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74 Cards in this Set
- Front
- Back
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where is mitral valve best heard?
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apex
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where is tricuspid valve best heard?
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left parasternal border
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where is pulmonary valve best heard?
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left second and third intercostal spaces
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where is aortic valve best heard?
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left sternal border for regurgitation murmurs and right second intercostal space for ejection murmurs
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concentric hypertrophy?
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concentric thickening of ventricular wall caused by increased afterload
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eccentric hypertrophy?
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dilation and hypertrophy of ventricular wall caused by increased preload
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causes of concentric left ventricular hypertrophy?
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essential HTN, aortic stenosis, hypertrophic cardiomyopathy
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causes of concentric right ventricular hypertrophy?
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pulmonary HTN, pulmonary artery stenosis
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causes of eccentric hypertrophy of left ventricle?
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mitral or aortic valve regurgitation, L to R shunting of blood (ventricular septal defect)
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causes of eccentric hypertrophy of right ventricle?
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tricuspid or pulmonary valve regurgitation
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causes of S4 heart sound?
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ventricular hypertrophy: blood entering a noncompliant ventricle
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definition of congestive heart failure (CHF)?
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heart fails when it is unable to eject blood delivered to it by the venous system
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pathogenesis of paroxysmal nocturnal dyspnea?
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without gravity, fluid from interstitium moves to vascular compartment thereby overwhelming failed heart and backing up to lungs to produce pulmonary edema - relieved by standing or placing pillus under the head
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forward failure is also known as?
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left-sided heart failure
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backward failure is also known as?
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right-sided heart failure
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ateriovenous fistula and causes?
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arteriovenous communications bypass the microcirculation leading to increased venous return to the heart; causes: trauma from knife wound, surgical shunt for hemodialysis, mosaic bone in Paget's disease
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most common site of coronary artery thromboses?
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left anterior descending
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which artery is primary supplier to atrioventricular and sinoatrial nodes?
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right coronary artery
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types of ischemic heart disease?
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angina pectoris, chronic ischemic heart disease, sudden cardiac death, myocardial infarction
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prinzmetal's angina?
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intermittent coronary artery vasospasm at rest with or without superimposed coronary artery atherosclerotic disease, due to thromboxane A2 or increase in endothelin
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chronic ischemic heart disease?
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progressive CHF from long-term ischemic damage to myocardial tissue resulting from replacement of myocardial tissue with noncontractile scar tissue
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sudden cardiac death?
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unexpected death within 1 hour after the onset of symptoms, most commonly in morning when hypercoagulability is at its peak precipitated by ventricular fibrillation
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most common cause of death in adults in the US?
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acute myocardial infarction
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what part of myocardium involved in subendocardial infarction?
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inner third of myocardium
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how does reperfusion alter irreversibly damaged cells?
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influx of Ca2+ causes hypercontraction of myofibrils in dying cells
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when is coagulation necrosis evident after an MI?
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12-24 hours
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when do neutrophils begin to enter the area of infarction of a MI?
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from 0-24 hours
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when are neurtophils abundant and lysing dead myocardial cells after a MI?
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days 1-3
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when is there red granulation tissue and the heart most in danger of rupturing following a MI?
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3-7 days
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when is granulation tissue and collagen formation evident after a MI?
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days 7-10
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pathogenesis of 'silent' acute MIs?
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due to high pain threshold or problems with nervous system
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what is timeline for appearance/disappearance of creatinine kinase isoenzyme (CK-MB)?
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CK-MB appears within 4-8 hours; peaks at 24 hours to disappear within 1.5-3 days
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timeline for cardiac troponins I (cTnI) and T (cTnT)?
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cTnI and cTnT appear within 3-12 hours, peak at 24, and disappear within 7-10 days
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timeline for LDH?
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appears within 10 hours, peaks at 2-3 days, disappears within 7 days; mainly replaced by troponins
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most common congenital heart disease and is associated with harsh pansystolic murmur at lower left sternal border?
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ventricular septal defect
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what heart murmur is associated with atrial septal defects?
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mild systolic murmur at upper sternal border; fixed splitting of S2
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heart murmur associated with patent ductus arteriosus?
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machinery murmur heard during systole and diastole
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pathogenesis of differential cyanosis seen with patent ductus arteriosus?
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unoxygenated blood enters aorta below subclavian artery resulting in pink upper body and cyanotic lower body
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antibodies and hypersensitivities encountered with rheumatic fever?
