PA-622 Heart Exam (Luke's Quizlets Combined)

In the pathogenesis of atherosclerosis, what can accumulate in the intima at sites of endothelial cell injury?

LDL - high cholesterol content (LDL is oxidized, ingested by macrophages, chemotactic for monocytes)

patient would be in shock with low blood pressure

Escherichia coli septicemia would result in what condition?

True or False. Angiotensin II causes vasodilation, decreasing blood pressure.

False. Angiotensin II causes vasoconstriction, elevating blood pressure.

True or False. Vasculitis is a local disease rather than a systemic one.

False. Vasculitis can be local or systemic.

starts the process of a thrombosis

Intermittent platelet aggregation would cause what to occur?

This is a type of cancer that forms in the lining of blood and lymph vessels and causes lesions to grow in the skin, lymph nodes, internal organs, and mucous membranes lining the mouth, nose, and throat. It's development is greatly associated with immunocompromised patients.

Kaposi sarcoma

This is a virus-associated neoplasm of mesenchymal or endothelial cell that is associated with immunocompromised conditions.

Kaposi sarcoma (malignant)

This is a condition that causes inflammation in the walls of some blood vessels in the body. It's most common in infants and young children and early stages include a rash and fever. Symptoms include high fever and peeling skin.

Kawasaki disease (type II hypersensitivity syndrome)

This marker rises 2-4 hours after a MI occurs and peaks at 18 hours post MI, an increase in these enzymes may mean you have an inflammation of the heart muscle or are having or recently had a heart attack.

CK-MB

What is the most common cause of chronic cor pulmonale?

COPD

Explain how the chambers of the heart sit on an AP chest radiograph.

RA = Right-most chamber RV = Anterior-most chamber LA = Posterior-most chamber LV = Left-most chamber

This is a condition in which some areas of the body feel numb and cool in certain circumstances. It affects smaller arteries that supply blood to the skin which will constrict excessively in response to cold, limiting blood supply to the affected area.

Raynaud's disease

Which heart sound is associated with LV failure?

S3 (ventricular gallop; blood hits dilated wall)

What would you see on an ECG that is indicative of a MI?

ST segment elevation

_____________ occurs when effusions accumulate acutely around the heart.

Tamponade

autoimmune disease; thoracic aorta aneurysm

Tertiary syphilis would cause what to occur?

(A) Thinning of the media (All other options would cause the start of, or are a sequence of a thrombosis; this would cause an aneurysm)

The development of atheromatous plaque formation with subsequent complications is observed in an experiment. Atherosclerotic plaques are shown to change slowly but constantly in ways that can promote clinical events, including acute coronary syndromes. In some cases, changes occurred that were not significantly associated with acute coronary syndromes. Which of the following plaque alterations is most likely to have such an association? (A) Thinning of the media (B) Ulceration of the plaque surface (C) Thrombosis (D) Hemorrhage into the plaque substance (E) Intermittent platelet aggregation

True or False. Heart failure is actually a problem with the blood (could be hemoglobin issue), not the heart. The heart works harder (higher output) and eventually fails.

True.

True or False. Hypertension is a risk factor for atherosclerosis that is more important in age groups over 45 years and those with a BP of 169/95 have a 5X greater chance of ischemic heart disease than someone with a BP of 140/90.

True.

True or False. The greater the surface area of a blood vessel (aneurysm formation), the greater the tension.

True.

This is the more common and dangerous type of aortic dissection which involves a tear of the proximal aorta (10cm above valve). The tear may also occur in the ascending aorta, which may extend into the abdomen

Type A aortic dissection

Which type of aortic dissection involves a tear in the descending aorta that may extend into the abdomen?

Type B aortic dissection

thrombosis

Ulceration of the plaque surface in a coronary artery would be indicative of what problem?

hypertension (between ages 40-60)

What are tears in the aorta most commonly caused by?

compromised immune system; occurs in the feet; malignant tumor

What does Kaposi sarcoma cause?

systemic lupus erythematosus (rash that's described as making someone look like a wolf)

What is SLE?

primarily affects young Asian women, disease of the aorta, type of vasculitis, pulseless vasculitis

What is Takayasu arteritis?

sparse elastin fibers (black lines)

What is abnormal in this picture?

renal function

What is creatinine used to test for?

infection by mycoplasma

What is cryoglobulinemia?

cytoplasmic anti-neutrophil cytoplasmic antibody - causes vasculitis

What is elevated C-ANCA titer?

systemic sclerosis (scarring)

What is scleroderma?

fibrillin gene

What is the genetic defect in Marfan Syndrome?

