Heart Disease

Question 1

What is a common kind of circulatory failure?

Answer 1

Chronic (congestive) heart failure (CHF)

Question 2

With the onset of heart failure, __________________ are activated in order to maint adequate blood flow

Answer 2

Compensatory mechanisms

Question 3

Ventricular dilation, myofiber hypertorphy and activation of neurohumoral mechanisms are examples of what

Answer 3

Compensatory mechanisms

Question 4

__________ improves contraction by stretching the myofibers according to Frank Starling mechanisms

Answer 4

Ventricular dilation (compensatory mechanism)

Question 5

_________ is associated with the heart’s decreased ability to maintain minimum levels of output and therapy may be required for cardiac survival

Answer 5

Decompensation

Question 6

An increase in blood volume leads to what kind of hypertrophy of myocardium?

Answer 6

Left ventricular

Question 7

Pathologic hypertrophy leads to ____________ while “physiologic” hypertrophy ____________

Answer 7

Anatomical and physiological changes that compromise cardiac function; seems to have little ill effect

Question 8

What is the most common cause of CHF?

Answer 8

Left side ventricular failure

Question 9

Causes of left side ventricular failure (3)

Answer 9

1 - Coronary heart disease (ischemic heart disease)
2 - Systemic HTN
3 - Aortic and mitral valve disease

Question 10

Symptoms of left side ventricular failure (2)

Answer 10

1 - pulmonary congestion
2 - reduced output

Or, “backward failure” and “forward failure”

Question 11

Symptoms of pulmonary congestion?

Answer 11

• breathless when lying down
• rusty sputum
• pleural effusion

Pulmonary congestion, “backward failure”

Question 12

Symptoms of reduced output?

Answer 12

Low cardiac output leads to

• decreased arterial perfusion
• systemic hypoxia

Reduced output, “forward failure”

Question 13

_______ ___________ contributes to pulmonary HTN and RIGHT ventricular failure but develops in the absence of left ventricular failure.

Answer 13

Mitral stenosis

Question 14

Outline the steps of left ventricular failure

Answer 14

Low output
Systemic hypoxia
Overfilling of left atrium leading to:

• pulmonary HTN and edema

Can also then lead to right ventricular failure (AKA combined failure)

Question 15

Outline the steps of RIGHT ventricular failure

Answer 15

Overfilling right atrium
Increased central venous pressure
Overfilling systemic veins and capillaries
Chronic venous congestion, systemic edema with cyanosis leading to

• Reduced output to lungs

Question 16

_____________ is characterized by chronic congestion of systemic veins, systemic edema and cyanosis

Answer 16

RIGHT ventricular failure

Including: jugular veins, congestion and distension of liver

Question 17

List contributing causes of RIGHT ventricular failure (2)

Answer 17

• left heart failure (most common)

- diseases of lung and pulmonary arteries (because lung diseases restrict blood flow through lungs)

Question 18

Disease of lung and pulmonary arteries can cause right ventricular failure. Examples include

Answer 18

Chronic bronchitis
Emphysema
Silicosis
Cystic fibrosis
Severe kyphoscoliosis

Question 19

Fullness of neck and abdomen (from subQ edema) and a nutmeg pattern on the liver suggests

Answer 19

RIGHT ventricular failure

Question 20

What are the major heart diseases (4) that (nearly) all lead to CHF?

Answer 20

1 - Ischemic heart disease (most common)
2 - Systemic HTN heart disease
3 - Pulmonary HTN
4 - Congenital heart disease

Question 21

What are the 4 variants of ischemic heart disease (IHD)?

Answer 21

1 - chronic ischemic heart disease
2 - angina pectoris
3 - myocardial infarction
4 - sudden cardiac death

Question 22

What type of ischemic heart disease (IHD) is characterized by progressive myocardial atrophy and fibrosis from artherosclerotic disease with fixed (stable plaques) coronary artery stenoses?

