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CRRAB 1 > Wk5: Witrak > Flashcards

Wk5: Witrak Flashcards

1
Q

Leading cause of M&M in developed world with 95% due to what

A

Ischemic heart disease; coronary atherosclerosis

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2
Q

What defines an unstable atherosclerotic plaque?

A

risk of rupture with partial or complete lumen occlusion by aggregated platelets/thrombosis

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3
Q

What is acute coronary syndrome?

A

Coronary blood supply is suddenly blocked - either unstable angina or MI

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4
Q

How many minutes of complete ischemia -> myocardial death

A

30 minutes +

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5
Q

EKG changes with subendocardial and transmural infarctions

A

Sub: usually non-STEMI
Transmural: more likely STEMI (older -> Q waves)

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6
Q

Subacute sequelae of MI (days to 2 weeks)

A

Mural thrombosis, LV rupture (free wall, septal, or papillary muscles), fatal hemopericardium, acute VSD, mitral regurg/flail, peri-infarct pericarditis

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7
Q

Chronic sequelae of MI

A

LV aneurysm, chronic CHF, pleural effusions, 2* RV CHF, Dressler’s pericarditis

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8
Q

What is another name for Dressler’s pericarditis, and what is it?

A

Post-cardiac injury syndrome. Believed to be an immune response to damaged tissue after MI, trauma, surgery to pericardium or heart.

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9
Q

How does stable chronic atherosclerotic disease present a risk of sudden death?

A

Sudden/fatal vent dysrhythmia from ischemic aggravation to the conduction system

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10
Q

What causes left-sided hypertensive heart disease? What happens?

A

Chronic systemic (arterial) htn -> concentric LV hypertrophy (free wall >1.5 cm) -> LV failure

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11
Q

Isolated Right Sided hypertensive heart disease (cor pulmonale) cause

A

Inc pulm artery pressure from: 1)chronic pulm parenchymal disease e.g. COPD, fibrosing 2)chronic hypoxia e.g. sleep apnea -> pulm vasoconstriction 3)pulm vasc disease e.g. 1* pulm htn and chronic recurrent thromboemboli

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12
Q

Size of RV free wall in RV hypertrophy

A

Free wall >0.5 cm.

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13
Q

Cause of most RV HF

A

LV HF

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14
Q

Possible causes of aortic valve regurg

A

Thoracic aortic aneurysm -> valves can’t close properly. Aortic dissection.

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15
Q

Causes of AV valve insufficiency

A

CHF -> valve ring dilation, papillary muscle dysfunction from LV ischemia with CAD

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16
Q

Define cardiomyopathy

A

Intrinsic myocardial disease NOT assoc w ischemic, valvular, hypertensive, or structural congen heart disease

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17
Q

What type of cardiomyopathy is essentially 100% genetic/mutational cause

A

Hypertrophic

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18
Q

What is cardiac tamponade?

A

Pericardial fluid critically compresses the heart

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19
Q

What is constrictive pericarditis?

A

progressive pericardial space fibrosis (like a growing scar) -> compression of heart

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20
Q

Causes of pericardial effusion

A

infectious and non-infectious disease, CHF, neoplastic infiltration, uremia

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21
Q

Most primary tumors of the heart are what type?

A

Atrial myxomas, very rare, usually left atrium

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22
Q

Other primary cardiac tumors

A

Rhabdomyomas - children esp tuberous sclerosis (gene defect -> growth of benign tumors). Cardiac sarcomas: very rare, usually lethal.

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23
Q

Are myocytes or the pericardium more likely to be sites of metastases?

