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116 Cards in this Set
- Front
- Back
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What is the most common congential heart defect?
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Ventricular Septal Defect
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What are the symptoms associated with Tetralogy of Fallot?
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Pulmonary stenosis
Overriding aorta Right Ventricular Hypertrophy Interventricular Septal Defect Common right to left shunt |
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What is the artery of sudden death?
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The first septal perforating branch of LAD
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What is significant about the artery of sudden death?
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Supplies the muscular septum at the point where right and left bundle branches divide
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If the LAD is blocked, what happens?
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The passage of cardiac impluses to the apex of the heart is interrupted
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What is the predominant cause of death in the US?
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Heart disease
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What race has the highest death rate for heart disease?
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Black males
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What are the 5 basic categories of cardiac disease?
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Congenital heart disease
Ischemic heart disease Hypertensive heart disease Valvular heart disease Nonischemic myocardial disease |
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What is the primary cause of valvular disease?
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Rheumatic heart disease
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What is nonischemic myocardial disease associated with?
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Transplant and cardiomyopathy
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How much of the cardiac function is lost before patients become symptomatic?
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70-80%
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What are the 5 basic causes of cardiac dysfunction?
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Pump failure
Obstruction of blood flow Regurgitant flow Disorders of cardiac conduction Disruption of the circulatory system |
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What is cardiac dysfunction?
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An inability to pump blood at a rate necessary for metabolizing tissues
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What is it called when cardiac dysfunction become chronic?
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Congestive Heart Failure
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When most CHF patients present with symptoms, what have they most likely developed?
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Cardiac Hypertrophy
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CHF is characterized by what two things?
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Diminished cardiac output (forward failure)
Damning of blood in the venous system (backward failure) |
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What is systolic dysfunction?
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Progressive deterioration of myocardial contractility
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What is diastolic dysfunction?
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Inability of the heart chambers to relax
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Where is left sided heart failure going to back up?
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In the lungs--they become edematous
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What are the two basic clinical syndromes of left sided heart failure?
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Chronic--slowly progressive, develops over time, can cause right sided failure
Acute--Rapidly progressive fatal course; medical emergency |
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What are the pathologic findings in left sided heart failure?
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Cardiomegaly and secondary enlargement of the left atrium
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What are the extracardiac effects of left side heart failure?
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Lungs-dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Kidney--renal hypoperfusion which leads to activation of the RAA system which further causes fluid retention Brain--hypoxic encephalopathy |
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What is right heart failure most commonly a consequence of?
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Right sided heart failure
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What is Pure or Isolated right sided heart failure?
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Uncommon; usually caused by pulmonary hypertension--Cor Pulmonale
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What are the extracardiac effects of right sided heart failure?
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Pitting edema
Liver--congestion and necrosis in liver sinusoids Spleen--congestive splenomegaly Pleural and pericardial cavities--effusions |
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Where does left sided failure lead to accumulation of fluid?
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Lungs
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Where does right sided failure lead to accumulation of fluid?
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Systemic/body caivities
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What is the adaptive response to increased cardiac workload on the heart?
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Hypertrophy
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What are the two types of hypertrophy seen in heart failure?
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Pressure overload--increase in the thickness of the venticle wall
Volume overload--chamber dilationWhat with increaesd ventricular diameter; muscle mass has increased |
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What type of hypertrophy is hypertension?
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Pressure overload hypertrophy
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What type of hypertrophy is valvular disease?
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Pressure and/or volume overload
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What type of hypertrophy is a MI?
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Volume overload
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What must be present for a diagnosis of Hypertensive Heart Disease?
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Left ventricular hypertrophy in the absence of other cardiovascular pathology
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What is pulmonary (right sided) hypertensive heart disease usually associated with?
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Cor pulomonale or any type of lung disorder
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What is the most common cause of IHD?
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Reduction of coronary blood flow due to atherosclerotic coronary obstruction
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What is the leading cause of death for males in females in the US?
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Ischemic heart disease
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What is sudden cardiac death?
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Unexpected death from cardiac causes early after onset of symptoms (within 1 hour) or sudden death w/o symptoms
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What is most often the cause of sudden cardiac death?
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A lethal arrhythmia--asystole or v fib
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What is stable angina?
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Chronic stenosing coronary atherosclerosis--reduction in coronary artery perfusion
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What provokes stable angina?
