Cardiology Quiz

<p>The larger N2A form</p> Signup and view all the answers

<p>Hypertrophic cardiomyopathy (HCM)</p> Signup and view all the answers

<p>Acute viral myocarditis</p> Signup and view all the answers

<p>Adenovirus</p> Signup and view all the answers

<p>Immune-mediated injury triggered by viral constituents</p> Signup and view all the answers

<p>Multiple pregnancies</p> Signup and view all the answers

<p>Normal coronary anatomic distribution</p> Signup and view all the answers

<p>Increased sympathetic stimulation</p> Signup and view all the answers

<p>Pulmonary and systemic congestion</p> Signup and view all the answers

<p>Presence of amyloid fibrils or iron deposits in patients</p> Signup and view all the answers

<p>B-Blockers</p> Signup and view all the answers

<p>Digitalis</p> Signup and view all the answers

<p>2% to 4% per year in adults</p> Signup and view all the answers

<p>HCM Echocardiography</p> Signup and view all the answers

<p>Amyloidosis</p> Signup and view all the answers

<p>All of the above</p> Signup and view all the answers

<p>All of the above</p> Signup and view all the answers

<p>All of the above</p> Signup and view all the answers

<p>Asymmetric hypertrophy of the ventricular septum</p> Signup and view all the answers

<p>Hypertrophic obstructive cardiomyopathy</p> Signup and view all the answers

<p>AICD</p> Signup and view all the answers

<p>Orthostatic light-headedness</p> Signup and view all the answers

<p>The anterior mitral leaflet is drawn toward the septum by Venturi forces</p> Signup and view all the answers

<p>Ventricular fibrillation</p> Signup and view all the answers

<p>All of the above</p> Signup and view all the answers

<p>All of the above</p> Signup and view all the answers

<p>Prominent Q waves in the lateral leads</p> Signup and view all the answers

<p>Coxsackievirus group B</p> Signup and view all the answers

<p>Immune-mediated injury triggered by viral constituents</p> Signup and view all the answers

<p>Multiple pregnancies</p> Signup and view all the answers

<p>Regional left ventricular dysfunction</p> Signup and view all the answers

<p>Increased heart rate and contractility</p> Signup and view all the answers

<p>Increased ventricular volume</p> Signup and view all the answers

<p>Peripheral edema</p> Signup and view all the answers

<p>Microvascular dysfunction</p> Signup and view all the answers

<p>Normal ECG findings</p> Signup and view all the answers

<p>Direct viral invasion</p> Signup and view all the answers

<p>Cardiac catheterization</p> Signup and view all the answers

<p>Myocyte disarray and fibrosis</p> Signup and view all the answers

<p>Restrictive cardiomyopathy</p> Signup and view all the answers

<p>Genetic abnormalities</p> Signup and view all the answers

<p>TTN</p> Signup and view all the answers

<p>N2A form</p> Signup and view all the answers

<p>Viral myocarditis</p> Signup and view all the answers

<p>Transient left ventricular dysfunction with apical ballooning</p> Signup and view all the answers

<p>Chest pain</p> Signup and view all the answers

<p>Prior ventricular tachycardia</p> Signup and view all the answers

<p>Elevated diastolic LV pressures</p> Signup and view all the answers

<p>Increased myocardial oxygen demand</p> Signup and view all the answers

<p>Positive inotropic drugs</p> Signup and view all the answers

<p>Syncope</p> Signup and view all the answers

<p>Amyloidosis</p> Signup and view all the answers

<p>Digitalis</p> Signup and view all the answers

<p>Presence of amyloid fibrils or iron deposits in patients</p> Signup and view all the answers

