Chapter 18 - Pathophysiology

Which serum biomarker(s) are indicative of irreversible damage to myocardial cells?

Elevated CK-MB, troponin I, and troponin T

Although smoking has been linked to heart disease, it is no longer considered a major risk factor.

False

Chest pain brought on by activity and resolved by rest is called Prinzmetal angina.

False

Pulmonary valvular stenosis is characterized by a high right atrial/right ventricular pressure gradient during diastole.

False

Stable angina pectoris may produce significantly elevated serum cardiac enzymes.

False

The high-density lipoprotein (HDL) value must be greater than 60 mg/dl to decrease the risk of coronary artery disease.

False

Patients presenting with symptoms of unstable angina and no ST segment elevation are treated with

antiplatelet drugs.

Atherosclerotic plaques with large lipid cores are prone to

rupture

The most reliable indicator that a person is experiencing acute myocardial ischemia is a. severe, crushing chest pain. b. ST-segment elevation. c. dysrhythmias. d. pain radiating to the jaw and neck.

b. ST-segment elevation.

Angina due to coronary artery spasm is called _____ angina. a. stable b. classic c. unstable d. Prinzmetal variant

d. Prinzmetal variant

What compensatory sign would be expected during periods of physical exertion in a patient with limited ventricular stroke volume? a. Hypertension b. Bradycardia c. Aortic regurgitation d. Tachycardia

d. Tachycardia

A patient with chest pain who exhibits ST elevation on an ECG should be evaluated for thrombolytic therapy.

True

A person who experiences signs and symptoms consistent with acute coronary syndrome should immediately take an aspirin.

True

Acute myocardial infarction and unstable angina are both acute coronary syndromes.

True

Diastolic heart murmurs are always pathologic.

True

Most myocardial infarctions occur when an atherosclerotic plaque stimulates thrombus formation at the site.

True

Acute coronary syndrome in the presence of thrombosis may present as (Select all that apply.)

a. unstable angina. b. MI. c. sudden cardiac arrest

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding? a. Increased LDL levels are associated with increased risk of coronary artery disease. b. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of his disease. c. Increased LDL levels are indicative of moderate alcohol intake, and patients should be advised to abstain. d. Elevated LDL levels are an expected finding in the elderly and therefore not particularly significant.

a. Increased LDL levels are associated with increased risk of coronary artery disease.

Aortic regurgitation is associated with a. diastolic murmur. b. elevated left ventricular/aortic systolic pressure gradient. c. elevated systemic diastolic blood pressure. d. shortened ventricular ejection phase.

a. diastolic murmur.

Diagnostic tests used to diagnose or confirm MI include (Select all that apply.) a. electrocardiogram. b. cardiac catheterization. c. echocardiography. d. radionuclide scintigraphy. e. computed tomography.

a. electrocardiogram. b. cardiac catheterization. c. echocardiography. d. radionuclide scintigraphy.

Restrictive pericarditis is associated with a. impaired cardiac filling. b. cardiac hypertrophy. c. increased cardiac preload. d. elevated myocardial oxygen consumption.

a. impaired cardiac filling.

A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is a. stable angina. b. myocardial infarction. c. coronary vasospasm. d. unstable angina.

a. stable angina.

A patient with significant aortic stenosis is likely to experience a. syncope. b. hypertension. c. increased pulse pressure. d. peripheral edema.

a. syncope.

An elderly patient's blood pressure is measured at 160/98. How would his left ventricular function be affected by this level of blood pressure? a. This is an expected blood pressure in the elderly and has little effect on left ventricular function. b. Left ventricular workload is increased with high afterload. c. High blood pressure will enhance left ventricular perfusion during systole. d. High-pressure work will lead to left ventricular atrophy.

b. Left ventricular workload is increased with high afterload.

Mitral stenosis is associated with a. a prominent S4 heart sound. b. a pressure gradient across the mitral valve. c. left ventricular hypertrophy. d. a muffled second heart sound (S2).

b. a pressure gradient across the mitral valve.

Myocarditis should be suspected in a patient who presents with a. chest pain and ST elevation. b. acute onset of biventricular failure. c. murmur and abnormal valves on echocardiogram. d. family history of cardiomyopathy.

b. acute onset of biventricular failure.

Decreased cardiac output, muffled heart sounds, and equalized intracardiac pressures are manifestations of a. myocardial infarction. b. cardiac tamponade. c. congestive heart failure (CHF). d. cardiomyopathy.

b. cardiac tamponade.

β-Adrenergic antagonist (beta blocker) drug therapy may be indicated in the management of myocardial infarction to a. decrease myocardial oxygen demands. b. decrease the effect of prolonged SNS stimulation. c. decrease aortic resistance to flow (afterload). d. increase intracardiac volume (preload).

b. decrease the effect of prolonged SNS stimulation

The compensatory mechanisms that are triggered following myocardial infarction a. protect the heart from further ischemia. b. increase myocardial oxygen demands. c. reduce heart rate and blood pressure. d. result from parasympathetic activation.

b. increase myocardial oxygen demands.

Inflammatory disorders that may alter endothelial cell function include (Select all that apply.) a. multiple sclerosis. b. lupus erythematosus. c. Kawasaki syndrome. d. rheumatoid arthritis. e. polyarteritis nodosa

b. lupus erythematosus. c. Kawasaki syndrome. e. polyarteritis nodosa

Which of the following is an accurate description of patent ductus arteriosus? a. An opening between the atria b. A stricture of the aorta that impedes blood flow c. A communication between the aorta and the pulmonary artery d. A cyanotic heart defect associated with right-to-left shunt

c. A communication between the aorta and the pulmonary artery

Which of the following statements regarding myocardial cell regeneration is correct? a. The myocardium is incapable of significant regeneration. b. Differentiated myocardial cells have the capacity to divide to form new cells. c. Differentiated myocytes cannot divide, but stem cells present in the heart can. d. Myocardial cells are incapable of cell division, and all growth is from hypertrophy.

c. Differentiated myocytes cannot divide, but stem cells present in the heart can.

A patient who presents with a loud pansystolic murmur that radiates to the axilla most likely has a. aortic regurgitation. b. aortic stenosis. c. mitral regurgitation. d. mitral stenosis.

c. mitral regurgitation

An example of an acyanotic heart defect is a. tetralogy of Fallot. b. transposition of the great vessels. c. ventricular septal defect. d. all right-to-left shunt defects.

c. ventricular septal defect.

Rheumatic heart disease is most often a consequence of a. chronic intravenous drug abuse. b. viral infection with herpes virus. c. β-hemolytic streptococcal infection. d. cardiomyopathy.

c. β-hemolytic streptococcal infection.

The majority of cardiac cells that die after myocardial infarction do so because of a. cell rupture. b. insufficient glucose. c. necrosis. d. apoptosis.

d. apoptosis.