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Side ASide B
General increase in bulk of a part of organ not due to tumor formation.
What is the normal weight of the heart?
300 grams in males and 250g in females
Abnormal tissue displacement is known as...
The changing from one cell type to another is known as...
Hyperplasia is defined as...
An increase in the # of cells
Define adaptive hypertrophy...
working out causes increase in the size of muscle
Give an example of compensatory hypertrophy...
one kidney fails, the other gets larger b/c it works harder
True/False:mitral valve stenosis means the mitral valve does not open correctly.
What chambers of the heart have increased pressure during mitral valve stenosis? Decreased pressure?
LA and RV; LV will have decreased pressure
Under what 2 conditions would the LEFT ventricle undergo hypertrophy?
Arterial hypertension & Aortic Stenosis
Under what condition would the RV undergo hypertrophy?
Mitral valve stenosis with accompanying pulmonary hypertension
What does an enlarged chamber size indicate? hypertrophy or dialation?
An increase in cardiac weight or size is termed...
What valve separates the RA from the RV?
How many 'leaflets' does the mitral valve have?
How many 'leaflets' does the Pulmonic valve have?
What two valves may be referred to as 'semilunar?'
Pulmonic and Aortic valve
How many 'leaflets' does the Aortic valve have?
Which valve of the heart is the largest?
Back flow occurs when what goes wrong with a particular valve?
When a valve does not close properly, back flow occurs (which leads to hypertrophy)
Which valve is the smallest?
What is the 'nodule of Arantius?'
small nodule on each of the 3 leaflets of the aortic valve which facilitates closure
What valves are associated with chordae tendineae?
Atrioventricular valves (mitral and tricuspid)
What do chordae tendineae attach to?
Papillary muscles in the ventricular wall
Coordinated actions of related structures that aid in the proper function of one of the AV valves is known as what?
What components make up the mitral apparatus?
Annulus, leaflets, cords, papillary muscles and LV wall
Cardiac valves are lined with what type of cells?
What is the function of the loose connective tissue associated with cardiac valves known as 'spongiosa?'
How are cardiac valves nourished?
via diffusion from the heart's blood
The point where aortic valve leaflets are joined together is known as....
Widening of aortic valve commissures is an indication of a disease known as....
What 4 structures comprise the conducting system of the heart?
SA node, AV node, Purkinje fibers and Bundle of His
True/False:Myocytes do not have a distinct outer boundary meaning they are virtually continuous with the cytoplasm of neighboring cells.
Cardiac myocytes are organized into a Syncitial arrangement. This is essential for what two actions?
Transmission of electrical impulses & synchronized contraction of chambers
What are considered the functional units of each cardiac myocyte?
What two contractile proteins are associated with sarcomeres?
actin and myosin
Sarcomeres are separated by what dark, fibrous structure?
What mechanism accounts for the pattern of contractile strength in relation to sarcomere length?
True/False:Ventricular myocytes are smaller than atrial myoctes which allows for a greater strength of contraction
False; they are larger than atrial myocytes
Atrial natriuretic peptide is stored where?
In 'specific atrial granules'
Where are'specific atrial granules' located within the atrial cells?
Where is atrial natriuretic peptide synthesized?
atrial muscle cells
What are the functions of natriuretic peptides?
1. Vasodialation2. Natriuresis3. Supression of Renin-angiotensinaldosterone axis 4. Fall in arterial pressure
True/False:Natriuretic peptides are harmful to the heart that is in a pathological state.
False; it is beneficial
True/False:Epicardium and Pericardium make up the pericardial sac and are comprised of the SAME mesothelial cells.
True, they are very closely related
The cardiac pacemaker is known as...
The SA node creates cardiac impulses at a rate of....
The AV node transmits the impulses from the SA node to the Bundle of His; however, when the SA node fails the AV node can take over. It produces impulses at a rate of....
When the AV node takes over for a faulty SA node it is known as....
Where is the AV node located?
