CCR 2

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julieaburch
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CCR 2
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2011-09-05 21:13:12
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CCR 2
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  1. What does it mean if the PR interval is longer than 0.20 secs, and there is a QRS complex after every P wave? What is this called?
    • There is a delayed conduction through the AV node
    • First Degree Block
  2. What is it called when a site in the muscle becomes the pacemaker for one beat?
    PVC
  3. What is the difference between atresia and stenosis?
    • Atresia: complete obstruction
    • Stenosis: partial obstruction
  4. What happens to emboli in Paradoxical Embolism?
    May pass to systemic circulation by bypassing the lungs due to a right-to-left shunt. Can lodge in the brain (brain infarction) or in the coronary artery (cardiac infarction)
  5. What are common causes of Left-to-Right Shunts (5)?
    • ASD
    • VSD
    • PDA
    • Complete Atrioventricular Canal Defect
    • Large VSD with Irreversible Pulmonary Hypertension
  6. What two things does a VSD commonly result in?
    • Right Ventricular Hypertrophy
    • Eisemenger Syndrome
  7. A PDA is usually asymptomatic early in life. What can it result in?
    Eisemenger Syndrome
  8. Right-to-left shunts commonly result in what two things?
    • Early onset cyanosis
    • Paradoxical Embolism
  9. Left-to-right shunts commonly result in what 3 things?
    • Right Ventricular Hypertrophy
    • Irreversible Pulmonary Hypertension
    • Late Onset Cyanosis -- Eisenmenger's Syndrome
  10. What syndrome results when high pressure blood enters the low pressure pulmonary circulation? Long-term this promotes irreversible narrowing of the pulmonary vessels and irreversible pulmonary hypertension. Pressure increases on right side of heart higher than on left. Blood flows from right to left -- late onset cyanosis.
    Eisenmenger Syndrome
  11. Why do atrial septal defects of the secundum type usually not result in Eisenmenger Syndrome?
    Because it is low pressure blood flowing from the left to right atrium; therefore, there is no irreversible pulmonary hypertension
  12. What is the primary concern with a secundum type atrial septal defect?
    • Paradoxical Embolism (due to a small amount of regurgitation)
    • Also get ventricular hypertrophy
  13. What type of cyanosis do right-to-left shunts result in? Left-to-right shunts?
    • Early Onset Cyanosis
    • Late Onset Cyanosis
  14. What are the five causes of a right-to-left shunt?
    • Tetralogy of Fallot (depending on degree of pulmonary stenosis)
    • Transposition of Great Arteries
    • Persistent Truncus Arteriosus
    • Tricuspid Atresia
    • Total Anomalous Pulmonary Venous Connection
  15. A Persistent Truncus Arteriosus results in what two things?
    • Early Onset Cyanosis
    • Eisenmenger Syndrome
  16. In what cardiac defect do the pulmonary veins not connect with the left atrium? Oxygenated blood is returned to the right ventricle. Blood shunts from the right to the left atrium. Cyanosis is present, and surgery is required shortly after birth.
    Total Anomalous Pulmonary Venous Connection
  17. A Preductal (Infantile) Coarctation of the Aorta results in what type of cyanosis? Where is hypertension experienced in this syndrome? How does blood flow in this syndrome?
    • Early onset cyanosis in trunk and lower extremities
    • Hypertension in head, neck, and upper extremities
    • Depends on patent ductus arteriosus from blood to get to trunk and lower extremities
  18. Where is hypertension seen in a Postductal Coarctation of the Aorta? How does blood flow in this?
    • Hypertension in head, neck, and upper extremities
    • Hypotension in lower extremities
    • Development of a collateral circulation (large intercostal arteries)
