Heart Pt. 2 Flashcards
1
Q
What is the clinical term for a heart attack?
A
Myocardial infarction
2
Q
Myocardial infarction always involves what structural change?
A
Myocardial necrosis
3
Q
What is the lethality rate for a heart attack?
A
1/3
4
Q
What is the most common cause of a heart attack?
A
Acute coronary artery thrombosis (90%)
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
6
Q
What gender and age group are more at risk for heart attacks?
A
Males, ages 40-60
7
Q
What are additional risks for myocardial infarctions?
A
Postmenopausal women, hypertension, smoking, diabetes, sickle cell disease, amyloidosis, congestive heart failure
8
Q
Risks of what other cardiac condition resemble that of myocardial infarctions?
A
CAD
9
Q
Which artery is most likely to be involved in a heart attack?
A
Left anterior descending coronary artery (40-50%)
10
Q
Why is arrhythmia present with myocardial infarctions?
A
Electrical instability
11
Q
What type of arrhythmia is associated with myocardial infarctions and 80-90% of sudden cardiac deaths?
A
Ventricular fibrillation
12
Q
What is a common medication for thrombolysis?
A
t-PA
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
14
Q
What kind of aid is needed for a few days following a myocardial infarction?
A
Temporary pump assistance
15
Q
What is the treatment for a myocardial infarction?
A
CPR, defibrillation
16
Q
What are treatment options following a myocardial infarction?
A
Thrombolytic/vasodilator meds, angioplasty, stent, bypass graft
17
Q
What is the procedure that involves a graft as treatment following a heart attack?
A
Coronary artery bypass graft (CABG “cabbage”)
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
19
Q
Describe the pulse associated with a myocardial infarction?
A
Rapid and weak, “thready”
20
Q
What percentage of myocardial infarctions are considered “silent” and smaller than normal?
A
10-15%
21
Q
Elevations of what substances are seen in lab tests associated with heart attacks?
A
CK-MB and troponins (general myoglobin, as well)
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)
23
Q
What is the lethality of heart attacks that occur outside of a hospital?
A
30%
24
Q
What is the lethality of heart attacks in-hospital?
A
7%
25
What condition is likely to result following a survival of a heart attack?
Chronic ischemic heart disease
26
What is the prognosis for chronic ischemic heart disease following an M.I.?
Poor: recurring heart attack, arrhythmia, SCD, CHF
27
What are some features of chronic ischemic heart disease?
Hypertrophy and dilation of myocardium, walls rupturing due to weakness, arrhythmia, CHF, cardiogenic shock, pericarditis
28
Lethal arrhythmia/sudden cardiac death most commonly involves which chamber of the heart?
Left ventricle
29
What is unique about the symptoms of SCD?
No symptoms in previous 24 hours seen
30
What type of arrhythmia is seen in 80-90% of SDC cases?
Ventricular-fibrillation
31
What is sudden cardiac death?
Sudden/unexpected death resulting from sustained and lethal arrhythmia
32
What can improve the prognosis of SCD?
Defibrillation by an AED
33
What is an AED?
Automated external defibrillator (book calls it an automatic cardioverter-defibrillator)
34
What is commotio cordis?
"Agitation of the heart" due to precordial trauma
35
Does commotio cordis result in structural damage or heart disease?
No, simply disrupts heart rhythm
36
Who are at risk for commotio cordis?
Adolescent males, average age of 15 years
37
What is the treatment for commotio cordis?
Defibrillation
38
What is the prognosis for commotio cordis?
Poor: around 65% lethal
39
What type of hypertrophy presents with hypertensive heart disease?
The problematic type, concentric hypertrophy
40
What happens to the ventricles during hypertensive heart disease?
Dilation as an attempt to compensate
41
What is the cardiac decompensation we see following hypertensive heart disease?
Eventual loss of contractility due to increased metabolic demands that are unable to be met
42
What are the two types of hypertensive heart disease?
Systemic and pulmonary hypertensive heart disease
43
What sided heart disease is produced by systemic hypertensive heart disease?
Left sided
44
What systemic blood pressure level is associated with systemic hypertensive heart disease?
