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Cardiac Flashcards

1
Q
A
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2
Q

EKG of stable angina would show

A

ST depression (subendocardial ischemia)

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3
Q

EKG of stable angina would show

A

ST depression (subendocardial ischemia)

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4
Q

EKG of Prinzmetal Angina would show

A

ST elevation (transmural ischemia)

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5
Q

Most common artery causing an MI

A

Left anterior descending (LAD)

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6
Q

LAD supplies

A

Apex, anterior left ventricle, one third of the anterior right ventricle, anterior 2/3 of the intraventricular septum

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7
Q

Right coronary a. supplies

A

remaining 2/3 of anterior right ventricle, posterior right ventricle, posterior half of left ventricle, posterior 1/3 of interventricular septum

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8
Q

Left circumflex a. supplies

A

lateral wall of the LV

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9
Q

Cardiac enzymes elevated in MI

A

Troponin I, CK-MB

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10
Q

After an MI, Troponin I peaks at

A

24 hours

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11
Q

After an MI, Troponin I begins to rise at

A

2-4 hours

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12
Q

After an MI, Troponin I returns to baseline by

A

7-10 days

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13
Q

After an MI, CK-MB peaks at

A

24 hours

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14
Q

After an MI, CK-MB begins to rise at

A

4-6 hours

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15
Q

After an MI, CK-MB returns to baseline by

A

72 hours

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16
Q

CK-MB help detect

A

re-infarction that occurs days after an initial MI

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17
Q

Contraction band necrosis is seen after

A

returned blood/Ca2+ entry into dead myocytes after MI followed by angioplasty, causes contraction

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18
Q

Reperfusion injury results from

A

returning of O2 to irreversibly damaged myocytes resulting in the generation of free radicals

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19
Q

Key events seen 4-24 hours after MI

A

Coagulative necrosis –> arrhythmia

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20
Q

Key events seen 1-3 days after MI

A

Neutrophil infiltration of acute inflammation –> fibrinous pericarditis

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21
Q

Key events seen 4-7 days after MI

A

Macrophage infiltration of acute inflammation –> rupture of ventricle wall

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22
Q

Key events seen 1-3 weeks after MI

A

Granulation tissue (emerging red border)

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23
Q

Key events seen Months after MI

A

Fibrosis –> aneurysm, mural thrombus, Dressler Syndrome

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24
Q

Scarring after MI contains primarily

A

Type I collagen

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25
Q

Sudden cardiac death is typically due to

A

severe atherosclerosis

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26
Q

LSHF causes edema in the _________ causing

A

lungs, PND, orthopnea, crackles

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27
Q

Heart failure cells are

A

hemosiderin-laden macrophages

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28
Q

Heart failure cells are seen with what condition/s

A

LSHF

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29
Q

Nutmeg Liver is seen with what condition/s

A

RSHF

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30
Q

Nutmeg Liver is due to congestion of

A

central veins of the liver

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31
Q

What congenital heart defect results typically from fetal EtOH syndrome?

A

Ventricular Septal Defects

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32
Q

Eisenmenger Syndrome

A

late-stage VSD; R->L Shunt; RV hypertrophy, cyanosis, polycythemia, clubbing

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33
Q

What congenital heart defect may be associated w/ Down’s Syndrome?

A

Atrial Septal Defect

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34
Q

What PE finding is associated w/ Atrial Septal Defect?

A

Split S2 (due to high BV in RA and delayed closure of pulmonic valve)

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35
Q

Significant risk involved w/ Atrial Septal Defect?

A

paradoxical embolus

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36
Q

What congenital heart defect may be associated w/ Congenital Rubella?

A

Patent Ductus Arteriosus (PDA)

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37
Q

What PE finding is associated w/ Patent Ductus Arteriosus (PDA)?

A

holosystolic machine-like murmur

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38
Q

Patent Ductus Arteriosus (PDA) + pHTN resulting in Eisenmenger Syndrome would have what PE finding?

A

Cyanosis of the LE

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39
Q

Treatment for Patent Ductus Arteriosus (PDA)?

