Term
| Cardiac equivalent of pump powersource |
|
Definition
|
|
Term
| cardiac equivalent of pump motor |
|
Definition
|
|
Term
| cardiac equivalent of pump valves |
|
Definition
|
|
Term
| cardiac equivalent of pump control circuit |
|
Definition
| conducting system and neurohumoral control |
|
|
Term
| pathological consequence of blood vessel/oxygen supply failure |
|
Definition
|
|
Term
| pathological consequence of myocardium failure |
|
Definition
|
|
Term
| pathological consequence of valve failure |
|
Definition
| inadequate forward flow/increased back pressure |
|
|
Term
| pathological consequence of conducting system failure |
|
Definition
|
|
Term
| pathological consequence of neurohumoral system failure |
|
Definition
| inadequate compensation for pathologic processes |
|
|
Term
| failure of any parts of the heart "pump" can result in inadequate oxygen delivery to peripheral tissues otherwise known as |
|
Definition
|
|
Term
| a faster than normal heart rate |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| physical exam: tachycardia and diaphoresis; EKG: abnormal with Q-wave; labs: elevated troponin I and CK-MB; classic presentation of? |
|
Definition
|
|
Term
| mismatch bewteen oxygen supply and demand |
|
Definition
|
|
Term
| ischemic heart disease typically develops from |
|
Definition
| atherosclerosis and narrowing of the coronary arteries |
|
|
Term
| name 2 other causes of ischemic heart disease other than atherosclerotic narrowing of the coronary arteries |
|
Definition
| 1) vasculitis; 2) intramyocardial coronary arteries |
|
|
Term
| individuals whose coronary arteries are shut off by myocardial contraction with each cycle and become ischemic have |
|
Definition
| intramyocardial coronary arteries |
|
|
Term
| two examples of ischemic heart disease caused by unusually high oxygen demand |
|
Definition
| 1) thyrotoxicosis; 2) tachycardia |
|
|
Term
|
Definition
| elevated thyroid hormone -- increased oxygen demand due to increased metabolic demand |
|
|
Term
| typical presentation of ischemic heart disease |
|
Definition
|
|
Term
| technical term for chest pain with exertion |
|
Definition
|
|
Term
| many ___ ___ are the initial presentation of ischemic heart disease |
|
Definition
|
|
Term
| most common cause of sudden death |
|
Definition
|
|
Term
| long standing ischemic heart disease in which the heart doesn't fail catastrophically but instead slowly decreases in its ability to produce |
|
Definition
| cardiac failure -- chronic wasting disease |
|
|
Term
| presentation of eschemic heart disease is usually atypical in which gender |
|
Definition
| women (decreased exercise tolerance rather than pain with exercise) |
|
|
Term
| typical age for ischemic heart disease in men |
|
Definition
|
|
Term
| typical age for ischemic heart disease in women |
|
Definition
| about 10 years later than men -- older than 70 |
|
|
Term
| modifiable risk factors of ischemic heart disease |
|
Definition
| hyperlipidemia (especially LDL cholesterol), high blood pressure, smoking, diabetes |
|
|
Term
| recommendation for hyperlipidemia (LDL cholesterol) |
|
Definition
|
|
Term
| what happens in patients with high blood pressure |
|
Definition
| damage to the endothelium resulting in atherosclerosis |
|
|
Term
| smoking and diabetes can both be related to ischemic heart disease as |
|
Definition
| toxic insults to the endothelium |
|
|
Term
| in MI, coronary arteries are |
|
Definition
| partially to completely occluded by atherosclerosis |
|
|
Term
| significant changes in blood flow occur with |
|
Definition
| >75% narrowing of the arteries |
|
|
Term
| atherosclerotic plaques rupture, resulting in |
|
Definition
|
|
Term
| last two steps of coronary pathology in MI |
|
Definition
| complete occlusion; myocardial necrosis |
|
|
Term
| acute coronary syndomes include |
|
Definition
| mural thrombus with variable obstruction / emboli and occlusive thrombus |
|
|
Term
| occlusive thrombus may result in |
|
Definition
| acute transmural myocardial infarction or sudden death |
|
|
Term
| mural thrombus with variable obstruction / emboli can result in |
|
Definition
| unstable angina or acute subendocardial myocardial infarction or sudden death |