Answer 22

Chronic ischemic heart disease (CIHD)

Question 23

What is the most common symptom of IHD that is characterized by pain of myocardial ischemia WITHOUT infarction (but still increased risk)?

Answer 23

Angina pectoris

Question 24

Deep paroxysmal pain in precordial region that lasts <30 minutes and may be relieved by rest or administration of nitrites

Answer 24

“Angina”

Question 25

Pt says they have pain when the climb stairs or when they are in cold weather; the pain stops when they sit down. They also say they have been having pain at work during a particularly stressful week. What might this be?

Answer 25

“Stable” angina Provoked by increased HR and BP, usually relieved by rest and vasodilators

Question 26

Pt says they randomly get attacks of pain no matter if they are climbing up stairs or sitting at their desk. When they sit down, the pain does not go away.

Answer 26

“Unstable” angina Random, unpredictable, NOT relieved by rest. Note: Of the angina family, this is the MOST likely to contribute to infarction

Question 27

A different kind of chest pain, not called “angina,” appears to be caused by coronary artery spasms. Does respond to vasodilators. What is it?

Answer 27

Prinzmetal Note: Of the angina family, this is the LEAST likely to contribute to infarction

Question 28

What kind/symptom of IHD usually results from thrombotic occlusion of one or more atherosclerotic coronary artery segments?

Answer 28

Myocardial infarction

Question 29

Where is a common location for myocardial infarction?

Answer 29

Left ventricle (95% of the time)

Question 30

What kind of symptoms/lab findings will you see that would lead you to think myocardial infarction?

Answer 30

- angina (50% of the time) - pallor, anxiety, sweating, nausea, breathlessness (66%) - ECG changes including altered rhythm and irregular cardiac cycle - lab findings like increased enzymes CPK (creative kinase enzyme) and LDH (lactate dehydrogenase) and troponin levels (regulator of Calcium-mediated muscle contractions) - female > male

Question 31

High BP in systemic arterial circulation can damage walls of arteries, arterioles and left ventricle of the heart. What kind of heart disease is this?

Answer 31

Systemic hypertensive heart disease

Question 32

Why is the left ventricle enlarged in systemic hypertensive heart disease?

Answer 32

Left ventricle responds to increased BP by hypertrophy. This is a compensatory mechanism. Eventually the hypertrophied muscle outgrows its O2 supply and angina and cardiac failure result.

Question 33

What are the classifications of HTN?

Answer 33

- 2˚ HTN - 1˚ or essential (idiopathic) HTN - Benign - Malignant

Question 34

What is the most common classification of HTN?

Answer 34

1˚ / essential HTN (90-95% cases)

Question 35

What is the most evil classification of HTN?

Answer 35

Malignant

Question 36

What causes malignant HTN?

Answer 36

2˚ HTN most often due to renal failure that rapidly progresses with damage, necrosis and thrombosis of renal arteries and arterioles Note: malignant HTN is when diastolic (not systolic) is over 120mmHg

Question 37

Why does 1˚ / essential HTN happen?

Answer 37

Don’t know. Likely family history, racial variations, lifestyle patterns, stress influence, obesity, alcohol, insufficient physical activity, likely excessive salt consumption

Question 38

__________________ is a common consequence of many conditions that affect the lung and heart. Long term results include RIGHT ventricular and atrial hypertrophy and dilation, hoarseness and chest pain

Answer 38

Pulmonary HTN (hypertension)

Question 39

_____ _______ is defined as RIGHT ventricular hypertrophy secondary to pulmonary HTN

Answer 39

Cor pulmonaie

Question 40

What is the most common heart disease under the age of 4?

Answer 40

Congenital heart disease

Question 41

What are contributing factors to congenital heart disease?

Answer 41

- chromosomal abnormalities - familial patterns, Marfan’s, etc - environment: drugs, rubella/infectious disease, maternal diabetes/smoking/alcohol ** this is mostly just FYI **

Question 42

What is the kind of congenital heart disease that is asymptomatic at birth because it promotes left to right shunting of blood, allowing for adequate oxygenation of systemic arterial blood?

