Term
-Heart disease accounts for _____% of postnatal deaths in the US
-Atherosclerosis causes _____% of heart disease
-________ is an important complication of atherosclerosis
-HTN can occur independent of atherosclerosis and accounts for ______% of heart disease |
|
Definition
|
|
Term
| Heart action is critically dependent on a constant supply of ________ and _________ |
|
Definition
|
|
Term
| _______ blood pressure, which depends primarily on the pumping of the heart, is regulated by __________ and _________/_________ |
|
Definition
arterial
hormones
biogenic amines |
|
|
Term
| THe large vol. of blood that passes through the heart makes it susceptible to what? |
|
Definition
|
|
Term
| Immunoglobulins in the blood and circulating immune complexes may be deposited in the heart and cause ________ and ________ |
|
Definition
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|
Term
| ________/_______ diseases often affect the heart and BVs, what is the most common? |
|
Definition
|
|
Term
| What is the common endpoint of many cardiac diseases? How many are affected each year? How many fatalities? |
|
Definition
|
|
Term
|
Definition
| Most CHF caused by deterioration of myocardial contractile function, resulting mainly from ischemic heart disease or HTN |
|
|
Term
|
Definition
| contraction is normal, but relaxation is abnormal; mainly older women with HTN or DM |
|
|
Term
| What is an example of something that causes valve failure? |
|
Definition
|
|
Term
| WHat is an abnormal load? |
|
Definition
| volume or pressure overload |
|
|
Term
| In CHF, how do our bodies respond: by activation of what (3)? |
|
Definition
| -Neurohumoral systems (NE, renin angiotensin, and ANP), frank-starling mech, hypertrophy |
|
|
Term
| What eventually happens in CHF, after the system responds. |
|
Definition
myocytes degenerate
heart needs more oxygen
myocardium becomes vulnerable to ischemia |
|
|
Term
| In left sided heart failure, the left _______ fails and blood backs up into the _________ |
|
Definition
|
|
Term
| What are the 4 most common causes of left sided heart failure |
|
Definition
-ischemic heart disease
-systemic hypertension
-mitral or aortic valve disease
-primary disease of the myocardium |
|
|
Term
| In left sided heart failure, the left ventricle is usually __________ and _____________ |
|
Definition
|
|
Term
| In left-sided heart failure, secondary enlargement of the left atrium with a-fib may lead to what 3 things? |
|
Definition
-reduced stroke volume
-blood stasis
-thrombus formation |
|
|
Term
| In right sided heart failure the right _________ fails and blood backs up in the ___________ |
|
Definition
|
|
Term
| What is the most common cause of R sided heart failure? |
|
Definition
| -left sided heart failure: pressure increase in the pulmonary circulation produces increased burden on the R side of the heart |
|
|
Term
| Isolated R sided heart failure is less common, what are 3 common causes other than L sided heart failure? |
|
Definition
-disease of the lung parenchyma a/o lung vasculature; cor pulmonale
-pulmonic or tricuspid valve disease
-congenital heart diseases with a left-to-right shunt |
|
|
Term
| In R sided heart failure the R ventricle and atrium become ___________ and ______________ |
|
Definition
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|
Term
| Congenital heart disease (CHD) is due to faulty ___________, at week _____-_____ |
|
Definition
|
|
Term
| What are the three major groups of CHD? |
|
Definition
-L to R shunts (most common; non-cyanotic)
-R to L shunts (cyanotic)
-Obstructions |
|
|
Term
|
Definition
| an abnormal communication between cardiac chamber or BVs, a shunt permits blood to flow between chambers or vessels that are normally isolated from each other |
|
|
Term
| What is a R to L cardiac shunt? |
|
Definition
| pulmonary circulation is bypassed and poorly oxygenated blood enters the systemic circulation causing blueness of the skin (cyanosis) |
