Chapter 10: The Heart (Part 2) Flashcards
(148 cards)
1
Q
What is the cause of cardiac syndromes?
A
significant reduction in cardiac blood supply (occlusion of the coronary arteries)
2
Q
What are the four types of cardiac syndromes?
A
1) Angina Pectoris
2) Acute Myocardial Infarction
3) Sudden Cardiac Death
4) Chronic IHD
3
Q
True or False: Cellular Death is present in all four types of cardiac Syndromes.
A
False; not present in angina pectoris
4
Q
What are the three causes of coronary atherosclerosis?
A
1) Inflammation
2) Thrombosis
3) Vasoconstriction
5
Q
What can cause inflammation of the coronary vessels?
A
Atherosclerosis and vulnerable plaques
6
Q
What are the risks for vasconstriction of the coronary arteries?
A
Increased SNS, inflammation, endothelial dysfunction
7
Q
What is angina pectoris?
A
Pain from myocardial ischemia
8
Q
What causes angina pectoris?
A
Critical stenosis ( greater than or equal to 70% occlusion)
9
Q
Where is the pain usually located in angina pectoris?
A
sub-sternal pain: jaw, left arm, back, and shoulders
10
Q
What are the three types of angina pectoris?
A
Stable, Variant, and Unstable
11
Q
What is the frequency of stable angina?
A
episodie and exertional
12
Q
How is stable angina managed?
A
Relieved with rest and vasodilators
13
Q
When can variant angina occur?
A
vasospasms at rest
14
Q
How is variant angina managed?
A
responds to vasodilators
15
Q
What are the major symptoms of unstable angina?
A
Increased intensity, frequency and duration; provoked by less exertion
16
Q
What percentage of occlusion must be present to have an onset of unstable angina?
A
90% occlusion
17
Q
What two possible events could precede an unstable angina?
A
acute plaque disruption or thromboembolism
18
Q
Is angina pectoris in females the same as in males?
A
No, less predictable features
19
Q
What are some of the more unique features in angina pectoris in females?
A
many have no angina
frequent nausea, dizziness, back pain
discomfort or pressure in lower chest or epigastric regions
will have dyspnea and fatigue
20
Q
How many myocaridal infarctions are lethal?
A
Only 1/3
21
Q
What is the most common cause of myocardial infarctions?
A
coronary artery acute thrombosis
22
Q
What occurs during a myocardial infarction?
A
Sudden loss of contractility leading to infarction
23
Q
What are the risk factors for myocardial infarctions?
A
HTN, smoking, CHF, diabetes, males, ages 40-60, postmenopausal females, sickle cell disease, amyloidosis
24
Q
Match the coronary artery to the percentage of MI cases seen:
1) Left Anterior Descending Coronary Artery
2) Right Coronary Artery
3) Left Circumflex Artery
A)30-40%
B)40-50%
C) 15-20%
A
1) B
2) A
3) C
25
Two hours after a myocardial infarction, the zone of necrosis is seen in the:
subendocardial zone
26
24 hrs after a myocardial infarction, the zone of necrosis is seen almost in every layer of the heart, this is known as:
transmural infarct
27
How quickly does loss of contraction occur during a myocardial infarction?
1-2 mins
28
How quickly does necrosis occur during a myocardial infarction?
20-40 mins
29
Inflammation during a myocardial infarction can induce:
arrhytmias
30
In order to cause reperfusion of the heart tissue, what artificial techniques can be used?
thrombolytic meds, angioplasty, stent, bypass
31
What chain of events can reperfusion cause that ultimately leads to a temporarily "stunned" myocardium?
Ischemic Reperfusion injury -> Increased ROS -> endothelial swelling -> blocked capillaries
32
What mechanical device may be needed for a few days to assist after an Ischemic Reperfusion Injury?
Ventricular Assist Device
33
What are the signs and symptoms of a myocardial infarction:
```
the following lasting anywhere from minutes to hours:
- "Crushing pain"
-Intense "pressure"
in the neck, jaw, epigastrium, left arm
-unrelieved by nitroglyerine
-pulse is rapid and weak
-dyspnea, nausea, sweaty
```
34
What percentage of myocardial infarctions are lethal in community? in hosptials?
```
Community = 30%
Hospital= 7%
```
35
What percentage of myocardial infarctions are small and "silent"?
