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Questions and Answers
What is the most common cause of myocarditis?
What is the most common cause of myocarditis?
Cardiomyopathy is always caused by a known factor.
Cardiomyopathy is always caused by a known factor.
False (B)
What are the two main classifications of cardiomyopathy?
What are the two main classifications of cardiomyopathy?
Primary and secondary
Myocarditis is characterized by inflammation, ______ infiltration, and necrosis of cardiac muscle cells.
Myocarditis is characterized by inflammation, ______ infiltration, and necrosis of cardiac muscle cells.
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Match the following terms to their respective definitions:
Match the following terms to their respective definitions:
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What is the primary cause of chronic coronary syndromes?
What is the primary cause of chronic coronary syndromes?
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A decrease in perfusion pressure can be a cause of myocardial ischemia.
A decrease in perfusion pressure can be a cause of myocardial ischemia.
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What are the two main categories of coronary syndromes?
What are the two main categories of coronary syndromes?
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Unstable angina and myocardial infarction are both considered ______ coronary syndromes.
Unstable angina and myocardial infarction are both considered ______ coronary syndromes.
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Which of the following conditions is NOT a chronic coronary syndrome with slow progression?
Which of the following conditions is NOT a chronic coronary syndrome with slow progression?
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Stable angina is always a precursor to myocardial infarction.
Stable angina is always a precursor to myocardial infarction.
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Match the following coronary syndromes with their primary characteristic:
Match the following coronary syndromes with their primary characteristic:
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What is the consequence of mitral stenosis on the blood flow during ventricular diastole?
What is the consequence of mitral stenosis on the blood flow during ventricular diastole?
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Aortic stenosis results in extra volume work for the heart.
Aortic stenosis results in extra volume work for the heart.
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What are the common symptoms associated with mitral stenosis?
What are the common symptoms associated with mitral stenosis?
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Mitral stenosis can lead to chronic pulmonary __________.
Mitral stenosis can lead to chronic pulmonary __________.
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Match the following conditions with their effects on the heart:
Match the following conditions with their effects on the heart:
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What is characterized by vasospasms and abnormal secretion of vasospastic chemicals?
What is characterized by vasospasms and abnormal secretion of vasospastic chemicals?
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Unstable angina is associated with complete occlusion of the coronary artery.
Unstable angina is associated with complete occlusion of the coronary artery.
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What type of therapy are patients with ST-segment elevation candidates for?
What type of therapy are patients with ST-segment elevation candidates for?
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Patients with unstable angina show no ST elevation on the ECG and are classified as ______.
Patients with unstable angina show no ST elevation on the ECG and are classified as ______.
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Which one of these symptoms indicates that chest pain lasts longer than typical angina?
Which one of these symptoms indicates that chest pain lasts longer than typical angina?
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Match the following terms with their definitions:
Match the following terms with their definitions:
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Calcium channel-blocking drugs are ineffective in treating coronary heart disease.
Calcium channel-blocking drugs are ineffective in treating coronary heart disease.
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Name a common diagnostic tool used to evaluate acute coronary syndrome.
Name a common diagnostic tool used to evaluate acute coronary syndrome.
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What is a common cause of dilated cardiomyopathy?
What is a common cause of dilated cardiomyopathy?
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Dilated cardiomyopathy is associated with a high ejection fraction.
Dilated cardiomyopathy is associated with a high ejection fraction.
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Name one potential genetic cause of hypertrophic cardiomyopathy.
Name one potential genetic cause of hypertrophic cardiomyopathy.
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Dilated cardiomyopathy may progress to __________ heart failure.
Dilated cardiomyopathy may progress to __________ heart failure.
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Match the following conditions to their associated features:
Match the following conditions to their associated features:
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Which symptoms are commonly associated with the clinical course of hypertrophic cardiomyopathy?
Which symptoms are commonly associated with the clinical course of hypertrophic cardiomyopathy?
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The progression of hypertrophic cardiomyopathy is typically fast.
The progression of hypertrophic cardiomyopathy is typically fast.
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What can lead to hyperkinetic ventricular muscle in hypertrophic cardiomyopathy?
What can lead to hyperkinetic ventricular muscle in hypertrophic cardiomyopathy?
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What is a defining characteristic of Acute Coronary Syndrome?
What is a defining characteristic of Acute Coronary Syndrome?
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Atypical symptoms of myocardial infarction (MI) include chest pain only.
Atypical symptoms of myocardial infarction (MI) include chest pain only.
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What serum markers increase during an MI?
What serum markers increase during an MI?
