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116 Cards in this Set

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  • Back
What is the most common congential heart defect?
Ventricular Septal Defect
What are the symptoms associated with Tetralogy of Fallot?
Pulmonary stenosis
Overriding aorta
Right Ventricular Hypertrophy
Interventricular Septal Defect
Common right to left shunt
What is the artery of sudden death?
The first septal perforating branch of LAD
What is significant about the artery of sudden death?
Supplies the muscular septum at the point where right and left bundle branches divide
If the LAD is blocked, what happens?
The passage of cardiac impluses to the apex of the heart is interrupted
What is the predominant cause of death in the US?
Heart disease
What race has the highest death rate for heart disease?
Black males
What are the 5 basic categories of cardiac disease?
Congenital heart disease
Ischemic heart disease
Hypertensive heart disease
Valvular heart disease
Nonischemic myocardial disease
What is the primary cause of valvular disease?
Rheumatic heart disease
What is nonischemic myocardial disease associated with?
Transplant and cardiomyopathy
How much of the cardiac function is lost before patients become symptomatic?
70-80%
What are the 5 basic causes of cardiac dysfunction?
Pump failure
Obstruction of blood flow
Regurgitant flow
Disorders of cardiac conduction
Disruption of the circulatory system
What is cardiac dysfunction?
An inability to pump blood at a rate necessary for metabolizing tissues
What is it called when cardiac dysfunction become chronic?
Congestive Heart Failure
When most CHF patients present with symptoms, what have they most likely developed?
Cardiac Hypertrophy
CHF is characterized by what two things?
Diminished cardiac output (forward failure)
Damning of blood in the venous system (backward failure)
What is systolic dysfunction?
Progressive deterioration of myocardial contractility
What is diastolic dysfunction?
Inability of the heart chambers to relax
Where is left sided heart failure going to back up?
In the lungs--they become edematous
What are the two basic clinical syndromes of left sided heart failure?
Chronic--slowly progressive, develops over time, can cause right sided failure

Acute--Rapidly progressive fatal course; medical emergency
What are the pathologic findings in left sided heart failure?
Cardiomegaly and secondary enlargement of the left atrium
What are the extracardiac effects of left side heart failure?
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
What is right heart failure most commonly a consequence of?
Right sided heart failure
What is Pure or Isolated right sided heart failure?
Uncommon; usually caused by pulmonary hypertension--Cor Pulmonale
What are the extracardiac effects of right sided heart failure?
Pitting edema

Liver--congestion and necrosis in liver sinusoids

Spleen--congestive splenomegaly

Pleural and pericardial cavities--effusions
Where does left sided failure lead to accumulation of fluid?
Lungs
Where does right sided failure lead to accumulation of fluid?
Systemic/body caivities
What is the adaptive response to increased cardiac workload on the heart?
Hypertrophy
What are the two types of hypertrophy seen in heart failure?
Pressure overload--increase in the thickness of the venticle wall

Volume overload--chamber dilationWhat with increaesd ventricular diameter; muscle mass has increased
What type of hypertrophy is hypertension?
Pressure overload hypertrophy
What type of hypertrophy is valvular disease?
Pressure and/or volume overload
What type of hypertrophy is a MI?
Volume overload
What must be present for a diagnosis of Hypertensive Heart Disease?
Left ventricular hypertrophy in the absence of other cardiovascular pathology
What is pulmonary (right sided) hypertensive heart disease usually associated with?
Cor pulomonale or any type of lung disorder
What is the most common cause of IHD?
Reduction of coronary blood flow due to atherosclerotic coronary obstruction
What is the leading cause of death for males in females in the US?
Ischemic heart disease
What is sudden cardiac death?
Unexpected death from cardiac causes early after onset of symptoms (within 1 hour) or sudden death w/o symptoms
What is most often the cause of sudden cardiac death?
A lethal arrhythmia--asystole or v fib
What is stable angina?
Chronic stenosing coronary atherosclerosis--reduction in coronary artery perfusion
What provokes stable angina?
Increased cardiac demand (emotion, exercise)--usually relieved by rest or sublingual nitro
What is Prinzmetal Angina?
Uncommon pattern of episodic angina that occurs at rest
What is the cause of Prinzmetal angina?
Coronary artery vasospasm
What induces unstable crescendo angina?
Disruption of a plaque with a sumperimposed thrombus
What type of angina may occur at rest?
Unstable/Crescendo angina
What is a transmural infarction?
Necrosis involves full or near full thickness of the ventricular wall in a single coronary artery
What is a transmural infarction most commonly associated with?
Acute plaque change with overlying thrombosis
What is a subendocardial infarction?
Area of necrosis limited to the inner 1/3-1/2 of the ventricular wall
What causes a subendocardial infarction?
Acute plaque change and overlying thrombosis

