Cardiovascular

Question 1

What valve has only 2 leaflets?

Answer 1

Mitral valve

Question 2

3 layers of the heart wall

Answer 2

Epicardium: outer layer next to pericardial fluid
Myocardium: muscular part
Endocardium: next to blood

Question 3

3 layers of blood vessels

Answer 3

Adventitia: connection between blood vessels and connective tissue (outer layer)
Media: contractile and smooth muscle
Endothelium: inner layer

Question 4

Arteries versus veins for pressure, flow and walls

Answer 4

Veins have lower pressure, non-pulsatile flow, and thinner walls
Also have valves and bigger lumen

Question 5

What is a congenital heart disease

Answer 5

Defects involving heart or large arteries and veins that are present at birth

Question 6

3 general causes of congenital heart disease

Answer 6

1. Heart developed and functional by 10th week of gestation (primitive tube that septates, twists, and segments)
2. Endogenous causes (chromosomal)
3. Exogenous causes (infections or toxins)

Question 7

Atrial septal defect

and clinical presentations

Answer 7

Atrial septum is improperly closed
Various types
Clinical presentations: murmur, paradoxical emboli, infection, arrhythmia
Usually of minor consequence

Question 8

Ventricular septal defect

and clinical presentations

Answer 8

Ventricular septum improperly closed
Various types
Clinical presentation: murmur, pulmonary hypertension, infection, cyanosis (late)
Spontaneous or surgical closure

Question 9

Complex defects

Answer 9

Multiple anatomical abnormalities

Several types

Question 10

Which disease has early versus late cyanosis

Answer 10

Late: ventricular septal defect
Early: Tetralogy of Fallot

Question 11

Tetralogy of Fallot

Answer 11

10% of CHD
Clinical presentations: cyanosis (early), murmur, failure to thrive, infection
Requires surgical repair

Question 12

4 problems in tetralogy of Fallot

Answer 12

1. Overriding aorta
2. Pulmonary stenosis
3. Ventricular septal defect
4. Right ventricle hypertrophy

Question 13

Is atherosclerosis systemic or localized?

Answer 13

Systemic arterial disease

Usually involves multiple vascular territories so it is generalized

Question 14

What hormone is protective against atherosclerosis?

Answer 14

Estrogen

Question 15

What initiated atherosclerosis? (and 2 examples)

Answer 15

Initiated by endothelial injury

Ex: Physical (hypertension) or metabolic (diabetes, obesity)

Question 16

Athero versus Sclero

Answer 16

Sclero is hard: collagen and calcified material

Athero is soft: lipids and necrotic debris

Question 17

4 Modifiable risk factors

Answer 17

Dyslipidemia
Hypertension
Diabetes mellitus
Smoking

Question 18

3 Not modifiable factors

Answer 18

Age
Sex
Family history

Question 19

2 Protective factors

Answer 19

Exercise

Estrogen

Question 20

Aortic dissection

Answer 20

Blood tunnels between aortic layers
Can appear as aneurysm
Unrelated to atherosclerosis

Question 21

3 Aneurysm complications

Answer 21

Rupture
Thrombosis
Mass effect (impinges on other structures, like a tumor)

Question 22

Claudication

Answer 22

Cramping in the legs when exercising, caused by obstruction of the arteries
Can only walk a very little bit before they get tired and have pain in their legs/feet/butt

Question 23

4 presentations of ischemic heart disease

Answer 23

Angina pectoris
Acute myocardial infarction
Congestive heart failure
Sudden death

Question 24

At what percentage of stenosis do you start to get major problems?

Answer 24

Over 50%
Then can get ischemic heart disease
Under 50% and the arteries can dilate enough that the lumen stays the same diameter

Question 25

How can you date a myocardial infarction?

Answer 25

``` Its irreversible injury from ischemia too long, so can date ischemic myocyte death 1-4 days: cell death, neutrophils 4-5 days: macrophages 1-2 weeks: granulation tissue >2 weeks: scar formation ```

Question 26

5 outcomes after ischemic heart disease

Answer 26

``` Thrombus Rupture of heart wall Aneurysm Congestive heart failure Death ```

Question 27

2 things you can look for as serologic evidence of myocyte death

Answer 27

Troponin I/T Creatinine kinase-MB (levels of both increase)

Question 28

What is infective endocarditis?

