robbypowell's version from 2015-11-11 12:35


Question Answer
most common form of ArteriosclerosisAtherosclerosis
hardening of small arteries what subtype of Arteriosclerosis?Arteriolosclerosis
characterized by deposits of “atheromatous plaques” 2◦ to high cholesterolAtherosclerosis (AS)
Characterized by calcific deposits in the media of arteries in people > 50Medial Calcific Sclerosis (Monckeberg Arteriosclerosis)
T/F: in Monckeburg Arteriosclerosis calcifications do not encroach on the vessel lumenTrue
elevated fatty plaques are also called _____ plaquesAtheromatous plaques
elevated ____ levels lead to AtherosclerosisLDL Cholesterol
Which elevated blood pressure is closely associated with Atherosclerosis?Diastolic
Men age ___ and older and women age ___ and older are at greater risk for Atherosclerosis50; 55
Imbalance between the myocardial need of oxygen & its blood supplyIschemic Heart Disease (myocardial infarct?)
oronary artery vasospasm voccurs in patients w/ pre-existing plaque, perhaps releasing vasospastic mediators such as ____ ___ from platelet aggregatesThromboxane A2
symptom complex characterized by paraoxysmal, intermittent chest pain caused by transient, but reversible “myocardial ischemia”Angina Pectoris
the two types of Angina Pectoris are ____ and ____Stable; Unstable
Type of Angina associated with being irreversibleUnstable
Type of Angina that is considered reversible and has pain lasting 15 seconds to 15 minutesStable
Type of Angina precipitated by progressively less exertions.Unstable
Angina Pain is relieved by rest or ____Nitroglycerine
Type of Angina Associated w/ fixed plaque occluding ≥ 75% of vessel lumen Stable
Type of Angina myocardial ischemia due to “acute plaque changes”Unstable
Myocardial Infarction results in ___ necrosisIschemic (becomes coagulative)
Acute myocardial infarction results from Ischemia for greater than ____ minutes20 minutes
cardiac tissue death resulting from complete occlusion & failure of blood flow of the coronary arteryMyocardial Infarction
greater than ___ million in the US suffer an acute MI each year1 million
_____ fatalities from Myocardial Infarction every year500,000
In age range _________-_________ men are 5 times more likely to have MI than women, at age ___ the risks are the same across genders45-55; 80
in a sizable minority of cases, _________ to _________ %, MI is painless “silent”, usually in diabetics or hypertensive or in elderly patients20-30
In MI, ___ levels rise w/in 2-4 hrs & peaks in 24 (sensitive, but non-specific) & returns to normal in 72 hrsCreatine Kinase
In MI, ___ levels rise in 2-4 hrs & peak in 18-24 hrs & returns to normal in 48 hrsCK-MB
In MI, ___ levels become detectable in 2-6 hrs & remains elevated for 10 days laterTroponin
After MI, ____ levels rise within 4-6 hours may imply a very recent injury to the heart or other muscle tissueMyoglobin
Of the two types of MI, which is most common?Transmural (>2.5cm)
MI that Involves the full thickness of the heart ventricular wall (endo-, myo- & pericardium)Transmural
Type of MI Usually associated w/ coronary atherosclerosis w/ superimposed thrombosis of a single coronary arteryTransmural
Type of MI with localized area of tissue death limited to the inner 1/3-1/2 of heart wallSubendocardial
Type of MI that may be caused by a spasm in a small coronary arterySubendocardial
define: loss of blood supply --> cutoff O2 & nutrients to cellsInfarction
What is the most important chemical in irreversible cell damage from hypoxia?Calcium (enters the cell and activates phospholipase)
How does lack of depletion of ATP lead to irreversible damage in hypoxia?Na pumps not running, Ca enters cell, Ca activates phospholipase
This enzyme is activated by Calcium and tears apart the cell membrane (in hypoxia)Phospholipase
bright eosinophilic bands of condensed contractile proteins that run at right angles to the long axis of the cardiac myocyteContraction bands
pharmaceutical treatment of MIThrombolytic (liquefy blood clot) (blood thinner, later)
2 types of surgical treatment for MIAngioplasty (balloons/stents) Bypass
nability of the heart to “pump” an adequate cardiac output to meet the body’s metabolic demandsCongestive heart failure
CHF occurs in ___% in people 65 yrs of age & older76%
CHF Affects _________ millions in US5.7 million
CHF, ____ new cases every year300,000
CHF _____ hospital cases/yr1 million
___: CHF results in deficient stroke volume relative to the body needs, w/ the inability of the cardiac output to keep pace w/ the venous return EDEMASequelae
____ is most often caused by decreased myocardial contractility (e.g., myocardial infarction, w/ subsequent fibrosis OR pressure-volume overloadCHF
Compensatory Changes of CHFDilation of the heart (caused compensation for increased work overload) Tachycardia (in response to decreased stroke volume) Salt &water retention (which causes expansion of blood volume)
heart failure cells are seen with ___ sided heart failureLeft
Right sided heart failure is commonly caused by what?Left sided heart failure
Pitting edema of the lower extremities, Nutmeg Liver, and Cerebral Hypoxia are signs of what?Right sided heart failure
Right ventricular hypertrophy & dilatationCor Pulmonale (expand)
This (right ventricular) enlargement is usually due to pulmonary hypertension or other disorders that affect structure or function of lungsCor Pulmonate (e.g., COPD, TB, Pneumoconiosis)
valve diseases leading to obstruction are caused by ___Stenosis
valve diseases leading to regurgitation are caused bt ___Incompetence
three layers of vascular tissue (in to out)Tunica Intima (inner) Tunica Media (middle) Tunica Adventitia (outer)
what has greater (relative) tunica media makeup, arteries or veins?arteries
What layer of vascular tissue contains muscle fibers?Tunica Media
this is the result of Loss of Elasticity of arterial wallsArteriosclerosis
3 steps in pathogenesis of Atherosclerosis1. lipid infiltration (insudation) (under endothelial cells) 2.
