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49 Cards in this Set
- Front
- Back
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What is the function of the pericardium?
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• isolates the heart from other thoracic structures
• maintains the hearts position in the thorax • prevents overfilling • prevents frictional forces from developing |
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What is pulsus paradoxus?
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a 10 mm Hg or more fall in arterial blood pressure during normal breathing
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What is the most common cause of acute pericarditis?
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Viral infection
• coxsackievirus • echovirus • Epstein-Barr • hepatitis • HIV • influenza • mumps • varicella |
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What are manifestations of pericarditis?
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• chest pain
• pericardial friction rub • EKG changes |
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What is a Kussmaul's sign?
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• an inspiratory distention of the jugular veins
• caused by the inability of the right atrium, encased in its rigid pericardium, to accommodate the increase in venous pressure that occurs w/ inspiration |
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What is the most common cause of CHD?
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atherosclerosis
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What is the most frequent cause of myocardial infarction and sudden death?
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atherosclerotic plaque disruption
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Name and describe the 2 types of atherosclerotic lesions.
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• fixed or stable plaque: obstructs blood flow and is commonly implicated in stable angina
• unstable or vulnerable plaque: can rupture and cause platelet adhesion and thrombus formation; implicated in unstable angina and myocardial infarction |
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What is the MOA of aspirin?
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acts by inhibiting the synthesis of the prostaglandin, thromboxane A
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What is the MOA of Ticlopidine and Clopidogrel?
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irreversibly inhibiting the binding of ADP to its receptor on platelets
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What is the MOA of drugs such as abciximab, eptifibatide, and tirofiban?
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these drugs are GP IIB/IIIA rexeptor inhibitors that block the receptor involved in the final common pathway for platelet adhesion, activation, & aggregation
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What are the two types of corornary heart disease?
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• chronic heart disease
• acute coronary syndrome |
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What are the 3 types of chronic ischemic heart disease?
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• stable angina
• variant (or vasospastic) angina • silent myocardial ischemia |
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What is the definition of angina pectoris?
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a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia
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What is the inital manifestation of ischemic heart disease in approximately half of people with CHD?
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stable angina
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What are characteristics of silent myocardial ischemia?
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• occurs in the absence of anginal pain
• caused by atherosclerosis or vasospams • theoretical causes include: 1. shorter episodes that involve less myocardial tissue that those producing pain 2. defects in pain threshold or transmission 3. autonomic neuropathy w/ sensory denervation |
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What is the MOA of beta-blockers?
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• act as antagonist that block beta-receptor-mediated functions of the sympathetic nervous system
• decrease cardiac work and myocardial oxygen consumption |
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What is the mainstay of treatment of variant angina?
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calcium channel blockers & short- and long-term nitrates
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Acute coronary syndrome is used to decribe the spectrum of acute ischemic heart disease that includes what?
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• unstable angina
• non-ST-segment elevation • myocardial infarction • ST- segment elevation (Q-wave) myocardial infarction |
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Name and describe serum markers used in diagnosis of myocardial infarction
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• Troponin: begins to rise 3-6 hrs after the onset of MI; may remain elevated for up to 14 days; most sensitive & specific
• CK-MB (creatine kinase): an intracellular enzyme found in muscle cells; begins to rise within 4-8 hrs of myocardial injury; falls within 2-3 days • Myoglobin: becomes elevated within 1 hr of onset; peak levels within 4-8 hrs; not cardiac specific |
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What are 3 features that characterize the pain of unstable angina?
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• pain occurs at rest (or w/ minimal exertion) usually lasting more than 20 minutes
• pain is severe and describe as frank pain and of new onset • pain occurs with a pattern that is more severe, prolonged, or frequent that previously experienced |
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How do you differentiate between unstable angina and non-ST segment elevation MI?
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• Unstable angina: persons who have no evidence of serum markers for myocardial damage
• Non-STEMI: indicated if a serum marker of myocardial injury is present |
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What is usually the attributable cause of sudden death in patients with acute MIs?
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• fatal arrhythmias
• ~ 30-50% die of ventricular fibrillation within the first few hours after symptoms begin |
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What is the difference between a transmural and subendocardial infarct?
