Cardiac Path Part 2

Question 1

Normal conduction of the heart cascade?

Answer 1

SA node
AV node
Bundle of his and bundle branches
Purkinje fibers

Question 2

What is an Arrhythmia?

Answer 2

Conduction abnormality

Question 3

What is the most common cause of Arrhythmias?

Answer 3

Ischemic heart disease

Question 4

Sick Sinus Syndrome

Answer 4

SA node is damaged

= Bradycardia

Question 5

Sick Sinus Syndrome

Answer 5

SA node is damaged

= Bradycardia

Question 6

Atrial Fibrillation

Answer 6

Myocytes depolarize independently and sporadically with variable AV node transmission

Question 7

Myocytes depolarize sporadically and independently with variable AV node transmission?

Answer 7

Atrial fibrillation

Question 8

Atrial Fibrillation increases your risk for?

Answer 8

Thromboemoblism

Question 9

Heart block

Answer 9

Dysfunctional AV node

Question 10

1st degree Heart Block (AV node dysfunction)

Answer 10

Prolonged PR interval

Question 11

2nd degree Heart Block (AV node dysfunction)

Answer 11

Intermittent transmission

Question 12

3rd degree Heart block (AV node dysfunction)

Answer 12

Complete failure

Question 13

Ion channels are needed for electrical signal propagation in the heart. When they are abnormal that is called?

Answer 13

Hereditary Channelopathies

Question 14

Most common type of Hereditary Channelopathies?

Answer 14

Long QT syndrome

Question 15

What channels are usually abnormal with Hereditary Channelopathies?

Answer 15

K+ or Na+

Question 16

Manifestation of Long QT Syndrome?

Answer 16

Sudden death after exertion

Question 17

Sudden death after exertion

Answer 17

Long QT syndrome

– type of hereditary channelopathies (abnormal ion channels)

Question 18

Sudden cardiac deaths are usually due to?

Answer 18

Coronary A. disease that causes an ischemia induced arrhythmia

Question 19

Sudden cardiac deaths are usually due to?

Answer 19

Coronary A. disease that causes an ischemia induced arrhythmia

Question 20

In younger patients that present with sudden cardiac death, what should you suspect?

Answer 20

Drugs or hereditary abnormalities

Question 21

High blood pressure can cause LV hypertrophy. What does this cause to happen?

Answer 21

• Increased O2 demand = systolic dysfunction

- Inability to relax = diastolic dysfunction

Question 22

What does volume overload cause in the heart? Ex.?

Answer 22

Stretched ventricles are weaker and pump out less blood

ex. Dilated cardiomyopathy

Question 23

Congestive heart failure

Answer 23

Pump failure = inadequate blood delivery

Question 24

Congestive heart failure may result from diastolic or systolic dysfunctions. Describe those.

Answer 24

Diastolic = inability to fill ventricles
Systolic = loss of myocardial contractile function

Question 25

Systolic Left sided Heart Failure sign?

Answer 25

DECREASED ejection fraction

Question 26

Diastolic Left Sided Heart Failure sign?

Answer 26

Decreased volume due to decreased filling capacity | -- NORMAL ejection fraction

Question 27

What are the top causes of Left Sided Heart Failure?

Answer 27

Ischemic heart disease Hypertension Left-sided valve disease

Question 28

General results of Left Sided Heart Failure?

Answer 28

Pulmonary congestion/edema | DECREASED tissue perfusion

Question 29

Symptoms of Left Sided Heart Failure?

Answer 29

Cough, crackles, wheezes, dyspnea, cyanosis, paroxysmal nocturnal dyspnea -- ALL things lungs

Question 30

What will be seen on CXR with Left sided Heart Failure?

Answer 30

Kerley B lines

Question 31

What will be seen on Histo with Left Sided Heart Failure?

Answer 31

Hemosiderin-laden macrophages

Question 32

Cough, crackles, dyspnea, cyanosis and paroxysmal nocturnal dyspnea can suggest?

Answer 32

Left Sided Heart Failure

Question 33

What usually causes Right sided Heart Failure?

