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cardio pathology > cardio pathology key terms and important concepts > Flashcards

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.

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2
Q

IMPORTANT CONCEPT 2: _________ is right heart disease caused by pulmonary hypertensive diseases, especially emphysema, embolism and interstitial lung disease.

A

cor pulmonale

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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.

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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

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5
Q

IMPORTANT CONCEPT 5: A cardiac arrhythmia, especially heart block, in a young African American suggests the possibility of _______________

A

cardiac sarcoidosis.

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6
Q

IMPORTANT CONCEPT 6: A prolonged QT interval, corrected QT (QTc), over __________milliseconds is a signal of dangerous heart disease.

A

440

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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

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8
Q

heart disease caused by lung disease

A

Cor pulmonale

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9
Q

disturbance in heart rhythm due to deranged cardiac electrical signaling

A

Arrhythmia

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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

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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:

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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

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13
Q

immediately life-threatening arrhythmia of chaotic ventricular activation at a rapid rate with lack of cardiac pumping

A

Ventricular fibrillation:

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14
Q

heart disease of arrhythmias due to defective cardiac myocyte ion channels, usually due to genetic mutations

A

Channelopathy

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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:

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16
Q

IMPORTANT CONCEPT 1: _________ are a classic sign of vasculitis.

A

Palpable purpura

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17
Q

IMPORTANT CONCEPT 2: It behooves physicians who prescribe medications that cause___________ to recognize it and stop the drugs.

A

hypersensitivity angiitis

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18
Q

IMPORTANT CONCEPT 3: ____________for temporal arteritis can save elderly white females from blindness.

A

Steroid therapy

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19
Q

FYI: IMPORTANT CONCEPT 4: Prompt diagnosis and treatment of Kawasaki disease can save babies from chronic heart disease or death.

A

fyi

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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

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21
Q

heterogeneous group of uncommon, primarily autoimmune, occasion-nally life-threatening diseases, having in common inflammation of blood vessels

A

Vasculitis:

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22
Q

an acute necrotizing inflammatory disease of the smallest blood vessels (arterioles, capillaries, venules), especially in the skin

A

Hypersensitivity angiitis

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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

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24
Q

mucocutaneous lymph node syndrome, an acute childhood primary vasculitis of medium arteries, especially coronaries

A

Kawasaki disease

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25
Q

blood clot that forms on the lining of the heart or aorta over an abnormality in the wall, like a ________ painting on a wall

A

Mural thrombus:

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26
Q

impaired cardiac filling and function due to something in the pericardial sac compressing it (blood, other fluid or fibrous adhesions)

A

Cardiac tamponade:

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27
Q

IMPORTANT CONCEPT 1: A _______ml hemopericardium from a ruptured myocardial infarction can be fatal, but a _______ ml chronic pleural effusion can be tolerated

A

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

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28
Q

components of Beck’s Triad

A

IMPORTANT CONCEPT 2:

Jugular venous distention,muffled heart sounds and hypotension are Beck’s triad of physical findings of cardiac tamponade.

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29
Q

Acute Pericarditis most commonly idiopathic (viral), self-limited to 1-3 weeks with any 2 of of which symptoms?

A
  1. sharp substernal pleuritic positional chest pain
  2. pericardial friction rub
  3. diffuse upward concave ST segment elevation
  4. pericardial effusion
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30
Q

simultaneous inflammation of myocardium and pericardium, commonly attributed to viral infection

A

Myopericarditis:

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31
Q

jugular venous distention, muffled heart sounds and hypotension, signs of cardiac tamponade

A

Beck’s triad

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32
Q

define Pulsus paradoxus:

A

an exaggeration of the normal decrease in blood pressure with inspiration >10 mm Hg systolic, associated with cardiac tamponade or asthma

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33
Q

superficial scratchy or squeaking sound, frequently triphasic, associated with acute pericarditis

A

Pericardial friction rub

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34
Q

IMPORTANT CONCEPT 1: ________can cause hypertrophic or restrictive cardiomyopathy to take on features of dilated cardiomyopathy.

A

Decompensation

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35
Q

IMPORTANT CONCEPT 2: Hypertrophic cardiomyopathy is simultaneously a ____________and ________disease.

A

structural and functional disease.

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36
Q

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.

A

Hypertrophic cardiomyopathy

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37
Q

IMPORTANT CONCEPT 4: ________________ is primarily a disease of older adults who present with heart failure.

