Cardio Small Groups Flashcards
IMPORTANT CONCEPT 1: Atherosclerosis is a disease of?
Medium arteries, especially coronary and cerebral, and aorta.
IMPORTANT CONCEPT 2: The five step process to atherosclerosis is thought to begin with?
Endothelial injury.
IMPORTANT CONCEPT 3: An atherosclerotic plaque with a large loose atheromatous core and a thin fibrous cap is?
Vulnerable to rupture and superimposed thrombosis with severe consequences.
IMPORTANT CONCEPT 4: Thrombosis superimposed on rupture of a coronary atherosclerotic plaque is?
Especially likely to lead to total occlusion and transmural (full thickness) myocardial infarction.
Atherosclerosis:
Chronic inflammatory disease of tunica intima of medium and large arteries causing narrowing due to buildup of lipid followed by fibrosis.
Atheroma:
Earlier stage of atherosclerosis, with buildup of lipid and lipid-laden macrophages in tunica intima.
Vulnerable plaque:
Atherosclerotic plaque with a large loose atheromatous core and a thin fibrous cap, prone to rupture and occlusive superimposed thrombosis
IMPORTANT CONCEPT 1: Brief ischemia can provide ischemic preconditioning protection for subsequent ischemia, but longer ischemia can?
Stun myocytes rendering them temporarily unable to work and chronic ischemia can make them hibernate.
IMPORTANT CONCEPT 2: Myocardial infarction is?
Irreversible necrosis of heart muscle due to prolonged ischemia (longer than 20 minutes).
IMPORTANT CONCEPT 3: Contraction band necrosis is?
The form of irreversible myocyte injury associated with reperfusion.
IMPORTANT CONCEPT 4: Reperfusion injury is the?
Perverse damage caused by restoring blood flow to previously injured tissue.
Stunned myocytes:
Myocytes injured by acute ischemia, which look normal microscopically, but need time to repair before they work normally again.
Hibernating myocytes:
Chronically ischemic myocytes, which have cleared cytoplasm due to catabolism of their contractile proteins and need time to regenerate their contractile proteins before they work normally again.
Myocytolysis:
The light microscopic appearance of hibernating myocytes.
Ischemic preconditioning:
Resistance to mild-moderate ischemia due to induction of protective proteins by brief episodes of ischemia.
Contraction band necrosis:
Dead myocytes with dense hypereosinophilic transverse bands of hypercontracted sarcomeres, associated with reperfusion.
No reflow phenomenon:
Failure of relieving obstruction at the arterial level to restore blood flow, attributed to microvascular obstruction or edema.
Reperfusion injury:
Hemorrhage and other injurious phenomena associated with bringing oxygen and calcium to injured tissue, attributed to reactive oxygen species and metabolic effects of calcium
IMPORTANT CONCEPT 1: Aortic aneurysms are?
Familial
IMPORTANT CONCEPT 2: Aortic dissection is?
Medical or sometimes surgical emergency.
IMPORTANT CONCEPT 3: History and physical examination is all you should need to diagnose?
Peripheral arterial disease.
IMPORTANT CONCEPT 4: Acute arterial occlusion is manifested by the five Ps?
Pain, pallor, paralysis, paresthesia and pulselessness, and is a surgical emergency.
IMPORTANT CONCEPT 5: The most essential aspect of the treatment of Buerger disease is?
Getting the patient to quit smoking.
Aneurysm:
Abnormal localized dilatation (outpouching) of an artery, vein or heart.
Pseudoaneurysm:
Contained ruptures of the tunica intima and media and sometimes even adventitia of an artery.
Aortic dissection:
A catastrophic tear of the tunica intima letting luminal blood under high pressure into the tunica media, where it tunnels a second lumen.
Claudication:
Ischemic pain of the periphery, usually the legs, usually the calves, usually intermittent, usually brought on by exertion and relieved by rest.
Buerger disease:
Thromboangiitis obliterans, a chronic thrombosing inflammatory disease of small and medium arteries and veins of arms and legs.
IMPORTANT CONCEPT 1: Palpable purpura are a classic sign of?
Vasculitis
IMPORTANT CONCEPT 2: It behooves physicians who prescribe medications that cause hypersensitivity angiitis to?
