Gen Path Exam 1 - Cardiovascular Path Flashcards
What disease?
Various diseases characterized by inability of the coronary arteries to deliver adequate oxygen to meet the needs of the myocardium
Ischemic heart disease
What disease?
Leading cause of ischemic heart disease
Coronary artery disease
What disease?
Causes include coronary artery disease, atherosclerosis, thromboemboli, coronary artery vasospasm, and conditions that increase workload and oxygen demand
Ischemic heart disease
What disease?
Clinical manifestations are chronic ischemic heart disease (most common), angina pectoris, and myocardial infarction
Ischemic heart disease
What disease?
Leads to congestive heart failure, angina pectoris, MI, sudden cardiac death
Chronic ischemic heart disease
What disease?
Episodic, paroxysmal, substernal or precordial chest pain or discomfort resulting from myocardial ischemia, usually due to the inability of diseased coronary vessels to provide adequate blood for myocardial oxygenation
Angina pectoris
What disease?
Caused by a fixed coronary artery obstruction secondary to atherosclerosis
Stable (classic) angina
What disease?
Symptoms are episodic, paroxysmal, substernal or precordial pressure, heaviness, pain or discomfort usually brought on by exertion and relieved by rest or nitrates (nitroglycerin).
Stable (classic) angina
What disease?
Attacks are no longer than 15-20 mins, predictable, and follow a precipitating event associated with temporary increase in demands of heart
Stable (classic) angina
What disease?
Symptoms are relieved by decreased cardiac demand or nitroglycerin
Stable (classic) angina
What disease?
Attacks occur more frequently, are longer, and produce more severe symptoms. Pain is more easily provoked and may occur at rest
Unstable (pre-infarction) angina
What disease?
Undistinguishable from NSTEMI
Unstable (pre-infarction) angina
What disease?
Pain occurs at rest and lasts longer than 20 mins
Pain is severe and of new onset
Pain occurs with a crescendo pattern
Unstable (pre-infarction) angina
What disease?
Coronary artery vasospasm is an important mechanism and pain occurs at rest
Variant (vasospastic) angina
What disease?
Characterized by symptoms of myocardial ischemia, persistent EKG changes, and release of biomarkers of myocardial necrosis resulting from an insufficient supply of oxygenated blood to an area of the heart
MI
What disease?
Caused by irreversible myocardial injury, occurring as a result of prolonged ischemia
MI
What disease?
Most frequently involves LV and leading cause is coronary artery atheroscleorsis
MI
What disease?
Initiating factor in most cases is sudden disruption of partially occlusive coronary artery atherosclerotic plaque
MI
What disease?
Classified by:
Degree of ventricular wall involvement
Location within heart or specific artery involved
Presence or absence of ST elevation on EKG
MI
What specific MI?
Involve full thickness of ventricle and result in ST segment elevation
Transmural MI
What specific MI?
Limited to inner third of myocardium and DO NOT exhibit ST segment elevation
Subendocardial MI
MI resulting from a blockage of which artery is most common?
L anterior descending coronary artery
T/F: STEMIs are more common than NSTEMIs
True
What disease?
MIs characterized by profound, acute transmural myocardial ischemia and associated with ST segment elevation on EKG
Acute MI
Describe the pathogenesis of acute MIs
Plaque is disrupted
Platelets adhere, aggregate, and are activated
Release of ADP + thromboxane A2
Thrombus grows and occludes coronary artery
Coagulative necrosis
Gross and microscopic appearance of an MI depends on _____ of the injury
age
Describe how the areas of damage after an MI change morphologically
Coagulative necrosis -> acute then chronic inflammation -> fibrosis
What disease?
Sudden onset of chest pain that is similar to the pain of angina but is more severe and prolonged, generally lasting more than 15-20 mins, and is unrelieved by nitroglycerin
Acute MI
What symptom of acute MI?
History of alteration in the pattern of angina, recent onset of typical or atypical (unstable) angina, or unusual “indigestion” or pressure or squeezing felt in the chest.
Premonitory pain
What symptom of acute MI?
Chest pain/discomfort at rest, nitroglycerin has no effect relieving pain
Pain of infarction
What disease?
Cold sweat, weak/apprehensive, light headed, syncope, dyspnea, orthopnea, cough, wheezing, nausea, vomiting, abdominal bloating
Acute MI
What disease?
Diagnosed by triad of:
Ischemic type discomfort
EKG abnormalities
Elevated serum cardiac markers
MI
Name the serum cardiac markers used to diagnose MI
Troponin I and T
Creatine Kinase isozyme MB
What disease?
Diagnosed with coronary artery angiography or perfusion scintigraphy test
MI
What disease?
Complications include arrhythmias, progressive heart failure, ventricular aneurysm, mural thrombus, rupture of myocardium, fibrinous pericarditis, heart chamber dilation
MI
Most common cause of sudden cardiac death in first hour after MI
Vfib
Most common cause of death among hospital patients with acute MI
Cardiogenic shock
Occurs between 4-7 days after MI and is responsible for 20% of all fatal MIs
Rupture of myocardium
What disease?
