Test 2 - RU Heart

Question 1

chronic inflammatory response in the walls of arteries

Answer 1

atherosclerosis

Question 2

inflammatory disease of blood vessels

Answer 2

vasculitides

Question 3

S/S of vasculitides

Answer 3

fever, malgias, athralgais

ischemia, thrombus formation

Question 4

M/C arteritis after 50 yrs

involves medium and small arteries

granulomatous formation is T cell mediated

Answer 4

giant cell arteritis

Question 5

ocular disturbances and weakened upper extremity pulse

Answer 5

takayasu arteritis

Question 6

typically involves small and medium arteries, especially renal vessels

autoimmune

affects young adults

transmural inflammation of the arterial wall

nodular formation causes segmental weakening resulting in rupture

Answer 6

polyarteritis nodosa (PAN)

Question 7

autoimmune

acute necrotizing granulomas in respiratory tract

renal disease - “crescentic glomerulonephritis”

Answer 7

wegener’s granulomatosis

Question 8

onset before age 35

affects heavy smokers

involves segmental thrombosing and inflammation of medium and small arteries

Answer 8

thromboangiitis obliterans “buerger disease”

Question 9

localized, abnormal dilation of a blood vessel wall or wall of the heart

Answer 9

aneurism

Question 10

true vs false aneurism

Answer 10

true: involves all layers: atherosclerotic, symphilitis, congenital vascular aneurism, left vascular aneurism (MI)
false: leak in the vessel wall leading to a hematoma (PAN)

Question 11

blood enters the vessel wall and forms a hematoma resulting in a dissection of the layers of the wall

usually caused by atherosclerosis and cyctic median necrosis

Answer 11

dissection

Question 12

affects mainly men 50+

mostly results from atherosclerosis

abdominal aorta - below renal artery but above the bifercation

obstruction, shock, aneuris, embolism

Answer 12

abdominal aortic aneurism

Question 13

typically men between 40-60 with history of hypertension

thoracic aorta

S/S: aortic valve insufficiency, difficulting breathing, encroachment of mediastinal structures

Answer 13

syphilitic (leutic) and aortic dissection

Question 14

benign, malformation of the endothelial cells lining blood vessels

majority are superficial, occuring in the head, neck and liver

Answer 14

hemangioma

Question 15

located in skin, sub-cutaneous tissue and mucus membranes of oral cavities and lips

Answer 15

capillary hemangioma

juvenile : strawberry patch seen in new borns

cavernous : large, often located in the brain or brainstem

Question 16

most often seen in AIDS patients

Answer 16

karposi sarcoma

Question 17

malignant endothelial neoplasm

most common primary malignancy of the heart

Answer 17

angiosarcoma

Question 18

most frequently occurring cardiac tumor and is found most often in adults; benign

Answer 18

myxoma of the left atrium

Question 19

most common in infants and young children

notable for its association with tuberous sclerosis; benign

Answer 19

rhabdomyoma

Question 20

5 principles of cardiac dysfunction

Answer 20

1. failure of the pump - muscle contracts weakly, incomplete emptying of chambers, insufficient ventricular filling
2. obstruction of flow: incomplete valve opening, increased ventricular pressure
3. flow regurgitation: insufficient closure of the valve casuing blood to flow backwards
4. disorders of conduction: due to heart-block or arhythmeas
5. disruption of the continuity of the circulatory system

Question 21

group of syndromes caused by myocardial ischemia

Answer 21

ischemic heart disease

Question 22

acute heart attack

Answer 22

myocardial infarction

Question 23

severe chest pain (stable, prinzmetal, and unstable)

Answer 23

angina pectoris

Question 24

unstable angina, MI, sudden death

Answer 24

acute coronary syndromes

Question 25

blood supply to the heart is interrupted

Answer 25

myocardial infarction

Question 26

transmural MI involves ischemic necrosis of the full thickness of the \_\_\_\_\_\_\_