  19. What defects do Pulmonary Atresia result in?
    • Right Ventricular Hypoplasia
    • Cyanosis
    • Must have compensitory ASD or PDA for survival
  20. What are the consequences of Pulmonary Stenosis?
    • Right Ventricular Hypertrophy
    • Mild -- usually asymptomatic, compatible with life
    • Severe -- similar symptoms to atresia
  21. What are the consequences of Aortic Atresia?
    • Cyanotic
    • Must have compensitory PDA or ASD
    • Requires surgery with first week of life
  22. What are the consequences of Aortic Stenosis?
    • Left Ventricular Hypertrophy
    • Usually well-tolerated if not severe
    • Increases risk for left heart failure
  23. What does a Bicuspid Aortic Valve predispose a patient to? What can it lead to?
    • Progressive Degenerative Calcification with Age
    • Leads to Stenosis of Aortic Valve
  24. What is the most common Inherited Channelopathy -- Long QT Syndrome? What is the other one?
    • Romano-Ward
    • Jervell-Nielson
  25. What is the mainstay of treatment of the Long QT Syndrome?
    Beta-blockers
  26. What is the most common mechanism of clinical arrhythmias?
    Reentry
  27. What are the three requirements for reentry?
    • Obstacle
    • Uni-directional block
    • Conduction delay
  28. What is the remnant piece of muscle that allows for reentry called?
    Anulus Fibrosus
  29. What syndrome is associated with Paroxysmal Supraventricular Tachycardia (PSVT) due to AV reentrant tachycardia? This has a congenital atrio-ventricular myocardial connection, and is associated with pre-excitation.
    Wolf-Parkinson-White Syndrome
  30. What is most commonly given for acute treatment of Paroxysmal Supraventricular Tachycardia? Chronic treatment?
    • IV Adenosine
    • Class I (Flecainide, Propafenone) or III (Sotalol) Anti-Arrhythmic Drugs
    • Catheter Ablation
  31. How is ventricular fibrillation treated acutely? Chronically?
    • Acute: defibrillation
    • Chronic: implantable defibrillator; anti-arrhythmic drugs; catheter ablation
  32. Where do many atrial fibrillations originate?
    Pulmonary Veins
  33. What is the most common arrhythmia?
    Atrial Fibrillation
  34. What is the treatment for atrial fibrillation?
    • Anticoagulation
    • Rate control by blocking the AV node
    • Sinus rhythm maintenance
  35. The CHADS Score is a scale for the risk for stroke in non-valvular atrial fibrillation. What does a score of 0 indicate? 1? 2?
    • 0: Need for aspirin
    • 1: Aspirin or Warfarin
    • 2: Warfarin
  36. In catheter ablation for atrial fibrillation, what do we try to isolate?
    Pulmonary Vein
  37. In symptomatic patients, what is the most common presenting symptom for peripheral artery disease?
    Atypical exertional leg pain
  38. What is an easy, non-invasive method for early diagnosis of peripheral artery disease?
    • Ankle-Brachial Index
    • Ratio of pressure in upper extremities : lower extremities
  39. What does an ABI (ankle-brachial index) over greater than 1.30 indicate?
    Noncompressible (calcific vessel; diabetes; chronic renal insufficiency; and older age)
  40. What does an ABI (ankle-brachial index) of 0.91-1.30 indicate?
    Normal
  41. What does an ABI (ankle-brachial index) of 0.71-0.90 indicate?
    Mild PAD
  42. What does an ABI (ankle-brachial index) of 0.41-0.70 indicate?
    Moderate PAD
  43. What does an ABI (ankle-brachial index) of 0-0.40 indicate?
    Severe PAD
  44. What does a Lower Extremity Arteriogram (LEA) provide?
    A localization of where the problem is (ie, where drop in pressure is located)
  45. What type of ultrasound is normal (tiphasic, biphasic, monophasic)?
    Triphasic
  46. What are the 6 Ps of Acute Limb Ischemia?
    • Pain
    • Pallor
    • Pulselessness
    • Poikilothermia ("coldness")
    • Paralysis
    • Paresthesia
  47. What is the only pharmacological intervention method for peripheral artery disease (PAD)?
    Cilostazol
  48. What is a common aging process that consists of calcific deposits in the media of muscular arteries? It does not cause narrowing of the lumen of the artery. It is of no clinical significance.
