Path 12B Flashcards

Which mechanism most accurately defines ischemic heart disease?

A. Excess perfusion relative to demand
B. Perfusion-demand imbalance
C. Coronary spasm causing necrosis
D. Myocardial inflammation reducing contractility

A 59-year-old man has recurrent myocardial ischemia during exertion. Although coronary vasospasm can produce ischemia, which abnormality accounts for most cases of myocardial ischemia?

A. Epicardial coronary atherosclerosis
B. Isolated coronary vasospasm
C. Myocardial inflammatory edema
D. Pericardial vascular compression

A patient with coronary atherosclerosis remains asymptomatic at rest but develops chest pressure with exercise. Approximately what degree of coronary obstruction generally permits exercise-induced symptomatic ischemia?

A. Greater than 25%
B. Greater than 40%
C. Greater than 50%
D. Greater than 70%

Coronary angiography demonstrates several atherosclerotic plaques responsible for myocardial ischemia. Where are these plaques most commonly concentrated?

A. Distal intramyocardial vessels
B. Proximal major coronary arteries
C. Coronary venous branches
D. Myocardial capillary networks

A 62-year-old woman develops substernal squeezing during brisk walking. Her symptoms resolve without evidence of myocardial cell death. Which description best defines her episode?

A. Transient ischemia without necrosis
B. Persistent ischemia with necrosis
C. Coronary thrombosis with infarction
D. Chronic myocardial scar formation

During myocardial ischemia, several locally generated substances contribute to the perception of anginal pain by stimulating cardiac afferent nerves. Which mediator is specifically involved?

A. Histamine
B. Acetylcholine
C. Adenosine
D. Dopamine

A patient describes discomfort associated with myocardial ischemia. Which description is most characteristic of typical angina pectoris?

A. Sharp, pinpoint pleuritic pain
B. Superficial localized chest tenderness
C. Brief electric chest sensation
D. Deep poorly localized pressure

A 64-year-old man consistently develops chest pressure after walking several blocks. The symptoms occur at a predictable workload and reflect a fixed limitation in myocardial blood supply. Which diagnosis is most likely?

A. Stable angina
B. Prinzmetal angina
C. Unstable angina
D. Sudden cardiac death

A patient with known coronary artery disease develops chest pressure during emotional stress that resolves after resting. What mechanism most directly explains this pattern?

A. Episodic coronary thrombosis
B. Fixed perfusion-demand mismatch
C. Spontaneous coronary vasospasm
D. Progressive myocardial necrosis

A 58-year-old patient has predictable exertional chest discomfort caused by stable angina. Which intervention would most characteristically relieve an acute episode?

A. Continued physical exertion
B. Increased emotional stimulation
C. Rest or vasodilators
D. Increased myocardial oxygen demand

A 45-year-old woman experiences recurrent episodes of chest discomfort while resting. The episodes are unrelated to exercise and resolve rapidly after vasodilator administration. Which mechanism most likely causes her symptoms?

A. Fixed severe coronary narrowing
B. Chronic myocardial scar formation
C. Progressive plaque thrombosis
D. Episodic coronary artery spasm

A patient with Prinzmetal variant angina asks why symptoms can occur while resting rather than during exertion. Which feature best explains this presentation?

A. Ischemia requires myocardial necrosis
B. Spasm occurs independently of activity
C. Fixed stenosis requires exercise
D. Plaque rupture occurs during rest

A young adult develops episodic chest pain after recreational drug use. Evaluation suggests transient coronary vasospasm rather than a fixed perfusion limitation. Which drug is most strongly associated with this mechanism?

A. Cocaine
B. Acetaminophen
C. Amoxicillin
D. Metformin

A patient develops episodic coronary artery spasm after taking a sympathomimetic medication. Which drug from the provided material can produce this complication?

A. Aspirin
B. Adenosine
C. Ephedrine
D. Bradykinin

A 70-year-old man with previously predictable exertional angina now develops more frequent and severe episodes, including pain at rest lasting approximately 25 minutes. Which diagnosis best fits this progression?

