Cardiology Flashcards
1
Q
what is the symptom of SOB, or difficulty breathing subjectively felt by the patient?
A
dyspnea
2
Q
SOB in supine position, esp common in LEFT HT Congestive Failure called?
A
orthopnea
3
Q
what does LEFT Congestive HT failure signify?
A
signifies edema of LU
4
Q
when the brain experiences hypoxia, the hypothalamus signals to wake the person up, this condition is known as?
A
paroxysmal (episodic) nocturnal dyspnea
5
Q
when centers of the brain that control breathing are not working properly, this is called?
A
central sleep apnea
6
Q
medical term for fainting?
A
syncope
7
Q
which chest pain is characterized by squeezing, heavy, crushing pain?
A
ischemic pain
8
Q
which chest pain is characterized by stabbing, sharp quality, and aggravated by supine position? why?
A
pericardial pain
bc pressure of HT beat rubs agains teh pericardium
9
Q
what is echocardiography?
A
ultrasound of heart
10
Q
what blood tests are available for cardio-vascular pathology?
A
CBC, urinalysis, C-reative protein, ESR, Cardiac and Liver enzyme, Lipid profile
11
Q
what is Ischemic Heart Disease (IHD), what is another name?
A
myocardial ischemia
is a disease characterized by reduced blood supply to HT muscle, usu due to coronary artery disease (atherosclerosis of the coronary arteries)
12
Q
what are the main causes of atherosclerosis, which is the disease process underlying IHD?
A
age, smoking, hyperlipidemia (high cholesterol and high fats in the blood), diabetes mellitus, hypertension, and family history of IHD
it is more common in MEN
13
Q
what are the 5 types of IHD?
A
- stable angina pectoris
- unstable angina pectoris
- prinzmetal angina
- myocardial infarction (AKA MI or Heart Attack)
- Sudden Cardiac Death Syndrome
14
Q
which IHD is characterized by ischemic/ “heavy, stone-like, crashing-like” chest pain episodes upon exertion of a “predictable amount” for more than 15-20 min?
A
stable angina pectoris
15
Q
which IHD is characterized by ischemic/ “heavy, stone-like, crashing-like” chest pain, but episodes may occur either with any exertion or at rest?
A
unstable angina pectoris
16
Q
which IHD is characterized by sudden ischemic chest pain due to paroxysmal/episodic vasospasm?
A
prinzmetal angina
*coronary spasm, blood vessels just squeeze from time to time, reason unknown
17
Q
which IHD is characterized by partial necrosis of the cardiac wall
A
myocardial infarction (AKA MI or Heart Attack)
*usu follow patterns of angina, but doesn’t have to, coagulative necrosis
18
Q
which IHD is characterized by sudden profound ischemia of the HT, leading to inability of HT and brain fx due to anoxia, resulting in sudden death?
A
Sudden Cardiac Death Syndrome
19
Q
how do you DX IHD?
A
based on clinical presentation
ECG, blood tests of MI markers
US and chest x-ray studies
Angiography with or w/o catheterization and angioplasty could be involved, if atherosclerosis is severe
20
Q
for confirmation of DX of MI, what is required?
A
the TRIPLE SCREEN
- ECG
- Cardiac enzymes blood level elevation: troponin and CK-B (creatine kinase B)
- clinical presentation
21
Q
what are possible tx and prevention methods for IHD?
A
- control and possible elimination of modifiable risk factors
- re-vascularization: restoration and potency of arteries (catheterization/aingioplasty)
- blood-thinning medications
- adjustment/modifications of life style
- monitoring
22
Q
what is a condition in which a problem w the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body’s needs. Hence, the deficiency of the heart as a pump leads to def of cardiac output?
A
Heart Failure (HF)
23
Q
what is an outcome of many altered states of cardiovascular and respiratory systems?
A
Congestive Heart Failure (CHF)
24
Q
What are the common causes of CHF?
A
myocardial infarctions, and other forms of ischemic heart disease, hypertension, valvular heart disease and cardiomyopathy, along with COPD or other obstructive lung conditions leading to COR PULMONALE
*CHF is end stage of HT disease, due to multiple etiology of HT disease
25
what are some S&S of HF?
