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Systems Pathology Final > Heart Pt. 2 > Flashcards

Heart Pt. 2 Flashcards

1
Q

What is the clinical term for a heart attack?

A

Myocardial infarction

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2
Q

Myocardial infarction always involves what structural change?

A

Myocardial necrosis

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3
Q

What is the lethality rate for a heart attack?

A

1/3

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4
Q

What is the most common cause of a heart attack?

A

Acute coronary artery thrombosis (90%)

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5
Q

What is the pathway for a heart attack caused by acute coronary artery thrombosis?

A

Ruptured atheroma –> vasospasm and coagulation –> rapid/severe coronary artery obstruction

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6
Q

What gender and age group are more at risk for heart attacks?

A

Males, ages 40-60

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7
Q

What are additional risks for myocardial infarctions?

A

Postmenopausal women, hypertension, smoking, diabetes, sickle cell disease, amyloidosis, congestive heart failure

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8
Q

Risks of what other cardiac condition resemble that of myocardial infarctions?

A

CAD

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9
Q

Which artery is most likely to be involved in a heart attack?

A

Left anterior descending coronary artery (40-50%)

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10
Q

Why is arrhythmia present with myocardial infarctions?

A

Electrical instability

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11
Q

What type of arrhythmia is associated with myocardial infarctions and 80-90% of sudden cardiac deaths?

A

Ventricular fibrillation

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12
Q

What is a common medication for thrombolysis?

A

t-PA

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13
Q

What are the side effects of cardiac reperfusion following survival of a heart attack?

A

Reactive oxygen species, hemorrhage, endothelial swelling leading to blocked capillaries, temporarily “stunned” myocardium

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14
Q

What kind of aid is needed for a few days following a myocardial infarction?

A

Temporary pump assistance

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15
Q

What is the treatment for a myocardial infarction?

A

CPR, defibrillation

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16
Q

What are treatment options following a myocardial infarction?

A

Thrombolytic/vasodilator meds, angioplasty, stent, bypass graft

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17
Q

What is the procedure that involves a graft as treatment following a heart attack?

A

Coronary artery bypass graft (CABG “cabbage”)

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18
Q

What is unique about the treatment used for angina pectoris when it comes to myocardial infarctions?

A

Nitroglycerine relieves angina pectoris but does NOT relieve angina from a myocardial infarction

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19
Q

Describe the pulse associated with a myocardial infarction?

A

Rapid and weak, “thready”

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20
Q

What percentage of myocardial infarctions are considered “silent” and smaller than normal?

A

10-15%

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21
Q

Elevations of what substances are seen in lab tests associated with heart attacks?

A

CK-MB and troponins (general myoglobin, as well)

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22
Q

Why are elevations of CK-MB and troponins better biomarkers for a heart attack when seen in a lab test?

A

Specific to CARDIAC muscle breakdown (myoglobin is seen with all muscle breakdown)

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23
Q

What is the lethality of heart attacks that occur outside of a hospital?

A

30%

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24
Q

What is the lethality of heart attacks in-hospital?

A

7%

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25
Q

What condition is likely to result following a survival of a heart attack?

A

Chronic ischemic heart disease

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26
Q

What is the prognosis for chronic ischemic heart disease following an M.I.?

A

Poor: recurring heart attack, arrhythmia, SCD, CHF

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27
Q

What are some features of chronic ischemic heart disease?

A

Hypertrophy and dilation of myocardium, walls rupturing due to weakness, arrhythmia, CHF, cardiogenic shock, pericarditis

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28
Q

Lethal arrhythmia/sudden cardiac death most commonly involves which chamber of the heart?

A

Left ventricle

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29
Q

What is unique about the symptoms of SCD?

A

No symptoms in previous 24 hours seen

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30
Q

What type of arrhythmia is seen in 80-90% of SDC cases?

A

Ventricular-fibrillation

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31
Q

What is sudden cardiac death?

A

Sudden/unexpected death resulting from sustained and lethal arrhythmia

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32
Q

What can improve the prognosis of SCD?

A

Defibrillation by an AED

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33
Q

What is an AED?

A

Automated external defibrillator (book calls it an automatic cardioverter-defibrillator)

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34
Q

What is commotio cordis?

A

“Agitation of the heart” due to precordial trauma

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35
Q

Does commotio cordis result in structural damage or heart disease?

A

No, simply disrupts heart rhythm

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36
Q

Who are at risk for commotio cordis?

A

Adolescent males, average age of 15 years

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37
Q

What is the treatment for commotio cordis?

A

Defibrillation

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38
Q

What is the prognosis for commotio cordis?

A

Poor: around 65% lethal

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39
Q

What type of hypertrophy presents with hypertensive heart disease?

A

The problematic type, concentric hypertrophy

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40
Q

What happens to the ventricles during hypertensive heart disease?