    Monckeberg Medial Sclerosis
  49. What are the two types of arteriolosclerosis? Which is more common?
    • Hyaline & Hyperplastic
    • Hyaline
  50. What is the most common cause of death in the US?
    Atherosclerosis
  51. What is the term for the formation of atheromas -- accumulations of lipid within the intima of the artery covered by a fibrous cap -- within intima of arteries? These protrude into and narrow the lumen of the artery.
    Atherosclerosis
  52. What is the term that literally means "hardening of the arteries"?
    Arteriosclerosis
  53. In what two diseases is Hyaline Arteriolosclerosis common in? In what disease is Hyperplastic Arteriolosclerosis seen?
    • Hypertension & Diabetes Mellitus
    • Very Severe Hypertension
  54. Identify the pathology below:
    Hyaline Arteriosclerosis
  55. Identify the pathology below:
    Hyperplastic Arteriosclerosis
  56. What are the five complications associated with Atherosclerosis?
    • Ischemia or infarction of the organ
    • Thrombosis overlying plaque
    • Embolization of thrombus or cholesterol
    • Aneurysm formation
    • Rupture or dissection
  57. What is the term to describe small accumulations of lipid within intima? This is common, even in children, but may be a precursor lesions to atheromatous plaques. Most do not progress to this point, however, and by itself, this is of no clinical significance.
    Fatty Streaks
  58. Identify the pathology below:


    Fatty Streaks
  59. Identify the pathology below:
    Early/small atherosclerotic plaques
  60. Identify the pathology below:
    Atherosclerotic Plaques
  61. Identify the pathology below:
    Advanced Atherosclerotic Plaques
  62. Identify the pathology below:
    Plaque Ulceration
  63. Identify the pathology below:
    Thrombus Formation on Plaque
  64. Identify the pathology below:
    Atherosclerotic Plaque
  65. Identify the pathology below:
    Thrombus Formation on Plaque
  66. Identify the pathology below:
    Atherosclerotic Emboli
  67. Identify the pathology below:
    Atherosclerotic Emboli
  68. What is the hypothesis for the generation of atheromas?
    "Response to Injury:" process probably starts with damage to the endothelium
  69. What is the term for an abnormal localized dilation of a blood vessel or the heart? When this is true it is a dilation of an attenuated but intact wall of the blood vessel, and when it is false it is due to a defect in the vascular wall, which leads to an extravascular hematoma that communicates with the intravascular space.
    Aneurysm
  70. What are two inherited syndromes that predispose to aneurysm formation?
    • Marfan Syndrome
    • Ehlers-Danlos Syndrome
  71. What are the two main predisposing factors to aneurysm? Where do each predispose to an aneurysm?
    • Hypertension: thoracic aorta
    • Atherosclerosis: abdominal aorta
  72. Infection can cause aneurysms if the microorganisms seed to the vessel through the blood stream. What are these aneurysms called?
    Mycotic Aneurysms
  73. __________ aneurysms bulge out to one side; __________ aneurysms are dilations of the entire wall.
    • Saccular
    • Fusiform
  74. ___________ is hemorrhage into the wall of the blood vessel, which then extends proximally or distally to the entrance. It may occur within a preexisting aneurysm, but often occurs without a preexisting aneurysm.
    Dissection
  75. What is the initiating event in an aortic dissection?
    A tear in the intima of the aorta, allowing blood entrance into the media from which it can dissect either proximally or distally (or both)
  76. Identify the pathology below:

    Aortic Dissection
  77. What is the consequence of an aortic dissection dissecting into the pericardial sac?
    Cardiac Tamponade: occurs when the pericardial sac is so filled with fluid that it compresses the heart so that the right ventricle can't fill with blood. If not corrected relatively quickly, this is lethal
