Lecture 1 - CVS and Heart Pathologies

Question 1

what are the 5 main CVD’s?

Answer 1

congenital HD
ischemic vascular disease
HTN - related disease
inflammatory disease (infection/autoimmune)
metabolic disease

Question 2

which week of pregnancy is the heart completely formed and functional?

Answer 2

10th week of pregnancy

Question 3

what are 4 causes of congenital heart disease?

Answer 3

viral infections (rubella)
toxins (FAS)
chromosomal abnormalities (Down’s syndrome)
x-ray exposure

Question 4

what is the best known cause for congenital heart defects?

Answer 4

rubella virus - during organogenesis (first trimester)

Question 5

heart defects are often associated with that chromosomal abnormality?

Answer 5

Down’s - trisomy 21

Question 6

what are two examples of congenital heart defects?

Answer 6

isolated, simple septal defect (atrial and ventricular septal defects)
complex heart defect - tetralogy of fallot

Question 7

what is the most common form a congenital heart disease?

Answer 7

interatrial and interventricular septal defects (30-40%)

Question 8

septal defects may occur as isolated defects (most common) or may be part of_____

Answer 8

complex malformation syndromes

Question 9

interatrial septal defects may occur due to what 2 events?

Answer 9

incomplete formation of septum

incomplete closure of foramen ovale

Question 10

atrial septal defects are recognized clinically by a murmur caused by….

Answer 10

passage of blood from the left to right atrium during systole

Question 11

what is more common interatrial or interventricular septal defects?

Answer 11

interventricular (occurs most often in uppermost part of the septum - most present with no sx)

Question 12

what causes symptoms from a interventricular septal defect?

Answer 12

mix of oxygenated and de-oxygenated blood

Question 13

with interventricular septal defects, what causes right ventricular hypertrophy and pulmonary hypertension?

Answer 13

left to right shunt (=dyspnea)

Question 14

what is the result of a right to left shunt?

Answer 14

de-oxygenated blood enters systemic circulation causing cyanosis

Question 15

what does overriding the aorta mean in relation to tetralogy of Fallot?

Answer 15

aorta is positioned more to the right, directly over a ventricular septal defect instead of LV

Question 16

what are the 4 components of tetralogy of fallot?

Answer 16

overriding aorta
pulmonary stenosis
RV hypertrophy
ventricular septal defect

Question 17

define ‘atheromas’

Answer 17

fatty deposit in inner lining (intima) of an artery - central part is soft, covered by fibrous tissue

Question 18

T or F: atheromas are highly thrombogenic?

Answer 18

True

Question 19

what are 2 components of a sclerotic aorta that can lead to hypertension and in turn the formation of an aneurysm?

Answer 19

cannot adapt to changes in BP (decreased elasticity)

cannot expand during systole

Question 20

what are 3 complications of aortic aneurysms, which are often clinically silent?

Answer 20

may rupture=sudden death
emboli
pressure on neighboring organs/tissues

Question 21

what is a common cause of PVD?

Answer 21

atherosclerosis involving extremities and major abdominal organs - kidneys and intestines

Question 22

what happens to the kidneys if aortic atherosclerosis spreads into renal arteries?

Answer 22

reduces kidneys functional capacity - increases release of renin and reduces excretion of sodium which increases BP - HTN will permanently damage kidneys

Question 23

PVD of the intestines most common form is chronic ischemia of intestinal vessels which may cause what?

Answer 23

constipation, poor digestion, malabsorption and food intolerance

Question 24

define ‘coronary heart disease’

Answer 24

pathologic condition of myocardium caused by lack of oxygen (atherosclerosis of coronary arteries is the most important factor)

Question 25

define ‘myocardial infarction’

Answer 25

sudden (acute) occlusion of a coronary artery

Question 26

what coronary artery’s sudden occlusion is the most common in terms of an MI?

Answer 26

descending branch of left coronary artery (50%)
(R coronary 30-40%)
(left circumflex 15-20%)

Question 27

progressive ischemia of the heart leads to what?

Answer 27

congestive heart failure

Question 28

what are the 3 most important clinical presentations of coronary heart disease?

Answer 28

congestive heart failure
angina pectoris
MI

Question 29

what are 2 physiologic characteristics of congestive heart failure?

Answer 29

heart is unable to pump enough blood

back pressure from stagnant blood impedes venous return to heart

Question 30

right ventricular failure causes what?

Answer 30

congestion of peripheral organs and extremities (leads to hepatomegaly and pain in right hypochondriac region and ascites)

Question 31

left ventricular failure leads to what?

Answer 31

pulmonary congestion and edema (failure of LV to maintain normal output of blood)

Question 32

what is post infarction angina due to?

Answer 32

residual ischemia that lasts longer then 15 minutes

Question 33

what is prinzmetal’s-vasospastic angina?

Answer 33

unrelated to exertion, more common in women

Question 34

what is decubitus angina?

Answer 34

unrelated to exertion, not relieved by rest, reduced when sitting or standing, more common in women

Question 35

what may angina in women feel like?

Answer 35

inhaling cold air, weakness, lethargy

Question 36

what is sudden death mostly due to in terms of a MI?

Answer 36

a major arrhythmia (ventricular fibrilation) and subsequent heart failure or cardiac arrest

Question 37

define ‘prodromal’

Answer 37

period between the appearance of initial symptoms and the full development of condition

Question 38

what are 3 prodromal symptoms 2/3 of patients experience with an MI?

Answer 38

sudden, severe and progressive angina, partially relieved or not relieved by rest or nitroglycerine
SOB
fatigue and profuse sweating

Question 39

what is a highly specific serum enzyme level elevation related to MI?

Answer 39

troponin I or T in blood, 3-6 hours after occulsion

Question 40

what are 4 early complications of an MI?

Answer 40

arrhythmia (90%)
CHF (60%)
cardiogenic shock (12%)
heart-wall rupture (1%)

Question 41

what are 3 late complications of an MI?

Answer 41

CHF (70%)
arrhythmia (20%)
thromboembolism (10%)