A. Stable angina
B. Prinzmetal angina
C. Chronic ischemic disease
D. Unstable angina

A patient with coronary atherosclerosis develops new prolonged chest discomfort at rest. The episodes have become progressively more frequent during the past week. What underlying event most commonly produces this syndrome?

A. Plaque disruption with thrombosis
B. Isolated chronic vasospasm
C. Progressive ventricular hypertrophy
D. Coronary venous obstruction

Which finding most strongly favors unstable angina over the patient's previous pattern of stable angina?

A. Pain reliably follows exercise
B. Increasing frequency and severity
C. Symptoms resolve with rest
D. Fixed perfusion-demand mismatch

Two patients have transient myocardial ischemia without myocardial necrosis. Patient 1 develops predictable pain during exercise, whereas Patient 2 develops episodes at rest unrelated to activity. Which mechanism most likely explains Patient 2's symptoms?

A. Fixed coronary obstruction
B. Exercise-induced oxygen demand
C. Coronary artery spasm
D. Permanent myocardial necrosis

A patient with longstanding stable angina reports that chest discomfort previously occurred only with strenuous exercise. He now experiences prolonged episodes at rest lasting more than 20 minutes. Which change is most concerning for plaque disruption and superimposed thrombosis?

A. Predictable exertional symptoms
B. Relief following rest
C. Poorly localized pressure
D. Crescendo anginal pattern

A patient develops prolonged severe myocardial ischemia resulting in permanent death of cardiac muscle cells. Which diagnosis best describes this process?

A. Stable angina
B. Myocardial infarction
C. Prinzmetal angina
D. Reversible myocardial ischemia

A coronary artery becomes completely occluded during an acute ischemic event. Approximately how quickly can myocardial contractility be lost?

A. Within 2 minutes
B. Within 20 minutes
C. Within 2 hours
D. Within 6 hours

Shortly after severe myocardial ischemia begins, oxygen delivery becomes inadequate for normal cardiac metabolism. Which metabolic consequence occurs early?

A. Increased glycogen synthesis
B. Increased aerobic metabolism
C. Increased phosphate production
D. Decreased high-energy phosphate production

A cardiac myocyte is exposed to severe ischemia. Impaired aerobic metabolism causes accumulation of which substance within the ischemic tissue?

A. Glycogen
B. High-energy phosphates
C. Lactic acid
D. Sarcolemmal proteins

A myocardial biopsy is obtained very early after coronary occlusion, before irreversible injury has developed. Which finding would represent an early reversible ischemic change?

A. Myofibrillar relaxation
B. Sarcolemmal disruption
C. Transmural necrosis
D. Myocyte death

During the earliest reversible phase of myocardial ischemia, cardiac myocytes begin consuming their intracellular energy reserves. Which cellular finding would be expected?

A. Increased glycogen storage
B. Glycogen depletion
C. Sarcolemmal rupture
D. Transmural cell death

A patient experiences brief but severe myocardial ischemia that is corrected before permanent injury develops. Which additional reversible cellular change may already have occurred?

A. Membrane fragmentation
B. Transmural necrosis
C. Biomarker leakage
D. Cellular swelling

A coronary artery is completely occluded, producing severe myocardial ischemia. Approximately when does irreversible cardiac myocyte injury begin?

A. 1–2 minutes
B. 5–10 minutes
C. 20–40 minutes
D. 2–3 hours

A patient undergoes rapid restoration of coronary blood flow 10 minutes after severe ischemia begins. Based solely on the expected timing of irreversible injury, which outcome is most likely?

A. Injury may remain reversible
B. Transmural necrosis is complete
C. Half myocardium is necrotic
D. Sarcolemmal disruption is unavoidable

Severe myocardial ischemia persists for 35 minutes before coronary flow is restored. Which process has most likely begun by this point?

A. Complete transmural necrosis
B. Irreversible myocyte injury
C. Fifty-percent wall necrosis
D. Full contractile recovery

Which cellular alteration represents the earliest detectable feature indicating that an ischemic cardiac myocyte has undergone necrosis?