  78. What is the consequence of an aortic dissection dissecting into the aortic root?
    Acure Aortic Valve Incompetence
  79. What is the consequence of an aortic dissection dissecting into the pleural or peritoneal cavity?
    Catastrophic Hemorrhage
  80. What is the consequence of an aortic dissection dissecting back into the lumen of the aorta?
    "Double-barreled" Aorta with False Lumen: Survivable
  81. Where do most aortic dissections occur?
    Proximally, in the ascending or arch of the aorta; these are also more severe
  82. What is inflammation of a vessel wall known as?
    Vasculitis
  83. What are the two most common causes of vasculitis?
    • Immune-mediated inflammation
    • Direct invasion of vessel by microorganisms
  84. What are the two types of large vessel vasculitis? What is the biggest difference between them?
    • Giant Cell Arteritis & Takayasu Arteritis
    • Age: over 50 = Giant cell
  85. What is the most common type of arteritis in the elderly population in the western world? The temporal arteries are very commonly involved; other cranial arteries can also be involved. Involvement of the opthalmic arteries can result in blindness, which can be sudden in onset.
    Giant Cell Arteritis
  86. What are the presenting symptoms of Giant Cell Arteritis? What lab value is seen, and how is this definitively diagnosed?
    • Facial pain and headache; sudden blindness
    • Very high ESR rate -- over 100 mm/hr
    • Diagnosis depends on biopsy of an artery
  87. What are the presenting symptoms of Takayasu Arteritis?
    Initially non-specific (fever, weight loss, fatigue), but vascular symptoms later appear; then can include myocardial infarctions due to involvement of coronary arteries, ocular disturbances including blindness, and others
  88. What is a very common vasculitis that generally involves medium-sized arteries? It most often involves visceral organs, but can involve arteries anywhere in the body. It typically occurs in young adults. Segmental transmural necrotizing inflammation ("fibrinoid necrosis") is seen, followed by scarring. This can result in infarctions of involved organs. ~30% of cases are associated with hepatitis B virus infection; cause of remainder is unknown.
    Polyarteritis Nodosa (PAN)
  89. What are the common symptoms associated with Polyarteritis Nodosa (PAN)?
    • Systemic symptoms including malaise, fever, weight loss
    • Abdominal Pain
    • GI Bleeding
  90. Identify the pathology below (arrow points to normal tissue):
    • Polyarteritis Nodosa (PAN)
    • Bright red material is necrosis -- "Fibrinoid Necrosis"
    • There is a lot of inflammation seen
  91. What disease presents with conjuctival and oral erythema and erosion, swelling and erythema of the hands and feet, desquamative skin rash and enlarged lymph nodes? It typically involves infants and children, most less than four years old. This is an acute febrile illness of children. It is usually self-limited, but has a predilection for involving coronary arteries; can cause aneurysms, myocardial infarctions, and sudden death.
    Kawasaki Disease
  92. What disease is associated with necrotizing vasculitis involving arterioles, capillaries, and small venules? There is frequent involvement of glomerular and pulmonary capillaries; skin, mucous membranes, brain, heart, and many other organs may be involved. This is associated with antineutrophil cytoplasmic antibodies (ANCA).
    Microscopic Polyangiitis
  93. What capillaries are often involved with Microscopic Polyangiitis? What antibodies is it associated with?
    • Glomerular and Pulmonary Capillaries
    • Antineutrophil Cytoplasmic Antibodies (ANCA)
  94. What two type of ANCAs are associated with Microscopic Polyangiitis?
    • P-ANCA: antibodies against myeloperoxidase
    • C-ANCA: antibodies against proteinase 3
  95. What is a necrotizing granulomatous vasculitis of small to medium-sized vessels? The characteristic presentation is a triad: upper respiratory tract, lungs -- pulmonary hemorrhage, and kidneys -- necrotizing glomerulonephritis. What ANCA is this commonly associated with?