15%
36
Which cardiac marker is the most significant in diagnosing myocardial infarctions?
Troponin I
37
What condition is seen with progressive heart failure usually following injuries such as CAD, CHF, and past MI?
Chronic Ischemic Heart Disease
38
What happens to the myocardium during chronic ischemic heart disease?
viable myocardium is overworked because the compensatory mechanisms begin to fail
39
Chronic Ischemic Heart Disease can cause contractile dysfunction which could lead to heart conditions such as?
Arrhythmia, CHF, and cardiogenic shock
40
What is the prognosis for chronic ischemic heart disease?
poor, lead to 2nd MI, arrhthmia, and CHF
41
What is sudden cardiac death?
when someone has a sustained arrhythmia that leads to death. is sudden or unexpected because there are no symptoms in previous 24 hours
42
What are the two types of sudden cardiac death? Which is the most common?
1) Asystole
| 2) Ventricular fibrillation (MC)
43
What is the most common cause of sudden cardiac death?
ischemic injury
44
What type of defibrillators improve the progonosis of sudden cardiac death?
AED and ICD
45
What is commotio cordis?
An emerging disease where precordial trauma disrupts rhythm of the heart. This arrhthmia can lead to sudden cardiac death.
46
What is unique about the heart structure with commotio cordis?
no structural damage heart disease
47
What age group is at most risk for commotio cordis?
adolescent males, avg age 15 years old, have underdeveloped chests.
48
What is the treatment for commotio cordis?
AED
49
What is the prognosis for commotio cordi?
poor prognosis
| Most cases 65% lethal
50
What is the cause of hypertensive heart disease?
high blood pressure overloads the heart
51
What can occur as a result of hypertensive heart disease?
concentric hypertrophy and later on possible dilation
52
What causes the high blood pressure to overload the heart?
increase in metabolic demands, but no increase in blood supply to help compensate
53
How does hypertensive heart disease cause cardiac decompensation?
eventual loss of contractility
54
What are the two types of hypertensive heart disease?
1) Systemic Hypertensive Heart Disease
| 2) Pulmonary Hypertensive Heart Disease
55
Systemic Hypertensive Heart Disease causes what sided heart disease?
left-sided heart disease
56
What are the major indicators for left-sided heart disease in Systemic hypertensive heart disease?
1) history/current HTN
| 2) left ventricular hypertrophy (increase in myocyte diameter, increase fibrosis)
57
What complications can arise from Systemic Hypertensive Heart Disease?
1) CHF
2) Arrhythmia
3) Stroke
4) Renal Failure
58
What can be done to decrease risk of systemic hypertensive heart disease?
BP management, even reversible if HTN is managed early
59
Pulmonary Hypertensive heart disease causes which sided heart disease?
Right-sided heart disease
60
What causes right-sided heart failure?
lung pathologies such as CF, COPD, PE, pulmonary fibrosis, pulmonary HTN, and the hypertrophy and dilation of rt. ventricle
61
What can cause acute pulmonary hypertensive heart disease?
large PE which occludes >505 of pulmonary artery
62
What can cause chronic pulmonary hypertensive heart disease?
prolonged lung pathologies which leads to gradual rt-sided hypertrophy
63
What are Life's Simple 7 ways to prevent heart disease? (probably NT)
1. Keep low blood pressure
2. control cholesterol
3. keep low blood sugar
4. be active
5. eat a heart-healthy diet
6. lose weight/maintain a healthy body weight
7. don't smoke
64
What is valvular stenosis?
narrowing, failure to completely open
65
Stenosis can be causes by which conditions?
dystrophic calcification, fibrosis
66
What is 'insufficiency'?
failure to appropriately close
67
What are the two main types of insufficiencies related to the heart?
A. Valvular destruction
| B. Abnormal supportive structures
68
True or False: A murmur is a turbulent, palpable vibration.
False, that is a thrill.
A murmur is just turbulent flow through a diseased valve.
69
What is the most common cause of aortic valve stenosis?
Calcific Aortic Stenosis
70
What are the early signs and symptoms of Calcific Aortic Stenosis?
