pathology

Question 1

definition of pulmonary hypertension

and d/t

Answer 1

mean pulmonary artery pressure equal to or above 25 mmHg at rest

• Due to increased pulmonary vascular resistance (>30-50% of pulmonary arterial tree is occluded)

Question 2

persistent systolic BP more than 130 mm HG and/or diastolic BP more than 80 mm HG

Answer 2

hypertension

Question 3

is the following systemic or pulmonary hypertension?

Elevated systolic and/or diastolic blood pressure
- Measured on 3 separate occasions

• Excess salt with low potassium intake, chronic inflammation, low magnesium, chronic stress or anxiety, insulin resistance, renal hormone imbalance, obesity, arteriosclerosis
• Complications include chronic renal failure, retinopathy, aneurysm ruptures, congestive heart failure
• High pressure causes chronic damage and can affect any organ sensitive to minor vascular damage
• Most are asymptomatic for a long period of time
• Very high pressure can cause dizziness, blurry vision, and headaches

Answer 3

systemic

Question 4

which is more common systolic or diastolic CHF?

Answer 4

systolic CHF - MORE common

Question 5

which type of CHF:
Lung disease leads to right ventricular failure initially followed by left-sided failure
- Due to left-sided CHF, left-sided lesions (mitral stenosis), pulmonary hypertension, cardiomyopathy and diffuse myocarditis, tricuspid or pulmonary valvular disease
- Renal hypoxia (fluid retention, pitting edema), pleural effusion and ascites, enlarged and congested liver and spleen, neck venous distension

Answer 5

Right-sided CHF “Blue bloater”

Question 6

which type of CHF:

Caused by ischemic heart disease (i.e. MI), hypertension, aortic and mitral valvular disease, cardiomyopathy, myocarditis
- Dyspnea and orthopnea due to pulmonary congestion and edema, pleural effusion with hydrothorax, reduced renal perfusion and therefore water and salt retention, cerebral anoxia

Answer 6

Left-sided CHF “Pink puffer”

Question 7

what type of ischemic heart disease?

Episodic chest pain due to insufficient oxygen supply to the myocardium
- Pain or discomfort in jaw, back, epigastrium, shoulders, or neck
o Dyspnea, nausea, or diaphoresis may occur during an attack

Answer 7

angina pectoris

Question 8

match: stable,unstable Prinzmetal’s angina pectoris to the following

1.
- Severe narrowing of the coronary arteries
- Occurs during exertion and relieved by rest or nitroglycerin

2. • Unpredictable → can occur at rest or sleep
   • Nitroglycerin DOES NOT bring relief
3. • Caused by vasospasm
   • Can occur at rest
   • Nitroglycerin brings relief

Answer 8

1. stable
2. unstable
3. prinzmetal’s

Question 9

• No acute event unless an asymptomatic myocardial infarction occurred earlier
• Slowly proceeds to congestive heart failure
• Small areas of scar tissue are found in the heart as a result of numerous small, subclinical Mis

Answer 9

Chronic Ischemic Heart Disease

Question 10

• Coagulation necrosis of the myocardium due to ischemia
• Caused by decreased or complete cessation of blood flow to a portion of the myocardium
• Blockage of the left anterior descending (LAD) coronary artery is the leading cause of a myocardial infarction

Answer 10

Myocardial Infarction

Question 11

subendocardial or transmural myocardial infarction:

Myocardial necrosis is limited to the inner 1/3 of the heart wall generally a result of a partial coronary occlusion or an occlusion within the heart’s vascular tree

• Sudden crushing chest pain (radiating into neck, jaw, left arm, back, or shoulders), nausea, vomiting, dyspnea, feeling of impending doom, palpitations, cyanosis
• Complications:
  o Arrthythmias
  o Myocardial rupture – within 4-10 days after an MI; can cause blood to enter the pericardial sac, cardiac tamponade, and death
  o Mural thrombosis – a thrombus may form over the infarct and can lead to an embolism
  o Ventricular aneurysm (dilation of the ventricle)
  o Ruptured papillary muscle

Answer 11

Subendocardial

Question 12

transmural or subendocardial MI

Myocardial necrosis that spans the endocardium to pericardium usually results from an occlusion in the proximal portion of a coronary artery

Answer 12

transmural

Question 12

which valvular disease:

• Generally congenital but can be a result of rheumatic disease
• Aortic valve becomes calcified that causes outflow to be obstructed leading to left ventricular hypertrophy
• Most commonly due to calcification of a congenitally bicuspid aortic valve
• Chest pain, syncope, dyspnea on exertion, palpable chest thrill/heave
• Diamond shaped crescendo-decrescendo systolic murmur, which lasts throughout systole
  o Best heard in the right upper sternal border