Answer 26

ventricular wall

Question 27

morphologic changes of MI 4hrs 4-24 hrs 1-3 days 3-7 \>7

Answer 27

4hrs - no gross damage 4-24hrs - collagen necrosis 1-3 days - necrosis with inflammation (neutrophilic infiltrate) 3-7 days - dying neutrophils and necrosis \>7 days - necrosed myocardium is replaced with connective tissue (fibrosis)

Question 28

consequences of MI

Answer 28

contractile dysfunction arrhythmias pericarditis ventricular anurism myocardial rupture

Question 29

usually caused by significant coronary occlusion congenital, structural coronary arterial abnormalities aortic valve stenosis mitral valve prolapse dialted or hypertrophic cardiomyopathy pulmonary hypertension

Answer 29

sudden cardiac death

Question 30

hear tis large and heavy due to left ventricular hypertrophy and dilation myocardial hypertrophy found with ischemic cardiomyopathy

Answer 30

chronic ischemic heart disease

Question 31

sustained diastolic blood pressure \> 90mmHg or sustained systolic blood pressure \> 140mmHg

Answer 31

hypertension

Question 32

priamary vs secondary hypertension

Answer 32

primary: abnormality in the rennin-angiotensin system resulting in an increase in blood volume, increase in peripheral resistance secondary: often caused by renal disease, caused by adrenohyperfunction (cushing syn), caused by pregnancy, stress, and cardiovascular pathology

Question 33

found in elderly patients without hypertension leakage of plasma components across vascular wall increase in extra-cellular matrix production by smooth muscle cells hyaline deposition

Answer 33

hyaline atherosclerosis

Question 34

acute or rapid elevation in blood pressure narrowing of the arteriole lumen due to a concentric laminated thickening (onion skin) smooth muscle cells thicken and replicate the basement membrane results in fibrinoid deposition and acutre necrosis of the vessel

Answer 34

hyperplastic atherosclerosis

Question 35

hypertension retinopathy 1 2 3 4

Answer 35

1 - generalized narrowing of the arterioles 2 - grade 1 + focal arteriole spasms 3 - grade 2 + flame shpaed hemorrhages, cotton wool spots and hard waxy exudates 4 - grade 3 + optic disc edema

Question 36

inflammation of the endothelial and subendothelial tissues

Answer 36

endocarditis

Question 37

autoimmune occurs after strep infections produces Macculm plaques - subendocardial thickening from regurgitation, left atrium changes usually occur in mitral valve leaflet thickening commissural fusion shortening and thickening of cordea tendenea

Answer 37

rheumatic valvulitis

Question 38

autoimmune involves the mitral and tricuspid valves small vegetations on both sides of valves found in fibrinoid necrosis

Answer 38

liebman - sacks (SLE)

Question 39

caused by highly virulent bacteria: strep aureus / viridans commonly involves aortic or pulmonary valves devastating destruction of the valves

Answer 39

acute INFECTIVE endocarditis

Question 40

caused by low virulence bacteria: alpha hemolytic Streptococci - S. milleri, S. Mutans and S. salivarus, S. bovis. Staphylococcus aureus or E.coli. results in large irregular vegetations involving valves and cords

Answer 40

subacute bacterial endocarditis

Question 41

seen in debilitated patients (cancer, sepsis, etc) causes vegetations containing fibrin and platelts (thrombus) no bacteria seen with: venous thrombosis, pulmonary embolism, hypercoagulability

Answer 41

non-bacterial thrombotic endocarditis (NBTE)

Question 42

inflammation of myocardium infections - viral coxsackie A bacterial - diphtheria, lyme disease immune - SLE, rheumatic idopathic - sarcoidosis

Answer 42

myocarditis

Question 43

deterioration of the heart

Answer 43

cardiomyopathy

Question 44

acquired via alcoholism or pregnancy hypertrophy followed by dilation, impairment of contractility, systolic dysfunction enlarged heart

