REVIEW 1 (Cardiac) Flashcards

1
Q

An anterior wall infarct is typically caused by occlusion of the _______ coronary artery?

A

LAD

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2
Q

An infarct of the lateral wall of the left ventricle is usually caused by occlusion of the ______

A

Left circumflex coronary artery

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3
Q

What % of people survive their first MI?

A

75%

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4
Q

Among the 75% of survivors of their first MI, most develop what?

A
  1. Most develop signs of heart failure and cardiogenic shock.
  2. This hypoperfusion results in multisystemic major organ failure
  3. Most dangerous= consequences of cerebral ischemia, which may lead to permanent mental injury and loss of CNS functions.
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5
Q

An infarct of the right ventricle and posterior wall of the left ventricle is usually caused by occlusion of the _________

A

right coronary artery.

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6
Q

The following is the cause of ________ which occurs in ~25% of MIs:

  1. Major cardiac arrhythmia (i.e. V-fib)
  2. or later complete heart block and pump failure.
A

Sudden Cardiac Death from MI

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7
Q

What are the 3 complications of post MI?

A
  1. LV myocardial rupture
  2. Cardiac tamponade
  3. LV aneurysm with Mural thromus (can embolize to brain and cause stroke)
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8
Q

What are the two types of MIs?

A
  1. Transmural
  2. Subendocardial or Intramural
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9
Q

Which type of MI?

  • infarction involves all three layers of the heart
  • usually involves the free wall of the LV and/or the interventricular septum.
A

Transmural

*this is the worst MI- can lead to rupture b/c entire side is necrotic

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10
Q

Which type of MI?

-the infarction is usually concentric around the subendocardial layer of the left ventricle.

A

Subendocardial or Intramural

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11
Q

Which side of the heart is more likely to have an MI?

A

Occlusion of the LAD accounts for over 50%

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12
Q

What is the “Tiger Effect” and what condition causes this?

A

-pathology relates to pale and congested areas with mild hypertrophy, along with biventricular dilatation and generalized hypokinesis of the myocardium (Tiger effect)

*Seen in Acute Viral Myocarditis

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13
Q

Over 80% of Myocarditis cases are caused by what?

A

***Coxsackie B Virus***

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14
Q

Which Pericarditis causes a “Bread and Butter” pericarditis?

A

Fibrinous pericarditis

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15
Q

Which pericarditis is described by the following:

  • surface of the heart is covered w/ shaggy, yellowish layers of fibrin that bridges the space b/w the 2 layers of the pericardial sac
  • When the friable fibrin strands are separated, the epicardium and pericardium resemble bread and butter taken apart
A

Fibrinous pericarditis

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16
Q

What type of inflammation is seen in “bread and butter” pericarditis?

A

Fibrinous inflammation

(exudate is rich in fibrin, formed by long strands of polymerized fibrinogen)

17
Q
A
18
Q

What is considered a multifactorial disease (genetic+environmental) with the following risk factors (4 of 9):

  1. Old Age
  2. Sex (M>F, differences less after menopause)
  3. Heredity
  4. Lipid metabolism
  5. HTN
  6. Obesity
  7. Diabetes
  8. Cigarette smoking
  9. Stress
A

Atherosclerosis

19
Q

What hormone has a protective effect against atherosclerosis?

A

Female sex hormones

-women who take replacement estrogen therapy after menopause reduce progression of atherosclerosis

20
Q

What are the risk factors of Atherosclerosis?

A

“Cigarrettes HOLDS ASH”

  1. Age (old)
  2. Sex (M>F, differences less after menopause)
  3. Heredity
  4. Lipid metabolism
  5. HTN
  6. Obesity
  7. Diabetes
  8. Cigarette smoking
  9. Stress
21
Q

What is the best known cause for familial atherosclerosis that is considered a hereditary risk factor of Atherosclerosis?

A

Familial Hypercholesterolemia (defect of LDL receptors)

22
Q

What condition:

  • genetic defect of LDL receptors, which does not allow lipoproteins into the liver
  • causes atherosclerosis at an early age
A

Familial Hypercholesterolemia

23
Q

Which Atherosclerotic risk factor has to do with the following:

triglycerides directly correlate with the extent and severity, and with the early onset of clinical symptoms (ex: serum cholesterol >260 increases risk 5x)

A

Lipid Metabolism

24
Q

Which Atherosclerotic risk factor has to do with the following:

  • direct correlation with the acceleration of atherosclerosis if not properly controlled
  • exact role in the development in not fully understood
A

HTN

25
Q

Which atherosclerotic risk factor causes a secondary hyperlipidemia due to increased total body fat

-These pts develop atherosclerosis at an earlier age and is more pronounced

A

Obesity

  • This is b/c the tissue fat is in equilibrium with the circulating lipids
26
Q

How does DM predispose individuals to atherosclerosis?

A
  • Hyperglycemia alters the metabolism of basement membranes and damages small blood vessels (diabetic microangiopathy) of the glomerular capillaries and larger renal arterioles.
  • Diabetes also accelerates atherosclerosis in larger arteries (coronaries, cerebral, and aortic).
27
Q

Where do occlusions occur most often? What location of the infact ?

A

MC is from occlusion of the LAD-

Causes an anterior wall infarct

28
Q

Occlusion of _________ accounts for 30-40%

Causes an infarct of the right ventricle and posterior wall of the left ventricle

A

RCA

usually causes an infarct of the right ventricle and posterior wall of the left ventricle

29
Q

CAD:

Occlusion of _________ accounts for 10-20% (least common)

-Usually causes infarct of the lateral wall of the left ventricle

A

Left Circumflex Artery

30
Q

What is the only way we get right sided heart vegetations (esp. of the tricuspid valve)?

A

IVDA

most cases are caused by St. aureus (followed by Strept. species and Candida)

31
Q

Where do LEFT sided heart vegetations most commonly embolize to?

A

MC: The brain

-1/3 of patients: Retinal (blindness), coronary (MI), cerebral (strokes), splenic, and renal (from renal abscesses to glomerulonephritis)

32
Q

Where do RIGHT sided heart vegetations most commonly embolize to?

A

Pulmonary embolism

(from IVDA’s)