A

Dilation as an attempt to compensate

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41
Q

What is the cardiac decompensation we see following hypertensive heart disease?

A

Eventual loss of contractility due to increased metabolic demands that are unable to be met

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42
Q

What are the two types of hypertensive heart disease?

A

Systemic and pulmonary hypertensive heart disease

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43
Q

What sided heart disease is produced by systemic hypertensive heart disease?

A

Left sided

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44
Q

What systemic blood pressure level is associated with systemic hypertensive heart disease?

A

Greater than 140/90

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45
Q

Hypertrophy of which heart chamber is associated with systemic hypertensive heart disease?

A

Left ventricle

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46
Q

What type of valve defect could also present left ventricular hypertrophy similar to systemic hypertensive heart disease?

A

Aortic valve calcification

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47
Q

How can systemic hypertensive heart disease be managed and possibly reversed?

A

Reduction in blood pressure and management of hypertension

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48
Q

What conditions could result from systemic hypertensive heart disease?

A

Congestive heart failure, arrhythmia, SCD, cerebral infarction, renal failure

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49
Q

High blood pressure in what arteries is associated with pulmonary hypertensive heart disease?

A

Pulmonary arteries

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50
Q

Pulmonary hypertensive heart disease can be promoted by what lung pathologies?

A

Pulmonary fibrosis, cystic fibrosis, COPD, PE, scoliosis

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51
Q

Hypertrophy and dilation of which heart chamber is seen with pulmonary hypertensive heart disease?

A

Right ventricle

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52
Q

What sided heart failure is associated with pulmonary hypertensive heart disease?

A

Right sided

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53
Q

Cor pulmonale is associated with which type of hypertensive heart disease?

A

Pulmonary

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54
Q

A large pulmonary embolism and greater than 50% of pulmonary artery occlusion is seen with what version of pulmonary hypertensive heart disease?

A

Acute

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55
Q

Gradual right side ventricular hypertrophy due to a lung pathology is associated with which version of pulmonary hypertensive heart disease?

A

Chronic

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56
Q

What occurs with valvular stenosis?

A

Narrowing, failure to completely open

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57
Q

What is an insufficient valve?

A

Failure to appropriately close

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58
Q

How does valvular stenosis typically develop?

A

Calcification, scarring (chronic development)

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59
Q

What are other terms for an insufficient valve?

A

Regurgitations incompetence

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60
Q

What can lead to an insufficient valve?

A

Valvular destruction, abnormal supportive structures

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61
Q

What is the term for the noise heard due to turbulent flow through a diseased valve?

A

Heart murmur

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62
Q

What type of valvular disease is seen in 2% of births due to calcification?

A

Bicuspid aortic valve (instead of the usual three valves)

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63
Q

What is the most common cause of aortic valve stenosis?

A

Calcific aortic valve

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64
Q

What are some signs seen with early calcific aortic stenosis?

A

Murmur, decreased cardiac output

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65
Q

What are some signs seen with late calcific aortic stenosis?

A

Possible calcium deposits on X-ray

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66
Q

What is the usual age range for calcific aortic stenosis?

A

60-80 years due to wear and tear

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67
Q

What conditions accelerate calcific aortic stenosis?

A

Hypertension, inflammation

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68
Q

Is fusion common with calcific aortic valve stenosis?

A

No

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69
Q

In what type of valve disease is fusion common?

A

Rheumatic valve disease

70
Q

What type of infection leads to rheumatic valvular disease?

A

Group A beta-hemolytic strep infections (causative agent for strep throat)

71
Q

What age range is more at risk for rheumatic valvular disease?

A

5-15

72
Q

Rheumatic valvular disease follows what prior condition?

A

Pharyngitis (strep throat)

73
Q

What is the chance of strep throat leading to rheumatic fever if left untreated?

A

3%

74
Q

What percentage of people will develop rheumatic valvular disease following an untreated pharyngitis?

A

1.5%

75
Q

What is the most common sign of rheumatic fever seen in children?

A

Carditis

76
Q

What is the most common sign of rheumatic fever seen in adults?

A

Migratory polyarthritis

77
Q

What type of motion issue is associated with the signs of rheumatic fever?

A

Sydenham’s chorea (St. Vitus dance)

78
Q

What are some abnormal tests and measurements seen with rheumatic fever?

A

ECG, increased ESR, increased CRP

79
Q

What type of subcutaneous sign is seen with rheumatic fever?

A

Skin rash or subcutaneous (rheumatoid) nodules

80
Q

What is another term for rheumatic heart disease?

A

Pancarditis

81
Q

What are the most common valves affected by rheumatic valvular disease?

A 
#1 mitral valve
#2 aortic valve
82
Q

What are the groupings of fibrosis seen on the valves with rheumatic valvular disease in the acute stages?