Answer 33

Left sided HF | Lung diseases

Question 34

General result of Right Sided Heart Failure?

Answer 34

Venous congestion

Question 35

Symptoms of Right Sided Heart Failure?

Answer 35

Hepatosplenomegaly Distended jugalr veins Edema and effusions

Question 36

Hepatosplenomegaly, distended jugular veins, edema and effusions can suggest?

Answer 36

Right sided Heart Failure

Question 37

What liver changes will be seen with Right Sided Heart Failure?

Answer 37

Nutmeg liver

Question 38

Chronic Pericardial Effusion

Answer 38

- Slow accumulation of fluid = ASYMPTOMATIC | ex. serous effusion with CHF

Question 39

What will be seen on CXR with Chronic Pericardial Effusion?

Answer 39

Globular enlarged heart

Question 40

Acute Pericardial Effusion

Answer 40

- Rapid accumulation of fluid = SYMPTOMATIC cardiac tamponade ex. Hemopericardium from trauma, etc.

Question 41

Pericarditis and symptoms?

Answer 41

Inflammation of pericardial sac | = Increased pain when LAYING down and decreased pain when SITTING up

Question 42

What will be heard with Pericarditis?

Answer 42

Friction rub

Question 43

What causes Fibrinous and Serofibrinous Pericarditis? (3)?

Answer 43

MI Dressler Syndrome Uremia

Question 44

Fibrinous and Serofibrinous Pericarditis is described as?

Answer 44

Bread and butter appearance

Question 45

What causes Purulent or Suppurative Pericarditis?

Answer 45

ACTIVE infection due to microbial invasion

Question 46

Caseous Pericarditis features?

Answer 46

- Tuberculous in origin = Cheese-like appearance = Histo: Necrotizing granuloma

Question 47

What causes Hemorrhagic Pericarditis?

Answer 47

Malignant neoplasm

Question 48

Constrictive Pericarditis

Answer 48

Heart is encased in a dense scar that limits diastolic expansion and cardiac output

Question 49

A majority of the cardiac tumor are ___ besides the _____

Answer 49

BENIGN | - besides the angiosarcoma

Question 50

#1 cardiac tumor in adults?

Answer 50

Myxoma

Question 51

#1 cardiac tumor in children?

Answer 51

Rhabdomyoma

Question 52

Usual location and cytokine release of Myxomas?

Answer 52

``` Left atrium (begins in fossa ovalis) = IL-6 release!!! ```

Question 53

What cardiac tumor releases IL-6?

Answer 53

Myxoma

Question 54

Lipoma

Answer 54

Mass of lobulated fat

Question 55

Papillary Fibroelastoma looks like?

Answer 55

Sea anemone lesions on valves

Question 56

Rhabdomyoma

Answer 56

Hamartoma of developing myocytes

Question 57

What tumor suppressor mutations are associated with Rhabdomyomas?

Answer 57

TSC1 or TSC2

Question 58

Rhabdomyomas have what type of cell?

Answer 58

Spider cell

Question 59

Cell mediated rejection of a heart transplant is mediated by what cells/infiltrate?

Answer 59

T cells | Lymphocytic response

Question 60

Antibody mediated rejection of a heart transplant is mediated by what cells/infiltrate?

Answer 60

Antibodies | Neutrophil infiltrate

Question 61

Cell mediated and Antibody mediated rejection of heart transplant occurs when?

Answer 61

Weeks to years after

Question 62

Allograft Vasculopathy

Answer 62

Concentric Intimal Thickening | - Many years after heart transplant

Question 63

What does Allograft Vasculopathy cause occur?

Answer 63

Silent MI

Question 64

What are the complications of heart transplants?

Answer 64

Chronic Immunosuppression - Infections/malignancy/skin cancer - EBV lymphoproliferative disorder with irregular lymphocytes

Question 65

Aging Heart changes

Answer 65

- Decreased compliance, elasticity and ventricle cavity space - Increased epicardial fat, lipofuscin granules and amyloid