cardio pathology key terms and important concepts Flashcards
1
Q
IMPORTANT CONCEPT 1: The most common cause of right heart failure is __________
A
left heart failure.
2
Q
IMPORTANT CONCEPT 2: _________ is right heart disease caused by pulmonary hypertensive diseases, especially emphysema, embolism and interstitial lung disease.
A
cor pulmonale
3
Q
4 manifestations of RIGHT heart failure
A
IMPORTANT CONCEPT 3: Leg edema, hepatomegaly, ascites and jugular venous distention can all be manifestations of right heart failure.
4
Q
IMPORTANT CONCEPT 4: _________myocardial disease, especially __________, are a common anatomic substrate for fatal reentrant ventricular tachycardia
A
Small patches of myocardial disease, especially scarring
5
Q
IMPORTANT CONCEPT 5: A cardiac arrhythmia, especially heart block, in a young African American suggests the possibility of _______________
A
cardiac sarcoidosis.
6
Q
IMPORTANT CONCEPT 6: A prolonged QT interval, corrected QT (QTc), over __________milliseconds is a signal of dangerous heart disease.
A
440
7
Q
IMPORTANT CONCEPT 7: _________ of an infant, child or young adult is commonly due to familial disease and accurate diagnosis can yield life-saving interventions for other family members.
A
Sudden cardiac death
8
Q
heart disease caused by lung disease
A
Cor pulmonale
9
Q
disturbance in heart rhythm due to deranged cardiac electrical signaling
A
Arrhythmia
10
Q
time from start of P wave to end of QRS, normally 120-200 ms, indicative of conduction block around AV node if prolonged
A
PR interval
11
Q
time from start of QRS to end of T wave, normally <440 ms, dangerous if prolonged due to risk of ventricular tachyarrhythmias
A
QT interval:
12
Q
arrhythmia of chaotic atrial activation at a rapid rate causing an irregular heart rhythm due to variable conduction through the AV node
A
Atrial fibrillation
13
Q
immediately life-threatening arrhythmia of chaotic ventricular activation at a rapid rate with lack of cardiac pumping
A
Ventricular fibrillation:
14
Q
heart disease of arrhythmias due to defective cardiac myocyte ion channels, usually due to genetic mutations
A
Channelopathy
15
Q
a polymorphic ventricular tachycardia with variation in QRS size and shape, creating an outline resembling a twisted ribbon on EKG
A
Torsades de pointes:
16
Q
IMPORTANT CONCEPT 1: _________ are a classic sign of vasculitis.
A
Palpable purpura
17
Q
IMPORTANT CONCEPT 2: It behooves physicians who prescribe medications that cause___________ to recognize it and stop the drugs.
A
hypersensitivity angiitis
18
Q
IMPORTANT CONCEPT 3: ____________for temporal arteritis can save elderly white females from blindness.
A
Steroid therapy
19
Q
FYI: IMPORTANT CONCEPT 4: Prompt diagnosis and treatment of Kawasaki disease can save babies from chronic heart disease or death.
A
fyi
20
Q
FYI: IMPORTANT CONCEPT 5: When heart failure occurs as a complication of acute myocardial infarction, it is important to differentiate the patients who will benefit from diuresis, volume expansion or neither.
A
fyi
21
Q
heterogeneous group of uncommon, primarily autoimmune, occasion-nally life-threatening diseases, having in common inflammation of blood vessels
A
Vasculitis:
22
Q
an acute necrotizing inflammatory disease of the smallest blood vessels (arterioles, capillaries, venules), especially in the skin
A
Hypersensitivity angiitis
23
Q
giant cell arteritis, a granulomatous inflammatory disease of medium and larger arteries, especially in the head, in elderly white females
A
Temporal arteritis
24
Q
mucocutaneous lymph node syndrome, an acute childhood primary vasculitis of medium arteries, especially coronaries
A
Kawasaki disease
25
blood clot that forms on the lining of the heart or aorta over an abnormality in the wall, like a ________ painting on a wall
Mural thrombus:
26
impaired cardiac filling and function due to something in the pericardial sac compressing it (blood, other fluid or fibrous adhesions)
Cardiac tamponade:
27
IMPORTANT CONCEPT 1: A \_\_\_\_\_\_\_ml hemopericardium from a ruptured myocardial infarction can be fatal, but a _______ ml chronic pleural effusion can be tolerated
IMPORTANT CONCEPT 1: A **_200 ml_** hemopericardium from a ruptured myocardial infarction can be fatal, but a **_2000 ml_** chronic pleural effusion can be tolerated
28
components of Beck's Triad
IMPORTANT CONCEPT 2:
**_Jugular venous distention_,****_muffled heart sounds_ and _hypotension_** are Beck’s triad of physical findings of cardiac tamponade.