A

Aschoff bodies

83
Q

Scarlet fever most commonly affects what group?

A

Children

84
Q

Scarlet fever is a reaction to a few strains of what?

A

Group A beta-hemolytic strep (same as strep throat/rheumatic fever)

85
Q

What is the unique secretion released from a few strains of Group A strep associated with scarlet fever?

A

Erythrogenic toxin

86
Q

What is the appearance of the rash associated with scarlet fever?

A

Pink punctate skin rash with multiple spots and sand-like texture

87
Q

Circumoral pallor is a unique characteristic of the rash associated with what disease?

A

Scarlet fever

88
Q

What is circumoral pallor?

A

Paleness around the mouth

89
Q

What are common locations for the rash associated with scarlet fever?

A

Neck, chest, axillae, groin, thighs

90
Q

Scarlet fever has the potential to transition into what condition?

A

Rheumatic fever

91
Q

What is most commonly the type of pathogen of infective endocarditis?

A

Bacteria

92
Q

What else besides bacteria can cause infective endocarditis?

A

Fungi

93
Q

What can usually be the cause of death with severe infective endocarditis?

A

Lethal arrhythmia or renal failure

94
Q

What bacterial agent is associated with the acute form of infective endocarditis?

A

Staph. aureus

95
Q

What bacterial agent is the culprit in subacute infective endocarditis?

A

Strep. viridans

96
Q

Which form of infective endocarditis is the most destructive and difficult to treat?

A

Acute

97
Q

Which form of infective endocarditis arises from previously abnormal tissue?

A

Subacute

98
Q

Which form of infective endocarditis is easier to treat?

A

Subacute

99
Q

Infective endocarditis is more commonly seen on what side of the heart?

A

Left (mitral and aortic valves)

100
Q

What are potential sources of infection that could cause infective endocarditis?

A

Skin infection, dental procedures, surgery

101
Q

What is the prognosis for infective endocarditis with prosthetic valves as treatment?

A

Even worse (15% cure)

102
Q

What is the most common type of prosthetic valves?

A

Mechanical

103
Q

The “blender effect” involving hemolysis is seen with what type of prosthetic valve as a consequence?

A

Mechanical

104
Q

What is a benefit of bioprosthetic valves?

A

No anti-coagulation

105
Q

What is an issue with both type of prosthetic valves?

A

Prone to infection (20% of infective endocarditis cases)

106
Q

Are cardiomyopathies usually a primary disorder or secondary to a systemic disorder?

A

Usually primary

107
Q

What is usually the cause of cardiomyopathies?

A

Most commonly idiopathic with genetic risks

108
Q

What is the most common group of cardiomyopathies?

A

Dilated

109
Q

What is the least common group of cardiomyopathies?

A

Restrictive

110
Q

What are the three groups of cardiomyopathies?

A

Dilated, hypertrophic, restrictive

111
Q

What group of cardiomyopathies involve progressive dilation of all heart chambers resulting in systolic dysfunction, dyspnea, and fatigue?

A

Dilated

112
Q

Dilated cardiomyopathies mimic what other condition?

A

Congestive heart failure

113
Q

What is the difference in how dilated and hypertrophic hearts are measured?

A

Dilated - overall weight of heart (can be 2-3X normal)

Hypertrophic - measure width of affected chamber

114
Q

What are risks for dilated cardiomyopathies?

A

Genetics (20-50%), viral infections, toxins like alcohol, hemochromatosis, decreased thiamine, dystrophinopathy

115
Q

What is the usual age range for dilated cardiomyopathies?

A

20-50

116
Q

What is the prognosis for most dilated cardiomyopathies?

A

Poor: only 25% 5-year survival rate

117
Q

What is the treatment for dilated cardiomyopathies?

A

Heart transplant or ventricular assist device

118
Q

What conditions are possible with dilated cardiomyopathies?

A

Mitral regurgitation, arrhythmia, thromboemboli

119
Q

What is the most common genetic association with hypertrophic cardiomyopathies?

A

Beta-myosin

120
Q

What specific part of the cardiac muscle is hyper-contractile in hypertrophic cardiomyopathies?

A

Sarcomeres

121
Q

What kind of dysfunction do we see with hypertrophic cardiomyopathies?

A

Diastolic (difficulty relaxing)

122
Q

What chamber is most likely to be affected greatly by hypertrophic cardiomyopathies leading to decreased stroke volume and cardiac output?

A

Left ventricle

123
Q

Asymmetrical septal hypertrophy is associated with what kind of cardiomyopathies? What is it?

A

Hypertrophic; ventricular septum > ventricular wall

124
Q

What other conditions can hypertrophic cardiomyopathies mimic?

A

Hypertension, CAD, atrial stenosis, amyloidosis

125
Q

What is the cause of 1/3 of sudden cardiac death among younger athletes?