In the RA at the posterior part of the interatrial septum
What is the normal function of the Bundle of His?
transmit impulses to the ventricles
Can the Bundle of His originate cardiac impulses?
Yes, at a rate of 36 bpm (very slow)
What is occurring with a condition known as 'Heart Block?'
The SA and AV node have failed and the Bundle of His has taken over in the production of cardiac impulses
What is the terminal branch of the conducting system of the heart?
True/False:When all else fails, the Purkinje fibers are capable of producing cardiac impulses
A Bundle Branch Block effects what portion of the cardiac conducting system?
Purkinje fibers; this results in loss of efficiency of ventricular contraction
A condition where the ventricular muscle is incapable of maintaining a circulation adequate for the needs of the body....
Congestive Heart Failure (CHF)
What is the difference between forward and backward heart failure?
Forward HF is characterized by decreased Cardiac output while backward HF is characterized by damming back of blood in the venous system due to inadequate emptying of...
True/False:It is an uncommon and very serious condition when both forward and backward HF occur simultaneously.
False; although any HF is a serious condition, forward and backward HF are commonly found together
What is the most common (very serious) disease of the heart that leads to primary muscle failure?
Ischemic Heart Disease
True/False:Inflammation & toxic degeneration of the mycardium leads to Primary Pump Failure.
True/False:Valvular diseases and Electrical disorders involving the SA node, AV node etc. are associated with Primary Pump Failure.
False; secondary pump failure
Cardiomyopathies lead to what type of pump failure?
An increased work load will eventually lead to what type of pump failure?
All pump failures (primary or secondary) ultimately lead to what condition?
At autopsy, the hearts of patients having CHF are generally characterized by what 4 findings?
1. Increased weight2. Chamber dialation3. Thin walls4. Having microscopic changes of hypertrophy
The onset of heart failure is usually preceded by what?
True/False:Cardiac hypertrophy initially mediates enhanced function but it eventually leads to heart failure.
True/False:Failure of the LA is associated with passive congestion of the lungs & pulmonary edema
False; LV not LA
Chronic pulomonary edema leads to what condition?
Failure of which chamber is characterized by generalized subcutaneous edema as well as enlargement of the liver and spleen?
Progressive damming of blood within the pulmonary circulation and diminished peripheral blood flow leads to what condition?
Left sided heart failure
Which of the following are not considered causes of left sided heart failure?a - Ischemic heart diseaseb - Excessive Renin secretionc - Aortic valvular stenosisd - Non ischemic myocardial...
e - all of the above
A fibrillating left atrium carries an increased risk of developing what condition?
Where is the most prominent extra-cardiac effect manifested in left ventricular failure?
Macrophages that ingest hemoglobin from edema in the lungs are known as...
What is the cardinal complaint of patients suffering from left-ventricular failure?
Hemosiderin-containing macrophages found in cells that have undergone HF are called....
Hemosiderin-containing macrophages in the alveoli indicates previous episodes of .
Dyspnea while lying down that is relieved by sitting or standing is known as what?
Sudden onset of extreme dyspnea bordering on suffocation (usually occurs at night) is characteristic of a condition known as....
Paroxysmal nocturnal dyspnea
True/False:Cough is a common accompaniment of left-ventricular failure.
True; the cough is the lungs plea for more air
What secondary organs are affected by left-ventricular failure?
Kidneys and Brain
Cause of RV failure or LV failure:a - Lung Disease (emphysema, fibrosis, etc.)b - Congenital heart diseasec - Ischemic heart diseased - Mitral stenosise - Systemic Hypertensionf - Mitral...
a - RVb - RVc - LVd - RVe - LVf - LVg - LV
Nitrogen retention resulting from something other than primary renal disease is known as what?
Dilation & hypertrophy of the right heart in response to pulmonary hypertension is known as...
Pure right-sided heart failure most often occurs as a result of what condition?
Chronic severe pulmonary hypertension
Acute right heart failure occurs most commonly in response to an obstruction of the outflow tract of the RV. What is this obstruction?