A

Cardiac amyloidosis

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38
Q

IMPORTANT CONCEPT 5: ______________is primarily a disease of young African Americans who present with arrhythmias.

A

Cardiac sarcoidosis

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39
Q

fyi: IMPORTANT CONCEPT 6: As a general principle, some cardiomyopathies are more likely to present with heart failure and others with arrhythmias.

A

fyi

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40
Q

heterogeneous group of myocardial diseases associated with mechanical and/or electrical dysfunction of the heart

A

Cardiomyopathy

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41
Q

group of genetic diseases with hypertrophy as a compensatory mechanism for mutations in genes encoding contractile proteins of the cardiac sarcomere

A

Hypertrophic cardiomyopathy

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42
Q

wastebasket category of nonspecific end-stage heart disease with cardiac dilatation and heart failure and no cause evident

A

idiopathic dilated cardiomyopathy:

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43
Q

benign gelatinous mesenchymal neoplasm of endocardium

A

Cardiac myxoma:

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44
Q

What are causes of a long QT?

A
  1. Ischemic heart disease
  2. Low K+, Ca+ or Mg+
  3. Channelopathy
  4. Many other things
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45
Q

What is the risk of early afterdepolarizations?

A

Ventricular tachycardia

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46
Q

What is the risk of ventricular tachycardia?

A

sudden cardiac death

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47
Q

The type of polymorphic ventricular tachycardia typical of congenital long QT syndromes is called __________

A

torsades de pointes.

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48
Q

What is Brugada syndrome? most common in which population?

A

Group of channelopathies causing shortened cardiac myocyte action potentials and risk of ventricular tachycardia and sudden cardiac death. Most common in young Asian males

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49
Q

how can brugada syndrome be recognized?

A

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)

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50
Q

Disease due to mutations in cardiac ryanodine receptor, sarcoplasmic calcium release channel, causing ventricular tachycardia or ventricular fibrillation during emotional or physical stress.

A

familial catecholaminergic polymorphic ventricular tachycardia

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51
Q

What is the mechanism of arrhythmias?

A

Triggered activity resulting from delayed afterdepolarizations due to high intracellular calcium.

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52
Q

How many babies, children and young adults are estimated to die of channelopathies in the US each year?

A

4,000

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53
Q

Viral Myocarditis: Pathology

A

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)

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54
Q

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.

A

right ventricular cardiomyopathy

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55
Q

how does right ventricular cardiomyopathy begin?

A

The disease begins in right ventricle with fatty replacement of myocytes, frequently with lymphocytic infiltration and later fibrous scarring.

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56
Q

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 ___________

A

right ventricular cardiomyopathy

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57
Q

What is the life-saving preventative treatment for right ventricular cardiomyopathy?

A

defibrillator

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58
Q

what all lung diseases that cause cor pulmonale have in common is ____________

A

pulmonary HTN

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59
Q

how many americans die each year from sudden cardiac death?

A

250,000

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60
Q

which section of the heart does sarcoidosis favor?

A

base of heart

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61
Q

what is the limit of sinus tachycardia?

A

sinus tachycardia will not go over a rate of 220-patient’s age

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62
Q

describes which arrythmia: rhythm is irregular; the rate is high or normal(60-220) and there ARE NO P WAVES

A

ATRIAL FIBRILLATION(more than 3 million americans have AFIB)

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63
Q

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

A

atrial flutter

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64
Q

________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

A

supraventricular tachycardia

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65
Q

polymorphic ventricular tach can degenerate into ___________

A

ventricular fibrillation (immediately life threatening)

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66
Q

define v-fib

A

totally disordered rapid stimulation of ventricles

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67
Q

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)

A

hypertrophic cardiomyopathy

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68
Q

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

A

amyloid

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69
Q

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

A

sarcoidosis

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70
Q

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

A

idiopathic dilated cardiomyopathy

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71
Q

IMPORTANT CONCEPT 1: Calcific aortic stenosis presents with ______, _______ or ________ and _________after the development of symptoms greatly improves survival.

A

IMPORTANT CONCEPT 1: Calcific aortic stenosis presents with angina, syncope or dyspnea and valve replacement after the development of symptoms greatly improves survival.

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72
Q

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.

A

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.

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73
Q

IMPORTANT CONCEPT 3: ___________ is the most common valve disease in the US and usually benign.

A

IMPORTANT CONCEPT 3: Mitral valve prolapse is the most common valve disease in the US and usually benign.

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74
Q

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.

A

fyi

75
Q

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.

