Mod 9: Heart Disorders

Explain the possible connection between a sore throat and valvular heart disease. You need to be specific and include all important details.

A sore throat is commonly investigated for cold, flu, or infection (i.e Group A strep, EBV). In the case that the sore throat is caused by exposure to Group A streptococcal pharyngitis (aka strep), then this could lead to the body's immune system generating T cells and B cells to fight the bacterial antigen. Specifically, the T cells are activated by the streptococcal antigens, and the B cells produce the antistreptococcal antibodies. However, the antistreptococcal antibodies and T cells will also react with strep-like antibodies in cardiac muscle and valves. About 2-6 weeks after Strep, children develop acute rheumatic fever, an autoimmune disease, which manifests in fever, migratory polyarthritis, valvulitis, myocarditis, and pericarditis. If solely migratory polyarthritis (moving joint pain) was present then the patients could recover fully. However, this is not the case leading up to valvula heart disease. Instead, the vasculitis (inflammation of heart valves) and myocarditis (inflammation of the heart muscle tissue) must be present at high extremes caused by repeated antigen exposure. Consequently, chronic rheumatoid heart disease (RHD) is the result, which is the main manifestation of valvular disease. Additionally, valvulitis, myocarditis, and pericarditis are present. The inflammation of the valves, vasculitis, worsens and develops as calcification of the mitral valve, known as mitral stenosis since the mitral valve is the most commonly affected valve.

One of the common side effects of rate lowering drugs such as digitalis and beta blockers is abnormally low heart rate called _________________.

Bradycardia

One of the most important tests that should be done immediately in patients older than 45 that present with epigastric pain, chest pain and nausea is __________________ in order to rule out angina pectoris.

EKG

T/F: Most cases of isolated atrial septal defects (ASD) cause severe complications and lead to death within the first few weeks of life.

F

T/F: The finding of a single premature ventricular beat heralds a dangerous cardiac condition that requires immediate cardioversion.

F

Nontender hemorrhagic lesions in the hands and feet that are seen in infective endocarditis are called _________________.

Janeway lesions

An EKG with normal narrow complex QRSs has twice as many P waves. Every other P wave is not followed by a QRS. What is the diagnosis based on this EKG?

My diagnosis is 2nd-degree block because SA node signals fail to pass through the AV node and bundle of His (ventricular regions) caused by ischemia/infarction/ drugs/toxins. This leads to dropped ventricular beats and long PR intervals with normal narrow complex QRS waves (on V1 lead QRS are negative inflections); however, every 2,3, or 4 P wave is not followed by a QRS (missed beat) as in this case.

A _____ longer than 200 milliseconds (msec) is indicative of _____ AV block.

PR interval, first degree

Ventricular depolarization is seen on ECG as the _______________ complex.

QRS

Compare right-to-left and left-to-right shunts by explaining the most significant immediate and long term consequences of both.

