Pathology Tbl 5: Cardio: Block Ii

Front 1

This biomarker rises within 2 hours of cell injury, peaks at 6-9 hrs, and returns to normal after 24-36 hours

Back 1

Myoglobin

Front 2

This biomarker rises within 3-4 hours of cell injury, peaks at 24 hrs, and returns to normal after 5-6 days

Back 2

Troponin- I

Front 3

This biomarker rises within 4-8 hours of cell injury, peaks at 24 hours, and returns to normal after 3 days

Back 3

CK-MB

Front 4

This heart sound is heard when there is already fluid in the ventricle, as with a dilated ventricle

Back 4

S3

Front 5

This heart sound is heard with decreased compliance of the ventricle, as with hypertrophic ventricle

Back 5

S4

Front 6

What does a right sided S3 indicate?

Back 6

High pressure and volume overload in the in the pulmonary circuit.

Front 7

What would be some causes of a right sided S3 sound?

Back 7

Severe tricuspid insufficiency due to pulmonary HTN or sudden right ventricular ejection obstruction, such as PE

Front 8

Right sided S4 is heard in patients with conditions that causes an increase in what?

Back 8

Right ventricular pressure over 100 mmHg.

Front 9

Which two conditions would cause a right sided S4?

Back 9

Pulmonary stenosis and pulmonary HTN

Front 10

This is a greater than normal decrease in systolic blood pressure with inspiration:

Back 10

Pulsus Paradoxus

Front 11

Name three causes of pulsus paradoxus:

Back 11

1. Constrictive Pericarditis
2. Cardiac Tamponade due to cardiac effusion
3. Severely increased intrathoracic pressures (severe obstructive lung disease)

Front 12

What causes diffuse PMI?

Back 12

Conditions that cause dlated cardiomyopathy

Front 13

Name some causes of dilated cardiomyopathy:

Back 13

Alcohol, drugs, thiamine deficiency, postpartum, hypothyroidism, and acromegaly.

Front 14

Which four conditions can cause unequal pulses in both upper extremities?

Back 14

1. Aortic Dissection
2. Atherosclerosis
3. Compartment Syndrome
4. Takayasu arteritis

Front 15

Decreased pulse pressure <30 mmHg

Back 15

Narrowed pulse pressure

Front 16

Which two conditions can cause a narrowed pulse pressure?

Back 16

1. Hemodynamically significant aortic stenosis
2. Pericardial effusion/ constrictuve pericarditis

Front 17

Increased pulse pressure > 40 mmHg

Back 17

Widened pulse pressure

Front 18

Name four conditions that could cause a widened pulse pressure:

Back 18

1. Patent Ductus Ateriosus
2. Coarctation of the Aorta
3. Distributive shock
4. Aortic regurgitation

Front 19

A widened mediastinum is seen in 75% of cases of what?

Back 19

Aortic dissection

Front 20

Blood pooling in the aorta casues a widened mediastinum. Which two genetic disorders is this associated with?

Back 20

Marfan Syndrome and Ehler-Danlos

Front 21

Which artery ischemia affects the posterior and inferiot walls of the heart?

Back 21

Right coronary artery

Front 22

If leads II, III, and aVF on the EKG are abnormal, which artery is ischemic?

Back 22

Right coronary artery

Front 23

Which artery ischemia affects the anterior wall of the heart?

Back 23

Proximal left anterior descending artery

Front 24

Which artery is ischemic if leads V1 to V4 are abnormal?

Back 24

Proximal left anterior descending artery

Front 25

Which part of the heart is affected if leads V1 to V4 are abnormal?

Back 25

Anterior wall of the heart

Front 26

Which two arteries supply the anterolateral heart wall?

Back 26

Distal LAD and LCA

Front 27

If leads V4-V6, I and aVL are abnormal, which part of the heart is affected? Which arteries supply this region?

Back 27

Anterolateral heart - supplied by distal LAD to LCA

Front 28

Which artery is ischemic if leads I aVL, V5 and V6 are abnormal?

Back 28

LCA

Front 29

Immediate presentation with onset of arterial occlusion, acute loss of pump function with severe ischemia.

Back 29

Cardiogenic shock

Front 30

This condition presents with hypotension, dyspnea, inability to speak due to shortness of breath, cyanosis, crackles, acute pulmonary edema, and pallor.

Back 30

Cardiogenic shock

Front 31

Anterior MI casues what type of arrythmias?

Back 31

Right or left bundle branch block

Front 32

This kind of MI causes sinus bradycardia, AV node block, PVC's, and palpitations.

Back 32

Inferior MI

Front 33

If a patient presents with ischemia and bradycardia it is assumed to be which condition until proven otherwise?

Back 33

Inferior MI (and probably RCA in origin)

Front 34

Why can ventricular or atrial fibrillation occur with ischemia in any area?

