Exam 2, heart gomez Flashcards Preview

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Flashcards in Exam 2, heart gomez Deck (204):
1

what causes foramen ovale to be a problem

when the R ventricular pressure overcomes the L
like in pulmonary HTN

2

a

a

3

what is unique about cardiac muscle cells

intercalated discs with gap junctions etc

4

what occurs in heart chambers with age

increased left atrial size
decreased ventricula size
sigmoid shaped venricular septum

5

what occurs in heart valves with age

aortic valve calcific deposits
mitral valve annular calcific deposits
fibrous thickening

6

what occurs to the epicardial coronary arteries in an aging heart

tortuosity

7

what happens to the myocardium in an aging heart

decreased pass, brown atrophy
lipofuscin deposition (aging pigment)

8

what happens to the aorta with an aging heart

dilated ascending aorta

9

What are the five basic categories of cardiac disease

congenital heart disease
HTN heart disease
ischemic heart disease
valvular heart disease
nonischemic primary myocardial disease

10

what is the cardiac reserve

the CO that is not used at rest
use 10-20% maximal output

11

What are the six general causes of cardiac dysfunction

-pump failure
-obstruction to blood flow through the heart
-regurgitant flow
-shunted flow
-disorders of cardiac conduction
-disruption of continuity of circulatory system

12

What are the six general causes of cardiac dysfunction

-pump failure
-obstruction to blood flow through the heart
-regurgitant flow
-shunted flow
-disorders of cardiac conduction
-disruption of continuity of circulatory system

13

what are examples of pump failure

primary myocardiopathy
ischmic cardiac disease

14

what are causes of obstruction blood flow through heart

valvular disease (stenosis)
HTN disease

15

what is an example of regurgitant flow

valvular disease (insufficiency)

16

what is an example of shunted flow cardiac dysfunction

congenital heart disease (PDA ASD and VSD)

17

what are examples of disruption to continuity of circulatory system

gunshot, ventricular rupture

18

what are examples of disruption to continuity of circulatory system

gunshot, ventricular rupture

19

what can cause an increased workload resulting in hypertrophy

increased physiologic need by a normal heart
or
overall decreased intrinsic myocardial contractility

20

what is the difference of cardiac hypertrophy and cardio megaly

megaly is heart size and weight, hypertrophy is ventricular thickness or weight

21

what is the normal weight for male and femal hearts

male 300-500 female 250-300

22

what can cause a heart to weigh >800 gm

aortic regurgitation or hypertrophic cardiomyopathy

23

what can cause a heart to weigh >400

pulmonary HTN, IHD, systemic HTN aortic stenosis, mitral regug, dilated cardiomyopathy

24

what is the definition for cardiac dysfunction

inability to pump blood at a rate necessary for metabolizing tissues

25

What catecholamine is released in cardiac dysfunction

NE, neurohumoral stimulation, leads to more work for the heart. not good

26

What catecholamine is released in cardiac dysfunction

NE, neurohumoral stimulation, leads to more work for the heart. not good

27

What is the hearts response to pressure overload?
volume overload?

pressure= concentric Hypertrophy
volume= eccentric

28

what are causes of concentric hypertrophy in each ventricle

L-- systemic HTN or aortic stenosis
R-- cor pulmonale

29

what can cause a volume overload that results in eccentric hypertrophy

valve disorders and congenital heart disease

30

What can lead to CHF

insufficient pump rate
pump can only meet demands with increase in filling pressure

31

What 2 type of dysfunction can lead to decreased CO (forward failure) leading to CHF

systolic dysfunction from progressive deterioration of myocardial contractility
diastolic dysfunction from inability of heart chambers to relax sufficiently to fill during diastole

32

describe fluid accumulation differences in left sided heart failure versus right

left leads to accumulation of fluid within the lungs and pleural cavities
right sided leads to accumulation of fluid in all other body sites and all body cavities

33

describe fluid accumulation differences in left sided heart failure versus right

left leads to accumulation of fluid within the lungs and pleural cavities
right sided leads to accumulation of fluid in all other body sites and all body cavities

34

L sided heart fialure is most commonly caused by

ischemic heart disease
HTN heart disease
aortic and mitral valvular disease
primary nonischemic myocardial disease (cardiomyopathy)

