Robbins Ch 12 Cardiac Pathology Part 2

Question 1

Coarctation of the Aorta is more common in?

Answer 1

1) Males

2) Females with Turner syndrome (XO)

Question 2

How is Coarctation with Patent Ductus Arteriosus characterized?

Answer 2

1) Present in infants

2) Proximal to PDA

Question 3

How is Coarctation without Patent Ductus Arteriosus characterized?

Answer 3

1) Present in adults

2) Distal to aortic arch

Question 4

How does Coarctation without PDA present?

Answer 4

1) Weak Pulses in the LE
2) Hypotension in the LE
3) Intermittent pain (claudication) on excess movement of the legs

Question 5

What commonality is seen between adult and infant coarctation of the aorta?

Answer 5

Systolic murmur that may be associated with a vibratory thrill

Question 6

What does severe aortic congenital atresia lead to?

What additional condition allows this condition to be compatible with life?

Answer 6

1) Hypoplastic left heart syndrome

2) PDA

Question 7

90% of Ischemic heart disease cases comes from?

Answer 7

Atheromas in the coronary arteries

Question 8

What effect does tachycardia have on the heart?

Answer 8

1) Increases oxygen demand

2) Decreases functional supply by decreasing the relative time spent in diastole

Question 9

With chronic ischemia, at 75% occlusion and 25% flow patients will experience?

At 90% occlusion and 10% flow?

Answer 9

1) Exercise induced ischemia

2) Ischemia at rest

Question 10

Because anginas result in partial occlusion that lasts 15 seconds to 15 minutes, what results?

Answer 10

No myocardial death

Question 11

What is the most common angina?

What is it caused by?

Answer 11

1) Stable Angina

2) Imbalance in coronary perfusion relative to metabolic demand

Question 12

Variant (Prinzmetal) Angina are irregular attacks caused by?

What do they respond well to?

Answer 12

1) Coronary artery vasospasm

2) Nitrates

Question 13

What type of Angina leads to severe stenosis, thrombus, or vasospasm not alleviated by nitrates?

Answer 13

Unstable (Crescendo) Angina

Question 14

What myocardial response is seen to coronary artery obstruction?

Answer 14

There is loss of function before there is cell death

Question 15

What coronary vessel supplies most of the apex, anterior wall of the LV, and the anterior 2/3 of the ventricular septum?

Answer 15

Left anterior descending artery

Question 16

What is a transmural MI sometimes referred to as?

Answer 16

STEMI

Question 17

Which area of the heart is the least well perfused and is the most vulnerable for MI?

Answer 17

Subendocardium

Question 18

What are subendocardial MI sometimes referred to as?

Answer 18

NSTEMI

Question 19

What artery is most commonly infarcted?

Most transmural MI involve at least part of the?

Answer 19

1) LAD

2) Left ventricle

Question 20

What method is used for reperfusion of the heart by eliminated the thrombus but not the plaque?

What effect does late reperfusion (>6hrs) have?

Answer 20

1) Thrombolytics

2) Doesn’t help and may actually be hazardous

Question 21

What are the eosinophilic intracellular strips composed of closely packed sarcomeres?

When are they seen?

Answer 21

1) Contraction bands

2) Irreversibly injured myocytes

Question 22

What labs confirm the diagnosis of MI?

When do they begin to appear?

Answer 22

1) Troponin and CK-MB

2) 3-12 hours

Question 23

Why is CK-MB sensitive, but not specific?

Answer 23

It can be elevated after skeletal muscle injury

Question 24

What is the treatment plan for an MI?

Answer 24

MONA:

1) Morphine
2) Oxygen
3) Nitrates
4) Aspirin

Question 25

What is the most common type of myocardial rupture seen after having an acute MI?

Answer 25

Rupture of the ventricular free wall

Question 26

A fibrinous or fibrinohemorrhagic pericarditis that occurs 2-3 days after transmural MI due to underlying myocardial inflammation is known as?

Answer 26

Dressler syndrome

Question 27

With changes seen in the surrounding non-infarcted heart tissue, some of the deleterious effects of ventricular remodeling appear to be reduced by?

Answer 27

ACE inhibitors

Question 28

What accounts for 50% of all heart transplant recipients?

Answer 28

Chronic ischemic heart disease

Question 29

What is the most common cause of arrhythmias?

Answer 29

Ischemic injury

Question 30

What effect does atrial fibrillation have on heart rate?

Answer 30

Irregularly irregular rhythm

Question 31

What is the prototype of channelopathies?

Answer 31

Long QT syndrome

Question 32

What is the most common underlying etiology of sudden cardiac death? The mechanism is most commonly from?

Answer 32

1) Coronary artery disease | 2) Lethal arrhythmia (Asystole or ventricular fibrillation)

Question 33

Right sided hypertensive heart disease as a result of pulmonary hypertension is known as?

Answer 33

Cor pulmonale

Question 34

What is the earliest change of systemic hypertensive heart disease?

Answer 34

Myocytes show an increased transverse diameter

Question 35

What is stenosis?

Answer 35

Failure of a valve to open completely which impedes forward flow

Question 36

What is insufficiency (regurgitations, incompetence)?

Answer 36

Failure of a valve to close completely which allows reversed flow

Question 37

What is the most common of all valvular problems and involves age-related wear and tear?

Answer 37

Calcific Aortic Stenosis

Question 38

What is not present in Calcific Aortic Stenosis as seen in rheumatic and congenital aortic stenosis?

Answer 38

Commissural fusion

Question 39

Calcific stenosis of congenitally bicuspid aortic valve involves what gene on chromosome 9?

Answer 39

NOTCH

Question 40

What is the gross morphology of Mitral Valve Prolapse?

Answer 40

Leaflets are enlarged, redundant, thick, and rubbery

Question 41

What is the histological morphology of Mitral Valve Prolapse?

Answer 41

Marked thickening of the spongiosa layer with deposition of mucous material (This is called myxomatous degeneration)

Question 42

When are clicks heard with mitral valve prolapse?

Answer 42

Mid-systolic clicks

Question 43

Which sex is mitral valve prolapse 7x more common in?

Answer 43

Women

Question 44

What is virtually the only cause of mitral valve stenosis?

Answer 44

Rheumatic fever from strep pyogenes A

Question 45

What are the inflammatory lesions seen with rheumatic heart disease?

Answer 45

Aschoff Bodies

Question 46

The inflammatory process of acute rheumatic heart disease is best characterized as chronic inflammation, with what cells?

Answer 46

T cells and macrophages

Question 47

In chronic Rheumatic heart disease, what are the vegetations that overly the necrotic foci and along the lines of closure?

Answer 47

Verrucae

Question 48

What clinical feature is seen on acute rheumatic heart disease?

Answer 48

Erythema marginatum

Question 49

How is rheumatic heart disease diagnosed?

Answer 49

J♥NES criteria: 1) Joints 2) Heart 3) Nodules, subcutaneous 4) Erythema marginatum 5) Sydenham chorea

Question 50

What is acute infectious endocarditis caused by?

Answer 50

Infection of a previously normal valve by staphylococcus aureus

Question 51

What is subacute infectious endocarditis caused by?

Answer 51

Infection of a previously deformed valve by viridans streptococci

Question 52

What does strep viridans commonly cause? Staph aureus is common in what population? Staph Epidermidis commonly infects?

Answer 52

1) Dental issues 2) IV drug users 3) Prosthetic valves

Question 53

What is the most consistent sign of Infectious Endocarditis?

Answer 53

Fever