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Exam 2 APP > APP Module (GTown) - Cardiovascular Pathophysiology II (Hrs 3 and 4) > Flashcards

APP Module (GTown) - Cardiovascular Pathophysiology II (Hrs 3 and 4) Flashcards

1
Q

What is the defining feature of disseminated intravascular coagulation?

A

its consumptive coagulopathy

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2
Q

Give a general outline of the steps in the progression of endothelial injury

A

1) endothelium ceases making normal antithrombic/vasodilatory substances
2) immune inflammatory response
3) oxidation and phagocytosis
4) fatty streak accumulates and smooth muscle proliferates

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3
Q

What are three clinical consequences of atherosclerosis?

A

1) aneurysm and rupture
2) occlusion by thrombosis
3) critical stenosis

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4
Q

What is the relationship of genetic factors, acquired factors, and age?

A

Genetic factors play a large role at an early age, but this transitions to acquired factors playing more of a role as time goes on

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5
Q

What are the four steps in thrombosis?

A

1) propagation thru platelet accumulation/fibrin
2) embolization
3) dissolution
4) organization and recanalization

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6
Q

Where do arterial thrombi usually begin?

A

at a site of turbulence or endothelial injury

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7
Q

In what direction do arterial thrombi grow?

A

retrograde, against the flow

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8
Q

What is a mural thrombus?

A

a thrombus that accumulates on the wall of the heart

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9
Q

What is a cause of a mural thrombus?

A

myocardial infarction which causes injury to the wall of the heart and thus stagnation of blood

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10
Q

What is a clinical consequence of rheumatic heart disease?

A

mitral valve stenosis

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11
Q

Mitral valve stenosis leads to left atrial enlargement which leads to the risk of what?

A

LAE predisposes to AFib which increases the risk of a thromboembolic event, especially a stroke

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12
Q

What are venous thrombi caused by?

A

usually stasis of blood flow and hypercoagulability

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13
Q

Which direction do venous thrombi grow?

A

anterograde, in the direction of flow

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14
Q

Why might venous stasis cause endothelial injury?

A

stasis of blood leads to accumulation of toxins and waste byproducts leading to a damaged endothelium

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15
Q

What are the two types of venous thrombi?

A

1) local or superficial venous thrombi

2) deep vein thrombi

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16
Q

What is an embolism?

A

a detached intravascular mass, whether solid, liquid, or gas, e.g. fibrin clot, fat, or air

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17
Q

What is a primary cause of the thrombus in a pulmonary embolism?

A

deep veins of the leg

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18
Q

What percentage of the pulmonary circulation must be occluded to cause sudden death?

A

> 60%

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19
Q

What is the worst type of PE?

A

saddle embolus

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20
Q

Where is a saddle embolus located?

A

Bifurcation of the pulmonary trunk

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21
Q

What are some examples of systemic thromboemboli?

A

intracardiac or mural thrombi, ulcerated atherosclerotic plaques

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22
Q

What is the first step in atherosclerosis?

A

intimal thickening

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23
Q

What is atherosclerosis defined as?

A

a hyperinflammatory state

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24
Q

What are the factors in plaque formation?

A

1) endothelial dysfunction
2) monocyte adhesion and emigration
3) smooth muscle cell migration to intima
4) smooth muscle cell proliferation
5) ECM elaboration
6) lipid accumulation

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25
Q

What is an atheroma?

A

an accumulation of degenerative material, usually foam cells, LDL, lipids, and fibrous tissue in the inner layer of an artery wall.

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26
Q

What is the difference between a vulnerable plaque and a stable plaque?

A

A stable plaque has a stable fibrous cap and more overlying fibrotic tissue whereas a vulnerable plaque will have a larger necrotic center and less extensive fibrous cap vulnerable to rupture

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27
Q

What are the two factors that are imbalanced in the initiation of myocardial ischemia?

A

1) coronary artery blood supply

2) myocardial oxygen demand

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28
Q

What are some factors that affect coronary artery blood supply?

A

1) presence of coronary plaques
2) perfusion pressure
3) arterial blood oxygen content

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29
Q

What are some factors that affect myocardial oxygen demand?

A

1) preload
2) heart rate
3) afterload
4) contractility

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30
Q

What are the two factors in the regulation of blood pressure?

A

1) cardiac output

2) peripheral vascular resistance

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31
Q

What two factors affect cardiac output?