|
|
Term
| What is a L to R cardiac shunt? |
|
Definition
| increases pulmonary blood flow, increasing pressure and volume of pulmonary circulation, causing R ventricular hypertrophy |
|
|
Term
|
Definition
| decreased vascular flow caused by narrowing (stenosis) or complete blockage (atresia) of the heart chambers, valves, and major BVs |
|
|
Term
| What are more common, atrial sepatal defects (ASDs) or ventricular septal defects (VSDs) |
|
Definition
| ventricular septal defects |
|
|
Term
| ASDs are _____ likely than VSDs to close spontaneously, what does this mean when it comes to diagnosing them? |
|
Definition
-less likely
-they are the most common CHDs to first be diagnosed in adults |
|
|
Term
| ASDs are ____ to _____ shunts |
|
Definition
|
|
Term
| In ASDs, pulmonary vascular resistance may _______ , leading to a _______ to _______ shunt |
|
Definition
increase (pulmonary HTN)
R to L shunt (Eisenmenger syndrome) |
|
|
Term
| What can be done about ASDs? |
|
Definition
| surgical repair prevents irreversible pulmonary changes and heart failure |
|
|
Term
| What is the most common CHD at birth |
|
Definition
|
|
Term
| Most VSDs _______ spontaneously in childhood |
|
Definition
|
|
Term
| Which has a greater incidence in adults, VSDs or ASDs? |
|
Definition
|
|
Term
| VSDs are a _______ to _______ shunt |
|
Definition
|
|
Term
| What percentage of VSDs occur with other cardiac malformations? |
|
Definition
|
|
Term
| Small VSDs are __________ |
|
Definition
|
|
Term
| What are some possible consequences of large VSDs |
|
Definition
-characterized by a severe L to R shunt which may lead to EIsenmenger syndrome, with cyanosis and CHF
-this would occur earlier and more often than with ASDs |
|
|
Term
| What is required for large VSDs? |
|
Definition
|
|
Term
| The ductus arteriosus permits blood to flow from pulmonary _________ to _________, bypassing _________ during fetal development |
|
Definition
|
|
Term
| Ductus arteriosus closes spontaneously by day 1-2 of life, in 7% of CHD cases it fails to close, this is called? |
|
Definition
| Patent Ductus Arteriosus (PDA) |
|
|
Term
| What percentage of PDA are isolated? |
|
Definition
|
|
Term
|
Definition
| a "machinery-like" murmur |
|
|
Term
| Small PDA is asymptomatic, what can a large PDA lead to? |
|
Definition
| L to R shunt, leading to Eisenmenger syndrome with cyanosis and CHF |
|
|
Term
| Tetralogy of Fallot is a ______ to _______ shunt |
|
Definition
|
|
Term
| What is the most common cause of cyanotic CHD? |
|
Definition
| tetralogy of fallot (R to L shunt) (5% of CHD) |
|
|
Term
| What are the four physiological features of tetralogy of Fallot? |
|
Definition
-Large VSD
-Aorta overrides the VSD
-obstruction to RV outflow tract
-RV hypertrophy
- |
|
|
Term
| What are the 4 major signs and symptoms of tetralogy of fallot? |
|
Definition
-cyanosis
-clubbing of the fingertips
-polycythemia
-paradoxical emboli (should lodge in the lungs, but bypasses lungs due to disorder) |
|
|
Term
| The clinical severity of the tetralogy of fallot depends not he degree of _________/_________/_______ |
|
Definition
| pulmonary outflow obstruction |
|
|
Term
| What is the issue in transposition of the great arteries (TGA)? |
|
Definition
| the aorta arises from the R ventricle and the pulmonary artery arises from the L ventricle |
|
|
Term
| How are the atrium-ventricle connects in TGA? |
|
Definition
|
|
Term
| What is the outcome of TGA? |
|
Definition
| separation of systemic and pulmonary circulations |
|
|
Term
| Is TGA compatible with life? |
|
Definition
| NO, unless there is a big VSD |
|
|
Term
| Even if there is a stable shunt, most pts with uncorrected TGA will die within the ______/_______/_______. What must happen for these pts to live? |
|
Definition
first few months of life
correct surgery within the first few weeks of life |
|
|
Term