What accounts for 30% of MIs being "silent"?

common in DM patients, or elderly with hypertension

This type of hypertrophy of the heart shows thickness of the walls increasing without increase in chamber size.

concentric hypertrophy

This is a disease of the right heart chambers caused by pulmonary HTN and results from pulmonary parenchymal or pulmonary vascular disease.

cor pulmonale

What has to happen in order for ischemic heart disease to become symptomatic?

coronary artery becomes critically stenosed (75% obstructed) with plaque

This is damage or disease in the heart's major blood vessels. The usual cause is the buildup of plaque that causes arteries to narrow, limiting blood flow to the heart.

coronary artery disease

This an accumulation of basophilic ground substance in the media with the formation of cyst-like pools that is seen in various connective tissue disorders.

cystic medial degeneration (CMD)

This type of ANCA is mainly directed against neutral leukocyte proteinase (PR3) in primary granules of PMNs.

cytoplasmic ANCAs (CANCAs)

This is a benign composition of capillary or cavernous channels filled with blood or lymph, when it involves larger regions of the body referred to as "angiomatosis."

hemangioma

If the fatty streaks do not resolve, over time ________________ cells around the streaks proliferate and elaborate collagen, elastin, and glycoproteins.

smooth muscle

How are the majority of MIs caused?

spontaneous coronary artery thrombosis (disruption of plaque)

This refers to an antibody-mediated immune reaction in which antibodies (IgG or IgM) are directed against cellular or extracellular matrix (host) antigens with the resultant cellular destruction, functional loss, or damage to tissues.

type II hypersensitivity reaction

What protein is found in the muscles of the heart? If found in the blood it may indicate heart damage.

troponin 1

This part of a blood vessel consists of connective tissue to provide structural reinforcement.

tunica adventitia (externa)

"That's what characterizes atherosclerosis, an accumulation of fibrofatty material in the _________________."

tunica intima

This consists of endothelial cells that form a monolayer, tight junctions, and can form gap junctions as a result of elevation in cardiovascular pressure. It also consists of basement membrane.

tunica intima (interna)

Atherosclerosis atrophies and weakens which part of the blood vessel, causing the formation of aneurysms?

tunica media

This consists of smooth muscle cells and elastic fibers for elastic recoil.

tunica media

This is an allergic reaction provoked by re-exposure to a specific type of antigen referred to as an allergen. It is usually mediated by histamine. (Ex: hives)

type I hypersensitivity reaction

What causes degenerative calcific aortic stenosis?

"senile" degenerative changes (wear and tear) (accelerated degeneration in bicuspid)

(a) ______________ acts on the distal segments of the kidney's nephrons, this results in the resorption of a lot of (b) __________. This fluid retention will increase the cardiac volume, increasing cardiac output, thus elevating blood pressure.

(a) Aldosterone (b) sodium

(a) ___________ is released by the juxtaglomerular cells in response to low BP. It then cleaves angiotensinogen (released by liver) turning it into (b) _________________. Then, (c) ________, found predominately in to the pulmonary system, converts "(b)" into angiotensin II.

(a) Renin (b) angiotensin I (c) ACE (angiotensin converting enzyme)

Structures that are needle-shaped in an atherosclerotic plaque are known as (a) _________ or silhouettes. These spaces were once occupied by (b) ____________________.

(a) clefts (b) cholesterol crystals

How long after an MI does papillary muscle dysfunction occur?

3 days post MI (papillary muscle may rupture -> acute LV failure)

How does RV failure present?

1. congestion of venous system (increased hydrostatic pressure) 2. jugular venous distention 3. soft tissue edema 4. passive congestion of liver 5. pleural and pericardial effusions

What is the second step in the pathogenesis of atherosclerosis, and what happens during this?

1. endothelial cell dysfunction 2. increased permeability, leukocyte adhesion, monocyte adhesion and emigration

What is the most likely time period a patient will develop cardiac tamponade from external rupture?

4-7 days

What are some laboratory test to determine congestive heart failure?

1. CBC 2. BUN and creatinine (measure of how well your kidneys are filtering blood) 3. electrolytes

1. A person with Marfan Syndrome will have a defect in what gene? 2. What does this gene code for?

1. FBN1 gene 2. fibrillin-1

Which compensatory mechanisms will engage before congestive heart failure occurs?

1. Frank-Starling mechanism 2. sympathetic nervous system activity 3. heart hypertrophies

What local factors affect peripheral resistance?

1. autoregulation 2. ionic (pH, hypoxia)

What are the three types of hemangiomas?