29
Acute Pericarditis most commonly idiopathic (viral), self-limited to 1-3 weeks with any 2 of of which symptoms?
1. sharp substernal pleuritic positional chest pain
2. pericardial friction rub
3. diffuse upward concave ST segment elevation
4. pericardial effusion
30
simultaneous inflammation of myocardium and pericardium, commonly attributed to viral infection
Myopericarditis:
31
jugular venous distention, muffled heart sounds and hypotension, signs of cardiac tamponade
Beck’s triad
32
define Pulsus paradoxus:
an exaggeration of the normal decrease in blood pressure with inspiration **_\>10 mm Hg systolic_**, associated with cardiac tamponade or asthma
33
superficial scratchy or squeaking sound, frequently triphasic, associated with acute pericarditis
Pericardial friction rub
34
IMPORTANT CONCEPT 1: \_\_\_\_\_\_\_\_can cause hypertrophic or restrictive cardiomyopathy to take on features of dilated cardiomyopathy.
Decompensation
35
IMPORTANT CONCEPT 2: Hypertrophic cardiomyopathy is simultaneously a \_\_\_\_\_\_\_\_\_\_\_\_and \_\_\_\_\_\_\_\_disease.
structural and functional disease.
36
IMPORTANT CONCEPT 3: _______________ is the most common cause of sudden death of American athletes under age 35, but atherosclerotic cardiovascular disease is the most common cause of sudden death of American athletes over age 35.
Hypertrophic cardiomyopathy
37
IMPORTANT CONCEPT 4: ________________ is primarily a disease of older adults who present with heart failure.
Cardiac amyloidosis
38
IMPORTANT CONCEPT 5: \_\_\_\_\_\_\_\_\_\_\_\_\_\_is primarily a disease of young African Americans who present with arrhythmias.
Cardiac sarcoidosis
39
fyi: IMPORTANT CONCEPT 6: As a general principle, some cardiomyopathies are more likely to present with heart failure and others with arrhythmias.
fyi
40
heterogeneous group of myocardial diseases associated with mechanical and/or electrical dysfunction of the heart
Cardiomyopathy
41
group of genetic diseases with hypertrophy as a compensatory mechanism for mutations in genes encoding contractile proteins of the cardiac sarcomere
Hypertrophic cardiomyopathy
42
wastebasket category of nonspecific end-stage heart disease with cardiac dilatation and heart failure and no cause evident
idiopathic dilated cardiomyopathy:
43
benign gelatinous mesenchymal neoplasm of endocardium
Cardiac myxoma:
44
What are causes of a long QT?
1. Ischemic heart disease
2. Low K+, Ca+ or Mg+
3. Channelopathy
4. Many other things
45
What is the risk of early afterdepolarizations?
Ventricular tachycardia
46
What is the risk of ventricular tachycardia?
sudden cardiac death
47
The type of polymorphic ventricular tachycardia typical of congenital long QT syndromes is called \_\_\_\_\_\_\_\_\_\_
torsades de pointes.
48
What is Brugada syndrome? most common in which population?
Group of channelopathies causing shortened cardiac myocyte action potentials and risk of ventricular tachycardia and sudden cardiac death. Most common in young Asian males
49
how can brugada syndrome be recognized?
Persistently **elevated ST segments (≥2 mm)** descending with an **upward convexity to an inverted T wave** (classic "coved type“ Brugada pattern) in leads V1-V3 (present at rest)
50
Disease due to mutations in cardiac ryanodine receptor, sarcoplasmic calcium release channel, causing ventricular tachycardia or ventricular fibrillation during emotional or physical stress.
familial catecholaminergic polymorphic ventricular tachycardia
51
What is the mechanism of arrhythmias?
Triggered activity resulting from delayed afterdepolarizations due to high intracellular calcium.
52
How many babies, children and young adults are estimated to die of channelopathies in the US each year?