Recognize it and stop the drugs.
IMPORTANT CONCEPT 3: Steroid therapy for temporal arteritis can?
Save elderly white females from blindness.
IMPORTANT CONCEPT 4: Prompt diagnosis and treatment of Kawasaki disease can?
Save babies from chronic heart disease or death.
The seven most common complications of myocardial infarction are?
(1) cardiac arrhythmias, (2) heart failure, (3) mural thrombus formation, (4) cardiac rupture, (5) pericarditis, (6) aneurysm formation and (7) papillary muscle rupture.
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.
Vasculitis:
Heterogeneous group of uncommon, primarily autoimmune, occasion-nally life-threatening diseases, having in common inflammation of blood vessels.
Hypersensitivity angiitis:
An acute necrotizing inflammatory disease of the smallest blood vessels (arterioles, capillaries, venules), especially in the skin.
Temporal arteritis:
Giant cell arteritis, a granulomatous inflammatory disease of medium and larger arteries, especially in the head, in elderly white females.
Kawasaki disease:
Mucocutaneous lymph node syndrome, an acute childhood primary vasculitis of medium arteries, especially coronaries.
Mural thrombus:
Blood clot that forms on the lining of the heart or aorta over an abnormality in the wall, like a “mural” painting on a wall.
Cardiac tamponade:
Impaired cardiac filling and function due to something in the pericardial sac compressing it (blood, other fluid or fibrous adhesions).
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.
IMPORTANT CONCEPT 2: Jugular venous distention, muffled heart sounds and hypotension are?
Beck’s triad of physical findings of cardiac tamponade.
IMPORTANT CONCEPT 3: The diagnostic criteria for acute pericarditis are any two of the following:
Typical chest pain, pericardial friction rub, suggestive EKG changes and pericardial effusion.
Myopericarditis:
Simultaneous inflammation of myocardium and pericardium, commonly attributed to viral infection.
Beck’s triad:
Jugular venous distention, muffled heart sounds and hypotension, signs of cardiac tamponade.
Pulsus paradoxus:
An exaggeration of the normal decrease in blood pressure with inspiration >10 mm Hg systolic, associated with cardiac tamponade or asthma.
Pericardial friction rub:
Superficial scratchy or squeaking sound, frequently triphasic, associated with acute pericarditis.
IMPORTANT CONCEPT 1: Decompensation can cause hypertrophic or restrictive cardiomyopathy to?
Take on features of dilated cardiomyopathy.
IMPORTANT CONCEPT 2: Hypertrophic cardiomyopathy is?
Simultaneously a structural and functional disease.
IMPORTANT CONCEPT 3: Hypertrophic cardiomyopathy is the most common cause of?
Sudden death of American athletes under age 35.
IMPORTANT CONCEPT 3: Atherosclerotic cardiovascular disease is the most common cause of?
Sudden death of American athletes over age 35.
IMPORTANT CONCEPT 4: Cardiac amyloidosis is primarily?
A disease of older adults who present with heart failure.
IMPORTANT CONCEPT 5: Cardiac sarcoidosis is primarily a disease of?
Young African Americans who present with arrhythmias.
IMPORTANT CONCEPT 6: As a general principle, some cardiomyopathies are more likely to?
Heart failure and others with arrhythmias.
Cardiomyopathy:
Heterogeneous group of myocardial diseases associated with mechanical and/or electrical dysfunction of the heart.
Hypertrophic cardiomyopathy:
Group of genetic diseases with hypertrophy as a compensatory mechanism for mutations in genes encoding contractile proteins of the cardiac sarcomere.
Idiopathic dilated cardiomyopathy:
Wastebasket category of nonspecific end-stage heart disease with cardiac dilatation and heart failure and no cause evident.
Cardiac myxoma:
Benign gelatinous mesenchymal neoplasm of endocardium.
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.
IMPORTANT CONCEPT 3: Heart failure is the most common?
Hemodynamic disorder, by far, and has a wide array of etiologies and pathogenic mechanisms.
IMPORTANT CONCEPT 4 The two most specific symptoms of heart failure?
Paroxysmal nocturnal dyspnea and orthopnea.
IMPORTANT CONCEPT 4: The two most common nonspecific symptoms of heart failure?