| What is the most important form of obstructive congenital heart disease? |
|
Definition
| coarctation (narrowing) of the aorta |
|
|
Term
| How often are males affected with coarctation of the aorta compared to females? |
|
Definition
|
|
Term
| Preductile ("infantile") and postductal ("adult") coarctation of the aorta, which one is fatal? |
|
Definition
-preductal: fatal without intervention usually
-postductal: usually asymptomatic |
|
|
Term
| Coarctation of the aorta often causes ________ and ______ blood pressure in the lower extremities |
|
Definition
|
|
Term
| What is a generic designation for a group of related syndromes resulting from myocardial ischemia? |
|
Definition
Ischemic Heart Disease (IHD)
the cardiac blood supply cannot meet the myocardial oxygen demand |
|
|
Term
| What is IHD usually caused by? |
|
Definition
| decreased coronary artery blood flow (coronary artery disease) |
|
|
Term
| What is the leading cause of death in the US? |
|
Definition
|
|
Term
| What are the 4 basic clinical syndromes of IHD? |
|
Definition
angina pectoris
Acute MI
chronic IHD
sudden cardiac death |
|
|
Term
|
Definition
| intermittent chest pain caused by transient, reversible myocardial ischemia |
|
|
Term
| Define typical (stable) angina |
|
Definition
-episodic pain on exertion
-narrowing (> or equal to 75%) of one or more coronary arteries |
|
|
Term
| Define prinzmental (variant) angina |
|
Definition
paint at rest
coronary artery spasm of unknown etiology |
|
|
Term
| define unstable (crescendo) angina |
|
Definition
increasing pain with less exertion, longer duration
plaque disruptions and thrombosis |
|
|
Term
| What is a myocardial infarction (MI)? |
|
Definition
necrosis of the heart muscle resulting from ischemia
aka heart attack |
|
|
Term
| What are most MIs caused by? |
|
Definition
acute coronary artery thrombosis
-sudden plaque disruption
-platelets adhere
-coagulation cascade activated
-thrombus occludes lumen within minutes
-irreversible injury/cell death in 20-40 minutes |
|
|
Term
| What is the therapeutic goal following an acute MI? |
|
Definition
| salvage ischemic tissue by reperfusion |
|
|
Term
| What are three ways reperfusion is achieved? |
|
Definition
| -thrombolysis -balloon angioplasty -coronary artery bypass graft |
|
|
Term
| What are two ways that reperfusion can lead to greater local injury than if no treatment was performed? |
|
Definition
oxygen free radicals
microvascular injury and hemorrhage |
|
|
Term
| What is the number one symptom of an MI in most cases? |
|
Definition
severe, crushing chest pain with or w/o radiation
typically lasts 20 min to several hours
not significantly relieved by nitroglycerin or rest |
|
|
Term
| What is the pulse generally like in an MI? |
|
Definition
|
|
Term
| What can develop following a massive MI? |
|
Definition
cardiogenic shock
(>40% of the LV affected) |
|
|
Term
| in what percentage of MI's are there no symptoms |
|
Definition
|
|
Term
| What causes the Q wave abnormalities following an MI? |
|
Definition
|
|
Term
| What causes the ST-segment abnormalities and T-wave inversion following an MI? |
|
Definition
| abnormalities in myocardial repolarization |
|
|
Term
| What causes the arrhythmias seen following an MI? |
|
Definition
| electrical abnormalities of ischemic myocardium and conductance system |
|
|
Term
| What accounts for most deaths from MI that occur before hospitalization? |
|
Definition
| SCD (sudden cardiac death) due to lethal arrhythmias |
|
|
Term
| What is the laboratory evaluation of MI based on measuring? |
|
Definition
| cardaic troponins T and I, which are released from the cardiac muscle into the blood following an MI |
|
|
Term
| Troponins increase within what time period following an MI? How long do they remain elevated? |
|
Definition
|
|
Term
| What is the second best lab test to run following an MI? |
|
Definition
| total creatine kinase (CK) and a myocardial specific isoform (CK-MB) |
