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Heart Flashcards

1
Q

Three mechanisms that initially maintain cardiac output in HF

A

1) Frank-Starling, 2) hypertrophy and/or dilation, 3) neurohormonal (adrenergic, RAAS, and ANP)

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2
Q

Effect of pressure overload

A

Parallel formation of new sarcomeres = hypertrophy (lalaki to cope)

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3
Q

Effect of volume overload

A

Series formation of new sarcomeres = dilation (dadami to cover greater volume)

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4
Q

Common causes of left-sided HF

A

Ischemic heart disease, HTN, aortic and mitral valve diseases, primary myocardial diseases

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5
Q

Common causes of right-sided HF

A

Left-sided HF (most common) and cor pulmonale

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6
Q

Organ more affected by left-sided HF than right-sided HF

A

Lungs

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7
Q

Organs hypoperfused by left-sided HF

A

Kidneys (prerenal azotemia) and brain (hypoxic enceph)

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8
Q

More prominent finding in right-sided HF due to third spacing

A

Effusions and ascites

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9
Q

Most common genetic cause of congenital heart disease

A

Trisomy 21

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10
Q

Marks the irreversibility of CHD lesions

A

Pulmonary HTN

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11
Q

Most common type of ASD

A

Ostium secundum (90%)

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12
Q

ASD adjacent to AV valves

A

Ostium primum

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13
Q

Associated with ostium primum

A

AV valve defects and VSD

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14
Q

ASD near the entrance of the SVC

A

Sinus venosus

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15
Q

Clinical findings pointing to ASD

A

Widely fixed split S2 (due to prolonged ejection of RV and increased blood flow across PV), and murmur (pulmonic stenosis-like due to increase blood flow across PV)

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16
Q

Most common congenital heart defect

A

VSD

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17
Q

Most common type of VSD

A

Perimembranous (90%), other types include infundibular and muscular

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18
Q

Cut-off size for VSD that would determine if clinically symptomatic or well-tolerated

A

> 10 mm

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19
Q

T or F: Small muscular VSDs are more likely to close than membranous

A

True

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20
Q

Vast majority of VSDs that close do so before age __

A

Four years of age

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21
Q

Adult remnant of PDA

A

Ligamentum arteriosum

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22
Q

Embryonic structure represented by median umbilical ligament

A

Urachus

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23
Q

Embryonic structure represented by medial umbilical ligament

A

WALA (mediaNNNN ang urachus)