35

What are common physical findings in left-sided heart failure

cardiomegaly, hypertrophy, chamber dilation
secondary enlargement of left atrium

36

what can lead to left atrial enlargement

atrial fib
mural thrombus

37

What heart sound is heart with left sided heart failure

third heart sound S3 (gallop)
diastolic ventricular filling
mitral regurg will have systolic murmur

38

What occurs in lungs because of left sided heart failure

pulmonary congestion and edma that is heard as rales or crackles and possible effusions
flash pulmonary edema- extremely rapid onset
dyspnea, orthopnea, paroxysal nocturnal dyspnea

39

what occurs in kidney because of left sided heart failure

decreased CO leads to renal hypoperfusion
activates RAAS (fluid retention and expansion of vascular volume- a vicious cycle)
severe: prerenal azotemia

40

what occurs in brain because of left sided heart failure

hypoxic encephalopathy

41

when does right sided heart failure usually occur

consequence of left sided heart failure

42

what are examples of isolated right sided heart failure

cardiac hypertophy and dilation confined to right sides
sequela of severe pulm HTN

43

what are the systemic effects of right sided heart failure

pitting edema in subcut tissue
liver and portal system congestion and slpeen leadting to HSM
pleural and pericardial cavities (effusions)

44

what are the systemic effects of right sided heart failure

pitting edema in subcut tissue
liver and portal system congestion and slpeen leadting to HSM
pleural and pericardial cavities (effusions)

45

What is BNP

produced by ventricles from increased P used to determine CHF

46

what is C type natriutetic peptide

made by endothelial cells from shear stress

47

what is the effect of natriutetic peptides

vasodilation, natriuresis and diuresis

48

What level of BNP makes it unlikely to be CHF

<100 pg/ml

49

what other conditions can cause an increase in BNP

right filling P increase, primary pulm HTN, end stage renal failure, cirrhosis, hormone replacement therapy

50

what other conditions can cause an increase in BNP

right filling P increase, primary pulm HTN, end stage renal failure, cirrhosis, hormone replacement therapy

51

when do ehart defects occur in development

between 3 and 8 weeks gestational age

52

what are envrironmental factors that can cause congenital heart disease

congenital rubella infection

53

what are the genetic contributions to congenital heart disease

familial forms
trisomies 13 18 21 and turner syndrome

54

which trisomy has 40% associated with heart defects

21

55

What are the 3 most common congenital cardiac malformations

bicuspid aortic valve- 2% population!!!
ventricular septal defect
atrial septal defect

56

what is the most common cardiac anomaly first diagnosed in adulthood and more comman than VSD in adult population

ASD
commonly Dx with onset pulmonary HTN

57

which gene is associated with cardiav outflow tract defects

TBX1 del 22q11.2

58

what gene is mutated in marfan syndrome

fibrillin

59

what gene is mutated in marfan syndrome

fibrillin

60

What gene is affected in digeorge syndrome

TBX1 del 22q11.2

61

what are the Sx of Digeorge syndrome

catch 22
cardiac
abnormal facies
thymic aplasia
cleft palate
hypocalcemia

62

what are the Sx of Digeorge syndrome

catch 22
cardiac
abnormal facies
thymic aplasia
cleft palate
hypocalcemia

63

what are examples of left to right shunt

ASD, VSD, PDA, AVSD

64

Are babies cyanotic with left to right shunts?

not initally once the pulmonary HTN gets high enough (shunt reversal) there is a shift from right to left and causes cyanosis

65

Describe a ventricular septal defect

pressures same in both ventricles
pressure ypertrophy in R ventricle
Volume hypertrophy in L
90% involve membranous septum
sypmtpms depend on size of anomaly

66

Describe a ventricular septal defect

pressures same in both ventricles
pressure ypertrophy in R ventricle
Volume hypertrophy in L
90% involve membranous septum
sypmtpms depend on size of anomaly

67

What are the 3 major types of ASD

secundum, primum and sinus venosus

68

what is the msot common ASD

secundum, involving patent foramen ovalis

69

untreated ASD coyld lead to what

pulmonary HTN

70

untreated ASD coyld lead to what

pulmonary HTN

71

what causes ductus arteriosus to close

increase in O2
dec pulm vasc R
dec PGE2

72

describe findings of PDA

90% isolated defets
continous harsh machine-like murmur
chornic= pulm HTN and cyanosis

