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SP16- Gen Path Exam 1 > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

1
Q

What is congestive heart failure?

A

failure to pump an adequate amount of blood to supply the metabolic requirements of the organs

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2
Q

True or False: Congestive Heart failure may be due to pathologic conditions related to the heart or due to peripheral problems.

A

True

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3
Q

In most cases of congestive heart failure, what is the problem?

A

the heart cannot keep pace with the metabolic demands of the tissues

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4
Q

What are the compensatory mechanisms of congestive heart failure?

A
  1. Activation of neurohumoral systems (Norepi, Epi, Renin-angiotensin)
  2. Frank-Starling mechanism (increased EDV stretching)
  3. Myocardial hypertrophy
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5
Q

Describe the Frank-Starling Mechanism.

A

increased EDV stretches the cardiac muscle fibers

  • AT FIRST…the fibers contract more forcefully and increase cardiac output (compensated heart failure)
  • EVENTUALLY… the fibers cannot keep up, they hypertrophy, stack on top of each other, and give up (decompensated heart failure)
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6
Q

What is myocardial hypertrophy?

A

increase in muscle fiber SIZE = increased thickness of ventricular wall WITHOUT an increase in the size of the lumen

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7
Q

Why do compensatory mechanisms usually fail?

A

due to increased oxygen requirements of myocardium without increased capillary supply (susceptibility to ischemia)

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8
Q

What are the causes of left-side heart failure?

A
  • ischemic heart disease
  • hypertension
  • myocarditis
  • cardiomyopathy
  • valvular disease
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9
Q

What are the causes of right-side heart failure?

A
  • LEFT SIDED HEART FAILURE (pulmonary congestion leads to increased pulmonary arterial pressure)
  • Pulmonary Hypertension
  • Valve Disease
  • Septal Defects with left-to-right shunts
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10
Q

Pulmonary edema and congestion, orthopnea (trouble breathing while lying down), and/or chronic cough are signs for _______ ________ failure.

A

left ventricular

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11
Q

True or False: Cerebral hypoxia is a manifestation for right ventricular failure only.

A

False: left OR right ventricular failure

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12
Q

How might a “Right Ventricular Failure” manifest in the liver?

A

Congestion of the liver (or spleen) would results in a “nutmeg liver”

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13
Q

Edema (pitting) of subcutaneous tissues in lower extremities would be potential manifestation of _______ _______ failure.

A

right ventricular

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14
Q

How do right and left ventricular failures differ in their manifestation of edema?

A

Right–> LOWER extremity pitting
Left –> PULMONARY

left = lungs, right = run

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15
Q

In a picture of a “nutmeg” liver, which hepatocytes are vital? (bright red or orange)

A

orange

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16
Q

Compression of subcutaneous tissue that remains indented is a clinical presentation of edema, also known as ______. If its in the ankle, which side of the heart was affected?

A

pitting
right

remember, Run (legs) = Right Ventricular

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17
Q

True or False: Congenital Heart Disease is very common in the US.

A

False: only ~6 per 1,000 live births

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18
Q

______ % of congenital heart diseases are of unknown cause.

A

90

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19
Q

What are the two forms of Congenital Heart Disease?

A

cyanotic (blue)

non-cyanotic (pink)

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20
Q

What are two possible causes of Congenital Heart Disease?

A
  1. Environmental Factors (i.e. maternal diabetes, rubella, etc)
  2. Chromosomal Abnormalities
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21
Q

Congenital Heart Disease patients may have ______ connections, _____, or _______ connections.

A
  • absence of normal
  • shunts
  • abnormal
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22
Q

True or False: ASD is the most common form of Noncyanotic Congenital Heart Disease.

A

False, MOST surgeries are due to ASD but VSD is the most common!

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23
Q

True or False: Surgery of VSD is extremely common.

A

False, most VSD will resolve spontaneously even though it is the MOST COMMON congenital heart defect from birth

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24
Q

ASD and VSD are of what form of Congenital Heart Disease?

A

Non-cyanotic

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25
Q

What does the Ductus Arteriosus connect?

A

Aorta

Pulmonary Artery

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26
Q

When should the Ductus Arteriosus close? What happens if it doesn’t?

A

should close within a few days of birth

if NOT = VSD

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27
Q

What does VSD stand for?

A

Ventricular Septal Defect

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28
Q

What does ASD stand for?

A

Atrial Septal Defect

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29
Q

What causes ASD?

A

failure to close the Foramen Ovale = mixing of blood between the two atria

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30
Q

What are the two CYANOTIC forms of Congenital Heart Disease?

A
  • Tetralogy of Fallot
  • Transposition of the Great Arteries

(the “T” diseases look Turquoise)

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31
Q

What are the 4 anomalies associated with the Tetralogy of Fallot?