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24
Q

CHD associated with continuous, machinery-like murmur

A

PDA

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25
Administered to infants relying on PDA to survive other CHDs
PGE2 (alprostadil), a prostaglandin analogue (vs indomethacin, which can be used to close the PDA)
26
Most common cyanotic heart disease overall
TOF
27
Most common cyanotic heart disease in newborns
TGA
28
Defect causing TOF
Anterosuperior displacement of infundibular septum
29
Components of TOF
RVH, VSD, overriding aorta, pulmonary outflow obstruction
30
Couer en sabot
Boot-shaped heart on CXR
31
The degree of ___ determines clinical consequences
PS (if mild, "pink TOF" that acts like VSD; if considerable, then classic TOF with tet spells)
32
Epidemiologic profile of patients with TGA
Infant of diabetic mothers and male (3:1)
33
Frequently associated abnormalities in TGA necessary for survival
PFO, ASD, PDA (50% also have VSD)
34
Radiographic appearance of TGA
Egg on a string or apple on a stem
35
Location of infantile coarctation of the aorta
Tubular hypoplasia proximal to the PDA (preductal)
36
Location of adult coarctation of the aorta
Coarctation opposite the ligamentum arteriosum distal to arch vessels (postductal)
37
Associated genetic syndrome with infantile coarctation of the aorta
Turner syndrome
38
Clinical findings of infantile coarctation
Lower extremity cyanosis
39
Clinical findings of adult coarctation
Upper extremity hypertesion with rib notching on CXR
40
Most common cause of ischemic heart disease
Atherosclerosis of epicardial coronary arteries
41
Earliest detectable feature of myocyte necrosis
Sarcolemmal membrane disruption, leading to myocardial proteins in the blood
42
Length of time to loss of contractility in IHD
<2 mins
43
Length of time to loss of irreversible cell injury in IHD
20-40 mins
44
Three patterns of infarction
Transmural, subendocardial, multifocal microinfarction
45
Pattern of infarction leading to regional permanent occlusion that occurs in STEMI
Transmural
46
Pattern of infarction leading to transient or partial occlusion or global hypotension (circumferential) occuring in NSTEMI
Subendocardial
47
Most commonly involved coronary arteries in MI
LAD > RCA > L circumflex
48
Gross morphology of infarcts after 2-3 hours
Triphenyltetrazolium chloride pale zone
49
Gross morphology of infarcts after 12-24 hours
Reddish-blue (stagnated, trapped blood) or dark mottling, with conversion to pale tan, soft infarct
50
Gross morphology of infarcts after 10-14 days
Bounded by hyperemic zone of granulation (conversion to fibrous scar)
51
Microscopic morphology of infarcts after 6-12 hours
Ischemic coagulative necrosis
52
Microscopic morphology of infarcts after 1-3 days
Acute inflammation with PMNs
53
Microscopic morphology of infarcts after 3-7 days
Macrophages
54
Microscopic morphology of infarcts after 1-2 weeks
Granulation tissue
55
Most sensitive and specific cardiac troponins
Trop T and trop I
56
Cardiac biomarker used to assess reinfarction
CK-MB
57
Cardiac biomarkers that peak within 24 hours
Trop I and CK-MB
58
Cardiac biomarkers that return to normal in 5-10 days
Trop I
59
Cardiac biomarkers that return to normal in 48-72 hours
CK-MB
60
Fibrinous pericarditis post MI
Dressler syndrome
61
Unexpected death from cardiac causes either without symptoms or within 1 to 24 hours of symptom onset
Sudden cardiac death
62
Most common cause of sudden cardiac death
CAD (80%)
63
Most common mechanism of sudden cardiac death
Arrhythmia (asystole or v fib)
64
Most common cause of arrhythmia
Ischemic injury
65
Earliest change seen in left-sided HHD
Increase in transverse diameter of myocytes, leading to variable cell or nuclear enlargement with interstitial fibrosis
66
Seen in acute cor pulmonale from left-sided HHD
RV dilation
67
Seen in chronic cor pulmonale from left-sided HHD
RV hypertrophy, dilation, and possible R-sided HF
68
Most common cause of MVP
Unknown
69
Most common known cause of MVP
Fibrillin-1 gene defect (Marfan's)
70
In MVP, marked thickening of spongiosa with deposition of mucoid material
Myxomatous degeneration
71
Antibodies and CD4 T cells directed vs streptococcal M proteins also recognize cardiac self-antigens
Molecular mimicry
72
Composed of T-cells, plasma cells, and macrophages
Aschoff body (seen in RF)
73
Plump, activated macrophages with condensed chromatin pattern ("slender wavy ribbon"), also known as caterpillar cells
Anitschkow cells
74
Most commonly involved valve in RHD
Mitral > aortic > tricuspid >pulmonic
75
Calcification and fibrous bridging of valvular commisures seen in RHD
Fish mouth or button hole deformity
76
Small vegetations along lines of closure overlying foci of fibrinoid necrosis seen in RHD
Verrucae
77
Subendocardial irregular thickenings due to regurgitant jets seen in RHD
MacCallum plaques
78
Hallmark of infective endocarditis
Vegetations
79
Common organisms in acute IE
Staph aureus (also in IV drug users), damage more pronounced
80
Common organisms in subacute IE
Viridans strep and HACEK organisms
81
Most commonly affected valves in IE
Aortic and mitral
82
Two kinds of non-infective vegetations
Nonbacterial thrombotic endocarditis (NBTE) or marantic endocarditis, and Libman-Sacks endocarditis (in SLE)
83
Consequence of IE vegetations
Septic embolus
84
Associated with marantic endocarditis
Systemic hypercoagulable states, mucinous adenoCA, endocardial trauma
85
Three broad categories of cardiamyopathies
Dilated CM, hypetrophic CM, restrictive CM
86
Dysfunction in dilated CM
Systolic (impaired contractility)
87
Dysfunction in hypertrophic CM and restrictive CM
Diastolic (impaired compliance)
88
Genetic neurological disease associated with hypertrophic CM
Friedreich ataxia
89
Other associated causes of hypetrophic CM
Friedreich ataxia, storage diseases, infant of diabetic mothers
90
Causes of restrictive CM
Amyloidosis, radiation-induced fibrosis, endomyocardial fibrosis
91
Most common viral causes of myocarditis
Coxsackie A and B, enteroviruses
92
Parasitic causes of myocarditis
T. cruzi (Chagas disease) and Trichinella spiralis
93
Most common helminthic cause of myocarditis
Trichinella spiralis
94
Most common primary cardiac tumor in adults
Myxoma
95
Most common primary cardiac tumor in children
Rhabdomyoma
96
Location of myxoma
LA > RA
97
Location of rhabdomyoma
Ventricles
98
Conditions associated with myxoma
McCune-Albright and Carney complex
99
Condition associated with rhabdomyoma
Tuberous sclersosis
100
Number of mxyoma
Usually solitary
101
Number of rhabdomyoma
Usually multiple
102
Thin strands of cytoplasm from nucleus to nuclear membrane, found in rhabdomyoma
Spider cells
103
Beck's triad of cardiac tamponade
Hypotension, engorged neck veins, muffled heart sounds
104
Radiographic appearance of pericardial effusion
Water-bottle appearance
105
Most common type of acute pericarditis
Fibrinous/serofibrinous
106
Most common cause of hemorrhagic pericarditis
Neoplasms
107
Most common cause of caseous pericarditis
TB
108
Two types of chronic pericarditis
Adhesive mediastinopericarditis, constrictive pericarditis
109
Clinical findings of adhesive mediastinopericarditis
Systolic retraction of the rib cage and diaphragm, pulsus paradoxus
110
Clinical findings of constrictive pericarditis
Diastolic dysfunction
111
Clinical findings of acute pericarditis
Pericardial friction rub, chest pain relieved when leaning forward

Pathology (13 decks)

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