<p>2% to 4% per year in adults</p> Signup and view all the answers

<p>Chest pain</p> Signup and view all the answers

<p>Family history of sudden cardiac death</p> Signup and view all the answers

<p>Hypertrophic cardiomyopathy (HCM)</p> Signup and view all the answers

<p>Genetic abnormalities</p> Signup and view all the answers

<p>Titin (TTN)</p> Signup and view all the answers

<p>Viral infection</p> Signup and view all the answers

<p>Cardiac MRI</p> Signup and view all the answers

<p>Viral infection</p> Signup and view all the answers

<p>Fatigue</p> Signup and view all the answers

<p>Multiple pregnancies</p> Signup and view all the answers

<p>Regional left ventricular dysfunction</p> Signup and view all the answers

<p>Increased heart rate</p> Signup and view all the answers

<p>Increased pathologic myocardial fibrosis</p> Signup and view all the answers

<p>Viral infection</p> Signup and view all the answers

<p>Chest pain</p> Signup and view all the answers

<p>Direct viral invasion</p> Signup and view all the answers

<p>Vigorous systolic LV contractile function</p> Signup and view all the answers

<p>Digitalis</p> Signup and view all the answers

<p>Asymmetric hypertrophy of the ventricular septum</p> Signup and view all the answers

<p>Viral myocarditis</p> Signup and view all the answers

<p>Transvenous endomyocardial biopsy</p> Signup and view all the answers

<p>Digitalis</p> Signup and view all the answers

<p>Asymmetrical wall thickness</p> Signup and view all the answers

<p>Beta-blockers</p> Signup and view all the answers

<p>Amyloidosis</p> Signup and view all the answers

<p>2% to 4% per year in adults</p> Signup and view all the answers

<p>Orthopnea</p> Signup and view all the answers

<p>Elevated diastolic LV pressures</p> Signup and view all the answers

<p>High oxygen demand of increased muscle mass</p> Signup and view all the answers

<p>Family history of sudden death</p> Signup and view all the answers

<p>Abnormal motion of the anterior mitral valve leaflet toward the LV outflow tract</p> Signup and view all the answers

<p>Left ventricular hypertrophy and left atrial enlargement</p> Signup and view all the answers

<p>Dilated cardiomyopathy (DCM) = Ventricular chamber enlargement with impaired systolic contractile function Hypertrophic cardiomyopathy (HCM) = Thickened ventricular wall with abnormal diastolic relaxation, but usually intact systolic function Restrictive cardiomyopathy = Stiffened myocardium leading to impaired diastolic relaxation, but systolic contractile function is typically normal or near normal</p> Signup and view all the answers

<p>Dilated cardiomyopathy (DCM) = Truncating mutations in the large sarcomeric gene titin (TTN) Hypertrophic cardiomyopathy (HCM) = Mutations in genes coding for sarcomere proteins Restrictive cardiomyopathy = Mutations in genes coding for sarcomere and/or cytoskeletal proteins</p> Signup and view all the answers

<p>N2A form = More compliant ventricle N2B form = Stiffer heart</p> Signup and view all the answers

<p>Dilated cardiomyopathy (DCM) = Impaired systolic contractile function Hypertrophic cardiomyopathy (HCM) = Abnormal diastolic relaxation Restrictive cardiomyopathy = Impaired diastolic relaxation</p> Signup and view all the answers

<p>Dilated cardiomyopathy (DCM) = Ventricular chamber enlargement Hypertrophic cardiomyopathy (HCM) = Thickened ventricular wall Restrictive cardiomyopathy = Stiffened myocardium</p> Signup and view all the answers

<p>Dilated cardiomyopathy (DCM) = Ventricular chamber enlargement Hypertrophic cardiomyopathy (HCM) = Thickened ventricular wall Restrictive cardiomyopathy = Stiffened myocardium</p> Signup and view all the answers

<p>Atrial fibrillation = LA dilation Decreased SV = CO Severe LV dilation = Ventricular enlargement</p> Signup and view all the answers

<p>Fatigue, Light-headedness, Exertional dyspnea = Decreased tissue perfusion Dyspnea, orthopnea, paroxysmal nocturnal dyspnea = Pulmonary congestion Ascites and peripheral edema = Chronic systemic venous congestion</p> Signup and view all the answers

