PATH Flashcards
1
Q
define hemodynamics
A
flow of blood
2
Q
systole
A
blood pumping phase of the cardiac cycle
3
Q
diastole
A
chamber filling phase of the cardiac cycle
4
Q
preload
A
the ventricular wall tension at teh end of diastole (degree of myocyte stretch) determined by end-diastolic volume, reflected in end-diastolic pressure
5
Q
afterload
A
the resistance the ventricle must overcome to pump its contents, determined by systolic blood pressure, reflected in ventricular systolic pressure
6
Q
myocardial contractility
A
inotropic state determining the portion of the force of contraction independently of preload and afterload
7
Q
compliance
A
the distendibility of the ventricle, determining the ease of filling it and indirectly, the amount of filling and hence the amount of blood pumped
8
Q
heart failure
A
inability of the heart to pump sufficient blood to meet the needs of the body
9
Q
B-type natriuretic peptide
A
a hormone secreted by left ventricle in heart failure in proportion to the severity
10
Q
normal LV EDV
A
150 mL
11
Q
normal LV End-systolic volume
A
50 mL
12
Q
normal stroke volume
A
100 mL
13
Q
normal ejection fraction
A
67%
14
Q
normal LV end diastolic pressure
A
11 mmHg
15
Q
normal LV systolic pressure
A
130 mmHg
16
Q
normal RA pressure
A
3 mmHg
17
Q
normal RV systolic pressure
A
25 mmHg
18
Q
normal LA pressure
A
8 mmHg
19
Q
what percentage reduction in forward stroke volume is the threshold for heart failure
A
25% reduction
20
Q
what are 5 major modifiable risk factors for heart disease
A
smoking HTN obesity diabetes dyslipidemia
21
Q
what does B-type natriuretic peptide do?
A
it causes you to excrete sodium and water, it is counterregulatory
22
Q
Severe acute uncompensated aortic regurgitation is a __________________
A
surgical emergency
23
Q
what is diastolic dysfunction
A
impaired cardiac filling
24
Q
what is systolic dysfunction
A
impaired cardiac pumping
25
heart disease due to aortic stenosis severe hypertension or CAD typically ____________the ejection fraction
lowers
26
heart failure due to left ventricular hypertophy, restrictive cardiomyopathy or pericardial disease is typically with ______________ in ejection fraction
preservation
27
what is restrictive cardiomyopathy
when ventricular compliance decreases below the ability of the atrium to fill it normally it restricts (impairs) cardiac pumping
28
what is the most common cause of right heart failure
left heart failure
29
Sudden cardiac death is 3x more common in __________
males
30
approximately _________% of sudden cardiac deaths are attributed to CAD.
80%
31
Sudden cardiac death is usually due to_____________
ventricular tachyarrhythmia
32
what is automaticity
cell's ability to depolarize itself to a threshold generating a spontaneous action potential
33
what is the most common cause of prolonged QT interval
myocardial ischemia (ischemic heart disease)
34
what do you call it if all QRS complexes look alike
monomorphic
35
what do you call it when the QRS complexes vary in morphology
polymorphic
36
what is the most common tachyarrhythmia
atrial fibrillation
37
what is the 2nd most comon tachyarrhythmia
atrial flutter
38
what is the risk of early afterdepolarizations
ventricular tachycardia
39
what is the risk of ventricular tachycardia
sudden cardiac death
40
about how many babies, children and young adults die of channelopathies in US each year
4,000
41
____________ of a channelopathy could save a young person's life
recognizing the EKG signs
42
define compensated heart failure
if dilated ventricle is able to maintain CO w/ heart failure
43
pressure overload effect on the heart
concentric hypertrophy (wall-thickening)
44
volume overload on the heart
dilation of ventricle (eccentric hypertrophy)
45
what is stenosis
failure of a valve to open completely, obstructing forward flow
46
what is valvular insufficiency
results from failure of a valve to close completely thereby allowing regurgitation of blood
47
antibodies to which protein on group A strep are responsible for rheumatic valvular disease
M-protein
48
what is most common cause of death in the US?
