Myocardial Infarction Quiz
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Questions and Answers

Which symptom is often reported in women experiencing a myocardial infarction?

  • Radiating pain to the left arm
  • Severe chest pain
  • Shortness of breath at night (correct)
  • Nausea and vomiting

    • What is a key characteristic of cardiac troponin T (TnT) following a myocardial infarction?

  • It remains elevated for 5 to 7 days after MI. (correct)
  • It is only elevated in cases of heart failure.
  • It is the first enzyme to rise after an MI.
  • It is not specific to myocardial tissue damage.

    • Which of the following measurements would indicate death of myocardial tissue?

  • Serum CPK-MB level elevated > 3% (correct)
  • ECG showing normal S-T segment
  • Normal serum troponin levels
  • Elevated blood pressure

    • What complication may occur during the recovery phase following a myocardial infarction?

    <p>Cardiogenic shock</p> Signup and view all the answers

    How long after a myocardial infarction does CPK-MB typically peak?

    <p>24 to 36 hours</p> Signup and view all the answers

    What is the primary purpose of a transesophageal echocardiography (TEE)?

    <p>To obtain clearer images of the heart structure</p> Signup and view all the answers

    Which physical examination finding is classically associated with myocardial infarction?

    <p>Substernal chest pain of crushing nature</p> Signup and view all the answers

    What is a symptom that may not follow the classic pattern in myocardial infarction?

    <p>Women showing atypical symptoms</p> Signup and view all the answers

    What is the primary cause of angina pectoris in most cases?

    <p>Coronary artery disease (CAD)</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with angina pectoris?

    <p>Rapid heartbeat</p> Signup and view all the answers

    What happens during an angina episode?

    <p>Myocardial O2 Demand &gt; Myocardial O2 Supply</p> Signup and view all the answers

    Which statement about hypertension is true?

    <p>Symptoms may include headache.</p> Signup and view all the answers

    What might a change in pattern or severity of angina indicate?

    <p>Disease progression</p> Signup and view all the answers

    Which physical sensations are commonly associated with angina pectoris?

    <p>Tightness or pressure in the chest</p> Signup and view all the answers

    What is the effect of increased myocardial oxygen needs during angina?

    <p>Imbalance leading to ischemia</p> Signup and view all the answers

    What is true about the presentation of angina pectoris symptoms among different patients?

    <p>Patients may experience symptoms differently.</p> Signup and view all the answers

    What is the primary mechanism through which the body initially attempts to compensate for a failing heart?

    <p>Increasing vagal stimulation</p> Signup and view all the answers

    What occurs as a result of left-sided heart failure?

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

    What is a likely consequence of increased blood volume during heart failure?

    <p>Strain on the heart</p> Signup and view all the answers

    Which compensatory mechanism might backfire and worsen the heart's condition?

    <p>Activating the Renin Angiotensin System</p> Signup and view all the answers

    Which phase represents the condition when compensatory mechanisms fail and worsen heart failure?

    <p>Decompensated phase</p> Signup and view all the answers

    What characterizes the third compensatory phase in the context of heart failure?

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

    Which of the following symptoms is most commonly associated with right-sided heart failure?

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

    Increased heart rate during heart failure is primarily a response from which system?

    <p>Sympathetic nervous system</p> Signup and view all the answers

    What is the most common triad of symptoms associated with Mitral Valve Prolapse (MVP)?

    <p>Palpitations, dyspnea, and profound fatigue</p> Signup and view all the answers

    Which factor is a known cause of aortic stenosis?

    <p>Progressive valvular calcification</p> Signup and view all the answers

    Which symptom best indicates a poor prognostic outcome in a patient with aortic stenosis?

    <p>Onset of angina</p> Signup and view all the answers

    How do valvular incompetence and insufficiency affect heart chambers?

    <p>They allow regurgitation of blood</p> Signup and view all the answers

    What demographic factor is contributing to the increasing prevalence of aortic stenosis?

    <p>Aging population</p> Signup and view all the answers

    What are the characteristics of individuals with significant valvular lesions?

    <p>Often asymptomatic until condition is advanced</p> Signup and view all the answers

    Individuals with aortic stenosis who are asymptomatic should still receive what precaution?

    <p>Prophylactic antibiotics against infective endocarditis</p> Signup and view all the answers

    What might indicate advanced aortic stenosis during auscultation?

    <p>Characteristic sounds related to stenosis</p> Signup and view all the answers

    What occurs when aortic regurgitation develops gradually?