A
  1. Ventricular Septal Defect (ASD)
  2. Narrowed Right Ventricular Outflow to Pulmonary
  3. Overriding aorta
  4. Right Ventricular Hypertrophy
"IHOP"
Interventricular septal defect
Hypertrophy of right ventricle
Overriding aorta
Pulmonary stenosis
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32
Q

If there is a “transposition of the great arteries” where do the ventricles drain? What does this mean for the baby?

A

Right–> into the aorta (should drain into Pulmonary)
Left –> into Pulmonary (should drain into the aorta)

there is a shortage of oxygen flowing from the heart to the rest of the body and it cannot function

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33
Q

If the right ventricle pumps into the aorta, what kind of blood is being pumped out to the body?

A

De-oxygenated blood enters circulation…bad news

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34
Q

______ of the fingers or toes is often associated with a heart or lung disease that limits the amount of oxygen reaching the body.

A

Clubbing

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35
Q

What is Ischemic Heart Disease?

A

a group of related disorders that are all characterized by imbalance between myocardial blood supply and myocardial oxygen demand (ischemia)…DEMANDS ARE NOT BEING MET FOR THE HEART AND, THEREFORE, ANYWHERE ELSE!

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36
Q

90% of Ischemic Heart Diseases (IHD) are due to ____ _______.

A

Coronary Artery Atherosclerosis (Coronary Artery Disease)

37
Q

What is the leading cause of death in the US (500,000 annually)?

A

Ischemia Heart Disease

38
Q

Atherosclerosis or Thrombosis of which artery is associated with Ischemic Heart Disease?

A

Coronary Artery

aka: the artery that supplies the heart muscles

39
Q

How much narrowing (atherosclerosis) must occur in order to cause IHD?

A

> 75%

40
Q

What are other contributing factors (other than thrombus or atherosclerosis) to Ischemic Heart Disease?

A
  • increased myocardial oxygen demand (Hypertension)
  • decreased blood volume (hypotension/Shock)
  • decreased oxygenation (Pneumonia)
  • decreased Oxygen-carrying capacity (Anemia)
(the heart is in bad SHAPe when these happen)
Shock
Hypertension
Anemia
Pneumonia
41
Q

What do streptokinase and TPA do when an embolism occludes an artery?

A

they try to break up the clot!

42
Q

Name the four discussed types of Ischemic Heart Disease.

A
  1. Angina Pectoris
  2. Myocardial Infarction
  3. Chronic IHD (ischemic) with CHF (congestive)
  4. Sudden Cardiac Death
43
Q

________: Intermittent chest pain caused by transient, reversible myocardial ischemia

A

angina pectoris

44
Q

What is “stable” angina?

A

chest pain that occurs predictably at certain levels of exertion

  • crushing/squeezing
  • substernal pain
  • pain down left arm or jaw
45
Q

Stable angina can be relieved by _____ or ______.

A 
rest
sublingual nitroglycerin (vasodilates to increase coronary perfusion)
46
Q

What is “unstable” angina?

A

chest pain that increases in frequency during little to no exertion

  • longer lasting than stable
  • precedes serious ischemia or MI
47
Q

_______: necrosis of cardiac muscle caused by ischemia.

A

Acute Myocardial Infarction (“heart attack”)

48
Q

What is the most common caused for heart attack?

A

an acute coronary artery thrombosis secondary to existing atherosclerosis

49
Q

Of the 1.5 million heart attacks in the US annually, how often are they fatal?

A

1/3 are fatal (aka: 33% of the time)

50
Q

Severe ischemia lasting longer than _______ will cause irreversible myocyte injury and cell death.

A

20-40 minutes

51
Q

Myocardial ischemia contributes to _______ due to electrical instability/irritability.

A

arrhythmias

52
Q

Arrhythmias may lead to __________.

A

ventricular fibrillation

53
Q

What are the clinical manifestations of ischemic heart disease?

A
  • chest pain
  • nausea/vomiting
  • diaphoresis (unusual sweating)
  • low grade fever
  • Shortness of Breath (SOB)
54
Q

A common test for heart disease is the _____.

A

ECG

55
Q

Chest Pain = Draw Blood…

Now, elevated levels of which serum proteins would indicate damaged cardiac myocytes?

A

Troponin T
Troponin I
CK-MB (Myocardial-Specific Isoform of Creatine Kinase)

“T.I.C.” (TIC-toc get to the doc)

56
Q

How long must you wait in order to see infarcted areas on an autopsy?

A

12-24 hours after MI; before that, they won’t be grossly apparent

57
Q

After an MI, you wait 12 hours to look at the autopsy…what color is the infarcted area?

A

reddish-blue

58
Q

Where does necrosis begin following coronary artery occlusion?

A

The “Zone of Perfusion”… the small area of myocardium beneath the endocardial surface in the center of the ischemic zone

59
Q

Why is the zone of perfusion at such high risk?

A

the region depends entirely on the occluded vessel for blood supply

60
Q

The zone of perfusion is at the ______.

A

apex

61
Q

What is the treatment for heart attacks?

