2 Articles - Cardiac Tumors and Cardiac Remodeling

Question 1

The signs and symptoms of a cardiac tumor are generally determined by the ________ of the tumor in the heart rather by its ___________.

Answer 1

location

histopathology

Question 2

Some symptoms seen that are caused by tumors. (5)

Answer 2

• obstruction of circulation (most frequent)
• interference with valves
• direct invasion of myocardium
• invasion of adjacent lung
• embolization

Question 3

If a cardiac tumor is suspected, what is the simplest technique for its evaluation? What are two other evaluation techniques that would yield more information?

Answer 3

• echocardiography

- MRI and CT

Question 4

Are the majority of cardiac tumors malignant?

Answer 4

no, they are mostly benign.

Question 5

The majority of tumors are what type?

Answer 5

myxomas

Question 6

The majority of myxomas arise where?

Answer 6

in the left atrium

most of the remainder are found in the right atrium

Question 7

Are primary malignant tumors of the heart rare?

Answer 7

yes

primary malignant tumors of the heart are typically sarcomas

Question 8

Primary sarcomas arising in the heart generally are rapidly progressive and cause death by doing what? (3)

Answer 8

• infiltrating into the myocardium
• obstructing circulation
• distant metastases

Question 9

Is metastatic involvement of the heart rare? (like, say the tumor originated somewhere besides the heart, but now the heart is involved)

Answer 9

that is actually pretty frequent

Question 10

Patients with smaller excised tumors, minimal cardiac symptoms, and no evidence of mitral regurgitation had lower or higher risk of embolization?

Answer 10

higher risk

Question 11

What is the most serious complication of left atrial tumor embolization?

Answer 11

neurologic symptoms

Question 12

Define cardiac remodeling.

Answer 12

an alteration in the structure and/or function of the heart is response to hemodynamic load and/or cardiac injury

Question 13

Remodeling may be classified as one of two processes. What are they?

Answer 13

adaptive (or physiologic)

maladaptive (or pathologic)

Question 14

What are the three general patterns of remodeling?

Answer 14

1. concentric LV remodeling (response to pressure overload)
2. eccentric LV hypertrophy (response to volume overload)
3. mixed concentric/eccentric hypertrophy

Question 15

The process of cardiac remodeling involves what 4 types of changes to cardiac myocytes and the interstitial collagen matrix?

Answer 15

• structural
• functional
• cellular
• molecular

Question 16

What 3 systemic factors can influence cardiac remodeling?

Answer 16

• changes in hemodynamic load
• neurohormonal activation (causing HTN)
• metabolic status

Question 17

Cardiac dysfunction is defined as an alteration in the relationship between ______ and _______ ________.

Answer 17

preload

stroke volume

(depicted by Frank-Starling curves)

Question 18

The heart can respond to environmental stimuli by growth or shrinkage with a dynamic range of at least ____%.

Answer 18

100%

that’s the reason why the Grinch’s heart was able to get so big

Question 19

What is meant by concentric remodeling?

Answer 19

characterized by increased relative wall thickness (wall thickness as compared to cavity size)

• increased thickness of sarcomeres

Question 20

What is meant by eccentric remodeling?

Answer 20

characterized by increased cardiac mass and chamber volume

• increased length of sarcomeres

Question 21

Are ACE inhibitors and some beta blockers capable of slowing, and in some cases reversing, certain parameters of cardiac remodeling?

Answer 21

yes

Question 22

After an infarct, how long until LV remodeling takes place?

Answer 22

within the first few hours and progresses over time

Question 23

Post-infarction remodeling can be predicted by what change on the EKG?

Answer 23

inverted T waves

Question 24

As the heart undergoes remodeling, it becomes less _______ and more ________.

Answer 24

less elliptical

more spherical

Question 25

What 3 cellular changes are seen with remodeling?

Answer 25

1. myocyte hypertrophy
2. apoptosis of myocytes (or necrosis)
3. fibroblast proliferation and fibrosis

Question 26

What 3 hormones are a part of the neurohormonal activation?

Answer 26

1. renin
2. norepi
3. ADH

Question 27

What is an important factor in the overall extent of remodeling?

Answer 27

the size of the infarct