Chapter 12- The Heart Flashcards
1
Q
What are syndromes of ischemic heart disease usually due to
A
Atherosclerosis of coronary
2
Q
What is the term for chest pain that arises with exertion or emotional stress (no pain at rest)
A
Stable angina
3
Q
What is the hallmark of stable angina
A
Cellular swelling
4
Q
What is the typical presentation of stable angina
A
Chest pain lasting less than 20 minutes that radiates to left arm or jaw; diaphoresis; SOB
5
Q
What is the EKG finding with stable angina
A
ST segment depression
6
Q
What is the term for chest pain that occurs at rest
A
Unstable angina
7
Q
What is unstable angina due to
A
Atherosclerotic plaque with thrombosis and incomplete occlusion of a coronary artery
8
Q
What is the EKG finding with unstable angina
A
ST segment depression
9
Q
What is prinzmetal angina due to
A
Coronary artery vasospasm
10
Q
What is the EKG finding with prinzmetal angina
A
ST segment elevation due to transmural ischemia
11
Q
What part of the heart does MI usually involve
A
Left ventricle (usually spares RV and both atria)
12
Q
Describe levels of troponin I
A
Rises 2-4 hrs after infarction; peaks at 24 hours and returns to normal in 7-10 days
13
Q
Describe levels of Ck-MB
A
Rises 4-6 hours after infarction; peaks at 24 hours; returns to normal by 72 hours
14
Q
What is happening less than 4 hours after an MI
A
Carcinogenic shock, CHF, arrhythmias
15
Q
What is happening 4-24 hours after infarction
A
Gross change (dark discoloration), micro change (coagulative necrosis), complication is arrhythmia
16
Q
What is happening 1-3 days after infarction
A
Gross change (yellow pallor), micro (neutrophils), complication is fibrinous pericarditis
17
Q
What is happening 4-7 days after infarction
A
Yellow pallor, macrophages
18
Q
What is happening 1-3 weeks after infarction
A
Red border; granulation tissue with plump fibroblasts, collagen and blood vessels
19
Q
What is sudden cardiac death usually due to
A
Fatal ventricular arrhythmia
20
Q
What is the most common etiology of sudden cardiac death
A
Acute ischemia
21
Q
What should you think of with heart failure cells
A
Left sided congestive heart failure
22
Q
What is heart failure cells
A
Iron build-ups in macrophages (hemosiderin)
23
Q
What is R sided heart failure usually due to
A
L-sided heart failure
24
Q
Is left or right sided heart failure associated with nutmeg liver
A
Right
25
What are clinical presentations of eisenmenger syndrome
Right ventricular hypertrophy, polycythemia, clubbing
26
What is the most common ASD
Ostium secundum
27
What is the ostium primum type of ASHD associated with
Down syndrome
28
What congenital infection is associated with PDA
Congenital rubella
29
What type of murmur is heard with PDA
Machine like
30
What should you think of with boot shaped heart
TOF
31
What are the features of TOF
Stenosis of RV outflow tract, RV hypertrophy, VSD, overriding aorta
32
What disorder is transposition of great vessels associated with
Maternal diabetes
33
What is the presentation of truncus arteriosus
Early cyanosis
34
What is infantile coarctation of aorta associated with
PDA
35
How does infantile coarctation of aorta present
Lower extremity cyanosis; associated with turners syndrome
36
Wher does the coarctation in adult form coarctation of aorta occur
Lies distal to aortic arch
37
What is the presentation of adult coarctation of aorta
HTN in upper extremity and hypotension with weak pulses in lower extremity
38
What are the jones characteristics associated with acute rheumatic fever
Joint (migratory polyarthritis), heart (pancarditis-shaped like an "o"), nodules (subcutaneous), erythema marginatum, sindenhemps (in muscle) corona
39
What should you think of with ashoff bodies
Pancarditis of acute rheumatic fever
40
What should you think of with anitchcall cells
Acute rheumatic fever
41
What valve is almost always involved in chronic rheumatic valvular disease
Mitral valve
42
What should you think of with fish mouth appearance of valves
Chronic rheumatic valvular disease
43
What is aortic stenosis usually due to
Fibrosis and calcification from wear and tear; presents in late adulthood (60yo+)
44
What murmur is associated with aortic stenosis
Systolic ejection click followed by a crescendo-decrescendo murmur
45
What is the term for backflow of blood from aorta into LV during diastole
Aortic regurgitation
46
What are some things that can cause aortic regurgitation
Aortic root dilation (syphilitic aneurysm) or valve damage (IE)
47
What is the clinical presentation of aortic regurgitation
Early blowing diastolic murmur
48
What is the clinical presentation of mitral valve prolapse
Mid-systolic click followed by regurgitation murmur; usually asymptomatic
49
What is the term for reflux of blood from LV into LA during systole
Mitral regurgitation
50
What is mitral regurgitation usually a complication of
Mitral valve prolapse
51
What type of murmur is heard with mitral regurgitation
Holosystolic blowing murmur
52
What does mitral regurgitation result in
Volume overload and left sided HF
53
What is the most common overall cause of infectious endocarditis
S. Viridans
54
What does S. viridans IE result in
Small vegetations that do NOT destroy valves
55
