Cardiac Flashcards
1
Q
A
2
Q
EKG of stable angina would show
A
ST depression (subendocardial ischemia)
3
Q
EKG of stable angina would show
A
ST depression (subendocardial ischemia)
4
Q
EKG of Prinzmetal Angina would show
A
ST elevation (transmural ischemia)
5
Q
Most common artery causing an MI
A
Left anterior descending (LAD)
6
Q
LAD supplies
A
Apex, anterior left ventricle, one third of the anterior right ventricle, anterior 2/3 of the intraventricular septum
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
8
Q
Left circumflex a. supplies
A
lateral wall of the LV
9
Q
Cardiac enzymes elevated in MI
A
Troponin I, CK-MB
10
Q
After an MI, Troponin I peaks at
A
24 hours
11
Q
After an MI, Troponin I begins to rise at
A
2-4 hours
12
Q
After an MI, Troponin I returns to baseline by
A
7-10 days
13
Q
After an MI, CK-MB peaks at
A
24 hours
14
Q
After an MI, CK-MB begins to rise at
A
4-6 hours
15
Q
After an MI, CK-MB returns to baseline by
A
72 hours
16
Q
CK-MB help detect
A
re-infarction that occurs days after an initial MI
17
Q
Contraction band necrosis is seen after
A
returned blood/Ca2+ entry into dead myocytes after MI followed by angioplasty, causes contraction
18
Q
Reperfusion injury results from
A
returning of O2 to irreversibly damaged myocytes resulting in the generation of free radicals
19
Q
Key events seen 4-24 hours after MI
A
Coagulative necrosis –> arrhythmia
20
Q
Key events seen 1-3 days after MI
A
Neutrophil infiltration of acute inflammation –> fibrinous pericarditis
21
Q
Key events seen 4-7 days after MI
A
Macrophage infiltration of acute inflammation –> rupture of ventricle wall
22
Q
Key events seen 1-3 weeks after MI
A
Granulation tissue (emerging red border)
23
Q
Key events seen Months after MI
A
Fibrosis –> aneurysm, mural thrombus, Dressler Syndrome
24
Q
Scarring after MI contains primarily
A
Type I collagen
25
Sudden cardiac death is typically due to
severe atherosclerosis
26
LSHF causes edema in the _________ causing
lungs, PND, orthopnea, crackles
27
Heart failure cells are
hemosiderin-laden macrophages
28
Heart failure cells are seen with what condition/s
LSHF
29
Nutmeg Liver is seen with what condition/s
RSHF
30
Nutmeg Liver is due to congestion of
central veins of the liver
31
What congenital heart defect results typically from fetal EtOH syndrome?
Ventricular Septal Defects
32
Eisenmenger Syndrome
late-stage VSD; R-\>L Shunt; RV hypertrophy, cyanosis, polycythemia, clubbing
33
What congenital heart defect may be associated w/ Down's Syndrome?
Atrial Septal Defect
34
What PE finding is associated w/ Atrial Septal Defect?
Split S2 (due to high BV in RA and delayed closure of pulmonic valve)
35
Significant risk involved w/ Atrial Septal Defect?
paradoxical embolus
36
What congenital heart defect may be associated w/ Congenital Rubella?
Patent Ductus Arteriosus (PDA)
37
What PE finding is associated w/ Patent Ductus Arteriosus (PDA)?
holosystolic machine-like murmur
38
Patent Ductus Arteriosus (PDA) + pHTN resulting in Eisenmenger Syndrome would have what PE finding?
Cyanosis of the LE
39
Treatment for Patent Ductus Arteriosus (PDA)?
Indomethacin (decreases PGE)
40
4 Key findings w/ Tetralogy of Fallot
P: Pulmonary stenosis R: RV hypertrophy O: Overriding aorta V: VSD
41
Clinical presentation of Tetralogy of Fallot
cyanotic baby, relieved by squatting
42
Key X-ray finding of Tetralogy of Fallot
boot-shaped heart
43
What congenital heart defect may be associated w/ maternal diabetes?