SOB (typically when lying flat = orthopnea)
coughing
ankle swelling and reduced exercise capacity
signs of portal hypertension (LR blood stagnation) - when RT congestive HT failure is involved
26
what is the most COMMON cause of LEFT CHF?
systemic Arterial Hypertension
27
what is the most COMMON cause of RIGHT CHF?
what is 2nd most common?
failure of LEFT HEART (left CHF)
*second most common reason for Right CHF is Cor Pulmonale due to sustained COPD
28
why are the symptoms of LEFT Congestive Heart Failure predominately respiratory in nature? what are the S&S?
- failure of the left ventricle causes congestion of the pulmonary vasculature, and so the symptoms are predominately respiratory in nature
- the patient will have dsypnes (SOB) on exertion, and in severe cases, at rest
- increasing breathlessness on lying flat (=orthopnea) occurs --> measured in pillows required to lie comfortably... severe patient sleeps sitting up
- paroxysmal nocturnal dyspnea = "cardiac asthma"
- easy fatigue-ability and exercise intolerance
- compromised of left ventricle forward fx may result in symptoms of poor systemic circulation such as dizziness, confusion and cool extremities at rest
- MOST COMMON CAUSE - arterial hypertension
29
pathomechanism and S&S of RIGHT Congestive Heart Failure?
- failure of RT ventricle leads to congestion of systemic venous capillaries
- this leads to excess fluid accumulation in body --> causing swelling under the skin (peripheral edema or anasarce) and usually affects the dependent parts of body first (causing foot and ankle swelling in people who are standing up, and sacral edema in people who are predominantly lying down)
- Nocturia (frequent night-time ruination) may occur when fluid from legs is returned to bloodstream while lying down at night
- severe cases, ascities (fluid accumulation in abd cavity causing swelling) and hepatomegaly (enlarged LR)
- significant LR congestion results in impaired LR fx, and jaundice and coagulopathy (decreased blood clotting)
- other S&S of Liver Blood Stagnation / or portal hypertension: esophageal varices, hemorrhoids, tremor of extremities, distention of periumbilical veins
- MOST COMMON CAUSE - left CHF
- 2nd most common cause - Cor Pulmonale
30
what is Cardiomyopathy?
"pathology of Heart Muscle"
is a weakness of heart muscle, which is not relevant to or beyond of the concurrent inflammatory process (it is not carditis!)
31
what are the major types of Cardiomyopathy?
1. Dilated Cardiomyopathy (DCM)
2. Hypertrophic Cardiomyopathy (HCM)
3. Restrictive Cardiomyopathy (RCM)
32
which type of Cardiomyopathy is the most common form, and one of the leading indications for heart transplantation?
what are pathomechanism and epidemiology?
Dilated Cardiomyopathy (DCM)
- in DCM, the heart (esp left ventricle) is enlarged and pumping fx is diminished.
- Approx 40% of cases are familial, but genetic poorly understood
- some cases peripartum cardiomyopathy (during pregnancy), and some other causes associated with alcoholism
33
which type of Cardiomyopathy is a genetic disorder caused by various mutations in genes encoding sarcomere proteins?
what are pathomechanism and epidemiology?
Hypertrophic Cardiomyopathy (HCM)
- heart muscle is thickened, which can obstruct blood flow and prevent heart from fx properly.
- young male athletes, collapsing and dying of sudden cardiac death syndrome, while playing sports are rare but well recognized outcome
34
which type of Cardiomyopathy is uncommon?
pathomechanism?
Restrictive Cardiomyopathy (RCM)
-walls of ventricles are stiff, and resist the normal filling of the heart with blood
35
how is Cardiomyopathy usually found? what other condition is it commonly confused with?
- usually found incidentally during routine check up
| - Cardiomyopathy often confused with mental tension, stress, and anxiety
36
what is "malignant" Cardiomyopathy and it presents with what symptoms?
- (or accelerated Cardiomyopathy) is distinct as a late phase in teh condition, and may present with headaches, blurred vision, and end-organ damage
37
Cardiomyopathy is commonly accompanied by what other condition? and for this reason may result in what?
arterial hypertension, and as a result may lead to poor outcome (including end stage CHF of Sudden Cardiac Arrest --> death)
38
what a re tx options for Cardiomyopathy?
- depends on type, but may include medication, implanted pacemakers, defibrillators, or ventricular assist devices (LVADs), or Ablation
- goal of tx is often symptom relief, and sometimes transplant
39
what is inflammatory heart disease that involves inflammation of the heart muscle and/or tissue surrounding it?