<p>Cool extremities = Owing to peripheral vasoconstriction and lack of flow Decreased Bp = Sign of decreased CO Pulmonary venous congestion and rales = Presence of crackles Basilar chest dullness to percussion = Presence of pleural effusions</p> Signup and view all the answers

<p>Enlarged heart, S3 heart sound, Murmur = MV regurgitation Systemic venous congestion, Jugular vein distention, Hepatomegaly, Ascites and peripheral edema = RV failure TV regurgitation with subsequent murmur = RV failure</p> Signup and view all the answers

<p>Atrial and Ventricular enlargement, A-fib, V-tach, LBBB or RBBB, and Q waves = ECG Enlargement of the affected ventricle(s), No concentric hypertrophy, Global reduction of systolic ventricular function, Mitral and/or tricuspid regurgitation = Echocardiography</p> Signup and view all the answers

<p>Blood stasis in the ventricles = Poor systolic function Stasis in the atria = Chamber enlargement or atrial fibrillation Systemic venous stasis = Poor circulatory flow</p> Signup and view all the answers

<p>Viral myocarditis = Usually a self-limited illness with full recovery Peripartum cardiomyopathy = Presents with heart failure symptoms between the last month of pregnancy and up to 6 months postpartum Takotsubo Cardiomyopathy = A form of temporary DCM, characterized by acute and transient left ventricular dysfunction after a severe emotional or physically stressful event DCM = Characterised by ventricular dilatation with decreased contractile function</p> Signup and view all the answers

<p>Mitochondrial oxidative function = Impairment of cellular function Myofilament protein synthesis = Decrease Cytosolic calcium levels = Alteration Myocyte apoptosis = Leads to</p> Signup and view all the answers

<p>The Frank–Starling mechanism = More preload and more output to a point Neurohormonal activation = Increased HR and contractility and renin–angiotensin–aldosterone</p> Signup and view all the answers

<p>Increased sympathetic stimulation = Increases heart rate and contractility Increased RAAS activity = Leads to fluid retention, contributing to preload Vasopressin secretion = Leads to fluid retention, contributing to preload Venoconstriction = Augments preload, and contributes to ventricular enlargement</p> Signup and view all the answers

<p>Arteriolar vasoconstriction and increased systemic resistance = Makes it more difficult for the LV to eject blood in the forward direction Rise in intravascular volume = Further burdens the ventricles resulting in pulmonary and systemic congestion Chronically elevated levels of angiotensin II and aldosterone = Directly contribute to pathologic myocardial remodeling and fibrosis</p> Signup and view all the answers

<p>Older maternal age, African American, Multiple pregnancies = Peripartum cardiomyopathy Severe emotional or physically stressful event = Takotsubo Cardiomyopathy</p> Signup and view all the answers

<p>HCM Echocardiography = Quantifies the degree of LV hypertrophy, Asymmetrical wall thickness readily identified and measured Cardiac catheterization = Useful when percutaneous septal ablation is planned, Quantify pressure gradient within the outflow portion of the LV Genetic testing = Can be helpful in establishing, or excluding, the diagnosis of HCM in family members of an affected patient when a specific mutation in that family has been identified AICD = HCM patients who are at high-risk of sudden cardiac death should receive an ICD</p> Signup and view all the answers

<p>B-Blockers = Reduce myocardial oxygen demand, Lessen any LV outflow gradient during exercise Calcium Channel Antagonists = Verapamil may improve ventricular relaxation and filling (reduce stiffness) Diuretics = Should be used cautiously to avoid worsening outflow obstruction Nitrites = Should be avoided because they can reduce LV size, worsening obstruction</p> Signup and view all the answers

<p>Antiarrhythmics = Atrial fibrillation is poorly tolerated in HCM and should be controlled aggressively. Amiodarone and disopyramide are the best tolerated agents Digitalis = Should be avoided (undesirable positive inotropic effect) which can worsen outflow tract obstruction Surgical (Myomectomy) = Considered for patients whose symptoms do not respond adequately to pharmacologic therapy AICD = HCM patients who are at high-risk of sudden cardiac death should receive an ICD</p> Signup and view all the answers