A

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
Q

IMPORTANT CONCEPT 6:___________ is infection of thrombi on heart valves, important because prompt diagnosis decreases the mortality from 100% to 20%.

A

IMPORTANT CONCEPT 6: Infective endocarditis is infection of thrombi on heart valves, important because prompt diagnosis decreases the mortality from 100% to 20%.

77
Q

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.

A

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
Q

billowing of redundant mitral valve into the left atrium during systole

A

Mitral valve prolapse

79
Q

immune-mediated inflammation of the heart, especially valves, triggered by group A streptococcal infection

A

Rheumatic heart disease:

80
Q

autoimmune inflammation of the heart valves as part of systemic lupus erythematosus

A

Libman-Sacks endocarditis

81
Q

non-bacterial thrombotic endocarditis, the deposition of blood clot on heart valves

A

Marantic endocarditis

82
Q

colorful misnomer for blood clots on heart valves

A

Vegetations

83
Q

pea-sized tender nodules in fingers and toes from infected thromboemboli from infective endocarditis

A

Osler nodes

84
Q

hemorrhages on the palms or soles from infected thromboemboli from infective endocarditis

A

Janeway lesions

85
Q

_________is counterregulatory

A

BNP

86
Q

Does heart failure ever lead to a
pro-inflammatory cytokine profile?

A

Yes, tumor necrosis factor (TNF),
interleukin-1 (IL-1) and
interleukin-6 (IL-6) are sometimes
elevated.

87
Q

What is the most common
symptom of infective endocarditis?

A

FEVER

88
Q

What are the three symptoms
in a three-way tie for
second most common,
each half as common as fever (of infective endocarditis)?

A

Infective Endocarditis

Common Symptoms

Fever 80% ,Chills 40%, Weakness 40%, Dyspnea 40%

89
Q

How do the bacteria
that cause
infective endocarditis
get into the bloodstream?

A

Central venous catheterization—esp pic lines that have been in there for months also the mouth, with gingivitis (shown here),

brushing teeth, chewing, dental procedures

90
Q 
Infective endocarditis is destructive and
 may cause (4 features described in lecture)
A

perforation of valve
* adjacent abscess
* fibrotic scarring
* calcification

91
Q

General Principle: The larger a vegetation the more likely it is ________

A

General Principle: The larger a vegetation the more likely it is infective

92
Q

which condition?

A

infective endocarditis

Large variegated red-tan-white infective vegetations

93
Q

which condition?

A

infective endocarditis

Moderate size tan vegetations, proved to be infective

94
Q

Where are infected (“septic”) emboli
from endocarditis most likely to go?

A

Kidneys, heart, spleen, brain

95
Q

which condition?

A

infective endocarditis

Infective vegetation (top) on valve (bottom)

96
Q

which condition?

A

infective endocarditis

Upper: inflammatory cells in the vegetation,
lower: bacteria hiding out in the valve under
a layer of acellular fibrous tissue

97
Q

which condtion?

A

infective endocarditis

Close-up: neutrophils, many degenerating, on valve

98
Q

What is normal end-diastolic volume?

A

150ml

99
Q

Take Home Point

Severe acute
uncompensated
aortic regurgitation
is a
__________

A

Take Home Point

Severe acute
uncompensated
aortic regurgitation
is a
surgical emergency

100
Q

which condition?

A

infective endocarditis

Osler nodes in fingers, tender if you could touch them

101
Q
A

Splinter hemorrhage under fingernail (not specific for
endocarditis, much more commonly due to trauma)

102
Q
A

Janeway lesions: hemorrhages on palms or soles

103
Q
A

Roth spots: retinal hemorrhages due to endocarditis

104
Q

Transthoracic echocardiography
_______ sensitivity for vegetations

A

Transthoracic echocardiography
_ 60%_ sensitivity for vegetations

105
Q

Transesophageal echocardiography
>90% sensitivity for _____

A

Transesophageal echocardiography
>90% sensitivity for vegetations

106
Q

t/f: The absence of vegetations on echocardiogram does not exclude the diagnosis of endocarditis

A

true

107
Q

Continuous low-grade bacteremia is
characteristic of ________

A

Continuous low-grade bacteremia is
characteristic of infective endocarditis.

108
Q

How many blood cultures should you get for infective endocarditis ?

A

Three, from 3 different sites,
30 to 60 minutes apart,
before starting antibiotics, because 86 to 96% of first culturesreturn positive

and 98 to 100% of first two cultures.

109
Q

Why should you alert the
microbiology laboratory that
endocarditis is suspected?

