Path: congenital, transplant, HF

Question 1

Describe a paradoxical embolism.

Answer 1

Basically an embolus that forms in the veins and moves thru the heart lungs and into the arteries.

Question 2

Four characteristics of tetralogy of Fallot.

Answer 2

1. VSD
2. Overriding Aorta
3. Pulmonary Stenosis
4. RVH

Question 3

How does TOF appear on CXR?

Answer 3

Appears as a boot-shaped opacity.

Question 4

Most common ASD.

Answer 4

Ostium Secundum ASD

Question 5

Condition commonly associated with Atrioventricular Septal Defects (AVSDs)..

Answer 5

Down Syndrome

Question 6

Condition associated with Coarctation of the aorta.

Answer 6

Turner Syndrome

Question 7

Describe the two forms of Coarctation of the aorta.

Answer 7

1. Infantile: hypoplasia of the aortic arch near a PDA

2. Adult: Discrete ridgelike infolding of the aorta opposite the closed ductus arteriosus distal to the arch vessels

Question 8

What two conditions are most commonly treated with heart Transplant?

Answer 8

Dilated cardiomyopathy

Ischemic Heart Disease

Question 9

What 3 factors can improve the effects of Heart Transplant?

Answer 9

1. Effect Immunosuppression
2. Careful candidate selection
3. Early detection of transplant rejection

Question 10

What is the only reliable method to detect transplant rejection?

Answer 10

Biopsy
-during transplant, the nerves to the heart are cut, so the patient will not feel any damage to the heart that would occur with CAD, or MI.

Question 11

How does mild acute transplant rejection of a heart transplant appear on biopsy?

Answer 11

Lymphocytes surrounding the blood vessels

No necrosis of myocytes

Question 12

How does moderate to severe acute rejection of a heart transplant appear on biopsy?

Answer 12

Lymphocytes located around myocytes

Necrosis of myocytes seen

Question 13

What is the major current limitation to the long-term success of cardiac transplantation?

Answer 13

Stenosis of the coronary vessels due to intimal proliferation.

Question 14

Main malignancy that occurs after cardiac transplant.

Answer 14

B-cell lymphoma due to EBV infection

Question 15

What are the six principle mechanisms that lead to HF?

Answer 15

1. Pump Failure
2. Obstruction to flow
3. Shunted Flow
4. Regurgitated Flow
5. Conduction abnormalities
6. Rupture of Heart or Major vessels

Question 16

Describe concentric vs. eccentric hypertrophy.

Answer 16

Concentric: due to pressure overload (increased afterload). Myocytes respond by adding sarcomeres in parallel which thickens the myocytes and ventricular walls.

Eccentric: due to volume overload (increased preload). Myocytes respond by adding sarcomeres in series which lengthens the myocytes leading to a more dilated ventricular chamber.

Question 17

Major causes of left sided HF.

Answer 17

Ischemic Heart Disease
Hypertension
Aortic and Mitral Valvular Disease
Nonischemic Myocardial Diseases

Question 18

What is the major consenquence of Left heart failure.

Answer 18

Atrial Fibrillation leading to thrombus and embolus formation.

(right sided HF also occurs)

Question 19

Major cause of Right-Sided HF.

Answer 19

Left Sided HF