RIGHT-TO-LEFT SHUNTS include Tetralogy of Fallot, Reverse phases of Ventricular Septal defect and Patent ductus arteriosus (explained in left-to-right section). Side note: open foramen ovale at fetal development is a normal right-to-left shunt. 1. Tetralogy of Fallot: (4 anatomical abnormalities) Immediate consequences: deoxygenated blood from the right ventricle bypasses the lungs due to VSD and pulmonary/annulusstenosis of pulmonary valve, and the blood mixes with oxygenated blood in the left ventricle through VSD; Results are: increased outflow to aorta due to misplaced aorta, low oxygenation of blood, hypoxia, cyanosis, clubbing of fingers and toes, polycythemia, loud systolic murmur Long-term consequences: depends on the degree of pulmonary outflow. *Mild R-to-L: shunting is negligible *Severe: thickened right ventricle (hypertrophy), cyanosis baby blue syndrome during crying/defecating, increased forced R-to-L shunting, failure to thrive. 2. Transposition of the Great Arteries Immediate consequences: isolation of arterial and venous systems into separate circuits with the arteries working in parallel. Oxygenated blood is recirculated to the lungs by the pulmonary circulation; deoxygenated blood is recirculated to the body via the systemic circulation. Long-term consequences: death can occur within hours or days. Surgical correction is a must for survival. 3. Persistent Truncus Arteriosus: Immediate consequences: there is a mixing of blood from both ventricles via the Ventricular Septal defect that connects at the truncal valve which leads to the single vessel, truncus arteriosus before dividing into the aorta and pulmonary valves. Long-term consequences: death within days to weeks after birth if there is no surgical correction. LEFT-TO-RIGHT SHUNTS 1. Atrial septal defect (ASD): Immediate consequences: interatrial hole causes increased blood volume in right atrium, right ventricular volume overload, increased pulmonary blood flow, increased pulmonary vascular resistance, pulmonary hypertension. Sign/sympx: dyspnea, easy fatigability, palpitations and mild systolic murmurs. Long-term consequences: can go unnoticed until later in life, but the pulmonary hypertension may be permanent and irreversible. Right heart failure may be the result. 2. Patent Foramen Ovale: Immediate consequences: foramen ovale left open leads to higher left atrial pressure than right atrial pressure; shunting is usually asymptomatic Long-term consequences: *mild cases: aymptomatic for decades and require no treatment *severe cases: pulmonary hypertension, embolic episodes, transient ischemic attacks (TIAs) or strokes, mild systolic murmurs. 3. Ventricular Septal defect (VSD): Immediate consequences: mixing of left oxygenated and right unoxygenated ventricle blood, blood flows into the left ventricle and left atrium causing backflow into the lungs; pulmonary blood volume increases, pulmonary resistance increases, pulmonary hypertension Long-term consequences: *small VSDs: may close spontaneously after a few years, or may exist a lifetime without creating significant problems *large VSDs: right ventricular pressure rises too which reverses to right-to-left shunt, blood bypasses oxygenation in the lungs; hypoxia, cyanosis, polycythemia. 4. Patent (perisistent) ductus arteriosus: Immediate consequences: blood passes directly from the pulmonary artery to descending aorta bypassing the lungs, higher blood volume in aorta causes backflow to LV and LA so higher pulmonary blood volume, increased pulmonary vascular resistance, pulmonary hypertension; machinery-like murmur; hypoxia Long-term consequences: very high pulmonary vascular resistance and pulmonary hypertension leads to shunt reversing to right-to-left; Deoxygenated blood from the pulmonary artery will bypass the lungs and go directly into the aorta, leading to hypoxia and cyanosis.

The most common abnormal change seen on EKG that is associated with MI is ______. Other changes include T wave _____ and Q waves.

ST segment elevation, inversion

T/F: Arrhythmias are among the most serious and deadly complications of myocardial infarction.

T

T/F: The presence of an abnormality such as a ventricular septal defect or a patent ductus arteriosus is beneficial for the survival of a neonate born with transposition of the great arteries.

T

T/F: Wide complex QRS waves may be either ventricular in origin or produced by aberrant conduction of supraventricular impulses.

T

_____ drugs such as aspirin, _____drugs such as heparin, and _____ drugs such as ACE inhibitors are among the drugs commonly used in treatment of MI.

antiplatelet, anticoagulant, antihypertensive

Peritoneal effusion is called _____ and it is a sign of severe _____ failure.

ascites, right heart

An irregular irregularity of the heart rhythm in which the atria quiver is called ______. The patient with this condition may develop atrial thrombi, which may _____ to the brain and cause a _____. To prevent this from happening, patients are treated with rate-lowering drugs and _______.

atrial fibrillation, embolize, stroke, anticoagulants

_____ is the first drug of choice to be used in treatment of pathologic _______, which is defined as resting heart rate of less than 60 bpm.

atropine, Bradycardia

Invasive gum surgery and many other types of dental work may produce transient _______ that could seed an abnormal heart value and cause ________.

