100% sensitive, no specificity

152

25% of MI occur as

sudden death

153

Complications due to MI

arrhythmias, heart block (transmural), rupture (4-5 d post-MI), ventricular aneurysm, mural thrombi/emboli, fibrohemorrhagic pericarditis (fusion), cardiogenic shock

154

Treatment of ischemic heart disease

preventative (diet, lifestyle) after: O2, thrombolytic agents, angioplasty/stenting, rest

155

Chronic ischemic heart disease

angina +/- MI 5-10 yrs prior to CHF

156

Gross Findings in ischemic heart disease

atherosclerosis, calcification of mitral valve

157

Microscopic Findings in ischemic heart disease

perivascular interstitial fibrosis and patches of fibrosis, areas of myocytolysis

158

Sudden cardiac death

death w/in 1 hour of onset of symptoms

159

Sudden cardiac death is typically due to

lethal arrhythmias due to severe atherosclerosis

160

Other causes of Sudden cardiac death

valvular stenosis, congenital anomalies, myocarditis, cardiomyopathies and mitral valve prolapse

161

The main cardiac effect of systemic hypertension is

concentric left ventricular hypertrophy without other cardiovascular pathology

162

The systemic effects of left ventricular hypertrophy

subendocardial myocardial infarction to CHF or sudden death

163

Cor pulmonale effects on the heart

right ventricular dilation and hypertrophy

164

Acute Cor Pulmonale

extreme right ventricular dilation caused by massive PE

165

Chronic Cor Pulmonale

lung disease -> hypoxemia/acidosis -> vasoconstriction -> pHTN -> RV hypertrophy

166

Causes of Cor Pulmonale

Lung disease (COPD, CF, etc) Pulmonary vessel disorder (PE, sclerosis) Chest movement disorder (neuro, diaphragm) Pulmonary a. constriction (hypoxia/acidosis)

167

Maternal rubella during 1st trimester

PDA

168

Boot-shaped heart

tetralogy of fallot

169

PDA in tetralogy of fallout is

protective

170

Maternal diabetes

transposition of great arteries

171

In utero survival of transposition of great arteries is dependent on

PDA and foramen ovale

172

postnatal survival of transposition of great arteries is dependent on

PDA 60% VSD 30%

173

Corrected transposition of greta arteries

great arteries and ventricles transposed. allows oxygenation but causes RV hypertrophy

174

Taussig-Bing

aorta arises from RV, pulmonary a overrides VSD R-to-L shunt

175

Lutembacher syndrome

atrial septal defect occurring with rheumatic mitral stenosis

176

machinery murmur is associated w/

PDA

177

Cyanosis of LE in infants

infantile coarctation of aorta

178

HTN in UE and hypotension in LE

adult coarctation of aorta

179

Pulmonary stenosis/atresia is associated w/

ASD and PDA

180

Aortic stenosis is associated w/

bicuspid valve and calcification

181

Ectopia cordis

heart is located outside the body

182

Dextrocardia

apex pointing to the right

183

Situs inversus totalis

All abdominal and thoracic viscera are on opposite sides

184

Isolated dextrocardia

only the heart is malrotated

185

congenital aortic stenosis

calcification extends from the cusp to the base of the valve

186

age-related aortic stenosis

calcification extends from the base to the cusp

187

Marfan syndrome

mitral valve prolapse

188

Patients w/ MVP are at an increased risk for

infectious endocarditis, progressive mitral insufficiency, atrial or ventricular arrhythmias, and sudden death

189

Aschoff bodies

myocardial Microscopic inflammatory regions associated w/ acute rheumatic fever

190

Anitschkow cells

acute rheumatic fever

191

Fibrinous pericarditis

acute rheumatic fever

192

acute rheumatic fever - migratory polyarthritis

nonspecific mononuclear infiltrates of joints

193

acute rheumatic fever - subcutaneous nodules

nodules are characterized by the presence of Aschoff bodies and are usually located over the extensor tendons

194

acute rheumatic fever - arteritis

hypersensitivity arteritis

195

Patient population of acute rheumatic fever

5-15 y/o w/in 1-5 weeks of initial pharyngitis

196

Intravenous drug abusers are particularly prone to _______ valve bacterial endocarditis whose vegetations may release septic thrombi, causing _____________________

tricuspid; pulmonary infection and abscess

197

Valvular endocarditis of the mitral and aortic valves may cause

embolic glomerulonephritis

198

Calcification of mitral annulus

Calcium is deposited upon and within the supporting ring of the mitral valve

199

Dilated (congestive) cardiomyopathy may cause

Intraventricular thrombi

200

Pericardial effusion

fluid accumulation due to CHF, infection, or neoplasm

201

Hemopericardium

blood accumulation due to infection , neoplasm, trauma, rupture

202

Hemopericardium that completely fills the pericardium is called

pericardial tamponade

203

Serous pericarditis definition

inflammatory exudates and inflammation of pericardium

204

Serous pericarditis causes

rheumatic fever, SLE, scleroderma, neoplasms, and uremia

205

Cell types found in serous fluid of Serous pericarditis

segmented neutrophils, lymphocytes, and histiocytes

206

Fibrinous and serofibrinous pericarditis definition

inflammation with the accumulation of serous fluid and fibrinous exudate; COMMON

207

Fibrinous and serofibrinous pericarditis causes

MI, autoimmune, uremia, radiation, rheumatic fever, SLE, and trauma

208

Purulent pericarditis causes

infection

209

Hemorrhagic pericarditis definition

blood mixed with fibrin or suppurative effusion

210

Hemorrhagic pericarditis causes

tuberculosis, acute bacterial infections, malignant neoplasm, uremia, hematologic disorder

211

Caseous pericarditis causes

tuberculosis

212

Adhesive mediastinal carditis

chronic pericarditis cause by caseous pericarditis, surgery, radiation that caused fibrosis and fusion of the pericardium and epicardium

213

Adhesive mediastinal carditis may lead to

Increased workload, cardiac hypertrophy and/or dilation, CHF

214

Constrictive pericarditis

Dense fibrocalcific scars adhere the pericardium and epicardium

215

Constrictive pericarditis may lead to

limited diastolic expansion and restricting cardiac output, hypertrophy cannot occur due to scarring

216

Rheumatoid heart disease is associated w/

subcutaneous rheumatoid nodules, vasculitis and Felty syndrome

217

Rheumatoid heart disease manifests w/

fibrinous pericarditis and thickening of the pericardium, Rheumatoid nodules w/in heart, amyloidosis

218

Lipoma location

LV, RA, or atrial septum

219

Primary malignant tumors of the heart

angiosarcomas and rhabdomyosarcomas

220

Secondary malignant tumors of the heart

lung, breast, leukemia, lymphoma, renal cell carcinoma, hepatocellular carcinoma and malignant melanoma