CARDIAC LECTURE 2: Endocardial, valvular, myocardial, pericardial & congenital heart disease

Question 1

What are 4 reasons the endocardial or valvular structures may be damaged?

Answer 1

1. Inflammation
2. Scarring
3. Calcification
4. Congenital

Question 2

What is the term for the failure of the valve to open completely?

Answer 2

Stenosis

Question 3

What is the term for the inability of the valve to close completely?

Answer 3

Regurgitation/insufficiency

Question 4

What is the term for the sounds of improper flow or leaking of blood?

Answer 4

Murmurs

Question 5

What is the term for impaired blood flow from the left atrium to the left ventricle during ventricular diastole?

Answer 5

Mitral stenosis

Question 6

Why does mitral stenosis lead to atrial enlargement/hypertrophy?

Answer 6

The blood cannot leave the left atrium, increasing the pressure in the chamber

Question 7

Why does mitral stenosis lead to pulmonary hypertension, right ventricular hypertrophy, and right sided heart failure?

Answer 7

The pressure in the pulmonary circuit and right side of the heart is elevated since the blood cannot flow into the left ventricle properly

Question 8

What is the term for backflow of blood from the left ventricle to the left atrium during ventricular systole?

Answer 8

Mitral regurgitation

Question 9

Why does mitral regurgitation lead to left sided dilation and hypertrophy?

Answer 9

Due to extra blood volume in the heart

Question 10

Why does mitral regurgitation lead to left sided heart failure?

Answer 10

Left side of the heart must work harder to pump enough blood out to the body, as blood pumped out of the LV goes back into the LA

Question 11

What is the term for displacement of the mitral valve leaflets into the left atrium during ventricular systole?

Answer 11

Mitral valve prolapse

Question 12

What are the signs and symptoms of mitral valve prolapse?

Answer 12

Typically asymptomatic, but patients may eventually develop mitral regurgitation or heart failure

Question 13

Which valve disorder results in obstruction of aortic outflow from the left ventrciel into the aorta during systole?

Answer 13

Aortic stenosis

Question 14

What is the predominant cause of aortic stenosis?

Answer 14

Age-related calcium deposits

Question 15

Why does aortic stenosis result in left ventricular hypertrophy and left sided heart failure?

Answer 15

Pressure builds up in LV, muscle must work harder to pump

Question 16

What valvular disorder involves blood leaking back from the aorta into the left ventricle during diastole?

Answer 16

Aortic regurgitation

Question 17

What causes aortic regurgitation?

Answer 17

Aortic valve or root dilation

Question 18

Why does aortic regurgitation lead to left ventricular dilation and hypertrophy and eventually left sided heart failure?

Answer 18

Left ventricle must accomodate a higher volume of blood

LV works harder to pump blood to the rest of the body

Question 19

Why would mitral stenosis lead to atrial clots?

Answer 19

Because the blood cannot flow out of the left atrium, causing stasis

Question 20

What is a unique clinical sign of aortic regurgitation?

Answer 20

Wide pulse pressure

Question 21

Which cardiac disorder is an acute inflammatory disease that follows infection with group A streptococci, and involves immune attack on individual’s own tissues?

Answer 21

Rheumatic heart disease

Question 22

What tissues do antibodies target in rheumatic heart disease?

Answer 22

Connective tissue in joints, skin, and heart (especially valves)

Question 23

Which cardiac disorder involves invasion and colonization of the endocardium/heart valves by microorganisms, and leads to vegetations and tissue destruction?

Answer 23

Infective endocarditis

Question 24

What are vegetations in infective endocarditis composed of, and why are they significant?

Answer 24

1. Platelets, fibrin, cellular debris, pathogens
2. Pathogens hide from immune system within vegetations

Question 25

What is required in contracting infective endocarditis?

Answer 25

Microbes gain access to bloodstream through incision or via GI tract

Question 26

Which form of infective endocarditis can develop in anyone if the number or virulence of the pathogen is high enough?

Answer 26

Acute infective endocarditis

Question 27

Which form of infective endocarditis only develops in susceptible hosts with pre-existing conditions?

Answer 27

Subacute infective endocarditis

Question 28

What are 3 consequences of infective endocarditis?

Answer 28

1. Valve stenosis 2. Heart failure 3. Septic emboli

Question 29

What are 4 complications that can develop with artificial valves?

Answer 29

1. Coagulation 2. Intravascular hemolysis due to shear force 3. Structrual deterioration 4. Infective endocarditis

Question 30

What is the term for an inflammatory disorder of the myocardium characterized by damage and necrosis of cardiomyocytes?

Answer 30

Myocarditis

Question 31

What are 4 causes of myocarditis?

Answer 31

1. Infection 2. Toxins 3. Allergies 4. Autoimmune

Question 32

What are 2 histological characteristics of myocarditis?

Answer 32

1. Cytotoxic T cell and macrophage infiltration 2. Collagen deposition

Question 33

What are 2 treatments for myocarditis?

Answer 33

1. Immunosuppressants 2. Supportive therapy

Question 34

Which term describes a heterogeneous group of diseases involving structural or functional abnormalities of the myocardium?

