Heart

Question 1

Stable angina

Answer 1

chest pain with exertion

ST depression

Question 2

What heat problem can be caused by hypertension causes left heart failure?

Answer 2

concentric left ventricular hypertrophy

Heart wall becomes thicker - more difficult to supply oxygen – longstanding hypertension leads to ischemia and eventual left heart failure

Question 3

What is dilated cardiomyopathy?

Answer 3

heart chambers dilate strech walls and less efficient at contracting –> left ventricular dilated cardiomyopathy leads to lower ejection fraction and left heart failure

Question 4

What is restrictive cardiomyopathy?

Answer 4

can’t fill the heart appropriately so can’t pump blood appropriately –> leads to left heart failure

Question 5

What is the major consequence of left sided heart failure?

Answer 5

pulmonary hypertension/congestion

Question 6

What symptoms are associated with pulmonary congestion secondary to left heart failure?

Answer 6

Pulmonary edema with dypsnea
Orthopnea
Crackles
Paroxysmal nocturnal dyspnea

Question 7

What is paroxysmal nocturnal dyspnea? What causes it?

Answer 7

Dyspnea when you lay flat over period of hours

with orthopnea dyspnea occurs in minutes

Question 8

Describe the consequence of microvessel hemmorage secondary to pulmonary hypertension

Answer 8

capillaries rupture > blood leaks into alveoli > macrophages enter alveoli to consume blood > iron from heme accumulates in macrophages (hemosiderin laden macrophages aka heart-failure cells)

Question 9

What heart problem can cause activation of RAAS? What is the consequence?

Answer 9

left heart failure resulting in decreased forward perfusion

leads to to less renal blood flow and activation of juxtoglomerular apparatus, which triggers renin release from juxtoglomerular cells, which then leads to ATII and aldosterone ==> sodium/water reabsoption, increased blood volume and constriction of peripheral arterioles ==> hypertension ==> concentric LV hypertrophy and further left ventricular ischemia/worsening of congestive heart failure

Question 10

What is most common cause of right heart failure?

Answer 10

left heart failure due to back up of blood into pulmonary circuit and back up of blood into right heart

Question 11

What is the consequence of left to right shunting (left ventricular to right ventricular)

Answer 11

right heart failure - because more blood is pumping into right heart.

can be caused by ventricular septal defect

Question 12

What is the pathophysiology leading to right heart failure from left to right ventricular shunt?

Answer 12

left to right shunt can result in equalization of pressure between left and right ventricals

right ventrical exhibits pressure induced hypertrophy

left ventrical exhibits volume hypertrophy

Question 13

Describe the consequence of patent ductus arteriosis

Answer 13

ductus arteriosus connects pulmonary artery (containing deoxygenated blood) with the aorta. When opening persists the higher pressure in the aorta will shunt blood to the pulmonary circuit.

Because of the high pressure, pulmonary HTN will arise preventing blood from flowing from pulmonary artery

if pressure is high enough the blood will be sent back to aorta (descending branch) and cause cyanosis of lower extremities

Question 14

describe the pathophysiology of atrioventricular septal defect

Answer 14

tbd

Question 15

What is a consequence of chronic pulmonary disease?

Answer 15

hypoxia of pulmonary vessels causes them to constrict

Question 16

What is core polmonoly?

Answer 16

right heart failure due to chronic long hypoxia and vascular constriction leading to increased pulmonary pressure and strain on right ventrical

Question 17

Name the clinical consequences of hepatosplenomegaly

Answer 17

JVD

painful hepatosplenomegaly ==> cardiac cirrosis (cardogenic hepatic cerrosis)

increased hydrostatic pressure in lower extremities ==> dependent pitting edema

Question 18

What congenital defect is associated with fetal alcohol syndrome?

Answer 18

ventricular septal defect (most common septal defect!)

Question 19

What problem is vaused by ventricular septal defect?

Answer 19

left to right shunt

Question 20

what will eventually happen from a left to right shunt?

Answer 20

Blood will initially flow from LV to RV during systole, increased ejection fraction of RV into pulmonary circuit cases pulmonary hypertension. Eventually pressure in right ventrical builds up so high that left to right shunt is reversed to form right to left shunt

Question 21

What is the consequence of reversed left to right shunting secondary to ventricular septal defect?

Answer 21

Cyanosis - from right to left shunt secondary to pulmonary hypertension causes deoxygenated blood to be pumped into systemic circuit

Question 22

What is Eisenmenger syndrome?