1. capillary hemangioma (packed with capillaries separated by CT, subject to traumatic ulceration) 2. cavernous hemangiomas (on skin or MM, can involve deeper structures) 3. pyogenic granuloma (skin, oral mucosa, gingival mucosa)

Explain the two main components of total cholesterol.

1. Low Density Lipoprotein: deposits cholesterol in tissue ("bad cholesterol") 2. High Density Lipoprotein: mobilizes lipids from plaques and transport to liver for excretion ("good cholesterol")

What is the first step in the pathogenesis of atherosclerosis, and what can cause it to occur?

1. chronic endothelial cell injury 2. hyperlipidemia, hypertension, smoking, immune reactions, hemodynamic factors, toxins, viruses

What two ST segment readings would you expect to see in a NSTEMI?

1. ST segment depression 2. T wave inversion

What neural factors affect peripheral resistance?

1. alpha-adrenergic (constrictor) 2. beta-adrenergic (dilator)

What are some humoral factors that constrict peripheral resistance?

1. angiotensin II 2. catecholamines 3. thromboxane 4. leukotrienes 5. endothelin

How does angina pectoris present?

1. episodic chest discomfort associated with exertion/stress 2. relieved by nitroglycerin (vasodilator) 3. normal or tachycardia

What are some risk factors for hypertension?

1. family Hx or heart disease 2. high sodium diet 3. smoking 4. obesity 5. ethnicity (African-American) 6. advanced age

What characteristics would you see in tissue myocardium 8 weeks post infarction?

1. gross: area is grey 2. micro: fibroblasts have replaced tissue with scar tissue

What characteristics would you see in tissue myocardium 24 hours post infarction?

1. gross: area of pallor 2. micro: peripheral mononuclear infiltrate (neutrophils/macrophages clean up)

What characteristics would you see in tissue myocardium 12 hours post infarction?

1. gross: no changes 2. micro: coagulation necrosis and eosinophilic casts

What characteristics would you see in tissue myocardium 5-7 days post infarction?

1. gross: pale, firm, area surround by hyperemia 2. micro: lymphocytes, macrophages, fibroblasts (long-term inflammatory response)

What are some cardiac factors that affect cardiac output?

1. heart rate 2. contractility

Explain why gender a risk factor for atherosclerosis.

1. higher risk for males 2. women have protection until menopause 3. not a risk factor after 80 yo

Which two organs or structures are severely affected by chronic hypertension?

1. kidneys 2. retinas

Explain the three different sizes of arteries.

1. large: elastic arteries (aorta) 2. medium: muscular arteries (coronary arteries) 3. small: less than 2mm (arterioles)

1. What is the most common cause of right ventricular failure? 2. Name some other causes.

1. left ventricular failure 2. cor pulmonale (lung disease), pulmonic or tricuspid valve disease 3. left to right shunt

What are some humoral factors that dilate peripheral resistance?

1. prostaglandins 2. kinins 3. NO/EDRF (nitric oxide/endothelium derived relaxing factor)

What are some types of secondary hypertension?

1. renal 2. endocrine 3. vascular 4. neurogenic

What is the third step in the pathogenesis of atherosclerosis, and what occurs during this?

1. smooth muscle emigration from media to intima 2. macrophage activation

What is the fifth step in the pathogenesis of atherosclerosis, and what happens during this?

1. smooth muscle proliferates 2. collagen, elastin, and glycoproteins deposit around the lipid core

What are some factors of blood volume that affect cardiac output?

1. sodium 2. mineralocorticoids 3. atriopeptin

What are some common mechanisms of vessel disease?

1. stenosis or occlusion 2. dilation 3. rupture

What are the three complications of atherosclerosis?

1. stenosis or occlusion of the blood vessel 2. atrophy of the tunica media resulting in aneurysms 3. spontaneous thrombosis due to a change or crack in the atherosclerotic plaque (results in occlusion of coronary artery causing MI)

What can cause left ventricular failure?

1. systemic hypertension 2. mitral or aortic valve disease 3. ischemic HD 4. intrinsic diseases of myocardium

What is the primary etiology of pericarditis?

1. viruses (#1) 2. bacteria

What is the peak incidence of ischemic heart disease? What are common associations?

60-70 years old; hypertension, DM, smoking, high LDL-C, genetic factors

How long does troponin 1 stay elevated in mature myocardial muscle only after a MI occurs?

7 days (most sensitive and specific marker)

Generally, where would you like to see a person's blood cholesterol level?