A

cardiac factors

blood volume

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32
Q

What are the three factors which mediate peripheral resistance?

A

1) local factors
2) humoral factors
3) neural factors

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33
Q

What are the two major influences of hypertension?

A

1) genetic factors

2) environmental factors

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34
Q

What three genetic and environmental influences lead to an individual with hypertension?

A

1) defects in renal sodium homeostasis
2) functional vasoconstriction
3) defects in vascular smooth muscle growth and structure

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35
Q

What is an aneurysm?

A

abnormal dilation of a blood vessel

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36
Q

What is a true aneurysm and what are the two types?

A

A true aneurysm is actual dilation of the entire vessel wall. The two types of true aneurysm are the 1) saccular aneurysm, and the 2) fusiform aneurysm.

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37
Q

What is a false aneurysm?

A

A false aneurysm is a tear in the inner layer of a blood vessel causing an extravasation into the outer layers and thus dilation into the adventitia

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38
Q

What is a dissection?

A

A tearing of the vessel wall so that blood enters the space between the intima and media

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39
Q

What are the most common cause of abdominal aortic aneurysms?

A

atherosclerosis

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40
Q

What are the most common cause of thoracic aortic aneurysms?

A

hypertension

41
Q

What is forward (heart) failure?

A

When the left ventricle cannot pump enough blood to meet the demands of the body

42
Q

What is backward (heart) failure?

A

When failure of the heart causes venous back-up

43
Q

What are three causes of forward failure?

A

1) systemic hypertension
2) mitral or aortic valve disease
3) ischemic heart disease

44
Q

What is it termed when the adaptive mechanisms we employ are enough to make up for a decrease in heart function?

A

compensated heart failure

45
Q

What remodeling of the ventricular wall occurs in heart failure?

A

dilatation

46
Q

What is concentric hypertrophy?

A

equal or concentric hypertrophic growth of the whole ventricle

47
Q

What is concentric hypertrophy caused by?

A

chronic pressure overload

48
Q

What is eccentric hypertrophy?

A

unequal, or eccentric, hypertrophic growth that increases the lumen or chamber size preferentially

49
Q

What is eccentric hypertrophy caused by?

A

chronic volume overload

50
Q

What happens when are adaptive mechanisms fail to make up for heart dysfunction?

A

decompensated heart failure

51
Q

What are some signs/symptoms of decompensated heart failure?

A
  • orthopnea
  • dyspnea
  • pulmonary congestion
  • cyanosis
  • acidosis
52
Q

What is the cause of ischemic heart disease (IHD)?

A

Imbalance in myocardial oxygen demand and supply

53
Q

What is another term for ischemic heart disease?

A

coronary heart disease or coronary artery disease

54
Q

What is a common cause of IHD?

A

coronary artery lumen narrowing

55
Q

What are the four presentations of IHD?

A

1) angina pectoris
2) acute MI
3) sudden cardiac death
4) chronic ischemic heart disease leading to CHF (ischemic cardiomyopathy)

56
Q

What is angina pectoris?

A

substernal and intermittent chest pain caused by a (>70%) blockage of the coronary artery causing transient and reversible myocardial ischemia

57
Q

What are the three types of angina pectoris?

A

1) stable
2) variant
3) unstable

58
Q

What is stable angina?

A

Chest pain relieved with rest or decreased demand

59
Q

What is variant angina?

A

Chest pain even at rest but that occurs in cycles due to vasospasm

60
Q

What is unstable angina?

A

Chest pain that is worsening or not relieved by decreased demand, rest, or vasodilators

61
Q

What is another term for unstable angina?

A

acute coronary syndrome

62
Q

What is the difference between unstable angina and an acute MI?

A

You do not see appreciable myocardial damage in unstable angina and thus troponins are negative or not significantly elevated

63
Q

What is the first region to be affected in an MI?

A

endocardium, that section of the heart which is furthest from the blood vessels

64
Q

What does the cell death from an MI cause to leak into the blood stream?

A

1) LDH
2) CK-MB
3) troponin T and I

65
Q

What two cardiac enzymes are used to determine an acute MI and which one is more specific?

A

1) CK-MB (creatine kinase)

2) troponin (more specific)

66
Q

What is the timeline of CK-MB levels after a myocardial event?

A

1) presence in blood detected 2-4 hours after
2) peaks at 18 hours
3) normal by 48 hours

67
Q

What is the timeline of troponin levels after a myocardial event?