A. Glycogen depletion
B. Cellular swelling
C. Myofibrillar relaxation
D. Sarcolemmal membrane disruption

Serum cardiac biomarkers become detectable after myocardial necrosis. What pathologic change provides the cellular basis for their appearance in blood?

A. Loss of membrane integrity
B. Reduced myocardial perfusion
C. Increased glycogen utilization
D. Decreased aerobic metabolism

A patient develops severe sustained myocardial ischemia. Which myocardial region is expected to undergo ischemic injury first?

A. Epicardial surface
B. Subendocardium
C. Outer myocardium
D. Entire wall simultaneously

Why is the subendocardium particularly vulnerable during severe myocardial ischemia?

A. Greatest glycogen concentration
B. Highest aerobic metabolism
C. Least myocardial perfusion
D. Earliest sarcolemmal disruption

Severe ischemia persists after injury has developed in the subendocardium. How does myocardial necrosis characteristically progress?

A. Epicardium toward endocardium
B. Randomly throughout myocardium
C. Simultaneously through entire wall
D. Subendocardium toward outer myocardium

A pathologist describes progressive myocardial cell death spreading outward from the innermost myocardium during persistent ischemia. What is this pattern called?

A. Wavefront of cell death
B. Reversible ischemic injury
C. Glycogen depletion pattern
D. Sarcolemmal recovery pattern

A coronary occlusion remains untreated for approximately 2–3 hours. Roughly what proportion of myocardial thickness may become necrotic?

A. One-quarter thickness
B. Half the thickness
C. Three-quarters thickness
D. Entire wall thickness

A patient has severe sustained coronary ischemia for approximately 6 hours. Which pathologic consequence can develop by this time?

A. Reversible cellular swelling
B. Isolated glycogen depletion
C. Transmural myocardial necrosis
D. Myofibrillar relaxation only

Which sequence best describes the progression of severe myocardial ischemia from its earliest metabolic effect toward irreversible injury?

A. Necrosis → swelling → ATP increase
B. Swelling → aerobic metabolism → necrosis
C. ATP increase → glycogen storage → necrosis
D. Energy loss → reversible changes → necrosis

A cardiac myocyte becomes acutely ischemic. Before necrosis occurs, which combination of findings would be most consistent with reversible injury?

A. Swelling, relaxation, glycogen depletion
B. Membrane rupture, biomarker leakage, necrosis
C. Transmural death, swelling, biomarker leakage
D. Necrosis, glycogen depletion, membrane rupture

Which finding most clearly distinguishes irreversible myocardial injury from early reversible ischemic injury?

A. Lactic acid accumulation
B. Sarcolemmal membrane disruption
C. Glycogen depletion
D. Myofibrillar relaxation

Which event occurs earliest following complete coronary occlusion?

A. Loss of myocardial contractility
B. Irreversible myocyte injury
C. Half-thickness myocardial necrosis
D. Transmural myocardial necrosis

Which event would be expected latest during uninterrupted severe myocardial ischemia?

A. Decreased phosphate production
B. Cellular swelling
C. Sarcolemmal disruption
D. Transmural necrosis

A patient has severe myocardial ischemia lasting only several minutes. Which finding could occur despite the absence of irreversible myocyte injury?

A. Complete transmural necrosis
B. Lactic acid accumulation
C. Extensive biomarker leakage
D. Sarcolemmal membrane rupture

A pathologist examines myocardial tissue after prolonged ischemia and finds necrosis involving approximately half the wall thickness. Which ischemic duration best fits this finding?

A. Approximately 2 minutes
B. Approximately 20 minutes
C. Approximately 2–3 hours
D. Approximately 30 seconds

A patient experiences severe uninterrupted ischemia. Which temporal relationship is most accurate?

A. Necrosis precedes contractile loss
B. Transmural injury occurs first
C. Half-wall necrosis occurs immediately
D. Contractility fails before necrosis

A patient develops complete occlusion of a major epicardial coronary artery. Pathologic examination later shows necrosis extending through the full thickness of the affected ventricular wall. Which infarct pattern is present?

