Combank path - cardio

Question 1

What is occurring within 2-4 days post MI?

Answer 1

Abundant neutrophil emigration takes place to lyse dead myocardial cells and extensive coagulative necrosis takes place

Question 2

What occurs 7-8 weeks post MI and what is the patient at risk for during this time?

Answer 2

Dense type I collagen replaces the primitive type III collagen; heart is at risk of a ventricular aneurysm b/c the scar tissue has diminished contractile properties that can become weak and bulge out to cause an aneurysm

Question 3

What occurs 4-12 hours post MI?

Answer 3

Early coagulative necrosis is seen as neutrophils begin to migrate towards the recently infected area to degrade the tissue. Content of necrotic cells such as troponins, CK-MB, and CPK are then released into the bloodstream from the myocardial cells

Question 4

What occurs 5-10 days post MI?

Answer 4

Macrophages begin to replace neutrophil degradation; there is extensive granulation tissue that is necrotic, soft and brown yellow; this soft necrotic tissue renders the heart susceptible to free wall rupture, tamponade, papillary muscle rupture and septum rupture

Question 5

Name the valvular disorder — harsh systolic crescendo decrescendo murmur heard best at right upper sternal border

Answer 5

Aortic stenosis

Question 6

What is one way that aortic stenosis is differentiated from mitral regurgitation?

Answer 6

aortic stenosis radiates to the carotids

Question 7

What is the classic triad of symptoms that is associated with aortic stenosis?

Answer 7

angina, syncope, heart failure

Question 8

What is the most common cause of aortic stenosis in the United States?

Answer 8

Aortic valve calcification – increases with age

Question 9

What is the most common cause of mitral stenosis?

Answer 9

Rheumatic fever

Question 10

What type of drugs have been shown to reduce mortality in post MI patients?

Answer 10

beta blockers

Question 11

What is Wolff-Parkinson-White syndrome?

Answer 11

an accessory conduction pathway from atrial to ventricles causes premature ventricular excitation; this leads to paroxysmal tachycardia; ECG findings show short PR interval and an upward deflection before the QRS called a delta wave

Question 12

A banana shaped left ventricle on echocardiogram indicates?

Answer 12

Hypertrophic cardiomyopathy

Question 13

What type of axis deviation would show on ECG for hypertrophic cardiomyopathy?

Answer 13

left axis deviation

Question 14

What type of dysfunction does hypertrophic cardiomyopathy cause?

Answer 14

asymmetrical interventricular septal hypertrophy and hypertrophy of the LV produces a diastolic dysfunction (ventricle can’t fill!)

Question 15

What is hemochromatosis?

Answer 15

an AR d/o causing increased iron absorption in the intestines

Question 16

What are the most common signs of hemochromatosis at the time of presentation?

Answer 16

hepatomegaly, skin pigmentation, arthritis

Question 17

Which cardiomyopathy can result from hemochromatosis?

Answer 17

dilated cardiomyopathy due to iron deposition within the myocardium

Question 18

When should surgical repair of an AAA be performed

Answer 18

if aneurysm is ruptured; grows > 1 cm in one year; grows beyond 5.5 cm for men or 4.5 cm for women

Question 19

What is Friederich’s ataxia?

Answer 19

AR trinucleotide repeat d/o (GAA) that causes poor mitochondrial function; staggering gait, nystagmus, pes cavus and hammer toes are characteristic findings

Question 20

What is the most common cause of death in Friedreich’s ataxia?

Answer 20

hypertrophic cardiomyopathy

Question 21

What is multiple myeloma?

Answer 21

hematologic malignancy that causes neoplastic proliferation of plasma cells resulting in overproduction of monoclonal IgG, IgA and or light chains

Question 22

The secreted monoclonal immunoglobulin proteins caused by multiple myeloma can form what type of amyloid and where can they deposit?

Answer 22

AL amyloid; can infiltrate the myocardium causing normal sized ventricular cavities to become stiff, this leads to restrictive cardiomyopathy

Question 23

Digoxin toxicity is increased by quinidine because?

Answer 23

it decreases digoxin’s renal clearance

Question 24

T/F hypercalcemia and hypokalemia increase digoxin toxicity

Answer 24

T

Question 25

What class of drugs is known to increase survival of CHF?

Answer 25

ACE inhibitors

Question 26

What is Beck’s Triad and in what cardiac condition is it seen in?

Answer 26

Becks Triad consists of hypotension, decreased heart sounds, jugular venous distension; classically seen in cardiac tamponade

Question 27

A syphilitic aneurysm is characterized by?

Answer 27

obliterative endarteritis of the vasa vasorum of the media; usually affects the proximal ascending aorta resulting in aortic dilation and aortic valve insufficiency