73

What is a complete artioventricular septal defect
AVSD

large combined AV septal defect and large common AV valve
all 4 chambers comunicating and 4 chamebr hypertrophy
1/3 have down syndrome

74

What is a complete artioventricular septal defect
AVSD

large combined

75

What is the main cardiac defect associated with downs syndrome

AVSD>VSD>ASD>PDA>tetralogy of Fallot

76

what type of shunts cause cyanosis

right to left shunts
decreased amount of blood going to lungs to be oxygenated

77

what are signs of right to left shunts

clubbing of tips of fingers and toes and polycythemia due to hypoxia
paradoxical embolism- emboli from periphery bypass lungs through cardiac defect and enter systemic circulation

78

what is the shape of the heart and why in tetralogy of fallot

embryologically anterosuperior displacement of infundibular septum so result is a boot shaped heart

79

what is the shape of the heart and why in tetralogy of fallot

embryologically anterosuperior displacement of infundibular septum so result is a boot shaped heart

80

the direction of shunting in tetralogy of fallot depends on what

severity of subpulmonic stenosis

81

What is pink tetralogy of fallot

when the subpulmonic stenosis is mild and so the lungs are perfused, behave slike VSD

82

what causes transposition of the great arteries

defect with truncal and aortapulmonary septae
separation of pulmonary and systemic circulations

83

What makes transposition of great arteries somewhat compatibile with lfe

VSDm patent foramen ovale, or PDA

84

what is the most important thing to do in a patient with transposition of great arteries and PDA

give PGE2 to keep PDA open until surgery because keeping them alive

85

What is the infantile form of coarctation of aorta

hypoplasia of aorta prior to PDA (cyanosis of inferior body and weak femoral pulses)

86

What is the adult form of coarctaion of aorta

ride like fold opposite ligamentum arteriosus (HTN upper extremities with low P and pulses in lower extremities)

87

what are the types of congenital aortic stenosis or atresia

valvular- hypolastic dysplastic or abnormal # cusps
subaortic- ring or collar below cusps
aupravalvular- elastin gene mutation with aortic dysplasia (thickening)q

88

What is williams beuren syndrome

deletion of 28 genes from chrom 7 with elastin causing haploinsufficiency, hyperCa, glucose intolerance, facial and cognitive defects
have supravalvular aortic stenosis

89

coarcation of the aorta is mroe common in what pipulation

M:F 2:1 and more common in turners syndrome

90

coarctaion of arota is associated with what valvular defect

bicuspid aortic valve

91

what happends to the intercostal aa in coarctation of aorta

dilated

92

what type of murmur is heard in adult coarctaion of aorta

pansystolic mrumur from renatl HTN and blood flow through collaterals

93

What is the definition of cardiac ischmia

imbalance between the supply and demand of the hear for oxygenated blood

94

90% of IHD is due to what

atherosclerotic coronary arterial obstruction

95

What are common causes of IHD

athersclerosis narrowing of coronaries
thrombosis from dirupted plaque
localized platelel aggregation
vasospams
emboli
hypotension
coronary artery vasculitis

96

What are common causes of IHD

athersclerosis narrowing of coronaries
thrombosis from dirupted plaque
localized platelel aggregation
vasospams
emboli
hypotension
coronary artery vasculitis

97

what percent of fixed obstruction leads to Sx with exercise in IHD? what aobut lead to ischemia at rest?

with exercise >75%
at rest >90%

98

What are the characteristics of unstable plaques

the ones with large cores and thin caps

99

what are the acute plaque changes

rupture.fissuring
erosion/ulceration
hemorrhage into atheroma (plaque)

100

where does acute plaqu change not usually occur

in severely stenoic portions of aa

101

What aa to plaques tend to involve

proximal LAD and LCX
entire RCA

102

what syndrome has an occlusive plaque-associated thormbus

transmural myocardial infarction

103

plaque disruption is common in what coronary artery syndromes

unstavle angina and transmural MI

104

stenoses is severe in what coronary artery syndrome

sudden death

105

What are the levels of moderate risk CRP

1-3mg/L

106

what is prinzmetal angina (variant)

sustained vasospasm causing angina

107

What is cardiac raynaud

cold or emotion induced cardiac vasospasm
if vasospasm >20 minutes can lead to myocardial infarction