Answer 44

dialated cardiomyopathy (congestive carediomyopathy)

Question 45

hypertrophy and fibrosis, impairment of compliance, diastolic dysfunction

Answer 45

hypertrophic (obstructive) cardiomyopathy

Question 46

least common of cardiomyopathy amyloidosis, sarcoidosis, radiatio, fibrosis pericardial constriction, diastolic and systolic dysfunction

Answer 46

restrictive cardiomyopathy

Question 47

inflammation of pericardium

Answer 47

pericarditis

Question 48

fibrinous: bread and butter appearance

Answer 48

pericarditis

Question 49

risk factors of CHD

Answer 49

preterm infants genetic factors (trismony 13,15,18,21, turner syndrome) enviromental factors (rubella, toxoplasma infections)

Question 50

abnormal communication between chambers or vessels direction of blood flow is dependent on pressure relationship between chambers

Answer 50

shunt

Question 51

atrial septal defect (ASD) ventricular septal defect (VSD) patent ductus arteriosis (PDA) atrioventricular septal defect (AVSD) all part of ______ shunt: ___ cyanosis

Answer 51

left to right shunt late cyanosis

Question 52

tetralogy of fallout transposition of greater vessels tricuspid atresia anomalies (connections) all part of ______ shunt: ____ cyanosis

Answer 52

right to left shunt early cyanosis

Question 53

obstructive CHD

Answer 53

coarctiation of aorta aortic valve stenosis and atresia pulmonary valve stenosis and atresia

Question 54

asymptomatic until adulthood seen with volume hypertrophy of the ventricles types: secundum: most common, defect on fossa ovale primum: occurs adjacent to atrioventricular valves (cleft mitral valve leaflet) sinus venosus: near the entrance of the superior vena cava

Answer 54

atrial septal defect L -\> R shunt

Question 55

most common congenital anomaly usually closes by itself types: membranous: upper part of septum muscular: lower part of septum early - R to L shunt (no cyanosis) right ventricle responds with hypertrophy shunt shifts to L to R shunt with cyanosis

Answer 55

ventricular septal defect

Question 56

connection between aorta and pulmonary artery mostly asymptomatic pulmonary hypertension which causes a reversal of the shunt to the R to L machine like 'harsh murmur' can be heard

Answer 56

patent ductus arteriosus

Question 57

R to L shunt 1. ventricular septal defect 2. pulmonary valve or subpulmonary valve stenosis 3. overriding of the aorta over the ventricular septal defect 4. right ventricular hypertrophy (heart becomes 'boot shaped') child is born with cyanosis

Answer 57

tetralogy of fallot R to L shunt

Question 58

congenital anomaly where the aorta narrows where the ductus arteriosis inserts infantile: aortic hypoplasia proximal to the patent ductus arteriosis adult: rigid like folding the aorta opposite to the closed ductus arteriosis. higher blood pressure in the upper extrem than in lower extrem

Answer 58

coarctation of aorta

Question 59

inability of the heart to pump blood at a rate commensurate with the demand of the tissues at normal pressure

Answer 59

heart failure

Question 60

enhanced contractility with icnreased preload heart failure

Answer 60

frank sterling mechanism

Question 61

heart rate and contractility increased heart failure

Answer 61

norepinephrine release

Question 62

to increase blood volume heart failure

Answer 62

activation of the renin-angiotensin-aldosterone system

Question 63

pathophys of systolic failure vs diastolic failure

Answer 63

systolic - deterioration of myocardial contractility diatole - inability of muscle to relax (decreased filling)

Question 64

etiology: ischemic heart disease, angina, cardio myopathy, MI results in decreased perfusion to the kidneys (prerenal azotemia) and brain hypoxic encephalopathy

Answer 64

left sided heart failure

Question 65

blood backs up into the venous system results in: congestive hepatomegaly centrilobar hemorrhagic necrosis cardiac clerosis portal hypertension venous congestion in the brain

Answer 65

right sided heart failure