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antibodies against GAS M proteins cross react with similar proteins (type II hypersensitivity) and cell-mediated immunity has also been implicated (type IV hypersensitivity)
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which valve is most commonly involved in rheumatic fever endocarditis?
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mitral valve (followed by aortic valve)
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mitral valve stenosis is most commonly caused by?
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recurrent attacks of rheumatic fever
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heart murmur associated with mitral valve stenosis?
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opening snap followed by an early to mid-diastolic rumble
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most common cause of mitral valve regurgitation?
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mitral valve prolapse
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heart murmur associated with mitral valve regurgitation?
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pansystolic murmur; S3 and S4 heart sounds
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mitral valve prolapse associations?
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AD inheritance, women, or Marfan and Ehlers-Danlos syndromes
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hear murmur associated with mitral valve prolapse?
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mid-systolic click due to sudden restraint by the chordae of the prolapsed valve; mid to late systolic regurgitant murmur follows the click
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what age does calcific aortic valve stenosis typically occur?
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>60 yo
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heart murmur associated with aortic valve stenosis?
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systolic ejection murmur with S4 heart sound
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clinical consequences of aortic valve stenosis?
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angina with exercise (decreased filling of coronary arteries) and syncope with exertion (decreast blood flow to brain)
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heart murmur in aortic valve regurgitation?
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early diastolic murmur; S3 and S4 heart sounds
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which valvular condition can produce increased pulse pressure and hyperdynamic circulation (bounding pulses)?
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aortic valve regurgitation
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murmur associated with tricuspid valve regurgitation?
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pansystolic murmur; S3 and S4 heart sounds
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murmur associated with pulmonary valve stenosis?
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systolic ejection murmur
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murmur associated with pulmonary valve regurgitation?
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diastolic murmur; S3 and S4 heart sounds
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most common cause of infective endocarditis?
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streptococcus viridans - infects previously damaged valves
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consequential clinical findings with infective endocarditis?
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fever, microembolization findings (splinter hemorrhage, etc)
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libman-sacks endocarditis findings and association?
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sterile vegetations over mitral valve surface and chordae resulting in valve deformity and mitral valve regurgitation; associated with SLE
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pathogenesis of nonbacterial thrombotic endocarditis (marantic endocarditis)?
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mucin from mucin-producing tumors (colon/pancrease) have procoagulant effect
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pathogen causes of myocarditis?
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coxsackie virus (most common), trypanosoma cruzi, lyme disease
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pathology observed in myocarditis?
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global enlarement of the heart and dilation of all chambers, lymphocytic infiltrate with focal areas of necrosis
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prognosis for myocarditis?
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50% die within 5 years
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what is observed on chest xray of a patient with pericardial effusion?
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water bottle configuration
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most common cause of constrictive pericarditis?
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TB
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definition of cardiomyopathy?
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group of diseases that primarily involve the myocardium and produce myocardial dysfunction
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most common cardiomyopathy?
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dilated cardiomyopathy
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most common cause of sudden death in young individuals?
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hypertrophic cardiomyopathy
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genetics of familial form of hypertrophic cardiomyopathy?
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AD with nearly complete penetrance, chromosome 14 with missense mutation for one of cardiac sarcomere proteins (ex mutation in myosin heavy chain gene)
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where is predominant hypertrophy in hypertrophic cardiomyopathy?
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interventricular septum as opposed to free left ventricular wall, possibly leading to obstruction of outflow tract
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characteristics of murmur heard with hypertrophic cardiomyopathy?
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harsh systolic ejection murmur that increases with decreased preload and decreases with increased preload
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treatment for hypertrophic cardiomyopathy?
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beta-blockers (increase preload and decrease contractility), implantable cardioconvertor defibrillator (prevent ventricular tachycardia/fibrillation and sudden cardiac death)
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causes of restrictive cardiomyopathy?
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amyloidosis, myocardial fibrosis following open-heart surgery, radiation, hemochromatosis, sarcoidosis, systemic sclerosis, etc
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cardiac myxoma?
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benign primary mesenchymal tumor
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location and pathology of cardiac myxoma?
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left atrium with 'ball valve' effect that blocks mitral valve orifice (block diastolic filling of ventricle simulation mitral valve stenosis
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rhabdomyoma?
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hamartoma (non-neoplastic) arising from cardiac muscle with major association with tuberous sclerosis
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