Cardiac II

Question 1

What are the types of congestive heart failure

Answer 1

Systolic dysfunction- Heart can’t generate enough force to pump blood (low cardiac output, anything below 40% ventricular volume)

Diastolic dysfunction- can’t dilate adequately to fill with enough blood

Left sided heart failure
Right sided heart failure

High output failure- cardiac output is normal but demand for blood flow is high

Low output failure- cardiac output is low but demand for blood is normal

Question 2

Pathogenesis of congestive heart failure

Answer 2

• Increased hydrostatic pressure
• renin angiotensin aldosterone system activation
• sodium retention

Question 3

What is diastolic heart failure

Answer 3

a condition caused by increased resistance to the filling of one or both ventricles

will have no time to relax

Question 4

What is acute rheumatic fever, what causes it and main concern

Answer 4

Autoimmune inflammatory process due to group A strep inf

.3-3% of time will develop rheumatic heart disease

Question 5

Clinical presentation of acute rheumatic fever (symptoms)

Answer 5

• Sore throat
• Polyarthritis (usually symmetrical and involves large jts)
• Sydenham chorea (neuro involunatry monts)

Question 6

Jones criteria for dx of rheumatic fever

Answer 6

1 required criteria and 2 major and 0 minor (or 1 maj and 2 minor)

Required- Evidence of strep
Major- Carditis, poly arthritis, chorea, erythema marginatum,, subcutaneous nodules

Minor- Fever, arthralgia, prev fever

Question 7

What kind of cells form in acute rheumatic fever

Answer 7

Formation of small giant cell granulomas called aschoffs bodies mainly in left atrium and ventricle

Question 8

When does chronic rheumatic valve disease occur and what does it target

Answer 8

develops up to 30 years after first attack of RF

attacks mitral valve in 50% of cases

Question 9

What is endocarditis and clinical manifestation

Answer 9

inflamation of the innermost layer of heart

• new cardiac murmur
• osler nodes (raised tender lesions on hand)
• Roth spots (pale lesions in retina)
• Janeway lesions (erythematous lesion palm/sole)
• Splinter hemmorrages

Question 10

What is the characteristic lesion in infective endocarditis

Answer 10

Vegatations- occur on valve leaflets or chordae tendineae

NEVER occur on the atheromatous plaques in the aorta

Question 11

Endocarditis cause in prostatic valves and elterly

Answer 11

prosthetic- staphylococci

Elderly- S auerus

Question 12

What is the etiology of mitral valve stenosis and what is it + complications

Answer 12

Rheumatic heart disease is the cause of almost all cases of mitral stenosis

atrial fibrillation
thrombus in left atrium
pulmonary venous hypertension

Question 13

What is the pathology of mitral incompetence

Answer 13

post inflammatory scarring of the mitral valve, holds the cusps in a partly open pos
increased rigidity and fusion of cusps often cause combo of stenosis and incompetence

-results in left ventricular function and failure

Question 14

What is papillary mm ischemia

Answer 14

Loss of contractility of papillary mm as a result of mitral incompetence
-following infarction, rupture of infarcted papillary mm may cause sudden and severe incompetence with rapidly fatal left ventricular faulure

Question 15

Main causes of aortic stenosis 92)

Answer 15

idiopathic calcified aortic stenosis

rheumatic heart disease

Question 16

main complications of aortic valve stenosis

Answer 16

concentric left ventricular hypertrophy-> left ventricular failure

Question 17

Pathology of tricuspid valve stenosis and comon causes (2)

Answer 17

similar to mitral valve (both stenosis or incompetence)

mc- infective endocarditis + IV drug

Question 18

What are cardiomyopathies and 3 classifications

Answer 18

associated w mechanical or electrical dysfunction of heart

• hypertrophic cardiomyopathy
• congestic cardiomyopathy
• restrictive cardiomyopathy

Question 19

What is hypertrophic cardiomyopathy, etiology and symtoms

Answer 19

HCM is a genetic disorder that causes myocardial hypertrophy that is inappropriate and asymmetrical and occurs in the absence of obvious inciting hypertrophic stim

s/s- Sudden death, angina, dyspnea, syncope, dizziness

Question 20

What is dilated (congestive) cardiomyopathy

Answer 20

Progressive, irreversible, disease causing global systolic contractile dysfunction w heart

• dialated chancers unable to contract to maintain outoput
• idiopathic process

Question 21

Causes of dilated cardiomyopathy

Answer 21

usually genetic

Question 22

What is restrictive cardiomyopathy

mc causes

Answer 22

The myocardium is infiltrated w a material that results in impaired ventricular filling

causes- amyloidosis, hemochromatosis, collagen deposition

Question 23

main causes of myocarditis, complications

Answer 23

Viral inf- enterovirus

complications- sudden death- lethal arryhymias

Question 24

what is transudate pericardial disease

Answer 24

Transudate is an extra cellular fluid and a result of increased fluid pressure or low oncotic pressure

• low pro conc
• low spec gravity
• clear
• low lactate dehydrogenase

Question 25

What is an exudate pericardial disease

Answer 25

Exudate is an inflammatory fluid

• cloudy apperence
• increased specific gravity
• increased pro
• increased inflammatory cells

Question 26

Symptoms of pericarditis

Answer 26

Sharp retrosternal chest pain, mainly left sided, abrupt onset, pain worsens in inspiration an dreleievd when leaning forward

Question 27

Serous pericarditis features

Answer 27

• Minimal inflammation
• no exudation of fibrin
• fluid collection

Question 28

Fibrinous pericarditi features

Answer 28

Increased strands of fibrin

Question 29

What is pericardial effusion, types (4) and symptoms

Answer 29

Accumulation of fluid in pericardial sac

1. Transudate (CHF, nephrotic syndrome)
2. Exudate- TB, Pleural empyema
3. Hemorrhagic- traumatic
4. Malignant- metastatic fluid accumulation

s/s- pain, dyspnea, pericardial friction rib etc

Question 30

what is cardiac tamponade and presentation

Answer 30

compression of the heart due to increase in fluid within pericardiac sac

pres- slow development of Dyspnea, fatigue
signs- pulses paradoxes, pulses electrical activity

Question 31

histology of cardiac tumors

Answer 31

3/4 of primary heart tumors are benign, half of which are myxomas

Question 32

mc primary cardiac tumor

Answer 32

Atrial myxoma (benign)
in left atrium