February 13th and 18th Lectures

Question 1

What disease are the following risk factors associated with? Acquired valvular heart disease, implantation of prosthetic heart valves, ventricular septal defects, male

Answer 1

Infective endocarditis

Question 2

What are some casual agents of infective endocarditis?

Answer 2

Bacteria, viruses, fungi, rickettsiae, parasites

Question 3

What are the 3 critical elements required for infective endocarditis?

Answer 3

1. Endocardium must be prepared for colonization
2. Blood-borne microorganisms must adhere
3. Adherent organisms must proliferate and promote propagation of infective endocardial vegetation

Question 4

What are some classic findings of Infective endocarditis?

Answer 4

Fever, cardiac murmur, petechial lesions of the skin, conjunctiva and oral mucosa

Question 5

What are the two types of myocardial diseases (general)?

Answer 5

Myocarditis and Cardiomyopathy

Question 6

Which type of myocardial disease is acute and stormy?

Answer 6

Myocarditis

Question 7

What is the cause of myocarditis?

Answer 7

Inflammation, leukocyte infiltration and necrosis of cardiac muscle cells
Many causes- North America- viral

Question 8

What condition can myocarditis progress to?

Answer 8

Dilated cardiomyopathy

Question 9

What do most types of cardiomyopathy result from?

Answer 9

Underlying cardiovascular disorders or secondary to infections, toxins, etc.

Question 10

What are the three types of cardiomyopathy?

Answer 10

Dilated, Hypertrophic, Restrictive

Question 11

What type of cardiomyopathy fits these facts?

Ventricular dilation, diminished myocardial contractility, decrease ejection fraction, increased EDV

Answer 11

dilated cardiomyopathy

Question 12

What are common symptoms of dilated cardiomyopathy?

Answer 12

Dyspnea, fatigue, pulmonary congestion

Question 13

Is dilated cardiomyopathy inflammatory or non-inflammatory

Answer 13

Inflammatory

Question 14

What are the two types of hypertrophic cardiomyopathy?

Answer 14

1. Asymmetrical septal

2. Hypertensive or valvular hypertrophic

Question 15

What type of cardiomyopathy is idiopathic, from an autosomal dominant inherited disorder

Answer 15

Asymmetrical septal hypertrophy cardiomyopathy

Question 16

What is the cause of hypertensive cardiomyopathy?

Answer 16

Increased resistance to ventricular ejection

Question 17

What happens with restrictive cardiomyopathy?

Answer 17

Myocardium becomes rigid and non-compliant

Ventricular filling is impeded- diastolic pressure is raised

Question 18

What other heart problem does restrictive cardiomyopathy mimic clinically?

Answer 18

Constrictive pericarditis

Question 19

What are the two types of pericardial diseases?

Answer 19

Pericardial effusion

Pericarditis

Question 20

What is a pericardial effusion?

Answer 20

Any accumulation of fluid in pericardial cavity

Question 21

What happens if pericardial effusion has enough fluid to compress the heart

Answer 21

Cardiac tamponade

Question 22

What side the of the heart is affected first by cardiac tamponade?

Answer 22

Right side, decreased atrial fluid first

Question 23

What is pulsus paradoxus?

Answer 23

Arterial BP during expiration is 10 mm Hg greater than inspiration (sign of cardiac tamponade)

Question 24

What are the two types of pericarditis?

Answer 24

Acute and Chronic

Question 25

What type of pericarditis is often idiopathic, has a sudden onset of severe chest pain, and has a friction rub?

Answer 25

Acute pericarditis

Question 26

What happens with chronic pericarditis?

Answer 26

Fibrous scarring with some calcification of pericardium Visceral and parietal layers adhere Heart becomes encased in rigid shell

Question 27

What is a general term that describes several types of cardiac dysfunction that result in inadequate tissue perfusion?

Answer 27

Heart failure

Question 28

In systolic heart failure, what increases with decreased contractility or excess plasma volume?

Answer 28

Preload (LVEDV)

Question 29

What is the increased afterload in systolic heart failure associated with?

Answer 29

Hypertension or aortic valvular disease

Question 30

What is the name for cardiac muscle weakness due to hypertension induced hypertrophy?

Answer 30

Hypertensive hypertrophic cardiomyopathy

Question 31

What does RAA do?

Answer 31

Increase PVR and plasma volume | increase afterload and preload further

Question 32

Why is RAA activated?

Answer 32

Because there is a fall in CO

Question 33

What is the only helpful hormone in response to systolic heart failure?

Answer 33

Natriuertic peptide, as it causes blood volume to decreases thereby decreasing afterload helps to excrete salt

Question 34

What are the three main pathways that mediate heart failture

Answer 34

Baroreceptors --> SNS activation RAA activation --> fluid retention ventricular wall tension --> hypertrophy

Question 35

Are the following forward or backward effects of left ventricular heart failure? DOE, orthopnea, cough, cyanosis

Answer 35

Backward effects

Question 36

What are some forward effects of left sided ventricular heart failure?