4,000
53
Viral Myocarditis: Pathology
Gross: Pale mottled flabby dilated heart
Microscopic: Inflammation multifocal, interstitial, usually mononuclear (primarily lymphocytic) associated with myocyte injury and necrosis (not as confluent as in infarcts)
54
Disease due to mutations in genes encoding desmosomal proteins, probably with a second “hit”, possibly enteric viral infection of right heart. The disease causes reentrant ventricular tachycardia originating from the right ventricle, possibly related to abnormalities in myocyte adhesion via desmosomal proteins.
right ventricular cardiomyopathy
55
how does right ventricular cardiomyopathy begin?
The disease begins in right ventricle with fatty replacement of myocytes, frequently with lymphocytic infiltration and later fibrous scarring.
56
Epsilon wave (notch in terminal part of QRS) [most prominent in lead V1] (present at rest) reflecting abnormal right ventricular activation can be a manifestation of \_\_\_\_\_\_\_\_\_\_\_
right ventricular cardiomyopathy
57
What is the life-saving preventative treatment for right ventricular cardiomyopathy?
defibrillator
58
what all lung diseases that cause cor pulmonale have in common is \_\_\_\_\_\_\_\_\_\_\_\_
pulmonary HTN
59
how many americans die each year from sudden cardiac death?
250,000
60
which section of the heart does sarcoidosis favor?
base of heart
61
what is the limit of sinus tachycardia?
sinus tachycardia will not go over a rate of 220-patient's age
62
describes which arrythmia: rhythm is irregular; the rate is high or normal(60-220) and there ARE NO P WAVES
ATRIAL FIBRILLATION(more than 3 million americans have AFIB)
63
which arrhythmia is described: results from reentrant circuit around tricuspid valve; usually features two P-waves for each QRS complex and yields a HR around 150/min
atrial flutter
64
\_\_\_\_\_\_\_\_is usually due to a reentrant pathway in the atria right near the AV node. it responds to home remedy vagal maneuvers such as a Valsalva maneuver, carotid sinus massage
supraventricular tachycardia
65
polymorphic ventricular tach can degenerate into \_\_\_\_\_\_\_\_\_\_\_
ventricular fibrillation (immediately life threatening)
66
define v-fib
totally disordered rapid stimulation of ventricles
67
which condition?
**epi: **1/500 (2:1 M:F); most common cause of sudden death in young athletes
**features: **Genetic diseases of contractile proteins;Feature in common: compensatory hypertrophy
**clinical features:** Asymmetric hypertrophy of septum;Dyspnea, angina, syncope or sudden death
**tx: **NO sports;
(Alcohol injection to infarct part of septum if have subaortic obstruction)
hypertrophic cardiomyopathy
68
which condition?
**epi:*****2.5% of cardiomyopathy cases, usually in older adults***
**features:****Abnormal protein deposition; Congo red stain positive**
**clinical features:****Multiorgan or limited to heart**
**notable tx: transplantation**
amyloid
69
which condition?
**epidemiology**:10 x more common in African- Americans
**features: **Noncaseating granulomas; commonly involves base of heart and conduction system
**clinical features: **Multiorgan inflammatory disease;
Syncope or sudden death due to arrhythmias
**notable tx: **Steroids
sarcoidosis
70
**epi:** Not common;
Not rare
**features:**Dilated left ventricle with no cause evident
**clinical features**: Nonspecific signs and symptoms of heart failure;
**Diagnosis of exclusion **
**notable tx:** Heart failure drugs; Transplantation
idiopathic dilated cardiomyopathy
71
IMPORTANT CONCEPT 1: Calcific aortic stenosis presents with \_\_\_\_\_\_, \_\_\_\_\_\_\_ or ________ and \_\_\_\_\_\_\_\_\_after the development of symptoms greatly improves survival.
IMPORTANT CONCEPT 1: Calcific aortic stenosis presents with **angina,** **syncope or dyspnea** and **valve replacement** after the development of symptoms greatly improves survival.
72
IMPORTANT CONCEPT 2: \_\_\_\_\_\_reduction of forward stroke volume from the normal of 100 ml to 75 ml is associated with clinical manifestations of heart failure.
IMPORTANT CONCEPT 2: **25%** reduction of forward stroke volume from the normal of 100 ml to 75 ml is associated with clinical manifestations of heart failure.