|
|
Term
| plaque disruption and platelet aggregation can lead to |
|
Definition
|
|
Term
|
Definition
| mural thrombus with variable obstruction / emboli or occlusive thrombus |
|
|
Term
| healing of plaque disruption leads to |
|
Definition
| severe fixed coronary obstruction (chronic eschemic heart disease) |
|
|
Term
| fixed coronary obstruction leads to |
|
Definition
|
|
Term
| early changes occur in __ to __ hrs in MI and are seen only at the ___ level |
|
Definition
| 0.5-1 hrs and ultrastructural level |
|
|
Term
| early intervention with ___ or ___ can save myocardium in MI |
|
Definition
| thrombolytics or angioplasty |
|
|
Term
| over the ensuing half day in MI irreversible ___ occurs and can be identified by |
|
Definition
| necrosis; light microscope |
|
|
Term
| by 24 hours after MI, there is clear ___ and ___ begin to invade the infarct |
|
Definition
|
|
Term
| what is the first time at which the infarct is identifiable by gross examination |
|
Definition
| at 24 hours when there is clear necrosis and neutrophils have begun to invade the infarct |
|
|
Term
| name two serum enzymes measure in MI |
|
Definition
|
|
Term
| CK-MB goes up slowly over the first __ hours and the first time you can detect it is at __ hours |
|
Definition
|
|
Term
| which enzyme has become the mainstay for measurement of myocardial damage in patients |
|
Definition
|
|
Term
| CK-MB comes down at about |
|
Definition
|
|
Term
| over the ensuing week after MI, the infarct is overrun by |
|
Definition
|
|
Term
| dead tissue is removed by |
|
Definition
|
|
Term
| slowly the infarct is repaired by |
|
Definition
| granulation tissue followed by fibrosis |
|
|
Term
| number one complication in MI |
|
Definition
|
|
Term
| inability to generate an adequate blood pressure to the periphery because the heart has failed |
|
Definition
| cardiac failure and cardiogenic shock |
|
|
Term
| to have cardiac failure/cardiogenic shock, the infarct has to occupy more than |
|
Definition
|
|
Term
| additioinal infarction or the occluded artery reoccludes |
|
Definition
|
|
Term
| interior surface of the endothelium, the endocardial surface of the heart, becomes thrombogenic because it's necrotic; blood clots on the thrombotic surface can then become dislodged and flow into systemic circulation, causing periopheral infarcts or stroke |
|
Definition
|
|
Term
| need to keep BP low in first week to avoid |
|
Definition
|
|
Term
| muscles involved in the infarct can rupture and have valvular regurgitation |
|
Definition
|
|
Term
| if you have high blood pressure during wall weakness, the walls may dilate and cause |
|
Definition
|
|
Term
| myocardial proteins are released into systemic circulation causing an immune reaction; thre is a cross reaction with the endocardium and you get |
|
Definition
| post MI latent pericarditis |
|
|
Term
| list 8 complications of MI |
|
Definition
| cardiac arrhythmias; cardiac failure/cardiogenic shock; extension of infarct; thromboembolism; ventricular rupture; papillary muscle rupture; ventricular aneurysm; post MI pericarditis |
|
|
Term
| name two other presentations of ischemic heart disease |
|
Definition
| sudden death and chronic ischemia with heart failure |
|
|
Term
| frequently cannot determine the cause but there is always a strong association with coronary atherosclerosis |
|
Definition
|
|
Term
| poor oxygenation results in myocardial atrophy and some myocyte loss resulting in poor cardiac performance |
|
Definition
| chronic ischemia with heart failure |
|
|
Term
| revascularization can help in |
|
Definition
|
|
Term
| in patients with hypertension or diabetes, there is no way for there to be |
|
Definition
|
|
Term
|
Definition
|
|
Term
| myocarditis can be caused by |
|
Definition
| infection from virus, bacteria or fungus |
|
|
Term
| what kind of infection is the most common in myocarditis? |
|
Definition
|
|
Term
| what kind of infection is the least common in myocarditis? |
|
Definition
|
|
Term
| myocarditis may also be secondary to infections resulting in |
|
Definition
| an autoimmune inflammation of the myocardium |
|
|
Term
| examples of myocarditis as secondary to infection include |
|
Definition
