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Heart > Robbins > Flashcards

Robbins Flashcards

1
Q

component of the conduction system that has a gatekeeper function

A

AV node

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2
Q

what pattern of hypertrophy -new sarcomeres are predominantly assembled in parallel to the long axes of cells, expanding the cross-sectional area of myocytes in ventricles and causing a concentric increase in wall thickness.

A

pressure-overload hypertrophy

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3
Q

what pattern of hypertrophy?
-is characterized by new sarcomeres being assembled in series within existing sarcomeres

A

volume-overload hypertrophy

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4
Q

best measure of hypertrophy in dilated hearts

A

heart weight

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5
Q

T/F myocyte hypertrophy is accompanied by a proportional increase in capillary numbers

A

False

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6
Q

____ is associated with volume-load hypertrophy accompanied by increases in capillary density

A

aerobic exercise

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7
Q

what physiologic mechanism?
Increased filling volumes dilate the heart, thereby increasing actin-myosin cross-bridge formation, and enhancing contractility and stroke volume.

A

Frank-Starling mechanism

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8
Q

the most common known genetic cause of CHD is

A

trisomy 21 (Down syndrome)

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9
Q

deletion of chromosome 22q11.2 casuse CHD in a syndrome called

A

DiGeorge syndrome

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10
Q

deletion of this transcription factor gene in DiGeorge syndrome causes CHD

A

TBX1

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11
Q

pathway associated with a variety of congenital heart defects

A

Notch pathway

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12
Q

gene mutation in bicuspid aortic valve

A

NOTCH1

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13
Q

gene mutations in tetralogy of Fallot (2)

A

JAG1 and NOTCH2

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14
Q

right-to-left shunts cause (5)

A

hypoxemia and cyanosis
paradoxical emobolism
polycythemia
clubbing
hypertrophic osteoarthropathy

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15
Q

Most important right-to-left shunts (5)

A

-tetralogy of Fallot (TOF)
-transposition of the great arteries (TGA)
-persistent truncus arteriosus
-tricuspid atresia
-total anomalous pulmonary venous connection

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16
Q

left-to-right shunts increase _____ blood flow

A

pulmonary

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17
Q

In left-to-right shunts, pulmonary vascular resistance eventually approaches systemic levels, and the shunt becomes a right-to-left shunt that introduces poorly oxygenated blood into the systemic circulation. This is called ______ syndrome

A

Eisenmenger syndrome

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18
Q

left-to-right shunts (3)

A

ASD
VSD
PDA

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19
Q

CHD category where there is abnormal narrowing of chambers, valves, or blood vessels

A

obstructive

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20
Q

obstructive CHDs (3)

A

coarctation of the aorta
aortic valvular stenosis
pulmonary valvular stenosis

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21
Q

the most common CHD category

A

left-to-right shunt

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22
Q

most common type of ASD

A

Secundum ASD

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23
Q

Left-to-right shunt that is usually asymptomatic until adulthood

A

ASD

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24
Q

patent foramen ovale closes permanently in ~80% by age

A

2

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25
Q

most common form of CHD

A

VSD

26
Q

what causes irreversible obstructive pulmonary vascular disease

A

prolonged pulmonary arterial vasoconstriction stimulates the development of irreversible obstructive intimal lesions analogous to the arteriolar changes seen in systemic hypertension

27
Q

ductus arteriosus constricts and and closes in response to (3)

A

-increased arterial oxygenation
-decreased pulmonary vascular resistance
-declining local levels of prostaglandin E2

28
Q

the most common right-to-left shunt

A

TOF

29
Q

four cardinal features of TOF

A

vsd
subpulmonic stenosis
overiding aorta
right ventricular hypertrophy

30
Q

CHD that produces ventriculoarterial discordance (the ventricle outflow going to the wrong outflow vessel)

A

Transposition of the Great Arteries (TGA)

31
Q

the aorta arises from the right ventricle, and the pulmonary artery emanates from the left ventricle (ventriculoarterial discordance). The atrium-to-ventricle connections are normal (concordant), with the right atrium joining the right ventricle and the left atrium emptying into the left ventricle.