Answer 34

Cardiomyopathies

Question 35

How are cardiomyopathies classified by cause?

Answer 35

Primary and secondary

Question 36

Which type of cardiomyopathy is the most common type, and is characterized by dilation/impaired contraction of one or both ventricles?

Answer 36

Dilated cardiomyopathy

Question 37

In what manner does the heart enlarge in dilated cardiomyopathy?

Answer 37

Heart can triple in size, but ventricular walls look normal or thinned

Question 38

Which cardiomyopathy is purely genetic, and is characterized by thickened, hypercontractile ventricular muscle mass?

Answer 38

Hypertrophic cardiomyopathy

Question 39

What are 2 ways hypertrophic cardiomyopathy impairs cardiac function?

Answer 39

1. Impaired diastolic filling 2. Aortic stenosis / obstruction

Question 40

What are 2 treatments for hypertrophic cardiomyopathy?

Answer 40

1. CCBs and beta blockers (relaxes ventricles to improve filling) 2. Surgical septal myectomy

Question 41

What is the main difference between dilated and hypertrophic cardiomyopathy?

Answer 41

Dilated=hypocontractility Hypertrophic=hypercontractility

Question 42

Which type of cardiomyopathy is the rarest form, and is characterized by a rigid, fibrotic, noncompliant ventricle?

Answer 42

Restrictive cardiomyopathy

Question 43

How does restrictive cardiomyopathy impair cardiac function?

Answer 43

Ventricles cannot fill

Question 44

What are 2 reasons for restrictive cardiomyopathy?

Answer 44

1. Genetic mutations in genes for sarcomeres and cytoskeleton 2. Amyloidosis (protein fragment deposition in heart)

Question 45

How is restrictive cardiomyopathy treated?

Answer 45

There is no treatment

Question 46

What is the term for accumulation of fluid in the pericardial sac?

Answer 46

Pericardial effusion

Question 47

What are 4 types of pericardial effusion?

Answer 47

1. Serous 2. Serosanguineous 3. Purulent 4. Chylous

Question 48

What is the term for exaggerated systolic BP decrease with inspiration, a clinical manifestation of cardiac tamponade?

Answer 48

Pulsus paradoxus

Question 49

What is the term for 3 clinical manifestations of cardiac tamponade: hypotension, dilated neck veins, and muffled heart sounds?

Answer 49

Beck's triad

Question 50

What procedure would be performed to treat cardiac tamponade?

Answer 50

Pericardiocentesis

Question 51

What is the cause of most cases of acute pericarditis?

Answer 51

Idiopathic, presumed viral

Question 52

What auscultation finding is characteristic of acute pericarditis?

Answer 52

Pericardial friction rub

Question 53

What are 2 treatments for acute pericarditis?

Answer 53

1. NSAIDs 2. Pericardial drainage

Question 54

Chronic pericarditis can lead to what condition, where the pericardial sac becomes dense, non-elastic, fibrous, and scarred?

Answer 54

Constrictive pericarditis

Question 55

What are 3 treatments for chronic pericarditis?

Answer 55

1. NSAIDs 2. Glucocorticoids 3. Pericardiectomy

Question 56

What are the 2 major forms of congenital heart diseases?

Answer 56

1. Shunts 2. Obstructions

Question 57

What is the term for a shunt where deoxygenated blood enters the left side of the heart without passing through the lungs?

Answer 57

Cyanotic defect

Question 58

What is the term for a shunt where oxygenated blood enters the right side to be sent to the lungs again, causing right sided hypertrophy?

Answer 58

Acyanotic defect

Question 59

What is the term for the fetal heart valve that allows blood to flow from the right atrium straight to the left atrium?

Answer 59

Foramen ovale

Question 60

What is the term for the channel between the pulmonary artery and the aorta in the fetal heart?

Answer 60

Ductus arteriosus

Question 61

In cases of atrial and ventricular septal defects, which way will the blood flow?

Answer 61

Left to right (acyanotic), at least at first

Question 62

Why may a septal defect eventually reverse to become a right-left shunt?

Answer 62

Increase in pulmonary blood flow leads to pulmonary hypertension and right ventricular hypertrophy

Question 63

What is the most common congenital cardiac defect?

Answer 63

Ventricular septal defects

Question 64

What are the consequences in patent ductus arteriosus?

Answer 64

Pulmonary hypertension Right sided heart failure

Question 65

Which congenital heart defect is characterized by obstruction of blood flow from the right ventricle to the pulmonary circulation, usually due to abnormal fusion of valvular cusps?

Answer 65

Pulmonary stenosis

Question 66

How can pulmonary stenosis be treated?

Answer 66

Balloon valvuloplasty

Question 67

What are the 4 features of tetralogy of Fallot?

Answer 67

1. Pulmonary stenosis 2. Ventricular septal defect 3. Overriding aorta 4. Right ventricular hypertrophy

Question 68

What kind of shunting is involved in tetralogy of Fallot?

Answer 68

Right to left (cyanotic)