Question 1

Which condition is a cause of acquired aortic regurgitation?

Accepted Answer

Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation.

Question 2

What is the cause of the dyspnea resulting from a thoracic aneurysm?

Accepted Answer

Clinical manifestations of an aneurysm depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs directly causes symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness). A thoracic aneurysm does not cause dyspnea through poor oxygenation, atherosclerotic lesions, or impaired blood flow.

Question 3

What factors contribute to the development of orthostatic hypotension? (Select all that apply.)

Accepted Answer

Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process. Volume overload would not produce orthostatic hypotension.

Question 4

A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has elevated pulmonary vascular resistance. Which complication would the health care professional assess the patient for?

Accepted Answer

Right heart failure is most often caused by left heart failure, but if it occurs in isolation it is usually due to pulmonary conditions such as pulmonary hypertension, COPD, or cystic fibrosis. The professional would assess the patient for this condition at healthcare visits. Eventually the left side of the heart will fail if right-sided failure is left untreated. Restrictive cardiomyopathy is caused by infiltrative diseases. Hypertrophic cardiomyopathy is caused by hypertension.

Question 5

What electrocardiogram (ECG) change would the healthcare professional assess for when a patient's myocardial infarction extends through the myocardium from the endocardium to the epicardium?

Accepted Answer

Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI (ST segment elevation myocardial infarction). A prolonged QT interval can lead to dysrhythmias. A prolonged PR interval is a benign first degree AV block.

Question 6

What is the most common cause of infective endocarditis?

Accepted Answer

Infective endocarditis is a general term used to describe infection and inflammation of the endocardium-especially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci.

Question 7

What cardiac pathologic condition contributes to ventricular remodeling?

Accepted Answer

Myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling.

Question 8

What is the trigger for angina pectoris?

Accepted Answer

Angina pectoris is chest pain caused by myocardial ischemia. Atherosclerotic lesions make angina more likely as vessel lumens narrow in coronary artery disease. High lipid levels are a risk factor for CAD. Myocardial necrosis is death of heart tissue and would be the consequence of ischemia that was not relieved.

Question 9

Which statement is true concerning the cells' ability to synthesize cholesterol?

Accepted Answer

Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol. It is not affected by aging nor do cells only produce cholesterol when dietary fat is low. Most is not converted to the low-density form.

Question 10

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume?

Accepted Answer

Activation of the RAAS increases preload through the effects of aldosterone secretion, a sequela of the RAAS activity. RAAS also increases afterload through vasoconstriction mediated by angiotensin II.

Question 11

Which assessment findings would the health care professional correlate with aortic stenosis? (Select all that apply.)

Accepted Answer

The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

Question 12

How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?

Accepted Answer

Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways, including causing peripheral vasoconstriction and fluid retention. These homeostatic responses increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II does not cause hyperkalemia and dysrhythmias; it does not reduce cardiac contractility, and it does not stimulate the SNS.

Question 13

Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy?

Accepted Answer

Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. This characterization is not true of the other forms of cardiomyopathy.

Question 14

A patient has infective endocarditis. Which risk factors should the healthcare professional assess this patient for? (Select all that apply.)

Accepted Answer

Risk factors for infective endocarditis include acquired valvular heart disease and valve replacements, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Rheumatic fever is not considered a direct risk factor for infective endocarditis.

Question 15

A healthcare provider is assessing a patient who has a pericardial effusion and notes a pulsus paradoxus. A student asks for an explanation of how this occurs. What description by the professional is best?

Accepted Answer

Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mmHg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers.

Question 16

A patient in the Emergency department is suspected of having a myocardial infarction (MI). The initial cardiac troponin 1 level was negative. What action by the healthcare professional is best?

Accepted Answer

Several cardiac biomarkers exist including the most specific, cardiac troponin 1 (cTnI), cTnI begins to rise within 2 to 4 hours after cardiac injury, so if the initial result is normal, the test should be repeated within 6 to 9 hours and again at 12 to 24 hours. It is not known yet if the patient has had an MI so treatment with thrombolytic therapy would be premature. The patient should not be dismissed since the professional suspected an MI. The patient does need oxygen and pain medication (if pain is present) but that option is not directly related to the question.

Question 17

Which information regarding fatty streaks does the pathophysiology student learn? (Select all that apply.)

Accepted Answer

The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall. They are not formed by killer T cells.

Question 18

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with breathing and when lying down. What action by the healthcare professional is most appropriate?

Accepted Answer

This patient has manifestations of acute pericarditis, which also include dysphagia, restlessness, irritability, anxiety, malaise, and weakness. The treatment is generally a course of nonsteroidal antiinflammatory medication. A pericardiocentesis would be used for a cardiac tamponade. The patient does not need an ECG or diuretics.

Question 19

A patient in the clinic reports fever, arthralgia, a rash, and nosebleeds. What other information should the healthcare professional elicit from this patient?

Accepted Answer

These manifestations are characteristic of rheumatic fever and usually occur 1 to 5 weeks after a streptococcal infection of the nasopharynx. The professional should inquire about recent illnesses and infections. Other family members may or may not have been sick too, so this is not the best question. These symptoms are not seen after chest trauma or with Marfan syndrome.

Question 20

A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy?

Accepted Answer

Only hypertrophic obstructive cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.

Quiz 33: Alterations of Cardiovascular Function