A. Subendocardial infarction
B. Multifocal microinfarction
C. Transmural infarction
D. Takotsubo cardiomyopathy

A patient presents with an acute full-thickness myocardial infarction caused by complete epicardial coronary occlusion. Which electrocardiographic and clinical classification is classically associated with this pattern?

A. ST elevation with STEMI
B. ST depression with NSTEMI
C. ST elevation with NSTEMI
D. ST depression with STEMI

Myocardial necrosis in another patient is confined primarily to the inner portion of the ventricular wall rather than involving its full thickness. Which infarct pattern best describes this finding?

A. Transmural infarction
B. Takotsubo cardiomyopathy
C. Multifocal microinfarction
D. Subendocardial infarction

A patient develops an infarction limited to the subendocardial myocardium. Which electrocardiographic and clinical pattern is classically associated with this lesion in these notes?

A. ST elevation with STEMI
B. ST depression with NSTEMI
C. ST elevation with NSTEMI
D. Normal ST segment with STEMI

A pathologist identifies numerous small areas of myocardial necrosis without occlusion of a major epicardial artery. The primary vascular pathology involves small vessels located within the myocardium. Which diagnosis is most likely?

A. Multifocal microinfarction
B. Transmural infarction
C. Subendocardial infarction
D. Stable myocardial ischemia

A patient develops scattered myocardial microinfarcts after small emboli obstruct intramural coronary vessels. Which mechanism most directly explains this pattern?

A. Complete epicardial thrombosis
B. Fixed proximal atherosclerosis
C. Coronary microembolization
D. Ventricular wall hypertrophy

A patient with inflammation affecting small intramyocardial coronary vessels develops multiple microscopic areas of myocardial necrosis. Which underlying process can produce this pattern?

A. Stable angina
B. Vasculitis
C. Chronic venous congestion
D. Coronary dominance

Multifocal myocardial microinfarction develops in a patient after intense catecholamine activity and exposure to a vasoactive drug. Which mechanism can account for the myocardial injury?

A. Fixed coronary stenosis
B. Coronary venous obstruction
C. Epicardial plaque calcification
D. Catecholamine-induced vasospasm

A previously healthy patient develops acute cardiac dysfunction shortly after experiencing intense emotional distress. In these notes, the condition is described as an ischemic dilated cardiomyopathy. Which diagnosis is most likely?

A. Takotsubo cardiomyopathy
B. Subendocardial infarction
C. Multifocal microinfarction
D. Chronic ischemic cardiomyopathy

When major coronary lesions responsible for myocardial infarction are ranked from most frequent to least frequent, which sequence is correct?

A. RCA > LAD > LCX
B. LAD > LCX > RCA
C. LAD > RCA > LCX
D. LCX > LAD > RCA

A patient develops an infarction involving the cardiac apex, anterior left ventricular wall, and anterior 2/3 portion of the ventricular septum. Which coronary artery is most likely occluded?

A. RCA
B. LAD
C. LCX
D. Dominant coronary artery

Which combination of myocardial regions is normally supplied by the LAD?

A. RV wall and posterior septum
B. Lateral LV and posterior septum
C. Posterobasal LV and RV wall
D. Apex, anterior LV, anterior septum

A myocardial infarction affects the ventricular septum supplied by the LAD. Which portion of the septum is expected to be involved?

A. Anterior two-thirds
B. Posterior one-third
C. Entire posterior septum
D. Posterior two-thirds

A patient with a right-dominant coronary circulation develops infarction involving the right ventricular free wall, posterobasal left ventricular wall, and posterior ventricular septum. Which artery is most likely involved?

A. LAD
B. LCX
C. RCA
D. Left main coronary

In a right-dominant heart, which myocardial territory is supplied by the RCA?

A. Anterior LV and apex
B. RV wall and posterobasal LV
C. Lateral LV wall only
D. Anterior two-thirds septum

A patient has an infarction localized primarily to the lateral wall of the left ventricle. Which coronary artery most likely supplies the affected territory?