Answer 12

aortic stenosis

Question 13

• Most common valvular disease = Narrowing of the mitral valve
• Main cause is Rheumatic fever
• Shortness of breath, fatigue, feet or leg swelling, heart palpitations, dizziness/fainting, chest discomfort
• Complications include pulmonary hypertension and edema, heart failure, cardiac hypertrophy, and atrial fibrillation

Answer 13

mitral stenosis

Question 14

which valvular disease

• Inflammation of the endocardium
• Most of the damage is done to the valves (vegetations)
• Infective endocarditis due to bacterial and sometimes fungal infection of the endocardium

Answer 14

endocarditis

Question 15

which valvular disease: acute or subacute endocarditis

• Staphylococcus aureus
• Often secondary to an infection elsewhere
• More virulent organisms

Answer 15

acute endocarditis

Question 16

which valvular disease: acute or subacute endocarditis

Streptococcus viridans
- More common in patients with congenital heart disease or pre-existing valvular heart damage (i.e. rheumatic valvular disease)
- Less virulent organisms

Answer 16

subacute

Question 17

which valvular disease:

Mitral valve leaflets are enlarged (protrude into the left atrium) and the chordae tendinae are elongated
- Mid-systolic click and sometimes a late systolic murmur (mitral regurgitation)
- Generally benign and asymptomatic but can result in mitral regurgitation
- Hyper-sympathetic syndrome, palpitations, orthostatic hypotension, fatigue, chest pain
- More susceptible to endocarditis

Answer 17

mitral valve prolapse

Question 18

• Carcinoid syndrome occurs when a rare cancerous tumor called a carcinoid tumor/neuroendocrine cells that secrete high amount of serotonin into the bloodstream
• Carcinoid tumors occur most commonly in the gastrointestinal tract (SI) or lungs
• When carcinoid syndrome affect the heart, it most frequently causes tricuspid valve regurgitation
• Initial symptoms include fatigue and dyspnea
• Can result in pellagra
• Skin flushing, excessive diarrhea, right-sided heart disease, and bronchoconstriction

Answer 18

Carcinoid Heart Diseases

Question 19

which valvular cdx:
- Sequelae of a Group A beta hemolytic Streptococcus pyrogens infection
- Strep Ab cross-react with the heart tissue (type II hypersensitivity reaction)
- Inflammation occurs in all 3 layers (endocarditis, myocarditis, pericarditis)
o Vegetations are found in the heart valves which is the ENDOCARDIUM
- Other symptoms include:
o Aschoff bodies (granulomatous inflammatory lesions)
o erythema marginatum (trunk/extremities)
o migratory polyarthritis
o fever
o subcutaneous nodules
o chorea
o malaise
o elevated ESR

Answer 19

Rheumatic Heart Disease

Question 20

which type of cardiomyopathy:

• Most common cause of cardiomyopathy is characterized by dilation of all 4 chambers + thinning of muscular wall, systolic dysfunction, and right- & left-sided heart failure
• Most commonly due to chronic death of myocardial cells and lesser due to acute myocardial inflammation
• Fibrosis occurs in the left and right ventricles causing dyspnea on exertion and easy fatiguing
  o Cough, edema (legs, ankles, feet), or even liver problems can occur which can cause ascites
• Causes include viral infection, hypothyroidism, toxin exposure, post-partum, thiamine deficiency

Answer 20

dilated/conjestive

Question 21

which type of cardiomyopathy

Stiffened and less compliant, but size of ventricle stay relatively the same
- Rigid ventricular walls (primarily the left) which causes decreased output -> diastolic HF
- Due to diffuse infiltration of hardening substances (ex. iron) or chronic inflammation
- Hypertrophy → fibrosis
- Dyspnea on exertion, edema, orthopnea, arrhythmias

Answer 21

restrictive

Question 22

which type of cardiomyopathy

Significant ventricular hypertrophy not due to outflow obstruction such as aortic valve diseases or hypertension
- Anterior leaflet of mitral valve is misplaced
- Congenital, acquired, idiopathic forms
- Syncope and sudden death

Answer 22

hypertrophic

Question 23

• Inflammation of the myocardium which can lead to chronic health issues and sudden death
• Bacterial infection can follow sepsis which causes neutrophil invasion
• Symptoms include: chest pain, palpitations, fever, CHF, fatigue, systolic murmur, dysnea
• Usually managed similar to HF

Answer 23

myocarditis