Dyspnea and fatigue are the two most common.
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.
IMPORTANT CONCEPT 6: The atrial gallop of hypertensive heart disease sounds like?
Tennessee
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.
Hemodynamics:
The flow of blood.
Systole:
The blood pumping phase of the cardiac cycle
Diastole:
The chamber filling phase of the cardiac cycle
Preload:
The ventricular wall tension at the end of diastole (degree of myocyte stretch) determined by end-diastolic volume, reflected in end-diastolic pressure.
Afterload:
The resistance the ventricle must overcome to pump its contents, determined by systolic blood pressure, reflected in ventricular systolic pressure.
Myocardial contractility:
Inotropic state determining the portion of the force of contraction independently of preload and afterload.
Compliance:
The distendibility of the ventricle, determining the ease of filling it and, indirectly, the amount of filling and hence the amount of blood pumped.
Heart failure:
Inability of the heart to pump sufficient blood to meet the needs of the body.
B-type natriuretic peptide:
A hormone secreted in heart failure in proportion to the severity.
IMPORTANT CONCEPT 1: Calcific aortic stenosis presents with?
(SAD) Syncope, Angina, or Dyspnea and valve replacement after the development of symptoms greatly improves survival.
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.
IMPORTANT CONCEPT 3: Mitral valve prolapse is the most common?
Valve disease in the US and usually benign.
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.
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.
IMPORTANT CONCEPT 6: Infective endocarditis is infection of thrombi on heart valves, important because prompt diagnosis?
Decreases the mortality from 100% to 20%.
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.
Mitral valve prolapse:
Billowing of redundant mitral valve into the left atrium during systole.
Rheumatic heart disease:
Immune-mediated inflammation of the heart, especially valves, triggered by group A streptococcal infection.
Libman-Sacks endocarditis:
Autoimmune inflammation of the heart valves as part of systemic lupus erythematosus.
Marantic endocarditis:
Non-bacterial thrombotic endocarditis, the deposition of blood clot on heart valves.
Vegetations:
Colorful misnomer for blood clots on heart valves.
Osler nodes:
Pea-sized tender nodules in fingers and toes from infected thromboemboli from infective endocarditis.
Janeway lesions:
Hemorrhages on the palms or soles from infected thromboemboli from infective endocarditis.
IMPORTANT CONCEPT 1: The most common cause of right heart failure is?
Left heart failure.
IMPORTANT CONCEPT 2: Cor pulmonale is right heart disease caused by?
Pulmonary hypertensive diseases, especially emphysema, embolism and interstitial lung disease.
IMPORTANT CONCEPT 3: Leg edema, hepatomegaly, ascites and jugular venous distention can all be manifestations of?
Right heart failure.
IMPORTANT CONCEPT 4: Small patches of myocardial disease, especially scarring, are?
A common anatomic substrate for fatal reentrant ventricular tachycardia.
IMPORTANT CONCEPT 5: A cardiac arrhythmia, especially heart block, in a young African American suggests?
The possibility of cardiac sarcoidosis.
IMPORTANT CONCEPT 6: A prolonged QT interval, corrected QT (QTc), over 440 milliseconds is a signal of?
Dangerous heart disease.
IMPORTANT CONCEPT 7: Sudden cardiac death 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.
Cor pulmonale:
Heart disease caused by lung disease.
Arrhythmia:
Disturbance in heart rhythm due to deranged cardiac electrical signaling.
PR interval:
Time from start of P wave to end of QRS, normally 120-200 ms, indicative of conduction block around AV node if prolonged.
QT interval:
Time from start of QRS to end of T wave, normally <440 ms, dangerous if prolonged due to risk of ventricular tachyarrhythmias.
Atrial fibrillation:
Arrhythmia of chaotic atrial activation at a rapid rate causing an irregular heart rhythm due to variable conduction through the AV node.
Ventricular fibrillation:
Immediately life-threatening arrhythmia of chaotic ventricular activation at a rapid rate with lack of cardiac pumping.
Channelopathy:
Heart disease of arrhythmias due to defective cardiac myocyte ion channels, usually due to genetic mutations.
Torsades de pointes:
A polymorphic ventricular tachycardia with variation in QRS size and shape, creating an outline resembling a twisted ribbon on EKG