    <p>The left ventricle dilates and hypertrophies.</p> Signup and view all the answers

    Which of the following symptoms is considered an early sign of valve disease?

    <p>Resting tachycardia</p> Signup and view all the answers

    What is a consequence of severe aortic regurgitation?

    <p>Pulmonary edema due to blood backing up</p> Signup and view all the answers

    When sound is heard during diastole due to leakage in the valve, what is this condition called?

    <p>Aortic Insufficiency</p> Signup and view all the answers

    Which physiological change occurs as a result of decreased stroke volume and cardiac output due to valve lesions?

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

    What symptom is most likely to occur later in the progression of valve disease?

    <p>Orthostatic hypotension</p> Signup and view all the answers

    What is a potential risk related to aortic regurgitation in terms of coronary blood flow?

    <p>Decreased coronary blood flow</p> Signup and view all the answers

    What is indicated by paroxysmal nocturnal dyspnea (PND) in patients with valve disease?

    <p>Fluid redistribution in central circulation</p> Signup and view all the answers

    What characterizes a Left to Right shunt in acyanotic lesions?

    <p>Blood is shunted from the oxygenated left side to the right side.</p> Signup and view all the answers

    Which condition is classified under cyanotic lesions?

    <p>Pulmonary Atresia</p> Signup and view all the answers

    What is a common consequence of a Left to Right shunt?

    <p>Increased preload leading to heart overexertion.</p> Signup and view all the answers

    Which of the following is an example of a stenotic lesion?

    <p>Coarctation of Aorta</p> Signup and view all the answers

    What happens to cardiac output in a condition with a Left to Right shunt?

    <p>Cardiac output increases to compensate.</p> Signup and view all the answers

    Which of the following statements is true regarding cyanotic conditions?

    <p>They lead to blood bypassing the pulmonary circulation.</p> Signup and view all the answers

    What is a significant effect of a Right to Left shunt in cyanotic lesions?

    <p>Cyanosis due to unoxygenated blood entering the body.</p> Signup and view all the answers

    Which condition is characterized by narrowing within the aorta leading to left ventricular hypertrophy?

    <p>Coarctation of the Aorta</p> Signup and view all the answers

    Study Notes

    Cardiac Pathophysiology: Coronary Artery Disease

    • Coronary artery disease (CAD) is a condition where the coronary arteries become narrowed or blocked.
    • This blockage prevents the heart muscle from receiving enough oxygen, leading to ischemia and potentially infarction.
    • CAD is responsible for the majority of deaths globally.
    • One in three adults in the US have cardiovascular disease.
    • Nearly 40% of American adults have a total cholesterol level of 200 mg/dL or higher.
    • Atherosclerosis is the underlying cause of CAD.
    • Atherosclerosis is characterized by the thickening and loss of elasticity of the arterial walls.
    • High blood pressure and cigarette smoking are primary risk factors for CAD.

    Objectives (Coronary Artery Disease)

    • Understand coronary artery disease.
    • Identify risk factors for coronary artery disease.
    • Recognize gender disparity in CAD.
    • Describe the pathogenesis of coronary artery disease.
    • Identify the clinical presentation of CAD.
    • List diagnostic tools for CAD.

    Coronary Artery Disease (CAD) Pathogenesis

    • Narrowing or blockage of coronary arteries reduces blood flow to the heart muscle.
    • Areas of the heart muscle deprived of oxygen become ischemic and may be injured.
    • Infarction can result, a severe consequence of CAD.
    • Atheromas and their rupture trigger inflammatory responses that lead to the development of CAD and eventual complications like heart attack.

    Risk Factors for CAD

    • Modifiable: Smoking, hypertension, hypercholesterolemia, physical inactivity, diabetes, obesity, stress.
    • Non-modifiable: Heredity, male sex (until menopause), age.
    • Half of Americans have at least one of these three modifiable risk factors.

    Myocardial Infarction (MI)

    • Heart attack, a result of decreased blood flow to the heart.
    • 80-90% of MIs originate from thrombi at sites of pre-existing atherosclerotic blockages.
    • MIs are more common during early morning hours.
    • Silent ischemia is linked to diabetes.

    Myocardial Infarction (MI): Pathogenesis

    • Plaque rupture or sclerosis within the coronary arteries leads to thrombus formation.
    • Blood vessels get occluded by this thrombus.
    • The most common site of MI involvement is the left ventricle.

    Myocardial Infarction (MI): Pathogenesis Cont.