A

Indomethacin (decreases PGE)

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40
Q

4 Key findings w/ Tetralogy of Fallot

A

P: Pulmonary stenosis R: RV hypertrophy O: Overriding aorta V: VSD

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41
Q

Clinical presentation of Tetralogy of Fallot

A

cyanotic baby, relieved by squatting

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42
Q

Key X-ray finding of Tetralogy of Fallot

A

boot-shaped heart

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43
Q

What congenital heart defect may be associated w/ maternal diabetes?

A

Transposition of great vessels

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44
Q

Treatment for Transposition of great vessels

A

PGE

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45
Q

Tricuspid Atresia is almost always seen in association w/

A

ASD and an aplastic RV

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46
Q

Location of an infantile Coarctation of the Aorta

A

distal to arch, proximal to PDA

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47
Q

Key PE finding of infantile Coarctation of the Aorta

A

LE cyanosis

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48
Q

What congenital heart defect may be associated w/ Turner’s Syndrome?

A

infantile Coarctation of the Aorta

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49
Q

Key PE finding of adult Coarctation of the Aorta

A

UE HTN and LE hypotension

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50
Q

Key X-ray finding of adult Coarctation of the Aorta

A

Notching of the ribs due to collateral circulation

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51
Q

Diagnosis of Acute Rheumatic Fever first involves establishing

A

evidence of a previous GAS infection w/ high ASO or DNase B titers

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52
Q

Acute Rheumatic Fever results from

A

molecular mimicry from M proteins produced by a previous GAS infection (pharyngitis) 2-3 weeks prior

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53
Q

JONES criteria for Acute Rheumatic Fever findings

A

Migratory polyarthritis, pancarditis, nodules, erythema marginatum, Syndenham chorea

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54
Q

Pancarditis due to Acute Rheumatic Fever

A

Endocarditis: vegetations on mitral valve -> mitral regurgitation Myocarditis: Aschoff bodies w/ Anitschkow cells Pericarditis: friction rub

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55
Q

Chronic Rheumatic Valvular Disease affects which valves

A

Mitral stenosis (thickening of chord tendineae) and occasionally Aortic valve stenosis (fusion of commissures)

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56
Q

Bicuspid aortic valve increases risk of ________?

A

Aortic stenosis

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57
Q

Aortic stenosis may arise as a complication of

A

Chronic Rheumatic Valvular Disease (fusion + mitral stenosis)

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58
Q

Key finding of Aortic Stenosis on PE exam?

A

systolic ejection click followed by a crescendo-decrescendo murmur

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59
Q

Typical presentation of pts w/ Aortic Stenosis?

A

angina, syncope w/ exercise

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60
Q

Lab findings w/ Aortic Stenosis?

A

Schistocytes due to Microangiopathic hemolytic anemia

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61
Q

What heart condition may result from Syphilitic aneurysm?

A

Aortic Regurgitation

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62
Q

Aortic Regurgitation most commonly arises as a result of

A

aortic root dilatation

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63
Q

Key finding of Aortic Regurgitation on PE exam?

A

Early, blowing diastolic murmur + Hyperdynamic circulation

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64
Q

Describe the Early, blowing diastolic murmur + Hyperdynamic circulation Sx w/ aortic regurg.

A

Bounding pulses, pulsatile nail bed, head bobbing

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65
Q

What heart condition may result from Marfan’s or Ehler-Danlos?

A

Mitral Valve Prolapse

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66
Q

Key finding of Mitral Valve Prolapse on PE exam?

A

Mid-systolic click ( +/- regurgitation murmur)

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67
Q

Key finding of Mitral Regurgitation on PE exam?

A

holosystolic “blowing” murmur

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68
Q

Key finding of Mitral Stenosis on PE exam?

A

opening snap, followed by a diastolic rumble

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69
Q

What heart condition may result from Acute Rheumatic Fever?

A

Mitral Regurgitation

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70
Q

What heart condition may result from Chronic Rheumatic Valvular Disease?