Carditis
40
what is inflammation of inner layer of the heart, the most common structures involved are the heart valves?
endocarditis
| inflammation of endocardium
41
inflammation of the muscular part of the heart is called?
myocarditis (inflammation of myocardium)
42
inflammation of the pericardial sac is?
pericarditis
43
total heart inflammation withe the involvement of all layers of the heart is called?
pancarditis
44
what structures may be involved in Endocarditis?
- heart valves (native or prosthetic valves)
| - may also involve interventricular septum, the chordae tendinae, mural endocardium, or intracardiac devices
45
which carditis is characterized by a prototypic lesions, the vegetation, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells>
endocarditis
46
myocarditis often resembles?
heart attack, but coronary arteries are not blocked
47
what are possible causes of myocarditis?
- often caused by auto-immune reaction, triggered by prior recent infection w Streptococcus bacteria or Coxsackle virus
- infection w HIV, parvovirus, rubella virus, and other microorganisms
- alcoholism, chemotherapeutic drugs, certain anti-psychotics (closapin), and other toxins (carbon monoxide, snake venom), electric shock and severe fever / hperthermia
48
what is the only definitive dx of myocarditis? and why is it rarely performed?
heart biopsy, which may lead to serious side effects.
thus dx is clinical, but clinical presentations could be mild (palpitations, mild fatigue) or very severe up to heart failure and cardiac death
49
what are etiological difference bt endocarditis and myocarditis?
endocarditis - tends to ne more bacterial infections
| myocarditis - tends to be more virus infections
50
fluid in the pericardial cavity is called?
| what procedure is performed to remove the fluid from pericardium and perform analysis of pericardial fluid?
pericardial effusion
pericardiocentesis
51
pericarditis is classified by duration, what are their characteristics?
ACUTE: more common than chronic condition, can occur as a complication of infections, immunologic conditions, or heart attack (less than 6 months)
Subacute (6weeks to 6 months)
CHRONIC: one form is constrictive pericarditis (more than 6 months)
52
what are the common causes of pericarditis?
- infectious: viral infection, MOST COMMON caused by coxsakie virus
- bacterial infection, esp by pneumococcus or the Tuberculosis bacillus (tuberculous pericarditis)
- Fungal
other causes:
- idiopathic
- immunologic conditions including lupus erythematousus or rheumatic fever
- trauma to heart (puncture, resulting in infection or inflammation)
- malignancy (paraneoplastic phenomenon)
- side effects of meds
- radiation induced
- aortic dissection
- tetracyclines
53
what is pericarditis after Myocardial Infarction called? what is pathomechanism?
Dressler's Syndrome or "reactive pericarditis"
in the process of MI healing period, the inflammation may spread to pericardium
54
what are clinical presentations of pericarditis?
CLASSIC PRESENTATION:
- chest pain of sharp or stabbing character, radiating to the back and relieved by sitting up forward and worsened by lying down
- friction rub
[OTHER, may include]
- dry cough, fever, fatigue, anxiety
- pericarditis can be misdx as MI, and vice versa
- diffused ST-elevation and PR-depression on ECG in all leads; cardiac tamponade (pulsus paradoxus w hypotension), and congestive heart failure (elevated jugular venous pressure w peripheral edema)
55
what are tx of pericarditis?
tx in viral or idiopathic pericarditis is non-steroidal anti-inflammatory drugs
in severe cases: periocardiocentesis, antibiotics, steroids, colchicine (gout drug), or surgery
56
what is SHOCK?
an extremely deficient arterial circulation, which is unable to keep up with metabolic demands of body
57
what are 3 major types of shock?
1. hypovolemic (failure of fluids)
2. cardiogenic (failure of pumps)
3. distributive (failure of tubes)
58
which type of SHOCK involves the heart not being able to pump due to MI, carditis, Pericarditis, tension pneumothorax, or anything that has to do with the pumping action ?
Cardiogenic shock (failure of pumps)
59
which type of SHOCK presents when the Heart is acutely dealing with no venous return of blood, which can be caused by internal bleeding, heat exhaustion, profound watery diarrhea, accidents or trauma?
This shock is defined by systolic (left circulation) BP lower than 90mm/Mg
Hypovolemic (failure of fluids)
("low volume of blood"
60
in which type of SHOCK, does the blood not get distributed to the peripheral circulation (for instance to brain, so person is sluggish and may loose consciousness)?
what are major causes of this type of shock?