108

what is takotsubo cardiomyopathy

dilated cardiomyopathy secondary to emotional or physical stress with normal coronary angiogram

109

what is apprpriate Tx for angina pectoris of any etiology

nitro

110

What is the definition of sudden cardiac death

unexpected death from cardiac causes early afeter onset of symptoms (1-24 hours) or sudden death from cardiac cause without antecedent acute symptoms

111

what is the mechanism of death in sudden cardiac death

lethal arrhythmia from electrical instability (irritability) v fib (80%) or asystole

112

what is the most common cause of sudden cardiac death

IHD

113

Channelopathies of heart are most likely what inheritance pattern

autosomal dominant

114

What channelopathies can lead to long QT syndrome

K channel KCNQ1 of KCNH2
SCN5A Na channel

115

what channelopathies can lead to short QT syndrome

K channels KCNQ1
KCNH2

116

What channelopathies can lead to catecholamingergic polymorphic ventricular tachycardia

RYR2
CASQ2
diastolic Ca release

117

What channelopathies can lead to catecholamingergic polymorphic ventricular tachycardia

RYR2
CASQ2
diastolic Ca release

118

What population is non ishchemic sudden cardiac death seen in

<40 y/o
young people

119

What are common causes of SCD in young adults

hypertrophic cardiomyopathy
coronary artery anomalies
myocarditis

120

What is chronic ischemic heart disease

insidious onset of CHF in patients with past MIs or anginas
cardiomegaly with L ventricular hypertophy and dilation
evidence of previous MIs (myocardial fibrosis)
arrhythmias

121

chronic ischemia that does not lead to necrosis can lead to what other remodeling

hypokinetic myocardium with myocyte hibernation

122

Angina PEctoris usually presents how

paroxysmal and usually recurrent substernal or precordial chest discomfort

123

What can cause angina pectoris

transient MI that falls short of causing necrosis

124

What is a stable angina

decreased perfusion from narrowing
most common
provoked by exercise or emotion
relived by rest or sublingual nitro

125

what is unstable angina

cresendo, have acute plaque change
progressive increase in frequency and severity of attacks
provoked by less effort and sometimes at rest
relieved by sublingual nitro and sometimes rest

126

what is prinzmetal angina

episodic angina from coronary artery spasm
relieved by rests, nitro, or CaChblockkers CCBs

127

what is the definition of a MI

death of cardiac muscle from ischemia

128

what factors account for 50-60% MIs

lipid risk factors

129

what genetic risk factors account for 10-20% MIs

prothrombin mutations, hyperhomocystenemia

130

What is a transmural infarction

ishcemic necrosis that involves more than 50% centricular thickness (acute plaque changes)

131

what is a subendocardial infarction

area of ischemic necrosis liminted to the inner 1/3 or at most the inner 1/2
may occur as resul tof acute plaque change and thrombosis or prolonged and severe recution in systemic blood pressure

132

What is the typical sequence of events in an MI

sudden change in plaque
formation initial platelet plug over plaque
vasospasm from platelet adhesion
propagation of platelt plug into stable clot from extrinsic clotting system
clot occludes lumen of involved vessel

133

Describe causes of transmural MI with NO atherosclerosis

vasospasm (cocaine)
embolie L atrium (a fib) ventricl (mural thrombus), valve vegetations, paroxysmal embolie
vasulitis, hemoglobinopathy

134

What type and when does adrenergic stimualtion induce MI

intense emotional stress
peak incidenc between 6 am and noon

135

When does dec in ATP occur in I

within seconds

136

whtn does irreversible cell injury occur in MI

20-40 minutes

137

when does microvascular injury occur in MI

>1 hr

138

when is there complete unsalvageable necrosis in I

6 hours

139

When are gross features seen in MI

around 12 hours. sometimes between 4 and 12 but usually around 12 hours or more (dark discoloration

