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Systems Path I Final > Chapter 10: The Heart (Part 2) > Flashcards

Chapter 10: The Heart (Part 2) Flashcards

1
Q

What is the cause of cardiac syndromes?

A

significant reduction in cardiac blood supply (occlusion of the coronary arteries)

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2
Q

What are the four types of cardiac syndromes?

A

1) Angina Pectoris
2) Acute Myocardial Infarction
3) Sudden Cardiac Death
4) Chronic IHD

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3
Q

True or False: Cellular Death is present in all four types of cardiac Syndromes.

A

False; not present in angina pectoris

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4
Q

What are the three causes of coronary atherosclerosis?

A

1) Inflammation
2) Thrombosis
3) Vasoconstriction

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5
Q

What can cause inflammation of the coronary vessels?

A

Atherosclerosis and vulnerable plaques

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6
Q

What are the risks for vasconstriction of the coronary arteries?

A

Increased SNS, inflammation, endothelial dysfunction

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7
Q

What is angina pectoris?

A

Pain from myocardial ischemia

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8
Q

What causes angina pectoris?

A

Critical stenosis ( greater than or equal to 70% occlusion)

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9
Q

Where is the pain usually located in angina pectoris?

A

sub-sternal pain: jaw, left arm, back, and shoulders

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10
Q

What are the three types of angina pectoris?

A

Stable, Variant, and Unstable

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11
Q

What is the frequency of stable angina?

A

episodie and exertional

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12
Q

How is stable angina managed?

A

Relieved with rest and vasodilators

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13
Q

When can variant angina occur?

A

vasospasms at rest

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14
Q

How is variant angina managed?

A

responds to vasodilators

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15
Q

What are the major symptoms of unstable angina?

A

Increased intensity, frequency and duration; provoked by less exertion

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16
Q

What percentage of occlusion must be present to have an onset of unstable angina?

A

90% occlusion

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17
Q

What two possible events could precede an unstable angina?

A

acute plaque disruption or thromboembolism

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18
Q

Is angina pectoris in females the same as in males?

A

No, less predictable features

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19
Q

What are some of the more unique features in angina pectoris in females?

A

many have no angina
frequent nausea, dizziness, back pain
discomfort or pressure in lower chest or epigastric regions
will have dyspnea and fatigue

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20
Q

How many myocaridal infarctions are lethal?

A

Only 1/3

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21
Q

What is the most common cause of myocardial infarctions?

A

coronary artery acute thrombosis

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22
Q

What occurs during a myocardial infarction?

A

Sudden loss of contractility leading to infarction

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23
Q

What are the risk factors for myocardial infarctions?

A

HTN, smoking, CHF, diabetes, males, ages 40-60, postmenopausal females, sickle cell disease, amyloidosis

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24
Q

Match the coronary artery to the percentage of MI cases seen:

1) Left Anterior Descending Coronary Artery
2) Right Coronary Artery
3) Left Circumflex Artery

A)30-40%
B)40-50%
C) 15-20%

A

1) B
2) A
3) C

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25
Q

Two hours after a myocardial infarction, the zone of necrosis is seen in the:

A

subendocardial zone

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26
Q

24 hrs after a myocardial infarction, the zone of necrosis is seen almost in every layer of the heart, this is known as:

A

transmural infarct

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27
Q

How quickly does loss of contraction occur during a myocardial infarction?

A

1-2 mins

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28
Q

How quickly does necrosis occur during a myocardial infarction?

A

20-40 mins

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29
Q

Inflammation during a myocardial infarction can induce:

A

arrhytmias

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30
Q

In order to cause reperfusion of the heart tissue, what artificial techniques can be used?

A

thrombolytic meds, angioplasty, stent, bypass

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31
Q

What chain of events can reperfusion cause that ultimately leads to a temporarily “stunned” myocardium?

A

Ischemic Reperfusion injury -> Increased ROS -> endothelial swelling -> blocked capillaries

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32
Q

What mechanical device may be needed for a few days to assist after an Ischemic Reperfusion Injury?

A

Ventricular Assist Device

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33
Q

What are the signs and symptoms of a myocardial infarction:

A 
the following lasting anywhere from minutes to hours:
- "Crushing pain"
-Intense "pressure"
in the neck, jaw, epigastrium, left arm
-unrelieved by nitroglyerine
-pulse is rapid and weak
-dyspnea, nausea, sweaty
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34
Q

What percentage of myocardial infarctions are lethal in community? in hosptials?

A 
Community = 30%
Hospital= 7%
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35
Q

What percentage of myocardial infarctions are small and “silent”?

A

15%

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36
Q

Which cardiac marker is the most significant in diagnosing myocardial infarctions?