bacteremia, infective endocarditis

Osler nodes are tender nodules in the pads of fingers and toes and are associated with ___________________.

bacterial endocarditis

Subungual splinter hemorrhages in the nail beds are among the classic signs of ______________________.

bacterial endocarditis

A _____ culture must be taken before antibiotics are started, when a patient has a fever of ____.

blood, unknown origin

The only pathway through which atrial electrical activity enters the ventricles is the ________________________.

bundle of his

Stroke volume X heart rate = ______________________.

cardiac output

Costochondral joint inflammation and cholecystitis are among conditions that need to be ruled out in a patient with __________________.

chest pain

The atrioventricular valve leaflets are tethered by _______________________ to papillary muscles.

chordae tendinae

A valve with floppy leaflets would not _____ fully, while a calcified and stenotic valve would not fully _____.

close, open

A severely enlarged left heart may prevent the mitral valve from ______ properly, which may cause ______ through the mitral valve and produce the abnormal sound of a ______.

closing, regurgitation, systolic murmur

Strong pulses in the arms and weak pulses in the legs may be due to a congenital heart disease known as ___________________.

coarctation of the aorta (**narrowing in the aorta causes low bp to the lower body legs, backflow of the aorta leads to high pressure in the LV/LA/lungs/arms)

Narrowing of a portion of the aortic arch in a congenital heart disease known as _____ will result in higher ____ that may impede normal blood flow out of the _____ ventricle causing ventricular _____ in the long run.

coarctation of the aorta, resistance, left, hypertrophy

Complete dissociation of atrial and ventricular activity is the hallmark of ____________________.

complete heart block

Stiff ventricular walls result in lower ventricular ______ during filling and lower _____ blood volume. This is called _____ dysfunction, which can lead to lung congestion and pulmonary ______.

compliance, end-diastolic, diastolic, hypertension (**restrictive cardiomyopathy: stiff, noncompliant ventricles that lead to poor filling, end diastolic volume (EDV), and lung cong/pulm HTN since blood gets backed up)

ST segment ______ is often a sign of cardiac ischemia, whereas ST segment may accompany many cases of myocardial infarction.

depression, elevation

Medical treatment of _____ dysfunction is geared toward reducing ventricular ______ to improve filling.

diastolic, contractility

In _____ cardiomyopathy, the heart muscle is enlarged and flabby. In sharp contrast to that, the myocardium is enlarged and stiff in ____cardiomyopathy.

dilated, hypertrophic

_______ cardiomyopathy is associated with a low ejection fraction resulting in _____ dysfunction.

dilated, systolic

_________________ is a small blood vessel that connects the pulmonary artery to the aorta and allow blood to bypass the lungs and the left heart in the fetus.

ductus arteriosus (**blood from pulm artery completely misses the lungs; build up of blood to the aorta creates backflow on LV, LA, and lungs so pulmonary hypertension is a result)

A(n) ____________________ is a very useful test that uses ultrasound technology with Doppler effect to measure the volume and speed of blood flow passing through the heart chambers and valves.

echocardiogram

If the SA node is too slow to fire, a(n) _____ beat is generated by autorhythmic cells that are further down the cardiac conduction system. This is known as a(n) ____ rhythm.

ectopic, escape

The fibrous skeleton physically and ____________________ separates the atria from the ventricles and supports the heart valves.

electrically

A distinctive skin rash associated with acute rheumatic fever is ________________.

erythema marginatum

Shortness of breath upon exertion is called ___________________.

exertional dyspnea

Untreated infective endocarditis is generally __________________.

fatal

FUO stands for ____________________.

fever of unknown origin

Ventricular _____ left untreated for more than a couple of minutes invariably results in a flat line on EKG known as _____.

fibrillation, asystole

____ is a small hole in the _____ septum that provides for a normal ______ shunting of blood. This allows blood to bypass the _____ before the fetus is born.

foramen ovale, interatrial, right to left, lungs

Cardiac silhouette is enlarged on chest X ray of patients with _______________ failure.