Distributive (failure of tubes)
major causes septic shock (bc of bacteria), and anaphylactic shock (bc of histamine and serotonin)
61
Sepsis: the failure of tubes (dilation of peripheral arterioles due to bacterial toxin action) causes which types of SHOCK?
Distributive Shock
blood vessels are tubes, failure of blood vessels to return blood to heart
62
which type of shock is caused by obstruction of flow, for instance cardiac tamponade (as failure of pump); thrombosis/embolism?
Cardiogenic Shock
63
what are clinical manifestations of shock, regardless of its causes?
= looks like yang collapse
- hypotension (BP is below 90mm/Mg)
- tachycardia
- altered mental state
- decreased urinary output (normal 30-55 mL/Hr)
- cool and clammy skin
64
what are TX of shock?
- ultimate goal is to get BP to 90mm/Hg for Systolic BP
- immediate/initial goa to get at least 60 mm/Hg for systolic BP, while investigating cause
- trendelenburg position (head down)
- oxygen
- IV fluids
- Foley catheter
- vasopressors
65
what is HYPERTENSION?
also called HTN or high blood pressure
- chronic medical condition resulted from persistently elevated blood pressure
- systemic arterial hypertension
***(do not get this confused with "portal hypertension" which means high blood pressure in venous system due to stagnation either in right heart and/or liver)
66
what are the 2 classification of hypertension? and what does it signify?
1. Essential Primary Idiopathic hypertension: MOST COMMON (90 -95%), unknown cause,
2. Secondary Hypertension: high blood pressure result of another condition, such as KIDNEY DISEASE (most common) or tumors of adrenal gland (adrenal adenoma or pheochromocytoma)
[other causes can include coarctation (narrowing) of aorta, RENAL ARTERY STENOSIS, hyperthyroidism, hypercalcemia, neurological causes
67
Persistent hypertension is one of the risk factors leading to?
stroke, MI, CHF, arterial aneurysm
| leading cause of Kidney failure
68
what is optimal normal blood pressure? why?
115/75 mm Hg
beginning at systolic pressure (which is peak pressure in the arteries, which occurs near the end of cardiac cycle when the ventricles are contracting) of 115 mmHg and diastolic pressure (which is minimum pressure in arteries, which occurs near the beginning of cardiac cycle when ventricles are filled with blood) of 75 mmHg
69
what rate is considered Pre-Hypertension
| and what rate is dx of hypertension and when should it be taken?
pre-hypertension - 125/75 mm Hg
Hypertension - two random measurements of 140/90 mmHg
70
what are clinical presentation of HTN?
-considered "SILENT KILLER" - bc mild to moderate essential hypertension is asymptomatic
- accelerated hypertension - headaches, somnolence, confusion, visual disturbances, nausea, vomiting (hypertensive encephalopathy)
- retina is affected w narrowing of arterial diameter to less than 50% of venous diameter, copper or silver wire appearance, exudates, hemorrhages, or papilledema (swelling of optic disc)
71
what hypertension S&S are especially important in infants and neonates?
-failure to thrive, seizures, irritability, or lethargy, respiratory distress
72
hypertension in pregnancy is called? what are S&S?
pre-eclampsia
-can have visual disturbances, edema, headaches, liver and kidney failure, seizures (eclampsia) and demise of fetus and/or mother
73
what S&S are important in suggesting SECONDARY medical cause of chronic hypertension?
centripetal obesity "buffalo hump" and/or wide purple abdominal striae and maybe a recent onset of diabetes suggest glucocorticoid excess either due to Cushing's syndrome or other causes.
other secondary endocrine disease - hyperthyroidism, hypothyroidism, or growth hormone excess show symptoms specific to these disease such as in hyperthyroid there may be weight loss, tremor, tachycardia, or atrial arrhythmia, palmar erythema and sweating
74
preload
tachycardia - preload is...?
-amount of blood before contraction, end diastolic volume of blood (calcium important for cardiac contraction)
-generates force of cardiac contraction
cardiac disorders due to elasticity of heart being compromised
tachycardia - preload is decreased - bc heart is beating faster
75
afterload
max amount of pressure which allows AV (bi, tricuspid valve) to close - systolic blood pressure
76
blood flood depends on what 2 resistance?
peripheral resistance due to
1. diameter of blood vessels - smaller diameter (hypertension), less blood flow; length of blood vessels
2. viscosity - if blood becomes more saturated with albumin or there is polycythemia, etc, blood will slow down and become more viscous --> less flow
77
why is pulmonary artery called artery?