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• Transmural infarcts: involve the full thickness of the ventricular wall and most commonly occur when there is obstruction of a single artery
• Subendocardial infarcts: involve the inner one-third to one-half of the ventricular wall and occur more frequently in the presence of severely narrowed but still patent arteries |
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What is a stunned myocardium?
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the recovering area of the heart which still has critical abnormalities in biochemical function, causing impaired ventricular function
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What is nitroglycerin's effect on preload and afterload?
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reduces both preload and afterload
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What is the MOA of thrombolytic drugs in the treatment of acute MI?
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• these agents interact with plasminogen to generate plasmin, which lyses fibrin clots
• digests clotting factors V, factor VIII, prothrombin, & fibrinogen |
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What are the 3 zones of tissue damage after a myocardial infarction?
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• area of necrosis
• area of injury (some cells will recover) • ischemic zone (area where cells can be salvaged if blood flow can be reestablished) |
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What is Dressler's syndrome?
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• Pericarditis post-MI
• thought to represent a hypersensitivity response to tissue necrosis |
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What is the definition of myocarditis?
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an inflammation of the heart muscle and conduction system without evidence of myocardial infarction
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What are causes of myocarditis?
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• Viral (coxsackie A & B, enterovirus, HIV)
• chemical or physical agents • cocaine • hypersensitvity reactions • radiation therapy |
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What are the different types of cardiomyopathy?
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• Dilated
• Hypertrophic • Restrictive • Arrhytmogenic Right Ventricular cardiomyopathy • Peripartum cardiomyopathy |
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What are causes of dilated cardiomyopathy?
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• alcohol
• genetics • idiopathic • immunologic disorders • metabolic influences • myocarditis • neuromuscular diseases |
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What is pulsus alterans?
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• when the pulse regularly alternates between weaker and stronger volume
• can be seen in dilated cardiomyopathy |
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Which cardiomyopathy is commonly a disease of young adulthood and is the most common cause of sudden cardiac death in the young?
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hypertrophic cardiomyopathy
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What are characteristics of hypertrophic cardiomyopathy?
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• an abnormality that involves excessive ventricular growth or hypertrophy
• produces intermittent left ventricular outflow obstruction |
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True/False: Hypertrophic cardiomyopathy is often of familial origin, being inherited as an autosomal recessive trait.
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• Hypertrophic cardiomyopathy is inherited as an autosomal dominant trait
• The correct answer is: False |
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What is the most common symptom associated with hypertrophic cardiomyopathy?
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• Dyspnea (most common)
also can have: • chest pain • fatigue • syncope |
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What are characterisitcs of restrictive cardiomyopathy?
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• least common cardiomyopathy in Western countries
• ventricular filling is restricted because of excessive rigidity of the ventricular walls • MCC are endocardial infiltrations such as amyloidosis |
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What two independant factors are normally required for infective endocarditis to develop?
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• a damaged endocardial surface
• a portal of entry by which the organism gains access to the circulatory system |
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What is the most common source of right-sided (tricuspid) lesions?
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• IV drug abuse
• staphylococcal infections are common |
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What organisms usually cause acute, subacute, and chronic endocarditis?
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• Acute: Staphylococcus aureus
• Subacute: Streptococcus viridans • Chronic: Legionella and Brucella |
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Which diagnostic procedure is most definitive and essential to guide the treatment of endocarditis?
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blood culture
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What is the most common finding of rheumatic fever?
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polyarthritis
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Which heart valves are most commonly affect by disease?
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mitral and aortic
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What is the most common congenital heart defect?
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ventricular septal defects
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What is Eisenmenger's Syndrome?
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a reversal of the direction of shunt flow
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What is the most common cause of aquired heart disease in young children?
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Kawasaki disease (aka mucocutaneous lymph node syndrome)
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What are characteristics of Kawaski disease?
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• an acute febrile disease of young children
• affects the skin, brain, eyes, joints, liver, lymph nodes • causes vasculitis that begins in the small vessels and progresses to the larger arteries • can produce dilatation and aneuryms in the coronary arteries |