A

Troponin I

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37
Q

What condition is seen with progressive heart failure usually following injuries such as CAD, CHF, and past MI?

A

Chronic Ischemic Heart Disease

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38
Q

What happens to the myocardium during chronic ischemic heart disease?

A

viable myocardium is overworked because the compensatory mechanisms begin to fail

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39
Q

Chronic Ischemic Heart Disease can cause contractile dysfunction which could lead to heart conditions such as?

A

Arrhythmia, CHF, and cardiogenic shock

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40
Q

What is the prognosis for chronic ischemic heart disease?

A

poor, lead to 2nd MI, arrhthmia, and CHF

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41
Q

What is sudden cardiac death?

A

when someone has a sustained arrhythmia that leads to death. is sudden or unexpected because there are no symptoms in previous 24 hours

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42
Q

What are the two types of sudden cardiac death? Which is the most common?

A

1) Asystole

2) Ventricular fibrillation (MC)

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43
Q

What is the most common cause of sudden cardiac death?

A

ischemic injury

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44
Q

What type of defibrillators improve the progonosis of sudden cardiac death?

A

AED and ICD

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45
Q

What is commotio cordis?

A

An emerging disease where precordial trauma disrupts rhythm of the heart. This arrhthmia can lead to sudden cardiac death.

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46
Q

What is unique about the heart structure with commotio cordis?

A

no structural damage heart disease

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47
Q

What age group is at most risk for commotio cordis?

A

adolescent males, avg age 15 years old, have underdeveloped chests.

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48
Q

What is the treatment for commotio cordis?

A

AED

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49
Q

What is the prognosis for commotio cordi?

A

poor prognosis

Most cases 65% lethal

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50
Q

What is the cause of hypertensive heart disease?

A

high blood pressure overloads the heart

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51
Q

What can occur as a result of hypertensive heart disease?

A

concentric hypertrophy and later on possible dilation

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52
Q

What causes the high blood pressure to overload the heart?

A

increase in metabolic demands, but no increase in blood supply to help compensate

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53
Q

How does hypertensive heart disease cause cardiac decompensation?

A

eventual loss of contractility

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54
Q

What are the two types of hypertensive heart disease?

A

1) Systemic Hypertensive Heart Disease

2) Pulmonary Hypertensive Heart Disease

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55
Q

Systemic Hypertensive Heart Disease causes what sided heart disease?

A

left-sided heart disease

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56
Q

What are the major indicators for left-sided heart disease in Systemic hypertensive heart disease?

A

1) history/current HTN

2) left ventricular hypertrophy (increase in myocyte diameter, increase fibrosis)

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57
Q

What complications can arise from Systemic Hypertensive Heart Disease?

A

1) CHF
2) Arrhythmia
3) Stroke
4) Renal Failure

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58
Q

What can be done to decrease risk of systemic hypertensive heart disease?

A

BP management, even reversible if HTN is managed early

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59
Q

Pulmonary Hypertensive heart disease causes which sided heart disease?

A

Right-sided heart disease

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60
Q

What causes right-sided heart failure?

A

lung pathologies such as CF, COPD, PE, pulmonary fibrosis, pulmonary HTN, and the hypertrophy and dilation of rt. ventricle

61
Q

What can cause acute pulmonary hypertensive heart disease?

A

large PE which occludes >505 of pulmonary artery

62
Q

What can cause chronic pulmonary hypertensive heart disease?

A

prolonged lung pathologies which leads to gradual rt-sided hypertrophy

63
Q

What are Life’s Simple 7 ways to prevent heart disease? (probably NT)

A
  1. Keep low blood pressure
  2. control cholesterol
  3. keep low blood sugar
  4. be active
  5. eat a heart-healthy diet
  6. lose weight/maintain a healthy body weight
  7. don’t smoke
64
Q

What is valvular stenosis?

A

narrowing, failure to completely open

65
Q

Stenosis can be causes by which conditions?

A

dystrophic calcification, fibrosis

66
Q

What is ‘insufficiency’?

A

failure to appropriately close

67
Q

What are the two main types of insufficiencies related to the heart?

A

A. Valvular destruction

B. Abnormal supportive structures

68
Q

True or False: A murmur is a turbulent, palpable vibration.

A

False, that is a thrill.

A murmur is just turbulent flow through a diseased valve.

69
Q

What is the most common cause of aortic valve stenosis?

A

Calcific Aortic Stenosis

70
Q

What are the early signs and symptoms of Calcific Aortic Stenosis?

A

Asymptomatic, possible murmur or decreased cardiac output

71
Q

What are the later signs and symptoms of Calcific Aortic Stenosis?