- brings venous deoxygenated blood to LU
- blood supply comes from HT, and comes into LU to be oxygenated
drainage of blood = veins
bring blood supply to = artery
78
pulmonary veins?
drainage of LU, so called veins
carrying oxygenated blood out of LU
drainage of blood = veins
bring blood supply to = artery
79
cardiac output?
stroke volume / heart rate
80
stroke volume vs ejection fraction?
stroke volume - how much blood comes out per stroke
ejection fraction - same amount of blood, but relative to preload, bc something is left in ventricle after contraction - measure relationship bt vol per stroke to preload
- 55% - 80% range
- at the end of diastole - how much blood was pushed out in relation to what it was at systole; after MI ejection fraction is diminished by 45%
81
SI sound made by
atrioventricular valves closing
R - tricuspid valve
L - mitral or bi cuspid valve
82
S2 sound made by
semilunar valve closing
83
conduction of HT
- synode atrium - major pace maker - located RT atrium under epicardium at exact place where superior vena cava is emptied into right atrium - any impact on chest toward right might produce contusion and people can die of arrhythmia
- atricentricular node - bundle of his - conduction is most rapid at the end - purkenje fibers, slowest is from synode to atriventriuclar node
84
what are major reasons people experience improper rhythms if HT
hypoxia, when HT fibers sarcomeres experience hypoxia, when cells are hypoxic, they cannot maintain resting membrane nicely, bc sodium potassium pumps malfx
85
what is ectopic arrhythmia?
when beat is generated by something outside of synode-atria node
86
what is pulse pressure and how is it calculated?
pulse pressure is difference bt systolic and diastolic pressure
87
the normal HT rate is within what limits? and it is generated by?
within 60-100 BPM
| generated by Sinoatrial node
88
HT is situated within?
just behind and slightly left of breastbone in inferior Mediastinum
89
what is systolic and diastolic pressure?
systolic - max pressure your heart exerts while beating
diastolic - pressure in your arteries between beats
90
in unstable angina pectoris, the typical character and onset of pain are?
Squeezing or heavy character, with possible onset with exertion or at rest
91
In hypertrophic cardiomyopathy, the preload of the left ventricle along with the cardiac output will be most likely?
Decrease
92
In dilated cardiomyopathy, the preload of the heart will be most likely
Increase
93
In distributive shock (septic or anaphylactic), peripheral microcirculation is in a state of
vasodilation
94
The most typical patient, affected by hypertrophic cardiomyopathy is the following:
A. An individual, suffering with chronic alcoholism
B. A pregnant female
C. A young athlete
D. A cancer patient
[C] young athlete
95
Reactive (Dressler’s) pericarditis is due to :
This is pericarditis due to Myocardial infarction. During the healing period of MI, the inflammation may spill into pericardium, so reactive pericarditis can be a reaction of healing of heart after MI. This is one of the reason recovery of MI needs to be in a hospitals for possible complications such as this.
96
Left atrium receives blood via the following blood vessels
Pulmonary veins from Lungs
97
List three blood vessels, which are emptying into the right atrium
Superior vena cava
Inferior vena cava
Coronary sinus
98
Describe the phenomenon of Portal Hypertension
Portal hypertension - high blood pressure in the venous system due to stagnation either in the right or/and liver”
*[“hypertension” by itself normally refers to systemic arterial hypertension]
99
Systemic arterial hypertension is a diagnosis, established when minimal blood pressure measurements on two random occasions are at or above?
normal blood pressure is?
pre-hypertension?
140/90 mm Hg
* normal blood pressure 115/75 mm Hg
* pre-hypertension 125/75 mm Hg
100
The most common cause of secondary systemic arterial hypertension is?
A. Anemia
B. Lung disease
C. Liver disease
D. Kidney disease
D. Kidney Disease
*[Secondary hypertension indicates that the high blood pressure is result (secondary) to another condition such as KD disease (most common) or tumors of adrenal gland (adrenal adenoma or pheochronocytoma), other causes include rental artery stenosis, hyperthyroidism, hypercalcemia, neurological causes.
101
The most common type of systemic arterial hypertension is ?