A

dextro-TGA

32
Q

TGA that does not lead to cyanosis

A

levo-TGA

33
Q

2 forms of the obstructive CHD, coarctation of the aorta

A

infantile with PDA (preductal coarctation)
adult (postductal coarctation)

34
Q

main abnormality in hypoplastic left heart syndrome

A

aortic stenosis or atresia

35
Q

an imbalance between myocardial supply (perfusion) and cardiac demand for oxygenated blood

A

Ischemic heart disease (IHD)

36
Q

how does tachycardia decrease oxygen functional supply to the heart

A

by decreasing the relative time spent in diastole, when cardiac perfusion occurs

37
Q

is typically cited as the threshold for symptomatic ischemia precipitated by exercise (characteristically manifesting as exertional angina).

A

critical stenosis (>70%)

38
Q

obstruction of ___% of the cross-sectional area of the lumen generally leads to inadequate coronary blood flow, even at rest.

A

90

39
Q

earliest detectable feature of myocyte necrosis

A

disruption of the integrity of the sarcolemmal membrane

40
Q

Irreversible injury of ischemic myocytes first occurs in the

A

subendocardial zone

41
Q

An infarct usually achieves its full extent within

A

3-6 hours

42
Q

Transmural infarctions occur when there is occlusion of an

A

epicardial vessel in the absence of any therapeutic intervention

43
Q

In the subendocardial infarcts that occur as a result of global hypotension, myocardial damage is often ____

A

circumferential

44
Q

time interval when dark mottling is grossly apparent after MI

A

12-24 hours

45
Q

time interval when scarring is grossly complete after MI

A

> 2 mos

46
Q

Owing to the characteristic electrocardiographic changes resulting from myocardial ischemia or necrosis in various distributions, a transmural infarct is sometimes referred to as an

A

ST-elevation myocardial infarct (STEMI)

47
Q

Owing to the characteristic electrocardiographic changes resulting from myocardial ischemia or necrosis in various distributions, a subendocardial infarct is sometimes referred to as

A

non–ST-elevation infarct (NSTEMI)

48
Q

The most common of all valvular abnormalities and is usually the consequence of age-associated “wear and tear” of either anatomically normal valves or congenitally bicuspid valves

A

Calcific Aortic Stenosis

49
Q

The characteristic anatomic change in MVP is

A

ballooning (hooding) of the mitral leaflets

50
Q

The key histologic change in MVP

A

myxomatous degeneration of spongiosa layer

51
Q

Distinctive lesions in the heart in rheumatic fever

A

aschoff bodies

52
Q

five most common tumors of the heart in descending order of frequency

A

myxomas
fibromas
lipomas
papillary fibroelastomas
rhabdomyomas

53
Q

most common primary tumor of the adult heart

A

myxomas

54
Q

About 90% of cardiac myxomas arise in the

A

atria

55
Q

favored site of origin of a myxoma in the atria

A

fossa ovalis

56
Q

usual locations of fibroelastomas

A

valves

57
Q

the most frequent primary tumor of the pediatric heart

A

rhabdomyomas

58
Q

Approximately one-half of cardiac rhabdomyomas are due to sporadic mutations; the other 50% of cases are associated with _____ with mutations in (2)

A

tuberous sclerosis, TSC1 and TSC 2

59
Q

The TSC1 and TSC2 proteins (hamartin and tuberin, respectively) function in a complex that inhibits the activity of_______ a kinase that stimulates cell growth and regulates cell size.

A

mammalian target of rapamycin (mTOR)

60
Q

Metastases can reach the heart and pericardium by

A

retrograde lymphatic extension from the mediastinum (mostly carcinomas), by hematogenous seeding (many tumors), by direct contiguous extension (of intrathoracic tumors), or by venous extension (tumors of the kidney or liver)

Heart (1 decks)

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