T/F: Valvular disorders can be congenital in origin, or acquireTrue
abnormal valves are more susceptible to infection and predisposing the patient to ____ ____Infective endocarditis
scarring & fusion of leaflets, in rheumatic heart diseaseMitral Valve Stenosis
blood borne pathogens can easily colonize on defective ____Valves
_________ _________ _________ is an acute, recurrent immunologically- mediated multisystem inflammatory disease that follows pharyngitis caused by group A of β-hemolytic streptococciRheumatic Heart Disease
In the majority of cases, Mitral Valve ___ do not require prophylactic antibiotics, in the cases where there is regurgitation, though... it is indicatedProlapse
ARF is a hypersensitivity reaction induced by what bacterial group?A β-hemolytic streptococci
Antistreptoccocal antibodies generated against the _________ ___ of bacteria cross-react w/ glycoprotein antigens in the heart, lungs, joints & kidneysM proteins
Acute fever caused by cross reactions in immune response to group A Beta-Hemolytic StreptococciAcute Rheumatic Fever (can cause damage to all layers of heart tissue)
proteins in bacterial cell wall that cause generation of damaging Antistreptococcal antibodiesM proteins
ARF follows strep throat ____ to ___ weeks after infection1-3 weeks
Absence of streptococci support the _____ component of Rheumatic Heart DiseaseAutoimmune
ARF occurs ~ _________% of patients 5-15 years of age3%
Although pharyngeal cultures for streptococci are –ve by the time ARF begins, antibodies against one or more streptococcal enzymes, such as ____ & ____ are presentStreptomycin O; DNAase Beta
Fever in children following strepthroat with Arthritis, Carditis (w/ Aschoff bodies), subcutaneous nodules (w/ Aschoff bodies), macular rash (in bathing suit pattern) & Sydenham Chorea... these are clinical features of...Rheumatic Fever
involuntary movement of the extremitiesSydenham Chorea (assoc w. Rheumatic Fever)
Aschoff bodies are associated with what disease?Rheumatic Fever (can be Rheumatic Heart Disease in heart)
macular rash, often in “bathing suit” patternErythema Marginatum of skin (assoc w. Rheumatic Fever)
Pericarditis is detected how clinically?abnormal heart sounds
Myocarditis would lead to what?Arrhythmia
Valvulitis leads to what?stenosis (heart murmur due to regurgitation)
RF licks the ___ and bites the ___joints; heart
Carditis (RHD) may develop _________ to _________ weeks after initial attack, but worsens with subsequent attacks1 to 5 weeks
fish mouth”/buttonhole defects of valves are caused by ___stenosis (assoc. w/ Rheumatic Fever/RHD)
Most common valve to be involved in Rheumatic CarditisMitral (90% of time involved)
Vegetation thrombi that embolize assoc w/...Rheumatic Heart Disease
Septic Embolus is associated with what heart condition?Infective Endocarditis (septic vegetation thrombi)
Fibrinous Pericarditis assoc w what heart condition?Rheumatic Heart Disease
Thickened, ropey, chordae tendinae assoc wRheumatic Heart Disease
Fusion of valves in Rheumatic Heart disease leading to incompetence of valveFish-mouth or Button-hole (stenosis?)
