Cardiac 3 Shea Flashcards
- Rare, but when they occur can result in serious problems
- Usually benign and are pedunculated (have a stalk for easy removal from wall of LA or wall of valve)
Primary Cardiac Tumors
What are the 3 types of cardiac tumors and which age groups are they most common in?
- Cardiac Myxomas (adults)
- Rhabdomyomas (Kids)
- Metastatic Tumors
The most common primary tumor (35 - 50%)
Cardiac Myxomas
- Most Cardiac Myxomas arise from where?
- What %?
- Left Atrium (75%)
- But, can occur in any chamber of heart or on a valve
- Glistening, gelatinous, polypoid mass (5 - 6cm)
- Short stalk
- Sometimes is sufficiently mobile, obstructing the mitral valve orifice (moves up and down causing conduction issue)
- What allows the motion to occur?
- Cardiac Myxomas
- Stalk
Over 1/2 of patients w/ myxomas of the LA have clinical evidence of what?
Mitral Valve Dysfunction
1/3 of patients w/ cardiac myxomas of the LA or LV die from what?
Embolization of tumor to the brain
(piece breaks off bc/ it is so soft)
What is the surgical success rate of cardiac myxomas.
Surgical removal is successful in most cases
The most common primary cardiac tumor in infants and children
Rhabdomyomas
Forms nodular masses in the myocardium
Rhabdomyomas
Almost all rhabdomyomas are multiple and involve which 2 heart chambers?
Left and Right Ventricles
1/3 of cases of rhabdomyomas occur where?
Atria
- In 1/2 of cases, the tumor mass projects into the cardiac chamber
- Grossly, are pale gray masses up to several cm
Rhabdomyomas
Which 3 types of cancer metastasize to the heart most often?
- lung cancer
- breast cancer
- GI tract cancers
Which 3 other cancers can metastasize to the heart, but less often than the other 3?
- Lymphomas
- Leukemias
- Malignant Melanomas
Metastatic cancers of the myocardium can result in manifestations of ____.
Restrictive Cardiomyopathy
What is the #1 cause of sudden cardiac death?
Cardiac Arryhthmias
What % of patients do not survive their first MI?
25%
Atherosclerosis of the coronaries which presents as myocardial ischemia owing to a slowly progressive narrowing by atherosclerosis or a sudden occlusion due to a thrombus
Coronary Artery Disease
Chronic progressive ischemia of Coronary Artery Disease results in hypoperfusion of the myocardium and slowly evolving _____.
Pump failure (CHF)
Acute coronary thrombosis is more common where?
Arteries already narrowed by atherosclerosis
What are the main killers?
- 1 A:
- 1 B:
- 2:
- 1 A: CAD (coronary artery disease)
- 1 B: Stroke
- 2: Cancer
Complete blockage of LAD
Widow Maker
The heart and the brain have what type of circulation?
Collateral Circulation
What does the sudden occlusion of a major coronary artery cause and does location of occusion differ?
Yes, MI
An anterior wall infarct is typically caused by occlusion of which vessel?
Left Anterior Descending coronary artery (LAD)
An infarct of the lateral wall of the left ventricle is usually caused by occlusion of which vessel?
Left Circumflex coronary artery
An infarct of the right ventricle and posterior wall of the left ventricle is usually caused by occlusion of which vessel?
Right Coronary Artery
Where do most occlusions of the heart occur?
1.
2.
3.
- LAD (over 50%)
- RCA (30 - 40%)
- Left Circumflex Artery (10 - 20%)
What are the 2 types of MIs and which is worst?
- Transmural (infarction that involves full thickness of myocardium -Epicardium/Myocardium/Endocardium) = WORST
- Subendocardial Infarction (better bc/ only involves inner 1/2 of heart)
Pathology of CAD
- The coronaries involved by atherosclerosis are transformed into rigid, heavily calcified cylinders that can be palpated beneath the ____.
Epicardium
Pathology of CAD
- On cross section, the lumina are narrowed due to the prominent fibrotic plaques and atheromas. The wall contains deposits of which 2 things?
- Calcium salts
- Cholesterol clefts
- Rapid, sudden occlusion of a coronary artery
- 80 - 90% of transmural infarcts are caused by what?
MI
- thrombosis of a coronary artery
Apart from thrombosis of a coronary artery, what are 2 other causes of a transmural infarct?
- Ulceration of an embolized atherosclerotic plaque
- Prolonged vasospasm
What is the cause of sudden cardiac death?
What % die from MI?
What % survive after MI?
- In 25% of cases = death
- 75% survive
- Most cases: major cardiac arrhythmias (V. fib)
or
- complete heart block
- pump failure
Among the 75% of patients who survive the onset of an MI, most develop signs of which 2 things?
- HF
- Cardiogenic Shock
Of the 75% who survive MI, what develops as a result of inadequate perfusion of tissue by blood from the failing heart?
Multisystemic major organ failure
What is the most dangerous result of an MI?
Consequences of cerebral ischemia. May lead to:
- Permanent mental injury
- Loss of CNS functions
What 2 organs are we most concerned about keeping perfused w/ an MI?
- Kidneys (or else they will go into Acute Tubular Necrosis *ATN* which is reversible if the heart tissue is taken care of) Otherwise, pt will go anuric/anuresis which means the patient cannot pass urine
- Brain, have pt take anticoagulants to dissolve baby clots so they don’t go to brain
What is the gold standard test?
Troponin
- How long can the kidneys take until they reach ATN (acute tubular necrosis)?
- How long can the brain last as ischemic?
- 20 mins
- minutes, then more minutes = death
A transmural MI usually involves which parts of the heart?
- Free wall of LV
And/Or
- Interventricular septum
A subendocardial or intramural MI is usually located where?
Usually concentric around the subendocardial layer of the LV
How much blood in the pericardial sac will cause heart to stop?
350 - 375 CCs
If a pt has a transmural MI, they are more at risk for which 3 things?
- LV rupture
- Aneurysm of ventricle
- Mural thrombi which can embolize
Heart disease resulting from a primary abnormality in the myocardium (myocytes)
Cardiomyopathy
In response to injury, if a heart has cardiomyopathy, which 2 things will it undergo?
- Dilatation
- Hypertrophy
Cardiomyopathy:
Long standing pressure changes results in ____.
Long standing volume changes results in ____.
- Hypertrophy
- Dilation
- What are the 3 types of cardiomyopathies?
- Which is most common?
- Dilated is #1
- Hypertrophic
- Restrictive
Usually a combination of Dilated and Hypertrophic
Which side of the heart is involved w/ cardiomypathy?
Left, right side is NOT involved