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Acute Coronary Syndrome can lead to a drop in ______.
Acute Coronary Syndrome can lead to a drop in ______.
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What ECG changes are indicative of a myocardial infarction?
What ECG changes are indicative of a myocardial infarction?
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Sympathetic nervous system activation does not affect heart rate during Acute Coronary Syndrome.
Sympathetic nervous system activation does not affect heart rate during Acute Coronary Syndrome.
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Match the following terms related to Acute Coronary Syndrome with their descriptions:
Match the following terms related to Acute Coronary Syndrome with their descriptions:
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In women and elderly patients, myocardial infarction may present with ______ symptoms.
In women and elderly patients, myocardial infarction may present with ______ symptoms.
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Flashcards
Myocarditis
Myocarditis
Inflammation of the heart muscle often due to infections or immune responses.
Causes of Myocarditis
Causes of Myocarditis
Includes microbial agents, immune disorders, and physical factors.
Left Ventricular Dysfunction
Left Ventricular Dysfunction
Characterized by a weak left ventricle and dilation of heart chambers.
Cardiomyopathy
Cardiomyopathy
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Types of Cardiomyopathy
Types of Cardiomyopathy
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Stenosis
Stenosis
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Endocardial Regurgitation
Endocardial Regurgitation
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Mitral Stenosis
Mitral Stenosis
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Atrial Enlargement
Atrial Enlargement
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Murmurs
Murmurs
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Dilated Cardiomyopathy
Dilated Cardiomyopathy
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Causes of Dilated Cardiomyopathy
Causes of Dilated Cardiomyopathy
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Biventricular Heart Failure
Biventricular Heart Failure
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Ejection Fraction
Ejection Fraction
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Hypertrophic Cardiomyopathy
Hypertrophic Cardiomyopathy
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Idiopathic Hypertrophic Subaortic Stenosis
Idiopathic Hypertrophic Subaortic Stenosis
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Clinical Course of Hypertrophic Cardiomyopathy
Clinical Course of Hypertrophic Cardiomyopathy
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Genetic Abnormality in Cardiomyopathy
Genetic Abnormality in Cardiomyopathy
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Autoregulation failure
Autoregulation failure
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Stable angina
Stable angina
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Acute occlusion
Acute occlusion
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Myocardial ischemia causes
Myocardial ischemia causes
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Acute coronary syndrome (ACS)
Acute coronary syndrome (ACS)
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Unstable angina
Unstable angina
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Myocardial infarction (MI)
Myocardial infarction (MI)
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Dysrhythmias
Dysrhythmias
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Vasospasms
Vasospasms
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Atherosclerosis hypercontractility
Atherosclerosis hypercontractility
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Vasospastic chemicals
Vasospastic chemicals
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Calcium channel blockers
Calcium channel blockers
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ST-segment elevation (STEMI)
ST-segment elevation (STEMI)
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Non-STEMI (NSTEMI)
Non-STEMI (NSTEMI)
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Acute Coronary Syndrome
Acute Coronary Syndrome
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Asymptomatic MI
Asymptomatic MI
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Atypical Symptoms
Atypical Symptoms
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ECG Changes
ECG Changes
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Serum Markers Changes
Serum Markers Changes
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Sympathetic Activation
Sympathetic Activation
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Creatine Kinase (CK-MB)
Creatine Kinase (CK-MB)
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Heart Rate Increase
Heart Rate Increase
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Study Notes
Coronary Heart Disease (CHD)
- CHD, also known as ischemic heart disease and coronary artery disease (CAD), is characterized by insufficient oxygen delivery to the myocardium due to atherosclerotic coronary arteries.
- Sequelae of CHD include angina pectoris, myocardial infarction, dysrhythmias, heart failure, and sudden cardiac death.
Etiology of Coronary Heart Disease
- Known risk factors include atherosclerosis and possible microcirculation abnormalities.
- Atherosclerosis causes narrowing of the arterial lumen, potentially leading to cardiac ischemia, through endothelial cell dysfunction.
- This can result from thrombotic formation and coronary vasospasm.
Mechanisms of Coronary Atherosclerosis
- Lipids are transported via apoproteins.
- Lipoproteins associated with a greater risk of atherosclerosis.
- High-density lipoproteins transport cholesterol from peripheral tissue to the liver, clearing atheromatous plaque.
- Atherosclerotic plaque formation begins with injury to coronary artery endothelium.
- LDL oxidation by endothelial cells and macrophages.
- Oxidized lipids damage endothelial and smooth muscle cells, stimulating macrophage recruitment.