heart

A permanent pacemaker is an appropriate treatment for a patient with complete ____, as well as some patients with _____ AV block.

heart block, second degree

Increased pulmonary vascular resistance will lead to pulmonary ______, which will cause a ________ shunt to reverse. The new shunt will cause some blood to bypass the _____ and will result in hypoxia and cyanosis.

hypertension, left to right, lungs (**ventricular septal defect)

Left ventricular outflow obstruction, along with severely reduced chamber size, is often seen in ___________________ cardiomyopathy.

hypertrophic

One of the most common life threatening cardiac conditions in young athletes that may result in sudden death is ___________________.

hypertrophic cardiomyopathy

Chest pain, breathlessness and syncope are serious signs and symptoms that may be caused by inadequate blood flow to tissues, which can be referred to as ______ of tissues. This leads to tissue ______and could progress to infarction.

hypoperfusion, ischemia

Medical closure of patent ductus arteriosus involves administration of ________________, a non-steroidal anti-inflammatory drug (NSAID).

indomethacin

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two nonspecific but useful blood markers of __________________.

inflamx

In ____ arrhythmias, the ectopic beats originate at or near the AV node. This is also called a ______tachycardia.

junctional, supraventricular

The _________________ coronary artery wraps around the upper edge of the left ventricle to supply its anterior and lateral aspects.

left circumflex

Increased pulmonary blood flow and pulmonary hypertension may result from a ____________________ shunt.

left to right (there is more pressure in the LA/LV so it backs up into the lungs (pulm veins) right before these)

A patent ductus arteriosus causes a _____ shunt because the pressure in the ____ is greater than the pressure in the _____.

left to right, aorta, pulmonary artery

A patent foramen ovale after birth will cause a _____ shunt because the pressure in the ____ is greater than the pressure in the .

left to right, left atrium, right atrium

Chronic increase in total peripheral resistance will result in ______________________ hypertrophy.

left ventricular (**so much vasoconstriction in the bodys veins causes back up on the aorta and left ventricle)

Angiotensin II receptor blockers are a class of drugs that are used in treatment of myocardial infarction because they ________________ preload and afterload.

lower

The __________________ valve is located between the left atrium and the left ventricle.

mitral

The left 5th intercostal space at the midclavicular line is the best location to hear murmurs of the ________________ valve.

mitral

The most common valve disease in the U.S. and worldwide is __________________.

mitral valve prolapse

The tricuspid valve closes when the pressure in the right ventricle is ____________ than right atrial pressure.

more

The isoenzyme of ___________________ primarily found in cardiac muscle is CK-MB.

myocardial infarction

Prolonged unremitting angina is a sign of _____________________.

myocardial infarction (**caused by unstable angina)

Antistreptococcal antibodies and T cells that attack the bacterial antigens can also bind self antigens in the heart causing ______, _______ and pericarditis.

myocarditis, valvulitis,

Difficulty breathing while lying down that is relieved by sitting up is called __________________.

orthopnea (ortho- straight,upright)

Unpredictable atrial fibrillation with abrupt onset and offset is called ____________________ Afib.

paroxysmal

The roots of the great vessels, the pulmonary artery and the aorta are fused in a congenital heart disease called _________________.

persistent truncus arteriosus

Blood exits the heart through the truncal valve in neonates born with the congenital heart disease known as ___________________.

persistent truncus arteriosus(**R/L ventricles are connected to both the aorta/pulm valve)

PVC is ______ ventricular contraction characterized by a _____ complex QRS. Immediately following a PVC, the ventricles cannot be depolarized by the next sinus contraction because they are in the _____ period. PVCs are often found by 24-hour continuous EKG recording done by a _____.

premature, wide, refractory, Holter monitor

Atrial flutter represents a(n) ______ irregularity, whereas atrial _____ represents an irregular irregularity.

regular, fibrillation

Metastatic infiltration of the myocardium or infiltration with a toxic substance resulting in inflammation and fibrosis are among the most important causes of _________________ cardiomyopathy.