|
|
Term
| CKMB increases within how long after an MI? When does it return to normal? |
|
Definition
|
|
Term
| What does the prognosis of an MI depend on? |
|
Definition
| depends on the infarct size, site, and thickness of the heart wall damage |
|
|
Term
| What is the overall 1 year mortality for MI? |
|
Definition
30%
3-4% mortality per year thereafter |
|
|
Term
| What is another name for chronic ischemic heart disease? |
|
Definition
|
|
Term
| What is chronic ischemic heart disease? |
|
Definition
-progressive heart failure from ischemic myocardial damage , usually there is a history of MI
-Enlarged heart from LV dilation and hypertrophy of remaining viable myocardium |
|
|
Term
| What account for many of the deaths due to chronic ischemic heart disease? |
|
Definition
|
|
Term
| Define sudden cardiac death (SCD) |
|
Definition
| unexpected death from cardiac causes without symptoms (or within 24 hr of symptom onset) |
|
|
Term
| What does SCD result from? |
|
Definition
|
|
Term
| What is the most common cause of SCD |
|
Definition
|
|
Term
| What is the most common cause of SCD in young victims? |
|
Definition
| Long-QT (LQT) syndrome caused by mutations in various cardiac ion channel genes |
|
|
Term
| What is hypertensive heart disease? |
|
Definition
the heart responds to increased pressure or volume overload with myocyte hypertrophy
-can effect either left or right ventricle |
|
|
Term
|
Definition
| R ventricle is enlarged due to pulmonary HTN caused by primary lung disorders |
|
|
Term
| What does pressure overload cause? Volume overload? |
|
Definition
ventricular wall thickness
ventricular wall dilation |
|
|
Term
| What are the reasons for heart failure in HTN? |
|
Definition
| they are poorly understood |
|
|
Term
| What causes valvular heart disease? |
|
Definition
| stenosis (failure to open completely) and/or regurgitation (insufficiency- failure to close completely) |
|
|
Term
| In valvular heart disease, abnormal blood flow through the diseased valves produces _______ |
|
Definition
|
|
Term
| Stenosis of what valves accounts for 2/3 of all valve disease? |
|
Definition
|
|
Term
| What is the most common cause of aortic stenosis in the US? |
|
Definition
|
|
Term
| Who does calcific aortic stenosis occur in? |
|
Definition
| -normal part of aging process in 70-80 yo's, OR congenitally bicuspid aortic valve (40-50 yo's) |
|
|
Term
| What does calcific aortic stenosis result in? |
|
Definition
increased LV pressure
LV hypertrophy
relative ischemia |
|
|
Term
| What are the symptoms of calcific aortic stenosis? prognosis? |
|
Definition
-symptoms of angina, CHF, or fainting
-50% mortality within 2 years without surgery |
|
|
Term
| Describe mitral valve prolapse? |
|
Definition
| the mitral leaflets are enlarged, rubbery, floppy, and prolapse back into the left atrium during systole. There is a deposition of myxomatous (mucoid) material within the leaflet |
|
|
Term
| How common is mitral valve prolapse? |
|
Definition
common, 3-5% of adults in US affected
-women 7x more than men |
|
|
Term
| Auscultation of someone with mitral valve prolapse would reveal what? |
|
Definition
|
|
Term
| What are the symptoms of mitral valve prolapse? people with this have an increased risk of what? |
|
Definition
-most people are asymptomatic
-3% may have CHF if the chord or valve leaflets rupture
-increased risk for infective endocarditis and sudden death from ventricular arrhythmias |
|
|
Term
| What is rheumatic fever? What does it cause? |
|
Definition
| systemic inflammatory disease occurring a few weeks after streptococcal pharyngitis (strep throat). causes acute rheumatic heart disease (RHD) |
|
|
Term
|
Definition
| valve deformities, especially scarring and stenosis of the mitral valve, followed by damage to both mitral valve and aortic valve |
|
|
Term
| What is infective endocarditis? |
|
Definition