    • Wegener Granulomatosis
    • C-ANCA
  96. What is a vasculitis of medium to small vessels which characteristically involves the extremities? There is inflammation and thrombosis of vessels, resulting in ischemia of extremities. This is strongly associated with cigarette smoking, and is severely painful
    Thromboangiitis Obliterans (Buerger Disease)
  97. What is Thromboangiitis Obliterans (Buerger Disease) strongly associated with? What is a common symptoms?
    • Heavy Cigarette Smoking
    • It is severely painful
  98. Common causes of Infectious Vasculitis are a spread of infection from surrounding tissue to the vessel, and hematogenous seeding from elsewhere. What type of organisms are commonly associated with this, and what two organisms in specific?
    • Fungi and Bacteria
    • Aspergillus and Mucor species
  99. What are benign tumors of blood vessels called, in general?
    Hemangiomas
  100. What are two intermediate-grade tumors of blood vessels?
    • Hemangioendothelioma
    • Kaposi Sarcoma
  101. What are two malignant tumors of blood vessels?
    • Angiosarcoma
    • Hemangiopericytoma
  102. Identify the pathology below:
    Hemangioma
  103. What vascular neoplasm is strongly associated with infection by HHV-8, a member of the Herpes family?
    Kaposi Sarcoma
  104. A Kaposi Sarcoma is a vascular neoplasm that is strongly associated with HHV-8. Which variant is typically found in older men of Eastern European or Mediterranean descent? It is rare in the US, and not associated with HIV infection. The course tends to be relatively chronic and indolent; it is usually restricted to the skin.
    Classic (chronic) KS
  105. A Kaposi Sarcoma is a vascular neoplasm that is strongly associated with HHV-8. Which variant typically occurs in Africa? It is rare in the US, and is not associated with HIV. Patients tend to have predominantly lymph node and visceral involvement; it is extremely aggressive.
    Lymphadenopathic KS
  106. A Kaposi Sarcoma is a vascular neoplasm that is strongly associated with HHV-8. Which variant is seen in solid-organ transplant recipients? It is probably related to immunosuppression, and is not associated with HIV. It tends to have nodal, mucosal, and visceral involvement; the course is often aggressive.
    Transplant-associated KS
  107. A Kaposi Sarcoma is a vascular neoplasm that is strongly associated with HHV-8. Which variant is associated with AIDS due to HIV infection? It used to be common in AIDS patients, but has now become rather rare. Patients tend to have widely disseminated disease which involve lymph nodes or viscera. Death is usually due to opportunistic infections, although KS can be the cause of death.
    AIDS-associated KS
  108. Identify the pathology below:


    Kaposi Sarcoma
  109. What are rare, malignant neoplasms of endothelial cells? They have a spectrum of clinical behavior and histologic appearance; the behavior can vary from relatively indolent to highly aggressive and lethal. These most often involve skin, soft tissue, breast, and liver.
    Angiosarcomas
  110. What are Hepatic Angiosarcomas often associated with?
    Arsenical Pesticides and Polyvinyl Chloride
  111. What are Varicose Veins caused by? What can they lead to?
    • Caused by prolonged increased intraluminal pressure and loss of vessel wall support
    • Can lead to stasis dermatitis and chronic ulcers
  112. What disease is characterized by concentric thickening of the left ventricular wall and interventricular septum in response to increased resistance to left ventricular emptying? This is a compensatory phenomenon, in response to the increased resistance to left ventricular emptying. In this disease, the heart becomes heavier; initially only slightly larger
    Hypertrophic Heart Disease due to increased afterload
  113. What is inflammation of the myocardium called?
    Myocarditis
  114. What are diseases of the myocardium resulting in decreased cardiac output called?
    Cardiomyopathies
  115. What is the most common cause of Hypertrophic Heart Disease?
    Hypertension
  116. What is a more or less inescapable consequence of hypertrophy?
    Fibrosis
  117. Identify the pathology below:
    Normal Myocardium:


    Pathological Myocardium (to be identified):
    Hypertrophic Myocardium (Hypertrophic Heart Disease): thicker myocardia; bigger, squared off, "box-car" nuclei