< 240mg/dL (200-240 is a grey area, anything over 240 is considered high cholesterol)

(E) Hemangioma

A 10-year-old boy is brought to the physician for a routine health maintenance examination. The physician notes a 2-cm spongy, dull red, circumscribed lesion (benign) on the upper outer left arm. The parents state that this lesion has been present since infancy. The lesion is excised, and its microscopic appearance is shown in the figure. Which of the following is the most likely diagnosis? (A) Kaposi sarcoma (B) Angiosarcoma (C) Lymphangioma (D) Telangiectasia (E) Hemangioma

(D) Lipid-filled foam cells and small numbers of T lymphocytes

A 12-year-old boy died of complications of acute lymphocytic leukemia. The gross appearance of the aorta at autopsy is shown in the figure. Histologic examination of the linear pale marking is most likely to show which of the following features? (A) Cap of smooth muscle cells overlying a core of lipid debris (B) Collection of foam cells with necrosis and calcification (calcification is advanced stage) (C) Granulation tissue with a lipid core and areas of hemorrhage (vascular tissue) (D) Lipid-filled foam cells and small numbers of T lymphocytes (E) Cholesterol clefts surrounded by proliferating smooth muscle cells and foam cells

(D) Marfan syndrome

A 23-year-old man experiences sudden onset of severe, sharp chest pain. On physical examination, his temperature is 36.9°C, and his lungs are clear on auscultation. A chest radiograph shows a widened mediastinum. Transesophageal echocardiography shows a dilated aortic root and arch, with a tear in the aortic intima 2 cm distal to the great vessels. The representative microscopic appearance of the aorta with elastic stain is shown in the figure. Which of the following is the most likely cause of these findings? (A) Scleroderma (B) Diabetes mellitus (C) Systemic hypertension (D) Marfan syndrome (E) Wegener granulomatosis (F) Takayasu arteritis

(A) Human herpesvirus-8 (HIV -> AIDS after 8 years; picture shows Kaposi sarcoma)

A 35-year-old man is known to have been HIV-positive for the past 10 years. Physical examination shows several skin lesions with the appearance shown in the figure. These lesions have been slowly increasing for the past year. Which of the following infectious agents is most likely to play a role in the development of these skin lesions? (A) Human herpesvirus-8 (B) Epstein-Barr virus (C) Cytomegalovirus (D) Hepatitis B virus (E) Adenovirus

(C) Diabetes mellitus (Diabetes is very atherogenic; causes aneurysms)

A 40-year-old man with a history of diabetes mellitus has had worsening abdominal pain for the past week. On physical examination, his vital signs are temperature, 36.9°C; pulse, 77/min; respirations, 16/min; and blood pressure, 140/90 mmHg. An abdominal CT scan shows the findings in the figure. Laboratory studies show his hemoglobin A1c is 10.5% (shouldn't be higher than 5-6%, terrible blood sugar control). Which of the following is the most likely underlying disease process in this patient? (A) Polyarteritis nodosa (B) Obesity (C) Diabetes mellitus (D) SLE (E) Syphilis (F) Varicose veins

(E) Endothelial cells (injury to EC opens up gap junctions and makes the area permeable)

A 50-year-old man has a 2-year history of angina pectoris (chest pain) that occurs during exercise. On physical examination, his blood pressure is 135/75 mm Hg, and his heart rate is 79/min and slightly irregular. Coronary angiography shows a fixed 75% narrowing of the anterior descending branch of the left coronary artery. Which of the following types of cells is the initial target in the pathogenesis of this arterial lesion? (A) Monocytes (B) Smooth muscle cells (C) Platelets (D) Neutrophils (E) Endothelial cells

(A) Stasis dermatitis (varicose vein complication)

A 55-year-old woman has noted the increasing prominence of unsightly dilated superficial veins over both lower legs for the past 5 years. Physical examination shows temperature of 37°C, pulse of 70/min, respirations of 14/min, and blood pressure of 125/85 mmHg (pre-HTN). There is no pain, swelling, or tenderness in either lower leg. Which of the following complications is most likely to occur as a consequence of this condition? (A) Stasis dermatitis (B) Gangrenous necrosis of the lower legs (C) Pulmonary thromboembolism (D) Disseminated intravascular coagulation (DIC, bleeding from orifices) (E) Atrophy of the lower leg muscles

(F) Elevated plasma renin (Secondary hypertension, caused from kidney issue)

A 55-year-old woman visits her physician for a routine health maintenance examination. On physical examination, her temperature is 36.8°C, pulse is 70/min, respirations are 14/min, and blood pressure is 160/105 mmHg. Her lungs are clear on auscultation, and her heart rate is regular. She feels fine and has had no major medical illnesses or surgical procedures during her lifetime. An abdominal ultrasound scan shows that the left kidney is smaller than the right kidney. A renal angiogram shows a focal stenosis of the left renal artery. Which of the following laboratory findings is most likely to be present in this patient? (B) Elevated C-ANCA titer (C) Cryoglobulinemia (D) Plasma glucose level 200 mg/dL (F) Elevated plasma renin (G) Serologic test for syphilis positive

