Pathology - Hf And Ihd

Front 1

Frank-starling mechanism says:

Back 1

longer lengths of sarcomere enhance contractility but there is a optimal sarcomere length for the most forceful contraction

Front 2

Atrial vs Ventricular myocytes?

Back 2

atrial myocytes are smaller and less structure than ventricles and have ANP granules released from vesicles upon distension

Front 3

Supplies apex?

Back 3

LAD

Front 4

Supplies anterior 2/3 of septum

Back 4

LAD

Front 5

supplies anterior wall of LV?

Back 5

LAD

Front 6

supplies lateral wall of LV?

Back 6

left circumflex aa

Front 7

supplise posterior 1/3 of septum?

Back 7

right coronary aa

Front 8

supplies posterior basal wall of LV?

Back 8

right coronary artery

Front 9

supplies RV free wall?

Back 9

right coronary artery

Front 10

coronary aa blood flow maximum during:

Back 10

diastole

Front 11

Chamber changes due to age?

Back 11

LA enlargement and LV cavity decreases in size

Front 12

What are lambl excrescences?

Back 12

small filiform processes on closure lines of aortic and mitral valves

Front 13

What is PORC D?

Back 13

five principle mechanisms of cardiac dysfunction.

Front 14

What does PORC D stand for?

Back 14

Pump failure, Obstruction to blood flow, Regurgitation, Conduction defects, Distruption of continuity of circulatory system

Front 15

Pathogenesis of heart pump failure?

Back 15

either sytolic of diastolic due to underlying pathology

Front 16

Types of systolic dysfunction?

Back 16

IHD, HTN or volume overload, DCM
(increased work)

Front 17

Types of diastolic dysfunction?

Back 17

LV Hypertrophy, amyloidosis, myocardial fibrosis, constrictive pericarditis
(impairment of filling)

Front 18

inability of the heart to pump blood at a high enough rate to meet metabolic demands

Back 18

heart failure

Front 19

the ability to pump blood at a rate enough to meet metabolic requirements but only at an elevated filling pressure

Back 19

heart failure

Front 20

acute causes of ventricular filling impairment?

Back 20

pericarditis of tamponade

Front 21

example of low CO heart failure

Back 21

AV fistula

Front 22

example of high CO heart failure

Back 22

anemia

Front 23

rapid adjustments in response to hemodynamic overload or impaired myocardial contractility?

Back 23

RAAS, ANP, NE release, frank starling

Front 24

Two stimuli for cardiac hypertrophy:

Back 24

volume overload and pressure overload.

Front 25

causes the largest hypertrophy of the heart:

Back 25

aortic regurg

Front 26

concentric hypertrophy

Back 26

seen in pressure overload and may end with reduction in cavity diameter

Front 27

hypertrophy with dilation:

Back 27

volume overload where wall thickness may not even change but there is enlargement of nuclei and cytoplasm

Front 28

Pathogenesis of why hypertrophy leads to cardiac failure

Back 28

increased myofiber size decreases capillary density and causes increase in intercapillary distance

Front 29

extension of normal myocardial growth with minimal or no deleterious effects

Back 29

physiology hypertrophy

Front 30

causes of LH failure

Back 30

ischemia, HTN, valvular diseases, cardiomyopathies

Front 31

most common cause of right heart failure

Back 31

left heart failure

Front 32

how does sleep apnea affect heart?

Back 32

causes pulmonary hypoxia and shunting to cause pulmonary HTN and cor pulmonale

Front 33

changes seen in systemic hypertensive heart disease?

Back 33

LV enlargement without dilation which causes stiffness (working against high pressures)

also atrial enlargement

Front 34

cause of acute cor pulmonale

Back 34

PE

Front 35

cuase of chronic cor pulmonale

Back 35

primary pulm HTN or emphysema

Front 36

What usually causes ischemic heart disease?

Back 36

usually its secondary to coronary artery disease

Front 37

What usually causes ischemic heart disease?

Back 37

usually its secondary to coronary artery disease

Front 38

ischemia without death of heart muscle

Back 38

angina pectoris

Front 39

ischemia without death of heart muscle

Back 39

angina pectoris

Front 40

what are MACS

Back 40

the clinical syndromes of ischemic heart disease.

Front 41

what are MACS

Back 41

the clinical syndromes of ischemic heart disease.

Front 42

What does MACS stand for

Back 42

The clinical syndromes of IHD:
MI
Angina pectoris
Chronic IHD without heart failure
Suddent cardiac death

Front 43

What does MACS stand for

Back 43

The clinical syndromes of IHD:
MI
Angina pectoris
Chronic IHD without heart failure
Suddent cardiac death

Front 44

What initial event causes IHD?

