Term
34
Describe Kawasaki Disease. |
|
Definition
condition that causes inflammation in the walls of medium-sized arteries throughout the body, including the coronary arteries, which supply blood to the heart muscle
-acute, self-limiting
-80% are 5yoa or younger
-peak in spring/winter
-etiology unknown |
|
|
Term
34.
how many stages are in Kawasaki disease? |
|
Definition
|
|
Term
34.
What is stageI of Kawasaki disease? |
|
Definition
| Stage I (days 1-12): small capillaries, arterioles, and venules become inflamed, as does the heart iteself |
|
|
Term
34.
what is stageII of Kawasaki disease? |
|
Definition
| StageII (days 13-25) Inflammation spreads to larger vessels, and aneurysms of the coronary arteries develop |
|
|
Term
34.
what is stage III of Kawasaki disease? |
|
Definition
Stage III (days 26-40)
Medium-size arteries begin the granulation process, causing coronary artery thickening;
inflammation resolves in the microcirculation;
there is risk of thrombus formation |
|
|
Term
34.
what is stage IV of Kawasaki disease? |
|
Definition
| Stage IV (day 41+) vessels develop scarring, intimal thickening, calcification, and stenosis of coronary arteries |
|
|
Term
34.
what are the 3 stages of manifestation, and describe them |
|
Definition
acute: fever, conjunctivitis, oral changes, rash, lymphadenopathy, irritability
subacute: fever ends; subacute ends when clinical signs resolve. -most at risk of coronary artery aneurysm development, desquamation of the palms and soles, thrombocytosis
convalescence: elevated ESR (erythrocyte sedimentation rate and platelet count, arthritis; ends when lab values return to normal |
|
|
Term
34.
what is required to diagnose Kawasaki disease? |
|
Definition
*Fever for 5 or more days
4/5 of the following:
1.bilateral conjuntivitis WITHOUT exudate
2. oral mucous membrane change (redness, swelling, dryness
3. extremity changes: edema, desquamation of palms/soles
4. rash, accentuated in perineum
5.cervical lymphadenopathy
May also have: high ESR, thromobytosis, high liver enzymes |
|
|
Term
34.
how is Kawasaki disease treated? |
|
Definition
|
|
Term
35.
what si the most common cyanotic congenital heart defect? |
|
Definition
|
|
Term
35.
what is tetralogy of Fallot? |
|
Definition
Four defects:
1. large ventricular-septal defect (VSD)
2. overiding aorta that straddles the VSD
3. pulmonary stenosis
4. RV hypertrophy |
|
|
Term
35.
when is surgery required for tetralogy of Fallot? |
|
Definition
| when hypercyanotic spells occur |
|
|
Term
35.
what role does squatting have to do with tetralogy of Fallot? |
|
Definition
squatting increases systemic resistance while decreasing venous return to the heart from the inferior vena cava. decreased systemic return makes more oxygenated blood available to the body
decreased systemic resistance reverses the shunt through the VSD to a left-to-right shunt |
|
|
Term
37.***
what are the four types of congenital heart defects? |
|
Definition
1. lesions increasing pulmonary blood flow
2. lesions decreasing pulmonary blood flow
3. obstructive lesions (right- or left-sided outflow prevent flow out of heart)
4. mixing lesions (where desaturated blood mixes with saturated blood) |
|
|
Term
37.
what are examples of lesions increasing pulmonary artery flow? |
|
Definition
patent ductus arteriosus,
atrial septal defect,
ventricular septal defect,
complete atrioventricular canal defect |
|
|
Term
37.
what are examples of lesions decreasing pulmonary blood flow? |
|
Definition
tetralogy of Fallot,
tricuspid atresia |
|
|
Term
37.
what are some examples of obstructive lesions? |
|
Definition
coarctation of the aorta,
hypoplastic left heart syndrome,
aortic stenosis,
pulonary stenosis |
|
|
Term
37.
what are some examples of mixing lesions? |
|
Definition
transposition of the great arteries,
total anomalous pulmonary venous connection,
truncus arteriosus |
|
|
Term
67.
what are the facors (triad of Virchow) that promote venous thrombosis? |
|
Definition
1. venous stasis (obesity, leg dependency, HF, age)
2. venous endothelial damage (trauma,meds)
3. hypercoagulable states (malignancy, pregnancy, contraceptives, estrogen, Factor V Leiden mutation, prothrombin mutation, antithrombin) |
|
|
Term
71.
What is arteriosclerosis? |
|
Definition
a condition commonly called hardening of the arteries.
-Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff — sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, |
|
|
Term
72.
