12 - Pathology: Heart 2

Front 1

Consequences of Left Sided Heart Failure

Back 1

Pulmonary congestion and Edema

Front 2

Consequences of Right-sided Heart Failure (4)

Back 2

Increase in Systemic Venous pressure
-Pitting Edema
-Ascites
-Nutmeg liver
-Pleural effusions

Front 3

What usually causes right sided heart failure?

Back 3

Left-sided heart failure

Front 4

What is Cor Pulmonale?

Back 4

Pure right-sided heart failure due to chronic severe Pulmonary Hypertension

Front 5

Histological cells of Left-sided Heart Failure

Back 5

Hemosiderin-laden Macrophages = Heart Failure cells

Front 6

Liver congestion in Right Sided Heart Failure first occurs in this part

Back 6

Central Vein = centrilobular necrosis

Front 7

Define Myocardial Ischemia

Back 7

an imbalance between the supply (perfusion) and demand of oxygen in the heart

Front 8

Causes 90% of Myocardial Ischemia

Back 8

reduction in coronary blood flow due to Atherosclerotic coronary artery obstruction

Front 9

An increased Myocardial metabolism could be due to this disease

Back 9

Hyperthyroidism -> tachycardia -> increased O2 demand

Front 10

Example of decreased oxygen transport resulting in Myocardial Ischemia

Back 10

Anemia

Front 11

How is the dominant artery chosen?

Back 11

the one that gives rise to teh Posterior Descending artery
-90% is the Right Coronary

Front 12

Risk factors for Ischemic Heart Disease

Back 12

HAS LIPIDS

Hereditary
Age
Sex (Male>Female)
Lipidemia
Increased weight
Pressure (Hypertension)
Inactivity
Diabetes
Smoking

Front 13

Ischemic Heart Disease can present in these 4 ways

Back 13

1. Angina Pectoris
2. Chronic Ischemic Heart Disease
3. Myocardial Infarct
4. Sudden Cardian Death

Front 14

Fixed obstruction occludes what percent of the lumen?

Back 14

>75%

Front 15

Soft atheromas are highly likely to result in what type of angina?

Back 15

Unstable Angina

Front 16

Most common form of angina

Back 16

Stable

Front 17

Stable angina is induced by __1__ and is caused by __2__

Back 17

1. exercise
2. ischemia due to atherosclerotic narrowing of coronary arteries

Front 18

Stable Angina is relieved by these 2 things

Back 18

Rest

Nitroglycerin

Front 19

Explain Prinzmetal Angina (3)

Back 19

-Coronary Artery SPASM at REST
- ST elevation = transmural ischemia
-Nitroglycerin helps

Front 20

What characterizes Unstable (Crescendo) Angina

Back 20

pain that is becoming more and more severe and is precipitated by less and less effort

Front 21

What usually causes Unstable Angina

Back 21

coronary atheromas that are prone to rupture

Front 22

What is Myocardial Akinesis

Back 22

where there are no contractions

Front 23

What is Myocardial Dyskinasis

Back 23

Where there are Abnormals contractions

Front 24

3 consequences of Plaque rupture in Coronary Arteries

Back 24

1. Healing
2. Embolism in downstream smaller mural vessels
3. Thrombosis -> unstable angina

Front 25

Parts of the Heart that the Right Coronary Artery supplies

Back 25

1. posterior wall of LV
2. Posterior part of Septum
3. RV

Front 26

Parts of the Heart that the LAD supplies

Back 26

1. anterior LV
2. Anterior septum

Front 27

Parts of heart that Left Circumflex artery supplies

Back 27

lateral wall of LV

Front 28

Frequencies of Coronary Artery obstruction

Back 28

LAD = 50%
RCA = 30%
LCX = 20%

Front 29

Part of heart that is most susceptible to damage when principal blood flow is compromised (Hypotension)

Back 29

Subendocardium (blood flows thru layers from outside to in)

Front 30

Most coronary artery blood flow occurs during ventricular __________

Back 30

diastole

Front 31

Loss that occurs within seconds of Cardiac Ischemia

Back 31

ATP

Front 32

This is dimished in <2 minutes with Cardiac Ischemia

Back 32

Contractility

Front 33

50% ATP depletion occurs within _____

Back 33

10 minutes

Front 34

90% ATP depletion occurs within ______

Back 34

40 minutes

Front 35

Irreversible Cell injury occurs within _________

Back 35

20-40 minutes

Front 36

Microvascular injury (endothelial damage of small terminal vessels) occurs after ________

Back 36

1 hour

Front 37

MI pathology:
4-24 hours = 1
1-2 days = 2
3-5 days = 3
5-7 days = 4
2-4 wks = 5
5-8 wks = 6

Back 37

1. mottling or no apparent gross changes
2. pale-yellow, cell necrosis, PMN's
3. central yellow, red rim, necrosis peaks
4. mottled yellow-red, Macrophages
5. red-gray, granulation tissue, fibroblasts
6. scarring; collagen

Front 38

When are the chances of Ventricular rupture the greatest after an MI

Back 38

during the first week b/c collagen has not been put down yet

Front 39

Characteristics of Transmural MI (4)

Back 39

1. Q wave abnormality
2. Coronary Occlusion
3. limited to an ANATOMIC area
4. Epicarditis can occur

Front 40

Characteristics of Subendocardial MI (4)

Back 40

1. non-Q wave
2. Hypoperfusion
3. Circumferential
4. No Epicarditis

Front 41

Irreversible injury of Ischemic Myocytes occurs first in this zone

Back 41

Subendocardial zone

Front 42

Preferred biomarker for diagnosing MI. Why?