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Increased cardiac demand (emotion, exercise)--usually relieved by rest or sublingual nitro
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What is Prinzmetal Angina?
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Uncommon pattern of episodic angina that occurs at rest
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What is the cause of Prinzmetal angina?
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Coronary artery vasospasm
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What induces unstable crescendo angina?
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Disruption of a plaque with a sumperimposed thrombus
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What type of angina may occur at rest?
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Unstable/Crescendo angina
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What is a transmural infarction?
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Necrosis involves full or near full thickness of the ventricular wall in a single coronary artery
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What is a transmural infarction most commonly associated with?
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Acute plaque change with overlying thrombosis
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What is a subendocardial infarction?
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Area of necrosis limited to the inner 1/3-1/2 of the ventricular wall
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What causes a subendocardial infarction?
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Acute plaque change and overlying thrombosis
OR From prolonged and sever reduction in systemic blodd pressure--shock, trauma, hemorrhage |
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What is the pathogeneis of a MI?
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Sudden change in atheromatous plaque
Formation of intial platelet plug over plaque Vasospasm Propgation into a larger and more stable clot Thrombosis and coronary occlusion |
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When does myocardial necrosis typically begin?
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30 minutes after coronary occlusion
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When is myocardial necrosis essentially complete?
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6 hours after coronary occlusion
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If coronary occlusion occurs in an anterior branch of the circulation, what are the symptoms most likely to be?
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Chest pain
Clenched fists "Elephant on my chest" |
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If coronary occlusion occurs in a posterior branch of the circulation, what are the symptoms most likely to be?
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GI symptoms--Heartburn, indigestion
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What is the most common coronary artery affected?
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LAD
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What determines what the symptoms of a MI will be?
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The artery affected
Location along the affected artery Duration of the occlusion Metabolic requirement of affected myocardium Extent of collateral blood supply Vasospasm |
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What is the time frame for a reversible injury?
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0-30 minutes
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What is the gold standard to restore blood flow to an area of infarct?
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CABG
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Do hearts suffering brief periods of ischemia of <20 minutes followed by refperfusion develop necrosis?
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No--reversible injury (Salvage)
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If occlusion extends >20 minutes duration, does reperfusion salvage the tissue?
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Reperfusion before 3-6 hours salvages the tissue but tissue exhibits "stunning" (Viable but nonfunctional)
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What are the signs and symptoms of an acute MI?
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Severe substernal chest pain with radiation of pain down left arm
Weak rapid pulse Sweating profusely Dyspnea |
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What are the complications of an acute MI?
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Contractile dysfunction
Arrhythmias Papillary muscle dysfunction with mitral regurg |
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What are the pathological changes seen with an acute MI?
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Myocardial rupture
Pericarditis Right ventricular infarction Mural thrombus Aneurysm |
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What are the most common valves involoved with diseases?
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Aortic and Mitral valve stenosis and insufficiency
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What is stenosis?
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Failure of a valve to open completely--impeding forward flow
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What is insuffciency?
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Failure of a valve to close--allowing reverse flow
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What is the most common of all valvular abnormalities?
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Calicific aortic stenosis
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When do clinical symptoms of calcific aortic stenosis occur?
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The 8th or 9th decade
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What are the clinical features of calcific aortic stenosis?
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Pressure hypertrophy results from flow obstruction and patient develops significant left ventricular hypertrophy
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What is calcific stenosis of congenitally bicuspid aortic valve?
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Results from incomplete separation during development--have a bicuspid valve instead of tricuspid valve--develop degenerative calcification earlier
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What 3 types of patients does mitral annular calcification occur in?
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Women over 60
Individuals with myxomatous mitral valves Patients with hypertension |
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Does mitral annular calcification affect valvular function?
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No
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What is mitral valve prolapse?
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Caused by myxoid degenration of the ground substance of the valve--causes a floppy cusp with prolapse into the atrium during systole--typically hear a murmur in these patients
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What is rheumatic fever?
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Swollen, painful joints
Acute carditis Cardiac enlargement and decreased function Subcutaneous nodule Erythema marginatum of skin Sydenham chorea |
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How is rheumatic fever diagnosed?
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Jones criteria
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What is rheumatic fever typically a sequelae of?
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Strep A
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What is acute bacterial endocarditis?
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Rapidly progressive destruction of infected cardiac valve--affected valve was previously normal
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What is the typical cause of acute bacterial endocarditis?
