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64 Cards in this Set

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Leading cause of death in the US?
Heart dz
Birth weight of heart?

Adult heart weight?

Hypertrophic hearts?
birth: 20 grams

adult: 300-350 grams (15x increase)

hypertrophic: 500-700 grams
Name the stress increases that deal with hemodynamic burden (3)?
1) Frank-Starling mechanism - increasing filling pressures and volumes (acute)

2) increase beta-adrenergic stimulation -> inotropic response (acute)

3)Cardiac hypertrophy (gradual)
3 major morphologic changes in cardiac hypertrophy?
1) cells get bigger (hyperTROPHY not hyperplasia)

2) increased interstitial fibrosis, most prevalent in pressure overload but can can be seen in volume overload

3) Decreased coronary reserve - ^ O2 demand from hypertrophy so ^ vasculature, however eventually ^ diffusion distance -> relative cardio myocyte hypoxia
Difference b/w physiologic and pathologic (pressure overload) hypertrophy?
Physiologic - stress and then relaxation (heart has time to recover and "wash out" cytokines and inflammatory mediators

Pathologic - stress on heart ALL THE TIME
4 major changes with cardiac hypertension
1) morphologic - cellular hypertrophy & fibrosis

2) structural - contracdtile proteins

3) metabolic - fetal isozymes

4) Altered Ca handling
Aerobic Exercise produces ___ hypertrophy

Tension exercise (Weights) produces ___ hypertrophy

Pregnancy produces ___ hypertrophy
aerobic - eccentric hypertrophy

tension - concentric hypertrophy

pregnancy - concentric hypertrophy
Pressure (tension process) overload produces ___ hypertrophy

Volume overload produces ___ hypertrophy
^ pressure = concentric

^ volume = eccentric
Pathologic hypertrophy metablic effects?
Altered glycolysis and glycogen oxidation - more susceptible to ischmic events or cardiac failure
LaPlace's Law states that you v wall stress by ?
increaseing wall thickness
Sarcomere cell pattern in response to pressure overload?
^ x-sectional AREA (DIAMETER)

produced in PARALLEL pattern

-to develop more tension
Sarcomere cell pattern in response to volume overload
individual cells LENGTHEN

produced in SERIES
2 results of ^ interstitial fibrosis in concentric hypertrophy?
1) makes chamber stiffer (inhibits relaxation)

2) affects diffusion distance
3 Functional changes in cardiac hypertrophy
1)Ventricular fxn - sys & dias dysfunction, alterations in Ca handling can bare consequences on both

2) Coronary vasculature - increased need for O2 consumption + increaseed diffusion distance = ^ O2 demand with v O2 supply (ANGINA even w/ normal coronary arteries...even worse with artherosclerosis)

3) Electrophysiology - with ^ tissue, there are more electrical abnormalities
Final outcome of pathologic hypertrophy?
CHF
Atheroscclerosis is initiated by ?

Tends to occur?
endothelial injury

at points of arterial bifurcation
4 major risk factors of atherosclerosis?
1) smoking

2) hypertension

3) diabetes

4) male gender
3 chronologic steps in the progrssion of atherosclerosis?
1) Fatty streak - can be seen in men as young as mid to late teens

2) Fibrofatty (atheromatous) plaque

3) Advanced/vulnerable (comples) Plaque - tends to ulcerate or rupture and progress to thrombosis

...can progress to aneurysm, occlusion by thrombus (mc detected when patient has heart attack, or critical stenosis
Eccentric Atherosclerosis plaques composed of?

How do the plaques become more stable? less stable?
1) Fibrous Caps

2) Necrotic Center - made of cholesterol, necrotic debris, and macrophages in the center


More stable = ^ thickness of fibrous cap

Less stable = v fibrous caps & more central lipids/necrosis
MC structure for aneurysm to occur?
Aorta
True aneurysm?

False aneurysm?
True = expansion of ALL 3 LAYERS of the vessel wall (intima, media & adventitia)

False = contained only by the adventitia
False aneurysms are usually caused by
hemorrhage
Aneurysms of the aorta are predominantly (95-99%) secondary to ?

Other causes?
Atheroscleosis

Syphilis, Marfan's, vasculitis and other CT diseases
Most common type of aneurysm?
Abdominal aneurysm (just inferior to the renal arteries and just superior to the iliac arteries

...followed by descending and ascending thoracic aorta aneurysms
Aneurysm with symmetric widening of vessel?
Fusiform
Aneurysm where one wall is dilated?
Saccular

"nutSAC hangs to one side"...yes you like that one ;)
Asymptomatic, pulsatile masses felt on abdominal palpitation
Clinical presentation for abdomnial aneurysm
Aneurysms are a disease of what age range?
Elderly, mos people are >60 yrs
What size aneurysm is there a major risk factor for rupture?
> 6 cm (50% will rupture in 10 yrs)
Aortic dissection is?
An intiaml tear allowing hemorrhage (through endothelial layer) into the media layer
Pathologic process of aortic dissection?
Cystic medial necrosis (though no cyst or necrosis...yea, wtf) - fragmentation of the elastic fibers in the wall of the elastic areteries and degeneration of the extracellular matrix
Key difference in pain w/ ADis and MI?
ADis = pain in BACK
-can also present with aneurysm if dilates posteriorly onto spinal roots