What is atherosclerosis? |
|
Definition
| A form of arteriosclerosis in which thickening and hardening of the vessel are caused by the accumulation of lipid-laden macrophages within the arterial wall; leads to formation of plaque |
|
|
Term
73.
what is tricuspid atresia? |
|
Definition
-no flow through tricuspid valve (imperforate)
-septal defectS (between atria, AND between ventricles)
-hypoplastic or absent RV (right vent.)
-enlarged mitral valve and LV (left vent.)
-pulmonic stenosis (variable) |
|
|
Term
73.
what is the treatment for tricuspid atresia? |
|
Definition
prostaglandins to maintain adequate pulmonary perfusion,
and surgery, PA band, shunt |
|
|
Term
|
Definition
infection of the dermis and subutaneous tissue by staph, group B strep, or MRSA
-associated with chronic venous insufficiency and stasis dermatitis |
|
|
Term
74.
what are risk factors for cellulitis? |
|
Definition
| DM, edema, PVD, tinea pedis, insect bites, immune suppression |
|
|
Term
75.
what is the most common cause of CAD (coronary artery disease)? |
|
Definition
|
|
Term
75.
persistent ischemia or the complete occlusion of a coronary artery causes _____. |
|
Definition
|
|
Term
75.
what is the term for irreversible myocardial injury? |
|
Definition
| infarction, or heart attack |
|
|
Term
76.
what are the major MODIFIABLE risk factors for CAD? |
|
Definition
non-modifiable:
1. age
2. male
3. family history |
|
|
Term
76.
what are the major NON-MODIFIABLE risk factors for CAD? |
|
Definition
modifialble:
1.dyslipidemia,
2. HTN
3. cigarette smoking
4. diabetes/insulin resistance
5. obesity
6. sedentary lifestyle
7. atherogenic diet |
|
|
Term
76.
what cholesterol levels put you at an increased risk for CAD? |
|
Definition
|
|
Term
76.
what is responsible for a two= to threefold increasd risk of atheroslcerotic cardiovascular disease, including MI? |
|
Definition
|
|
Term
76.
decreased adiponectin in obese individuals has been linked to a significant ________ (increase or decrease) in cardiovascular risk. |
|
Definition
increase.
effects include:anti-iflammatory, insulin sensitizing, enhancement of nitric oxide generation, attenuation of ROS's in endothelial cells, reduced vascular smooth muscle cell proliferation |
|
|
Term
77.
what is the result of prolonged ischemia that causes irreversible damage to heart muscle? |
|
Definition
|
|
Term
77.
what are the two classifications of MI? |
|
Definition
|
|
Term
77.
what is the term for ACS that results in reversible myocardial ischemia? why is recognition important? |
|
Definition
Unstable Angina
-it signals that the atherosclerotic plaque has ruptured, and infarction may soon follow |
|
|
Term
77.
what does the EKG reveal during unstable angina? |
|
Definition
ST-depression and T-wave inversion during pain
-EKG changes resolve with relief of pain |
|
|
Term
77.
if a thrombus breaks up before complete distal tissue necrosis has occurred, the infarction will involve only the myocardium directly beneath the endocardium. how does this appear on the EKG? |
|
Definition
ST depression and T-wave inversion:
non-STEMI! |
|
|
Term
77.
If the thrombus lodges permanently in the vessel, the infarction will extend through the myocardium all the way from endocardium to epicardium (transmural MI), resulting in severe cardiac dysfunction. What does this show on the EKG? |
|
Definition
|
|
Term
77.
what are some complications from reperfusion? |
|
Definition
-acidosis: hydrogen ion and lactic acid accumulation
-electrolyte distubances: loss of potassium, calcium, magnesium
-release of catecholamines (epinephrine and norepinephrine)
-hyperglycemia with 72 hours of acute MI |
|
|
Term
77.
what is the danger of exercise in 1-2 weeks after MI? |
|
Definition
-weak, fibrotic scar tissue forms, revascularization begins;
-very vulnerable to stress
-scarring not complete until 6 weeks |
|
|
Term
78/82.
what are the two types of left heart failure? |
|
Definition
2 types of CHF:
systolic heart failure- reduced ejection fraction
diastolic heart failure- preserved ejection fraction |
|
|
Term
78.
what are the 3 influences on stroke volume? |
|
Definition
contractility
preload
afterload |
|
|
Term
78/110.
what are the results of ventricular remodeling? |
|
Definition
-dilation of the myocardium causes progressive myocyte contractile dysfunction over time
-dopsition of collagen between myocites decreases contractility
-lack of kidney perfusion causes increased afterload due to increased PVR and plasma Vol.