73
IMPORTANT CONCEPT 3: ___________ is the most common valve disease in the US and usually benign.
IMPORTANT CONCEPT 3: **_Mitral valve prolapse_** is the most common valve disease in the US and usually benign.
74
FYI: IMPORTANT CONCEPT 4: Surgical valve replacement for chronic valve disease is not a pure cure, but rather more like the replacement of one chronic disease with another, on the average lesser one.
fyi
75
IMPORTANT CONCEPT 5:\_\_\_\_\_\_\_\_\_\_is the deposition of blood clot on heart valves, important because it is common, frequently embolizes and is the precursor to infective endocarditis.
IMPORTANT CONCEPT 5: **_Marantic (non-bacterial thrombotic) endocarditis_** is the deposition of blood clot on heart valves, important because it is common, frequently embolizes and is the precursor to infective endocarditis.
76
IMPORTANT CONCEPT 6:\_\_\_\_\_\_\_\_\_\_\_ is infection of thrombi on heart valves, important because prompt diagnosis decreases the mortality from 100% to 20%.
IMPORTANT CONCEPT 6: **_Infective endocarditis_** is infection of thrombi on heart valves, important because prompt diagnosis decreases the mortality from 100% to 20%.
77
IMPORTANT CONCEPT 7: If you astutely diagnose infective endocarditis, don’t wait for the echocardiographic confirmation; get the \_\_\_\_\_\_\_, put \_\_\_\_\_\_\_\_\_\_\_\_on the microbiology laboratory requisition and start the ______ therapy.
IMPORTANT CONCEPT 7: If you astutely diagnose infective endocarditis, don’t wait for the echocardiographic confirmation; get the **_blood cultures,_** put **_“suspect endocarditis”_** on the microbiology laboratory requisition and start the **_antibiotic therapy. _**
78
billowing of redundant mitral valve into the left atrium during systole
Mitral valve prolapse
79
immune-mediated inflammation of the heart, especially valves, triggered by group A streptococcal infection
Rheumatic heart disease:
80
autoimmune inflammation of the heart valves as part of systemic lupus erythematosus
Libman-Sacks endocarditis
81
non-bacterial thrombotic endocarditis, the deposition of blood clot on heart valves
Marantic endocarditis
82
colorful misnomer for blood clots on heart valves
Vegetations
83
pea-sized tender nodules in fingers and toes from infected thromboemboli from infective endocarditis
Osler nodes
84
hemorrhages on the palms or soles from infected thromboemboli from infective endocarditis
Janeway lesions
85
\_\_\_\_\_\_\_\_\_is counterregulatory
BNP
86
Does heart failure ever lead to a
pro-inflammatory cytokine profile?
Yes, tumor necrosis factor (TNF),
interleukin-1 (IL-1) and
interleukin-6 (IL-6) are sometimes
elevated.
87
What is the most common
symptom of infective endocarditis?
FEVER
88
What are the three symptoms
in a three-way tie for
second most common,
each half as common as fever (of infective endocarditis)?
Infective Endocarditis
## Footnote
Common Symptoms
Fever 80% ,Chills 40%, Weakness 40%, Dyspnea 40%
89
How do the bacteria
that cause
infective endocarditis
get into the bloodstream?
Central venous catheterization—esp pic lines that have been in there for months also the mouth, with gingivitis (shown here),
## Footnote
brushing teeth, chewing, dental procedures
90
```
Infective endocarditis is destructive and
may cause (4 features described in lecture)
```
perforation of valve
\* adjacent abscess
\* fibrotic scarring
\* calcification
91
General Principle: The larger a vegetation the more likely it is \_\_\_\_\_\_\_\_
General Principle: The larger a vegetation the more likely it is **_infective_**
92
which condition?
infective endocarditis
Large variegated red-tan-white infective vegetations
93
which condition?
infective endocarditis
Moderate size tan vegetations, proved to be infective
94
Where are infected (“septic”) emboli
from endocarditis most likely to go?
Kidneys, heart, spleen, brain
95
which condition?
infective endocarditis
Infective vegetation (top) on valve (bottom)
96
which condition?
infective endocarditis
Upper: inflammatory cells in the vegetation,
lower: bacteria hiding out in the valve under
a layer of acellular fibrous tissue
97
which condtion?
infective endocarditis
Close-up: neutrophils, many degenerating, on valve
98
What is normal end-diastolic volume?