Greater than 140/90
45
Hypertrophy of which heart chamber is associated with systemic hypertensive heart disease?
Left ventricle
46
What type of valve defect could also present left ventricular hypertrophy similar to systemic hypertensive heart disease?
Aortic valve calcification
47
How can systemic hypertensive heart disease be managed and possibly reversed?
Reduction in blood pressure and management of hypertension
48
What conditions could result from systemic hypertensive heart disease?
Congestive heart failure, arrhythmia, SCD, cerebral infarction, renal failure
49
High blood pressure in what arteries is associated with pulmonary hypertensive heart disease?
Pulmonary arteries
50
Pulmonary hypertensive heart disease can be promoted by what lung pathologies?
Pulmonary fibrosis, cystic fibrosis, COPD, PE, scoliosis
51
Hypertrophy and dilation of which heart chamber is seen with pulmonary hypertensive heart disease?
Right ventricle
52
What sided heart failure is associated with pulmonary hypertensive heart disease?
Right sided
53
Cor pulmonale is associated with which type of hypertensive heart disease?
Pulmonary
54
A large pulmonary embolism and greater than 50% of pulmonary artery occlusion is seen with what version of pulmonary hypertensive heart disease?
Acute
55
Gradual right side ventricular hypertrophy due to a lung pathology is associated with which version of pulmonary hypertensive heart disease?
Chronic
56
What occurs with valvular stenosis?
Narrowing, failure to completely open
57
What is an insufficient valve?
Failure to appropriately close
58
How does valvular stenosis typically develop?
Calcification, scarring (chronic development)
59
What are other terms for an insufficient valve?
Regurgitations incompetence
60
What can lead to an insufficient valve?
Valvular destruction, abnormal supportive structures
61
What is the term for the noise heard due to turbulent flow through a diseased valve?
Heart murmur
62
What type of valvular disease is seen in 2% of births due to calcification?
Bicuspid aortic valve (instead of the usual three valves)
63
What is the most common cause of aortic valve stenosis?
Calcific aortic valve
64
What are some signs seen with early calcific aortic stenosis?
Murmur, decreased cardiac output
65
What are some signs seen with late calcific aortic stenosis?
Possible calcium deposits on X-ray
66
What is the usual age range for calcific aortic stenosis?
60-80 years due to wear and tear
67
What conditions accelerate calcific aortic stenosis?
Hypertension, inflammation
68
Is fusion common with calcific aortic valve stenosis?
No
69
In what type of valve disease is fusion common?
Rheumatic valve disease
70
What type of infection leads to rheumatic valvular disease?
Group A beta-hemolytic strep infections (causative agent for strep throat)
71
What age range is more at risk for rheumatic valvular disease?
5-15
72
Rheumatic valvular disease follows what prior condition?
Pharyngitis (strep throat)
73
What is the chance of strep throat leading to rheumatic fever if left untreated?
3%
74
What percentage of people will develop rheumatic valvular disease following an untreated pharyngitis?
1.5%
75
What is the most common sign of rheumatic fever seen in children?
Carditis
76
What is the most common sign of rheumatic fever seen in adults?
Migratory polyarthritis
77
What type of motion issue is associated with the signs of rheumatic fever?
Sydenham's chorea (St. Vitus dance)
78
What are some abnormal tests and measurements seen with rheumatic fever?
ECG, increased ESR, increased CRP
79
What type of subcutaneous sign is seen with rheumatic fever?
Skin rash or subcutaneous (rheumatoid) nodules
80
What is another term for rheumatic heart disease?
Pancarditis
81
What are the most common valves affected by rheumatic valvular disease?
```
#1 mitral valve
#2 aortic valve
```
82
What are the groupings of fibrosis seen on the valves with rheumatic valvular disease in the acute stages?
Aschoff bodies
83
Scarlet fever most commonly affects what group?
Children
84
Scarlet fever is a reaction to a few strains of what?
Group A beta-hemolytic strep (same as strep throat/rheumatic fever)
85
What is the unique secretion released from a few strains of Group A strep associated with scarlet fever?