A

left ventricular hypertrophy, Ca++ -> severe stenosis

72
Q

What demographic is calcific aortic stenosis most commonly seen?

A

among older adults due to wear and tear, avg age= 60-80 years old

73
Q

What are some risk factors for calcific aortic stenosis?

A

HTN, inflammation, increased cholesterols

Bicsuspid aortic valve can make you have earlier presentations (40-50 vs 60 to 80)

74
Q

True or False: Calcific Aortic Stenosis happens on the outflow side and fusion of the valves is rare.

75
Q

In what cardiac condition is fusion of the valves common?

A

Rheumatic Valvular Disease

76
Q

What bacterial infection can cause rheumatic valvular disease?

A

Group A beta-hemolytic strep. infection

77
Q

3% of untreated strep. throats can lead to what condition?

A

Rheumatic Fever

78
Q

Which symptom from the Jone’s Criteria is common in children with Rheumatic Fever?

A

Carditis (50% of all RF patients)

79
Q

Which symptom from the Jone’s Criteria is common in adults with Rheumatic Fever?

A

migratory polyarthritis

80
Q

What is the Jones Criteria for Rheumatic Fever?

A 
J= Joints (polyarthritis)
O= Carditis .....ooookkkkk
N= Nodules
E= Erythema Marginatum
S= Sydenham chorea
81
Q

70% of Rheumatic Valvular Diseases effect which valve of the heart?

82
Q

25% of Rheumatic Valvular Diseases effect which valve of the heart?

83
Q

What unique feature will be present on acute features of Rheumatic Heart Disease?

A

Aschoff Bodies

84
Q

What is the characteristic look of the valves seen in rheumatic mitral stenosis?

A

fish-mouth or button-hole appearance

85
Q

Scarlet fever is caused by strains of GABHS that produce:

A

erythrogenic toxins

86
Q

How soon does scarlet fever develop and what demograph is most commonly affected?

A

1-4 days after strep. throat

children

87
Q

What type of skin rash is present on patients with scarlet fever?

A

pink punctate skin rash, multiple spots, sandpaper-like texture

88
Q

Where are some of the locations that a pink punctate skin rash would be present?

A

neck, chest, axillae, groin, thighs

89
Q

If a patient with rheumatic fever has pink punctate on their face this is known as:

A

circumoral pallor

90
Q

What serious condition could scarlet fever develop in to?

A

Rheumatic Fever

91
Q

What is infective Endocarditis?

A

Infection of the interior heart chambers/valves

92
Q

What is the most common cause of infective endocarditis?

93
Q

What are the signs and symptoms of infective endocarditis?

A

flu-like: fever, chills, fatigue, weight-loss

Can result in a lethal arrhythmia or renal failure

94
Q

What are the bulky and friable growths, possible thrombi seen in Infective Endocarditis patients called?

A

vegetations

95
Q

Are murmurs possible in patients with infective endocarditis?

96
Q

What are the key features of Acute Infective Endocarditis?

A

destructive, virulent, difficult to treat

Normal tissue, caused by S. Aureus

97
Q

What are the key features of Subacute Infective Endocarditis?

A

low virulence, easy to treat

Abnormal tissue, caused by S. viridans

98
Q

Which valves are most commonly infected in Infective Endocarditis?

A

left-sided heart valves: Aortic and Mitral

99
Q

What is the prognosis for infective endocarditis if left untreated?

100
Q

Is the prognosis for infective endocarditis worse or better for patients with prosthetic valves?

101
Q

What is the most common type of prosthetic cardiac valve?

A

mechanical

102
Q

What are some of the features of a mechanical prosthetic cardiac valve?

A

tilting disk, durable, long-term anticoagulation,

thrombosis and hemolysis= “blender effect”

103
Q

What are some of the features of a bioprosthetic cardiac valve?

A
  • made from pigs, cows or humans
  • no anticoagulation
  • ECM deteriorates leading to calcification leading to stenosis
104
Q

What percent of prosthethic cardiac valves lead to infective endocarditis cases?

105
Q

Define Cardiomyopathy:

A

heart+muscle+ disease = myocardial abnormality

106
Q

What causes primary cardiomyopathies?

A

disorder of myocardium

107
Q

What causes secondary cardiomyopathies?

A

systemic disorders such as muscular dystrophy

108
Q

What are the three pathophysiological groups of cardiomyopathies?

A

Dilated, Hypertrophic, Restrictive

109
Q

Which is the most common type of cardiomyopathy, causing 90% of all cardiomyopathies?

A

Dilated Cardiomyopathy

110
Q

What occurs to the chambers of the heart during dilated cardiomyopathies?

A

progressive dilation of all chambers

111
Q

What type of dysfunction is seen in dilated cardiomyopathies?