A

Because some bacteria causing
endocarditis are fastidious
or slow-growing or both, 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
Q

____________
are essential for
making a specific
diagnosis to guide
antibiotic therapy for
infective endocarditis.

A

Blood cultures
are essential for
making a specific
diagnosis to guide
antibiotic therapy for
infective endocarditis.

111
Q

which condition?

A

Infective vegetations, bugs have eaten through valve

112
Q

calicific aortic stenosis: epidemiology and causes(3)

A

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
Q

which condition?

A

calcific aortic stenosis

Rocks in sinuses of Valsalva squeezing lumen

114
Q

which condition?

A

aortic stenosis

Close-up of calcifications in a bicuspid valve

115
Q
A

Not too abnormal mitral valve,
seen from above, from the atrial side

116
Q

which condition?

A

Mitral valve prolapse (leaflet on left only)

117
Q

which condition?

A

Fixed removed mitral valve prolapse with
elongated thinned chordae (upper left)

118
Q

which condition?

A

mitral valve prolapse: Myxomatous zona spongios below thinned fibrosa

119
Q

You are a heart with mitral valve prolapse.
Rupture of chordae have just caused acute
regurgitation of 70 ml. How can you cope?

A
  1. Increased stroke volume
  2. Increased end-diastolic volume
120
Q

which condition?

A

Acute rheumatic fever: Close-up: tiny vegetations on line of closure

121
Q

which condition?

A

acute rheumatic fever

Fibrin-platelet vegetation, macrophages below it

122
Q

which condition?

A

acute rheumatic fever

Acute rheumatic Aschoff body in myocardium

123
Q

which condition?

A

Acute rheumatic Aschoff body in myocardium

124
Q

How can you prevent acute
rheumatic heart disease?

A

Antibiotic therapy
for strep throat

125
Q
A
126
Q

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

A

chronic rheumatic heart disease

127
Q

which condition?

A

Slit-like fishmouth
rheumatic mitral
stenosis with
severe dilatation
of the left atrium
behind the stenotic
valve

128
Q

which condition?

A

Slit-like fishmouth rheumatic mitral stenosis

129
Q

which condition?

A

chornic rheumatic stenosis: Round buttonhole rheumatic mitral stenosis

130
Q
A

chronic rheumatic stenosis: Fusion of commissures above and below

131
Q

fyi

A
132
Q

which condition?

A

Thickened fibrotic, partially fused chordae
tendineae (especially on right) characteristic
of old rheumatic mitral valve disease

133
Q

which condition?

A

Mitral stenosis & massive left atrial dilatation

134
Q

which condition?

A

Mitral valve fibrosis of old rheumatic valvulitis

135
Q

You are a heart with chronic mitral valve
regurgitation of 95 ml. How do you cope?

A
  1. Increased stroke volume
  2. Increased end-diastolic volume
  3. Left ventricular dilatation
136
Q

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

A

Libman-Sacks Endocarditis

137
Q

fyi

A

fyi

138
Q

which condition?

A

Red vegetations of Libman-Sacks endocarditis

139
Q

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

A

Marantic Endocarditis

140
Q

which condition?

A

Small tan vegetations of marantic endocarditis

141
Q

which condition?

A

Medium size red-tan uninfected marantic vegetations

142
Q

which condition?

A

Larger atypical red-tan marantic vegetations

143
Q

fyi

A
144
Q

Where are thromboemboli from marantic
endocarditis most likely to go?

A

Kidneys, heart, spleen, brain

145
Q

Marantic endocarditis
is the precursor for ______.

A

Marantic endocarditis
is the precursor for
infective endocarditis

146
Q

LV-end systomic volume?

A

50ml

147
Q

normal stroke volume? ejection fraction?

A

stroke: 100ml; ejection fraction: 67%

148
Q

NOrmal Hemodynamic pressures: LV systolic? RA pressure? RV systolic? LA pressure?

A

LV systolic: 130mm Hg; RA: 3mm Hg; RV systolic: 25 mmHg; LA pressure: 8 mm Hg

149
Q

IMPORTANT CONCEPT 2: The five major categories of the factors determining the heart’s function as a pump, the cardiac output, are _________.

A

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
Q

IMPORTANT CONCEPT 3: __________is the most common hemodynamic disorder, by far, and has a wide array of etiologies and pathogenic mechanisms.

A

IMPORTANT CONCEPT 3: Heart failure is the most common hemodynamic disorder, by far, and has a wide array of etiologies and pathogenic mechanisms.