Erythrogenic toxin
86
What is the appearance of the rash associated with scarlet fever?
Pink punctate skin rash with multiple spots and sand-like texture
87
Circumoral pallor is a unique characteristic of the rash associated with what disease?
Scarlet fever
88
What is circumoral pallor?
Paleness around the mouth
89
What are common locations for the rash associated with scarlet fever?
Neck, chest, axillae, groin, thighs
90
Scarlet fever has the potential to transition into what condition?
Rheumatic fever
91
What is most commonly the type of pathogen of infective endocarditis?
Bacteria
92
What else besides bacteria can cause infective endocarditis?
Fungi
93
What can usually be the cause of death with severe infective endocarditis?
Lethal arrhythmia or renal failure
94
What bacterial agent is associated with the acute form of infective endocarditis?
Staph. aureus
95
What bacterial agent is the culprit in subacute infective endocarditis?
Strep. viridans
96
Which form of infective endocarditis is the most destructive and difficult to treat?
Acute
97
Which form of infective endocarditis arises from previously abnormal tissue?
Subacute
98
Which form of infective endocarditis is easier to treat?
Subacute
99
Infective endocarditis is more commonly seen on what side of the heart?
Left (mitral and aortic valves)
100
What are potential sources of infection that could cause infective endocarditis?
Skin infection, dental procedures, surgery
101
What is the prognosis for infective endocarditis with prosthetic valves as treatment?
Even worse (15% cure)
102
What is the most common type of prosthetic valves?
Mechanical
103
The "blender effect" involving hemolysis is seen with what type of prosthetic valve as a consequence?
Mechanical
104
What is a benefit of bioprosthetic valves?
No anti-coagulation
105
What is an issue with both type of prosthetic valves?
Prone to infection (20% of infective endocarditis cases)
106
Are cardiomyopathies usually a primary disorder or secondary to a systemic disorder?
Usually primary
107
What is usually the cause of cardiomyopathies?
Most commonly idiopathic with genetic risks
108
What is the most common group of cardiomyopathies?
Dilated
109
What is the least common group of cardiomyopathies?
Restrictive
110
What are the three groups of cardiomyopathies?
Dilated, hypertrophic, restrictive
111
What group of cardiomyopathies involve progressive dilation of all heart chambers resulting in systolic dysfunction, dyspnea, and fatigue?
Dilated
112
Dilated cardiomyopathies mimic what other condition?
Congestive heart failure
113
What is the difference in how dilated and hypertrophic hearts are measured?
Dilated - overall weight of heart (can be 2-3X normal)
| Hypertrophic - measure width of affected chamber
114
What are risks for dilated cardiomyopathies?
Genetics (20-50%), viral infections, toxins like alcohol, hemochromatosis, decreased thiamine, dystrophinopathy
115
What is the usual age range for dilated cardiomyopathies?
20-50
116
What is the prognosis for most dilated cardiomyopathies?
Poor: only 25% 5-year survival rate
117
What is the treatment for dilated cardiomyopathies?
Heart transplant or ventricular assist device
118
What conditions are possible with dilated cardiomyopathies?
Mitral regurgitation, arrhythmia, thromboemboli
119
What is the most common genetic association with hypertrophic cardiomyopathies?
Beta-myosin
120
What specific part of the cardiac muscle is hyper-contractile in hypertrophic cardiomyopathies?
Sarcomeres
121
What kind of dysfunction do we see with hypertrophic cardiomyopathies?
Diastolic (difficulty relaxing)
122
What chamber is most likely to be affected greatly by hypertrophic cardiomyopathies leading to decreased stroke volume and cardiac output?
Left ventricle
123
Asymmetrical septal hypertrophy is associated with what kind of cardiomyopathies? What is it?
Hypertrophic; ventricular septum > ventricular wall
124
What other conditions can hypertrophic cardiomyopathies mimic?
Hypertension, CAD, atrial stenosis, amyloidosis
125
What is the cause of 1/3 of sudden cardiac death among younger athletes?
Ventricular fibrillation associated with hypertrophic cardiomyopathies
126
What is the ejection fraction associated with hypertrophic cardiomyopathies?
