Week 10: Cardiovascular Disorders P2

Question 1

What is coronary artery disease? (CAD)

Answer 1

CHD is characterized by insufficient delivery of oxygenated blood to the myocardium due to atherosclerotic coronary arteries (Coronary Arterial Disease or CAD)

Question 2

ArteRIOsclerosis vs. ATHEROsclerosis

Answer 2

ARTERIOsclerosis: Hardening of the arteries
ATHEROsclerosis: Thickening of the walls and plaque formation, making lumen smaller

Question 3

What is chronic stable angina?

Answer 3

Resulting from an imbalance between oxygen supply and myocardial demand

Question 4

What are factors that increase myocardial oxygen demand?

Answer 4

increased HR: hyperthyroidism
increased contractility: hyperthyroidism
increased wall stress: myocardial hypertrophy, aortic stenosis

Question 5

What are clinical manifestations of CHD?

Answer 5

etrosternal chest pain, tightness or discomfort radiating to left (and/or right) shoulder/arm/neck/jaw
diaphoresis, nausea, anxiety
precipitated by the “3 E’s”: exertion, emotion, eating
Levine’s sign

Question 6

How long does main with CHD usually last? What is it relived by?

Answer 6

Brief duration lasting <10-15 min and tpyically relived by rest and nitrates

Question 7

What is Levine’s sign?

Answer 7

Clutching fist over sternum when describing chest pain

Question 8

What are treatments of CHD?

Answer 8

Antiplatelet therapy (ASA or clopidogrel)
β-blockers (e.g., metoprolol, atenolol)
Nitrates
Calcium channel blockers
ACE inhibitors

Question 9

What is the etiology of unstable Angina, non-ST elevation MI (NSTEMI) and ST elevation MI (STEMI)

Answer 9

Artherosclerotic plaque rupture and thrombosis

Question 10

What is Unstable Angina (UA) and Non-ST elevation MI (NSTEMI)?

Answer 10

plaque rupture and thrombosis with incomplete or transient vessel occlusion

Question 11

What is myocarditis?

Answer 11

Inflammatory process involving the myocardium ranging from acute to chronic; an important cause of dilated cardiomyopathy

Question 12

What is the etiology of myocarditis?

Answer 12

idiopathic
infectious: viral (most common), bacterial, fungal
toxic: catecholamines, cocaine, chemotherapy
adverse drug reaction (antibiotics, diuretics, lithium)
systemic diseases: SLE, RA, sarcoidosis, autoimmune

Question 13

What are 3 types of diseases of the myocardium?

Answer 13

• Dilated cardiomyopathy (DCM)
• Hypertrophic cardiomyopathy (HCM)
• Restrictive cardiomyopathy (RCM)

Question 14

Explain dilated cardiomyopathy (DCM)

Answer 14

unexplained dilation and impaired systolic function of one or both ventricles
Etiology: idiopathic (perhaps viral) ~50% of cases; alcohol, familial/genetic, infectious, neuromuscular disease, endocrine

Question 15

What are clinical manifestations of Dilated Cardiomyopathy (DCM)?

Answer 15

may present as CHF
systemic or pulmonary emboli
arrhythmias
sudden death

Question 16

What is hypertrophic cardiomyopathy (HCM)?

Answer 16

defined as unexplained ventricular hypertrophy; generally presents in early adulthood

Etiology: believed to be a genetic defect involved in one of the cardiac sarcomeric proteins

Question 17

What are clinical manifestations / complications of Hypertrophic Cardiomyopathy (HCM)?

Answer 17

diastolic dysfunction
asymptomatic (common)
SOB on exertion, angina, syncope
CHF
arryhythmias

Complications: Afib, VT, sudden cardiac death (SCD)

Question 18

What is Restrictive Cardiomyopathy (RCM)?

Answer 18

impaired ventricular filling secondary to decrease in myocardial compliance (fibrosis and/or infiltration)
Etiology: infiltrative (amyloidosis, sarcoidosis); non-infiltrative (scleroderma, idiopathic myocardial fibrosis)

Question 19

What are clinical manifestations of Restrictive Cardiomyopathy (RCM)?

Answer 19

CHF (usually with preserved LV systolic function)
arrhythmias
elevated JVP
thromboembolic events

Question 20

What is pericarditis?

Answer 20

Inflammation of the pericardium

Question 21

What is the etiology of pericardial disease?

Answer 21

idiopathic (most common): presumed to be viral
infectious: viral, bacterial, TB, fungal
post-MI
post-cardiac surgery
metabolic: uremia
neoplasm

Question 22

What are clinical manifestations of pericardial disease?

Answer 22

diagnostic triad: chest pain, friction rub, and ECG changes
pleuritic chest pain (alleviated by sitting up and leaning forward)
with or without fever and malaise

Question 23

What is rheumatic heart disease/ rheumatic fever?

Answer 23

Acute inflammatory disease that follows infection with group A B-hemolytic streptococci
- Antibodies against streptococcal antigens damage connective tissues in joints, heart and skin
- Occurs mainly in children

Question 24

What is infective endocarditis (IE)?

Answer 24

infection of the endocardium, most commonly the valves
“leaflet vegetation” = patelet-fibrin thrombi, WBCs and bacteria

Question 25

What are clinical manifestations of Infective Endocarditis (IE)?

Answer 25

systemic: fever, chills, weakness, weight loss

cardiac: dyspnea, chest pain, regurgitant murmur, signs of CHF

embolic/vascular: petechiae over legs, focal neurological signs, splenomegaly

Question 26

Valvular disease: what is stenosis?

Answer 26

Narrowing of the valve, blood flow through the valve is reduced
- results in increased workload of the heart

Question 27

Valvular disease: What is regurgitation?

Answer 27

Inability of a valve to close completely
- results in increased workload of the heart

Question 28

What is etiology, pathogenesis and clinical manifestations of mitral regurgitation?

Answer 28

Etiology: MV prolapse, LV dilatation,, Marfan syndrome, acute MI
Pathogenesis: reduced CO → increased LV and LA pressure → LV and LA dilatation → CHF and pulmonary HTN
Clinical manifestations:
dyspnea, orthopnea, PND, palpitations, peripheral edema

Question 28

What is etiology, pathogenesis and clinical manifestations of mitral regurgitation?

Answer 28

Etiology: MV prolapse, LV dilatation,, Marfan syndrome, acute MI
Pathogenesis: reduced CO → increased LV and LA pressure → LV and LA dilatation → CHF and pulmonary HTN
Clinical manifestations:
dyspnea, orthopnea, PND, palpitations, peripheral edema

Question 29

What are the 3 major types of cardiac dysrhythmias?

Answer 29

Abnormal rates of sinus rhythm
Abnormal sites (ectopic) of impulse initiation
Disturbances in conduction pathways