- Macrophages engulf lipids, forming foam cells, which release inflammatory mediators and growth factors.
- Excessive lipid and debris accumulate within the vessel wall to form the lipid core.
Mechanisms of Coronary Atherosclerosis (Continued)
- Endothelial injury/dysfunction related to hyperlipidemia, hypertension, smoking, toxins, hemodynamic factors, immune reactions, and viruses.
- Monocyte adhesion and emigration into intima.
- Smooth muscle cell precursors migration.
- Cholesterol efflux via HDL.
- Macrophage function.
- Cytokine release (IL-1, MCP-1).
- Lipid uptake.
- Foam cells.
- Oxidized LDL.
- Cytokines/growth factors.
Vulnerable and Stable Plaques
- Vulnerable plaques may rupture or erode, stimulating clot formation.
- Vulnerable plaques are characterized by a large lipid core, thin cap, and high shear stress.
- Stable plaques have more collagen and fibrin, and a stable cap.
Mechanisms of Coronary Atherosclerosis (Continued 2)
- Increased plaque vulnerability due to active inflammation.
- Large lipid core and thin cap.
- Endothelial denudation, superficial platelet adherence.
- Fissured or ruptured cap.
- Severe stenosis predisposing to high shear stress.
- Lipid-lowering therapy.
- Plaque stabilization to decrease propensity to rupture.
Pathophysiology of Ischemia
- Ischemia occurs when oxygen supply is insufficient to meet metabolic demands.
- Critical factors in meeting cellular demands for oxygen include rate of coronary perfusion and myocardial workload.
- Coronary perfusion can be altered by large, stable atherosclerotic plaques, acute platelet aggregation, thrombosis, vasospasm, failure of autoregulation by the microcirculation, and poor perfusion pressure.
- Chronic occlusion of a coronary vessel leads to stable angina.
- Acute occlusion leads to unstable angina or myocardial infarction (MI).
- Myocardial ischemia may be caused by coronary vasospasm or hypoxemia. In addition, low perfusion pressure from volume depletion or shock.
Clinical Features and Management of Coronary Syndromes
- Chronic syndromes, with slow progression due to chronic obstruction from stable atherosclerotic plaques, include stable angina pectoris and ischemic cardiomyopathy.
- Acute coronary syndrome (ACS) is associated with acute changes in plaque morphology and thrombosis.
- Unstable angina, myocardial infarction, sudden cardiac death, and associated dysrhythmias can result from an ACS.
- Typical symptoms include chest pain, but this can differ between genders, age, or individuals with specific chronic conditions.
Angina Pectoris
- Chest pain associated with intermittent myocardial ischemia.
- The pain can be described as burning, crushing, squeezing, choking or referred.
- Inefficient cardiac pumping can result in pulmonary congestion and shortness of breath.
- No permanent myocardial damage occurs.
- Angina pectoris has three common patterns: stable, or typical; also called classic; characterized by stenotic atherosclerotic coronary vessels; onset of anginal pain is generally predictable and elicited by similar stimuli each time. Pain is relieved by rest or nitroglycerin. Unstable or crescendo angina; pain is unpredictable and not related to physical exertion. May progress to acute ischemia.
- Prinzmetal angina is typically unpredictable, unrelated to activity, often at rest, and usually treated with calcium channel-blocking drugs.
Acute Coronary Syndrome
- Chest pain is usually more severe and lasts longer than typical angina.
- Plaque rupture with acute thrombus development.
- Occlusion is partial in unstable angina.
- Occlusion is complete in myocardial infarction (MI).
- ECG and biomarkers are used for diagnosis.
- Patients with chest pain and evidence of acute ischemia on the electrocardiogram (ECG), such as ST-segment elevation (STEMI), are candidates for acute reperfusion therapy.
- Patients with chest symptoms, but no ST-elevation on the ECG (non-STEMI, NSTEMI), are candidates for antiplatelet drugs.
- Acute occlusion causes a range of cellular events depending on the availability and adequacy of collateral blood flow and relative workload.
- The ultimate size of the infarcted tissue depends on the extent, duration, and severity of ischemia.
- Infarction area becomes paler than surrounding tissues following 18 to 24 hours.
- Necrotic tissue becomes yellowish and soft with a rim of red connective tissue in 5 to 7 days.
- Necrotic tissue is gradually degraded, cleared and replaced by tough fibrous scar tissue within 1 to 2 weeks.
Acute Coronary Syndrome: Diagnosis
- Signs and symptoms.