What are 3 consequences?

Answer 22

consequence of large ventricular septal deftect (inital L>R shunt, pulmonary hypertension, reversal R>L shunt

Cyanosis
Right ventricular hypertrophy
Polythycemia

Question 23

What causes polythycemia? What congenital syndrome is it associated with? Do you understand why?

Answer 23

Decreased oxygenated blood (hypoxemia) detected by peritubular capillary interstial cells in the kidney that release secrete erythropoietin and cause more RBC production

associated with Eisenmenger syndrome

Reversed ventricular septal defect ==> cyanosis

Question 24

What is associated with patent ductus arteriousus?

Answer 24

Rubella

Question 25

What is keeps the patent ductus arteriosus open?

Answer 25

PGE

Question 26

What is treatment for patent ductus arteriosus?

Answer 26

Indomethacin ==> decreases PGE (which keeps it open)

Question 27

What are the 4 probalems caused by terology of fallot?

Answer 27

Stenosis of RV outflow Right ventricular hypertrophy Ventricular septal defect Aorder that overrides vent septal defect

Question 28

Transposition of great arteries can be treated with what?

Answer 28

PGE -transposition creates 2 independent circuits that do not mix PGE maintains patent ductus arteriosus alowing mixing Will still be cyanotic

Question 29

What is tricupid atresia?

Answer 29

tricuspid valve fails to form

Question 30

Coarctation of the aorta in the adult is associated with what finding on chest xray?

Answer 30

Notching of the ribs (from engorged blood vessels that arise because high pressure above the stenosis of the aorta causes colateral flow along intercostal arteries)

Question 31

What causes acute rhumatic fever?

Answer 31

beta-hemolitic strep infection of the throat that arises as a complication of pharangitis affects children 2-3 weeks after strep throat Caused by molecular mimicry - bacterial M protein resembles human tissues

Question 32

Which valve is affected by acute or recurring rhumatic fever?

Answer 32

mitral valve complication is endocarditis

Question 33

When aorta is involved in chronic rhumatic heart disease, what might arise?

Answer 33

fusion of the commisures (liks between the valve flaps - leads to less blood out **always mitral valve stenosis in chronic rhumatic fever

Question 34

What are the clinical featurees of aortic regurgitation?

Answer 34

LV dilation with eccentric (volume overload) hypertrophy Eccentric hypertrophy: sarcomeres are added series (big hart) Concentric hypertrophy: sarcomeres are added in parallel (thick heart)

Question 35

What are the features of aortic valve stenosis (regarding systolic/diastolic)

Answer 35

increased systolic pressure (because of eccentric hypertrophy), decreased diastolic pressure

Question 36

What change in the left ventrical can lead to mitral valve regurgitation?

Answer 36

left ventriculat dialation -- pulls valve flaps apart

Question 37

What is the difference between chronic vs acute rhumatic hart disease with regard to the mitral valve?

Answer 37

Chronic results in stenosis | Acute results in mitral regurgitation

Question 38

What heart sounds would you hear from mitral valve stenosis?

Answer 38

opening snap followed by diastolic rumble

Question 39

What consequences would chronic rhumatic heart disease cause?

Answer 39

stenosis prevent all the blood from the left atrium to be pumped into the left ventrical causes volume to increase and results in dilation of the left ventrical pulmonary congestion arises leading to pulmonary hypertension atrial fibrulation pulmonary hypertension caused by mitral valve stenosis and pulmonary HTN can cause right heart failure

Question 40

What are the "tetra" of problems caused by Tetrology of fallot ?

Answer 40

Tetrology of fallot 1. VSD 2. Over-riding aorta 3. Pulmonary stenosis – degree of pulmonic stenosis determines degree of cyanosis a. Squatting increases preload 4. Right ventricular hypertrophy

Question 41

Does blood return to the heart with inspiration or expiration?

Answer 41

Inspiration causes decrease in intrathoracic pressure -> increased blood return Expiration increases inthathoracic pressure which decreases return

Question 42

What is the most common cause of endocarditis?

Answer 42

S. viridans - only causes endocarditis in previously damaged tissue like valve stenosis or rhumatic heart disease results in small vegitations that do not destroy the valves

Question 43

Small vegitations of S. veridans on heart valves are low virulance themselves. How can these vegitations lead to infectious endocarditis?

Answer 43

damaged endocardial surface developes thombotic vegitations filled with platelets and fibrin. Secondary transient baceriemia can bind to these and that's how shit gets real.