Answer 28

Infection of endocardial surfaces | Most often valvular

Question 29

4 predisposing factors to infective endocarditis

Answer 29

Structural diseases Skin or mucosal breaks (portals of entry) Immunosuppression Intracardiac devices and prostheses

Question 30

What are the 3 main bacteria that cause infective endocarditis?

Answer 30

Staph Strep Enterococcus

Question 31

What are the 2 main fungi that cause infective endocarditis

Answer 31

Candida | Aspergillus

Question 32

Acute bacterial endocarditis

Answer 32

Febrile illness of sudden onset

Question 33

Subacute bacterial endocarditis

Answer 33

A lingering weakness accompanied by mild temperature elevations that wax and wane over a prolonged period

Question 34

Normal arterial blood pressure

Answer 34

120 (systolic) over 80 (distolic) | Measuring the left ventricle pressure

Question 35

2 vasoactive substances

Answer 35

Epinephrine | Norepinephrine

Question 36

What factor does contractility increase?

Answer 36

Stroke volume

Question 37

What pressure is considered hypertension

Answer 37

140 over 90 or higher | Only need to have one

Question 38

Essential disease

Answer 38

Same as primary | Dont know what the cause it

Question 39

Aortic coarctation

Answer 39

Narrowing of the lower descending aorta Correctabe with surgery BP in legs will be much lower than in the arms

Question 40

Cardiomegaly

Answer 40

Increase in heart weight Reflects LV myocyte hypertrophy (increase in size) Accompanied by interstitial fibrosis (stiff LV) Takes many years to develop Causes increased metabolic demands of the heart and leads to heart failure

Question 41

Pressure hypertrophy versus volume hypertrophy

Answer 41

Pressure: increase in the ventricular thickness, narrowing of the lumen, new sarcomeres assemble in parallel Volume: thickness stays the same but there is a lot of dilation going on, new sarcomeres assemble in series

Question 42

Benign hypertension

Answer 42

Causes hyalinization of the arterioles and fibrosis of the wall of small arteries

Question 43

Malignant hypertension

Answer 43

Sudden onset Systolic pressure over 200, and diastolic over 100 May cause fibrinoid necrosis of these vessels and concentric proliferation of smooth muscles in arterioles (proliferative endarteriolitis)

Question 44

Proliferative endarteriolitis

Answer 44

In malignant hypertension | May cause fibrinoid necrosis of these vessels and concentric proliferation of smooth muscles in arterioles

Question 45

Hypertensive encephalopathy

Answer 45

Refers to the vascular changes in the brain that usually cause acute or chronic cerebral ischemia

Question 46

Hypertensive retinopathy

Answer 46

Retinal changes that can impair vision and can eventually cause blindness

Question 47

Cardiomyopathy

Answer 47

A heterogenous group of diseases of the myocardium Mechanical and/or electrical dysfunction Inappropriate ventricular hypertrophy or dilatation Due to a variety of causes that frequently are genetic Exclude ischemic, hypertensive, valvular and congenital forms of heart disease Incurable - need heart transplant

Question 48

Dilated cardiomyopathy | and complications

Answer 48

Ventricles are markedly dilated and the heart appears to have a myocardium that is either flabby or thinned and has been partially replaced by fibrous tissue Systolic dysfunction and arrhythmia No obvious causes Complications: congestive heart failure, mural thrombus, sudden death

Question 49

Hypertrophic cardiomyopathy

Answer 49

Extensive thickening of the left ventricular myocardium Runs in families - autosomal dominant (66% familial, 33% sporadic) #1 cause of sudden death in young athletes Diastolic dysfunction and arrhythmis Mostly effects sarcomeric proteins

Question 50

Restrictive cardiomyopathy

Answer 50

Inability of the heart to expand adequately during diastole nor contract forcefully enough during systole Often occurs because the myocardium is infiltrated with some abnormal material like amyloid Diastolic dysfunction

Question 51

Arrhythmogenic cardiomyopathy

Answer 51

Common cause of sudden death in young athletes Arrhythmia and systolic dysfunction 100% genetic (familial and sporadic are 50% each) Mostly cell adhesion proteins Fibrofatty myocardial replacement, frequently only RV involved