Primary (essential) idiopathic hypertension is most common 90-95% - this means no medical cause can be found to explain the raised blood pressure
102
Atherosclerosis has the following major pathogenesis
Condition in which an artery wall thickens as result of build up of fatty materials such as cholesterol, platelets, fibrin, and thickening of vascular wall, leading to gradual obstruction to blood flow. It affects arterial blood vessels, a chronic inflammatory response in the walls of arteries, in large part due to accumulation of lipid loaded macrophages. It is commonly promoted by sustained hpertension and high level of LDL along with low level of HDL lipoproteins in blood plasma. It is characterized by formation of multiple plagues within arteries, which are called atheromas
103
What is the major risk factor for pulmonary embolism?
Deep Vein Thrombosis
104
What type of cardiomyopathy is the most common and what are its associated risk factors?
```
Dilated Cardiomyopathy (DCM)
Most cases are familial, some cases manifests as peripartum cardiomyopathy (during pregnancy), and other alcoholism.
```
105
What is the term for accumulation of the inflammatory fluid within the pericardial cavity?
Pericardial effusion
106
What is the procedure for removal of the blood or any other type of fluid from the pericardial cavity?
pericardiocentesis
107
Describe the chain of bio-chemical reactions, generated by the kidneys, as a result of their ischemia, and contributing to systemic arterial hypertension
Secondary Hypertension is established as a feedback mechanism bt cardiac output and KD dependence on blood supply.
There is systemic vasoconstriction due to various factor → KD will receive less blood suppy/blood flow per unit of time → activates secretion of hormone rennin → rennin will work on angiotensiogen I (from LR) to produce angiotensin I → delivered to circulation of LU and converted into angiotensin II → will decrease diameter of blood vessels ( increase tension) → and adrenals will increase production of aldolsteron (works on absorption of sodium in convoluted tubules / sodium retention) → antidirutic hormone (water retention) → increased osmolarity and blood volume along with increased vascular resistance/pressure
108
What is orthostatic hypotension?
When a person’s blood pressure suddenly falls when standing up or stretching – bc blood pooling in lower extremities when there is a change in body position
109
LU edema is result of clinical complications of ?
Left Congestive Heart Failure
110
icterus means?
jaundice
111
what is risk factor for all clinical manifestations of atherosclerosis? why?
Hypertension!!
| bc it is risk factor for atherosclerosis itself
112
what is aRTERIO-sclerosis?
diffused stiffening of arterioles, covered by fibrin deposition, like onion, eventually disables KD or KD can't get blood to itself
-long term consequence of series of arterial hypertension (not a cause of hypertension)
113
what is aTHERO-sclerosis?
condition in which an artery wall thickens as result of build-up of fatty materials such as cholesterol, platelets, fibrin, and thickening of vascular wall, leading to gradual obstruction to blood flow
- it is syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, in large part due to accumulation of lipid loaded macrophages
- it is commonly promoted by sustained hypertension and high level of LDL along with low level of HDL lipoproteins in blood plasma
- it is characterized by formation of multiple plaques within the arteries, which are called ATHEROMA (s)
114
what is difference bt ARTeriosclerosis and arterioLOsclerosis vs ATHerosclerosis ?
ARTeriosclerosis is general term describing ANY hardening (and loss of elasticity) of medium or large arteries
arteriOLosclerosis - hardening of arterioles (small arteries)
ATHerosclerosis - hardening of an artery specifically due to ATHEROMATOUS plaque, and atherosclerosis is a form of arteriosclerosis
115
what is pathogenesis of atherosclerosis?
1. arteries carry blood from heart to rest of body
2. build of fat in inner artery wall. this fat is LDL (bad) cholesterol. fat builds up due to damage to artery caused bu smoking, high blood pressure, raised cholesterol and diabetes. condition aggravated by ppor diet, lack of exercise, and obesity
3. recruitment of immune cells from blood. these cells make leukotrienes. the FLAP gene inside these cells encodes an enzyme involved in the pathway used to produce leukotrines
4. leukotrines act as chemical signal to attract more immune cells, causing blood vessel to become inflamed. More fat is trapped, and growing plague, as it is known, becomes encrusted with calcium. The plaque narrows the artery, reducing blood flow to tissue downstream
5. rough surface of plaque can cause blood to form a clot (thrombus) which can grow to block the diseased artery, starving tissue downstream of blood. pieces of thrombus can break off and be carried downstream to a smaller artery which becomes blocked. In the heart this can cause a heart attack. in head or neck, it can cause stroke.