| post viral; post bacterial (rheumatic heart disease); autoimmune disease like lupus |
|
|
Term
| primary dysfunction of the heart muscle is related to |
|
Definition
|
|
Term
| secondary dysfunction of the heart muscle results from |
|
Definition
| toxic, infectious and degenerative diseases |
|
|
Term
| failure of the heart muscle is called |
|
Definition
|
|
Term
| name the three types of cardiomyopathy |
|
Definition
| dilated; hypertrophic; and restrictive |
|
|
Term
|
Definition
| primary disease of the heart muscle (exludes myocardial changes resulting from hypertension, valvular disease, ischemic disease, and pericardial disease) |
|
|
Term
| ventricular chamber is dilated and the myocardium is modestly thickened |
|
Definition
|
|
Term
| myocardium is markedly thickened especially the septum |
|
Definition
| hypertrophic cardiomyopathy |
|
|
Term
| myocardium can be of normal thickness but is stiff and unable to relax in diastole |
|
Definition
| restrictive cardiomyopathy |
|
|
Term
| causes of dilated cardiomyopathy |
|
Definition
| genetic, viral/autoimmune; and toxic insults |
|
|
Term
| many cases of what are idiopathic and thought to be secondary to previous viral infections |
|
Definition
|
|
Term
| what is the most common toxic cause of dilated cardiomyopathy |
|
Definition
|
|
Term
| how do patients with dilated cardiomyopathy frequently present in heart failure |
|
Definition
| with huge hearts and poor contractility |
|
|
Term
| what is the prognosis of dilated cardiomyopathy |
|
Definition
| poor -- 5 year survival is < 50% |
|
|
Term
| what do patients with dilated cardiomyopathy die from |
|
Definition
| heart failure and arrhythmias |
|
|
Term
| ___ cardiomyopathy is primarily a genetic disease and may persis subclinically |
|
Definition
|
|
Term
| what do patients with hypertrophic cardiomyopathy present with |
|
Definition
| dyspnea, syncope or sometimes sudden death |
|
|
Term
| what is the typical pathology associated with athletes with hypertrophic cardiomyopathy |
|
Definition
|
|
Term
| what is the best diagnostic modality for hypertrophic cardiomyopathy? |
|
Definition
| echocardiography (but ECG and physical exam will also work) |
|
|
Term
| what is the pathology of hypertrophic cardiomyopathy |
|
Definition
| marked hypertrophy of the left ventricle with septal thickening |
|
|
Term
| what does septal hypertrophy cause? |
|
Definition
|
|
Term
| which cardiomyopathy patients may frequently be successfully managed? and how are they managed? |
|
Definition
| hypertrophic; heart rate of these patients should be maintained at a low rate |
|
|
Term
| cardiomyopathy marked by fibrosis or infiltration of the myocardium which causes marked stiffness and poor relaxation |
|
Definition
|
|
Term
| name 5 possible causes of restrictive cardiomyopathy |
|
Definition
| 1) fibrosis; 2) amyloid deposition; 3) sarcoidosis; 4) hemochromatosis; 5) storage diseases |
|
|
Term
| in which cardiomyopathy is cardiac filling impaired and patients present with diastolic heart failure? |
|
Definition
|
|
Term
| restrictive cardiomyopathy has a poor prognosis unless |
|
Definition
| the underlying cause can be treated |
|
|
Term
| which type of cardiomyopathy is the rarest? |
|
Definition
|
|
Term
| what is the most common cause of restrictive cardiomyopathy? |
|
Definition
|
|
Term
| what causes the ventricle to be stiff in restrictive cardiomyopathy? |
|
Definition
| things get into the interstitium and in-between the actual myocytes |
|
|
Term
| diastolic heart failure is the |
|
Definition
| inability to fill the heart |
|
|
Term
| name the two patterns of hypertrophy |
|
Definition
|
|
Term
| what is concentric hypertrophy caused by |
|
Definition
| pressure overload (hypertension) and valvular stenosis |
|
|
Term
| what is the result of concentric hypertrophy? |
|
Definition
| marked wall thickening with a smaller chamber |
|
|
Term
| how is the contractility and relaxation in concentric hypertrophy? |
|
Definition
| good contractility but poor relaxation |
|
|
Term
| what is the cause of eccentric hypertrophy? |
|
Definition
| volume overload like valve regurgitation or septal defects |
|
|
Term
| what is the result of eccentric hypertrophy? |