Massive pulmonary embolus
Compression of venous return to the heart due to increased volume of fluid in the pericardium is known as what?
True/False:Pure right sided heart failure is uncommon, it usually is a secondary consequence of left sided HF.
True/False:One of the common symptoms of Right sided heart failure is pulmonary congestion.
False; this is rarely a symptom, more often engorgement of the systemic & portal venous systems occur (peripheral edema)
What organs are effected by Right sided HF?
Liver & portal system
Cardiac sclerosis or cardiac cirrhosis can develop as a result of cardiac failure of which side of the heart?
Right sided HF
Right sided heart failure may lead to swelling of what two primary organs?
Liver and spleen
Congestion of the kidneys is marked more in Right or Left sided HF?
Right sided HF
Large effusions in the pleural and pericardial space effect the lungs in what way?
may cause partial atelectasis (lung collapse)
Generalized massive edema is called....
Peripheral edema is the hallmark of....
right sided HF
What are 4 major consequences of increased pressure in the alveolar capillaries?
1. Microhemorrhages release RBC's into alveolar spaces (formation of hemosiderin)2. Increased hydrostatic pressure forces fluid from blood into lungs (pulmonary edema)3. Fibrosis occurs...
Which of the following symptoms are associated with Right Sided HF?a - Pitting edemab - Jugular vein distensionc - orthopnead - paroxysmal nocturnal dyspneae - none of the above
b - Pitting edema
True/False:CHF is the consequence of inadequate cardiac output
A group of closely related syndromes resulting from myocardial ischemia is known as....
Ischemic Heart Disease
"to keep back or hold back blood due to mechanical obstruction" is the definition for what?
True/False:Inadequate removal of metabolites can lead to myocardial ischemia.
True; "garbage collectors are important too"
What is the etiology of Ischemic Heart Disease?
narrowing of one or more of the three coronary artery branches
What are the 3 coronary artery branches associated with IHD?
1. Left coronary A. (Anterior descending branch)2. Right coronary A.3. Left coronary A. (Circumflex branch)
98% of the cases of IHD are caused by....
Which type of ischemia (acute or chronic) is associated with 'sudden death?'
Which type of ischemia(acute or chronic) is associated with myocardial fibrosis?
Which type of ischemia(acute or chronic) is associated with coronary artery stenosis?
Myocardial infarcts involve primarily what anatomical areas of the heart?
Left ventricle, interventricular septum and conducting system**the atria and RV are rarely involved
Transmural infarcts are usually (90%) caused by what? (which form in the atherosclerotic coronary arteries.)
How is fibrinolysis (breaking down the fibrous component of clots) initiated?
by the activation of plasminogen to plasmin
True/False:Thrombolytic drugs are fibrinogen activators.
False; thrombolytic drugs are plasminogen activators
True/False:The second generation of plasminogen activators convert all plasminogen to plasmin throughout the body
False; this describes 1st generation plasminogen activators, 2nd generation activates selectively
What are two examples of first generation plasminogen activators?
Steptokinase & Uorkinase
What are to examples of second generation plasminogen activators?
Alteplase & Reteplase
Reprofusion injuries may be mediated by the generation of what?
oxygen free radicals
What is the most common complication of myocardial infarction that is also the most common causation of death?
Cardiac standstill or absence of contractions of the heart.
What is the most dangerous type of arrhythmia?
ventricular fibrillation (it leads to cardiac arrest)
True/False:The occurrence of tachyarrhythmias is related to the size of the infarct.
True/False:Alkaline phosphatase is an enzyme present in early-developing neutrophil granules.
False; present in late-developing granules
What enzyme is present in early developing neutrophil granules?
Peroxide reacting enzymes
What effect is the ultimate cause of death for a patient that has a rupture of the free wall of the LV?
How many days after a transmural infarct does fibrohemorrhagic pericarditis set in?
The epicardial manifestation of the underlying myocardial inflammation.....