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49 Cards in this Set

  • Front
  • Back
What is the function of the pericardium?
• isolates the heart from other thoracic structures
• maintains the hearts position in the thorax
• prevents overfilling
• prevents frictional forces from developing
What is pulsus paradoxus?
a 10 mm Hg or more fall in arterial blood pressure during normal breathing
What is the most common cause of acute pericarditis?
Viral infection

• coxsackievirus
• echovirus
• Epstein-Barr
• hepatitis
• influenza
• mumps
• varicella
What are manifestations of pericarditis?
• chest pain
• pericardial friction rub
• EKG changes
What is a Kussmaul's sign?
• 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
What is the most common cause of CHD?
What is the most frequent cause of myocardial infarction and sudden death?
atherosclerotic plaque disruption
Name and describe the 2 types of atherosclerotic lesions.
• 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
What is the MOA of aspirin?
acts by inhibiting the synthesis of the prostaglandin, thromboxane A
What is the MOA of Ticlopidine and Clopidogrel?
irreversibly inhibiting the binding of ADP to its receptor on platelets
What is the MOA of drugs such as abciximab, eptifibatide, and tirofiban?
these drugs are GP IIB/IIIA rexeptor inhibitors that block the receptor involved in the final common pathway for platelet adhesion, activation, & aggregation
What are the two types of corornary heart disease?
• chronic heart disease
• acute coronary syndrome
What are the 3 types of chronic ischemic heart disease?
• stable angina
• variant (or vasospastic) angina
• silent myocardial ischemia
What is the definition of angina pectoris?
a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia
What is the inital manifestation of ischemic heart disease in approximately half of people with CHD?
stable angina
What are characteristics of silent myocardial ischemia?
• 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
What is the MOA of beta-blockers?
• act as antagonist that block beta-receptor-mediated functions of the sympathetic nervous system
• decrease cardiac work and myocardial oxygen consumption
What is the mainstay of treatment of variant angina?
calcium channel blockers & short- and long-term nitrates
Acute coronary syndrome is used to decribe the spectrum of acute ischemic heart disease that includes what?
• unstable angina
• non-ST-segment elevation
• myocardial infarction
• ST- segment elevation (Q-wave) myocardial infarction
Name and describe serum markers used in diagnosis of myocardial infarction
• 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
What are 3 features that characterize the pain of unstable angina?
• 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
How do you differentiate between unstable angina and non-ST segment elevation MI?
• 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
What is usually the attributable cause of sudden death in patients with acute MIs?
• fatal arrhythmias
• ~ 30-50% die of ventricular fibrillation within the first few hours after symptoms begin
What is the difference between a transmural and subendocardial infarct?
• 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
What is a stunned myocardium?
the recovering area of the heart which still has critical abnormalities in biochemical function, causing impaired ventricular function
What is nitroglycerin's effect on preload and afterload?
reduces both preload and afterload
What is the MOA of thrombolytic drugs in the treatment of acute MI?
• these agents interact with plasminogen to generate plasmin, which lyses fibrin clots
• digests clotting factors V, factor VIII, prothrombin, & fibrinogen
What are the 3 zones of tissue damage after a myocardial infarction?
• area of necrosis
• area of injury (some cells will recover)
• ischemic zone (area where cells can be salvaged if blood flow can be reestablished)
What is Dressler's syndrome?
• Pericarditis post-MI
• thought to represent a hypersensitivity response to tissue necrosis
What is the definition of myocarditis?
an inflammation of the heart muscle and conduction system without evidence of myocardial infarction
What are causes of myocarditis?
• Viral (coxsackie A & B, enterovirus, HIV)
• chemical or physical agents
• cocaine
• hypersensitvity reactions
• radiation therapy
What are the different types of cardiomyopathy?
• Dilated
• Hypertrophic
• Restrictive
• Arrhytmogenic Right Ventricular cardiomyopathy
• Peripartum cardiomyopathy
What are causes of dilated cardiomyopathy?
• alcohol
• genetics
• idiopathic
• immunologic disorders
• metabolic influences
• myocarditis
• neuromuscular diseases
What is pulsus alterans?
• when the pulse regularly alternates between weaker and stronger volume
• can be seen in dilated cardiomyopathy
Which cardiomyopathy is commonly a disease of young adulthood and is the most common cause of sudden cardiac death in the young?
hypertrophic cardiomyopathy
What are characteristics of hypertrophic cardiomyopathy?
• an abnormality that involves excessive ventricular growth or hypertrophy
• produces intermittent left ventricular outflow obstruction
True/False: Hypertrophic cardiomyopathy is often of familial origin, being inherited as an autosomal recessive trait.
• Hypertrophic cardiomyopathy is inherited as an autosomal dominant trait
• The correct answer is: False
What is the most common symptom associated with hypertrophic cardiomyopathy?
• Dyspnea (most common)

also can have:
• chest pain
• fatigue
• syncope
What are characterisitcs of restrictive cardiomyopathy?
• 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
What two independant factors are normally required for infective endocarditis to develop?
• a damaged endocardial surface
• a portal of entry by which the organism gains access to the circulatory system
What is the most common source of right-sided (tricuspid) lesions?
• IV drug abuse
• staphylococcal infections are common
What organisms usually cause acute, subacute, and chronic endocarditis?
• Acute: Staphylococcus aureus
• Subacute: Streptococcus viridans
• Chronic: Legionella and Brucella
Which diagnostic procedure is most definitive and essential to guide the treatment of endocarditis?
blood culture
What is the most common finding of rheumatic fever?
Which heart valves are most commonly affect by disease?
mitral and aortic
What is the most common congenital heart defect?
ventricular septal defects
What is Eisenmenger's Syndrome?
a reversal of the direction of shunt flow
What is the most common cause of aquired heart disease in young children?
Kawasaki disease (aka mucocutaneous lymph node syndrome)
What are characteristics of Kawaski disease?
• 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