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[h] Cardiovascular System Flashcards

[i] Master this session in just 5 minutes.

[q] ………… is chest pain that arises with exertion or emotional stress due to atherosclerosis of coronary arteries with > 70% stenosis. Presents as chest pain (lasting < 20 minutes) that radiates to the left arm or jaw, diaphoresis, and shortness of breath. EKG shows ST-segment depression due to subendocardial ischemia. Relieved by rest or nitroglycerin.

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[q] ………… is chest pain that occurs at rest. Usually due to rupture of an atherosclerotic plaque with thrombosis and incomplete occlusion of a coronary artery. EKG shows ST-segment depression due to subendocardial ischemia but no cardiac biomarker elevation (unlike NSTEMI). Relieved by nitroglycerin.

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[f]IFVuc3RhYmxlIGFuZ2luYS4=[Qq]

[q] What is the most likely diagnosis?

30 years old heavy smoker female presenting with episodic chest pain unrelated to exertion + EKG shows ST-segment elevation with no elevation in cardiac enzymes +low doses of ergonovine induce coronary spasm, chest pain, and ST-segment elevation?

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[f]IFZhcmlhbnQgKFByaW56bWV0YWwpIGFuZ2luYS4=[Qq]

[q] ……….. is the most sensitive provocative diagnostic test for coronary vasospasm in variant (Prinzmetal) angina.

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[f]IFRoZSBlcmdvbm92aW5lIHRlc3Qu[Qq]

[q] In …………… angina there is coronary vasospasm which further can be aggravated by beta blockers because by blocking beta receptors, alpha receptors on the vasculature are left unopposed —-> aggravating the vasospasm.

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[f]IHByaW56bWV0YWwu[Qq]

[q] Drugs like …………and ………… causes vasodilation of coronary arterioles in nonischemic regions. This leads to decreased perfusion pressure within the collateral microvessels supplying the ischemic myocardium, diverting blood flow from ischemic areas to nonischemic areas.

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[f]IGFkZW5vc2luZSBhbmQgZGlweXJpZGFtb2xlLg==

[q] ……….. is the most commonly involved artery in MI (45% of cases) and ………… is the 2nd most common.

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[q] ………… is the type of myocardial infarction that is transmural (full thickness of myocardial wall involved) and shows ST elevation on ECG, Q waves.

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[q] ………… is the type of myocardial infarction that is subendocardial (inner 1⁄3) and shows ST depression on ECG.

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[f]IE5vbi1TVCBzZWdtZW50IGVsZXZhdGlvbiBNSSAoTlNURU1JKS4=

[q] Reperfusion of irreversibly damaged cells results in calcium influx, leading to ………..?

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[f]IGh5cGVyY29udHJhY3Rpb24gb2YgbXlvZmlicmlscyAoY29udHJhY3Rpb24gYmFuZCBuZWNyb3Npcyku[Qq]

[q] ……………….. usually occurs after repetitive activity and involves the upper costal cartilage at the costochondral or costosternal junctions. The pain is typically reproduced with palpation and worsened with movement or changes in position.

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[f]IENvc3Rvc3Rlcm5hbCBzeW5kcm9tZSAoYWxzbyBrbm93biBhcyBjb3N0b2Nob25kcml0aXMgb3IgYW50ZXJpb3IgY2hlc3Qgd2FsbCBzeW5kcm9tZSku[Qq]

[q] Within the 1st 4 hours of the myocardial infarction, …………. can be seen as microscopic changes and …………………….. as a possible complication.

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[f]IE5vbmUgKE5vcm1hbCBteW9jYXJkaXVtKSwgQ2FyZGlvZ2VuaWMgc2hvY2sgKG1hc3NpdmUgaW5mYXJjdGlvbiksIGNvbmdlc3RpdmUgaGVhcnQgZmFpbHVyZSwgYW5kIGFycmh5dGhtaWEu[Qq]

[q] Within 4-24 hours of the myocardial infarction, …………. can be seen as microscopic changes and …………………….. as a possible complication.

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[f]IEVhcmx5IGNvYWd1bGF0aXZlIG5lY3Jvc2lzLCByZWxlYXNlIG9mIG5lY3JvdGljIGNlbGwgY29udGVudHMgaW50byBibG9vZDsgZWRlbWEsIGhlbW9ycmhhZ2UsIHdhdnkgZmliZXJzLiBDb21wbGljYXRpb25zOiBBcnJoeXRobWlhIGlzIGFuIGltcG9ydGFudCBjYXVzZSBvZiBkZWF0aCBiZWZvcmUgcmVhY2hpbmcgdGhlIGhvc3BpdGFsIGFuZCB3aXRoaW4gdGhlIGZpcnN0IDI0IGhvdXJzIHBvc3QtTUku[Qq]

[q] Within 1-3 Days of the myocardial infarction, …………. can be seen as microscopic changes and …………………….. as a possible complication?

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[f]IEV4dGVuc2l2ZSBjb2FndWxhdGl2ZSBuZWNyb3Npcy4gVGlzc3VlIHN1cnJvdW5kaW5nIGluZmFyY3Qgc2hvd3MgYWN1dGUgaW5mbGFtbWF0aW9uIHdpdGggbmV1dHJvcGhpbHMu

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[q] Within 4-7 Days of the myocardial infarction, …………. can be seen as microscopic changes and …………………….. as a possible complication?