Question 44

What is most common cause of acute endocarditits in IV drug abusers?

Answer 44

S. aureas - high virulance - infects normal valves like the tri-cuspid valve (unlike S. veridans which needs already sick valve - more often aortic or mitral) and results in large vegitations that DESTROY valve hence name acute (again unlike S. viridans)

Question 45

What causes endocarditis in prosthetic implants?

Answer 45

S. epidermitidis

Question 46

What causes endocarditis in patients with underlying colorectal carcinoma?

Answer 46

S. bovis

Question 47

What can give endocarditis with negative blood cultures?

Answer 47

HACEK organisms - bugs are particularly difficult to grow

Question 48

What are the HACEK organisms?

Answer 48

``` hemophilus actinobacillus cardiobacterium eikenella kingella ```

Question 49

What are the clinical features of endocarditis?

Answer 49

Fever Murmur Janeway lesions (complications of septic emboli from thromotic vegitations - erythemitous non-tender lesions Osler nodes - painful lesions on fingers and toes Slinter hemorrhage (fingers - not necessarily painful) Anemia of chronic disease

Question 50

What are the lab findings of endocarditis?

Answer 50

Microcytic anemia hepsidein - traps iron (and other acute phase reactants released by liver) Trans-esophogeal echo - useful for detecting lesions on valves

Question 51

What is leibman sachs endocarditis? Which valve does it affect?

Answer 51

Sterile vegitation associated with SLE Mitral valvue - vegitation on both sides

Question 52

Dilated cardiomyopathy is results in systolic or diastolic dysfunction?

Answer 52

Systolic - dilation so can't pump out as much blood Complications are regurgitation becuase of valve stretching and arythmias (due to stretching of the conduction system)

Question 53

What is the most common cause of cadiomypoathy

Answer 53

myocarditis from cockakie virus - lymphcytic ilfiltrates in myocardium pts get chest pain, arythimia, sudden death if they survive - dilated cardiomyopathy

Question 54

Cardiomyopathy is usually idiopathic but what are other causes?

Answer 54

infection with coxackie virus alcohol abuse - dilated cardiomypathy drugs (doxyrubicin, cocaine = dilated cario) pregnancy

Question 55

What is most common cause of death among athletes?

Answer 55

ventricular arrythmias secondary to hypertrophic cardiomyopathy (diastolic dysfunction) -- can also cause syncope because typically affects the septum and creates a 'stenosis' for aortic outflow

Question 56

What is restrictive cardiomyopathy?

Answer 56

Decreased compliance of ventricular endocardium - restricts filling during diastole

Question 57

What is formular for ejection fraction? stroke volume? blood flow in the aorta (Q)?

Answer 57

SV/end diastolic volume (LV) SV=end diastolic volume - end systolic volume Q=SV*HR

Question 58

What are 5 causes of restrictive cardiomyopathy?

Answer 58

``` Amyloidosis Sarcoidosis Hemochromatosis (iron overload = toxic) Endocardial fibroelasotis (usually in children) Loeffler syndrome ```

Question 59

What is endocardial fibroelastosis?

Answer 59

epicardium gets covered in fibrosis and thus is less compliant - ventricle can't fill = diastolic dysfunction usually in children

Question 60

What is loeffler syndrome?

Answer 60

eosinic infiltrate in the wall of the heart that results in fibrosis of endocardium and myocardium - ventrical can't fill = diastolic dysfunction usually in children

Question 61

What is the common clinical presentation of cardiomyopathy?

Answer 61

congestive heart failure - Low voltage EKG with diminished QRS amplitude

Question 62

What is a myxoma?

Answer 62

benign mesenchymal proliferation with gelatinous appearance Abundant ground substance on histolgy Most common primary cardiac tumor in ADULTS usually grows in left atrium and causes syncopy due to obstruction of mitral valve due to formation of a peduculated mass

Question 63

What is Rhabdomyoma?

Answer 63

benign harmartoma of cardiac muscle most common primary cardiac tumor in CHILDREN arises in the ventricles (as oposed to myxoma which arises in the atrium) and is often associated with tuberous sclerosis (potatoe brain)

Question 64

T/F metastatic cardiac tumor are more common than primary tumors

Answer 64

true most common causes are breast/lung carcinoma, meanoma, lympoma typically involves pericardium and results in pericardial effusion (fluid in pericardial sac that exerts pressure on heart)