|
Definition
| wall thickening with dilation of the chamber |
|
|
Term
| how is the contractility and relaxation in eccentric hypertrophy? |
|
Definition
| good contractility and acceptable relaxation |
|
|
Term
| which type of hypertrophy is a more serious complication? |
|
Definition
|
|
Term
| normal wall thickness of ventricle |
|
Definition
|
|
Term
| normal ventricular volume |
|
Definition
|
|
Term
| what happens to the ventricle whne you get pressure overload? |
|
Definition
| wall thickening (1.3-1.5 cm) and decreased ventricular volume (60-70 mL) |
|
|
Term
| in severe cases of pressure overload, cardiac output may be reduced |
|
Definition
|
|
Term
| how does the pressure overload lead to increased wall thickness? |
|
Definition
| myocardium senses increased pressure --> makes more myocardial proteins --> sacromeres laid down parallel to each other give increased thickening (so each cell becomes thicker) |
|
|
Term
|
Definition
| you have a normal wall thickness but a very large ventricular volume |
|
|
Term
| in eccentric hpertrophy, new sacromeres lay down __ ___; making each myocyte ___ but not ___ |
|
Definition
| in series; longer, thicker |
|
|
Term
| right sided hypertrophy secondary to pulmonary hypertension followed by dilation and right heart failure |
|
Definition
|
|
Term
| secondary to pulmonary thromboembolism (secondary to valve fialure on the left side) |
|
Definition
|
|
Term
| secondary to primary pulmonary hypertension or chronic obstructive pulmonary disease (COPD) |
|
Definition
|
|
Term
| acute cor pulmonale is associated with a sudden increase in |
|
Definition
|
|
Term
| what happens to patients with acute cor pulmonale? |
|
Definition
| they have immediate right-sided failure and could die |
|
|
Term
| chronic cor pulmonale patients |
|
Definition
| get sicker and sicker because they can't get enough blood through the lungs and into the left side of the heart |
|
|
Term
| which valves are more commonly affected by valvular disease? |
|
Definition
|
|
Term
| what types of diseases are associated with valves? |
|
Definition
| degenerative, infectious, and autoimmune |
|
|
Term
| which valves are subject to valvular disease? |
|
Definition
|
|
Term
| it is said that patients can actually survive without which valve? |
|
Definition
|
|
Term
| why are left sided valves more commonly affected with valvular disease? |
|
Definition
| pressure is so much higher on the left side |
|
|
Term
| what is the mitral valve between? |
|
Definition
| left atrium and left ventricle |
|
|
Term
| what is the end result for the left atrium in mitral valve stenosis? |
|
Definition
| dilation until normal pressure is obtained |
|
|
Term
| mitral stenosis is usually a ___ disease |
|
Definition
|
|
Term
| what happens in mitral regurgitation? |
|
Definition
| blood can get into the left ventricle but when the contraction occurs a certain amount of it is injected back into the left atrium |
|
|
Term
| what can cause acute mitral regurgitation? |
|
Definition
|
|
Term
| what happens with acute mitral regurgitation? |
|
Definition
| immediate high pressure in the left atrium because there isn't time to dilate |
|
|
Term
| what happens in chronic mitral regurgitation? |
|
Definition
| blood back into the left atrium --> left atrium dilates and you still have normal pressures |
|
|
Term
| what is the most common valve abonormality? |
|
Definition
|
|
Term
| aortic stenosis is very common in |
|
Definition
|
|
Term
| where is the pressure increase with aortic stenosis? |
|
Definition
| left ventricle -- because they contract aginast a resistant valve |
|
|
Term
| what is a pathological result of aortic stenosis? |
|
Definition
| concentric hypertrophy (wall thickness increases while trying to eject more into the aorta) |
|
|
Term
| aortic stenosis patients are prone to ___ ___ by ___ ___ ___ |
|
Definition
| sudden death; acute heart failure |
|
|
Term
| acute aortic regurgitation is very |
|
Definition
|
|
Term
| some patients with aortic stenosis also have |
|
Definition
| chronic aortic regurgitation (valve becomes frozen and in an open position, but smaller than a normal orifice) |
|
|
Term