(B) Systemic hypertension (Blood vessel pictured is stained pink (hyaline) thus giving a diagnosis of hyaline arteriolosclerosis; caused by benign hypertension)

A 60-year-old woman has reported increasing fatigue over the past year. Laboratory studies show a serum creatinine level of 4.7 mg/dL (high) and urea nitrogen level of 44 mg/dL (high). An abdominal ultrasound scan shows that her kidneys are symmetrically smaller than normal. The high-magnification microscopic appearance of the kidneys is shown in the figure. These findings are most likely to indicate which of the following underlying conditions? (A) Escherichia coli septicemia (B) Systemic hypertension (C) Adenocarcinoma of the colon (D) Tertiary syphilis (E) Polyarteritis nodosa

(A) Cholesterol

A 61-year-old man had a myocardial infarction 1 year ago, which was the first major illness in his life. He now wants to prevent another myocardial infarction and is advised to begin a program of exercise and to change his diet. A reduction in the level of which of the following serum laboratory findings 1 year later would best indicate the success of this diet and exercise regimen? (A) Cholesterol (B) Glucose (C) Potassium (D) Renin (E) Calcium

change in bowel habits; microcytic anemia; fatigue

Adenocarcinoma of the colon would cause what to occur?

(D) Oxidized LDL (accumulates in the wall of the blood vessel causing monocytes to stick to the wall; all other options are correlates)

An experiment studies early atheromas. Lipid streaks on arterial walls are examined microscopically and biochemically to determine their cellular and chemical constituents and the factors promoting their formation. Early lesions show increased attachment of monocytes to endothelium. The monocytes migrate subendothelially and become macrophages; these macrophages transform themselves into foam cells. Which of the following is most likely to produce these effects? (A) C-reactive protein (B) Homocysteine (C) Lp(a) (D) Oxidized LDL (E) Platelet-derived growth factor (F) VLDL

This is believed to be an immune system response after damage to heart tissue or to the pericardium that develops weeks post MI.

Dressler syndrome

cracking of the plaque which would lead to a thrombosis

Hemorrhage into the plaque substance would cause what to occur?

This is an inherited disorder that affects connective tissue and most commonly affects the heart, eyes, blood vessels and skeleton.

Marfan Syndrome

This is characterized by the accumulation of calcific deposits in the media of muscular arteries and generally does not alter vessel cross sectional areas. It is generally asymptomatic and its risk factors occurs in patients 50 years and older.

Monckeberg's medial calcific sclerosis

PAN: vasculitis; caused by type III hypersensitivity reaction (no inflammation in blood vessel picture)

Polyarteritis nodosa would cause what to occur?

This will present as a pulsating mass and that may occlude the renal, iliac, or mesenteric arteries due to thromboembolic occlusion.

abdominal aortic aneurysm

What is the most common problem a patient will have that causes an aneurysm to form ?

atherosclerosis (causes atrophy of tunica media which confers elastic recoil - continues to dilate)

This is often caused by emboli obstructing greater than 50% pulmonary vascular bed, and the RV is dilated but not hypertrophied.

acute cor pulmonale (RV immediately fails)

A patient presents with a high fever, chills, and murmurs, and he is an IV drug abuser. The infection is determined to be from Staphylococcus aureus. What heart condition do you suspect?

acute endocarditis

A patient presents with a hallmark sign of foci of inflammation called Ascoff bodies, large histiocytes with basophilic cytoplasm and Antischkow cells. What are these signs of?

acute rheumatic fever

Angiotensin II operates on the zona glomerulosa of the adrenal cortex, and the adrenal cortex responds by elaborating the corticoid ________________.

aldosterone

This can develop as a consequence of a weakened vessel wall which can result from atherosclerosis with hypertension, connective tissue disorders, trauma, local infections, etc.

aneurysm

How can an aneurysm be responsible in a patient with a history of low back pain?

aneurysm is large enough to hit vertebral column

What is a condition marked by severe pain in the chest, often also spreading to the shoulders, arms, and neck, caused by an inadequate blood supply to the heart?

angina pectoris

What area on a lateral chest radiograph will you notice right ventricular hypertrophy?

anterior clear space

These are autoantibodies directed against antigens found in the cytoplasmic granules of neutrophils and monocytes.