- Electrocardiographic changes.
- Elevated specific marker proteins in the blood, like myoglobin, troponin, lactate dehydrogenase, and creatine kinase.
- Severe crushing, excruciating chest pain that may radiate to the arm, shoulder, jaw, or back.
- Symptoms accompanied by nausea, vomiting, diaphoresis (sweating), and shortness of breath.
- Symptoms are typically more than 15 minutes and not relieved by rest or nitroglycerin.
- Common in women, the elderly patients, and patients with diabetic neuropathies.
- Atypical symptoms include fatigue, nausea, back pain, and abdominal discomfort.
- ST-segment elevation, large Q waves, and inverted T waves are common ECG changes.
- Serum marker changes are typical of acute coronary syndrome including myoglobin, troponin, lactate dehydrogenase, and creatine kinase.
Acute Coronary Syndrome: Physiological Responses
- MI leads to a drop in cardiac output (CO).
- Compensating responses include sympathetic stimulation.
- Heart rate, contractility and blood pressure increase in response to the compensatory response.
Acute Coronary Syndrome: Prognosis
- Overall prognosis for acute myocardial infarction (MI) is difficult to determine.
- Factors in determining prognosis include how quickly treatment is sought, the extent and location of the infarct, previous cardiovascular health, and presence of other disease processes.
Acute Coronary Syndrome: Treatment
- Decreasing myocardial oxygen demand.
- Sympathetic antagonists.
- Rest.
- Heart rate control.
- Pain relief.
- Afterload reduction.
- Increasing myocardial oxygen supply.
- Thrombolysis.
- Angioplasty.
- Coronary bypass grafting.
- Monitoring and managing complications.
- Early detection and management of dysrhythmias and conduction disorders.
Sudden Cardiac Arrest
- Unexpected death due to cardiac causes within 1 hour of symptom onset.
- Often results from a lethal dysrhythmia, frequently ventricular fibrillation.
- Use of external defibrillators and CPR has significantly improved survival rates.
Coronary Ischemic (or Chronic) Cardiomyopathy
- Heart failure develops insidiously due to progressive damage.
- Typically has an antecedent history of angina or myocardial infarction (MI).
- Is a consequence of progressive, apoptotic death of myocytes.
- Typically found throughout the myocardium.
- More observed in older adults, poor prognosis
Endocardial and Valvular Disease
- Endocardial and valvular structures can be damaged and altered by inflammation, scarring, calcification, and congenital malformations.
- This damage alters hemodynamics and increases myocardial workload.
- Stenosis is the failure of a valve to completely open, increasing pressure workload.
- Regurgitation, or insufficiency, is the inability of a valve to close completely, resulting in extra volume workload for the heart.
- Murmurs often accompany valvular disorders.
Mitral Stenosis
- Blood flow from the left atrium to the left ventricle is impaired during ventricular diastole.
- Increased pressure in the left atrium leads to atria chamber enlargement and hypertrophy.
- Condition may lead to chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure.
- Characteristic symptoms include a low-pitched, rumbling diastolic murmur, open snap, atrial dysrhythmias, and atrial clots, often exacerbated with exercise.
Mitral Regurgitation
- Backflow of blood from the left ventricle to the left atrium (during ventricular systole).
- Left atrium and ventricle enlargement and hypertrophy (due to the extra volume).
- Possible result is left-sided heart failure, characterized by a high-pitched, pansystolic, blowing murmur, giant V waves, chronic weakness, and fatigue.
Mitral Valve Prolapse
- Displacement (ballooning) of mitral valve leaflets into the left atrium during ventricular systole is common in women more frequently than men.
- Typically asymptomatic.
- Characteristic symptoms include a midsystolic click or systolic murmur, as well as palpitations, rhythm abnormalities, dizziness, fatigue, dyspnea, chest pain, or depression and anxiety.
Aortic Stenosis
- Age-related calcium deposits on the aortic cusps are the primary cause.
- Obstruction results in aortic outflow from the left ventricle during systole.
- Left ventricle hypertrophy can result from ischemia.
- Left-sided heart failure can develop.
- Characteristic symptoms include a crescendo-decrescendo murmur during ventricular systole with a prominent S1. Other associated symptoms include syncope, fatigue, and angina.
Aortic Regurgitation
- Incompetent aortic valve allowing blood to leak back from the aorta to the left ventricle during ventricular diastole.
- Causes include aortic valve or aortic root dilation.
- Hypertrophy and dilation of the left ventricle is a potential result.