A

Systolic dysfunction leading to dyspnea and fatigue

112
Q

What are the risks for dilated cardiomyopathy?

A

Genetic, viral infections, toxins, hemocromatosis, decreased thiamine

113
Q

What are the two types of genetic conditions that could lead to dilated cardiomyopathy?

A

Becker and Duchenne M.D.

114
Q

What can cause hypertrophic cardiomyopathy?

A

result of genetic mutations, MC Beta- myosin

115
Q

What happens to the sarcomeres in hyerptrophic cardiomyopathy?

A

they become hyper-contractile, won’t relax leading to diastolic dysfunction

116
Q

Which chamber of the heart becomes massively hypertrophic in hypertrophic cardiomyopathy?

A

Lt. Ventricle (decreased cardiac output)

25% have a left ventricular outflow obstruction

117
Q

What is the characteristic sign of hypertrophic cardiomyopathy where the heart walls are very thick?

A

Asymmetrical Septal Hypertrophy

ventricular septum is larger than outer wall

118
Q

What cardiomyopathy causes 1/3 of sudden cardiac deaths in adolescent athletes?

A

hypertrophic cardiomyopathy

119
Q

What is the least common type of cardiomyopathy?

A

restrictive cardiomyopathy

120
Q

Interstitial fibrosis of the heart can cause what type of dysfunction in restrictive cardiomyopathies?

A

diastolic dysfunction( decreased filling)

121
Q

Who is most likely at risk for having a restrictive cardiomyopathy?

A

African Americans (4x)

122
Q

What happens during endomyocardial fibrosis and who is most likely to be impacted?

A

fibrosis of the ventricular endocardium

pediatrics/young adults in Africa due to malnutrition and helminth infxn.

123
Q

What are the causes for restrictive cardiomyopathy?

A

Amyloidosis
Endomyocardial fibrosis
chest irradiation
idiopathic

124
Q

What is myocarditis?

A

heart-wall inflammation

125
Q

What are the causes of myocarditis and which is most common?

A

Viral (MC)

Non-viral

126
Q

What are some of the examples of viral causes of myocarditis?

A

coxsackievirus A & B, HIV, CMV, influenza

127
Q

What are the some of the non-viral causes of myocarditis?

A

SLE, Chagas disease, Lyme disease, toxoplasmosis

128
Q

What is the presentation of cardiac tissue in myocarditis?

A

swollen, may be dilated, flabby, pale, possible hemorrhage or thrombus

129
Q

What are the signs and symptoms of myocarditis?

A

can be asymptomatic, or have pain, fever

130
Q

What are some of the possible complications that can arise from myocarditis?

A

dyspnea, arrhythmia/SCD, CHF

131
Q

What is pericarditis?

A

pericardial inflammation (fibrinous inflammation)

132
Q

What is the primary cause of pericarditis?

A

infection: viral (MC), bacterial fungal

133
Q

What are possible secondary causes of pericarditis?

A

MI, surgery, irradiation, rheumatic fever, SLE, CA

134
Q

What is unique about the presentation of pericarditis?

A

“atypical chest pain” and friction rub

If mild, may self-resolve or could lead to life-threatening complications

135
Q

Pericarditis can lead to what two conditions?

A

A. Cardiac Tamponade

B. Constrictive Pericarditis due to dense fibrosis

136
Q

What is the Beck’s Triad and what is it used to diagnose?

A

Beck’s Triad

  1. Low BP
  2. JVD
  3. Muffled Heart Sounds

Diagnose: cardiac tamponade (pericarditis)

137
Q

When auscultating the heart in pericarditis patients, the friction rub creates what unique sound?

A

squeaky leather

138
Q

What is the most common site of cardiac cancer metastasis?

139
Q

True or False: Primary Cardiac tumors are fairly common

A

False, they are rare

140
Q

What is the most common malignant cardiac neoplasm?

A

angiosarcoma

141
Q

What percentage of cardiac tumors are benign?

142
Q

What are the possible cardiac tumors in adults?

A

myxoma (MC), fibroma or lipoma

143
Q

What are the possible cardiac tumors in pediatrics?

A

rhabdomyoma

144
Q

What is the most common primary cardiac neoplasm in adults?

145
Q

Where are myxomas located 90% of the time?

A

near the fossa ovalis of the left atrium

146
Q

Why is myxoma like a ‘wrecking ball’?

A

It is mobile and can damage valves

147
Q

What occurs in a transplant rejection?

A

fever and T cell attack

decreased output, possible arrhythmia

148
Q

What occurs during an allograft arteriopathy?

A

stenosis of coronary arteries
long term limitation
lethal via silent MI, CHF< arrhythmia

Systems Path I Final (4 decks)

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