atherosclerotic CV disease
49
Atherosclerosis happens in which 2 categories of arteries?
medium (muscular) arteries
large elastic arteries
favors branchpoints
50
name the factors that mediate the recruitment of leukocytes into the tunica intima during atherosclerosis. (4)
Leukocyte adhesion molecules (LAM)
monocyte chemotactic protein 1
IFN-inducible protein 10
IL-8
51
name the 4 factors that mediate recruitment of smooth muscle cells into the tunica intima during atherosclerosis
PDGF
TNF-alpha
TGF-beta
IL-1
52
name the 4 factors that mediated ECM production by smooth muscle cells in atherosclerosis
IL-1
TNF-alpha
TGF-beta
FGF
53
what is atheroma
composed of amorphous eosinophilic debris, cholesterol clefts, fibrin, smooth muscle cells and foam cells
54
what is the fibrous cap of an atheroma composed of?
collagen
proliferating smooth muscle cells
macrophages
lymphocytes
55
what is a bad side effect of neovascularization?
the new abnormal blood vessels that are created are prone to rupture
56
what are the 3 main factors that predispose to thrombosis?
endothelial injury
hypercoagulability
abnormal blood flow (stasis & turbulence)
57
what is likely to happen after a plaque rupture?
thrombosis leading to 100% occlusion (transmural) of the artery and subsequent myocardial infarction
58
what is the most fearsome of the complications of atherosclerosis?
superimposed thrombosis
59
which 2 categories of arteries are involved in atherosclerosis?
Large elastic arteries
| medium muscular arteries
60
why does having more smooth muscle cells in a plaque indicate a greater mechanical strength?
in plaques the smooth muscle cells make collagen, the more collagen you have, the more stable you are
61
what are Nichols' 5 steps of atherosclerosis?
1. malfunction of injured endothelial cells
2. accumulation of lipid in tunica intima
3. wbc recruitment into tunica intima
4. foam cell formation
5. ECM deposition
62
how does LDL get trapped into the tunica intima in the 2nd step of atherosclerosis?
LDL trapped by binding to ECM proteoglycans whose production is increased by HTN
63
90% of myocardial infarctions are due to ______________________
coronary atherosclerosis
64
what are stunned myocytes?
myocytes injured by acute ischemia which look normal but need time to repair before they work normally again
65
what are stunned myocytes?
myocytes injured by acute ischemia which look normal but need time to repair before they work normally again
66
term for chornically ischemic myocytes, which have cleared cytoplasm due to catabolism of their contractile proteins and need time to regenerate their contractile proteins before they work again
hibernating myocytes
67
term for chornically ischemic myocytes, which have cleared cytoplasm due to catabolism of their contractile proteins and need time to regenerate their contractile proteins before they work again
hibernating myocytes
68
term for light microscopic appearance of hibernating myocytes
myocytolysis
69
term for light microscopic appearance of hibernating myocytes
myocytolysis
70
term for resistance to mild-mod. ischemia due to induction of protective proteins by brief episodes of ischemia
ischemic preconditioning
71
term for resistance to mild-mod. ischemia due to induction of protective proteins by brief episodes of ischemia
ischemic preconditioning
72
term for dead myocytes w/ dense hypereosinophilic transverse bands of hypercontracted sarcomeres, associated w/ reperfusion
contraction band necrosis
73
term for dead myocytes w/ dense hypereosinophilic transverse bands of hypercontracted sarcomeres, associated w/ reperfusion
contraction band necrosis
74
term for failure of relieving obstruction at the arterial level to restore blood flow, attributed to microvascular obstruction or edema
no reflow phenomenon
75
term for failure of relieving obstruction at the arterial level to restore blood flow, attributed to microvascular obstruction or edema
no reflow phenomenon
76
term for hemorrhage and other problems associated with bringing oxygen and Ca2+ to injured tissue, attributed to ROS and metabolic effects of Ca2+
reperfusion injury
77
term for hemorrhage and other problems associated with bringing oxygen and Ca2+ to injured tissue, attributed to ROS and metabolic effects of Ca2+
reperfusion injury
78
term for abnormal localized dilatation of an artery vein or heart
aneurysm
79
term for: contains ruptures of the tunica intima and media and sometimes even adventitia of an artery
pseudoaneurysm
80
term for: catastrophic tear of the tunica intima letting luminal blood under high pressure into the tunica media, where it tunnels a second lumen
aortic dissection
81
term for: ischemic pain of the periphery, usually legs, usually calves, usually intermittent, usually brought on by exertion and relieved by rest
claudication
82
alternate name for thromboangiitis obliterans, a chronic thrombosing inflammatory disease of small and medium arteries and veins of arms and legs
Buerger disease
83
ectasia
a generalized dilatation usually associated w/ aging
84
what are the 5 P's of acute arterial occlusion?