Answer 36

Fatigue, oliguria, increased HR, confusion

Question 37

What diseases can lead to right heart failure?

Answer 37

COPD, CF, ARDS (Acute respiratory distress syndrome)

Question 38

Are the following forward or backward effects of Right sided heart failure? Hepatomegaly, ascites, splenomegaly, anorexia, subcutaneous edema, JVD

Answer 38

Backward syndromes

Question 39

Are the following forward or backwards effects of right sided heart failure? Fatigue, oliguira, increase HR, faint pulses, restlessness, confusion, anxiety

Answer 39

Forward effects

Question 40

What do flow reduction in the systemic circuit lead to?

Answer 40

Ischemia --> hypoxia

Question 41

What is a blood clot attached to a vessel?

Answer 41

Thrombus

Question 42

What is a detached thrombus called?

Answer 42

Thromboembolus

Question 43

What are threats of arterial thrombi?

Answer 43

1. Occlusion of artery | 2. Thromboembolus causing occlusion at distant site

Question 44

What is a bolus of matter circulating in the bloodstream?

Answer 44

Embolus

Question 45

What is an air embolism?

Answer 45

Undissolved air (caused from IVs a lot)

Question 46

What is a sudden involuntary constriction of arterial smooth muscle that obstructs flow?

Answer 46

Vasospasm

Question 47

What is phlebitis

Answer 47

Inflammation of the intima of a vein

Question 48

What is valvular incompetence?

Answer 48

When intimal fold of venous valves are damaged

Question 49

What can valvular incompetence cause?

Answer 49

Varicose veins and chronic venous insufficiency

Question 50

What is a localized dilation of arterial wall?

Answer 50

Aneurysms

Question 51

What is AVF (arteriovenous fistulas)?

Answer 51

Abnormal communication b/w arteries and veins

Question 52

What is Buerger Disease? (AKA Thromboangilitis obliterals)

Answer 52

Type of arteritis Inflammatory disease of peripheral arteries Inflammatory lesions accompanied by thrombi and vasospams Can occlude and obliterate small and medium arteries in feet and hands

Question 53

In what disease do fingers look like the American flag?

Answer 53

Raynaud Syndrome

Question 54

What is the difference between Raynaud Syndrome and Raynaud phenomenon

Answer 54

Syndrome- attack of vasospasms in small arteries, idiopathic Phenomenon- secondary to systemic disease

Question 55

What is a true aneurysm?

Answer 55

Where all three tunics are affected | Subdivided into saccular or fusiform

Question 56

What is a false aneurysm

Answer 56

At least one tunic is not affected

Question 57

What is a dissecting aneurysm?

Answer 57

Tear in arterial wall that creates blood flow channel

Question 58

What are symptoms of dissecting aortic aneurysms?

Answer 58

Sudden, severe, tearing pain in back and abdomen

Question 59

What is it called when an embolism lodges in a major artery?

Answer 59

Acute arterial occlusion

Question 60

What are the 6 Ps?

Answer 60

Describe symptoms of acute arterial occlusion | Pallor, parasthesia, paralysis, pain, polar, pulseless

Question 61

What is the difference between varicose veins and chronic venous insufficiency?

Answer 61

Varicose veins involve superficial veins while chronic venous insufficiency involves deep vein valvular incompetence

Question 62

What conditions promote DVT (deep vein thrombosis) ?

Answer 62

Venous stasis Venous endothelial damage Hypercoagulable states

Question 63

What is the difference between primary and secondary lymphedema?

Answer 63

Primary- due to congenital absence or decreased number of lymphatics Secondary- surgical removal of lymph nodes or destruction of lymphatics

Question 64

What is secondary hypertension?

Answer 64

Caused by altered hemodynamics associated with a primary disease (ex- kidney failure)

Question 65

Do parasymp or sympathetic nervous systems cause vasoconstriction?

Answer 65

Sympathetic nervous system

Question 66

What does angiotensin II do?

Answer 66

Causes remodeling of blood vessels and hypertrophy of myocardium.

Question 67

What do mutation in gene for adducin lead to?

Answer 67

An increased risk of hypertension

Question 68

How does inflammation play a role in primary hypertension?

Answer 68

Endothelial damage and tissue ischemia cause release of inflammatory cytokines- chronically there is vasoconstriction and vessel remodeling

Question 69

What is the majority of the pathology of primary hypertension caused by?

Answer 69

Influence renal sodium excretions and shift pressure-natriuresis relationship

Question 70

What is secondary chronic orthostatic hypotension caused by?

Answer 70

Endocrine disorders- metabolic disorders, diseases of CNS and PNS