A

Mitral Stenosis

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71
Q

Most likely etiologic agent causing endocarditis in a previously injured heart (acute rheumatic fever)?

A

Strep viridans

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72
Q

Most likely etiologic agent causing endocarditis in a IV drug user?

A

S. aureus

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73
Q

Most likely etiologic agent causing endocarditis in a pt w/ a prosthetic valve?

A

Staph epidermidis

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74
Q

Strep bovis is associated w/

A

Endocarditis w/ underlying colorectal carcinoma

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75
Q

Presentation of pt w/ endocarditis?

A

Fever, murmur, janeway lesion, osler nodules, anemia of chronic disease (microcytic)

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76
Q

What heart condition is associated w/ SLE?

A

Libman-Sacks Endocarditis

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77
Q

Biopsy finding of valve in Libman-Sacks Endocarditis would show?

A

vegetations on BOTH SIDES of valves

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78
Q

Nonbacterial Thrombotic Endocarditis arises due to

A

hypercoagulable state affecting mitral valve

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79
Q

Dilated Cardiomyopathy leads to

A

biventricular CHF

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80
Q

Causes of Dilated Cardiomyopathy

A

Genetic mutation, Coxsackie A or B virus, EtOH use, doxorubicin, cocaine, pregnancy

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81
Q

Genetic mutations in the sarcomere proteins causes?

A

Hypertrophic Cardiomyopathy

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82
Q

Most common cause of sudden death in young athletes?

A

Hypertrophic Cardiomyopathy

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83
Q

Key pathology findings w/ Hypertrophic Cardiomyopathy

A

myofiber hypertrophy w/ disarray

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84
Q

Common causes of Restrictive Cardiomyopathy?

A

Amyloidosis, sarcoidosis, hemochromatosis, endocardial fibroelastosis (children), Loeffler Syndrome

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85
Q

Key finding on EKG of Restrictive Cardiomyopathy?

A

low-voltage EKG w/ diminished QRS

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86
Q

Myxoma originates from

A

mesenchymal tissue

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87
Q

Myxoma is most common in what pt population

A

adults

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88
Q

Myxoma features and location

A

pedunculated tumor in L. atrium

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89
Q

Presentation of pt w/ myxoma tumor?

A

Syncope due to tumore blocking mitral valve

90
Q

Myxoma pathology

A

ground substance - gelatinous appearance

91
Q

Rhabdomyoma originates from

A

cardiac muscle (skeletal)

92
Q

Rhabdomyoma is most common in what pt population

93
Q

Rhabdomyoma is associated w/ what disease?

A

Tuberous Sclerosis

94
Q

Rhabdomyoma arises typically in the

95
Q

Most common metastasis to the heart?

A

Breast and Lung carcinoma, melanoma, and lymphoma

96
Q

right ventricle measures

A

0.3 to 0.5 cm in thickness

97
Q

left ventricle measures

A

1.3 to 1.5 cm in thickness

98
Q

Papillary muscles attached to which valves

A

tricuspid valve and mitral valve

99
Q

tricuspid valve and mitral valve close during

100
Q

Purkinje fibers are located in which layer

A

myocardium

101
Q

Pathway of conduction pathway in the heart

A

SA node -> AV -> intraventricular septum -> apex -> bundle of his to ventricular walls

102
Q

End point of all serious heart disease

103
Q

CHF results from

A

decreased ability to contract OR increased pressure SV load

104
Q

CHF results in

A

forward failure (decreased CO) and/or backward failure (congestion of the venous system)

105
Q

LSHF is due to

A

ischemic heart disease, HTN, aortic/mitral valvular disease, myocardial disease

106
Q

What is the key pathological finding of pHTN due to LSHF?

A

perivascular cuffing, edema and widening of the intraalveolar septa

107
Q

Clinical presentation of pt w/ pHTN due to LSHF?

A

dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea, productive cough (blood tinged, frothy)

108
Q

LSHF effects on the kidney?

A

decreased perfusion causing tubular necrosis, RAAS activation

109
Q

LSHF effects on the CNS?