```
pain
pallor
paralysis
parathesia
pulselessness
```
85
which chronic thrombosing inflammatory disease has a very strong association with smoking?
Buerger's disease
86
you have an elderly white female come in with diplopia, jaw claudication, and a swollen tender artery, what does she have?
temporal (giant cell) arteritis
87
term for chronic autoimmune inflammatory disease of muscles that some regard as one end of a spectrum w/ temporal arteritis on the other end and the combo in the middle
polymyalgia rheumatica
88
prompt diagnosis and treatment of _________________ can save young asian baby boys from chronic heart disease of death.
Kawasaki's disease
89
term for simultaneous inflamm. of myocardium and pericardium commonly attributed to viral infection
myopericarditis
90
term for JVD, muffled heart sounds and hypotension, signs of cardiac tamponade
Beck's triad
91
term for an exaggeration of the normal decrease in BP w/ inspiration >10 mm Hg systolic, associated w/ cardiac tamponade or asthma
pulsus paradoxus
92
term for superficial scratchy or squeaking sound, frequently triphasic associated w/ acute pericarditis
pericardial friction rub
93
term for heterogeneous group of myocardial diseases associated w/ mechanical and or electrical dysfunction of the heart
cardiomyopathy
94
term for group of genetic diseases w/ hypertrophy as a compensatory mechanism for mutations in genes encoding contractile proteins of the cardiac sarcomere
hypertrophic cardiomyopathy
95
term for wastebasket category of nonspecific end stage heart disease w/ cardiac dilatation and heart failure and no cause evident
idiopathic dilated cardiomyopathy
96
term for benign gelatinous mesenchymal neoplasm of endocardium
cardiac myxoma
97
what is the most common disease of the pericardium?
acute pericarditis
98
what is the most common cause of death in young athletes?
hypertrophic cardiomyopathy
99
term for hypertrophic cardiomyopathy with features of asymmetric septal hypertrophy and subaortic stenosis
hypertrophic obstructive cardiomyopathy
100
if you have an african american who comes in with arrhythmias, causing syncope, or sudden death, what do you think he had?
cardiac sarcoidosis
101
leg edema, hepatomegaly, ascite and JVD can all be manifestations of ____________________
right heart failure
102
what do you call afterdepolarizaitons that occur during phase 2 or phase 3
early afterdepolarizations
103
what do you call afterdepolarizations that occur during phase 4
delayed afterdepolarizations (associated with high intracellular levels of calcium, can happen w/ digoxin or marked catecholamine stimulation)
104
a cardiac arrhythmia, especially heart block, in a young AA suggests the possibility of _________________
cardiac sarcoidosis
105
what is normal QTc?