antineutrophil cytoplasmic antibodies (ANCAs)

This is known as "small" vessel disease which thickens vessel walls and includes risk factors such as hypertension and diabetes mellitus.

arteriolosclerosis

This term encompasses three forms of vascular disease that all promote thickening and decreased elasticity of the arteries.

arteriosclerosis

Another complication of this condition is the rupture of plaques that can promote spontaneous thrombosis causing an infarction or thromboembolic disease.

atherosclerosis

This type of arteriosclerosis primarily affects large and medium vessels and is characterized by formation of intimal fibrofatty plaques called atheromas.

atherosclerosis

What is the most common cause of ischemic heart disease?

atherosclerosis of coronary arteries

When essential hypertension remains in its early stages for a prolonged period of time and without a specific known cause, it is known as, what?

benign essential hypertension

This is packed with capillaries separated by connective tissue and filled with RBCs, thrombus, and organized clot.

capillary hemangioma

What is commonly used to screen for changes in size and morphology of a patient's heart?

chest radiograph

Patient presents with atheromatous plaques in their pulmonary arteries (secondary to pulmonary HTN), and their RV is dilated. What condition do you suspect?

chronic cor pulmonale

What occurs with progressive CHF as consequence of ischemic injury?

chronic ischemic heart disease

A patient with moderate to severe atherosclerosis presents with an enlarged heart secondary to dilation of all chambers. She has areas of myocardial fibrosis and a history of MIs and angina. What diagnosis would you suspect?

chronic ischemic heart disease (takes years to develop)

Larger effusions in the pericardium can accumulate slowly causing the sac to remodel and enlarge. This is known as, what?

chronic pericardial effusion

This may take years to develop and causes a stenotic or incompetent mitral valve in 95% of cases (most common cause of mitral stenosis), and is known as destruction of one of more valves from a previous valvulitis.

chronic rheumatic heart disease

A patient presents with unilateral leg swelling, pain in his calf upon dorsiflexion, and has poor sensitivity and specificity. What condition would you suspect?

deep venous thrombosis

Patient presents with a weak, delayed pulse that splits the S2 beat, a systolic ejection murmur radiating to her carotids, angina, heart failure, and exertional syncope. What condition do you suspect?

degenerative calcific aortic stenosis

This can occur between ages 20-60, is more frequent in men, and is characterized by progressive cardiac hypertrophy, dilation, and contractile dysfunction.

dilated cardiomyopathy

What is the most common cardiomyopathy (90%)?

dilated cardiomyopathy

What is a dissection by blood traveling along laminar planes of the media creating false channels?

dissecting hematoma (when this occurs in the aorta it is referred to as an aortic dissection)

This type of hypertrophy of the heart shows an increase in wall thickness as well as increase in chamber size.

eccentric hypertrophy

During the process of pathogenesis of atherosclerosis, foam cells aggregate to form macroscopic _____________, which are known as the immediate precursors to atherosclerosis.

fatty streaks

These are a type of macrophage that localize to fatty deposits on blood vessel walls, where they ingest low-density lipoproteins and become laden with lipids, giving them a foamy appearance.

foam cells

This is a benign composition of capillary or cavernous channels filled with blood or lymph and has a high occurrence at birth with the majority of them regressing spontaneously.

hemangiomas (referred to as angiomatosis when involving larger regions of the body)

This effusion occurs when there is whole blood in the pericardium from a ruptured aortic aneurysm or ruptured ventricular wall secondary to a MI.

hemopericardium

What is the number one threat of an aneurysm?

hemorrhage

This type of arteriolosclerosis is usually observed in the elderly and is associated with longstanding benign hypertension and causes progressive lumen narrowing (frequently affecting the renal arteries).

hyaline arteriolosclerosis

This type of arteriolosclerosis is associated with acute and severe changes in blood pressure (malignant hypertension) and appears as a concentric laminated thickening of the walls of the arterioles ("onion skin lesion").

hyperplastic arteriolosclerosis

What is the antecedent (precursor) in 90% of aortic dissection cases? (What is another condition that can cause this?)

hypertension (connective tissue disorder) (look for age to tell the difference (40-60), younger individual (20s) more likely CT disorder)

Left ventricular hypertrophy is secondary to this as it increases metabolic demands on the heart without an increase in capillary density.

hypertensive heart disease

This condition presents with enlarged myocytes with "box-car" shaped nuclei (nuclear tetraploidy, which may be an absorptive attempt at replication).

hypertensive heart disease

A patient presents with exertional dyspnea, pulmonary congestion, and a harsh systolic ejection murmur, an S4 heart sound, and a crescendo systolic ejection. What is the suspected diagnosis?