150ml
99
Take Home Point
Severe acute
uncompensated
aortic regurgitation
is a
\_\_\_\_\_\_\_\_\_\_
Take Home Point
Severe acute
uncompensated
aortic regurgitation
is a
**_surgical emergency_**
100
which condition?
infective endocarditis
Osler nodes in fingers, tender if you could touch them
101
Splinter hemorrhage under fingernail (not specific for
endocarditis, much more commonly due to trauma)
102
Janeway lesions: hemorrhages on palms or soles
103
Roth spots: retinal hemorrhages due to endocarditis
104
Transthoracic echocardiography
_______ sensitivity for vegetations
Transthoracic echocardiography
**_ 60%_** sensitivity for vegetations
105
Transesophageal echocardiography
\>90% sensitivity for \_\_\_\_\_
Transesophageal echocardiography
\>90% sensitivity for **_vegetations_**
106
t/f: The absence of vegetations on echocardiogram does not exclude the diagnosis of endocarditis
true
107
Continuous low-grade bacteremia is
characteristic of \_\_\_\_\_\_\_\_
Continuous low-grade bacteremia is
characteristic of **_infective endocarditis._**
108
How many blood cultures should you get for infective endocarditis ?
**Three,** from 3 different sites,
30 to 60 minutes apart,
before starting antibiotics, because 86 to 96% of first culturesreturn positive
## Footnote
and 98 to 100% of first two cultures.
109
Why should you alert the
microbiology laboratory that
endocarditis is suspected?
Because some bacteria causing
endocarditis are **_fastidious_**
or **_slow-growing or bot_**h, so the
microbiology laboratory will use
extra **_“special” culture media_**
and hold the **_cultures longer,_** but
only if you alert them of the need.
110
\_\_\_\_\_\_\_\_\_\_\_\_
are essential for
making a specific
diagnosis to guide
antibiotic therapy for
infective endocarditis.
**_Blood cultures_**
are essential for
making a specific
diagnosis to guide
antibiotic therapy for
infective endocarditis.
111
which condition?
Infective vegetations, bugs have eaten through valve
112
calicific aortic stenosis: epidemiology and causes(3)
**Epidemiology:** second most common
valvular disease(mitral valve prolapse more common, but does not cause hemodynamic disorder)
(1% of population)
male predominance
-most common disease that causes a hemodynamic disorder
**Causes**: 1. anomalous bicuspid valve
(50%)(normal valve has 3 leaftlets)
2. “senile” degeneration
3. chronic rheumatic disease
113
which condition?
calcific aortic stenosis
Rocks in sinuses of Valsalva squeezing lumen
114
which condition?
aortic stenosis
Close-up of calcifications in a bicuspid valve
115
Not too abnormal mitral valve,
seen from above, from the atrial side
116
which condition?
Mitral valve prolapse (leaflet on left only)
117
which condition?
Fixed removed mitral valve prolapse with
elongated thinned chordae (upper left)
118
which condition?
mitral valve prolapse: Myxomatous zona spongios below thinned fibrosa
119
You are a heart with mitral valve prolapse.
Rupture of chordae have just caused acute
regurgitation of 70 ml. How can you cope?
1. Increased stroke volume
2. Increased end-diastolic volume
120
which condition?
Acute rheumatic fever: Close-up: tiny vegetations on line of closure
121
which condition?
acute rheumatic fever
Fibrin-platelet vegetation, macrophages below it
122
which condition?
acute rheumatic fever
Acute rheumatic Aschoff body in myocardium
123
which condition?
Acute rheumatic Aschoff body in myocardium
124
How can you prevent acute
rheumatic heart disease?
Antibiotic therapy
for strep throat
125
126
the following describes which condition?
Slitlike fishmouth
or round buttonhole stenosis
with fibrous thickening and rigidity of valve
+/- fusion of commissures
Thickening, retraction and fusion of chordae
chronic rheumatic heart disease
127
which condition?
Slit-like fishmouth
rheumatic mitral
stenosis with
severe dilatation
of the left atrium
behind the stenotic
valve
128
which condition?
Slit-like fishmouth rheumatic mitral stenosis
129
which condition?
chornic rheumatic stenosis: Round buttonhole rheumatic mitral stenosis
130
chronic rheumatic stenosis: Fusion of commissures above and below
131
fyi
132
which condition?
