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BOARDS > Cardio > Flashcards

Cardio Flashcards

1
Q

Sinus Node

A

specialized group of cells in
the right atrium that generates impulses that
coordinate the pumping of blood

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2
Q

Arrhythmia

A

Abnormal Heart Beat

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3
Q

Bradycardia

A

excessively slow heartbeat

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4
Q

Tachycardia

A

Excessively rapid heartbeat

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5
Q

V-fib

A

ventricles quiver

rather than pumping blood

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6
Q

ECG/EKG

A

A
study used to record the electrical
activity of the heart using electrodes
attached to the skin

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7
Q

P wave:

A

Represents atrial

activation

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8
Q

PR interval

A

Represents
the time from onset of atrial
activation to onset of
ventricular activation

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9
Q

QRS complex:

A

Represents

ventricular activation

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10
Q

QRS duration

A

Duration of

ventricular activation

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11
Q

ST-T wave:

A

Represents

ventricular repolarization

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12
Q

QT interval

A

Duration of
ventricular activation and
recovery.

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13
Q

Holter monitor

A

portable device that
records the electrical activity of the heart
over a period of time (at least 24 hours)

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14
Q

Cardiac stress test

A

measures the
heart’s ability to respond to external
stress (exercise or drugs) using an EKG
in a controlled setting

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15
Q

Echocardiogram

A

A test that uses
ultrasounds waves
to visualize that
heart

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16
Q

Color Doppler (echos)

A

used to visualize abnormal
communications between the left and right side of the
heart, leaking of blood through the valves, and if the
valves are opening properly.

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17
Q

Transthoracic echocardiogram (TTE)

A

Non-invasive technique

Most common form of echocardiogram

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18
Q

Transesophageal echocardiogram (TEE)

A

A probe containing an ultrasound transducer is
passed into the patient’s esophagus for visualization
of the heart

Clearer images

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19
Q

Ejection Fraction

A

measurement of the
blood ejected from the left ventricle with
each heart beat

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20
Q

normal ejection fraction

A

50% or higher

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21
Q

Heart catheterization

A

Invasive test that
involves the insertion of a catheter into a
chamber or vessel of the heart for
evaluation or other procedures

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22
Q

Reasons for Heart catheterization

A

Pulmonary arterial pressure or myocardial biopsy

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23
Q

Pacemaker

A

An electronic device
implanted to provide electrical impulses to
regulate the heartbeat

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24
Q

Reasons for a pacemaker

A

Used in individuals with a slow heart rate or problem

with the heart’s electrical conduction system

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25
Q

Automatic implantable cardioverter

defibrillator (ICD)

A

An electric device that
is implanted to monitor for and correct
cardiac arrhythmia

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26
Q

Reasons for an ICD

A

Used in individuals at risk for sudden cardiac death

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27
Q

Syncope

A

fainting, brief loss of
consciousness caused by temporary lack
of oxygenated blood

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28
Q

Palpitations

A

Feelings or sensations that
the heart is pounding/racing or skipped/
stopped beats. May represent a normal or abnormal heart
rhythm

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29
Q

Sudden Cardiac death

A

žDeath from an abrupt loss of heart
function
• Within 1 hour of the onset of cardiac symptoms
• Natural, rapid, unexpected
Symptoms: chest pain, palpitations, dizziness,
lightheaded, syncope
• 25-50% - no prior heart medical history

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30
Q

Survival rate of sudden cardiac death

A

Only an 8 percent survival rate

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31
Q

Coronary heart disease and heart attack

A 
žMultifactorial disease (with a few rare
exceptions)
• Risk factors
 - Family history (strongest independent risk factor)
 - Sedentary lifestyle
 - Smoking
 - Obesity
 - High-fat diet
ž
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32
Q

Familial Hypercholesterolemia

A

Significant elevations in total serum
cholesterol and LDL cholesterol early in
life

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33
Q

FH risks

A

Xanthomas
Atheromas
Elevated risk for CAD and myocardial infarction

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34
Q

Xanthomas

A

yellowish cholesterol-rich material in tendons or

other body parts

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35
Q

Atheromas

A 
accumulation of debris containing cholesterol in the
artery walls (plaques)
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36
Q

FH inheritance

A

AD - homozygotes have earlier age of onset and more severe disease

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37
Q

Genes for FH

A

LDL recepter gene (LDLR)
ApoB-100
others

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38
Q

Benefits of genetic testing for familial

hypercholesterolemia

A
  • Early screening for elevated cholesterol levels

* Risk-factor modification before onset of disease

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39
Q

Locus heterogeneity

A

Mutations in different genes causes a similar

phenotype

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40
Q

Allelic heterogeneity

A

Different mutations within the same gene cause a

similar phenotype

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41
Q

Phenotypic heterogeneity

A

Different mutations within the same gene cause

different phenotypes

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42
Q

Cardiomyopathy

A

žDiseases of the heart muscle
(myocardium)