116
what is peripheral artery occlusive disease (PAOD)?
atheroma in arm, or more often in leg arteries, which produces blood flow
117
atherosclerosis typically begins in early adolescence, and is usually found in most major arteries - what are symptoms? how is it dx?
it is usually ASYMPTOMATIC and not detected by most dx methods during life
in many cases, the first symptom of atherosclerotic cardiovascular disease is either clinically dramatic heart attack or sudden cardiac death
traditionally most common noninvasive testing method for blood flow limitation called Cardiac Stress Testing, which generally detects only lumen narrowing of ~75% or greater
118
what are risk factors for Atherosclerosis development?
```
same as IHD:
male
age
family history
HTN
high total cholesterol and LD with low HDL
smoking
diabetes mellitus
```
119
what can be LETHAL within atheroma?
BLEEDING
although disease is slowly progressive over decade, it usually remains asymptomatic until atheroma ulcerates which leads to immediate blood clotting at the site of atheroma ulcer.
--> triggers cascade of events causing clot enlargement --> may obstruct lumen of artery itself
--> complete blockage leads to ischemia of myocardial muscle and damge --> myocardial infarction / heart attack
120
what are tx and preventions of atherosclerosis?
drugs - statins, niacin, etc.
surgical interventions - arterial cathetherization, angioplasty
121
what is Congenital Heart Defect (CHD)?
defect in structure of heart and great vessels of newborn
-most defects either obstruct blood flow in heart or vessels near it or cause blood flow through the heart in abnormal pattern
122
what are etiological factors of Congenital Heart Defect?
- genetic predisposition or environmental influence
GENETIC:
- chromosomal abnormalities - trisomies 21, 13, and 18,
- genetic point mutations
- point deletions, etc...
ENVIRONMENTAL:
- maternal infections (rubella)
drugs (alcohol, lithium, thalidomide)
-maternal illness (diabetes mellitus, phenylketonuria, systemic lupus erythematosus
123
congenital defects with OBSTRUCTION means?
when HEART valves, arteries, or veins are abnormally narrowed or blocked.
such as:
-pulmonary valve stenosis
-aortic valve stenosis
-coarctation of aorta (narrowing of short section of aorta)
*any narrowing or block can cause heart enlargement or hypertension
124
congenital defects with SEPTAL DEFECT means?
- septum is wall of tissues separating left heart from right heart (inter-atrial septum or inter-ventricular septum)
* septal defects may or may not cause cyanosis depending on severity of defect
125
what is MOST COMMON types of congenital septal defect?
30% of adults have what type of septal defect?
congenital Ventricular septal defect
adults - atrial septal defect called patent foramen ovale
126
what are Congenital Defects with Cyanosis?
includes:
-persistent truncus arteriosis, total anomalous pulmonary venous connection, Tetralogy of Fallot, transposition of great vessels, tricuspid atresia
127
what is Tetralogy of Fallot?
Blue Baby Syndrome
- babies get bluish skin during episodes of crying or feeding
- congenital HT defect, most common Cyanotic HT Defect
has 4 HT abnormalities (although 2-3 are present):
1. pulmonary stenosis - narrowing of root of pulmonary artery as it departs from RT ventricle (to LU)
2. hypertrophy of RT ventricle
3. inter-ventricular foramen
4. dextra-position of aorta AKA overriding Aorta - the root of aorta is positioned over septal interventricular defect (root of aorta is sitting upon 'toilet bowl' sending deoxygenated blood to arterial circulation
128
what is pathogenesis of Tetralogy of Fallot?
environmental or genetic factors or combination
- chromosome 22 deletions and di Geroge syndrome
- specific genes: JAG1, NKX2-5, ZFPM2, VEGF
129
what causes right ventricular hypertrophy in Tetralogy of Fallot?
this results from combination of VSD, pulmonary stenosis, overriding aorta --> which causes resistance of blood flow from right ventricle
130
what is right-toleft shunt associated with Tetralogy of Fallot?
low oxygenation of blood due to mixing of oxygenated and deoxygenated blood in left ventricle via the ventricular septal defect and through overriding aorta
131
the primary symptom Tetralogy of Fallot is low blood oxygen saturation with or w cyanosis from birth to 1st year of life. If the baby is not cyanotic, then this is referred to as?
what are other symptoms?
pink tet
```
heart murmur
difficulty in feeding
failure to gain weight
retarded growth and physical development
dyspnea or exertion
clubbing of fingers and toes
polycythemia
```
132
what is 'tet spells' in Tetralogy of Fallot
```
acute SOB
severe cyanosis
syncope
hypoxia brain injury and death
older children will often squat during tet spell, which cuts off circulation to legs and therefore improves blood flow to brain and vital organs
```
133
when does Rheumatic fever RF) develop?