Back 44

upredictable and abrupt conversion of a plaque into unstable atherothrombotic lesion

Front 45

What initial event causes IHD?

Back 45

upredictable and abrupt conversion of a plaque into unstable atherothrombotic lesion

Front 46

Causes symptomatic ischemia induced by exercise:

Back 46

narrowing of coronary aa of >75%

Front 47

Causes symptomatic ischemia induced by exercise:

Back 47

narrowing of coronary aa of >75%

Front 48

amount of stenosis that will cause inadequate coronary flow at rest

Back 48

>90%

Front 49

amount of stenosis that will cause inadequate coronary flow at rest

Back 49

>90%

Front 50

Why does waking up in the morning cause an MI?

Back 50

awakening causes adrenergic stimulation which my initiate acute plaque change

Front 51

Why does waking up in the morning cause an MI?

Back 51

awakening causes adrenergic stimulation which my initiate acute plaque change

Front 52

Four steps to occlusion in IHD?

Back 52

1) fixed obstruction
2) acute plaque change
3) thrombosis
4) vasoconstriction

Front 53

Four steps to occlusion in IHD?

Back 53

1) fixed obstruction
2) acute plaque change
3) thrombosis
4) vasoconstriction

Front 54

what causes angina pectoris?

Back 54

transient myocardial ischemia without cellular necrosis

Front 55

what causes angina pectoris?

Back 55

transient myocardial ischemia without cellular necrosis

Front 56

angina that resonds to rest and nitroglycerin?

Back 56

Stable/typical variant

Front 57

Angina that occurs at rest and responds to nitroglycerin and CCBs?

Back 57

Prinzmetal or variant pattern

Front 58

Angina with progressive increasing frequency and often at rest and prolonged duration?

Back 58

Unstable or crescendo pattern

Front 59

Pattern of angina with high risk for MI?

Back 59

unstable/screscuendo because it implies distruption of plaque with superimposed thrombus already

Front 60

myocardial necrosis due to ischemia?

Back 60

MI aka heart attack

Front 61

risk factors for MI?

Back 61

Old men with HTN that smoke and have diabetes

Front 62

What are common causes of 10% of MIs not caused by acute plaque changes?

Back 62

emboli or cocaine abuse

Front 63

What occurs within 60 seconds of ischemia onset?

Back 63

loss of contractility

Front 64

What occurs within 20-40 minutes of ischemia onset?

Back 64

irreversible damage with coagulative necrosis

Front 65

What is a complication of MI?

Back 65

arrhythmias induced by myocardial irritability from the infarct can lead to sudden death

Front 66

Types of infarcts caused by MI?

Back 66

transmural or subendocardial (furthest form coronary arteries)

Front 67

Most transmural infarcts involve ___

Back 67

left ventricle

Front 68

most common coronary arteries involved with MIs:

Back 68

LAD: 50%
RCA: 40%
LCA: 20%

Front 69

What is tetrazolium stain?

Back 69

stain that will show pale areas of infarct 2-3 hrs post occurance

Front 70

red-blue color after MI

Back 70

necrosis 24 hrs post infarct

Front 71

yellow tan after MI

Back 71

1-10 days which indicates neutrophil and macrophage involvement

Front 72

hyperemic peripheral zone with central yell-tan post MI

Back 72

scar formation (granulation tissue and collagen deposition) 10-14 days post MI

Front 73

when does a scar form post MI?

Back 73

>2 weeks

Front 74

Reperfusion injury is usually due to:

Back 74

nosocomial:
thrombolytic therapies
balloon angioplasties
bypass grafting

Front 75

when is reperfusion helpful?

Back 75

within 3-4 hrs to limit the extent of ischemia

Front 76

Reperfusion injury due to:

Back 76

oxygen radicals and microvascular injury

Front 77

Complications of MI?

Back 77

cardiogenic shock/pump failure due to contractile dysfunction
-arrhythmias
- myocardial rupture
- mural thrombus, aneurysm, muscle dysfunction

Front 78

What is a patient at risk for 3-7 days post MI?

Back 78

myocardial rupture

Front 79

elderly patients with progressive heart failure as a consequence if ischemic myocardial damage

Back 79

chronic ischemic heart disease (occurs in 1/2 of all transplant pts)

Front 80

enlarged heart with LV hypertrophy, coronary AS, scars, and overall diffuse myocardial dysfunction

Back 80

chronic ischemic heart disease (ischemic cardiomyopathy)

Front 81

What is sudden cardiac death?

Back 81

death within one hour after symptom onset caused by LETHAL ARRHYTHMIA, usually a complication of IHD but can be caused by other things