A

Ventricular fibrillation associated with hypertrophic cardiomyopathies

126
Q

What is the ejection fraction associated with hypertrophic cardiomyopathies?

A

50-80%

127
Q

When are hypertrophic cardiomyopathies most commonly seen?

A

After puberty

128
Q

What is the term for the appearance of the ventricle in hypertrophic cardiomyopathy?

A

Banana like (elongated shape)

129
Q

What is the term for the murmur associated with hypertrophic cardiomyopathy?

A

Harsh murmur

130
Q

What is the least common type of cardiomyopathy?

A

Restrictive

131
Q

What type of dysfunction is seen with restrictive cardiomyopathy?

A

Diastolic resulting in decreased filling

132
Q

What race is more at risk for amyloidosis or senile cardiac amyloidosis?

A

African Americans (4X)

133
Q

How is the heart affected by restrictive cardiomyopathies?

A

Interstitial fibrosis leading to a stiff myocardium

134
Q

Endomyocardial fibrosis is most commonly seen among what group of people?

A

Pediatrics/young adults in Africa

135
Q

What is usually the cause of endomyocardial fibrosis among pediatrics and young adults in Africa?

A

Malnutrition and helminth infection

136
Q

Amyloidosis, endomyocardial fibrosis, and things like irradiation fall under what category of cardiomyopathies?

A

Restrictive

137
Q

What is the ejection fraction associated with restrictive cardiomyopathies?

A

45-90%

138
Q

What is the most common cause of myocarditis in the US?

A

Viral infections (Coxsackievirus A & B, HIV, CMV, influenza)

139
Q

What are some non-viral causes of myocarditis?

A

SLE, Lyme disease (5%), Chagas disease, ADRs

140
Q

What type of myocarditis is most common?

A

Acute

141
Q

What type of myocarditis involves aggressive multinucleate giant cells?

A

Chronic

142
Q

What type of myocarditis involves hypersensitivity reactions and possible necrosis?

A

Chronic

143
Q

What type of myocarditis involves diffuse lymphocytes?

A

Acute

144
Q

What type of myocarditis involves inflammation?

A

Both acute and chronic

145
Q

What is the most common cause of pericarditis?

A

Viral infection

146
Q

What could be primary causes of pericarditis?

A

Viral, bacterial, fungal

147
Q

What could be secondary causes of pericarditis?

A

Surgery, MI, irradiation, rheumatic fever, SLE, cancer

148
Q

What can result from the severe form of pericarditis?

A

Cardiac tamponade

149
Q

What are the signs and symptoms of pericarditis?

A

Atypical chest pain and friction rub

150
Q

Are most cardiac tumors primary or secondary?

A

Secondary (metastasis to heart from cancers of other organs)

151
Q

What is the most common type of cancer than metastasizes to the heart?

A

Lung cancer

152
Q

What cancers can metastasize to the heart?

A

Lung, lymphoma, breast, leukemia, melanoma, liver, colon

153
Q

Are more primary cardiac neoplasms benign or malignant?

A

Benign

154
Q

What is the most common benign primary cardiac neoplasm?

A

Myxoma (others = fibroma or lipoma)

155
Q

What benign primary cardiac neoplasm is associated with pediatrics?

A

Rhabdomyoma

156
Q

What is the most common malignant primary cardiac cancer?

A

Angiosarcoma

157
Q

What percentage of terminally ill cancer patients have secondary cardiac tumors?

A

5%

158
Q

What is the most common location for a myxoma (90%)?

A

On or near the fossa ovalis (left atrium)

159
Q

What kind of dysfunction can result from a myxoma?

A

Interference with valves

160
Q

How is a myxoma diagnosed?

A

Echocardiography

161
Q

How is a myxoma treated?

A

Surgical removal

162
Q

A possible “gelatinous appearance” is associated with what kind of cardiac tumor?

A

Myxoma

163
Q

Cardiac transplantation is a common treatment for what conditions?

A

Congestive heart failure or dilated cardiomyopathies

164
Q

What is the fatality rate change when cardiac transplants are administered?

A

Without treatment = 50% mortality per year

With transplant = 20%

165
Q

What are possible complications associated with cardiac transplants?

A

Acute cardiac rejection, allograft arteriopathy

166
Q

What is associated with an acute cardiac rejection?

A

Fever, decreased ejection fraction, arrhythmia, mural edema/thickening

167
Q

What is allograft arteriopathy?

A

Stenosis of coronary arteries

168
Q

Why is allograft arteriopathy lethal?

A

Can lead to a silent heart attack, CHF, or arrhythmia

169
Q

What kind of injury is associated with a transplant rejection?

A

T cell-mediated injury and myocyte damage

170
Q

What are the negative side effects of immunosuppressive medications for cardiac transplants?

A

Increased opportunistic infections and malignancy

Systems Pathology Final (2 decks)

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