A

decreased perfusion to the brain, encephalopathic changes

110
Q

RSHF is due to

A

LSHF, Cor pulmonale, myocardial disease, or tricuspid/pulmonary valvular disease

111
Q

RSHF effects on the liver?

A

congestion of central vein causing central lobular necrosis

112
Q

Key pathological finding of RSHF effects on the liver?

A

Nutmeg liver

113
Q

Chronic liver congestion due to RSHF results in

A

cardiac sclerosis - fibrosis of hepatic parenchyma

114
Q

Pitting edema of RSHF is due to

A

increased hydrostatic pressure and decreased hepatic circulation - decreased removal of Aldo, decreased albumin production

115
Q

Pleural effusion are seen w/ _____ sided HF?

116
Q

RSHF causes HSM, what deposits are found in the spleen?

A

Hemosiderin

117
Q

leading cause of death in the U.S.?

A

Ischemic heart disease

118
Q

Ischemic heart disease is defined as

A

increased O2 demand or decreased O2 supply

119
Q

Causes of Ischemic heart disease

A

Stenosing coronary a. atherosclerosis, Platelet aggregation, vasospasm, vasculitides, hemodynamic derangement

120
Q

Significant myocardial ischemia begins when the atherosclerotic lesion obstructs approximately

A

80-90% of lumen

121
Q

Causes of MI include:

A

atherosclerosis, emboli, arteritis, cocaine abuse, trauma

122
Q

Treatment for stable angina

123
Q

leading cause of death in the U.S. and industrialized nations

124
Q

Risk Factors for MI:

A

Age (40-65), Male, Smoking, Type A

125
Q

Factors known to decrease risk of MI

A

exercise, diet, moderate EtOH consumption

126
Q

Patient may initially become __________ before an MI

A

tachycardic

127
Q

What % of MIs are due to causes other than atherosclerotic lesions + thrombus?

A

10% due to vasospam, mural thrombi, emboli, valvular vegetations, paradoxical emboli

128
Q

MI size is dependent on

A

extent, severity, location, collateral circulation, metabolic demands

129
Q

Most common type of MI

A

transmural (> 2.5, 4-10cm typically)

130
Q

Transmural MI of LAD typically affects ___% of heart

131
Q

Transmural MI of RCA typically affects ___% of heart

132
Q

Transmural MI of LCA typically affects ___% of heart

133
Q

Subendocardial MIs typically occur as a result of

A

drop in BP or systemic oxygen supply (not usually thrombosis)

134
Q

Infarctions of what age are most prone to ventricular rupture

135
Q

Fibrosis and scarring occurs how long after an MI

136
Q

coagulation necrosis with edema, microscopic hemorrhage and the infiltration of segmented neutrophils occurs how long after an MI

137
Q

Contraction band necrosis can be seen how long after an MI

138
Q

At _____ there is florid coagulation necrosis with loss of nuclear structure and a very heavy infiltrate of segmented neutrophils

A

24-72 hours

139
Q

At ______, necrotic myofiber begins to disintegrate. Macrophages infiltrate the area and phagocytize debris.

140
Q

By _____ the infarction is well developed with necrosis in the center and fibrovascular response at the margins

141
Q

Symptoms of MI

A

angina, squeezing, impending doom, radiating to left arm or jaw

142
Q

Old cardiac markers

A

serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH) and MB isomer of creatine phosphokinase (CKMB).

