Cardiology: 8.1c: Sudden Cardiac Death/Chronic Ischemia

Question 1

What is chronic ischemic heart disease?

Answer 1

progressively worsening, poot myocardial function due to chronic ischemic damage (w or wo infarction)

Question 2

What causes mitral valve prolapse?

Answer 2

myxoid degeneration (accumulation of ground substance) of the valve –> valve becomes floppy

Question 3

What increases the intensity of the mumur heard in mitral valve prolapse? Why/how?

Answer 3

• squatting
• increases systemic resistance –> decreases left ventricular emptying

Question 4

Describe the murmur associated with mitral valve prolapse. Where is it heard best?

Answer 4

• late systolic crescendo murmur
• mid-systolic click
• heard best over the apex

Question 5

Name the causes of mitral regurg.

Answer 5

• most common:
  
  • mitral valve prolapse
• other causes:
  
  • dilatation (e.g., left-sided cardiac failure)
  • infective endocarditis
  • acute rheumatic heart disease
  • papillary muscle rupture post-MI

Question 6

What is the most common organism that will infect the damaged mitral valves to cause endocarditis?

Answer 6

• strep viridans

Question 7

What is myxoid degeneration?

Answer 7

accumulation of ground substance

Question 8

What are some complications of mitral valve prolapse?

Answer 8

• endocarditis
• arrhythmia –> death
• severe mitral regurgitation

Question 9

Myxomatous degeneration refers to _______.

Answer 9

a pathological weakening of connective tissue

Question 10

Why is there a click in the mitral valve prolapse murmur?

Answer 10

sudden tensing of the chordae tendinae

Question 11

What is mitral valve prolapse?

Answer 11

Ballooning of the mitral valve into the left atrium during systole

Question 12

In what diseases/syndromes is mitral valve prolapse common?

Answer 12

• Marfans
• Ehlers-Danlos
• Fragile X
• AD PKD
• congenital heart murmur

Question 13

What are some complications of mitral valve prolapse?

Answer 13

volume overload –> left-sided heart failure

Question 14

What is the tx for mitral valve prolapse?

Answer 14

valve replacement

Question 15

What is sudden cardiac death?

Answer 15

• Unexpected death due to cardiac disease
• occurs with or without symptoms
• death wi 1 hour of symptom onset

Question 16

What are the s/s of mitral valve prolapse?

Answer 16

• usu asymptomatic
• incidental finding of a mid-systolic click followed by a regurgitation murmur

Question 17

What is the underlying pathology in sudden cardiac death?

Answer 17

• most common:
  
  • acute ischemia;
    
    • 90% of patients have preexisting severe atherosclerosis
• other causes:
  
  • mitral valve prolapse
  • cardiomyopathy (hypertrophic, dilated)
  • hereditary ion channelopathies (ex: long QT syndrome)
  • cocaine abuse (vasospasm)

Question 18

What is the most common cause of sudden cardiac death?

Answer 18

fatal ventricular arrhythmia (ex: v-fib)

Question 19

What does chronic ischemic heart disease progress to?

Answer 19

congestive heart failure (CHF)

Question 20

Describe the murmur in mitral valve regurg. Where is it heard best? Does t radiate? What increases it?

Answer 20

• Holosystolic “blowing” murmur
• loudest @ apex
• radiates towards axilla
• increased by squatting, hand grip (increased total peripheral resistance), expiration