151
Q

IMPORTANT CONCEPT 4: __________ and orthopnea are the two most specific symptoms of heart failure, but dyspnea and fatigue are the two most common.

A

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
Q

IMPORTANT CONCEPT 5: _________ is a biomarker of heart failure and the level correlates with the severity of the heart failure.

A

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
Q

IMPORTANT CONCEPT 6: The atrial gallop of __________ sounds like Tennessee.

A

IMPORTANT CONCEPT 6: The atrial gallop of hypertensive heart disease sounds like Tennessee.

154
Q

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.

A
155
Q

the flow of blood

A

Hemodynamics

156
Q

the blood pumping phase of the cardiac cycle

A

Systole:

157
Q

: the chamber filling phase of the cardiac cycle

A

Diastole

158
Q

the ventricular wall tension at the end of diastole (degree of myocyte stretch) determined by end-diastolic volume, reflected in end-diastolic pressure

A

Preload

159
Q

the resistance the ventricle must overcome to pump its contents, determined by systolic blood pressure, reflected in ventricular systolic pressure

A

Afterload:

160
Q

inotropic state determining the portion of the force of contraction independently of preload and afterload

A

Myocardial contractility

161
Q

the distendibility of the ventricle, determining the ease of filling it and, indirectly, the amount of filling and hence the amount of blood pumped

A

Compliance

162
Q

inability of the heart to pump sufficient blood to meet the needs of the body

A

Heart failure:

163
Q

a hormone secreted in heart failure in proportion to the severity

A

B-type natriuretic peptide:

164
Q

which condition described: Condition of reversible inadequate

blood supply.

A

MYOCARDIAL ISCHEMIA

165
Q

Condition of reversible inadequate
blood supply due to which five causes

A

fixed coronary stenosis,
increased myocardial demand,
coronary vasospasm,
intraplaque hemorrhage,
superimposed thrombosis or
any combination of these factors

166
Q

look normal by light microscopy
but do not workand fatal arrhythmia may precede
irreversible injury to myocytes

A

Stunned myocytes

167
Q

stunned myocytes characteristics of acute or chronic MI?

A

acute MI

168
Q

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

A

CHRONIC MYOCARDIAL ISCHEMIA

169
Q

which condition?

A

CHRONIC MYOCARDIAL ISCHEMIA

Hibernating myocytes
with cytoplasm cleared of contractile
proteins (myocytolysis)

Myocytolysis (contractile proteins burnt for fuel)

170
Q

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

A

MYOCARDIAL INFARCTION

171
Q

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)

A

TRANSMURAL INFARCTION

172
Q

what do you see?

A

Fatal intraoperative coronary thrombosis

173
Q

describes which condition: Involving inner portion of heart wall more likely to be patchy and to have episodic extension becoming more common than transmural

A

SUBENDOCARDIAL INFARCTION

174
Q

Myocardial Infarction:
Gross (Macroscopic) Pathology:
Classic (Unreperfused): Acute Phase

0-12 hours:

12-24 hours:

2-3 days:

A

0-12 hours: none

12-24 hours: progressive pallor

2-3 days: yellow and softened

175
Q
A

Subendocardial pallor (easiest to appreciate
in the smallest slice [from the cardiac apex])
in a myocardial infarction 4 days old

176
Q

Myocardial Infarction:
Gross (Macroscopic) Pathology:
Classic (Unreperfused): Subacute Phase

4- 7 days:

1-6 weeks

6-12 weeks

A

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
Q

How old?

A

Sub-
acute
infarct 7 days old

Shrunken yellow infarct & red granulation tissue

178
Q

how old? which process?

A

Slice into middle of heart muscle revealing
red granulation tissue of subacute infarction
approximately 3 weeks old

179
Q

which condition? how old?

A

White scar & thinned wall of 10-month old infarct

180
Q

Myocardial Infarction: Microscopic
Pathology: Classic (Unreperfused):
Acute Phase (days 1-3)

Micropathology:

1st visible sign?

when does coagulation necrosis occur?

A
  • *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
Q

what do you see?

A

Normal cardiac myocytes with cross-striations

182
Q

what do you see?

A

Coagulation necrosis: loss of cross-striations

183
Q
A

Thin wavy myocytes (also lost nuclei here)

184
Q

Myocardial Infarction: Microscopic
Pathology: Classic (Unreperfused):
**Acute Phase (days 1-3): what do you see? **

A

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

cardio pathology (3 decks)

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