<p>Transvenous endomyocardial biopsy = Presence of amyloid fibrils or iron deposits (hemochromatosis) in patients suggests restrictive cardiomyopathy Computed Tomography (CT) = Presence of thickened pericardium is consistent with constrictive pericarditis MRI = Presence of thickened pericardium is consistent with constrictive pericarditis Echocardiography = Useful in distinguishing between restrictive cardiomyopathy and constrictive pericarditis</p> Signup and view all the answers

<p>Diastolic dysfunction = Restrictive cardiomyopathy Systolic dysfunction = Dilated cardiomyopathy Ventricular hypertrophy = Hypertrophic cardiomyopathy Arrhythmias and conduction impairments = Restrictive cardiomyopathy</p> Signup and view all the answers

<p>Fibrosis or scarring of the endomyocardium = Restrictive cardiomyopathy Infiltration of the myocardium by an abnormal substance = Restrictive cardiomyopathy Amyloidosis = Restrictive cardiomyopathy Genetic variants = Hypertrophic cardiomyopathy</p> Signup and view all the answers

<p>Dyspnea = Mainly due to elevated diastolic LV pressures, elevated pulmonary capillary pressures, high systolic LV pressure, and mitral regurgitation in patients with outflow tract obstruction Angina = Caused by the high oxygen demand of the increased muscle mass, narrowed small branches of the coronary arteries within the hypertrophied ventricular wall and increased wall stress if outflow tract obstruction is present Syncope = Induced by exertion in patients with outflow tract obstruction when the pressure gradient is made worse by the increased force of contraction, causing a transient fall in cardiac output Arrhythmias = Arise because of the structurally abnormal myofibers, worsened by the loss of the normal atrial 'kick' that impairs diastolic filling</p> Signup and view all the answers

<p>Systolic Anterior Motion (SAM) = An abnormal motion of the anterior mitral valve leaflet toward the LV outflow tract because of the protruding thickened septum Mitral Valve Regurgitation (MVR) = Results from poor leaflet coaptation, further elevates LA and PCWPs, worsening symptoms of dyspnea and development of A-fib Outflow Obstruction = Manifested by approximately one third of patients with HCM HCM Symptoms = Include dyspnea, angina, syncope, and arrhythmia</p> Signup and view all the answers

<p>History of syncope = Risk factor for sudden death Extreme hypertrophy of the LV wall (&gt;30mm in thickness) = Risk factor for sudden death Positive inotropic drugs = Contribute to and worsen outflow obstruction Certain high-risk HCM mutations = Genetic study is done on these patients</p> Signup and view all the answers

<p>Negative inotropic drugs (β-blockers, verapamil) = Decrease the amount of obstruction Myocardial ischemia = May be contributed to by the high oxygen demand of the increased muscle mass and the narrowed small branches of the coronary arteries within the hypertrophied ventricular wall Increased LV stiffness and diastolic dysfunction = Symptoms of obstructive HCM appear to primarily stem from these High systolic ventricular pressure = If outflow tract obstruction is present, this increases myocardial oxygen demand because of the increased wall stress and contributes further to ischemia</p> Signup and view all the answers

<p>Left ventricular hypertrophy and left atrial enlargement = Common ECG finding in HCM Prominent Q waves in the lateral leads = Reciprocal of powerful septal forces Diffuse T wave inversions = Common ECG finding in HCM Atrial and ventricular arrhythmias = Frequent in HCM and particularly ominous because they may herald ventricular fibrillation and sudden death</p> Signup and view all the answers

<p>AS murmur = Worse when ventricle is full HCM Murmur = Worse when ventricle is empty A-fibrillation = Most common arrhythmia in HCM, loss of the normal atrial 'kick' impairs diastolic filling and worsens symptoms of pulmonary congestion Orthostatic light-headedness = Common in patients with outflow tract obstruction as venous return to the heart is reduced on standing by the gravitational pooling of blood in the lower extremities</p> Signup and view all the answers