440 milliseconds
106
what are asteroid bodies in a cardiac biopsy indicative of?
cardiac sarcoidosis
107
which cardiac disease has a characteristic epsilon wave (notch in terminal part of QRS, most prominent in V1)
right ventricular cardiomyopathy
108
what are earliest lesions in atherosclerosis?
fatty streaks (reversible)
109
what kind of atherosclerotic plaque is vulnerable to rupture and superimposed thrombosis w/ severe conseqences?
atherosclerotic plaque w/ large loose atheromatous core and thin fibrous cap
110
term for irreversible necrosis of heart muscle due to prolonged ischemia, longer than 20 minutes
myocardial infarction
111
unreperfused MI gross path at 0-12 hrs (acute phase)
nothing
112
unreperfused MI gross path at 12-24 hrs (acute phase)
progressive pallor
113
unreperfused MI gross path at 2-3 days (acute phase)
yellow and softened
114
unreperfused MI gross path at 4-7 days (subacute phase)
red granulation tissue border
115
unreperfused MI gross path at 1-6 wks (subacute phase)
gradual replacement of yellow infarct by red granulation tissue
116
unreperfused MI gross path at 6-12 wks (subacute phase)
gradual white scarring
117
unreperfused MI micropath at 1-3 hours (acute phase)
thin wavy myocytes
118
unreperfused MI micropath at 4-12 hours (acute phase)
coagulation necrosis
119
unreperfused MI micropath at 6-12 hours (acute phase)
neutrophilic infiltration (usually associated w/ edema and hemorrhage, peaks on third day)
120
unreperfused MI micropath Early subacute phase (order of lymphocytes, macrophages, fibroblasts)
first lymphocytes at day 2
first macrophages at day 3
first fibroblasts at day 4
121
unreperfused MI micropath late subacute phase (day 11 to week 12)
angiogenesis and proliferation of fibroblasts, the fibroblasts eventually replace granulation tissue w/ fibrous scar
122
reperfused gross MI at 1-3 days (acute phase)
dark mottling and hemorrhage immediately following reperfusion
123
reperfused MI grosspath at days 4-5 (earliest subacute)
dark mottled red and brown (no change)
124
reperfused MI grosspath 6-10 days (early subacute)
shrunken red and brown and bits of gray-white
125
reperfused MI gross 11-14 days (midsubacute)
brown and intermingled w/ gray-white
126
reperfused MI gross path at 2-7 wks (late subacute)
progressive white, intermingled normal
127
reperfused MI micropath at 1-3 days (acute phase)
contraction band necrosis and hemorrhage immediately following reperfusion
128
reperfused MI micropath at 2 hours
coagulative necrosis first visible after 2 hours
129
reperfused MI micropath: macropages, fibroblasts
macs sooner and heavier at day 2
| fibroblasts sooner at day 3
130
reperfused MI micropath days 4-10 (early subacute phase)
lymphocytes, eosinophils, followed by formation of granulation then collagen (overall makes the infarct appear older than it is)
131
reperfused MI micropath days 11-end (late subacute phase)
healing can be rapidly accelerated, (reperfusion accelerates healing by about 40% on average)
132
what are the 9 reperfusion effects of MI
1. smaller
2. patchier
3. hemorrhage into it
4. more contraction band necrosis
5. accelerated inflamm. and repair
6. diffusion of inflamm. and repair
7. fewer polys
8. more macs
9. more interstitial fibrosis
133
term for outputouching of all 3 layers of an artery
true aneurysm
134
elevated blood levels of C-reactive protein and IL-6 are associated w/ what?
aneurysm formation
135
what is the major determinant for whether an aneurysm will rupture or not
DIAMETER
136
what are type A aortic aneurysms?
involve the ascending aortaand/or arch (MORE COMMON AND MORE SERIOUS)
137
what are type B aortic aneurysms?
involve descending aorta alone
138
Acute arterial occlusion is manifested by the 5 P's and regarding treatment, is a ________________________
surgical emergency
139
what is the first line treatment in peripheral artery disease?
exercise, especially walking (which develops collateral blood flow)
140
if you have a pt with intermittent claudication in the legs you might be thinking about
peripheral artery disease
141
you see an asian 20 something smoker with instep claudication, and you think he definitely has what?
Buerger disease (thromboangiitis obliterans)
142
how do you diagnose most peripheral vascular diseases?
history and physical examination
143
what is the main treatment for the guy with Bueger disease?
STOP SMOKING