žCan lead to heart failure (swelling of
lower extremities, dyspnea – shortness of
breath), risk for arrhythmia, stroke, and
sudden cardiac death

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43
Q

Dilated cardiomyopathy

A

• Most common type
• Usually occurs in adults
• Muscle that makes up the left ventricle stretches
and becomes thinner, spreads to the right
ventricle and atria
• Dilated heart chambers cannot pump blood
efficiently (systolic dysfunction – ejection
fraction less than 50%)

44
Q

Hypertrophic cardiomyopathy

A

• Affects all ages
• Muscle cells enlarge causing ventricular walls to
thicken and stiffen
• Ventricle cannot adequately relax and fill with
blood
• Can result in sudden cardiac arrest, arrhythmia,
chest pain, dizziness, fatigue, syncope, shortness
of breath, or fainting

45
Q

Restrictive cardiomyopathy

A
  • Mostly occurs in older adults
  • Scar tissue replaces normal heart muscle
  • Ventricles become stiff and rigid
  • Blood flow in the heart is reduced
  • Can lead to heart failure or arrhythmias
46
Q

Arrhythmogenic Right Ventricular Dysplasia

ARVD

A

• Often affects teens or young adults
• Muscle tissue in the right ventricle dies and is replaced
with scar tissue
• Disrupts the heart’s electrical signals and causes
arrhythmias
• Palpitations and fainting after physical activity

GENETIC

47
Q

Most common reason for referral for heart transplant

A

Dilated cardiomyopathy (DCM)

48
Q

Mutations in _ are the most common known cause of DCM

A

TTN (TITAN)

49
Q

TNNT2

A

DCM gene. TNNT2 mutations may be associated with earlyonset
and aggressive disease, but late onset has
also been reported.

50
Q

Phenotype: DCM with conduction system

disease

A

• LMNA: DCM with arrhythmias like atrial
fibrillation, risk of sudden cardiac death, often
require a pacemaker
- Mutations in LMNA also cause Emery-Dreifuss
muscular dystrophy
- Can present as cardiomyopathy alone, skeletal
myopathy alone, or both

• SCN5A

51
Q

X-linked transmission of DCM genes

A

DMD (Duchenne) and TAZ (Barth syndrome)

52
Q

Hypertrophic Cardiomyopathy

A

Left ventricular hypertrophy without
another predisposing cardiac condition
(like aortic stenosis and long-standing
hypertension)

53
Q

Symptoms of HCM

A 
• Shortness of breath (particularly with exertion),
chest pain, palpitations, and syncope
• May be asymptomatic
• Can lead to heart failure
• Can lead to sudden cardiac death
54
Q

Diagnosis of HCM

A

• Echocardiogram, electrocardiogram, physical
exam and history
• Heart tissue sample
• Genetic testing

55
Q

HCM Genes

A

60-70% caused by mutations in sarcomere genes
• Autosomal dominant
• Pathologic feature: myocyte hypertrophy and
disarray
MYH7 and MYBPC3 are the big ones!!

56
Q

Mutations in _ and _ each make up to 40% of HCM

A

MHY7 and MYPBC3

57
Q

MYH7 mutations are association with:

A

younger age of diagnosis, more severe
hypertrophy, and nearly complete
penetrance, but variable survival.

58
Q

Other “HCM” genes

A

PRKAG2 and LAMP2 and GLA
• Result in metabolic storage disease of the
myocardium
• Mutations in PRKAG2 may result in WolffParkinson-White
(WPW) syndrome with or
without HCM
• Mutations in LAMP2 result in Danon disease, an
x-linked disorder with cardiomyopathy, muscle
weakness, variable intellectual disability

59
Q

LAMP2

A

Mutations in LAMP2 result in Danon disease, an
x-linked disorder with cardiomyopathy, muscle
weakness, variable intellectual disability

60
Q

PRKAG2

A

Mutations in PRKAG2 may result in WolffParkinson-White
(WPW) syndrome with or
without HCM

61
Q

GLA

A

GLA
• Results in Fabry disease, x-linked, associated
with left ventricular hypertrophy, may be limited
to the heart

62
Q

RAS MAPK pathway genes

A

Other HCM genes. ~20% of individuals with Noonan syndrome develop HCM

63
Q

Non-Compaction Cardiomyopathy (NCCM)

A
  • žUsually seen as Left Ventricular noncompaction
    (LVNC)
  • žApproximately 70% of LVNC is inherited
  • žWide range of age of onset
    • Adult form = average age of onset is 40yo
    • Congenital form = average age of onset is 6yo
64
Q