A. LAD
B. RCA
C. Dominant septal artery
D. LCX

The coronary artery supplying the posterior one-third of the ventricular septum varies according to coronary dominance. Which vessel supplies this region?

A. Dominant coronary artery
B. LAD in all patients
C. RCA in all patients
D. LCX in all patients

A pathologist examines a heart with a transmural myocardial infarction. Regardless of the precise coronary artery involved, which chamber is affected to at least some extent in nearly all transmural infarctions?

A. Right atrium
B. Right ventricle
C. Left ventricle
D. Left atrium

A pathologist wants to distinguish viable from necrotic myocardium in a recently infarcted heart using an enzyme-dependent histochemical stain. Which stain is most appropriate?

A. Congo red
B. Prussian blue
C. TTC
D. PAS

Myocardial tissue is treated with triphenyltetrazolium chloride after an infarction. Which appearance identifies viable myocardium?

A. Brick-red staining
B. Pale unstained tissue
C. Dark-blue staining
D. Yellow vacuolated tissue

A pale region of myocardium fails to stain with TTC following an acute infarction. What best explains this finding?

A. Increased collagen deposition
B. Excess intracellular glycogen
C. Increased neutrophil activity
D. Loss of enzyme activity

A patient dies several hours after developing an acute myocardial infarction. At approximately what time does coagulative necrosis become morphologically apparent?

A. 1–2 hours
B. 6–12 hours
C. 1–2 days
D. 3–4 days

Histologic examination of an infarct shows elongated, distorted myocardial fibers at the edge of the necrotic region. Which finding is being described?

A. Wavy fibers
B. Granulation tissue
C. Dense collagen
D. Myocytolysis

Wavy fibers are identified along the peripheral margin of a myocardial infarction. What mechanism produces their characteristic appearance?

A. Macrophages digest contracting fibers
B. Water expands necrotic fibers
C. Viable fibers pull dead fibers
D. Collagen contracts surviving myocytes

Histology after myocardial ischemic injury shows vacuolated myocytes resulting from intracellular fluid accumulation. Which process best describes this finding?

A. Coagulative necrosis
B. Myocytolysis
C. Granulation tissue
D. Scar contraction

Which cellular change directly underlies myocytolysis after myocardial injury?

A. Intracellular collagen accumulation
B. Nuclear calcium deposition
C. Extracellular glycogen accumulation
D. Intracellular salt and water

During the early inflammatory response following myocardial infarction, which inflammatory cell becomes predominant?

A. Neutrophil
B. Macrophage
C. Lymphocyte
D. Plasma cell

Histologic examination of an infarct shows a dense polymorphonuclear leukocyte infiltrate. Approximately how long ago did the infarction most likely occur?

A. 6–12 hours
B. 1–2 weeks
C. 3–4 days
D. Several months

Several days after myocardial infarction, inflammatory cells begin removing the necrotic cardiac muscle. Which cells primarily perform this function?

A. Neutrophils
B. Macrophages
C. Fibroblasts
D. Lymphocytes

A patient several days after MI is at increased risk of structural disruption of the infarcted myocardium. Which stage of healing creates this vulnerability?

A. Before myocyte necrosis develops
B. During initial TTC staining
C. After mature scar formation
D. After macrophage tissue removal

Why is infarcted myocardium particularly weak after macrophage infiltration?

A. Dead tissue precedes scar replacement
B. Neutrophils increase collagen synthesis
C. Viable fibers become hypertrophic
D. TTC destroys myocardial enzymes

Histology approximately 10 days after an MI demonstrates highly vascularized reparative tissue within the infarct. Which tissue is most likely present?

A. Dense collagenous scar
B. Coagulative necrosis
C. Granulation tissue
D. Normal myocardium

During myocardial infarct healing, reparative changes do not develop uniformly throughout the lesion. Where does healing begin?