Back 42

Troponin I
-more specific for myocardial tissue
-increase in blood within 2-4 hours
-last for 7-10 days

Front 43

Characteristics of CK-MB

Back 43

1. elevated at 2-4 hours
2. lasts 72 hours (3 days)

Front 44

After MI's, do most people have complications or not?

Back 44

Complications arise in 80%

Front 45

Most common complication after MI

Back 45

Arrhythmia

Front 46

What would cause an Infarct extension?

Back 46

Retrograde movement of a thrombus

Front 47

3 Types of Myocardial Rupture and their consequences

Back 47

1. Ventricle Free wall rupture -> hemopericardium -> Cardiac Tamponade -> death

2. Ventricle Septum -> L to R shunt -> RV failure, Pulmonary HTN

3. Papillary Muscle rupture -> mitral regurgitation

Front 48

When does free-wall rupture most frequently occur?

Back 48

3-7 days post-MI = early complication

Front 49

When do Ventricular Aneurysms typically occur?

Back 49

Several Weeks-Months post-MI = Late Complication

Front 50

The Lumen of Ventricular Aneurysms often contains?

Back 50

Mural Thrombi

Front 51

Rupture of the Septum causing L-to-R shunting is an early or late complication?

Back 51

Early (3-7 days)

Front 52

Papillary Muscle ruptures causes...

Back 52

Mitral Valve Insuffiency
- Systolic Murmur
-Left-sided failure
-Pulmonary edema

Front 53

3 treatments for Coronary Thrombosis

Back 53

1. Thrombolytic Enzymes (Plasminogen Activator)

2. Coronary Angioplasty

3. Coronary artery bypass graft

Front 54

Rheumatic Fever:
-Median age = 1
-Where common? = 2
-Immune response to: 3

Back 54

1. 10 yoa
2. underdeveloped countries
3. S. pyogenes (Group A, beta-hemolytic)

Front 55

Type of S. pyogenes infection that Acute Rheumatic Fever follows

Back 55

Pharyngitis

Front 56

Explain how S. pyogenes causes RF

Back 56

S. pyogenes elicits an Immune response againsts its M protein that reacts with SELF

Front 57

Most common manifestations of RF (2)

Back 57

1. Joint pain
2. Carditis

Front 58

Major Criteria for RF

Back 58

1. Carditis
2. Polyarthritis
3. Chorea
4. Erythema Marginatum
5. Subcutaneous Nodules

Front 59

4 minor criteria for RF

Back 59

1. Previous history of RF
2. Fever
3. Lab findings
4. EKG (prolonged PR)

Front 60

Criteria that must be met to Diagnose someone with RF

Back 60

2 major, 1 minor
or
1 major, 2 minor

Front 61

Most common cause of death in Acute RF

Back 61

Myocarditis

Front 62

What are Aschoff Bodies?

Back 62

granulomas that consist of:
-central area of fibrinoid necrosis
-surrounding M0 and lymphocytes
-M0 have "owl-eye" appearance

Front 63

Type of Carditis that Acute RF causes

Back 63

Pancarditis = effects the whole heart

Front 64

RF Pericarditis has this appearance

Back 64

"bread and butter"

Front 65

Endocarditic Valve involvement in RF

Back 65

Mitral > Aortic > Tricuspid

Front 66

Are the verrucous lesions(fibrin vegetations) in RF sterile or septic?

Back 66

Sterile

Front 67

Chronic Endocarditis from RF results in ________

Back 67

Dystrophic Calcification -> Stenosis

Front 68

Valvular Heart Disease can result in these 2 things

Back 68

Valvular Stenosis

Valvular Insufficiency

Front 69

Mitral Stenosis murmur

Back 69

Diastolic
-opening snap
-mid-diastolic rumbling

Front 70

Consequences of Mitral Stenosis

Back 70

1. dilated/hypertrophy of L. Atrium
2. Pulmonary congestion
3. RVH

Front 71

Mitral Insufficiency murmur

Back 71

Systolic murmur

Front 72

Consequences of Mitral Insufficiency

Back 72

1. LA dilation/hypertrophy
2. Pulmonary congestion
3. RVH
4. *LVH* b/c it is receiving more blood

Front 73

Most common stenosis of all Valvular abnormalities

Back 73

Aortic Stenosis

Front 74

Aortic Stenosis does not allow the outflow of blood from the LV into the Aorta during ________

Back 74

Systole

Front 75

Consequence of Aortic Stenosis

Back 75

1.LVH
2. low peripheral arterial pressure

Front 76

Aortic Stenosis murmur

Back 76

high-pitched Systolic murmur

Front 77

Most common cause of Mitral Stenosis

Back 77

Rheumatic Fever

Front 78

Most common cause of Mitral Insufficiency

Back 78

Mitral Valve prolapse
-endocarditis and rupture
-or dysfxn of papillary muscle

Front 79

Most common cause of Aortic Stenosis

Back 79

Calcification due to old age

(or a congenital Bicuspid Aortic Valve)

Front 80

Aortic insufficiency is due to .........

Back 80

dilation of ascending aorta due Hypertension or Old Age

Front 81

Mnemonic for most common Congenital Heart Diseases

Back 81

VA-PATENT
-VSD
-ASD
-Patent ductus ateriosus
-Aortic Stenosis
-Tetralogy of Fallot
-Endocardial cushion defect
-Narrowing of Aorta (Coarctation)
-Transposition of great vessels