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Flashcards in Wk5: Witrak Deck (79):
1

Leading cause of M&M in developed world with 95% due to what

Ischemic heart disease; coronary atherosclerosis

2

What defines an unstable atherosclerotic plaque?

risk of rupture with partial or complete lumen occlusion by aggregated platelets/thrombosis

3

What is acute coronary syndrome?

Coronary blood supply is suddenly blocked - either unstable angina or MI

4

How many minutes of complete ischemia -> myocardial death

30 minutes +

5

EKG changes with subendocardial and transmural infarctions

Sub: usually non-STEMI
Transmural: more likely STEMI (older -> Q waves)

6

Subacute sequelae of MI (days to 2 weeks)

Mural thrombosis, LV rupture (free wall, septal, or papillary muscles), fatal hemopericardium, acute VSD, mitral regurg/flail, peri-infarct pericarditis

7

Chronic sequelae of MI

LV aneurysm, chronic CHF, pleural effusions, 2* RV CHF, Dressler's pericarditis

8

What is another name for Dressler's pericarditis, and what is it?

Post-cardiac injury syndrome. Believed to be an immune response to damaged tissue after MI, trauma, surgery to pericardium or heart.

9

How does stable chronic atherosclerotic disease present a risk of sudden death?

Sudden/fatal vent dysrhythmia from ischemic aggravation to the conduction system

10

What causes left-sided hypertensive heart disease? What happens?

Chronic systemic (arterial) htn -> concentric LV hypertrophy (free wall >1.5 cm) -> LV failure

11

Isolated Right Sided hypertensive heart disease (cor pulmonale) cause

Inc pulm artery pressure from: 1)chronic pulm parenchymal disease e.g. COPD, fibrosing 2)chronic hypoxia e.g. sleep apnea -> pulm vasoconstriction 3)pulm vasc disease e.g. 1* pulm htn and chronic recurrent thromboemboli

12

Size of RV free wall in RV hypertrophy

Free wall >0.5 cm.

13

Cause of most RV HF

LV HF

14

Possible causes of aortic valve regurg

Thoracic aortic aneurysm -> valves can't close properly. Aortic dissection.

15

Causes of AV valve insufficiency

CHF -> valve ring dilation, papillary muscle dysfunction from LV ischemia with CAD

16

Define cardiomyopathy

Intrinsic myocardial disease NOT assoc w ischemic, valvular, hypertensive, or structural congen heart disease

17

What type of cardiomyopathy is essentially 100% genetic/mutational cause

Hypertrophic

18

What is cardiac tamponade?

Pericardial fluid critically compresses the heart

19

What is constrictive pericarditis?

progressive pericardial space fibrosis (like a growing scar) -> compression of heart

20

Causes of pericardial effusion

infectious and non-infectious disease, CHF, neoplastic infiltration, uremia

21

Most primary tumors of the heart are what type?

Atrial myxomas, very rare, usually left atrium

22

Other primary cardiac tumors

Rhabdomyomas - children esp tuberous sclerosis (gene defect -> growth of benign tumors). Cardiac sarcomas: very rare, usually lethal.

23

Are myocytes or the pericardium more likely to be sites of metastases?

Pericardium

24

What O2 sat defines cyanosis

<85%

25

How long does it take a troponin to become positive in AMI? When does it peak, and how long does it persist?

2-4 hours to be positive. Peaks ~48 hours. Persists 7-10 days.

26

How does CK-MB compare to troponin?

Also elevated with myocardial necrosis but less specific than trop. Does drop down sooner allowing for detection of a second event.

27

What causes release of BNP? What are significant lab values?

Stretch of myocardium esp LV. 400 HF more likely cause of dyspnea

28

Main cause of hypercarbia

(inc pCO2 @ >45 mmHg): alveolar hypoventilation, usually due to COPD

29

When can O2 saturation be normal yet the patient is hypoxemic?

CO poisoning

30

AMI mortality within one month

30%

31

How might you get a circumferential LV subendocardial infarct?

Global hypotension

32

What is the immune response to death of cardiac myocytes?

Neutrophils within a couple days, fibroblasts in 1.5-3 weeks, collagen scar formation in 4-6 weeks.

33

Possible causes of CHF post infarct

1) Perforation of septum -> VSD -> acute CHF. 2) decreased functioning of myocardium due to necrotic regions -> CHF 3) transmural -> scarring -> loss of compliance -> akinetic -> CHF

34

Define systolic and diastolic HF

Systolic: low EF. Diastolic: preserved EF but decreased compliance -> can't relax -> can't fill appropriately and backs up blood -> pulmonary sx

35

How might diastolic failure lead to a-fib?

Associated atrial enlargement -> a-fib

36

Can LVH be reversed?

Yes, fairly quickly with control of hypertension

37

What does the LV look like in congenital LVH?

Thickening of septum moreso than the free wall.