143
Q

Current cardiac markers

A

Troponin T (cTnT) and Troponin I (cTnI)

144
Q

Course of cTnI after MI

A

rise 4-6 hrs, peaks 10-14h, drops 7-10d

145
Q

Course of cTnT after MI

A

rise 4-6 hrs, peaks 10-14h, drops 10-14d

146
Q

Course of CKMB after MI

A

rise 7-24h, peaks 20h, drops in 4d

147
Q

Course of SGOT after MI

A

rise 8h, peaks 18-36h, drops 3-4d

148
Q

Course of LDH after MI

A

rise 6-12h, peak 3-6d, drops 2weeks

149
Q

Normally LDH1 is _________ than LDH2, but after an MI

A

lower than; after an MI LDH1 rises above LDH2

150
Q

LDH of myocardium

151
Q

Course of myoglobin after MI

A

rise 0-2h, 100% sensitive, no specificity

152
Q

25% of MI occur as

A

sudden death

153
Q

Complications due to MI

A

arrhythmias, heart block (transmural), rupture (4-5 d post-MI), ventricular aneurysm, mural thrombi/emboli, fibrohemorrhagic pericarditis (fusion), cardiogenic shock

154
Q

Treatment of ischemic heart disease

A

preventative (diet, lifestyle) after: O2, thrombolytic agents, angioplasty/stenting, rest

155
Q

Chronic ischemic heart disease

A

angina +/- MI 5-10 yrs prior to CHF

156
Q

Gross Findings in ischemic heart disease

A

atherosclerosis, calcification of mitral valve

157
Q

Microscopic Findings in ischemic heart disease

A

perivascular interstitial fibrosis and patches of fibrosis, areas of myocytolysis

158
Q

Sudden cardiac death

A

death w/in 1 hour of onset of symptoms

159
Q

Sudden cardiac death is typically due to

A

lethal arrhythmias due to severe atherosclerosis

160
Q

Other causes of Sudden cardiac death

A

valvular stenosis, congenital anomalies, myocarditis, cardiomyopathies and mitral valve prolapse

161
Q

The main cardiac effect of systemic hypertension is

A

concentric left ventricular hypertrophy without other cardiovascular pathology

162
Q

The systemic effects of left ventricular hypertrophy

A

subendocardial myocardial infarction to CHF or sudden death

163
Q

Cor pulmonale effects on the heart

A

right ventricular dilation and hypertrophy

164
Q

Acute Cor Pulmonale

A

extreme right ventricular dilation caused by massive PE

165
Q

Chronic Cor Pulmonale

A

lung disease -> hypoxemia/acidosis -> vasoconstriction -> pHTN -> RV hypertrophy

166
Q

Causes of Cor Pulmonale

A

Lung disease (COPD, CF, etc) Pulmonary vessel disorder (PE, sclerosis) Chest movement disorder (neuro, diaphragm) Pulmonary a. constriction (hypoxia/acidosis)

167
Q

Maternal rubella during 1st trimester

168
Q

Boot-shaped heart

A

tetralogy of fallot

169
Q

PDA in tetralogy of fallout is

A

protective

170
Q

Maternal diabetes

A

transposition of great arteries

171
Q

In utero survival of transposition of great arteries is dependent on

A

PDA and foramen ovale

172
Q

postnatal survival of transposition of great arteries is dependent on

A

PDA 60% VSD 30%

173
Q

Corrected transposition of greta arteries

A

great arteries and ventricles transposed. allows oxygenation but causes RV hypertrophy

174
Q

Taussig-Bing

A

aorta arises from RV, pulmonary a overrides VSD R-to-L shunt

175
Q

Lutembacher syndrome

A

atrial septal defect occurring with rheumatic mitral stenosis

176
Q

machinery murmur is associated w/

177
Q

Cyanosis of LE in infants

A

infantile coarctation of aorta

178
Q

HTN in UE and hypotension in LE

A

adult coarctation of aorta

179
Q

Pulmonary stenosis/atresia is associated w/

A

ASD and PDA

180
Q

Aortic stenosis is associated w/

A

bicuspid valve and calcification

181
Q

Ectopia cordis

A

heart is located outside the body

182
Q

Dextrocardia

A

apex pointing to the right

183
Q

Situs inversus totalis

A

All abdominal and thoracic viscera are on opposite sides

184
Q

Isolated dextrocardia

A

only the heart is malrotated

185
Q

congenital aortic stenosis

A

calcification extends from the cusp to the base of the valve

186
Q

age-related aortic stenosis

A

calcification extends from the base to the cusp

187
Q

Marfan syndrome

A

mitral valve prolapse

188
Q

Patients w/ MVP are at an increased risk for

A

infectious endocarditis, progressive mitral insufficiency, atrial or ventricular arrhythmias, and sudden death