What is the most common cause of IE in IV drug users
S aureus
56
What does S aureus caused IE result in
Large vegetations that destroy valves
57
What is the major cause of IE in prosthetic valves
S. Epidermidis
58
What is the leading cause of IE in patients with underlying colorectal carcinoma
S. Bovis
59
What are some causes of endocarditis with negative blood cultures
Hemophilus, actinobacillus, Cardiobacterium, Eikenella, Kingella
60
Where do the vegetations appear with nonbacterial thrombotic endocarditis
Mitral valve along lines of closure
61
What is the term for sterile vegetations associated with SLE
Libyan-sacks endocarditis
62
What is the result of Libman sacks endocarditis
Mitral regurgitation
63
What is the most common form of cardiomyopathy
Dilated cardiomyopathy
64
What are some complications of dilated cardiomyopathy
Mitral and tricuspid regurgitation and arrhythmia
65
What drug is associated with dilated cardiomyopathy
Cocaine
66
What is mutated in hypertrophic cardiomyopathy
Sarcomeres proteins
67
What is common cause of sudden death in young athletes
Hypertrophic cardiomyopathy
68
What is found on biopsy of hypertrophic cardiomyopathy
Myofiber hypertrophy with disarray
69
When is filling restricted with restrictive cardiomyopathy
Restricts filling during systole
70
How does restrictive cardiomyopathy present
CHF
71
What is the classic finding on EKG with restrictive cardiomyopathy
Low voltage EKGs; diminished QRS amplitudes
72
What is the term for a cardiac tumor of benign mesenchymal proliferation with a gelatinous apperance
Myxoma
73
What is the most common primary cardiac tumor in adults
Myxoma
74
What is the presentation of myxoma
Pedunculated mass in LA (causes syncope due to obstruction of mitral valve)
75
What is the term for benign hamartoma of cardiac muscle
Rhabdomyoma
76
What is the most commmon primary cardiac tumor in kids
Rhabdomyoma
77
What cardiac tumor is assocated with tuberous sclerosis
Rhabdomyoma
78
What are some common metastasis to the Heart
Breast and lung carcinoma, melanoma, lymphoma
79
What is the collagenous ventricularis largely responsible for
Mechanical integrity of the valve
80
What is the pacemaker of the heart
SA node
81
What is systolic dysfunction
Progressive deterioration of myocardial contractile function
82
What is diastolic dysfunction
Inability of the chamber to expand and fill during diastole
83
How are the sarcomeres in pressure overload hypertrophy arranged
Concentric increase in wall thickness, sarcomeres in parallel
84
How are the sarcomeres arranged in volume over load hypertrophy
Sarcomeres in series
85
What are some major pathologic indications of pulmonary edema
Heart failure cells, Kerley B lines
86
What happens with systolic failure in left sided heart failure
Insufficient ejection fraction
87
What happens with diastolic failure in L-sided heart failure
LV is abnormally stiff and cannot relax during diastole (unable to increase output during exercise)
88
What transcription factors are important for the first heart field and what does the first heart field give rise to
TBX5, hand1; mainly LV
89
What transcription factors are involved in the second heart field and what does the second heart field give rise to
Hand2, FGF-10; outflow tract, RV, most of atria
90
What genes are involved in ASD or conduction defects
NKX2.5
91
What gene is involved in ASD or VSD
GATA4
92
What genes are involved in TOF
ZFPM2 or NKX2.5
93
What genes are involved in alagille syndrome (pulmonary artery stenosis or TOF)
JAG1 or NOTCH2
94
What gene is involved in char syndrome (PDA)
TFAP2B
95
What gene is involved in Holt-Oran syndrome
TBX5
96
What is the main culprit legion in Digeorge syndrome
TBX1
97
What are the multiple deficits associated with Digeorge syndrome
CATCH-22: cardiac abnormality, abnormal face, thymic aplasia, cleft palate, hypocalcemia, on chromosome 22
98
What is the most common genetic cause of congenital heart disease
Trisomy 21
99
What do ASD typically increase
Only RV and pulmonary outflow volumes
100
What do VSD and PDA cause increase in
Pulmonary blood flow and pressure
101
What type are most VSDs
Membranous
102
Where do infundivular VSD occur
Below pulmonary valve or within muscular septum
103
What CHD can lead to paradoxical embolism
Right to left shunts
104
What CHD produces ventriculoarterial discordance
Transposition of great arteries
105
Describe the murmur with subaortic stenosis
Prominent systolic murmur and sometimes thrill
106
What is subaortic stenosis caused by
Thickened ring or collar of dense endocardial fibrous tissue below the level of the cusps
107
What is the term for congenital aortic dysplasia with thickening of ascending aortic wall and consequent luminal constriction
Supravalvular aortic stenosis
108
What disorder is supravalvular aortic stenosis sometimes part of
Chromosome 7 deletion disorder
109
What is the leading cause of death worldwide for both men and women
Ischemic heart disease
110
What is the dominant cause of ischemic heart disease
Insufficient coronary perfusion relative to myocardial demand
111
What does stable angina result from
Increases in myocardial oxygen demand that outstrip the ability of stenosis coronary arteries to increase O2 delivery
112