Dilatation of the left atria would be caused by ___ valve stenosisMitral
Aschoff bodies in all layers of the heartRheumatic Heart Disease (pancarditis)
Giant cells in cardiac tissueAschoff bodies (assoc w/ Rheum H D)
Elongated cells w/ spikes coming out of "cardiomyocytes"Anitzschkow Myocites (not actually myocytes according to lecture)
treatments for RHDProphylaxis (of infective endocarditis),
T/F: Rheumatic Heart Disease is an infection of the heartFalse (autoimmune)
Colonization of the heart valves or mural endocardium by bacteriaInfective Endocarditis (blood borne pathogen hits cardiac defect esp. valvular)
Bulky friable vegetations with thrombotic debris and organismsInfective Endocarditis
Most common cause of Infective Endocarditis is ____Bacteria (staph Aureus* or streptococci)
Predisposing conditions to Infective endocarditisRHF, Congenital Heart Disease, Prosthetic Devices, IV Drug use
IV drug users will develop Infective endocarditis in what side of heart?Right
Complications of Infective endocarditis is mainly ____ and ____ emboliperforations (valve, septum); Septic Emboli
Valve with attached fibrinous vegetations and abscess burrowing into myocardium... what condition?Infective Endocarditis
3 types of patients w/ prophylactic antibiotics in dental officeMitral Stenoses, RHD, Cardiac Devices (valve replacement)
Do patients with unprepared cyanotic congenital heart disease need to be given prophylactic antibiotics?Yes
What is the standard prophylactic antibiotic (w/ no allergies)Amoxicillin
How long before the dental procedure should patients be given prophylactic antibiotics?1 hour before (is sufficient)
What prophylactic antibiotic is given for dental procedures for at risk patients with Penicillin allergy?Clindamycin
Do patients with RHD and no valvular defect require proph antibiotics?No
Do patients with Mitral valve prolapse require prophylactic antibiotics for dental treatment?No
Do patients with Calcified aortic stenosis require prophylactic antibiotics for dental treatment?No
Do patients with Congenital Ventricular / atrial septal defects require prophylactic antibiotics for dental treatment?No
Various insults before the end of week ___ can cause a congenital heart defect to occurweek 16
Chromosomal abnormalities; trisomy _________, _________ & ___ cause Congenital Heart disease13, 18 & 21
Up to _________% of congenital heart disease is of unknown cause90%
Congenital Heart disease where directionality of shunting is right--> left... would there be Cyanosis?yes
Immediate Cyanosis is caused by shunting from _________ side to _________ sideRight to Left
There is no immediate cyanosis when congenital shunting is from ___ side to ____ sideLeft to Right
Bluish discoloration of skin and mucous membraneCyanosis
normal ductus arteriousus communicates between ____ and ___Pulmonary Artery & Aorta
During fetal life elevated ____ helps maintain the Ductus Arteriosus, but in postnatal life elevated ___ suppresses the first biomolecule (results in closure of DA)PGE2 (prostaglandin E2); O2
When does Ductus Arteriosus normally close?first few days (postnatal)
Two rudimentary fetal canals of fetal circulationForamen Ovale & Ductus Arteriosus
What is the oxygen conc like in Umbilical arteries?LOW
this congenital disorder is most often seen in females & more frequently in babies born to mothers who were infected w/ Rubella during early pregnancyPatent Ductus Arterioles
___ ___ ___ causes high-pressure left-to-right shunt (audible as a harsh “machinery” murmur)Patent Ductus Arteriosus
Persistent elevated ____ causes patent ductus arterioususProstaglandin E2


Question Answer
How is cyanosis different in neonates and adults with Patent Ductus Arteriosus?no cyanosis for neonates; eventually cyanosis due to Pulmonary hypertension which leads to Right to Left shunting
Wide PDA will manifest as a murmur and may lead to death due to ___ side heart failure & potential for Infective EndocarditisRight side
PDA may be an isolated or may be associated with others, including what given exampleVentricular Septal Defect
Pharmaceutical for Patent Ductus Arteriosus to help neonates close the DAIndomethacin (lowers prostaglandin E2)
Congenital Defect, Transposition of great vessels, is more common in what gender?Males
Aorta arises from right ventricle & pulmonary artery arises from left ventricleTransposition of Great Vessels (congenital defect)
Aorta arises from left ventricle & pulmonary artery arises from right ventricleNormal physiology
2 examples of Antibodies against Strep that are detectable in the blood following Strep infectionStreptolysin O & DNAase B

timeline Histopathology of Infarct:

Question Answer
1-2 dayscontraction bands, coagulation necrosis
2-3 daysstriation lost, acute inflammation
5-7 daysreduced inflammation
1-2 weeksevidence of collagen
3-4 weeksfibrosis