REVIEW 1 (Cardiac)

Question 1

An anterior wall infarct is typically caused by occlusion of the _______ coronary artery?

Answer 1

LAD

Question 2

An infarct of the lateral wall of the left ventricle is usually caused by occlusion of the ______

Answer 2

Left circumflex coronary artery

Question 3

What % of people survive their first MI?

Answer 3

75%

Question 4

Among the 75% of survivors of their first MI, most develop what?

Answer 4

1. Most develop signs of heart failure and cardiogenic shock.
2. This hypoperfusion results in multisystemic major organ failure
3. Most dangerous= consequences of cerebral ischemia, which may lead to permanent mental injury and loss of CNS functions.

Question 5

An infarct of the right ventricle and posterior wall of the left ventricle is usually caused by occlusion of the _________

Answer 5

right coronary artery.

Question 6

The following is the cause of ________ which occurs in ~25% of MIs:

1. Major cardiac arrhythmia (i.e. V-fib)
2. or later complete heart block and pump failure.

Answer 6

Sudden Cardiac Death from MI

Question 7

What are the 3 complications of post MI?

Answer 7

1. LV myocardial rupture
2. Cardiac tamponade
3. LV aneurysm with Mural thromus (can embolize to brain and cause stroke)

Question 8

What are the two types of MIs?

Answer 8

1. Transmural
2. Subendocardial or Intramural

Question 9

Which type of MI?

• infarction involves all three layers of the heart
• usually involves the free wall of the LV and/or the interventricular septum.

Answer 9

Transmural

*this is the worst MI- can lead to rupture b/c entire side is necrotic

Question 10

Which type of MI?

-the infarction is usually concentric around the subendocardial layer of the left ventricle.

Answer 10

Subendocardial or Intramural

Question 11

Which side of the heart is more likely to have an MI?

Answer 11

Occlusion of the LAD accounts for over 50%

Question 12

What is the “Tiger Effect” and what condition causes this?

Answer 12

-pathology relates to pale and congested areas with mild hypertrophy, along with biventricular dilatation and generalized hypokinesis of the myocardium (Tiger effect)

*Seen in Acute Viral Myocarditis

Question 13

Over 80% of Myocarditis cases are caused by what?

Answer 13

***Coxsackie B Virus***

Question 14

Which Pericarditis causes a “Bread and Butter” pericarditis?

Answer 14

Fibrinous pericarditis

Question 15

Which pericarditis is described by the following:

• surface of the heart is covered w/ shaggy, yellowish layers of fibrin that bridges the space b/w the 2 layers of the pericardial sac
• When the friable fibrin strands are separated, the epicardium and pericardium resemble bread and butter taken apart

Answer 15

Fibrinous pericarditis

Question 16

What type of inflammation is seen in “bread and butter” pericarditis?

Answer 16

Fibrinous inflammation

(exudate is rich in fibrin, formed by long strands of polymerized fibrinogen)

Question 18

What is considered a multifactorial disease (genetic+environmental) with the following risk factors (4 of 9):

1. Old Age
2. Sex (M>F, differences less after menopause)
3. Heredity
4. Lipid metabolism
5. HTN
6. Obesity
7. Diabetes
8. Cigarette smoking
9. Stress

Answer 18

Atherosclerosis

Question 19

What hormone has a protective effect against atherosclerosis?

Answer 19

Female sex hormones

-women who take replacement estrogen therapy after menopause reduce progression of atherosclerosis

Question 20

What are the risk factors of Atherosclerosis?

Answer 20

“Cigarrettes HOLDS ASH”

1. Age (old)
2. Sex (M>F, differences less after menopause)
3. Heredity
4. Lipid metabolism
5. HTN
6. Obesity
7. Diabetes
8. Cigarette smoking
9. Stress

Question 21

What is the best known cause for familial atherosclerosis that is considered a hereditary risk factor of Atherosclerosis?

Answer 21

Familial Hypercholesterolemia (defect of LDL receptors)

Question 22

What condition:

• genetic defect of LDL receptors, which does not allow lipoproteins into the liver
• causes atherosclerosis at an early age

Answer 22

Familial Hypercholesterolemia

Question 23

Which Atherosclerotic risk factor has to do with the following:

triglycerides directly correlate with the extent and severity, and with the early onset of clinical symptoms (ex: serum cholesterol >260 increases risk 5x)

Answer 23

Lipid Metabolism

Question 24

Which Atherosclerotic risk factor has to do with the following:

• direct correlation with the acceleration of atherosclerosis if not properly controlled
• exact role in the development in not fully understood

Answer 24

HTN

Question 25

Which atherosclerotic risk factor causes a secondary hyperlipidemia due to increased total body fat

-These pts develop atherosclerosis at an earlier age and is more pronounced

Answer 25

Obesity

• This is b/c the tissue fat is in equilibrium with the circulating lipids

Question 26

How does DM predispose individuals to atherosclerosis?

Answer 26

• Hyperglycemia alters the metabolism of basement membranes and damages small blood vessels (diabetic microangiopathy) of the glomerular capillaries and larger renal arterioles.
• Diabetes also accelerates atherosclerosis in larger arteries (coronaries, cerebral, and aortic).

Question 27

Where do occlusions occur most often? What location of the infact ?

Answer 27

MC is from occlusion of the LAD-

Causes an anterior wall infarct

Question 28

Occlusion of _________ accounts for 30-40%

Causes an infarct of the right ventricle and posterior wall of the left ventricle

Answer 28

RCA

usually causes an infarct of the right ventricle and posterior wall of the left ventricle

Question 29

CAD:

Occlusion of _________ accounts for 10-20% (least common)

-Usually causes infarct of the lateral wall of the left ventricle

Answer 29

Left Circumflex Artery

Question 30

What is the only way we get right sided heart vegetations (esp. of the tricuspid valve)?

Answer 30

IVDA

most cases are caused by St. aureus (followed by Strept. species and Candida)

Question 31

Where do LEFT sided heart vegetations most commonly embolize to?

Answer 31

MC: The brain

-1/3 of patients: Retinal (blindness), coronary (MI), cerebral (strokes), splenic, and renal (from renal abscesses to glomerulonephritis)

Question 32

Where do RIGHT sided heart vegetations most commonly embolize to?

Answer 32

Pulmonary embolism

(from IVDA’s)