A
  • placement of stents to open the coronary vessel affected by atherosclerosis
  • coronary artery by-pass grafts (CABG)
  • “clot busting drugs” (streptokinase)
62
Q

True or False: Treatment for MI may result in reperfusion injury.

A

True
(Timely reperfusion facilitates cardiomyocyte salvage and decreases cardiac morbidity and mortality. Reperfusion of an ischemic area MAY result, however, in paradoxical cardiomyocyte dysfunction: myocardial stunning, microvascular and endothelial injury, and irreversible cell damage or necrosis)

63
Q

True or False: Arrythmia, Shock, Mural Thrombus, and Mitral Valve Regurgitation are all complications associated with MI.

A

True

64
Q

What is Mural Thrombus?

A

(complication of MI)

-developing thrombus on the lining of the heart chamber that can lead to LEFT-side embolism

65
Q

What is Mitral Valve Regurgitation?

A

(complication of MI)

-backflow due to papillary muscle dysfunction

66
Q

______ rupture is a complication associated with MI.

A

myocardial

67
Q

Infarct expansion can/will often move to involve the _____ ventricle.

A

right

68
Q

A ________ is a complication that may occur after a heart attack. They usually arise from a patch of weakened tissue in a ventricular wall, which swells into a ______ filled with blood. This, in turn, may block the passageways leading out of the heart.

A

ventricular aneurysm

bubble (i.e.: the reason its termed an aneurysm)

69
Q

What is Chronic Ischemic Heart Disease?

A

progressive heart failure due to ischemic myocardial damage

-usually: history of MI

70
Q

What is the most common cause of “Sudden Cardiac Death?”

A

Ischemic Heart Disease (80-90%)

71
Q

What are some causes of Sudden Cardiac Death in young patients?

A
  • congenital coronary artery abnormalities
  • aortic valve stenosis
  • mitral valve prolapse
  • myocarditis
  • dilated or hypertrophic cardiomyopathy
  • pulmonary hypertension
  • myocardial hypertrophy
72
Q

_____: disease of the heart muscle

A

Cardiomyopathy

73
Q

What is the difference between primary and secondary cardiomyopathy?

A

Primary: confined to the heart muscle
Secondary: involves the myocardium as part of a systemic condition

74
Q

What are the three functional patterns of cardiomyopathy (in order of commonality)?

A
  1. Dilated (90% of cases)
  2. Hypertrophic
  3. Restrictive
75
Q

Of the three patterns of cardiomyopathy, two of them can be either primary or secondary. Which one can be Primary only?

A

Hypertrophic

(autosomal dominant inheritance pattern, point mutation)

“HAD 1” from birth….hypertrophic, autosomal dominant, primary

76
Q

True or False: Dilated Cardiomyopathy can be either genetic or acquired.

A

True

77
Q

True or False: Dilated Cardiomyopathy can only be of primary classification.

A

False: primary or secondary

78
Q

Genetic acquirement of “Dilated Cardiomyopathy” is related to _____, _______, and ______.

A

alcoholism
myocarditis (virus)
pregnancy

79
Q

How many chambers are affected by Dilated Cardiomyopathy?

A

all 4

80
Q

Describe the histological findings of Dilated vs. Hypertrophic Cardiomyopathy.

A

Hypertrophic: MYOCYTE DISARRAY with fibrosis, looks like a messy, water-color painting

Dilated: nonspecific with fibrosis and myocyte hypertrophy, looks “bubbly or fatty” due to large myocytes

81
Q

What kind of dysfunction occurs with hypertrophic cardiomyopathy? Where is the mutation that causes dysfunction?

A 
diastolic dysfunction (stiff ventricles prevent adequate filling)
-point mutation in a sarcomeric gene loci = ventricle muscles don't work well
82
Q

______ cardiomyopathy causes poor ventricular CONTRACTILITY; whereas, the other two cause diastolic dysfunction during filling.

A

Dilated

contractility (systolic) –> dilated
Hypertrophic and Restrictive –> filling up (diastole)

83
Q

Restrictive cardiomyopathy causes ventricular stiffness and can be ideopathic or ________.

A

secondary to systemic conditions that affected the myocardium

  • radiation fibrosis
  • amyloidosis
  • hemochromatosis
  • sarcoidosis
84
Q

What is myocarditis?

A

inflammation and damage of the heart muscle

85
Q

True or False: Pyogenic bacteria could cause abscesses and myocarditis.

A

True

86
Q

What is Coxsackie A and B Virus? Which heart disease is it related to?

A 
related to MYOCARDITIS
A =
-cause flaccid paralysis 
-generalized myositis
B = 
-spastic paralysis  
-focal muscle injury 
-degeneration of neuronal tissue
87
Q

Which parasite is common in South America and causes myocarditis after trypanosomes invade individual myocytes or interstitium?

A

Chagas

88
Q

True or False: Hypersensitivity to drugs cannot cause Myocarditis.

A

False; drug hypersensitivity can cause perivascular inflammation with eosinophils

SP16- Gen Path Exam 1 (10 decks)

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