Transposition of great vessels
44
Treatment for Transposition of great vessels
PGE
45
Tricuspid Atresia is almost always seen in association w/
ASD and an aplastic RV
46
Location of an infantile Coarctation of the Aorta
distal to arch, proximal to PDA
47
Key PE finding of infantile Coarctation of the Aorta
LE cyanosis
48
What congenital heart defect may be associated w/ Turner's Syndrome?
infantile Coarctation of the Aorta
49
Key PE finding of adult Coarctation of the Aorta
UE HTN and LE hypotension
50
Key X-ray finding of adult Coarctation of the Aorta
Notching of the ribs due to collateral circulation
51
Diagnosis of Acute Rheumatic Fever first involves establishing
evidence of a previous GAS infection w/ high ASO or DNase B titers
52
Acute Rheumatic Fever results from
molecular mimicry from M proteins produced by a previous GAS infection (pharyngitis) 2-3 weeks prior
53
JONES criteria for Acute Rheumatic Fever findings
Migratory polyarthritis, pancarditis, nodules, erythema marginatum, Syndenham chorea
54
Pancarditis due to Acute Rheumatic Fever
Endocarditis: vegetations on mitral valve -\> mitral regurgitation Myocarditis: Aschoff bodies w/ Anitschkow cells Pericarditis: friction rub
55
Chronic Rheumatic Valvular Disease affects which valves
Mitral stenosis (thickening of chord tendineae) and occasionally Aortic valve stenosis (fusion of commissures)
56
Bicuspid aortic valve increases risk of \_\_\_\_\_\_\_\_?
Aortic stenosis
57
Aortic stenosis may arise as a complication of
Chronic Rheumatic Valvular Disease (fusion + mitral stenosis)
58
Key finding of Aortic Stenosis on PE exam?
systolic ejection click followed by a crescendo-decrescendo murmur
59
Typical presentation of pts w/ Aortic Stenosis?
angina, syncope w/ exercise
60
Lab findings w/ Aortic Stenosis?
Schistocytes due to Microangiopathic hemolytic anemia
61
What heart condition may result from Syphilitic aneurysm?
Aortic Regurgitation
62
Aortic Regurgitation most commonly arises as a result of
aortic root dilatation
63
Key finding of Aortic Regurgitation on PE exam?
Early, blowing diastolic murmur + Hyperdynamic circulation
64
Describe the Early, blowing diastolic murmur + Hyperdynamic circulation Sx w/ aortic regurg.
Bounding pulses, pulsatile nail bed, head bobbing
65
What heart condition may result from Marfan's or Ehler-Danlos?
Mitral Valve Prolapse
66
Key finding of Mitral Valve Prolapse on PE exam?
Mid-systolic click ( +/- regurgitation murmur)
67
Key finding of Mitral Regurgitation on PE exam?
holosystolic “blowing” murmur
68
Key finding of Mitral Stenosis on PE exam?
opening snap, followed by a diastolic rumble
69
What heart condition may result from Acute Rheumatic Fever?
Mitral Regurgitation
70
What heart condition may result from Chronic Rheumatic Valvular Disease?
Mitral Stenosis
71
Most likely etiologic agent causing endocarditis in a previously injured heart (acute rheumatic fever)?
Strep viridans
72
Most likely etiologic agent causing endocarditis in a IV drug user?
S. aureus
73
Most likely etiologic agent causing endocarditis in a pt w/ a prosthetic valve?
Staph epidermidis
74
Strep bovis is associated w/
Endocarditis w/ underlying colorectal carcinoma
75
Presentation of pt w/ endocarditis?
Fever, murmur, janeway lesion, osler nodules, anemia of chronic disease (microcytic)
76
What heart condition is associated w/ SLE?
Libman-Sacks Endocarditis
77
Biopsy finding of valve in Libman-Sacks Endocarditis would show?
vegetations on BOTH SIDES of valves
78
Nonbacterial Thrombotic Endocarditis arises due to
hypercoagulable state affecting mitral valve
79
Dilated Cardiomyopathy leads to
biventricular CHF
80
Causes of Dilated Cardiomyopathy
Genetic mutation, Coxsackie A or B virus, EtOH use, doxorubicin, cocaine, pregnancy
81
Genetic mutations in the sarcomere proteins causes?
Hypertrophic Cardiomyopathy
82
Most common cause of sudden death in young athletes?
Hypertrophic Cardiomyopathy
83
Key pathology findings w/ Hypertrophic Cardiomyopathy
myofiber hypertrophy w/ disarray
84
Common causes of Restrictive Cardiomyopathy?