-hypothalamus releases ADH |
|
|
Term
78.
what is the most common cause for increased afterload? |
|
Definition
| increased peripheral vascular resistance, as in hypertension |
|
|
Term
80.
what are 7 characteristics of systolic congestive heart failure? |
|
Definition
1.catecholamines (direct toxicity)
2. RAAS (angiotensin II, aldosterone--both cause fibrosis)
3. Arginine vasopressin (renal fluid retention, hyponatremia, edema)
4. Natriuretic Peptides (decrease preload-inadequate)
5. Inflammatory Cytokines (endothelin-vasocontrictor, TNF/IL-reduces NOx)
6. Myocyte calcium transport
7. Insulin resistance and DM (abnormal fatty acid metabolism, generation of ATP) |
|
|
Term
78.
what are s/s of heart failure? |
|
Definition
| dyspnea, orthopnea, cough of frothy sputum, fatigue, decreased urine output, edema, pulmonary edema, hypo/hyper tension S3 gallop, and CAD or hypertension |
|
|
Term
78.
what is the treatment for CHF? |
|
Definition
| ACE inhibitors, diuretics, and Beta-blockers |
|
|
Term
82.
what is needed to diagnose diastolic heart failure? |
|
Definition
-s/s of heart failure
-preserved left ventricular ejection fraction
-abnormal diastolic relaxation (-decreased compliance of left ventricle-stiffening) |
|
|
Term
81.
what is end diastolic volume? |
|
Definition
| the volume of blood in the heart at the end of diastole |
|
|
Term
83.
T or F?
disorders of the endocardium all damage the heart valves. |
|
Definition
|
|
Term
83/106.
what is valvular stenosis? |
|
Definition
| the valve orifice is constricted and narrowed, impeding the forward flow of blood and increasing the workload of the cardiac chamber proximal to the diseased valve |
|
|
Term
83/106.
what is valvular regurgitation? |
|
Definition
| the valve leaflets fail to shut completely, permitting blood flow even when it is supposed to be closed |
|
|
Term
83.
what is the most common valvular abnormality affecting nearly 2% of adults older than 65yoa? What are 3 common causes? |
|
Definition
aortic stenosis
1.congenital bicuspid valve
2. calcific degeneration related to aging
3.inflammatory damage caused by rheumatic heart disease
-also, genetic abnormalities |
|
|
Term
83.
which valve has 2 leaflets (cusps)? |
|
Definition
Mitral valve, or bicuspid valve
-between left atrium and left ventricle |
|
|
Term
83/107.
what is mitral valve prolapse syndrome? |
|
Definition
| when the anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole |
|
|
Term
|
Definition
used to assist diagnoses of an acute myocardial infarction. It measures the blood level of CK-MB
-superseded by troponin test
-found in the heart, muscles, and other organs. These include the small intestine, brain, and uterus |
|
|
Term
85.
what is myoglobin and why is it significant? |
|
Definition
myoglobin is only found in the bloodstream after muscle injury
Negative results obtained from a myoglobin test can be used to rule out a heart attack. However, positive results do not confirm that a heart attack has indeed occurre |
|
|
Term
106.
________ impairs the flow of blood from the left atrium to the left ventricle. |
|
Definition
|
|
Term
106.
what is the most common cause of mitral stenosis |
|
Definition
|
|
Term
106.
how does strep cause mitral valve stenosis? |
|
Definition
| autoimmunity is response to group A beta-hemolytic streptococcal M protein antigens leads to inflammation and scarring of the valvular leaflets-becoming fibrous and fused, with shortened chordae tendineae |
|
|
Term
106.
What are long term outcomes of untreated chronic mitral stenosis? |
|
Definition
pulmonary HTN,
edema,
right ventricular heart failure |
|
|
Term
106.
_______ results from an inability of the aortic valve leaflets to lose properly during diastole resulting from abnormalities of the leaflets or the aortic root, or both. |
|
Definition
|
|
Term
106.
What is the most common cause of mitral regurgitation? |
|
Definition
mitral valve prolapse and rheumatic heart disease
(other causes: endocarditis, CAD, Marfan syndrome, congestive cardiomyopathy) |
|
|
Term
106.
Is rheumatic fever limited only to infection by group a beta-hemolytic streptococci?
What is the best way to prevent rhematic fever? |
|
Definition
Yes, limited only to group A beta-hemolytic strep.
besides hygiene, appropriate antibiotic therapy within the first 9 days of infection prevents rheumatic fever |
|
|
Term
106
what layer of the heart is most often involved in carditis related to RHD?
(endocardium, myocardium, pericardium) |
|
Definition
| endocardium, which inclued heart valves |
|
|
Term
111.
what is a distinctive truncal rash often accompanying acute rheumatic fever?