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[f]IHJvYnVzdCBwaGFnb2N5dG9zaXMgb2YgZGVhZCBjZWxscyBieSBtYWNyb3BoYWdlcy4=

JiM4MjExOyBDb21wbGljYXRpb25zOg==
[Qq] 1. Free wall rupture –> cardiac tamponade. Ventricular free wall rupture is a complication of transmural (ST-elevation) myocardial infarction (Ml) that generally occurs 3 to 7 days after the onset of total ischemia, when coagulative necrosis, neutrophil infiltration, and enzymatic lysis of connective tissue have substantially weakened the infarcted myocardium. Free wall rupture causes cardiac tamponade, which greatly limits ventricular filling during diastole.

2. Papillary muscle rupture –> mitral regurgitation.

3. Interventricular septal rupture due to macrophage-mediated structural degradation –> VSD.

[q] Within 1-2 Weeks of the myocardial infarction, …………. can be seen as microscopic changes and …………………….. as a possible complication?

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[f]IFdlbGwtZGV2ZWxvcGVkIGdyYW51bGF0aW9uIHRpc3N1ZSB3aXRoIG5lb3Zhc2N1bGFyaXphdGlvbi4gwqBEdXJpbmcgdGhlIHNlY29uZCB3ZWVrIGFmdGVyIE1sLCB0aGUgZGFtYWdlZCB0aXNzdWUgaXMgcmVwbGFjZWQgYnkgZ3JhbnVsYXRpb24gdGlzc3VlIGFuZCBuZW92YXNjdWxhcml6YXRpb24gaXMgZm91bmQgaW4gdGhlIGluZmFyY3Qgem9uZS4=

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[q] Within 2 Weeks to several months of the myocardial infarction, …………. can be seen as microscopic changes and …………………….. as a possible complication?

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[f]IHByb2dyZXNzaXZlIGNvbGxhZ2VuIGRlcG9zaXRpb24gYW5kIHNjYXIgZm9ybWF0aW9uLg==

JiM4MjExOyBDb21wbGljYXRpb25zOg==
[Qq] 1. Aneurysm [Outward bulge with contraction (“dyskinesia”), associated with fibrosis].

2. Mural thrombus.

3. Dressler syndrome (autoimmune inflammatory reaction to myocardial neo-antigens formed as a result of the MI –> autoimmune pericarditis; it takes weeks for antibodies to develop Vs. post-infarction fibrinous pericarditis).

[q] (Early-onset or Late-onset) post-myocardial infarction (Ml) pericarditis develops between days 2 and 4 following a transmural myocardial infarction and represents an inflammatory reaction to cardiac muscle necrosis that occurs in the adjacent visceral and parietal pericardium?

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[q] (Early-onset or Late-onset) post-myocardial infarction (Ml) pericarditis begins one week to a few months following the Ml and affects less than 4% of cases and is thought to be an autoimmune polyserositis.

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[f]IExhdGUtb25zZXQgKERyZXNzbGVyJiM4MjE3O3Mgc3luZHJvbWUpLg==[Qq]

[q] ………… rises after 4 hours (peaks at 24 hr) and is ↑ for 7–10 days; more specific than other protein markers.

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[q] ……….. rises after 6-12 hours (peaks at 16–24 hr) and is predominantly found in myocardium but can also be released from skeletal muscle. Useful in diagnosing reinfarction following acute MI because levels return to normal after 48 hours.

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[q] Repetitive ischemia of cardiac myocytes or persistent hypoperfusion of myocytes can result in a chronic but reversible loss of contractile function, referred to as ………..?. ………….. is a less severe form of ischemia-induced reversible loss of contractile function but its repetition can result in hibernation.

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[f]IGhpYmVybmF0aW9uLCBNeW9jYXJkaWFsIHN0dW5uaW5nLg==[Qq]

[q] When ischemia lasts less than 30 minutes, restoration of blood flow leads to reversible contractile dysfunction, with contractility gradually returning to normal over the next several hours to days which is called ……….?. However, after about 30 minutes of total ischemia, ischemic injury becomes …………?

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[f]IG15b2NhcmRpYWwgc3R1bm5pbmcsIGlycmV2ZXJzaWJsZS4=

[q] Simple mitochondrial swelling is associated with (reversible or irreversible) cellular injury, however, mitochondrial vacuolization is typically a sign of (reversible or irreversible) cell injury?

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[q] The major determinant of whether or not a coronary artery plaque will cause ischemic myocardial injury is ………….?

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[f]IHRoZSByYXRlIG9mIGdyb3d0aCBhdCB3aGljaCBpdCBvY2NsdWRlcyB0aGUgaW52b2x2ZWQgYXJ0ZXJ5Lg==[Qq]

[q] In 90% of individuals occlusion of the right coronary artery can result in transmural ischemia of ……………., producing ST elevation in leads II, III, and aVF as well as  possible sinus node dysfunction —-> Bradycardia?

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[f]IHRoZSBpbmZlcmlvciB3YWxsIG9mIHRoZSBsZWZ0IHZlbnRyaWNsZS4=[Qq]

[q] Leads I and aVL corresponds to the lateral limb leads on ECG. Therefore, ST elevation or Q waves in these leads are indicative of infarction involving the lateral aspect of the left ventricle, which is supplied by …………?

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[f]IHRoZSBsZWZ0IGNpcmN1bWZsZXggYXJ0ZXJ5Lg==

[q] ………….. typically presents with hypotension and distended jugular veins, and clear lungs after ST elevation MI.

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[f]IFJpZ2h0LXNpZGVkIGhlYXJ0IGZhaWx1cmUu

[q] …………. is usually the first arrhythmia to appear as the result of acute myocardial ischemia and is the most common cause of lethal cardiac arrest in CAD-related SCD.

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[f]IFZlbnRyaWN1bGFyIGZpYnJpbGxhdGlvbi4=

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