February 11th Lecture

Question 1

What is coronary heart disease (CHD) characterized by?

Answer 1

Insufficient delivery of oxygenated blood to the myocardium

Question 2

What is coronary heart disease most commonly due to?

Answer 2

Coronary artery atherosclerosis

Question 3

How many minutes can the myocardium survive with no oxygenated blood?

Answer 3

20 minutes

Question 4

What are 3 other causes of CHD?

Answer 4

Abnormalities of blood oxygen content
Poor perfusion through coronary arteries
Abnormalities of microcirculation (genetic)

Question 5

What is arteriosclerosis

Answer 5

Chronic disease of arterial system
Abnormal thickening and hardening of vessel walls
Gradual narrowing of arterial lumen

Question 6

What is atherosclerosis

Answer 6

Form of arteriosclerosis
Caused by an accumulation of lipid-laden macrophages in arterial wall
Leads to plaque disease
Inflammatory disorder (not a single disease)

Question 7

Stages of coronary atherosclerosis

Answer 7

Endothelial injury
Endothelial cells become inflamed
Inflammatory cytokines and growth factors released
Macrophages adhere to injured endothelium
Macrophages create oxidative stress

Question 8

What are foam cells?

Answer 8

Macrophages fully of oxidized LDLs

Question 9

What is a fatty streak?

Answer 9

Accumulation of foam cells; produce progressive wall damage

Question 10

How does a fibrous plaque form?

Answer 10

When smooth muscle cells proliferate and migrate over a fatty streak

Question 11

What is cardiac muscle replaced with when it dies?

Answer 11

Dense, irregular, connective tissue

Question 12

What is CAD (coronary artery disease)?

Answer 12

Any vascular disorder that narrows or occludes coronary arteries
Can diminished blood supply enough to cause ischemia

Question 13

What is myocardial ischemia?

Answer 13

Narrowing >50%

Impairs blood flow during exercise

Question 14

How long does it take for a cardiac muscle cell to become ischemic?

Answer 14

10 seconds, lose contractibility after several minutes

Question 15

What is angina pectoris?

Answer 15

Chest pain due to myocardial ischemia

No permanent change, or damage if blood flow is restored

Question 16

What is Acute coronary syndrome?

Answer 16

Sudden obstruction due to thrombus formation of ruptured plaque

Question 17

What is unstable angina?

Answer 17

Type of acute coronary syndrome

reversible myocardial ischemia

Question 18

What is a myocardial infarction?

Answer 18

Type of acute coronary syndrome

Prolonged ischemia causing irreversible heart muscle damage

Question 19

What is sudden cardiac death?

Answer 19

Sudden arrest

Death from loss of heart function within 1 hour of onset of symptoms

Question 20

Chronic Ischemic Cardiomyopathy

Answer 20

Heart failure develop insidiously
Consequence of progressive ischemic myocardial damage
History of angina or MI
Consequence of slow, progressive apoptosis of myocytes
Poor prognosis- death of CHF

Question 21

Endocardial and valvular diseases are disorders of the

Answer 21

Endocardium

Damage heart valves

Question 22

Valvular Stenosis is when

Answer 22

Valve orifice is constricted and narrowed, impedes forward blood flow

Question 23

What does valvular stenosis lead to?

Answer 23

Myocardial hypertrophy

Question 24

What is valvular regurgitation?

Answer 24

Insufficiency or incompetence of a valve

Valve cusps fail to shut completely and blood flow is permitted when the valve is closed

Question 25

What is mitral stenosis?

Answer 25

Impairment of flow from left atria to left ventricle

Question 26

What are common causes of mitral stenosis?

Answer 26

Acute rheumatic fever or bacterial endocarditis

Question 27

What are some results of mitral stenosis

Answer 27

Narrowing as a result of inflammatory lesions Incomplete atrial emptying- increased atrial pressure- dilation and hypertrophy CO is decreased

Question 28

What is mitral regurgitation?

Answer 28

When blood flows back from the left ventricle to the left atria during ventricular systole

Question 29

Results of mitral regurgitation

Answer 29

Left ventricle becomes dilated and hypertrophied Back flow volume increases- left atrium dilates May lead to LV failure Increases in atrial pressure, can lead to RV failure

Question 30

What is mitral valve prolapse

Answer 30

``` Cusps of mitral valve billow upward Cusps are enlarged, thickened, scalloped Chordae may be elongated Leakage leads to regurgitation Minimal mortailty or morbidity ```

Question 31

Three common causes of aortic stenosis

Answer 31

Rheumatic heart disease Congenital malformation Degeneration thickening and calcification

Question 32

What happens with aortic stenosis

Answer 32

Diminished flow LV to aorta Pressure increase in LV Decreased SV, reduced systolic bp, narrowed pulse pressure, slow heart rate, faint pulse Left ventricular hypertrophy to compensate

Question 33

Aortic Regurgitation

Answer 33

Causes volume overload in LV during diastole- increases EDV | LV increases SV to maintain CO

Question 34

What is rheumatic Heart Disease?

Answer 34

Diffuse inflammatory disease Caused by delayed immune response to infection by A Beta- hemolytic streptococcus Begins as carditis- all 3 layers affected

Question 35

What is the acute form of rheumatic heart disease?

Answer 35

Febrile illness with joint, skin, nervous system, and heart failure

Question 36

What can happen when rheumatic heart disease is untreated

Answer 36

Scarring and deformity of cardiac structures

Question 37

Where is the primary lesion in rheumatic heart disease?

Answer 37

Endocardium; Swelling of heart valve leaflets

Question 38

What are Aschoff bodies?

Answer 38

Fibrotic areas of myocardium surronded by areas of necrosis | Associated with rheumatic heart disease

Question 39

How does scarring occur with rheumatic heart disease?

Answer 39

Clots develop along valves and cordae- progressively adherent

Question 40

What happens if rheumatic heart disease is untreated?

Answer 40

Cardiomegaly and left heart failure

Question 41

What are specific symptoms associated with rheumatic heart disease?

Answer 41

Carditis Acute migratory polyarthritis Chorea Erythema marginatum

Question 42

What is carditits?

Answer 42

A new heart murmur- mitral or aortic SL valve dysfunction | Chest pain from pericardial inflammation

Question 43

What is erythema marginatum

Answer 43

Truncal rash that accompanies rheumatic fever