OR

From prolonged and sever reduction in systemic blodd pressure--shock, trauma, hemorrhage
What is the pathogeneis of a MI?
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
When does myocardial necrosis typically begin?
30 minutes after coronary occlusion
When is myocardial necrosis essentially complete?
6 hours after coronary occlusion
If coronary occlusion occurs in an anterior branch of the circulation, what are the symptoms most likely to be?
Chest pain
Clenched fists
"Elephant on my chest"
If coronary occlusion occurs in a posterior branch of the circulation, what are the symptoms most likely to be?
GI symptoms--Heartburn, indigestion
What is the most common coronary artery affected?
LAD
What determines what the symptoms of a MI will be?
The artery affected
Location along the affected artery
Duration of the occlusion
Metabolic requirement of affected myocardium
Extent of collateral blood supply
Vasospasm
What is the time frame for a reversible injury?
0-30 minutes
What is the gold standard to restore blood flow to an area of infarct?
CABG
Do hearts suffering brief periods of ischemia of <20 minutes followed by refperfusion develop necrosis?
No--reversible injury (Salvage)
If occlusion extends >20 minutes duration, does reperfusion salvage the tissue?
Reperfusion before 3-6 hours salvages the tissue but tissue exhibits "stunning" (Viable but nonfunctional)
What are the signs and symptoms of an acute MI?
Severe substernal chest pain with radiation of pain down left arm
Weak rapid pulse
Sweating profusely
Dyspnea
What are the complications of an acute MI?
Contractile dysfunction
Arrhythmias
Papillary muscle dysfunction with mitral regurg
What are the pathological changes seen with an acute MI?
Myocardial rupture
Pericarditis
Right ventricular infarction
Mural thrombus
Aneurysm
What are the most common valves involoved with diseases?
Aortic and Mitral valve stenosis and insufficiency
What is stenosis?
Failure of a valve to open completely--impeding forward flow
What is insuffciency?
Failure of a valve to close--allowing reverse flow
What is the most common of all valvular abnormalities?
Calicific aortic stenosis
When do clinical symptoms of calcific aortic stenosis occur?
The 8th or 9th decade
What are the clinical features of calcific aortic stenosis?
Pressure hypertrophy results from flow obstruction and patient develops significant left ventricular hypertrophy
What is calcific stenosis of congenitally bicuspid aortic valve?
Results from incomplete separation during development--have a bicuspid valve instead of tricuspid valve--develop degenerative calcification earlier
What 3 types of patients does mitral annular calcification occur in?
Women over 60
Individuals with myxomatous mitral valves
Patients with hypertension
Does mitral annular calcification affect valvular function?
No
What is mitral valve prolapse?
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
What is rheumatic fever?
Swollen, painful joints
Acute carditis
Cardiac enlargement and decreased function
Subcutaneous nodule
Erythema marginatum of skin
Sydenham chorea
How is rheumatic fever diagnosed?
Jones criteria
What is rheumatic fever typically a sequelae of?
Strep A
What is acute bacterial endocarditis?
Rapidly progressive destruction of infected cardiac valve--affected valve was previously normal
What is the typical cause of acute bacterial endocarditis?
Staph aureas
What is subacute bacterial endocarditis?
Insidious onset and protracted clinical course--affected valve usually deformed or abnormal
What is the typical call of subacute bacterial endocarditis?
Strep viridans
What is NBTE?
Nonbacterial thrombotic endocarditis--small thrombi along the line of closure of the valve leaflets
What is the major risk factor of NBTE?
Hypercoaguable states--lesions are sterile and contain no organisms
What is the clinical significance of NBTE?
May fragment and produce systemic emboli that can produce obstruction in the heart and brain arteries
What is the disease associated with SLE patients?
Libman-Sacks Disease--small multiple vegetations that occur on the mitral and tricuspid valves
What type of vegetations are seen in RHD?
A row of small warty vegetations along lines of closure of the valve leaflets
What type of vegetations are seen in infective endocarditis?
Large, irregular masses on the valve cusps that extend onto the chordae
What type of vegetations are seen in NBTE?
Small bland vegetations usually attached at the line of closure
What type of vegetations are seen in Libman-Sacks?
Small-medium sized vegetations on either or both sides of the valves
What is carcinoid syndrome?
Caused by metastatic carcinoid tumor producing sustained, high levels of circulating serotonin
What are the consequences of carcinoid syndrome?
Thickening of the right ventricle, and the tricuspid and pulmonic valves
What causes the endocardial thickening in carcinoid syndrome?
Smooth muscle proliferation and increased acid mucopolysaccharide matrix
What is dilated cardiomyopathy?
Large flabby heart--muscles are weak and flabby
What is hypertrophic cardiomyopathy?
Markedly thickened left ventricle--muscle is thick and firm
What is restrictive cardiomyopathy?
Mild increase in cardiac mass without increase in volume of left ventricle
What is the typical etiology of cardiomyopathy?
Most are idiopathic
What are the characteristics of dilated cardiomyopathy?
Insidious, slowly progressive, intractable CHF--dilation, systolic dysfunction, hypertrophy, left ventricular wall thickness
Who is at greater risk for dilated cardiomyopathy?
African-American and males
Is dilated cardiomyopathy increasing or decreasing in incidence?
Increasing in incidence
What are some causes of dilated cardiomyopathy?
CIHD
Myocarditis
Alcohol
Pregnancy
Genetics
How do patients with dilated cardiomyopathy typically present?
Significant, symptomatic, congestive heart failure--disease has been slowly progressing up to this point
What is the most common indication for heart transplant?
Dilated cardiomyopathy
How does the heart look in a patient with dialted cardiomyopathy?
Increased size
Large and flabby
Dilation of all chambers
Mural thrombi
Valves free of narrowing
How does Arrythmogenic Right Ventricular Cardiomyopathy typically present?
With right sided failure and various rhythm disturbances--v tach