  118. What are the consequences of myocardial hypertrophy?
    • Increased oxygen requirement
    • Decreased oxygen diffusion (due to increased distance between capillaries and center of myocardial fiber)
    • Interstitial Fibrosis
    • Eventual Decompensation with dilatation and congestive heart failure
    • Arrhythmias and Mural Thrombi may occur
  119. In the slide below, identify the normal, hypertrophic, and decompensated hearts:
    • Left: Hypertrophic
    • Middle: Normal
    • Right: Decompensated
  120. What is the most common cause of Myocarditis in the US?
    Viral Infections -- Coxsackie A & B
  121. What is a common cause of Myocarditis in parts of South America -- fortunately rare in US?
    Trypanosoma cruzii (Chagas Disease)
  122. What is a granulmatous disease of unknown etiology; it most often affects the lungs and mediastinal lymph nodes, but it can also attach otehr organs all over the body? It is a poorly understood cause of myocarditis.
    Sarcoidosis
  123. What is a rare, severe form of myocarditis associated with giant cells in the myocardium; it may represent the msot severe end of the spectrum of myocarditis, rather than a distinct disease? It typically occurs in younger people, and frequently results in severe left ventricular dysfunction and death.
    Giant Cell Myocarditis
  124. What are the common symptoms associated with Myocarditis?
    • Fatigue
    • Fever
    • Dyspnea due to congestive failure
    • Chest Pain
  125. Identify the pathology below:


    Myocarditis -- note the large amount of lymphocytes
  126. Identify the pathology below:
    Hypersensitivity Myocarditis -- note the present of numerous eosinophils
  127. Identify the pathology below:
    Giant Cell Myocarditis
  128. What is the most common type of Cardiomyopathy?
    Dilated/Congestive
  129. What type of cardiomyopathy commonly results from systolic dysfunction: decreased left ventricular output? This results in decreased left ventricular output and backup of blood into the pulmonary circulation; it presents with the typical signs and symptoms of congestive heart failure. It can eventually result in right heart failure due to back up of blood from the pulmonary circulation and increased right ventricular pressure.
    Dilated Cardiomyopathy
  130. What type of cardiomyopathy is caused by a primary abnormality in the myocardium that results in restrictive problems due to a stiff left ventricle which doesn't fill in diastole? This may also result in obstructive problems: a block of left ventricular output through the aortic root.
    Hypertrophic Cardiomyopathies
  131. What type of cardiomyopathy results from deposition of material within the myocardium; this results in a stiff ventricle which cannot fill during diastole? Thus, it results in diastolic dysfunction. There is a decrease in cardiac output. This results in congestive heart symptoms, but the left ventricle is not dilated.
    Infiltrative Cardiomyopathy
  132. Which type of cardiomyopathy is essentially all genetic diseases?
    Hypertrophic Cardiomyopathies
  133. What are the 4 ultimate complications of all types of cardiomyopathies?
    • Heart Failure
    • Sudden Death (usually due to arrhythmias)
    • Atrial Fibrillation
    • Strokes or other Embolic Phenomena (due to embolization from thrombi forming in the atria or the poorly contractile ventricles)
  134. In what disease is the heart enlarged, with increased weight? It feels flabby, and all four chambers are usually dilated. There is usually some element of hypertrophy in the ventricles, and mural thrombi are common, and can be a source of emboli.
    Dilated (Congestive) Cardiomyopathy
  135. What is probably a relatively common cause of sudden death in young, otherwise healthy people who drop dead without warning?
    Hypertrophic Cardiomyopathy (HCM)
  136. 25-30% or people with Hypertrophic Cardiomyopathy have what?
    Outflow Obstruction -- due to hypertrophic interventricular septum bulging into and obstructing left ventricular outflow tract
  137. Hypertrophic Cardiomyopathies are due to abnormalities in genes encoding what protein type? How are these inherited?
    • Sarcomeric Proteins
    • Autosomal Dominant
  138. Identify the pathology below:
    Hypertrophic Cardiomyopathy
  139. Many people with Hypertrophic Cardiomyopathy are asymptomatic. What are two symptoms associated with this disease, in symptomatic patients?