| an increase in pressure in the left ventricle leads to |
|
Definition
| an increase in pressure in the left atrium and a decrease in pressure in the aorta |
|
|
Term
| if the regurgitation is enough, the patient also has |
|
Definition
| a constant volume overload in the left ventricle (combination of eccentric and concentric hypertrophy) |
|
|
Term
| the aortic valve can be successfully ___ even at the end stage |
|
Definition
|
|
Term
| why do replacement valves often fail? |
|
Definition
|
|
Term
| infectious endocarditis is frequently seen in patients |
|
Definition
| with other chronic valve disease and in prothetic valves |
|
|
Term
| damage to a valve surface provides |
|
Definition
| a site for bacterial adherence |
|
|
Term
| in infectious endocarditis patients, bacteria in the blood stream |
|
Definition
| adhere to the surface and proliferate |
|
|
Term
| where might the bacteria in infectious endocarditis be derived from? |
|
Definition
| the oral cavity, other bacterial infections or the GI tract during procedures |
|
|
Term
| bacteria can be injected by IV drug abusers and result in |
|
Definition
| right sided endocarditis (directly introduced bacteria into the venous system) |
|
|
Term
| what two types of infection might exist in infectious endocarditis? |
|
Definition
| indolent growth of bacterial colonies or highly destructive infection with valve destruction and incompetence |
|
|
Term
| strep viridans typically results in |
|
Definition
|
|
Term
|
Definition
|
|
Term
| prosthetic valves are frequently infected by |
|
Definition
| coagulase negative staph species |
|
|
Term
| both aggressive and indolent bacteria can |
|
Definition
| embolize and produce peripheral abcesses including the CNS |
|
|
Term
| indolent bacterial infection is a common cause of |
|
Definition
| intermittent fever or fevers of unknown origin |
|
|
Term
| non bacterial thrombotic endocarditis (NBTE) usually consists of |
|
Definition
| small vegetations usually occurring at the valve closure lines |
|
|
Term
| what are some other diseases associated with NBTE? |
|
Definition
| adenocarcinomas and cachexia |
|
|
Term
|
Definition
| asymptomatic and discovered incidentally |
|
|
Term
| NBTE can undergo bacterial colonization and lead to |
|
Definition
|
|
Term
| an acute, immunologically mediated, multisystem inflammatory disease that follows an untreated episode of group A streptococcal pharyngitis after an interval of a few weeks |
|
Definition
|
|
Term
|
Definition
| relatively rare in developed countries |
|
|
Term
| what is the peak age of incidence for rheumatic fever? |
|
Definition
|
|
Term
| inflammatory infiltrates may occur |
|
Definition
| in a wide range of sites including the heart |
|
|
Term
| acute rheumatic carditis involves |
|
Definition
| inflammatory changes in all three layers of the heart |
|
|
Term
|
Definition
| fibrinous pericarditis; effusions |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| repeated episodes of damage eventually |
|
Definition
| damage the valve and associated apparatus |
|
|
Term
| rheumatic endocarditis results in |
|
Definition
| valve stenosis with or without regurgitation |
|
|
Term
| which valves are most often affected with rheumatic endocarditis |
|
Definition
|
|
Term
| 99% of mitral stenosis is secondary to |
|
Definition
|
|
Term
| what is virtually the only cause of simultaneous mitral and aortic stenosis? |
|
Definition
|
|
Term
| rheumatic endocarditis can be the substrate for |
|
Definition
|
|
Term
| what is the most common cause of aortic stenosis? |
|
Definition
|
|
Term
| calcific aortic stenosis involves |
|
Definition
| irregular calcium deposits behind valve cusps |
|
|
Term
| calcific aortic stenosis results in |
|
Definition
| valves being stiff due to general calcification and potential occlusion if the calcification is big enough |
|
|
Term
| calcific aortic stenosis is most common in |
|
Definition
| congenital bicuspid valves (occurs earlier in these) |
|
|
Term
| occurs in normal valves as |
|
Definition
| age-related degenerative change |
|
|
Term
| most common valvular lesion of all |
|
Definition
|
|
Term
| how much of the population has mitral valve prolapse? |
|
Definition
|
|