Heart formation

A
  • žEmbryonic development of the heart is
    very complex
  • žThe myocardium is the muscle of the
    heart and starts off as a spongy layer
    • Starts off as trabecular fibers and recesses
    (spaces)

ž- Between weeks 5 and 8, this spongy
material compacts
• The recesses disappear or become capillaries
• If the myocardium does not compact as tightly as
it should, NCCM/LVNC is the result

65
Q

Clinical presentation of NCCM

A

žThromboembolic events
žAtrial fibrillation
žVentricular tachycardia
žHeart failure

66
Q

What is used to diagnose NCCM

A

ECG and echocardiography findings are
used to diagnose NCCM, and sometimes
cardiac MRI

67
Q

Most common gene to cause NCCM

A

MYH7

68
Q

Long QT syndrome

A

ž - Inherited or acquired
• Medication
• Metabolic abnormalities
• Bradycardia

-ž Prolonged QT interval

-ž Characteristic
polymorphic
ventricular tachycardia
• Torsades de pointes
(“twisting of points”)
• May result in syncope or
ventricular fibrillation
and cardiac arrest /
sudden cardiac death
69
Q

Romano-Ward syndrome

A

• Usually autosomal dominant
• 4% risk of sudden cardiac death in the 3 most
common subtypes from birth to age 40 years1

70
Q

Jervell and Lange-Nielsen Syndrome

A
  • Autosomal recessive
  • LQTS and sensorineural deafness
  • KLQT1 (KCNQ1) and KCNE1
71
Q

LQT8 type

A

Timothy syndrome

72
Q

LQT7 type

A

Anderson-Tawil syndrome

73
Q

Anderson-Tawil syndrome

A

• KCNJ2
• Skeletal abnormalities
• Periodic paralysis and LQTS exacerbated by
hypokalemia (low potassium)

74
Q

Timothy syndrome

A
  • CACNA1c
  • Syndactyly
  • Dysmorphic features
  • Intellectual disability
  • Autism
  • Arrhythmias
75
Q

LQT1 trigger, age, beta blockers effective?

A

exercise, before 10 y, likely effective

76
Q

LQT2 trigger, age, beta blockers effective?

A

emotion, after age 10, less likely effective

77
Q

LQT3 trigger, age, beta blockers effective?

A

Rest or sleep, after age 10, less likely effective

78
Q

Genes for Jervell and Lange-Nielson syndrome

A

KCNQ1 or KCNE1 in 94%

79
Q

Agents/circumstances to avoid for LQTS

A
  • žDrugs that cause further prolongation of
    the QT interval
  • žCompetitive sports/activities associated
    with intense physical activity and/or
    emotional stress
80
Q

Short QT syndrome

A
  • žA heritable disorder of the electrical system of the heart
  • žCharacterized by short QT interval on EKG (<320ms) and tall, peaked T waves
  • žIncreased risk for SCD and atrial fibrillation
  • žSame symptoms as long QT syndromeclinical presentation is indistinguishable from long QT
81
Q

Genetics of SQTS

A

žRare
• May account for some cases of SIDS

žVariable penetrance

žAustosomal Dominant
• KCNH2
• KCNQ1
• KCNJ2

žDetection rate unknown

82
Q

Brugada syndrome

A

Characterized by abnormal EKG and

increased risk of sudden cardiac death

83
Q

Sudden unexpected nocturnal death syndrome

SUNDS

A

(Brugada) Syndrome seen in Southeast Asia in which apparently healthy young persons (often males) die from cardiac arrest

84
Q

Brugada syndrome often presents:

A

• Often presents with syncope or cardiac arrest, often
at rest or while sleeping
• Often presents in the 3rd or 4th decade of life
• Can present as sudden infant death syndrome
(SIDS), or
• Sudden unexpected nocturnal death syndrome
(SUNDS)

85
Q

Management of Brugada syndrome

A
  • žImplantable cardioverter defibrillators
    (ICDs)
    • Only therapy known to be effective in affected
    individuals with syncope or cardiac arrest
  • žAvoid/treat fever, cocaine use, electrolyte
    disturbances, and medications that can
    induce arrhythmias
86
Q

Brugada syndrome EKG

A
  • ž Right bundle branch block and ST segment elevation in leads V1 through V3 with a “coved morphology”
  • ž May be spontaneous or induced by medication
87
Q

Gene with largest role in Brugada

A

SCN5A (15-30%)

88
Q

Pulmonary Arterial Hypertension (PAH)

A

Widespread obstruction and obliteration
of the smallest pulmonary arteries
• Resistance to blood flow through the lungs
increases and the right ventricle attempts to
compensate by generating higher pressure.
• Heart failure develops when the heart can no
longer compensate for the increased resistance.