    • Angina (due to ischemia)
    • Exertional Dyspnea
  140. What are four common causes of Restrictive Cardiomyopathy?
    • Amyloidosis
    • Sarcoidosis
    • Radiation
    • Metabolites from inborn errors of metabolism
  141. Identify the pathology below:
    • Restrictive Cardiomyopathy -- on the left, note that both atria are massively dilated; the left ventricular wall appears slightly thickened, but the left ventricular chamber is not dilated
    • On the right, note the pink material surrounding the red myocardial fibers; it shouldn't be there
  142. What is the number one killer in the US and worldwide?
    Ischemic Heart Disease
  143. What disease includes a group of conditions characterized by an imbalance between oxygen supply to the myocardium and myocardial oxygen demand, specifically insufficient oxygen supply to meet myocardial demand?
    Ischemic Heart Disease
  144. What is the most common cause of Ischemic Heart Disease?
    Coronary Atherosclerosis
  145. What are the 4 common manifestations of Ischemic Heart Disease?
    • Angina Pectoris
    • Myocardial Infarction
    • Chronic Ischemic Heart Disease
    • Sudden Cardiac Death (usually due to arrhythmias)
  146. What is the most common form of angina? It is usually associated with exertion, and is relieved by rest or nitroglycerin. It is usually associated with stable degrees of obstruction of coronary arteries due to atherosclerosis.
    Classic (Stable) Angina
  147. What type of angina is characterized by increasing frequency of anginal attacks and/or attacks occuring with lesser degrees of exertion; it can occur without exertion? The pain tends to be more prolonged, and may not be relieved by rest or nitroglycerin; however, there is no action myocardial necrosis. It often occurs when an atherosclerotic plaque in a coronary artery becomes ulcerated or ruptured and thrombus develops on top of the plaque, causing a sudden and marked increase in the degree of stenosis caused by the underlying plaque. If untreated, this has a high tendency to progress to MI.
    Unstable Angina
  148. What uncommon type of angina is caused by coronary artery vasospasm, usually superimposed on coronary artery atherosclerosis?
    Prinzmetal Variant Angina
  149. What term is used when there is actual myocardial necrosis due to ischemia?
    Myocardial Infarction
  150. What disease is characterized by congestive heart failure due to ischemic heart disease? The patient may or may not have a history of previous MIs.
    Chronic Ischemic Heart Disease
  151. What accounts for the majority of Myocardial Infarctions?
    Thrombosis superimposed on atherosclerosis
  152. What area of the myocardium is at greatest risk for ischemia?
    Subendocardium (innermost part of the myocardium) -- due to the fact that the tissue farthest away from where an artery enters an organ is at greatest risk of ischemia
  153. Progression of a myocardial infarct: from an area of at risk but non-infarcted tissue, to __________ necrosis, to __________ necrosis.
    • Subendocardial
    • Transmural
  154. In acute MIs, the ____________ changes lag far behind the _____________ changes.
    • Morphologic
    • Functional
  155. What is the earliest marker of myocardial injury?
    Myoglobin
  156. What are the most commonly used biochemical markers used in diagnosis of acute myocardial infarction?
    • Troponins (I or T)
    • MB isoform of the enzyme Creatinine Kinase
  157. Infarction of >40% of the left ventricle is associated with severe left heart failure, which has a high mortality rate. What is this called?
    Cardiogenic Shock
  158. There are several syndromes of Myocardial Rupture. What is the most common of these? What does it result in, and when does it typically occur?
    • Rupture of free ventricular wall
    • Results in Hemopericardium and Tamponade
    • Occurs 3-7 days after MI
  159. There are several syndromes of Myocardial Rupture. What does a rupture of the interventricular septum create?
    Acute Ventriculoseptal Defect and Left-to-Right Shunt
  160. There are several syndromes of Myocardial Rupture. What does necrosis and rupture of the papillary muscle cause?
    Acute Mitral Valve Insufficiency
  161. What is Dressler Syndrome?
    Pericarditis following an acute MI

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