Thickened fibrotic, partially fused chordae
tendineae (especially on right) characteristic
of old rheumatic mitral valve disease
133
which condition?
Mitral stenosis & massive left atrial dilatation
134
which condition?
Mitral valve fibrosis of old rheumatic valvulitis
135
You are a heart with chronic mitral valve
regurgitation of 95 ml. How do you cope?
1. Increased stroke volume
2. Increased end-diastolic volume
3. Left ventricular dilatation
136
which condition is described?
Part of systemic lupus erythematosus
more common in females, Usually in 15 to 45 year-olds , more common in blacks
Gross: small-medium verrucous,berrylike or flat vegetations,commonly on multiple valves, either or both sides
Microscopic: necrotic debris, fibrinoid material, degenerating leukocytes, fibroblasts and hematoxylin bodies
Libman-Sacks Endocarditis
## Footnote
137
fyi
fyi
138
which condition?
Red vegetations of Libman-Sacks endocarditis
139
which conditio is described?
Pathology:
Small (1-5 mm) fibrin + platelet thrombi,
most common on atrial side of mitral valve, second most common on ventricular side of
aortic valve, usually on line of valve closure
Marantic Endocarditis
140
which condition?
Small tan vegetations of marantic endocarditis
141
which condition?
Medium size red-tan uninfected marantic vegetations
142
which condition?
Larger atypical red-tan marantic vegetations
143
fyi
144
Where are thromboemboli from marantic
endocarditis most likely to go?
Kidneys, heart, spleen, brain
145
Marantic endocarditis
is the precursor for \_\_\_\_\_\_.
Marantic endocarditis
is the precursor for
**_infective endocarditis_**
146
LV-end systomic volume?
50ml
147
normal stroke volume? ejection fraction?
stroke: 100ml; ejection fraction: 67%
148
NOrmal Hemodynamic pressures: LV systolic? RA pressure? RV systolic? LA pressure?
LV systolic: 130mm Hg; RA: 3mm Hg; RV systolic: 25 mmHg; LA pressure: 8 mm Hg
149
IMPORTANT CONCEPT 2: The five major categories of the factors determining the heart’s function as a pump, the cardiac output, are \_\_\_\_\_\_\_\_\_.
IMPORTANT CONCEPT 2: The five major categories of the factors determining the heart’s function as a pump, the cardiac output, are **_(1) preload, (2) afterload, (3) contractility, (4) compliance and (5) heart rhythm. _**
150
IMPORTANT CONCEPT 3: \_\_\_\_\_\_\_\_\_\_is the most common hemodynamic disorder, by far, and has a wide array of etiologies and pathogenic mechanisms.
IMPORTANT CONCEPT 3: **_Heart failure_** is the most common hemodynamic disorder, by far, and has a wide array of etiologies and pathogenic mechanisms.
151
IMPORTANT CONCEPT 4: __________ and orthopnea are the two most specific symptoms of heart failure, but dyspnea and fatigue are the two most common.
IMPORTANT CONCEPT 4: **_Paroxysmal nocturnal dyspnea and orthopnea_** are the two most specific symptoms of heart failure, but dyspnea and fatigue are the two most common.
152
IMPORTANT CONCEPT 5: _________ is a biomarker of heart failure and the level correlates with the severity of the heart failure.
IMPORTANT CONCEPT 5: **_Serum B-type natriuretic peptide_** is a biomarker of heart failure and the level correlates with the severity of the heart failure.
153
IMPORTANT CONCEPT 6: The atrial gallop of __________ sounds like Tennessee.
IMPORTANT CONCEPT 6: The atrial gallop of **_hypertensive heart disease_** sounds like Tennessee.
154
fyi: IMPORTANT CONCEPT 7: Differentiating hypovolemic shock from cardiogenic shock is crucial because the treatments are opposite and mistaken diagnosis and treatment for one can be fatal for a patient who has the other.