hypertrophic cardiomyopathy

What is characterized by abnormal diastolic filling and intermittent ventricular out-flow obstruction?

hypertrophic cardiomyopathy

What is one of the most common causes of sudden death in otherwise healthy individuals (athletes) where a minor trauma (collision) can cause an arrhythmia?

hypertrophic cardiomyopathy

What is an infection of cardiac valves or mural surface that's caused by bacteria and forms an adherent mass of thrombotic debris and organisms ("vegetation")?

infectious endocarditis

"Why do abdominal aortic aneurysms develop just distal to the renal artery ostia?"

it is the area where atherosclerosis develops and causes atrophy to the tunica media, the blood vessel no longer has elastic recoil which promotes aneurysm formation

"The ____________ play an important role in regulating blood pressure. Most of the time they're regulating blood pressure to ensure that they are constantly being profused with blood."

kidneys

Patient has exertional dyspnea progressing to orthopnea (labored breathing while lying down), fatigue, and congestion of pulmonary vasculature. What is a suspected diagnosis?

left ventricular failure

The predominant symptoms of this are low cardiac output and pulmonary congestion, including dyspnea.

left ventricular failure

What is the fourth step in the pathogenesis of atherosclerosis?

macrophages and smooth muscle cells engulf lipid

This is mostly asymptomatic, but presents with palpitations, fatigue, atypical chest pain, CHF, a sharp mid-systolic click, and late systolic murmur.

mitral valve prolapse

What is the most common cause of valvular disease?

mitral valve prolapse

This occurs with an accumulation of loose ground substance within the leaflets and chordae, causing the valve to become too pliable, and sometimes the chordae are elongated and may rupture.

mitral valve stenosis (most often sporadic non-familial; CT disorders such as Marfan syndrome)

This is an injury to the myocytes by inflammation and is most commonly cause by a viral (such as coxsackievirus A & B or adenovirus), parasitic, or bacterial agent.

myocarditis

This is a benign, fatty tumor that is most commonly found in the left atria that can attach to the mitral leaflet valve and can occur at any age. The tumor is derived from multipotential mesenchymal cells and presents as an obstruction or emboli.

myxoma

This is characterized by formation of nodular deposits of protein on heart valves — these nodules are sterile and free of inflammation.

non-bacterial thrombotic endocarditis (not a true form of endocarditis)

A patient presents with atypical chest pain and states that leaning forward alleviates his pain — causing postural dependence. He tells you the sharp and brief pain is worse when he lays down on his back and when he inspires. Upon auscultation you hear a friction rub and faint heart sounds. The ECG is showing ST segment elevated on all leads. What condition do you suspect?

pericarditis

Acute MI is the most common cause of this condition's secondary etiology, while uremia is the most common systemic cause.

pericarditis

This type of ANCA is directed against myeloperoxidase in PMN (peripheral mononuclear) granules (localization due to an artifact of preparation).

perinuclear ANCAs (PANCAs)

A patient presents with intermittent limping (progressing to pain at rest), ulcerations, painful and cold/numb extremities, and reduced pulse pressure. What condition would you suspect?

peripheral arterial disease

This is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, known as atherosclerosis.

peripheral arterial disease (PAD)

This is a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. It is a sign of fatty deposits and calcium building up in the walls of the arteries (atherosclerosis).

peripheral artery disease

This disease biopsy will show a heavy infiltration of vessel walls with PMNs, Eos, and mononuclear cells. There will also be fibrinoid necrosis of the inner half of the vessel wall, a thrombosis may be present, and a common characteristic is multiple vessels may be in all stages of the disease.

polyarteritis nodosa

A biopsy shows transmural inflammation and a variety of white blood cells and an inner layer of fibrinoid necrosis would be indicative of what diagnosis?

polyarteritis nodosa (PAN)

This type of vasculitis is an acute, transmural necrotizing inflammation of medium to small arteries. It generally affects people aged 35-40 years old and can present with acute development of HTN, muscle aches, or hemorrhagic skin lesions (especially on lower extremities).

polyarteritis nodosa (PAN) (type III hypersensitivity reaction)

What area on a lateral chest radiograph will you notice left ventricular hypertrophy?

posterior clear space (retrosternal space)

This occurs when you have abnormally high blood pressure that's not the result of a medical condition. This form of high blood pressure is often due to obesity, family history and an unhealthy diet.

primary or essential hypertension

What is the polypoid form of a capillary hemangioma? One third of these develop after a trauma and 1% of pregnant women — commonly found on oral mucosa.