140

what is the earliest light microscopy can pick up on MI

4 hours, variable waviness of fibers at border

141

With MI how does neutrophilia help Dx

because around 12-24 hours the first cells to infiltrate are the neutrophils

142

When does granulation tissue begin to form in MI duration

7-10 days

143

can pathologist tell how long ago MI occured if scarring already done

no

144

can pathologist tell how long ago MI occured if scarring already done

no

145

What days of MI are neutrophils bery prominent

3-4 days

146

What coronary a is most commonly obstrcuted second?

first is LAD
2nd is RCA

147

What is the goal of reperfusion after MI

salvage ischemic myocardium from potential infarction by restoration of tissue perfustion as quickly as possive

148

what are problemes with cardiac reperfusion after MI

can cause an increase release of ROS and cause damage
can lead to arrhythmias
myocardial hemorrhage iwth contraction bands
endothelial swelling
reversible :myocardial stunning"

149

What are the intervention techniques for MIs

lysis of thrombus with fibrinolytic meds like streptokinase, urokinase or tPA
balloon angioplasy
coronary artery bypass graft

150

what is myocardial stunning

when there is prolonged ischemic dysfuntiong.
although reeprfused wll take mycardiocytes longer to recover and gain function

151

what are the clinical Sx of an MI

severe substernal chest pain with radiation of pain down left arm, neck, jaw, epigastrium, weak rapid pulse, sweating, nausea, dyspnea

152

How are asymptomatic MIs detected

STEMI and NSTEMI on EKG

153

What are the most useful cardiac markers

troponins

154

what cardiac markers do you use to detect MI a few days ago

troponins
TnT can go longer than TnI

155

what percent of MI patients have one or more complications of acute MI

75%

156

what are the physiologic complications of acute MI

contractile dysfunction: severe pump failure in 10-15% patients
arrhythmias: conduction distrubances along myocardial irritability
papillary muscle dysfunction with mitral regurgitation

157

what are the pathologic complications of acute MI

fmyocardial rupture
pericarditis
right ventricular infarction
infarct extension and expansion
mural thrombus
ventricular aneurysm
progressive late heart failuer

158

what are the types of myocardial ruptures that are complications of acute MI

free wall (anterior) leading to cardiac tamponade
interventricular septum leading to VSD and ASD
papillary muscle leading to acute valvular regurg

159

what is the criteria for Dx of left sided HTN heart disease

have to have Hx of systemic HTN and then also L ventricular hypertrophy without other CV path that could induce it

160

L sided HTN heart disease may present clinically with what other syndromes.signs

CHF and atrial arrhythmias

161

R sided HTN heart disase occurs with what disorders

pulmonary parenchyma disorders (COPD and diffuse interstitial lung disease)
pulmonary vessel disorders (recurrent pulmonary embolism, primary pulmonary HTN)
chest movement disorders (kyphoscoliosis)

162

what is an example of right sided HTN heart disease

cor pulmonale from pulmonary disorders with chornic severe pulm HTN

163

What disease of pulm parenchyma presdispose to core pulmonale

COPD
diffuse pulm interstitial fibrosis
pneumoconioses
cystiv fibrosis
bronchectasis

164

what diseases of pulm vessels could lead to cor pulmonale

recurrent pulm thromboembolism
orimary puml HTN
extensive pulmonary aa (wegener)
drug, toxin or radiation induced obstruction
extensibe pulmonary tumore microembolis

165

what disorders infcuing pulm arterial constrction may predispose to cor pulmonale

metabolic acidosis
hypoxemia
chronic altitiude sickness
obstruction major airways
idiopathic alveolar hypoventilation

166

what disorders infcuing pulm arterial constrction may predispose to cor pulmonale

metabolic acidosis
hypoxemia
chronic altitiude sickness
obstruction major airways
idiopathic alveolar hypoventilation

167

What are the 2 major types of cardiac valve dysfunctions

stenosis and insufficiency

168

stenosis is always what type of disease

chronic

169

what is functional regurgitation

normal valve leaflets but there is a dilated annulu from ventricular dilation that spreads apart valve leaflets

170

what is a pure vs mixed cardiac valve dysfunction

pure is only stenosis or insufficiency present
mixed is when both are present in same valve

