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81 Cards in this Set
- Front
- Back
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What is cardiac decompensation?
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heart failure, associated with marked dilatation of cardiac muscle so there is ineffective overlap of actin and myosin
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What characteristics define CHF?
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decreased cardiac output,damming of blood back to venous system
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What leads to the fibrosis involved in hypertrophy of the heart?
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myocyte death
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What are some of the common causes of left sided heart failure?
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IHD (ischemic heart disease),HTN,aortic and mitral valvular disease ,cardiomyopathy
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What are some of the clinical manifestations of left sided heart failure?
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Pulmonary congestion and edema,Siderophages,Dyspnea,orthopnea,PND (paroxysmal nocturnal dyspnea),Atrial fibrillation and mural thrombi,Reduction of renal perfusion,hypoxic encephalopathy
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What are some of the common causes of right sided heart failure?
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left ventricular failure,Primary and secondary pulmonary HTN
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What are some of the signs and symptoms of right sided heart failure?
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congestive hepatomegaly,peripheral edema ,pleural and pericardial effusions,Renal congestion,hypoxic encephalopathy,congestive splenomegaly,edema of the bowel wall, ascites
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What is the major cause of ischemic heart disease?
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coronary artery disease
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What type of angina is brought on by increased workload and relieved at rest?
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stable angina
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What is the cause of Prinzmetal angina?
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vasospasm
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What are the two major types of MI?
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transmural ,subendocardial
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What are some of the major mechanisms of MI?
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vasospasm,emboli,intramural vessel disease,hemoglobinopathies
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How much must the lumen of an artery be narrowed by a plaque to cause angina?
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75%
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Ischemic cardiac myocytes loose contractility in what time period?
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less than 2 min
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How long must a cardiac myocyte be ischemic to reduce ATP levels to 50%? 10%?
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10 minutes,40 minutes
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Irreversible cell injury and sarcolemmal defects occur in what time period in an ischemic cardiac myocyte?
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20-40 minutes
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Occlusion of which coronary artery would most likely result in an infarct involving the lateral wall of the left ventricle?
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left circumflex
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Occlusion of which coronary artery would most likely result in an infarct involving the anterior wall of the left ventricle?
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LAD
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Occlusion of which coronary artery would most likely result in an infarct involving the posterior wall of the left ventricle?
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Right coronary
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How old is this infarct likely to be? <pic earlyinfarct.jpg>
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1 day <pic earlyinfarct.jpg>
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How old is this infarct likely to be? <pic lateinfarct.jpg>
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2 to 4 days ,Neutrophil infiltration,Loss of nuclei and cross striations <pic lateinfarct.jpg>
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How old is this infarct likely to be? <pic 710dayinfarct.jpg>
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<pic 710dayinfarct.jpg> ,7-10 days,Macrophages have infiltrated and phagocytosed much of the debris
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How old is this infarct likely to be? <pic 3weeksinfarct.jpg>
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3 weeks <pic 3weeksinfarct.jpg> ,granulation tissue, blood vessels, and collagen
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When do troponin levels peak after a heart attack, when do they return to normal?
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48 hours,7-10 days
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When do CK-MB levels peak after a heart attack, when do they return to normal?
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24 hours,72 hours
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When do myoglobin levels peak after a heart attack, when do they return to normal?
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6-7 hours ,24 hours
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What are the most sensitive and specific biomarkers for confirming diagnosis of acute MI?
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Troponin I and T
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Calcific aortic stenosis usually is a result of what?
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wear and tear on normal valves in aged patients,or congenitally bicuspid valves
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what are the clinical manifestations of calcific aortic stenosis?
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LVH,angina,sudden death,syncope,CHF
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How is calcific aortic stenosis diagnosed?
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echocardiography
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In what population is mitral annular calcification most common?
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women over 60,myxomatous mitral valve,increased left ventricular pressure
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Ulceration of mitral annular calcification can lead to what significant problems?
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emboli,endocarditis
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What is the most common form of valvular heart disease in the industrialized world and is also associated with deposition of proteoglycans?
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mitral valve prolapse
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What is the major cause of myxomatous degeneration?
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autosomal dominant,defect in connective tissue,commonly seen in Marfan Syndrome
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How is myxomatous degeneration of the mitral valve diagnosed?
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asymptomatic systolic click,systolic murmur,echocardiography
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What are some of the most important clinical manifestations of rheumatic fever?
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carditis,migratory polyarthritis,subcutaneous nodules,erythema marginatum,Sydenham's chorea
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What are some of the clinical manifestations of rheumatic heart disease?
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murmurs,hypertrophy/dilation,CHF,atrial fibrillation,thromboemboli,infective endocarditis
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What are some of the morphological findings in rheumatic heart disease?
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fibrosis with leaflet thickening,commissural fusion,shortening/thickening/fusion of cords
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What is the pathogenesis of rheumatic heart disease?
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hypersensitivity to group A strep,Antibodies against M protein reacts with tissue glycoproteins,genetic factors regulate susceptibility
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Pancarditis, Aschoff bodies, Anitschkow cells and vegetations are indicative of what pathology?
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Rheumatic fever
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Plump, active macrophages with prominent chromocenters that are pathognomonic for rheumatic fever are called what?