Asymptomatic, possible murmur or decreased cardiac output
71
What are the later signs and symptoms of Calcific Aortic Stenosis?
left ventricular hypertrophy, Ca++ -> severe stenosis
72
What demographic is calcific aortic stenosis most commonly seen?
among older adults due to wear and tear, avg age= 60-80 years old
73
What are some risk factors for calcific aortic stenosis?
HTN, inflammation, increased cholesterols
Bicsuspid aortic valve can make you have earlier presentations (40-50 vs 60 to 80)
74
True or False: Calcific Aortic Stenosis happens on the outflow side and fusion of the valves is rare.
True
75
In what cardiac condition is fusion of the valves common?
Rheumatic Valvular Disease
76
What bacterial infection can cause rheumatic valvular disease?
Group A beta-hemolytic strep. infection
77
3% of untreated strep. throats can lead to what condition?
Rheumatic Fever
78
Which symptom from the Jone's Criteria is common in children with Rheumatic Fever?
Carditis (50% of all RF patients)
79
Which symptom from the Jone's Criteria is common in adults with Rheumatic Fever?
migratory polyarthritis
80
What is the Jones Criteria for Rheumatic Fever?
```
J= Joints (polyarthritis)
O= Carditis .....ooookkkkk
N= Nodules
E= Erythema Marginatum
S= Sydenham chorea
```
81
70% of Rheumatic Valvular Diseases effect which valve of the heart?
Mitral
82
25% of Rheumatic Valvular Diseases effect which valve of the heart?
Aortic
83
What unique feature will be present on acute features of Rheumatic Heart Disease?
Aschoff Bodies
84
What is the characteristic look of the valves seen in rheumatic mitral stenosis?
fish-mouth or button-hole appearance
85
Scarlet fever is caused by strains of GABHS that produce:
erythrogenic toxins
86
How soon does scarlet fever develop and what demograph is most commonly affected?
1-4 days after strep. throat
children
87
What type of skin rash is present on patients with scarlet fever?
pink punctate skin rash, multiple spots, sandpaper-like texture
88
Where are some of the locations that a pink punctate skin rash would be present?
neck, chest, axillae, groin, thighs
89
If a patient with rheumatic fever has pink punctate on their face this is known as:
circumoral pallor
90
What serious condition could scarlet fever develop in to?
Rheumatic Fever
91
What is infective Endocarditis?
Infection of the interior heart chambers/valves
92
What is the most common cause of infective endocarditis?
bacteria
93
What are the signs and symptoms of infective endocarditis?
flu-like: fever, chills, fatigue, weight-loss
Can result in a lethal arrhythmia or renal failure
94
What are the bulky and friable growths, possible thrombi seen in Infective Endocarditis patients called?
vegetations
95
Are murmurs possible in patients with infective endocarditis?
Yes
96
What are the key features of Acute Infective Endocarditis?
destructive, virulent, difficult to treat
Normal tissue, caused by S. Aureus
97
What are the key features of Subacute Infective Endocarditis?
low virulence, easy to treat
Abnormal tissue, caused by S. viridans
98
Which valves are most commonly infected in Infective Endocarditis?
left-sided heart valves: Aortic and Mitral
99
What is the prognosis for infective endocarditis if left untreated?
fatal
100
Is the prognosis for infective endocarditis worse or better for patients with prosthetic valves?
worse
101
What is the most common type of prosthetic cardiac valve?
mechanical
102
What are some of the features of a mechanical prosthetic cardiac valve?
tilting disk, durable, long-term anticoagulation,
thrombosis and hemolysis= "blender effect"
103
What are some of the features of a bioprosthetic cardiac valve?
- made from pigs, cows or humans
- no anticoagulation
- ECM deteriorates leading to calcification leading to stenosis
104
What percent of prosthethic cardiac valves lead to infective endocarditis cases?
20%
105
Define Cardiomyopathy:
heart+muscle+ disease = myocardial abnormality
106
What causes primary cardiomyopathies?
disorder of myocardium
107
What causes secondary cardiomyopathies?
systemic disorders such as muscular dystrophy
108
What are the three pathophysiological groups of cardiomyopathies?
Dilated, Hypertrophic, Restrictive
109
Which is the most common type of cardiomyopathy, causing 90% of all cardiomyopathies?
Dilated Cardiomyopathy
110
What occurs to the chambers of the heart during dilated cardiomyopathies?
progressive dilation of all chambers
111
What type of dysfunction is seen in dilated cardiomyopathies?