50-80%
127
When are hypertrophic cardiomyopathies most commonly seen?
After puberty
128
What is the term for the appearance of the ventricle in hypertrophic cardiomyopathy?
Banana like (elongated shape)
129
What is the term for the murmur associated with hypertrophic cardiomyopathy?
Harsh murmur
130
What is the least common type of cardiomyopathy?
Restrictive
131
What type of dysfunction is seen with restrictive cardiomyopathy?
Diastolic resulting in decreased filling
132
What race is more at risk for amyloidosis or senile cardiac amyloidosis?
African Americans (4X)
133
How is the heart affected by restrictive cardiomyopathies?
Interstitial fibrosis leading to a stiff myocardium
134
Endomyocardial fibrosis is most commonly seen among what group of people?
Pediatrics/young adults in Africa
135
What is usually the cause of endomyocardial fibrosis among pediatrics and young adults in Africa?
Malnutrition and helminth infection
136
Amyloidosis, endomyocardial fibrosis, and things like irradiation fall under what category of cardiomyopathies?
Restrictive
137
What is the ejection fraction associated with restrictive cardiomyopathies?
45-90%
138
What is the most common cause of myocarditis in the US?
Viral infections (Coxsackievirus A & B, HIV, CMV, influenza)
139
What are some non-viral causes of myocarditis?
SLE, Lyme disease (5%), Chagas disease, ADRs
140
What type of myocarditis is most common?
Acute
141
What type of myocarditis involves aggressive multinucleate giant cells?
Chronic
142
What type of myocarditis involves hypersensitivity reactions and possible necrosis?
Chronic
143
What type of myocarditis involves diffuse lymphocytes?
Acute
144
What type of myocarditis involves inflammation?
Both acute and chronic
145
What is the most common cause of pericarditis?
Viral infection
146
What could be primary causes of pericarditis?
Viral, bacterial, fungal
147
What could be secondary causes of pericarditis?
Surgery, MI, irradiation, rheumatic fever, SLE, cancer
148
What can result from the severe form of pericarditis?
Cardiac tamponade
149
What are the signs and symptoms of pericarditis?
Atypical chest pain and friction rub
150
Are most cardiac tumors primary or secondary?
Secondary (metastasis to heart from cancers of other organs)
151
What is the most common type of cancer than metastasizes to the heart?
Lung cancer
152
What cancers can metastasize to the heart?
Lung, lymphoma, breast, leukemia, melanoma, liver, colon
153
Are more primary cardiac neoplasms benign or malignant?
Benign
154
What is the most common benign primary cardiac neoplasm?
Myxoma (others = fibroma or lipoma)
155
What benign primary cardiac neoplasm is associated with pediatrics?
Rhabdomyoma
156
What is the most common malignant primary cardiac cancer?
Angiosarcoma
157
What percentage of terminally ill cancer patients have secondary cardiac tumors?
5%
158
What is the most common location for a myxoma (90%)?
On or near the fossa ovalis (left atrium)
159
What kind of dysfunction can result from a myxoma?
Interference with valves
160
How is a myxoma diagnosed?
Echocardiography
161
How is a myxoma treated?
Surgical removal
162
A possible "gelatinous appearance" is associated with what kind of cardiac tumor?
Myxoma
163
Cardiac transplantation is a common treatment for what conditions?
Congestive heart failure or dilated cardiomyopathies
164
What is the fatality rate change when cardiac transplants are administered?
Without treatment = 50% mortality per year
| With transplant = 20%
165
What are possible complications associated with cardiac transplants?
Acute cardiac rejection, allograft arteriopathy
166
What is associated with an acute cardiac rejection?
Fever, decreased ejection fraction, arrhythmia, mural edema/thickening
167
What is allograft arteriopathy?
Stenosis of coronary arteries
168
Why is allograft arteriopathy lethal?
Can lead to a silent heart attack, CHF, or arrhythmia
169
What kind of injury is associated with a transplant rejection?
T cell-mediated injury and myocyte damage
170
What are the negative side effects of immunosuppressive medications for cardiac transplants?
Increased opportunistic infections and malignancy