Answer 42

Acyanotic shunts

Question 43

What type of congenital heart disease is symptomatic at birth because it promotes right to left shunting of blood?

Answer 43

Cyanotic shunts

Question 44

Which shunt promotes L to R flow, which allows for adequate O2 of systemic arterial blood?

Answer 44

Acynotic shunts (eventually the shunt is overpowered and flow ends up reversing, which is when you find out) Contrast: Cyanotic shunts promote R to L flow, which is why there are symptoms at birth.

Question 45

Define and list the Tetralogy of Fallot (4)

Answer 45

Most common cause of neonatal cyanotic shunts 1 - interventricular septal defect 2 - overriding aorta 3 - pulmonary arterial stenosis 4 - RIGHT ventricular hypertrophy

Question 46

What is the inflammation and degeneration of endocardium and cardiac valves?

Answer 46

Endocarditis

Question 47

What kind of endocarditis gives rise to sterile valvular vegetations (fibrin, debris, other elements) which may become organized and deformed?

Answer 47

Non-bacterial (non-infectious) endocarditis E.g. thrombotic endocarditis, rheumatic fever, systemic lupus erythematosus

Question 48

What kind of endocarditis can be caused by virtually any infectious agent including opportunistic infections?

Answer 48

Infectious endocarditis

Question 49

What is an acute, systemic, posstreptococcal inflammatory disease (strep throat) that affects the joints, serosa, skin, CNS, blood vessels, and more, with the greatest effects on the heart valves?

Answer 49

Rheumatic fever (RF) which can lead to rheumatic heart disease

Question 50

The chronic phase of rheumatic fever is characterized by scarring and dysfxn of what

Answer 50

Cardiac valves

Question 51

In the chronic phase of rheumatic fever when there is scarring and dysfxn of cardiac valves, what characteristic feature will you see?

Answer 51

- Aschoff bodies which are small focal granulomas in the myocardium - pancarditis which is inflammation of all layers of the heart (“bread and butter pericarditis” which causes friction rub and adhesions) - valvular vegetations along lines of valve closures (most often on the left side of heart)

Question 52

What is a multisystemic autoimmune (AI) disorder with multiple autoantibodies

Answer 52

Systemic lupus erythematosus (SLE)

Question 53

What are the non-bacterial vegetations of cardiac valves associated with SLE?

Answer 53

Libman Sachs endocarditis | SLE, Systemic Lupus Erythematosus

Question 54

What valves are affected most often and are causes of heart failure and pulmonary congestion in most acquired valve disease?

Answer 54

Mitral (65-70%) and aortic (25%)

Question 55

The valve disease _______ _______ is most commonly caused by rheumatic fever. 2/3 patients are females.

Answer 55

Mitral stenosis

Question 56

The valve disease _______ _______ causes dilation and hypertrophy of left atrium, pulmonary hypertension and edema.

Answer 56

Mitral regurgitation

Question 57

The valve disease _______ _______ _______ is the 2nd most common valvular disorder. Usually asymptomatic but potential symptoms include vague chest pain, decreased exercise tolerance.

Answer 57

Mitral valve prolapse (floppy mitral valve)

Question 58

The valve disease _______ _______ is the most common valve abnormality. Reducing aortic aperture by 2/3+ contributes to left ventricular hypertrophy and complications. Calcification may extend into conducting tissue.

Answer 58

Aortic stenosis

Question 59

The valve disease _______ _______ occurs with dilation of aortic valve ring or degeneration of valve cusps (e.g. RF, endocarditis, AS, dissecting aneurysm or syphillis)

Answer 59

Aortic regurgitation

Question 60

The valves __________ and ________ are rarely affected by RF and may be slightly incompetent in healthy subjects.

Answer 60

Tricuspid and pulmonary

Question 61

Syphilitic heart disease is associated with what stage of syphilis?

Answer 61

Tertiary

Question 62

In syphilitic heart disease, the left ventricle hypertrophied 4x its normal size. What is the name of this?