Refers to a spectrum of clinical symptoms compatible with acute myocardial ischemia
Acute coronary syndrome
What disease?
Includes unstable angina, NSTEMI, and STEMI
Acute coronary syndrome
Unexpected death due to cardiac causes occurring in a short time period (in 1 hour of symptom onset) in a person with known or unknown cardiac disease in whom no previously diagnosed fatal condition is apparent
Sudden cardiac death
Symptom complex, not a disease entity, that can result from a variety of cardiac disorders
Congestive heart failure
What disease?
Characterized by inability of the heart to pump blood sufficiently to keep pace with the body’s circulatory demands
Congestive heart failure
What disease?
Develops when the body’s compensatory mechanisms to correct intravascular and interstitial volume overload and/or inadequate tissue perfusion (oxygenation) become overwhelmed
Congestive heart failure
What disease?
Caused by decreased myocardial function/cardiac valvular dysfunction (from previous MI), increased vascular resistance, increased blood volume, or excessive metabolic demand
Congestive heart failure
What disease?
Classified by:
Systolic vs diastolic
L vs R sided
Backward vs forward
Congestive heart failure
What specific Congestive heart failure?
Reduced cardiac contractility
Systolic Congestive heart failure
What specific Congestive heart failure?
Impaired cardiac relaxation and abnormal ventricular filling
Diastolic Congestive heart failure
What specific Congestive heart failure?
Failure of LV or excessive pressure in LA
Left sided Congestive heart failure
What specific Congestive heart failure?
Failure of RV or excessive pressure in RA
Right sided Congestive heart failure
What specific Congestive heart failure?
Not simultaneous, develops over time due to increased stress placed on remaining ventricle
Biventricular Congestive heart failure
What is the most frequently used index of cardiac pump function?
Ejection fraction
Ejection fraction equation
EF = 100 x SV/EDV
Where is ejection fraction measured?
LV
What is normal adult LV ejection fraction?
50-70%
What ejection fraction is considered systolic dysfunction?
40%
What disease?
Symptomatic congestive heart failure with a normal ejection fraction
Congestive heart failure with preserved ejection fraction
What specific Congestive heart failure?
Exertional dyspnea, dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, cough, and hemoptysis (coughing up blood).
Left sided Congestive heart failure
What specific Congestive heart failure?
Pulmonary edema and hemosiderin-laden alveolar macrophages (heart failure cells)
Left sided Congestive heart failure
What specific Congestive heart failure?
Systemic venous congestion, jugular venous distention; enlarged and tender liver and spleen; ascites (abdominal edema); and pitting edema of the extremities
Right sided Congestive heart failure
What specific Congestive heart failure?
LV is hypertrophied and dilated
Left sided Congestive heart failure
What specific Congestive heart failure?
Lungs are heavy and boggy due to pulmonary congestion and edema
Left sided Congestive heart failure
What disease?
A gross structural abnormality of the heart or intrathoracic great vessels that is present at birth and that is actually or potentially of functional significance.
Congenital heart disease
What disease?
Associated with chromosomal abnormalities
Congenital heart disease
What is Turner syndrome associated with?
Coarctation of aorta
What is Down syndrome associated with?
Atrial + ventricular septal defects
AV valve deformities
What is pregnancy while living at high altitudes associated with?
Patent ductus arteriosus
What is rubella syndrome associated with?
Patent ductus arteriosus
Pulmonary artery stenosis
Which form of Congenital heart disease?
R to L shunt because of increased pulmonary artery pressure
Cyanotic
Which form of Congenital heart disease?
L to R shunt
Non-cyanotic
What type of Congenital heart disease?
A hole from a septum secundum or septum primum defect in the interatrial septum normally produces a modest L to R, non-cyanotic shunt.
Atrial septal defect
Name the 1st, 2nd, and 3rd most common types of Congenital heart disease
1st = ventricular septal defect
2nd = atrial septal defect
3rd = patent ductus arteriosus
What type of atrial septal defect?
Smooth-walled defects near the foramen ovale, typically without other associated cardiac abnormalities.
Ostium secundum
What type of atrial septal defect?
Occur at the lowest part of the atrial septum and can be associated with mitral and tricuspid valve abnormalities
Ostium primum
What type of atrial septal defect?
affects the upper part of the atrial septum near the entrance of the SVC; accompanied by anomalous drainage of the pulmonary veins into the right atrium or SVC
Sinus venosus
What type of Congenital heart disease?
Clinical presentation includes heart failure, exertional fatigue, dyspnea, afib
Atrial septal defect
What type of Congenital heart disease?
Flaplike opening between the atrial septa primum and secundum at the location of the fossa ovalis that persists after age 1 year
Patent foramen ovale
What type of Congenital heart disease?
No clinical significance except when it leads to paradoxical embolism and cryptogenic strokes
Patent foramen ovale
What type of Congenital heart disease?
Transient R to L blood flow can occur, such as with Valsalva-type maneuvers
Patent foramen ovale