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Anitschkow bodies
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Commissural fusion is a characteristic feature of which valvular disease?
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rheumatic heart disease
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Mitral stenosis is most commonly caused by what disease?
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rheumatic heart disease
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What is the most common cause of infective endocarditis involving a normal valve?,An abnormal valve?,A prosthetic valve?
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Staph Aureus,Strep Viridans,Staph Epidermis
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What are the symptoms of infective endocarditis?
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fever,murmur,petechiae,Roth spots
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What are the common morphological features of infective endocarditis?
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vegetations,aortic/mitral involvement,tricuspid in IV users
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What are the major complications of infective endocarditis?
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regurgitation or stenosis,CHF,ring abscess,prosthetic valves,dehiscence with leak,septic emboli,glomerulonephritis
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How is infective endocarditis diagnosed?
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blood cultures,echocardiography
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How is infective endocarditis prevented?
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prophylactic antibiotics in abnormal or prosthetic valve patients
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What patients are most likely to have nonbacterial thrombotic endocarditis?
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debilitated patients,strong association with mucinous adenocarcinoma
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Where are the vegetations of nonbacterial thrombotic endocarditis most commonly found?
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along the line of closure of the valve
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Where are the vegetations of Libman-Sacks endocarditis (of SLE) located?
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upper and under surfaces of the mitral and tricuspid valves
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What kind of vegetative endocarditis is characterized by small vegetations along the closure of the valve?
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rheumatic heart disease
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What kind of vegetative endocarditis is characterized by small (1-5 mm) vegetations loosely attached along the closure of the valve?
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nonbacterial thrombotic endocarditis
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What kind of vegetative endocarditis is characterized by large, irregular, destructive vegetations?
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infective endocarditis
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What kind of vegetative endocarditis is characterized by small vegetations on the upper and under surfaces of the mitral and tricuspid valves?
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Libman-Sacks
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What type of heart disease involves the secretion of serotonin, flushing, nausea/vomiting, diarrhea and asthma like symptoms?
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carcinoid syndrome
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The thickening of the endocardium associated with carcinoid heart disease is largely due to what?
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deposition of acid mucopolysaccharides
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Plasma levels of what neurotransmitter correlate with the severity of carcinoid heart disease?
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serotonin
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Lesions of carcinoid heart disease occur on what side of the heart?
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the right side,(serotonin is inactivated in the lung)
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Heart disease resulting from a primary abnormality of the myocardium is called what?
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cardiomyopathy
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An enlarged, globoid & "flabby" heart often with mural thrombi is most likely what kind of heart disease?
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dilated cardiomyopathy
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What is the etiology of dilated cardiomyopathy?
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viral myocarditis (e.g. coxsackie),alcohol abuse,cobalt,chemotherapeutic drugs (Adriamycin),nutritional deficiency (thiamine),pregnancy (peripartum cardiomyopathy),genetic*,idiopathic
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What are the clinical features of hypertrophic cardiomyopathy?
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angina, arrhythmias, sudden death,atrial fib with mural thrombosis,systolic murmur, CHF,infective endocarditis
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What are the morphological features of hypertrophic cardiomyopathy?
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asymmetric septal hypertrophy,myocyte hypertrophy,myocyte disarray,fibrosis
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What is the pathogenesis of hypertrophic cardiomyopathy?
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all cases are due to mutations in sarcomere genes
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What type of cardiomyopathy is associated with normal or mildly hypertrophied ventricular walls and dilated atria?
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restrictive cardiomyopathy
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What are the most common virus's involved in viral myocarditis?
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coxsackie A and B
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What type of myocarditis is caused by a parasite?,What is the organism?
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Chagas disease,trypanosoma cruzi
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Myocarditis may progress to what more serious condition?
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dilated cardiomyopathy
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What are the major classifications of causes for myocarditis?
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Infection,Immune related reactions,unknown (sarcoidosis, giant cell myocarditis)
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What kind of pericarditis is associated with acute MI, postinfarction syndrome, radiation, heart surgery, rheumatic fever, SLE and uremia?
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fibrinous pericarditis
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What kind of pericarditis is associated with bacterial infection?
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suppurative pericarditis
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Hemorrhagic pericarditis is associated with what causes?
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malignancy,bacterial infection,bleeding diathesis,TB,Heart surgery
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What type of pericarditis is characterized by a history of hemorrhagic, suppurative or caseous pericarditis and is treated by pericardectomy?
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constrictive pericarditis
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What are the major primary cardiac tumors?
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Myxoma ,Fibroma ,Lipoma ,Papillary Fibroelastoma,Rhabdomyoma ,Angiosarcoma
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What is the most likely diagnosis for a gelatinous polypoid mass with stellate cells found in the atria obstructing the mitral valve orifice?
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Myxoma
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What drug can sometimes treat patent ductus arteriosus?
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indomethacin
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What are the four features of the Tetrology of Fallot?
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Overriding aorta,VSD,subpulmonary stenosis,right ventricular hypertrophy
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What type of coarctation of the aorta occurs proximal to the site of ductus arteriosus?
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infantile form
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What sounds would be observed on auscultation of coarctation of the aorta with a PDA?
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systolic murmur and continuous murmur
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