-pink, nonpruritic, erythematous macules NOT on the face or hands |
|
Definition
|
|
Term
106
when is active disease resolved in rheumatic fever? |
|
Definition
1. murmur disappears
2. major manifestations no longer present
3. afebrile
4 normal ESR |
|
|
Term
106
continuous prophylactic antibiotic therapy for as long as ____ _____ is necessary to prevent recurrence of acute rheumatic fever. |
|
Definition
|
|
Term
108
what are the 3 types of cardiomyopathy? |
|
Definition
dilated
hypertrophic
restrictive |
|
|
Term
108
what is dilated cardiomyopathy? |
|
Definition
diminished myocardial contractility
-result of ischemic heart disease, valvular disease, diabetes, renal failure, hyperthyroidism, alcohol or drug toxicity, peripartum complications, genetic disorder, or infection |
|
|
Term
108.
what is the most common inherited heart defect? |
|
Definition
| hypertrophic obstructive cardiomyopathy |
|
|
Term
108
what are the two major categories of thickening of the myocardium? |
|
Definition
1. hypertrophic obstructive cardiomyopathy
2. hypertensive or vavular hypertrophic cardiomyopathy |
|
|
Term
108
what is the most common clinical manifestation of restrictive cardiomyopathy? |
|
Definition
right heart failure with systemic venous congestion.
cardiomegaly and dysrhythmias are common |
|
|
Term
109
what are common causes of pulmonary hypertension not resulting from left heart failure?
(what is an encompassing term for this?) |
|
Definition
COPD
cystic fibrosis
ARDS
(cor pulmonale) |
|
|
Term
112
what is coarctation of the aorta? |
|
Definition
| narrowing of the lumen of the aorta, impeding blood flow |
|
|
Term
112
how does coarctation of the aorta present? |
|
Definition
-higher pressures proximal to the site of stenosis.
-collateral circulation may be present in direction of the descending aorta.
-decreased pulses in lower extremities
-with time, LV hypertrophy |
|
|
Term
112
what is the first step in treatment of the symptomatic infant with COA? |
|
Definition
prostaglandin administration
-also, mechanical ventilation, inotropic support for cardiac output |
|
|
Term
extra?
what is the difference between a pannus and thrombus on a mechanical valve? |
|
Definition
a pannus is a hanging flap of granulation tissue as a response to healing
-common years after surgery (not immediate)
-involves suture line
-appears as an arc rather than round glob |
|
|
Term
slides:
what is the best scan for DVT? |
|
Definition
|
|
Term
67
what is normal for a homocysteine level? |
|
Definition
|
|
Term
slides:
what are elevated blood pressures? |
|
Definition
SBP > 140 mmHg
DBP > 90 mmHg |
|
|
Term
slides:
what is average venous pressure? |
|
Definition
|
|
Term
slides:
average Cardiac output? |
|
Definition
|
|
Term
slides:
what are heart concerns with marfan syndrome? |
|
Definition
weak, small left ventricle
-prone to thoracic aortic aneurisms
-prone to mitral valve problems
=treat BP |
|
|
Term
slides:
what is CREST syndrome? |
|
Definition
a connective tissue disorder
Calcinosis
Raynaud's (exaggerated vasoconstriction)
Esophageal Dysfunction
Sclerodactyly (odd-shaped fingers/toes)
Telengiectasia (dilation of small vessels of face and eyes) |
|
|
Term
107
A bruit is auscultated over the carotid artery. We know this is associated with what valvular diseases? |
|
Definition
| aortic valve stenosis, and mitral regurgitation |
|
|
Term
106.
Which are worse, systolic murmurs or diastolic murmurs? |
|
Definition
|
|
Term
106.
Acronym for systolic murmurs: |
|
Definition
Mitral
Regurgitation
Physiological turbulence
Aortic
Stenosis
Systolic |
|
|
Term
106.
Acronym for diastolic murmurs: |
|
Definition
Mitral
Stenosis
Aortic
Regurgitation
Diasolic |
|
|
Term
slides:
what is high output failure? |
|
Definition
inability of the heart to supply the body with bloodborne nutrients, despite adequate volume and contractility
-associated with sepsis
Beri-Beri= thiamin deficiency |
|
|
Term
slides:
what is required to diagnose pediatric hypertension?
what is the difference between kids and adults? |
|
Definition
systolic and diastolic blood pressure levels are greater than the 95th percentile for age and gender on at least three occasions
-most commonly have underlying renal disease or coarctation of aorta
-cause is almost always found
-commonly asymptomatic |
|
|