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Staph aureas
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What is subacute bacterial endocarditis?
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Insidious onset and protracted clinical course--affected valve usually deformed or abnormal
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What is the typical call of subacute bacterial endocarditis?
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Strep viridans
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What is NBTE?
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Nonbacterial thrombotic endocarditis--small thrombi along the line of closure of the valve leaflets
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What is the major risk factor of NBTE?
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Hypercoaguable states--lesions are sterile and contain no organisms
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What is the clinical significance of NBTE?
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May fragment and produce systemic emboli that can produce obstruction in the heart and brain arteries
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What is the disease associated with SLE patients?
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Libman-Sacks Disease--small multiple vegetations that occur on the mitral and tricuspid valves
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What type of vegetations are seen in RHD?
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A row of small warty vegetations along lines of closure of the valve leaflets
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What type of vegetations are seen in infective endocarditis?
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Large, irregular masses on the valve cusps that extend onto the chordae
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What type of vegetations are seen in NBTE?
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Small bland vegetations usually attached at the line of closure
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What type of vegetations are seen in Libman-Sacks?
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Small-medium sized vegetations on either or both sides of the valves
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What is carcinoid syndrome?
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Caused by metastatic carcinoid tumor producing sustained, high levels of circulating serotonin
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What are the consequences of carcinoid syndrome?
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Thickening of the right ventricle, and the tricuspid and pulmonic valves
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What causes the endocardial thickening in carcinoid syndrome?
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Smooth muscle proliferation and increased acid mucopolysaccharide matrix
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What is dilated cardiomyopathy?
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Large flabby heart--muscles are weak and flabby
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What is hypertrophic cardiomyopathy?
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Markedly thickened left ventricle--muscle is thick and firm
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What is restrictive cardiomyopathy?
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Mild increase in cardiac mass without increase in volume of left ventricle
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What is the typical etiology of cardiomyopathy?
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Most are idiopathic
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What are the characteristics of dilated cardiomyopathy?
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Insidious, slowly progressive, intractable CHF--dilation, systolic dysfunction, hypertrophy, left ventricular wall thickness
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Who is at greater risk for dilated cardiomyopathy?
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African-American and males
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Is dilated cardiomyopathy increasing or decreasing in incidence?
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Increasing in incidence
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What are some causes of dilated cardiomyopathy?
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CIHD
Myocarditis Alcohol Pregnancy Genetics |
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How do patients with dilated cardiomyopathy typically present?
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Significant, symptomatic, congestive heart failure--disease has been slowly progressing up to this point
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What is the most common indication for heart transplant?
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Dilated cardiomyopathy
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How does the heart look in a patient with dialted cardiomyopathy?
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Increased size
Large and flabby Dilation of all chambers Mural thrombi Valves free of narrowing |
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How does Arrythmogenic Right Ventricular Cardiomyopathy typically present?
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With right sided failure and various rhythm disturbances--v tach
Right ventricle walled is thin with fat and fibrosis |
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What is hypertrophic cardiomyopathy characterized by?
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Myocardial hypertrophy
Abnormal diastolic filling Intermittent ventricular outflow obstruction |
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How does the heart wall in hypertrophic compared to dilated cardiomyopathy?
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HCM--thick walled and hypercontracting
DCM--Flabby and hypocontracting |
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Does HCM have diastolic or systolic dysfunction?
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Diastolic dysfunction
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Does HCM have CHF?
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No--exertional dyspnea only
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What type of mutations does HCM involve?
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Mutations in proteins of the sarcomere
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What type of mutations does DCM have?
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Mutations in the cytoskeleton
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What type of cardiomyopathy is most likely linked to SCD in young people?
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HCM
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What is restrictive cardiomyopathy?
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Primary decrease in ventricular compliance, resulting in impaired ventricular filling during diastole
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What are the heart findings in restrictive cardiomyopathy?
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Ventricles are normal sized or slightly enlarged
Ventricle chambers are normal size Biatrial enlargement is common |
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What is the most common cause of RCM?
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Amyloidosis
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What is the cause of myocarditis?
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Inflammatory process due to a viral response
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What is the major cause of myocarditis in the US?
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Coxsackie virus A and B
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What is Loeffler's endomyocarditis?
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Hypersensitvity endocarditis
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What is Senile Cardiac Amyloidosis?
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Occurs in aged patients >60 years; may be localized to both
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