189
Q

Aschoff bodies

A

myocardial Microscopic inflammatory regions associated w/ acute rheumatic fever

190
Q

Anitschkow cells

A

acute rheumatic fever

191
Q

Fibrinous pericarditis

A

acute rheumatic fever

192
Q

acute rheumatic fever - migratory polyarthritis

A

nonspecific mononuclear infiltrates of joints

193
Q

acute rheumatic fever - subcutaneous nodules

A

nodules are characterized by the presence of Aschoff bodies and are usually located over the extensor tendons

194
Q

acute rheumatic fever - arteritis

A

hypersensitivity arteritis

195
Q

Patient population of acute rheumatic fever

A

5-15 y/o w/in 1-5 weeks of initial pharyngitis

196
Q

Intravenous drug abusers are particularly prone to _______ valve bacterial endocarditis whose vegetations may release septic thrombi, causing _____________________

A

tricuspid; pulmonary infection and abscess

197
Q

Valvular endocarditis of the mitral and aortic valves may cause

A

embolic glomerulonephritis

198
Q

Calcification of mitral annulus

A

Calcium is deposited upon and within the supporting ring of the mitral valve

199
Q

Dilated (congestive) cardiomyopathy may cause

A

Intraventricular thrombi

200
Q

Pericardial effusion

A

fluid accumulation due to CHF, infection, or neoplasm

201
Q

Hemopericardium

A

blood accumulation due to infection , neoplasm, trauma, rupture

202
Q

Hemopericardium that completely fills the pericardium is called

A

pericardial tamponade

203
Q

Serous pericarditis definition

A

inflammatory exudates and inflammation of pericardium

204
Q

Serous pericarditis causes

A

rheumatic fever, SLE, scleroderma, neoplasms, and uremia

205
Q

Cell types found in serous fluid of Serous pericarditis

A

segmented neutrophils, lymphocytes, and histiocytes

206
Q

Fibrinous and serofibrinous pericarditis definition

A

inflammation with the accumulation of serous fluid and fibrinous exudate; COMMON

207
Q

Fibrinous and serofibrinous pericarditis causes

A

MI, autoimmune, uremia, radiation, rheumatic fever, SLE, and trauma

208
Q

Purulent pericarditis causes

209
Q

Hemorrhagic pericarditis definition

A

blood mixed with fibrin or suppurative effusion

210
Q

Hemorrhagic pericarditis causes

A

tuberculosis, acute bacterial infections, malignant neoplasm, uremia, hematologic disorder

211
Q

Caseous pericarditis causes

A

tuberculosis

212
Q

Adhesive mediastinal carditis

A

chronic pericarditis cause by caseous pericarditis, surgery, radiation that caused fibrosis and fusion of the pericardium and epicardium

213
Q

Adhesive mediastinal carditis may lead to

A

Increased workload, cardiac hypertrophy and/or dilation, CHF

214
Q

Constrictive pericarditis

A

Dense fibrocalcific scars adhere the pericardium and epicardium

215
Q

Constrictive pericarditis may lead to

A

limited diastolic expansion and restricting cardiac output, hypertrophy cannot occur due to scarring

216
Q

Rheumatoid heart disease is associated w/

A

subcutaneous rheumatoid nodules, vasculitis and Felty syndrome

217
Q

Rheumatoid heart disease manifests w/

A

fibrinous pericarditis and thickening of the pericardium, Rheumatoid nodules w/in heart, amyloidosis

218
Q

Lipoma location

A

LV, RA, or atrial septum

219
Q

Primary malignant tumors of the heart

A

angiosarcomas and rhabdomyosarcomas

220
Q

Secondary malignant tumors of the heart

A

lung, breast, leukemia, lymphoma, renal cell carcinoma, hepatocellular carcinoma and malignant melanoma

PATHOLOGY (18 decks)

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