    • The zone of ischemia is the region of the myocardium (heart muscle) with hypoxic injury but the reversible zone.
    • The zone of injury immediately surrounds the infarct zone with less serious damage, and with restoration of blood flow might return to normal.
    • The zone of infarction represents severely damaged areas of infarction with irreversible myocardium death.

    Myocardial Infarction (MI): Pathogenesis Cont.

    • Within hours of coronary occlusion, ischemia develops in the surrounding myocardial tissue.
    • Inflammation follows, leading to the release of enzymes within the tissue's cells.
    • The resulting scar tissue develops 6-8 weeks post-infarction.

    MI: Classification

    • Degree of wall involvement: Transmural (full wall thickness) or subendocardial (partial thickness).
    • Location: Determining which artery is affected and the area of heart muscle it supplies.
    • Size: Whether the MI is small or large, and any associated complications.

    Hypertension

    • Elevated blood pressure (sustained elevation of systolic or diastolic blood pressure).
    • Hypertension categories include normal, elevated, stage 1, stage 2, and hypertensive crisis.
    • Essential hypertension (primary) accounts for approximately 90% to 95% of cases.
    • Secondary hypertension attributes only to 5 to 10% of the cases and results from other conditions.

    Hypertension Pathogenesis

    • Blood pressure regulation involves blood flow and peripheral vascular resistance.
    • Peripheral arteriolar constriction is the usual underlying phenomenon of hypertension.
    • Key components are the sympathetic nervous system and the renin-angiotensin system.

    Angina Pectoris

    • Chest pain resulting from myocardial ischemia (reduced blood flow).
    • Typically precipitated by exertion, emotions, or eating.
    • CAD is the most common cause.
    • Differentiated types like stable, unstable, and Prinzmetal (variant).

    Angina Pectoris: Diagnosis

    • Patient history, nitroglycerin use, pharmacologic stress test, or in more severe cases, a cardiac catheterization.

    Congestive Heart Failure (CHF)

    • Inadequate pumping action of the heart leading to fluid overload in the lungs and/or body tissues.
    • Left-sided CHF leads to pulmonary edema, often characterized by shortness of breath (dyspnea).
    • Right-sided CHF mainly shows fluid accumulation in body tissues, and dependent edema.
    • Systolic CHF is caused by impaired myocardial contractility.
    • Diastolic heart failure occurs when the heart muscle isn't fully relaxing and filling adequately.

    CHF Clinical Manifestations

    • Symptoms of left-sided CHF tend to include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND).
    • Right-sided CHF often shows signs like dependent edema and jugular vein distension.

    Valvular Heart Disease

    • Valvular conditions, including stenosis (narrowing), insufficiency (regurgitation), and prolapse (bulging) affect blood flow through the heart.

    Mitral Stenosis

    • Thickening of the mitral valve, obstructing blood flow between the left atrium and ventricle.
    • Causes include rheumatic fever.
    • Symptoms include dyspnea and fatigue.
    • Left atrial enlargement may occur.

    Mitral Valve Prolapse (MVP)

    • The mitral valve leaflets bulge back into the left atrium during ventricular systole.
    • This condition's cause is frequently unknown.
    • Frequent symptoms are profound fatigue not associated with exertion, palpitations, and dyspnea.

    Aortic Stenosis

    • Narrowing of the aortic valve.
    • Usually progressive in older adults.
    • May lead to cardiac hypertrophy and reduced cardiac output due to the heart working harder.

    Aortic Regurgitation

    • The aortic valve doesn't close completely, leading to blood flowing back into the left ventricle during diastole.
    • Aortic insufficiency leads to left ventricular dilation and hypertrophy as the heart compensates.

    Congenital Heart Disease (CHD)

    • Congenital heart defects are present at birth due to abnormalities in the formation of the heart during fetal development.
    • Classification include Acyanotic (left to right) or Cyanotic (right to left) shunts.
    • Acyanotic shunts are usually common birth defects whereas cyanotic conditions have greater implications.

    Peripheral Arterial Disease (PAD)

    • PAD refers to atherosclerotic occlusive diseases.
    • Atherosclerosis is the primary cause of PAD, and it occurs due to the buildup of plaque in the arteries of the extremities (especially legs) of the body.
    • Risk factors include smoking, diabetes, high blood pressure, high cholesterol, and other lifestyle factors.

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    Description

    Test your knowledge on the symptoms, characteristics, and complications associated with myocardial infarction. This quiz covers important aspects such as cardiac biomarkers, diagnostic procedures, and recovery challenges. Perfect for medical students and professionals looking to refresh their understanding.

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