pyogenic hemangioma

What would you expect troponin 1 levels to be in a patient with unstable angina pectoris?

remains at normal levels

This is the narrowing of one or more arteries that carry blood to your kidneys. The narrowing of the arteries prevents normal amounts of oxygen-rich blood from reaching your kidneys, which need adequate blood flow to help filter waste products and remove excess fluids.

renal artery stenosis

A decline in kidney perfusion pressure can activate this system and the release of aldosterone causing secondary hyperaldosteronism.

renin-angiotensin system

This is not a single disease entity, but is a decrease in ventricular compliance causing impaired ventricular filling during diastole (left ventricle does not fill normally due to non-compliant wall).

restrictive cardiomyopathy

This presents with a stiff inelastic ventricle that does not pump blood efficiently, severe diastolic dysfunction, fatigue, dyspnea, chest pain, and Kussmaul's sign (JVD with inhalation).

restrictive cardiomyopathy

This is a form of valvular heart disease that is an autoimmune disease triggered by infection — not an infection itself. It succeeds a group of A-strep pharyngitis.

rheumatic fever and heart disease

This is high blood pressure that's caused by another medical condition. It can be caused by conditions that affect your kidneys, arteries, heart or endocrine system.

secondary hypertension

Pericarditis is caused by _____________________, which also causes electrical alternans.

serosanguinous effusion

A patient presents with a low-grade fever, malaise, weight loss, splinter hemorrhages, retinal hemorrhages (Roth spots), and tender nodules on his finger and toe pads (Osler nodes). What condition do you suspect?

subacute endocarditis

Which type of infarction involves 1/3 to 1/5 of myocardial wall and correlates with a NSTEMI?

subendocardial infarction (most-vulnerable)

This is inflammation of a vein just under the skin, usually in the leg. A small blood clot also commonly forms in the vein, but is usually not serious. The condition usually settles and goes within 2-6 weeks.

superficial thrombophlebitis - with no inflammation: linear or branching pattern of cords - with inflammation: painful induration with erythema

By definition, what would be considered high blood pressure?

systolic over 140 and a diastolic over 90

This is a rare form of vasculitis disease involving inflammation in the walls of the largest arteries in the body: the aorta and its main branches.

takayasu (pulseless) arteritis

This is the most common of all vasculitides and is characterized by segmental acute and chronic vasculitis of larger arteries of the head.

temporal (giant cell) arteritis

A biopsy of this disease will show artery segments developing nodular thickening with stenosis, granulomatous inflammation of the inner media, and unfortunately a negative biopsy does not rule out the disease.

temporal arteritis

This can present as enlarged temporal arteries, terminal branches of ophthalmic arteries, or vertebral arteries. Half of the patients with this have polymyalgia, and could also have vision loss.

temporal arteritis

This can cause compression of the lungs and airways (dyspnea) or the esophagus (dysphagea), as well as cause a cough and aortic valve insufficiency.

thoracic aneurysm

This is caused by small blood vessels that become inflamed and swollen (usually in the hands or feet). The vessels then narrow or get blocked by clots which may lead to infection and gangrene.

thromboangiitis obliterans

How is a chest radiograph used to determine if a patient's heart is hyperplastic?

transcardiac width is divided by the transthoracic width — must be .5 or less

Which type of infarction involves thickness of entire myocardial wall and correlates with STEMI?

transmural infarction

This is an abnormal immune response that is mediated by the formation of antigen-antibody aggregates called "immune complexes." They can precipitate in various tissues such as skin, joints, vessels, or glomeruli, and trigger the classical complement pathway. (Ex: polyarteritis nodosa)

type III hypersensitivity reaction

This is a cell-mediated immune reaction that does not involve the participation of antibodies, but is due primarily to the interaction of T cells with antigens.

type IV hypersensitivity reaction

A patient presents with constant chest pain that progressed over a short period of time. It seems to be caused by an acute change in coronary artery plaque promoting thrombosis.

unstable angina pectoris (crescendo)

Patient has a stenotic and incompetent myocardium causing their valves to be more prone to infection, predisposing them to valvular endocarditis. What condition do you suspect?

valvular heart disease

These cause increased intraluminal pressure creating a lack of vessel structural support and can be painfully distended. They also may cause congestion with edema due to incompetent venous valves.

varicose veins

This is inflammation of the blood vessels that causes changes in the blood vessel walls to thicken and/or narrow, cutting off vital blood supply to tissues and organs.

vasculitis

This is a fibrous out pouching of the heart wall that causes CHF or papillary muscle dysfunction, and is a complication of transmural MIs.

ventricular aneurysm