Systolic dysfunction leading to dyspnea and fatigue
112
What are the risks for dilated cardiomyopathy?
Genetic, viral infections, toxins, hemocromatosis, decreased thiamine
113
What are the two types of genetic conditions that could lead to dilated cardiomyopathy?
Becker and Duchenne M.D.
114
What can cause hypertrophic cardiomyopathy?
result of genetic mutations, MC Beta- myosin
115
What happens to the sarcomeres in hyerptrophic cardiomyopathy?
they become hyper-contractile, won't relax leading to diastolic dysfunction
116
Which chamber of the heart becomes massively hypertrophic in hypertrophic cardiomyopathy?
Lt. Ventricle (decreased cardiac output)
| 25% have a left ventricular outflow obstruction
117
What is the characteristic sign of hypertrophic cardiomyopathy where the heart walls are very thick?
Asymmetrical Septal Hypertrophy
| ventricular septum is larger than outer wall
118
What cardiomyopathy causes 1/3 of sudden cardiac deaths in adolescent athletes?
hypertrophic cardiomyopathy
119
What is the least common type of cardiomyopathy?
restrictive cardiomyopathy
120
Interstitial fibrosis of the heart can cause what type of dysfunction in restrictive cardiomyopathies?
diastolic dysfunction( decreased filling)
121
Who is most likely at risk for having a restrictive cardiomyopathy?
African Americans (4x)
122
What happens during endomyocardial fibrosis and who is most likely to be impacted?
fibrosis of the ventricular endocardium
pediatrics/young adults in Africa due to malnutrition and helminth infxn.
123
What are the causes for restrictive cardiomyopathy?
Amyloidosis
Endomyocardial fibrosis
chest irradiation
idiopathic
124
What is myocarditis?
heart-wall inflammation
125
What are the causes of myocarditis and which is most common?
Viral (MC)
| Non-viral
126
What are some of the examples of viral causes of myocarditis?
coxsackievirus A & B, HIV, CMV, influenza
127
What are the some of the non-viral causes of myocarditis?
SLE, Chagas disease, Lyme disease, toxoplasmosis
128
What is the presentation of cardiac tissue in myocarditis?
swollen, may be dilated, flabby, pale, possible hemorrhage or thrombus
129
What are the signs and symptoms of myocarditis?
can be asymptomatic, or have pain, fever
130
What are some of the possible complications that can arise from myocarditis?
dyspnea, arrhythmia/SCD, CHF
131
What is pericarditis?
pericardial inflammation (fibrinous inflammation)
132
What is the primary cause of pericarditis?
infection: viral (MC), bacterial fungal
133
What are possible secondary causes of pericarditis?
MI, surgery, irradiation, rheumatic fever, SLE, CA
134
What is unique about the presentation of pericarditis?
"atypical chest pain" and friction rub
If mild, may self-resolve or could lead to life-threatening complications
135
Pericarditis can lead to what two conditions?
A. Cardiac Tamponade
| B. Constrictive Pericarditis due to dense fibrosis
136
What is the Beck's Triad and what is it used to diagnose?
Beck's Triad
1. Low BP
2. JVD
3. Muffled Heart Sounds
Diagnose: cardiac tamponade (pericarditis)
137
When auscultating the heart in pericarditis patients, the friction rub creates what unique sound?
squeaky leather
138
What is the most common site of cardiac cancer metastasis?
Lungs
139
True or False: Primary Cardiac tumors are fairly common
False, they are rare
140
What is the most common malignant cardiac neoplasm?
angiosarcoma
141
What percentage of cardiac tumors are benign?
90%
142
What are the possible cardiac tumors in adults?
myxoma (MC), fibroma or lipoma
143
What are the possible cardiac tumors in pediatrics?
rhabdomyoma
144
What is the most common primary cardiac neoplasm in adults?
Myxoma
145
Where are myxomas located 90% of the time?
near the fossa ovalis of the left atrium
146
Why is myxoma like a 'wrecking ball'?
It is mobile and can damage valves
147
What occurs in a transplant rejection?
fever and T cell attack
| decreased output, possible arrhythmia
148
What occurs during an allograft arteriopathy?
stenosis of coronary arteries
long term limitation
lethal via silent MI, CHF< arrhythmia