171

what is the most common acquired heart valve disease

mitral stenosis from rheumatic heart disease

172

What stenoses account for 2/3 valvular diseases

aortic and mitral valves

173

what is most frequent cause of aortic stenosis

calcification of anatmoically normal and congenital bicuspid aortic valves

174

what is most common cause aortic insufficiency

dilation of ascending aorta due to HTN and agin

175

what is most common cause mitral stenosis

rheumatic heart disease

176

what is most common cause mitral insufficiency

myxomatous degeneration

177

What is the most common of all valvular abnormalities

calcific aortic stenosis from aging

178

what are the pathologic findings of calcific aortic stenosis (Senile)

nodular masses of Ca are heaped up within sinuses of valsalva

179

what are the clincal features of calcific aortic stenosis

around 60s-80s
pressure hypertrophy from flow obstruction and patient has Lconcentric hypertrophy
L ventricular cardiac mass tends to be ischemic and leads to CHF syncope and angina pectoris

180

bicuspid aortic valves are more prone to what

progressive degenerative calcification, develops earlier

181

What types of patients does mitral annular calcification occur in

women over 60
individuals with myxomatous mitral valves
patients with elevated L ventricular P (HTN)

182

What condition is mitral annular calcification

associated with arrhythmias

183

when are mitral annular calcifications Dx

with radiography done for other reasons

184

What is myxomatou degeneration of mitral valve

mitral valve prolapse

185

What murmur do you hear with mitral valve prolapse

mid systolic click and regurgitant murmu

186

is mitral valve prolpase more commoin in young women or men

7:1 W:M

187

mitral valve prolapse is seen in what other condition assocaited with cardiac anomlalies

marfans

188

What are the serious complicatinos with mitral valve prolapse

infective endocarditis, mitral insufficiency, strok or other systemic infarct, arrhythmias, atypical chest pain

189

when is mitral valve prolapse Dx

Echocardiography

190

what are the pathologic changes in mitral valve prolapse

intercordal ballooning of mitral valve leaflets
affected ones are enlarged thick and rubbery
concomitant involvemnt tricuspid valve
thinned fibrosa lyaer with thickend spongiosa layer and depsition of mucoid or (myxoid) material

191

what are jet leasions

fibrosis of valve leaglets and endocardial surfaces of atrium and ventricl in mitral valve prolapse form wehre it hits close

192

what are jet leasions

fibrosis of valve leaglets and endocardial surfaces of atrium and ventricl in mitral valve prolapse form wehre it hits close

193

what are the steps of rheumatic carditis

begins with strep pharyngitis that leads to production of Ab against self and then infects all layers of heart, pancarditis

194

when does chronic rheumatic valvular heart disease begin

10 days-6 weeks post strep throat

195

what cells are pathoneumonic of rheumatic heart valve disease

aschoff bodies which are colelcitons of activated histocytes
antischkow cells (mononuclear)
aschoff cells- multinucleated forms
caterpillar cells- unique linear chromatin pattern

196

what 5 major clinical signs are assoc with acute rheumatic fever

migratoyr polyarthritis of large joints
acute carditis with cardiac enlargement and diminshed fucntion
subcutaneous nodules
erythema marginatum of skin
sydenham chorea (involuntary, purposeless movements of extremities)

197

what is criteria for Dx acute rheumatic fever

evidence of prior group A strep infection with either 2 major sytem findings or 1 major finding plus 2 minoe

198

what are the minor findings with acute prheumatic fever

fever, arthralgia, evidence of acute phase reactants( inc sed rate or inc CRP

199

After intial attack of acute rheumatic fever what is risk and Tx

risk for repeat group A strep infections
should receive long term PCN prophylaxid well into adulthood and perhaps life

200

When does rheumatic heart disease occur

years of decades ater episodes of acute rheumatic fever

201

what valves are commonlay affected by rheumatic valvular disease

mitral and aortic valves
uncommonly tricuspid
rarely pulmonic

202

99% of all mitral stenosis is caused by what

Rheumatic heart disease

203

what percent of RHD patients have mitral and aortic valve problems

25%

204

what are hallmarks of rheumatoid heart disease

cardiac involvemtn in 20-40% cases rheumatoid arthritis
fibrinous pericarditis is most common
rheumatoid nodules in myocardium, endocardium, valves and aortic root may be present
rheumatoid valvulitis with fibrous thickeing and calcificaiton of aortic valve cusps