A

Pericardium

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24
Q

What O2 sat defines cyanosis

A

<85%

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25
How long does it take a troponin to become positive in AMI? When does it peak, and how long does it persist?
2-4 hours to be positive. Peaks ~48 hours. Persists 7-10 days.
26
How does CK-MB compare to troponin?
Also elevated with myocardial necrosis but less specific than trop. Does drop down sooner allowing for detection of a second event.
27
What causes release of BNP? What are significant lab values?
Stretch of myocardium esp LV. 400 HF more likely cause of dyspnea
28
Main cause of hypercarbia
(inc pCO2 @ >45 mmHg): alveolar hypoventilation, usually due to COPD
29
When can O2 saturation be normal yet the patient is hypoxemic?
CO poisoning
30
AMI mortality within one month
30%
31
How might you get a circumferential LV subendocardial infarct?
Global hypotension
32
What is the immune response to death of cardiac myocytes?
Neutrophils within a couple days, fibroblasts in 1.5-3 weeks, collagen scar formation in 4-6 weeks.
33
Possible causes of CHF post infarct
1) Perforation of septum -> VSD -> acute CHF. 2) decreased functioning of myocardium due to necrotic regions -> CHF 3) transmural -> scarring -> loss of compliance -> akinetic -> CHF
34
Define systolic and diastolic HF
Systolic: low EF. Diastolic: preserved EF but decreased compliance -> can't relax -> can't fill appropriately and backs up blood -> pulmonary sx
35
How might diastolic failure lead to a-fib?
Associated atrial enlargement -> a-fib
36
Can LVH be reversed?
Yes, fairly quickly with control of hypertension
37
What does the LV look like in congenital LVH?
Thickening of septum moreso than the free wall.
38
Define cor pulmonarle
Right-sided hypertensive heart disease due to chronic hypoxemic pulm disease (e.g. COPD) or pulm htn
39
Causes of valvular stenosis
Valvulitis (RF, SLE, RA), congen deform, CALCIFIC degen change, carcinoid syndrome, radiation
40
Commonest cause of mitral stenosis
Rheumatic fever
41
2/3 of clinically significant valve disease = acquired aortic or mitral stenosis. Causes?
1) gradual obstruction due to post inflam fibrosis/deform (RF, SLE, RA) 2)atherosclerotic or calcific degen (esp AS)
42
What is ankylosing spondylitis?
Inflammatory disease -> fusing of vertebrae
43
How are valvular diseases diagnosed?
echo
44
What is myxomatous degeneration?
Pathological weakening of connective tissues
45
Most common cause of isolated mitral regurg in N Amer requiring surgery
Myxomatous degeneration -> ballooning of valve leaflets and elongation of chordae tendinae
46
What is "fish mouth" associated with?
A valve with typical rheumatic fever damage
47
Other than IE, what may result in vegetations on heart valves?
hypercoagulable state due to malignancy
48
What is systolic click murmur syndrome?
Mitral valve prolapse
49
What is dilated CM?
Dilated ventricles -> systolic LV dysfunction with decreased LVEF
50
What is hypertrophic CM?
Thickened LV wall esp septum with normal to reduced LV chamber size -> diastolic LV dysfunction
51
What is restrictive CM? What causes it?
Diastolic LV dysfunction assoc with usually non-dilated, usually non-hypertrophic ventricles due to primary dec in vent compliance.
52
Dilation of atrium = risk for ?
Clot formation
53
Dilated CM associated with what
Increased cardiac mass, HF symptoms e.g. dyspnea and fatigue, atrial of ventricular arrhythmias, possible sudden death
54
Causes of dilated CM (6)
Genetic 20-50%, myocarditis, alc abuse, chemo e.g. doxorubicin, hemochromatosis, peripartum, idiopathic
55
Dilated CM age of onset and mortality
Commonly 20-50 y.o. and leading to 50% mortality within 2 years.
56
Treatment for dilated CM
Supportive HF measures, possibly a LVAD (for myocardial recovery or bridge to transplant)
57
Commonest cause of hypertrophic CM (specific)
Autosomal dominant defect in sarcomeric contractile proteins (60--70%)
58
How does the ventricle appear in hypertrophic CM (specifically)
Asymmetrically thickened septum, especially in subaortic/basal region
59
What component of functioning is impaired in hypertrophic CM?
Diastolic relaxation/ filling -> limited CO -> inc LVEDP. May have syst murmur due to blood trying to pass by fat septum
60
Top 3 causes of sudden death in young athletes
1. hypertrophic CM 2. anomalous coronary artery origin 3. myocarditis
61
Symptoms of HCM
DOE, myocardial ischemia without CAD, risk of a-fib, eventual vent. failure/dilation, vent arrhythmias, sudden death
62
How does LVH appear when due to inc BP or aortic stenosis
Usually concentric thickening
63
Treatment for hypertrophic CM
Beta blockers, occasionally partial septal ablation
64
How does restrictive CM present?
Manifests as right HF. Systolic fx usually normal early.
65
A few causes of RCM
Familial, amyoidosis, diabetic CM, sarcoidosis, chemo (esp anthracyclines), metabolite deposition from inborn errors of metab, radiation fibrosis
66
What is arrhythmogenic RV CM? What causes it?
Autosomal dominant. Markedly thinned RV wall with fibroadipose tissue -> conduction disturb -> RV failure
67
What disease is arrhythmogenic RV CM associated with?
palmar/plantar hyperkeratosis. The combo = Naxos syndrome
68
Mechanism of stress-induced CM
Catecholamine surge -> "myocardial stunning" with transient systolic dys
69
How does stress-induced CM present
ischemic heart sx, foci of myocardial necrosis
70
Other causes of CM
Pheochromocytoma (adrenal tumor), cocaine use
71
Clinical sequelae of hemochromatosis
CM/HF (usually dilated type), conduction disturbance, cirrhosis/hepatoma, endocrine dys, arthritis
72
What effect does excess hemosiderin have on myocytes?
Toxicity -> secondary fibrosis
73
How is hemochromatosis diagnosed
>45% transferrin saturation, HFE gene mut, hepatic iron index noted on liver biopsy
74
What occurs in amyloidosis?
deposition of amorphous proteinaceous substance that is congo red positive
75
Sequelae of cardiac amyloidosis
usually restrictive CM -> HF, low EKG voltage, increased vent thickness, non-dilated LV cavity
76
Most common causes of myocarditis in US
Viral: entero, coxsackie B, adenovirus, parvo B19, hep C, HHV-6, CMV, HIV
77
Cause of myocarditis in developing/ endemic latin American countries
Chagas: attacks heart and esophagus -> HF + dysphagia
78
Acute HF within weeks of viral prodrome, possibly with CP, arrhythmia, sudden death = classic presentation of ?
Myocarditis
79
Most common cause of HF in children
myocarditis

CRRAB 1 (12 decks)

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