Heart Path Lecture 1

Question 1

What 3 changes happen to the myocardium and chambers of the heart due to aging?

Answer 1

1. ) Increase LV size
2. ) Increased epicardial fat
3. ) Lipofuscin and basophilic degeneration

Question 2

What changes occur to the valves of the heart due to aging?

Answer 2

1. ) aortic and mitral valve calcification
2. ) fibrous thickening
3. ) Mitral leaflets buckle towards LA, increasing the size of the left atrium
4. ) Lambl excrescences (due to small thrombi)

Question 3

The hypertrophied heart is vulnerable to what?

Answer 3

ischemia related decompensation

Question 4

In the setting of pressure overload hypertrophy..? (HTN)

Answer 4

Myocytes become thicker (wider) and the LV increases concentrically

Question 5

In the setting of volume overload hypertrophy..? (MI)

Answer 5

Myocytes elongate and ventricular dilation is seen

Question 6

Left sided heart failure is most commonly a result of?

Answer 6

1. ) MI
2. ) HTN
3. ) Left sided valve dz.
4. ) Myocardial dz.

Question 7

What results clinically as a result of left sided heart failure?

Answer 7

Congestion in pulmonary circulation and decreased systemic perfusion

Question 8

What occurs morphologically as a result of left sided heart failure?

Answer 8

1. ) LVH
2. ) LA dilation -> a-fib, thrombus
3. ) Decreased EF -> decreased glomerular perfusion

Question 9

What are heart failure cells?

Answer 9

Hemosiderin laden macrophages

Question 10

What is the most common cause of right sided heart failure?

Answer 10

Left sided heart failure

Question 11

What happens to the liver as a result of right sided HF?

Answer 11

nutmeg liver

Question 12

What happens to the spleen as a result of right sided CHF

Answer 12

splenomegaly

Question 13

What is the most common cause of congenital heart dz?

Answer 13

Down syndrome. 40% of DS patients have a heart defect

Question 14

What pathways are associated with congenital heart dz?

Answer 14

Notch 1 (bicuspid aortic valve)
Jag1 and Notch 2 (tetralogy of fallot)

Question 15

When are ASD’s asymptomatic until?

Answer 15

> 30yo

Question 16

90% os ASDs are?

Answer 16

ostium secundum

Question 17

Left to right shunting leads to?

Answer 17

1. ) pulmonary HTN
2. ) paradoxical embolus
3. ) right sided CHF

Question 18

A PFO is what kind of defect?

Answer 18

ASD. R->L with increased pressure

Question 19

What can a PFO cause?

Answer 19

paradoxical embolus

Question 20

What is the most common cause of congenital heart dz?

Answer 20

VSD

Question 21

Large VSDs can lead to?

Answer 21

1. ) RVH
2. ) pulmonary HTN
3. ) reversal and cyanosis

Question 22

90% of MI’s are caused by?

Answer 22

atheromatous plaques

Question 23

LAD infarction (40-50%)

Answer 23

Apex, LV anterior wall, anterior 2/3 of septum

Question 24

RCA infarction (30-40%)

Answer 24

RV free wall, LV posterior wall, posterior 1/3 of septum

Question 25

LCX (15-20%)

Answer 25

LV lateral wall

Question 26

Troponin T and I rises how many hours after an MI?

Answer 26

3-12

Question 27

Troponin T peak somewhere between?

Answer 27

12-48 hrs post MI

Question 28

Troponin I peak at?

Answer 28

24 hours post MI

Question 29

CK MB rises?

Answer 29

3-12 hrs post MI

Question 30

CK MB peaks?

Answer 30

24 hrs

Question 31

CK MB normalizes?

Answer 31

48-72 hrs

Question 32

Troponin I normalizes?

Answer 32

5-10 days after

Question 33

Troponin T normalizes?

Answer 33

5-14 days after

Question 34

When does a myocardial rupture occur?

Answer 34

2-4 days post MI

Question 35

Which one peaks first?

Answer 35

myoglobin