restrictive

Radiation fibrosis is often a culprit in the pathogenesis of __________________ cardiomyopathy.

restrictive

Fever and polyarthritis are the most common symptoms of _____ that usually occur a few weeks after a group A streptococcal ____.

rheumatic fever, pharyngitis

____________________ disease is virtually the sole cause of mitral stenosis.

rheumatic heart

______ failure can cause accumulation of fluid in the interstitial space in the legs. This can be assessed by pressing on the patient's tibia to look for _____ edema.

right heart, pitting

Polycythemia is often present with congenital heart diseases that involve a ________________ shunt.

right to left

Hypoxia, cyanosis and polycythemia can result from a _________________ shunt.

right to left (**i.e Tetralogy of Fallot; Tetra = 4 issues, key: higher pressure in RV and RA due to pulmonary valve stenosis)

Clubbing of the fingers and toes can occur with congenital heart diseases that involve a _______________ shunt.

right to left (**i.e Tetralogy of Fallot; Tetra = 4 issues, key: higher pressure in RV and RA due to pulmonary valve stenosis, **Ventricular septal defect eventually shifts into right-to-left shunt and pressure builds up in RV causing higher pressure of RA/superior vena cava upstrteam (aka the hands get clubbed)).

Normal cardiac rhythm begins with a signal from the ______________ node.

sinoatrial(SA)

Chest pain of cardiac origin that is relieved by rest is termed __________________.

stable angina

Acute bacterial endocarditis is most often caused by __________________ infection of the endocardium.

staphylococcal

A serious cardiac arrhythmia in which absence of effective contraction lowers cardiac output to nearly zero may cause __________________.

sudden death (**caused by ventricular fib = quivering vent = CO stops = wiggly)

A cardiac arrhythmia that is caused by reentry loops at or near the AV node is termed ______ tachycardia. It is characterized by ____ complex QRSs and may be associated with alcohol or sympathomimetic agents such as ____.

supraventricular, narrow, caffeine

A disorder of irregular jerky movements that may follow rheumatic fever is called ____________________.

sydenham chorea

A complete temporary loss of consciousness and postural tone that is self-limiting and has complete recovery with no sequelae can be called ________________.

syncope

___and _____ circulations run in parallel in transposition of the great arteries.

systemic, pulmonary

___________________ belongs to a class of drugs that function to break up thrombi.

t-PA

Pulmonary and systemic circulations are disconnected from each other and run in parallel in ________________.

transposition of the great arteries

The most sensitive and specific blood marker for MI is cardiac __________________.

troponin

The chest pain in ___________ angina is not relieved by rest or medication.

unstable

Nitroglycerin is the drug used in CAD and MI. It causes ______ of the coronary arteries by _____"NO" levels to promote smooth muscle ______.

vasodilation, increasing, relaxation

Multiple ventricular ectopic foci due to continuous reentry loops is the pathogenesis of ___________________, the most dangerous cardiac arrhythmia which is often fatal.

ventricular fibrillation

The most dangerous cardiac arrhythmia that can quickly lead to death within seconds or a few minutes is ______. The treatment is immediate electrical cardioversion using a(n) .

ventricular fibrillation, automated external defibrillator

If left untreated, ventricular tachycardia could quickly convert to an extremely dangerous arrhythmia called ______. In this condition, the ventricles do not contract; they just ______. This can be seen on EKG as irregular lines. Electroconversion by an electrical must be done within 2 minutes to avoid permanent damage to the brain or death.

ventricular fibrillation, quiver, wiggly, defibrillator

_______ is defined as 3 or more consecutive _____ ventricular beats. These are due to formation of ____ loops caused by ischemia or infarction. This is a serious condition that requires immediate treatment by using an electrical ____ or by ______ drugs.

ventricular tachycardia, ectopic, reentry, defibrillator, antiarrhythmic

An ectopic ventricular beat produces a _____________________ QRS, which will be longer than 100 msec.

wide complex