89
Q

Symptoms of PAH

A

dyspnea (shortness of breath), Reynaud’s phenomenon, fatigue, syncope, chest pain, near syncope, palpitations, leg edema

90
Q

Diagnosis of PAH

A

-ž Right heart catheterization
• Mean pulmonary artery pressure >25 mmHg at rest
or >30 mmHg during exercise
-ž Exclude other known causes of pulmonary hypertension

91
Q

Other known causes of pulmonary hypertension

A 
• Advance stage lung disease
• Pulmonary embolism/disease of large pulmonary
vessels
• Advanced heart disease
• Connective tissue diseases
• Cirrhosis
• HIV infection
92
Q

Largest genetic contributor to PAH

A

BMPR2 (75%)

93
Q

PAH and HHT

A

-ž HHT
• Presence of multiple arteriovenous malformations
(AVMs)
If close to the surface of the skin, bleed with slight trauma
• Recurrent nosebleeds
• GI bleeding
• Complications of AVMs in the brain, liver, or lungs
-ž PAH and HHT can occur together
• ACVRL1
• ENG or SMAD8 (rarely)
• BMPR2 (reported in one family)

94
Q

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (AFVD/C)

A

Progressive fibrofatty replacement of the
myocardium, predisposing to ventricular
tachycardia and sudden death

95
Q

Four phases of AFVD/C

A

• Concealed phase (no clinical manifestations, but
potential risk of sudden cardiac death)
• Electrical disorder with symptomatic arrhythmias
• Right ventricular failure
• Biventricular pump failure resembling dilated
cardiomyopathy

96
Q

Diagnosis of ARVD

A
  • žNoninvasive
    • EKG, 24-hour Holter monitoring
    • Echocardiogram
  • žInvasive
    • Right ventricular angiography (RVA)
    • Right ventricular endomyocardial biopsy
    Fibrofatty replacement of the myocardium and/or
    atrophy of the right ventricular myocardium
97
Q

Genes for ARVD

A

DSP, PKP2, DSG2

98
Q

Catecholaminergic polymorphic ventricular tachycardia (CPVT)

A

-ž Cardiac electrical instability triggered by
acute activation of the adrenergic nervous
system (Catecholamines: epinephrine
(adrenaline), norepinephrine
(noradrenaline) and dopamine)
-ž Rapid heart beat that originates in one of
the lower chambers (the ventricles) of the
heart
• QRS complexes with frequent and rapid changes in
morphology

99
Q

Symptoms of CPVT

A 
- žSyncope occurs in 80% of affected
individuals
• Often during exercise or acute emotion
• ventricular tachycardia (bidirectional or
polymorphic).
•  Arrhythmias may self-terminate
•  Or may lead to ventricular fibrillation and cause
sudden cardiac arrest/death
  • žCardiac arrest occurs in 30% of affected
    individuals
100
Q

Genes in CPVT

A

RYR2 (AD - 50-55%) and CASQ2 (AR - 1-2%)

101
Q

Amyloid

A

a protein deposit exhibiting beta

sheet structure

102
Q

Amyloidosis

A

disease where there is a buildup

of amyloid in body tissue and organs

103
Q

Cardiac Amyloidosis

A

deposit of abnormal
protein (amyloid) in the heart tissue
• Amyloid deposits take the place of normal heart
tissue and may affected electrical signals

104
Q

Transthyretin (TTR) amyloidosis

A
  • Group of diseases caused by the accumulation
    of abnormal protein in the body
    ž- Clinical presentation can include peripheral
    and autonomic sensorimotor neuropathy,
    cardiomyopathy, vitreous opacities, and CNS
    amyloidosis
    ž- Transthyretin gene (TTR)
    -ž Autosomal dominant
    -ž De novo rate: 2/3 (66%)
105
Q

Cardio pedigree questions

A 
žCongenital Heart Disease
žPalpitations/arrhythmias
žChest pain
žHeart failure
• Shortness of breath, edema, fatigue
žEnlarged heart
žHypertension 
žHigh cholesterol
žHeart murmur
žStroke/TIA
žDeep vein thrombosis (DVT)
žHeart (and/or lung) transplant or surgery
žPacemaker/ ICD
žCongenital deafness 
žHeart attack
• Age?
• Coronary artery disease?
žSudden unexplained death
• SIDS
• Odd/unexplained accidents
• Single car accident
• Drowning in an experienced swimmer
• Sudden death in a young, apparently healthy
individual 
ž Fainting, black-out, dizziness, or near
fainting
• Context?
• Trigger?
ž Seizures
ž • Symptoms of other differential diagnoses
 • Numbness/tingling and heat/cold intolerance – Fabry
disease
 • Arachnodactyly and dislocated lens – Marfan syndrome
•  Muscular Dystrophies
•  Other hereditary conditions
106
Q

Sarcomere

A

heart muscle

107
Q

Causes of HCM

A

Genetic (60-70%); non-genetic or unknown (30-40%)

BOARDS (6 decks)

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