What is unstable angina caused by
Plaque disruption that results in thrombosis and vasoconstriction, and leads to severe but transient reductions in coronary blood flow
113
What type of MIs are most common
Transmural
114
What do LAD infarcts involve
Anterior wall of LV near the apex; anterior portion of ventricular septum; apex circumferential
115
What part of the Heart does Right coronary infarcts involve
Inferior/posterior wall of LV; posterior portion of ventricular septum; inferior/posterior RV free wall
116
What is the most common trigger for fatal arrhythmias
Acute myocardial ischemia
117
What is the cause of arrhythmias in most cases
Ischemic injury
118
What is pulmonary hypertensive heart disease (cor pulmonale) characterized by
RV hypertrophy, dilation and potentially right sided Heart failure
119
What is calcification aortic stenosis usually the consequence of
Age associated wear and tear
120
What does calcification stenosis of congenitally bicuspid aortic valve involve loss of function mutations in
NOTCH1
121
What is the most frequent site of calcific deposits in calcific stenosis of congenitally bicuspid aortic valve
Raphe
122
What overload does stenosis cause
Pressure overload
123
What overload does insufficiency/regurgitation cause
Volume overload
124
What degeneration is key in mitral valve prolapse
Myxomatous degeneration
125
What is the characteristic anatomical change in mitral valve prolapse
Interchordal ballooning (hooding) of mitral leaflets or portions thereof
126
What are common complications of mitral valve prolapse
Infective endocarditis, MI, stroke, arrhythmias
127
How many minor and major criteria of jones criteria must be met for rheumatic fever
2 major or 1 major and 2 minor + evidence of preceding strep infection
128
What should you think of when you see maccallum plaques
Acute rheumatic fever
129
What is the term for erythematous or hemorrhagic non-tender lesions on palms or soles (non-painful)
Janeway lesions
130
What is the term for subcutaneous nodules in the pulp of the digits
Osler nodes
131
What is the term for retinal hemorrhages in the eyes (round white spots surrounded by hemorrhage)
Roth spots
132
Who are noninfectious vegetations usually encountered in
Debilitated patients (ie cancer or sepsis)
133
What does carcinoid heart disease primarily affect
Endocardium and valves of right heart
134
Describe the lesions of carcinoid heart disease
Distinctive, glistening white intimal plaque-like thickening of the endocardial surfaces of the cardiac chambers and valve leaflets
135
What mutation is common in dilated cardiomyopathy
TTN (gene that encodes titin)
136
What is progression of myocarditis to dilated cardiomyopathy strongly associated with
Alcohol use
137
What is the most common manifestation of iron excess
Dilated cardiomyopathy
138
What disorder is characterized by LV contractile dysfunction following extreme psychological stress, which leads to apical ballooning
Takotsubo cardiomyopathy
139
What is the term for inherited disease of mycoardium causing RV failure and rhythm disturbances with sudden death
Arrhythmogenic RV cardiomyopathy
140
What is the disorder that is characterized by arrythmogenic RV cardiomyopathy and hyperkeratosis of plantar palmar skin surfaces specifically associated with mutations in the gene encoding the desmosome-associated protein plakoglobin
Naxos syndrome
141
Describe the RV in arrhythmogenic RV cardiomyopathy
Due to loss of myocytes, accompanied by extensive fatty infiltration and fibrosis
142
What genetic disorder is characterized by myocardial hypertrophy, poorly compliant LV myocardium leading to abnormal diastolic filling and intermittent ventricular outflow obstruction
Hypertrophy cardiomyopathy
143
What is typically mutated in hypertrophy cardiomyopathy
Mutations in sarcomere (beta-MHC)
144
What should you think of when there is banana-like configuration of the ventricular cavity
Hypertrophy cardiomyopathy
145
Describe the auscultation heard with hypertrophy cardiomyopathy
Harsh systolic ejection murmur caused by ventricular outflow obstruction as anterior mitral leaflet moves toward the ventricular septum during systole
146
How is endomyocardial fibrosis most common in
Children and young adults in Africa
147
What does loeffler endomyocarditis result in
Edomyocardial fibrosis, typically with large mural thrombi; often also peripheral eosinophilia
148
What is inhabited in the mechanics of hypertrophic and restrictive cardiomyopathy
Compliance (diastolic dysfunction)
149
What is the most common viral cause of myocarditis
Coxsachie viruses A and B
150
What is the most common helminthic cause of myocarditis
Trichinosis
151
What are the activating mutations involved in myxomas
GNAS1
152
What is the favorite site for myxoma
Fossa ovalis of atrial septum
153
What should you think of with wrecking ball effect
Pedunculated form of myxoma
154
What are localized, well-circumscribed, benign tumors composed of mature fat cells
Lipomas
155
What should you think of as sea-anemone lesions
Papillary fibroelastoma
156
What do the lesions involved in papillary fibroelastoma consist of
Cluster of hairlike projections
157
What should you think of with spider cells
Rhabdomyoma