155
the flow of blood
Hemodynamics
156
the blood pumping phase of the cardiac cycle
Systole:
157
: the chamber filling phase of the cardiac cycle
Diastole
158
the ventricular wall tension at the end of diastole (degree of myocyte stretch) determined by end-diastolic volume, reflected in end-diastolic pressure
Preload
159
the resistance the ventricle must overcome to pump its contents, determined by systolic blood pressure, reflected in ventricular systolic pressure
Afterload:
160
inotropic state determining the portion of the force of contraction independently of preload and afterload
Myocardial contractility
161
the distendibility of the ventricle, determining the ease of filling it and, indirectly, the amount of filling and hence the amount of blood pumped
Compliance
162
inability of the heart to pump sufficient blood to meet the needs of the body
Heart failure:
163
a hormone secreted in heart failure in proportion to the severity
B-type natriuretic peptide:
164
which condition described: Condition of reversible inadequate
## Footnote
blood supply.
MYOCARDIAL ISCHEMIA
165
Condition of reversible inadequate
blood supply due to which five causes
fixed coronary stenosis,
increased myocardial demand,
coronary vasospasm,
intraplaque hemorrhage,
superimposed thrombosis or
any combination of these factors
166
look normal by light microscopy
but do not workand fatal arrhythmia may precede
irreversible injury to myocytes
Stunned myocytes
167
stunned myocytes characteristics of acute or chronic MI?
acute MI
168
describes which condition:
Hibernating myocytes
with cytoplasm cleared of contractile
proteins (myocytolysis)
Collateral coronary arteries
growth into or enlargement of arteries
in areas of chronic ischemia
CHRONIC MYOCARDIAL ISCHEMIA
169
which condition?
CHRONIC MYOCARDIAL ISCHEMIA
## Footnote
Hibernating myocytes
with cytoplasm cleared of contractile
proteins (myocytolysis)
**Myocytolysis (contractile proteins burnt for fuel)**
170
Irreversible necrosis of heart muscle
from prolonged ischemia (\>20 minutes) thought to occur in a wavefront starting in subendocardial region and not complete until 6 hours after it started
## Footnote
MYOCARDIAL INFARCTION
171
Involving full thickness of heart wall 90% associated with occlusive thrombosis superimposed on atherosclerotic plaque with an acute change (disruption of an unstable vulnerable plaque byulceration or rupture)
## Footnote
TRANSMURAL INFARCTION
172
what do you see?
Fatal intraoperative coronary thrombosis
173
describes which condition: Involving inner portion of heart wall more likely to be patchy and to have episodic extension becoming more common than transmural
## Footnote
SUBENDOCARDIAL INFARCTION
174
Myocardial Infarction:
Gross (Macroscopic) Pathology:
Classic (Unreperfused): Acute Phase
0-12 hours:
12-24 hours:
2-3 days:
0-12 hours: none
## Footnote
12-24 hours: progressive pallor
2-3 days: yellow and softened
175
Subendocardial pallor (easiest to appreciate
in the smallest slice [from the cardiac apex])
in a myocardial infarction 4 days old
176
Myocardial Infarction:
Gross (Macroscopic) Pathology:
Classic (Unreperfused): **Subacute Phase**
4- 7 days:
1-6 weeks
6-12 weeks
4-7 days: red (granulation tissue) border
1-6 weeks: gradual replacement of yellow infarct by red granulation tissue
6-12 weeks: gradual white scarring
177
How old?
Sub-
acute
infarct 7 days old
Shrunken yellow infarct & red granulation tissue
178
how old? which process?
Slice into middle of heart muscle revealing
red granulation tissue of subacute infarction
approximately 3 weeks old
179
which condition? how old?
White scar & thinned wall of 10-month old infarct
180
Myocardial Infarction: Microscopic
Pathology: Classic (Unreperfused):
Acute Phase (days 1-3)
Micropathology:
1st visible sign?
when does coagulation necrosis occur?
* *Thin wavy myocytes, first visible**
* *at 1-3 hours**, if present, = **earliest finding**
**Coagulation necrosis**
= hypereosinophilia + loss of striations
+ nuclear pyknosis, then karyorrhexis,
karyolysis, loss, **first visible at 4-12 hours**
181
what do you see?
Normal cardiac myocytes with cross-striations
182
what do you see?
Coagulation necrosis: loss of cross-striations
183
Thin wavy myocytes (also lost nuclei here)
184
Myocardial Infarction: **Microscopic**
Pathology: Classic (Unreperfused):
**Acute Phase (days 1-3): what do you see? **
Neutrophilic infiltration (acute
inflammation) follows myocyte necrosis,
first visible at **6-12 hours,**
usually associated with edema,
sometimes with hemorrhage,
usually peaks in **day 3**