A

1) presence in blood detected 3-6 hours after
2) peaks at 16-30 hours
3) normal by 4-7 days, but may remain elevated for up to two weeks

68
Q

What is an MI?

A

area of ischemic necrosis due to occlusion of arterial supply or venous drainage from thrombus or sepsis

69
Q

What are the four factors which determine the nature of an infarction?

A

1) nature of the vascular supply
2) rate of development of occlusion
3) tissue vulnerability to hypoxia
4) oxygen content of blood

70
Q

What are four treatments for MI?

A

1) thrombolysis (tPA)
2) stent placement (drug-eluting or metal)
3) PTCA (percutaneous transluminal coronary angioplasty) or PCI (percutaneous coronary intervention)
4) CABG

71
Q

What is cardiomyopathy?

A

“heart muscle disease”

72
Q

What are the three types of cardiomyopathy?

A

1) dilated
2) restrictive
3) hypertrophic

73
Q

What is dilated cardiomyopathy?

A

progressive form of cardiac hypertrophy associated with dilation and cardiac systolic dysfunction

74
Q

What is hypertrophic cardiomyopathy?

A

asymmetric septal hypertrophy or idiopathic hypertrophy leading to impaired diastolic filling and dynamic outflow obstruction

75
Q

What is a primary cause of HCM?

A

genetics and myocardum mutations (dystrophin)

76
Q

What is the difference in the hearts of those with dilated vs. hypertrophic cardiomyopathy?

A

Dilated cardiomyopathy leads to a “baggy” heart that is hypocontracting. Hypertrophic cardiomyopathy leads to a thick hypercontracting heart

77
Q

What is restrictive cardiomyopathy?

A

Decrease in ventricular compliance which affects preload and a stiff and inelastic ventricle

78
Q

What are two common causes of restrictive cardiomyopathy?

A

1) endomyocardial fibrosis

2) cardiac amyloidosis

79
Q

What is cor pulmonale?

A

Heart disease caused by lung disease

80
Q

What does cor pulmunolae lead to?

A

pulmonary hypertension, right ventricular hypertrophy or dilation, and right heart failure

81
Q

What is the characteristic triad of aortic stenosis?

A

1) angina, not explained by IHD
2) dyspnea on exertion
3) syncope

82
Q

What is the most common cause of aortic stenosis?

A

Calcific valvular degeneration from normal wear and tear and old age (>50%)

83
Q

At what point does aortic stenosis become “hemodynamically significant”?

A

1) mean transvalvular gradient above 50 mm Hg

2) valvular surface area under 1 square cm

84
Q

What are the next most common causes of aortic stenosis after calcific valvular degeneration?

A

bicuspid aortic valve (30-40%)

rheumatic heart disease (10%)

85
Q

What causes almost all mitral valve stenosis?

A

post-inflammatory scarring causing fusion of mitral leaflets after rheumatic heart disease

86
Q

At what point does mitral stenosis become “hemodynamically significant”?

A

mitral valve area is less than 1 square cm

left atrial pressure rises to above 25 mm Hg

87
Q

What is the end outcome of severe mitral stenosis?

A

congestive heart failure

88
Q

What is rheumatic heart disease?

A

Group A strep infections cause a cross-reaction during the immune response which attacks the mitral valve. Healing after this infection causes valvular damage

89
Q

What does mitral stenosis also predispose you for?

A

atrial fibrillation

90
Q

What is another name for valvular regurgitation?

A

valvular incompetence or insufficiency

91
Q

What is the most common form of valvular heart disease?

A

mitral insufficiency (regurgitation)

92
Q

In what condition do you heart an Austin-Flint murmur?

A

aortic insufficiency

93
Q

What type of hypertrophy does aortic stenosis lead to?

A

concentric hypertrophy

94
Q

What is mitral valve prolapse?

A

the ballooning of the leaflets of the mitral valve in systole due to a lack of structural integrity

95
Q

The weakening of the connective tissue that occurs in MVP is termed?

A

myxomatous degeneration

96
Q

What are some acute causes of aortic regurgitation?

A

1) trauma
2) infective endocarditis
3) thoracic aneurysm dissection

97
Q

What are some chronic causes of aortic regurgitation?

A

1) prior rheumatic fever

2) persistent systemic hypertension

98
Q

What hemodynamic effect is characterized by aortic regurgitation?

A

Hyperdynamic pulses = ↑ pulse pressures

Exam 2 APP (5 decks)

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