| a bacterial invasion of heart valves and endocardium that destroys heart tissue (large, friable vegetations) |
|
|
Term
| What is acute endocarditis? |
|
Definition
highly virulent pathogen attacks normal valve
half of patients dead within days to weeks |
|
|
Term
| What is subacute endocarditis? |
|
Definition
low virulence pathogen colonized abnormal valve
slow onset, long course, most recover |
|
|
Term
| What are the symptoms and complications of infective endocarditis? |
|
Definition
-fever and flu like symptoms
-septicemia, arrhythmias, renal failure, systemic emboli |
|
|
Term
| What are cardiomyopathies? |
|
Definition
| a diverse group of disorders in which there is intrinsic myocardial dysfunction |
|
|
Term
| What are the three classifications of cardiomyopathies? |
|
Definition
Dilated cardiomyopathy (90%)
hypertrophic cardiomyopathy
restrictive cardiomyopathy |
|
|
Term
| What happens in a dilated cardiomyopathy? |
|
Definition
heart dilates, enlarges, ineffective contraction
(90% of cardiomyopathies) |
|
|
Term
| What are 4 causes of dilated cardiomyopathy? |
|
Definition
-viral
-alcohol/toxin
-peripartum
-25-35% caused by genetic mutations in genes that encode cytoskeletal proteins |
|
|
Term
| What is the prognosis of dilated cardiomyopathy? |
|
Definition
| slowly progressing CHF and 50% of patients are dead within 2 years |
|
|
Term
| What happens in hypertrophic cardiomyopathy (HCM)? |
|
Definition
myocardial hypertrophy where the myocardium does not relax, so there is abnormal diastolic filling
-ventricle is thick-walled, heavy, and hyper contracting, but has reduced SV |
|
|
Term
| What causes most cases of HCM? |
|
Definition
| missense mutations in at least 12 genes that encode the sarcomeric proteins that form the contractile apparatus of striated muscle |
|
|
Term
| What does HCM cause? What are the symptoms? What are the treatments? |
|
Definition
-reduced CO and secondary increase in pulmonary venous pressure
-exertional dyspnea, atrial fibrillation, CHF, arrhythmia, sudden death
-drugs to promote ventricular relaxation or surgical excision of part of the septum |
|
|
Term
| What is restrictive cardiomyopathy? |
|
Definition
| ventricle wall is stiffer, impairing filling during diastole |
|
|
Term
| WHat is the cause of restrictive cardiomyopathy? |
|
Definition
| idiopathic or secondary to systemic disease (amyloidosis, hemochromatosis, sarcoidosis) |
|
|
Term
| What are the symptoms of restrictive cardiomyopathy? |
|
Definition
| cough, shortness of breath, fatigue, peripheral edema |
|
|
Term
| What is the treatment and prognosis for restrictive cardiomyopathy? |
|
Definition
-not often helpful, may be candidates for a heart transplant
-70% of patients die within 5 years |
|
|
Term
| What is pericarditis caused by? |
|
Definition
Primary- very rare-mainly infection by viruses
Secondary, usual- acute MI, cardiac surgery, irradiation, pneumonia, uremia |
|
|
Term
| What are the symptoms of pericarditis? |
|
Definition
| atypical chest pain, not related to exertion, often worse when reclining |
|
|
Term
|
Definition
| a prominent friciton rub that can cause cardiac tamponade |
|
|
Term
| What are the three different types of pericardial effusions and their causes? |
|
Definition
-serous- CHF, hypoalbuminemia
-serosanguinous- blunt chest trauma, malignancy, ruptured MI, aortic dissection
-chylous- mediastinal lymphatic obstruction |
|
|
Term
| What is the outcome of pericardial effusions? |
|
Definition
depends on the ability of the pericardial sac to stretch, the amount of fluid accumulated, and speed of accumulation
-slow=asymptomatic
-sudden=fatal cardiac tamponade |
|
|
Term
| What are the most common tumors of the heart? |
|
Definition
-in general they are rare
-metastatic tumor from another tissue (lung, lymphoma, breast) |
|
|
Term
| What is the most common primary tumor of the heart? |
|
Definition
| myxoma, occurs usually in the L atrium |
|
|
