CHF

Question 1

3 types of compensatory mechanisms of CHF

Answer 1

1. activation of neurohumoral systems (release of NE, act of renin-angiotensin system)
2. Frank-starling mechanism
3. myocardial hypertrophy

Question 2

compensatory mechanisms usually fail due to ____ _____ requirements of myocardium, but without increased ____ ____, resulting in susceptibility to _____

Answer 2

increased oxygen requirements
capillary supply
ischemia

Question 3

causes of left sided heart failure

Answer 3

1. ischemic heart disease (IHD)
2. hypertension
3. myocarditis
4. cardiomyopathy
5. valvular disease

Question 4

causes of right sided heart failure

Answer 4

1. left sided heart failure
2. pulmonary hypertension
3. valve disease
4. septal defects with left to right shunts

Question 5

causes of congenital heart diseases

Answer 5

environmental factors (congenital rubella, maternal diabetes)
chromosomal abnormalities
90% are unknown and likely multifactorial

Question 6

3 types of noncyanotic congenital heart diseases

Answer 6

1. atrial septal defect
2. ventricular septal defect
3. patent ductus arteriosus

Question 7

2 types of cyanotic congenital heart diseases

Answer 7

1. tetrology of fallot

2. transposition of the great arteries

Question 8

4 anomalies of tetrology of fallot

Answer 8

1. ventricular septal defect
2. narrowed right ventricular outflow
3. overriding of VSD by the aorta
4. right ventricular hypertrophy

Question 9

what occurs in transposition of the great arteries?

Answer 9

the R ventricle empties into the aorta and the L ventricle empties into the pulmonary artery

Question 10

group of related disorders that are all characterized by imbalance between ____ and ____ (ischemia)

Answer 10

myocardial blood supply; myocardial oxygen demand

Question 11

> 90% of IHD due to _____

Answer 11

coronary artery atherosclerosis

Question 12

another cause of IHD is _____ due to fissure in the fibrous cap of an atherosclerotic plaque

Answer 12

coronary artery thrombosis

Question 13

other factors that lead to IHD

Answer 13

increased myocardial oxygen demand (hypertension)
decreased blood volume (hypotension/shock)
decreased oxygenation (pneumonia)
decreased oxygen carrying capacity (anemia)

Question 14

clinical types of IHD

Answer 14

1. angina pectoris
2. myocardial infarction
3. chronic IHD with CHF
4. sudden cardiac death

Question 15

severe ischemia (as in MI) lasting longer than ____ will cause irreversibly myocyte injury and cell death

Answer 15

20-40 min

Question 16

myocardial ischemia also contributes to _____, probably because ischemic regions cause _____ that may lead to _____

Answer 16

arrhythmias; electrical instability (irritability); ventricular fibrillation

Question 17

clinical manifestations of MI

Answer 17

-chest pain, shortness of breath, diaphoresis (sweating), nausea/vomiting, low grade fever

Question 18

diagnostic tests for acute MI include: ____ changes; elevation of ____ such as ____ and ____ derived from necrotic myocytes

Answer 18

ECG; serum enzymes; creatine kinase (CK-MB); troponin

Question 19

tx of MI by placement of ____ to open the coronary arteries clogged by atherosclerotic plaques, ______, or _____ such as tissue plasminogen activator (TPA) or streptokinase

Answer 19

stents; coronary artery bypass grafts (CABGs); “clot busting” drugs

Question 20

____ is a risk of MI tx

Answer 20

reperfusion injury

Question 21

complications of MI

Answer 21

1. arrhythmia and sudden death
2. CHF/shock
3. mural thrombus/emboli
4. myocardial rupture
5. mitral valve regurgitation
6. ventricular aneurysm
7. chronic IHD

Question 22

most common cause of sudden cardiac death is _____

Answer 22

IHD (80-90%)

Question 23

chronic IHD with CHF characterized by _____ following acute MI or secondary to smaller ischemic events, with eventual _____

Answer 23

progressive cardiac decompensation; mechanical pump failure

Question 24

sudden cardiac death occurs through sudden onset of _____ with or without _____; may occur in individuals with a without a previous history of IHD

Answer 24

ischemia-induced cardiac arrhythmia; myocardial necrosis (infarction)

Question 25

3 morphologic patterns of cardiomyopathy

Answer 25

dilated (most common form) hypertrophic restrictive

Question 26

histology of dilated cardiomyopathy shows ____ and _____; characterized by _____

Answer 26

variable fibrosis; myocyte hypertrophy; poor ventricular contractility (systolic dysfunction)

Question 27

hypertrophic cardiomyopathy is a disorder of _____, inherited as _____ with variable expression

Answer 27

sarcomeric proteins (myosin, myosin binding protein C, troponin T); autosomal dominant

Question 28

characteristic histology of hypertrophic cardiomyopathy is disarray of _____ and _____

Answer 28

cardiac myocytes; fibrosis

Question 29

restrictive cardiomyopathy characterized by _____ , resulting in _____ during diastole

Answer 29

decrease in ventricular compliance (wall is stiffer); impaired ventricular filling

Question 30

most common cause of myocarditis in the US is _____

Answer 30

viral infection (coxsackie A and B, other enteroviruses)

Question 31

myocarditis can also be caused by ____, ____, and ____ organisms

Answer 31

bacterial; fungal; parasitic

Question 32

non-infectious causes of myocarditis include:

Answer 32

toxins, hypersensitivity rxns, and autoimmune disorders

Question 33

clinical manifestations of L vent. failure

Answer 33

1. pulmonary edema and congestion, resulting in dyspnea 2. chronic cough 3. orthopnea

Question 34

clinical manifestations of L and/or R vent. failure

Answer 34

cerebral hypoxia

Question 35

clinical manifestations of R vent. failure

Answer 35

- congestion of liver (zonal or nutmeg pattern) and spleen | - edema (pitting) of subcutaneous tissues, particularly lower extremities

Question 36

most common of cardiac malformations; 4/1000 live births

Answer 36

VSD

Question 37

2nd most common congenital malformation

Answer 37

ASD

Question 38

intermittent chest pain caused by transient, reversible myocardial ischemia

Answer 38

angina pectoris

Question 39

occurs predictably at certain levels of exertion; crushing or squeezing substernal pain that may radiate down the left arm or jaw (referred pain). Relieved by rest or sublingual nitroglycerin (vasodilator to increase coronary perfusion)

Answer 39

stable angina

Question 40

increasing frequency of chest pain with minimal/no exertion. Longer lasting than stable angina. Often precedes more serious ischemia or MI

Answer 40

unstable angina

Question 41

heterogeneous group of cardiac diseases which may be primary or secondary, genetic or acquired

Answer 41

dilated cardiomyopathy

Question 42

restrictive cardiomyopathy can be idiopathic or associated with other conditions that happen to affect the myocardium such as:

Answer 42

radiation fibrosis, amyloidosis, hemochromatosis, and sarcoidosis

Question 43

viral infection of myocarditis produces a ______ with foci of necrosis

Answer 43

lymphocytic infiltrate

Question 44

pyogenic bacteria of myocarditis cause _____

Answer 44

abscesses

Question 45

parasites (trypanosomes in chagas disease) infect _____ or are in _____ with surrounding _____

Answer 45

individual myocytes; interstitial areas; inflammatory cells

Question 46

hypersensitivity in myocarditis (usually to drugs) causes a _____ with many _____

Answer 46

perivascular inflammatory infiltrate; eosinophils