MI = more anterior and ARM
MC location for an Adis?
Ascending thoracic aorta

...as opposed to aneurysms, which usually occur in the abdominal aorta
3 Major complications with Adis?
1) lethal hemorrhage into the body cavity

2) Obsturction of major artery branches

3) Expand the aortic valve annulus and cause valvular incompetence (least dangerous)
Therapy for Adis?
LOWER BP and then surgically close intimal tear & medial dissection
Arteriosclerosis obliterans from (2)
1) Atherosclerotic plaques directly occuldding arteries

2)Emboli may be genreated from complex plaques
Peripheral artery disease (PAD) prevalence MC in?
Elderly men UNTIL 75, thereafter men and women have same prevalence

PAD not common in people younger than 60
Most common occlusion in PAD?
Iliofemoral occlusion - pain in large leg muscle adn buttocks induced by exercise (claudication)
Common sites of Claudication for pain in...

1)buttocks, hips & thighs

2)calf & foot

3)thigh & calf
1)buttocks, hips & thighs
AORTIC or ILIAC artery

2)calf & foot
POPLIEAL artery

3)thigh & calf
FEMORAL ARTERY
Major reason it is difficult to exercise with syndromes of chronic occlusion (PAD)?
Not sufficient blood flow with collateral circulation

May be fine at rest but aerobic stress produces ischemic symptoms
PAD Physical exam may show (4)?
1) v pulses

2) arterial bruit

3) pallor

4) cyanosis
Ankle-brachial index used to diagnose what?

Steps?
Chronic occlusion (PAD)

1) Take BP at the ankleand the arm

2) Ankle BP should be > or = to that of the arm (gravity)

3) Ankle BP drops below 90% of the brachial artery, then the patient ahs significant arterial disease somewhere b/w ankle and heart
Treatment of PAD (3)
1)Revascularization by stents

2)Dialating arteries DOESNT work! Must v the VISCOSITY of the blood so that it flows better through arteries

3)Surgery - to bypass area of atherosclerosis

* is dont bypass problem, patients will get ISCHEMIC ULCERATION of the feet -> amputation!
Acute arterial obstruction usually caused by?

result?
Thrombosis in-situ
...but can ocur from embolization

May result in widespread necrosis b/c there is no time for collaterals to form
Acute arterial obstuction treated by (2)?
1)Thrombolytic therapy

2)Pulling the clot out directly with catheter

-May result in WIDESPREAD NECROSIS b/c there is no time for collateerals to form
*Symptoms of acute arterial obstruction (5)?*
1)Pain

2)Pulselessness

3)Palor

4)Paresthesia

5)Paralysis

"5P's"
Eggshell calcification in the media of the arterial wall
Monckeberg's sclerosis

-arteries become stiff, so patients wont have good vascular reactivity

...Seen in breat biopsies after a mammogram that showed calcification
Failure of the venous valves in the legs

Most common in?
Varicose veins

Women
Predisposing factors for thrombosis (3)?
Virchow's triad:

1)stasis

2)hypercoagulability

3)endothelial injury
Thrombosis MC in what people(4)?
1)Neoplastic diseases

2)Pregnant

3)post-operative

4)immobilized
Kidney disease always goes together with?
Hypertension

"hyptertensionand kidney disease are like the chicken adn the egg: they always go together"
New-onset (acute) glomerulonephritis typically comes with symproms of?
Hematuia, pain, sediments
Remember: Right outflow occurs when in life?
very EARLY (PA stenosis)
Hypertension and CHF share what similarities?
-pathologic activiation of the alpha-adrenergic nervous system

-pathologic activation of the renin-angiotensin system

-^ synthesis of extracellular matrix that impairs normal fxn

-salutary (favorable) response to ACE inhibitors
Most typcial drug that prolongs QT?

Predisposes users to?
Quinidine

Torsades de Pointes
Does anemia cause cyanosis?

Other causes of cyanosis?
No, b/c ALL of RBC (though there are less) are saturated

POLYCYTHEMIA - a person must have approximately 5g of deoxygenated hemoglobin to be cyanotic
What do you give to treat meconium babies?
NO to facilitate vasodilation
The MCC for cyanosis that does not improve with supplemental O2 is?
VSD with right to left shunt (ie Tetralogy of Fallot)
Olfactory hallucination is a symptom of ?
grand-mal seizures
The two "shapes" of renal vascular disease?
1)20-30 YO often FEMALE pt with problem of SMOOTH MUSCLE OF RENAL ARTERY, called FIBROMUSCULAR DYSPLASIA, manifests with severe hypertension (as high as 220/110)

2)Atherosclerotic plaques within the renal artery often occurring in MEN
TIMI measures?

Grades?
amount of flow through a vessel (Thrombolysis In Myocardial Infarction)

0 = no flow (bad)
3 = normal (GOOD!)
(1-2 are in between)
Lead II, III, AvL & AvF w/ ST segment elevation?
Inferior wall MI
V1 & V6 ST segment elevation?
Anterior/lateral wall MI
Retrostenal discomfort during strenuous exercise is most likely?
Stable angina