Amyloidosis, sarcoidosis, hemochromatosis, endocardial fibroelastosis (children), Loeffler Syndrome
85
Key finding on EKG of Restrictive Cardiomyopathy?
low-voltage EKG w/ diminished QRS
86
Myxoma originates from
mesenchymal tissue
87
Myxoma is most common in what pt population
adults
88
Myxoma features and location
pedunculated tumor in L. atrium
89
Presentation of pt w/ myxoma tumor?
Syncope due to tumore blocking mitral valve
90
Myxoma pathology
ground substance - gelatinous appearance
91
Rhabdomyoma originates from
cardiac muscle (skeletal)
92
Rhabdomyoma is most common in what pt population
children
93
Rhabdomyoma is associated w/ what disease?
Tuberous Sclerosis
94
Rhabdomyoma arises typically in the
ventricle
95
Most common metastasis to the heart?
Breast and Lung carcinoma, melanoma, and lymphoma
96
right ventricle measures
0.3 to 0.5 cm in thickness
97
left ventricle measures
1.3 to 1.5 cm in thickness
98
Papillary muscles attached to which valves
tricuspid valve and mitral valve
99
tricuspid valve and mitral valve close during
Systole
100
Purkinje fibers are located in which layer
myocardium
101
Pathway of conduction pathway in the heart
SA node -\> AV -\> intraventricular septum -\> apex -\> bundle of his to ventricular walls
102
End point of all serious heart disease
CHF
103
CHF results from
decreased ability to contract OR increased pressure SV load
104
CHF results in
forward failure (decreased CO) and/or backward failure (congestion of the venous system)
105
LSHF is due to
ischemic heart disease, HTN, aortic/mitral valvular disease, myocardial disease
106
What is the key pathological finding of pHTN due to LSHF?
perivascular cuffing, edema and widening of the intraalveolar septa
107
Clinical presentation of pt w/ pHTN due to LSHF?
dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea, productive cough (blood tinged, frothy)
108
LSHF effects on the kidney?
decreased perfusion causing tubular necrosis, RAAS activation
109
LSHF effects on the CNS?
decreased perfusion to the brain, encephalopathic changes
110
RSHF is due to
LSHF, Cor pulmonale, myocardial disease, or tricuspid/pulmonary valvular disease
111
RSHF effects on the liver?
congestion of central vein causing central lobular necrosis
112
Key pathological finding of RSHF effects on the liver?
Nutmeg liver
113
Chronic liver congestion due to RSHF results in
cardiac sclerosis - fibrosis of hepatic parenchyma
114
Pitting edema of RSHF is due to
increased hydrostatic pressure and decreased hepatic circulation - decreased removal of Aldo, decreased albumin production
115
Pleural effusion are seen w/ _____ sided HF?
Right
116
RSHF causes HSM, what deposits are found in the spleen?
Hemosiderin
117
leading cause of death in the U.S.?
Ischemic heart disease
118
Ischemic heart disease is defined as
increased O2 demand or decreased O2 supply
119
Causes of Ischemic heart disease
Stenosing coronary a. atherosclerosis, Platelet aggregation, vasospasm, vasculitides, hemodynamic derangement
120
Significant myocardial ischemia begins when the atherosclerotic lesion obstructs approximately
80-90% of lumen
121
Causes of MI include:
atherosclerosis, emboli, arteritis, cocaine abuse, trauma
122
Treatment for stable angina
Nitro
123
leading cause of death in the U.S. and industrialized nations
MI
124
Risk Factors for MI:
Age (40-65), Male, Smoking, Type A
125
Factors known to decrease risk of MI
exercise, diet, moderate EtOH consumption
126
Patient may initially become __________ before an MI
tachycardic
127
What % of MIs are due to causes other than atherosclerotic lesions + thrombus?