Answer 62

Cor bovinum

Question 63

What is inflammation of the pericardium and what are contributing causes?

Answer 63

Pericarditis: infection, myocardial infarct, CT disorders, malignancy, radiation, idiopathic factors

Question 64

What kind of pericarditis is associated with invasive tumors and mild hypersensitivity disease and causes straw-colored abuminous fluid?

Answer 64

Serous pericarditis

Question 65

_________ pericarditis is characterized by shaggy fibrinous exudates on the pericardium caused by RF, SLE, cardiac surgery, trauma, myocardial infarction, irradiation, etc.

Answer 65

Fibrinous

Question 66

What kind of pericarditis is associated with pyogenic infections and accumulation of pus inside pericardium?

Answer 66

Suppurative pericarditis

Question 67

What kind of pericarditis is associated with TB?

Answer 67

Casseous pericarditis

Question 68

______ _________ are fluid accumulations within pericardium

Answer 68

Pericardial effusions Normal contains 30-50ml but can increase to 100-300ml with this condition

Question 69

_______ is associated with transudates from CHF and hypoproteinemia

Answer 69

Hydropericardium

Question 70

_______ is associated with lymphatic obstruction resulting in a “milky” fluid accumulates that contains fats absorbed and transported by lymph from small intestine

Answer 70

Chylous pericardium

Question 71

______ is hemorrhage into pericardium.

Answer 71

Hemopericardium Causes: thoracic trauma, ruptured aneurysms of heart or aorta, myocardial infarct, penetrating abscesses or tumors

Question 72

Constrictive pericarditis is associated with calcification scars that may become calcified. These are known as:

Answer 72

Concretio cordis

Question 73

“Heart muscle disease”

Answer 73

Cardiomyopathy

Question 74

Why does cardiomyopathy happen and what age group does it affect?

Answer 74

Don’t know; any age

Question 75

What kind of necrosis is seen with myocardial infarction?

Answer 75

Ischemic (Coagulation) necrosis

Question 76

_______ tissue is most poorly perfumed and most infarcts start out here as laminar infarcts.

Answer 76

Subendocardial

Question 77

Congenital narrowing of the aortic arch which restricts flow

Answer 77

Coarctation Called preductal/infantile coarctation if narrowing is severe and requires surgery early on Called postductal/adult coarctation if narrowing is less severe and permits longer survival

Question 78

Other than symptoms associated with the heart, what other symptoms are present in the chronic phase of rheumatic fever?

Answer 78

- migratory polyarthritis - syndeham’s chorea (worm-like movements) - subcutaneous nodules on extremities - erythema marginatum (spreading rash)

Question 79

Primary heart muscle disease of undetermined origin

Answer 79

Idiopathic Cardiomyopathy

Question 80

If anterior interventricular artery is occluded causing ischemia, what part of the heart is affected?

Answer 80

Anterior wall of L ventricle and adjacent septum

Question 81

If the right coronary artery is occluded causing ischemia, what part of the heart is affected?

Answer 81

Posterior wall of L ventricle and adjacent septum

Question 82

If the left circumflex artery is occluded and causes ischemia, what part of the heart is affected?

Answer 82

Lateral wall of L ventricle

Question 83

An abrupt onset of pulmonary hypertension due to sudden embolization, leading to right ventricular failure

Answer 83

Acute cor pulmonale

Question 84

Chronic pulmonary hypertension from COPD, emphysema or other pulmonary fibrosis/scarring, leading to right ventricular hypertrophy

Answer 84

Chronic cor pulmonale

Question 85

How does tertiary syphilis progress to heart disease?

Answer 85

It causes inflammation of primarily the ascending aorta (aortitis) which degenerates and scars the tunica media and causes “tree-braking” of the intima”. This causes dilation/aneurysm of the aorta and the media continues to degrade. Aneurysmal dilation of the proximal aorta will lead to left ventricular hypertrophy and aortic valvular insufficiency.