Back 34

Because of the irritability of the muscular wall

Front 35

This occurs 1-7 days after a Q-wave (transmural) MI

Back 35

Acute pericarditis

Front 36

This condition appears following a transmural MI and is releived by sitting forward and exacerbated by leaning back

Back 36

Acute Pericarditis

Front 37

This complication of MI begins developing around 48 hours, is clinically recognized at 4-5 weeks, and can manifest as CHF due to lack of contractile tissue or thrombosis which can lead to stroke or PE

Back 37

Ventricular Aneurysm

Front 38

This complication of MI leads to increased risk of thrombosis due to turbulent blood flow

Back 38

Ventricular aneurysm

Front 39

This complication develops 6-8 weeks after and presents with fever and precordial friction rub.

Back 39

Autoimmune pericarditis (antibody-mediated)

Front 40

This complication of MI leads to acute onset of mitral or tricuspid valve insufficiency which causes systolic murmur and causes other associated symptoms (acute CHF, Pul edema, or JVD)

Back 40

Papillary Muscle rupture

Front 41

This complication of MI occurs within 1-10 days (usually 3-7) because neutrophils infiltrate to digest necrotic tissue which weakens the wall - leads to blood in pericardium

Back 41

Myocardial free wall rupture

Front 42

This complication of MI presents with hemotopericardium, leading to pericardial tamponade. Dyspnea, muffled heart sounds, JVD, enlarged heart on CXR with waterflask appearance, and pulsus paradoxus

Back 42

Myocardial free wall rupture

Front 43

This complication of MI occurs between 1-10 days (usually 3-7) because neutrophils infiltrate and digest necrotic tissue which weakens the wall and leads to left to right shunting.

Back 43

Interventricular septum rupture

Front 44

This complication of MI presents 3-7 days post MI with right to left shunting, acture pulmonary HTN, leading to right ventricular hypertrophy and eventually HF.

Back 44

Interventricular septum rupture

Front 45

Is caused by the early repolarization of the inner layer of the heart while the outer layer is still depolarized, which is opposite of normal.

Back 45

S-T elevation

Front 46

MI with ST elevation means what?

Back 46

Transmural infarction

Front 47

The most common triggering event is disruption of a plaque in an epicardial coronary artery which leads to a clotting cascade and total occlusion of the artery

Back 47

ST elevation MI

Front 48

This type of injury can lead to bruised appearance of the heart on gross exam, may have rupture of hemopericardium or aortic dissection

Back 48

Cardiac Trauma

Front 49

Diagnosis of this type of MI requires 1mm elevation in limb leads and 2mm in precordial leads

Back 49

ST elevation MI

Front 50

In this period following an MI Neutrophils begin to infiltrate the area of the infarct

Back 50

0-12 Hours

Front 51

This can occur following cardiac trauma when the muscle does not contract well

Back 51

Stunned myocardium

Front 52

Period following an MI when coagulation necrosis occurs

Back 52

12-24 hours

Front 53

Period following an MI when pallor tissue appears and myocyte nuclei and striations disappear

Back 53

1-3 days

Front 54

Period following an MI when red granulation tissue begins to appear and macrophages remove necrotic cells

Back 54

3-7 days

Front 55

Period following an MI when necrotic area becomes bright yellow, granulation tissue and collagen formation are well developed

Back 55

7-10 days

Front 56

Non-ST elevation MI

Back 56

Subendocardial infarction

Front 57

Can be caused by virus (Coxsackie A/B which are enteroviruses), rheumatic fever, autoimmunie/SLE, and chemotherapeutic drugs

Back 57

Myocarditis

Front 58

This condition presents similar to a heart attack but coronary arteries are not blocked

Back 58

Myocarditis

Front 59

This condition presents with fever, dyspnea, acute CHF, cardiac biomarkers stay persistently elevated and may have diffuse ST changes on ECG - can be mild to lethal

Back 59

Myocarditis

Front 60

This condition can cause death of myocardium and dilation of the heart

Back 60

Myocarditis

Front 61

This condition can be caused by rheumatic fever and histologically appears as lymphocytic infiltration and cardiac myocyte necrosis

Back 61

Myocarditis

Front 62

This cardiac condition can be seen in drug abusers or can be idiopathic (prinzmetal). It is not due to plaque or intraluminal obstruction.

Back 62

Coronary arterial vasospasm

Front 63

This condition may cause transient congestive heart failure due to ischemia - resolves before full thickness necrosis

Back 63

Coronary artery vasospasm

Front 64

This condition can look like STE-MI with symptoms of unstable angina, focal ST elevations and incresed troponins but you will find it in patients with normal coronaries on cath - look for young patient or Hx of drugs

Back 64

Coronary arterial vasospasm

Front 65

This cardiac condition occurs with connective tissue disorders or in association with aortic dissection from any cause (trauma, etc)

Back 65

Coronary aterial dissection

Front 66

This condition can look just like STE-MI and should be suspected if aortic dissection and unstable angina symptoms are present

Back 66

Coronary arterial dissection

Front 67

This cardiac condition can lead to severe ischemia and death due to total arterial occlusion and inability to respond to thrombolytics/cath. Have to do bypass surgery.

Back 67

Coronary arterial dissection

Front 68

This cardiac condition can lead to full thickness ischemia and all the complications associated with STE-MI if not caught and fixed ASAP

Back 68

CAD

Front 69

In this cardiac condition, ventricular aneurysms are less likely becasue it is not a full thickness injury

Back 69

Non-ST elevation MI