Rheumatic fever is an inflammatory disease that may develop 2 to 3 weeks after a Group A Beta-hemolytic Streptococcal infection (such as strep throat or scarlet fever)
134
what is Rheumatic Fever caused by? and what parts of the body does it affect?
believed to be caused by antibody cross-reactivity and can involve heart, joints, skin, and brain.
135
why does cross-reactivity of immune system occur in Rheumatic Fever?
cross-reactivity of immune system on streptococcal antigen is explained by molecular mimicry (likeness of connective tissues of humans / other mammals and streptococcus bacteria
136
what two conditions by itself is enough to dx rheumatic fever?
chorea - shaking and tremor
| carditis
137
major dx criteria for Rheumatic Fever are?
1) migratory polyarthritis
2) carditis
3) subcutaneous nodules
4) erythema marginatum
5) Sydenham's chorea (St Vitus' dance)
138
what is migratory polyarthritis?
temporary migrating inflammation of large joints, usu starting in legs and migrating upwards
139
what is carditis?
inflammation of heart muscle which can manifest as congestive heart failure with SOB, pericarditis with a rub, or new heart murmur
140
what is subcutaneous nodules?
painless, firm collections of collagen fibers over bones or tendons. they commonly appear on back of wrist, outside elbow, and front of knees
141
what is erythema marginatum?
a long lasting rash that begins on trunk or arms as macules and spreads outward to from a snake like ring while clearing in the middle. this rash never starts on face and it is made worse with heat
-looks like quarter size flat pancake with elevated borders
142
what is Sydenham's chorea (St Vitus' dance)?
a characteristic series of rapid movt w/o purpose of face and arms. This can occur very late in disease
143
elevated or rising Antistreptolysin O titer or DNAase indicates?
supporting evidence of Streptococcal infection
"O" in microbiology signify bacterial wall - antibody immune system created against DNAase (DNA of strep)
144
strep throat + rash = _________, which may lead to _____
| the rash in this disease feels like?
scarlet fever, this may lead to Rheumatic Fever
| rash in scarlet fever feels like SAND PAPER
145
if nose is running and you have sore throat, is this strep throat or not?
No,
| if nose is NOT running and you have other cold symp this may indicate strap throat
146
what is Thromboangiitis Obliterans, what is another name?
this disease is strongly associated with the use of?
Buerger's Disease
this is recurring inflammation and thrombosis (clotting) of small and medium arteries and veins of hands and feet
TABACCO products, primarily from SMOKING
(#1 etiology is 100% chronic smokers, mainly male in early 40s)
147
what is main symptoms of Buerger's Disease?
what are common complications?
- pain in affected areas, which occurs in episodes upon exertion (claudication) due to severe obstruction with ischemia
- common complications - ulcerations and gangrene in extremities, often resulting in need for amputation of involved extremity
148
possible TX for Thromboangiitis obliterns?
-STOP SMOKING
[+ vascular surgery can be helpful in tx limbs w poor perfusion secondary to this disease
+ use of vascular growth factor and stem cell injections have been showing promise in clinical studies]
149
what is Aneurysms?
localized, blood-filled dilation (ballon-like bulge) of blood vessel, caused by disease or weakening of vessel wall
150
where does aneurysms most commonly occur?
in arteries at base of brain (anterior cerebral artery from the Circle of Wills) and in aorta (aortic aneurysm)
151
most (94%) of non-intracranial aneurysms arises where?
distal to origin of renal arteries at infrarenal ABDOMINAL AORTA, condition mostly caused by atherosclerosis
152
what leads to AORTIC INSUFFICIENCY causing aneurysm?
thoracic aorta involves widening of proximal aorta and the aortic root, which leads to this condition
153
aneurysm can occur in what parts of the legs?
in the deep vessels (for instance popliteal vessels of knee)
154
what are risk factors associated with aneurysms development?
```
diabetes
obesity
hypertension
tabacco use
alcoholism
copper deficiency
Adult Polycystic Kidney Disease
Family History
```
155
********stopped at slide 33 in Cardiology 3
****need to look up EKG chart reading - study repolarization and depolarization, etc....