10% due to vasospam, mural thrombi, emboli, valvular vegetations, paradoxical emboli
128
MI size is dependent on
extent, severity, location, collateral circulation, metabolic demands
129
Most common type of MI
transmural (\> 2.5, 4-10cm typically)
130
Transmural MI of LAD typically affects \_\_\_% of heart
40-50
131
Transmural MI of RCA typically affects \_\_\_% of heart
30-40
132
Transmural MI of LCA typically affects \_\_\_% of heart
15-20
133
Subendocardial MIs typically occur as a result of
drop in BP or systemic oxygen supply (not usually thrombosis)
134
Infarctions of what age are most prone to ventricular rupture
3-7 days
135
Fibrosis and scarring occurs how long after an MI
\> 7 weeks
136
coagulation necrosis with edema, microscopic hemorrhage and the infiltration of segmented neutrophils occurs how long after an MI
4-12 hrs
137
Contraction band necrosis can be seen how long after an MI
18-24 hrs
138
At _____ there is florid coagulation necrosis with loss of nuclear structure and a very heavy infiltrate of segmented neutrophils
24-72 hours
139
At \_\_\_\_\_\_, necrotic myofiber begins to disintegrate. Macrophages infiltrate the area and phagocytize debris.
3-7 days
140
By _____ the infarction is well developed with necrosis in the center and fibrovascular response at the margins
10 days
141
Symptoms of MI
angina, squeezing, impending doom, radiating to left arm or jaw
142
Old cardiac markers
serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH) and MB isomer of creatine phosphokinase (CKMB).
143
Current cardiac markers
Troponin T (cTnT) and Troponin I (cTnI)
144
Course of cTnI after MI
rise 4-6 hrs, peaks 10-14h, drops 7-10d
145
Course of cTnT after MI
rise 4-6 hrs, peaks 10-14h, drops 10-14d
146
Course of CKMB after MI
rise 7-24h, peaks 20h, drops in 4d
147
Course of SGOT after MI
rise 8h, peaks 18-36h, drops 3-4d
148
Course of LDH after MI
rise 6-12h, peak 3-6d, drops 2weeks
149
Normally LDH1 is _________ than LDH2, but after an MI
lower than; after an MI LDH1 rises above LDH2
150
LDH of myocardium
LDH1
151
Course of myoglobin after MI
rise 0-2h, 100% sensitive, no specificity
152
25% of MI occur as
sudden death
153
Complications due to MI
arrhythmias, heart block (transmural), rupture (4-5 d post-MI), ventricular aneurysm, mural thrombi/emboli, fibrohemorrhagic pericarditis (fusion), cardiogenic shock
154
Treatment of ischemic heart disease
preventative (diet, lifestyle) after: O2, thrombolytic agents, angioplasty/stenting, rest
155
Chronic ischemic heart disease
angina +/- MI 5-10 yrs prior to CHF
156
Gross Findings in ischemic heart disease
atherosclerosis, calcification of mitral valve
157
Microscopic Findings in ischemic heart disease
perivascular interstitial fibrosis and patches of fibrosis, areas of myocytolysis
158
Sudden cardiac death
death w/in 1 hour of onset of symptoms
159
Sudden cardiac death is typically due to
lethal arrhythmias due to severe atherosclerosis
160
Other causes of Sudden cardiac death
valvular stenosis, congenital anomalies, myocarditis, cardiomyopathies and mitral valve prolapse
161
The main cardiac effect of systemic hypertension is
concentric left ventricular hypertrophy without other cardiovascular pathology
162
The systemic effects of left ventricular hypertrophy
subendocardial myocardial infarction to CHF or sudden death
163
Cor pulmonale effects on the heart
right ventricular dilation and hypertrophy
164
Acute Cor Pulmonale
extreme right ventricular dilation caused by massive PE
165
Chronic Cor Pulmonale
lung disease -\> hypoxemia/acidosis -\> vasoconstriction -\> pHTN -\> RV hypertrophy
166
Causes of Cor Pulmonale
Lung disease (COPD, CF, etc) Pulmonary vessel disorder (PE, sclerosis) Chest movement disorder (neuro, diaphragm) Pulmonary a. constriction (hypoxia/acidosis)
167
Maternal rubella during 1st trimester
PDA
168
Boot-shaped heart
tetralogy of fallot
169
PDA in tetralogy of fallout is
protective
170
Maternal diabetes
transposition of great arteries
171
In utero survival of transposition of great arteries is dependent on
PDA and foramen ovale
172
postnatal survival of transposition of great arteries is dependent on
PDA 60% VSD 30%
173
Corrected transposition of greta arteries
great arteries and ventricles transposed. allows oxygenation but causes RV hypertrophy
174
Taussig-Bing