- Characteristic symptoms include a high-pitched, blowing murmur during ventricular diastole, along with high systolic blood pressure, low diastolic blood pressure, and palpitations.
Diseases of the Endocardium
- Rheumatic heart disease is an acute inflammatory disease resulting from infection with group A beta-hemolytic streptococci.
- Damage due to an immune attack on the individual's own tissues.
- Antibodies against streptococcal antigens damage connective tissue in joints, heart, and skin (e.g., Sydenham's chorea).
- The condition predominantly presents in children with symptoms that include fever, sore throat, joint inflammation, neurological features (e.g., involuntary movements), and a distinctive truncal rash.
- Infective endocarditis results from the invasion and colonization of endocardial structures by microorganisms.
- Streptococcus and Staphylococcus are frequent causes.
- The condition frequently affects intravenous drug users.
- Prognosis for acute infective endocarditis is typically poor.
Myocardial Diseases
- Myocarditis is an inflammatory disorder of the heart muscle.
- Necrotic and degenerative changes to the myocytes.
- Myocarditis may be acute presenting with rapid symptoms; or chronic, presenting insidiously with symptoms that evolve over time with few initial symptoms.
- Myocarditis is commonly caused by microbial agents, immune responses, and physical agents—frequently viral in etiology.
- Characterized by left ventricular dysfunction (often appearing "flabby", with patchy or diffuse necrotic lesions), and general dilation of all four heart chambers.
Myocardial Diseases (Continued)
- Cardiomyopathy is categorized as primary, with unknown cause; or secondary, with known cause.
- Functional classifications for cardiomyopathy include dilated, hypertrophic, or restrictive.
- Dilated cardiomyopathy is associated with cardiac failure and dilation of one or both ventricular chambers.
- Causes may be related to alcohol toxicity, pregnancy, post-viral myocarditis, or genetic abnormalities.
- Symptoms may include a slow, progressive biventricular heart failure with low ejection fraction
- Hypertrophic cardiomyopathy involves thickening and hyperkinetic changes to the ventricular muscle mass, frequently characterized by septal thickening.
- Clinical course is variable and frequently slow progressing. Symptoms range from asymptomatic to dyspnea and angina.
- Restrictive cardiomyopathy is a rarer disorder in which the heart muscle becomes stiff and fibrotic.
- Its rigidity inhibits diastolic filling, leading to a marked reduction in cardiac output, left-sided heart failure, and associated symptoms such as exercise intolerance, dyspnea, and weakness.
Pericardial Diseases
- Pericardial diseases are typically sequelae to other conditions, including pericardial effusion, cardiac tamponade, and pericarditis.
- Pericardial effusion is the accumulation of noninflammatory fluid in the pericardial sac.
- Fluid types in the effusion can include serous, serosanguineous, purulent, and blood.
- Cardiac tamponade is the accumulation of large amounts of fluid in the pericardial sac, which can externally impinge on the heart's chambers and impair their filling.
- Pericarditis is an acute or chronic inflammation of the pericardium, sometimes associated with systemic infections, trauma, metabolic problems, or neoplasia.
- Acute Pericarditis is frequently viral and usually resolves spontaneously. Characteristic symptoms include chest pain, fever, leukocytosis, malaise, and tachycardia.
- Chronic pericarditis is a sequela of acute pericarditis that results in chronic pericardial dysfunction.
- Adhesive pericarditis occurs when the pericardial sac and the external aspect of the heart become stuck together, whereas Constrictive pericarditis results in a fibrous and scarred pericardial sac that restricts the filling of the heart.
Congenital Heart Diseases
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Congenital heart defects are present from birth and originate due to embryonic development abnormalities.
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Results in abnormalities in the blood flow and pressure through the heart's structures resulting in either shunting of blood or obstruction of blood flow.
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Shunts are anomalies that affect blood flow through abnormal pathways in the heart or great vessels; can be right to left (cyanotic) or left to right (acyanotic).
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Obstructions result from abnormal narrowing in vessels, leading to increased workload on the affected heart chamber(s).
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Acyanotic defects include atrial septal defect, ventricular septal defect, and patent ductus arteriosus.
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Cyanotic defects include tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, and tricuspid atresia.
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Etiology commonly includes maternal rubella during pregnancy, exposure to teratogens, and/or genetic influences.
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Description
Test your knowledge about myocarditis, cardiomyopathy, and coronary syndromes with this comprehensive quiz. Learn the classifications, characteristics, and symptoms associated with these heart conditions as you answer questions that challenge your understanding of cardiac health.