38

Define cor pulmonarle

Right-sided hypertensive heart disease due to chronic hypoxemic pulm disease (e.g. COPD) or pulm htn

39

Causes of valvular stenosis

Valvulitis (RF, SLE, RA), congen deform, CALCIFIC degen change, carcinoid syndrome, radiation

40

Commonest cause of mitral stenosis

Rheumatic fever

41

2/3 of clinically significant valve disease = acquired aortic or mitral stenosis. Causes?

1) gradual obstruction due to post inflam fibrosis/deform (RF, SLE, RA) 2)atherosclerotic or calcific degen (esp AS)

42

What is ankylosing spondylitis?

Inflammatory disease -> fusing of vertebrae

43

How are valvular diseases diagnosed?

echo

44

What is myxomatous degeneration?

Pathological weakening of connective tissues

45

Most common cause of isolated mitral regurg in N Amer requiring surgery

Myxomatous degeneration -> ballooning of valve leaflets and elongation of chordae tendinae

46

What is "fish mouth" associated with?

A valve with typical rheumatic fever damage

47

Other than IE, what may result in vegetations on heart valves?

hypercoagulable state due to malignancy

48

What is systolic click murmur syndrome?

Mitral valve prolapse

49

What is dilated CM?

Dilated ventricles -> systolic LV dysfunction with decreased LVEF

50

What is hypertrophic CM?

Thickened LV wall esp septum with normal to reduced LV chamber size -> diastolic LV dysfunction

51

What is restrictive CM? What causes it?

Diastolic LV dysfunction assoc with usually non-dilated, usually non-hypertrophic ventricles due to primary dec in vent compliance.

52

Dilation of atrium = risk for ?

Clot formation

53

Dilated CM associated with what

Increased cardiac mass, HF symptoms e.g. dyspnea and fatigue, atrial of ventricular arrhythmias, possible sudden death

54

Causes of dilated CM (6)

Genetic 20-50%, myocarditis, alc abuse, chemo e.g. doxorubicin, hemochromatosis, peripartum, idiopathic

55

Dilated CM age of onset and mortality

Commonly 20-50 y.o. and leading to 50% mortality within 2 years.

56

Treatment for dilated CM

Supportive HF measures, possibly a LVAD (for myocardial recovery or bridge to transplant)

57

Commonest cause of hypertrophic CM (specific)

Autosomal dominant defect in sarcomeric contractile proteins (60--70%)

58

How does the ventricle appear in hypertrophic CM (specifically)

Asymmetrically thickened septum, especially in subaortic/basal region

59

What component of functioning is impaired in hypertrophic CM?

Diastolic relaxation/ filling -> limited CO -> inc LVEDP. May have syst murmur due to blood trying to pass by fat septum

60

Top 3 causes of sudden death in young athletes

1. hypertrophic CM 2. anomalous coronary artery origin 3. myocarditis

61

Symptoms of HCM

DOE, myocardial ischemia without CAD, risk of a-fib, eventual vent. failure/dilation, vent arrhythmias, sudden death

62

How does LVH appear when due to inc BP or aortic stenosis

Usually concentric thickening

63

Treatment for hypertrophic CM

Beta blockers, occasionally partial septal ablation

64

How does restrictive CM present?

Manifests as right HF. Systolic fx usually normal early.

65

A few causes of RCM

Familial, amyoidosis, diabetic CM, sarcoidosis, chemo (esp anthracyclines), metabolite deposition from inborn errors of metab, radiation fibrosis

66

What is arrhythmogenic RV CM? What causes it?

Autosomal dominant. Markedly thinned RV wall with fibroadipose tissue -> conduction disturb -> RV failure

67

What disease is arrhythmogenic RV CM associated with?

palmar/plantar hyperkeratosis. The combo = Naxos syndrome

68

Mechanism of stress-induced CM

Catecholamine surge -> "myocardial stunning" with transient systolic dys

69

How does stress-induced CM present

ischemic heart sx, foci of myocardial necrosis

70

Other causes of CM

Pheochromocytoma (adrenal tumor), cocaine use

71

Clinical sequelae of hemochromatosis

CM/HF (usually dilated type), conduction disturbance, cirrhosis/hepatoma, endocrine dys, arthritis

72

What effect does excess hemosiderin have on myocytes?

Toxicity -> secondary fibrosis

73

How is hemochromatosis diagnosed

>45% transferrin saturation, HFE gene mut, hepatic iron index noted on liver biopsy

74

What occurs in amyloidosis?

deposition of amorphous proteinaceous substance that is congo red positive

75

Sequelae of cardiac amyloidosis

usually restrictive CM -> HF, low EKG voltage, increased vent thickness, non-dilated LV cavity

76

Most common causes of myocarditis in US

Viral: entero, coxsackie B, adenovirus, parvo B19, hep C, HHV-6, CMV, HIV

77

Cause of myocarditis in developing/ endemic latin American countries

Chagas: attacks heart and esophagus -> HF + dysphagia

78

Acute HF within weeks of viral prodrome, possibly with CP, arrhythmia, sudden death = classic presentation of ?

Myocarditis

79

Most common cause of HF in children

myocarditis