aorta arises from RV, pulmonary a overrides VSD R-to-L shunt
175
Lutembacher syndrome
atrial septal defect occurring with rheumatic mitral stenosis
176
machinery murmur is associated w/
PDA
177
Cyanosis of LE in infants
infantile coarctation of aorta
178
HTN in UE and hypotension in LE
adult coarctation of aorta
179
Pulmonary stenosis/atresia is associated w/
ASD and PDA
180
Aortic stenosis is associated w/
bicuspid valve and calcification
181
Ectopia cordis
heart is located outside the body
182
Dextrocardia
apex pointing to the right
183
Situs inversus totalis
All abdominal and thoracic viscera are on opposite sides
184
Isolated dextrocardia
only the heart is malrotated
185
congenital aortic stenosis
calcification extends from the cusp to the base of the valve
186
age-related aortic stenosis
calcification extends from the base to the cusp
187
Marfan syndrome
mitral valve prolapse
188
Patients w/ MVP are at an increased risk for
infectious endocarditis, progressive mitral insufficiency, atrial or ventricular arrhythmias, and sudden death
189
Aschoff bodies
myocardial Microscopic inflammatory regions associated w/ acute rheumatic fever
190
Anitschkow cells
acute rheumatic fever
191
Fibrinous pericarditis
acute rheumatic fever
192
acute rheumatic fever - migratory polyarthritis
nonspecific mononuclear infiltrates of joints
193
acute rheumatic fever - subcutaneous nodules
nodules are characterized by the presence of Aschoff bodies and are usually located over the extensor tendons
194
acute rheumatic fever - arteritis
hypersensitivity arteritis
195
Patient population of acute rheumatic fever
5-15 y/o w/in 1-5 weeks of initial pharyngitis
196
Intravenous drug abusers are particularly prone to _______ valve bacterial endocarditis whose vegetations may release septic thrombi, causing \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
tricuspid; pulmonary infection and abscess
197
Valvular endocarditis of the mitral and aortic valves may cause
embolic glomerulonephritis
198
Calcification of mitral annulus
Calcium is deposited upon and within the supporting ring of the mitral valve
199
Dilated (congestive) cardiomyopathy may cause
Intraventricular thrombi
200
Pericardial effusion
fluid accumulation due to CHF, infection, or neoplasm
201
Hemopericardium
blood accumulation due to infection , neoplasm, trauma, rupture
202
Hemopericardium that completely fills the pericardium is called
pericardial tamponade
203
Serous pericarditis definition
inflammatory exudates and inflammation of pericardium
204
Serous pericarditis causes
rheumatic fever, SLE, scleroderma, neoplasms, and uremia
205
Cell types found in serous fluid of Serous pericarditis
segmented neutrophils, lymphocytes, and histiocytes
206
Fibrinous and serofibrinous pericarditis definition
inflammation with the accumulation of serous fluid and fibrinous exudate; COMMON
207
Fibrinous and serofibrinous pericarditis causes
MI, autoimmune, uremia, radiation, rheumatic fever, SLE, and trauma
208
Purulent pericarditis causes
infection
209
Hemorrhagic pericarditis definition
blood mixed with fibrin or suppurative effusion
210
Hemorrhagic pericarditis causes
tuberculosis, acute bacterial infections, malignant neoplasm, uremia, hematologic disorder
211
Caseous pericarditis causes
tuberculosis
212
Adhesive mediastinal carditis
chronic pericarditis cause by caseous pericarditis, surgery, radiation that caused fibrosis and fusion of the pericardium and epicardium
213
Adhesive mediastinal carditis may lead to
Increased workload, cardiac hypertrophy and/or dilation, CHF
214
Constrictive pericarditis
Dense fibrocalcific scars adhere the pericardium and epicardium
215
Constrictive pericarditis may lead to
limited diastolic expansion and restricting cardiac output, hypertrophy cannot occur due to scarring
216
Rheumatoid heart disease is associated w/
subcutaneous rheumatoid nodules, vasculitis and Felty syndrome
217
Rheumatoid heart disease manifests w/
fibrinous pericarditis and thickening of the pericardium, Rheumatoid nodules w/in heart, amyloidosis
218
Lipoma location
LV, RA, or atrial septum
219
Primary malignant tumors of the heart
angiosarcomas and rhabdomyosarcomas
220
Secondary malignant tumors of the heart
lung, breast, leukemia, lymphoma, renal cell carcinoma, hepatocellular carcinoma and malignant melanoma