Right ventricle walled is thin with fat and fibrosis
What is hypertrophic cardiomyopathy characterized by?
Myocardial hypertrophy
Abnormal diastolic filling
Intermittent ventricular outflow obstruction
How does the heart wall in hypertrophic compared to dilated cardiomyopathy?
HCM--thick walled and hypercontracting

DCM--Flabby and hypocontracting
Does HCM have diastolic or systolic dysfunction?
Diastolic dysfunction
Does HCM have CHF?
No--exertional dyspnea only
What type of mutations does HCM involve?
Mutations in proteins of the sarcomere
What type of mutations does DCM have?
Mutations in the cytoskeleton
What type of cardiomyopathy is most likely linked to SCD in young people?
HCM
What is restrictive cardiomyopathy?
Primary decrease in ventricular compliance, resulting in impaired ventricular filling during diastole
What are the heart findings in restrictive cardiomyopathy?
Ventricles are normal sized or slightly enlarged
Ventricle chambers are normal size
Biatrial enlargement is common
What is the most common cause of RCM?
Amyloidosis
What is the cause of myocarditis?
Inflammatory process due to a viral response
What is the major cause of myocarditis in the US?
Coxsackie virus A and B
What is Loeffler's endomyocarditis?
Hypersensitvity endocarditis
What is Senile Cardiac Amyloidosis?
Occurs in aged patients >60 years; may be localized to both