A. Infarct center
B. Infarct margins
C. Ventricular endocardium
D. Epicardial surface

Which sequence best describes the direction of myocardial infarct healing?

A. Center toward margins
B. Epicardium toward endocardium
C. Septum toward free wall
D. Margins toward center

A myocardial infarction occurred several months ago. Which morphologic finding is most characteristic of the healed infarct?

A. Dense collagenous scar
B. Neutrophilic infiltrate
C. Wavy myocardial fibers
D. Highly vascular granulation tissue

Which sequence correctly represents the major progression of myocardial infarct healing?

A. Macrophages → neutrophils → necrosis → scar
B. Scar → neutrophils → macrophages → granulation
C. Necrosis → neutrophils → macrophages → scar
D. Granulation → necrosis → neutrophils → scar

A patient presents with suspected acute myocardial infarction. Which biomarkers listed in these notes provide the greatest sensitivity and specificity for myocardial damage?

A. CK-MB and myoglobin
B. CK-MB and troponin T
C. Troponin I and T
D. Myoglobin and troponin I

A patient develops an acute MI at noon. Which biomarker would be expected to reach its maximal concentration approximately 24 hours later?

A. Troponin I
B. Troponin T
C. Myoglobin
D. Creatine kinase

Serial cardiac biomarkers are obtained after an acute myocardial infarction. Troponin T would be expected to reach its peak during which time interval?

A. 1–3 hours
B. 3–6 hours
C. 6–10 hours
D. 12–48 hours

A patient presents several hours after the onset of myocardial infarction. Which temporal pattern best describes CK-MB?

A. Rises 24 hours, peaks 72
B. Rises 3–12, peaks 24
C. Rises immediately, peaks 6
D. Rises 48 hours, peaks 72

A patient has an elevated CK-MB following an acute MI. Assuming no additional myocardial injury occurs, when should CK-MB return toward normal?

A. Within 12–24 hours
B. Within 24–36 hours
C. Within 48–72 hours
D. Within 5–7 days

Three days after an acute myocardial infarction, a patient develops new severe chest pain concerning for another infarction. Which biomarker is particularly useful for detecting this recurrent event?

A. CK-MB
B. Troponin I
C. Troponin T
D. C-reactive protein

Why is CK-MB particularly useful for detecting recurrent myocardial infarction shortly after an initial MI?

A. It is myocardium-specific indefinitely
B. It rises before ischemia begins
C. It remains elevated for weeks
D. It normalizes relatively quickly

A patient sustains a very large myocardial infarction and subsequently develops severe hypotension, pulmonary vascular congestion, and evidence of pump failure. Which complication is most likely?

A. Ventricular aneurysm
B. Cardiogenic shock
C. Ventricular septal rupture
D. Acute pericarditis

Which underlying abnormality most directly produces cardiogenic shock following a large myocardial infarction?

A. Severe contractile dysfunction
B. Systemic venous vasodilation
C. Acute pericardial inflammation
D. Coronary microembolization

A patient develops an isolated right ventricular infarction. Which hemodynamic pattern is most characteristic compared with a large left ventricular infarction?

A. Pulmonary edema with hypertension
B. Pulmonary congestion without hypotension
C. Venous pooling with hypotension
D. Systemic hypertension with bradycardia

Several days after an acute myocardial infarction, a patient suddenly becomes hypotensive and develops cardiac tamponade. Which mechanical complication is most likely?

A. Papillary muscle rupture
B. Ventricular septal rupture
C. True ventricular aneurysm
D. Ventricular free-wall rupture

Ventricular free-wall rupture after myocardial infarction directly allows blood to enter the pericardial cavity. Which combination of complications results?

A. VSD and left-right shunting
B. Hemopericardium and tamponade
C. Mitral regurgitation and edema
D. Aneurysm and mural thrombosis

Why does ventricular free-wall rupture most commonly occur several days after myocardial infarction rather than immediately?

A. Collagen becomes excessively rigid
B. Ventricular hypertrophy rapidly disappears
C. Necrotic myocardium becomes weak
D. Coronary flow suddenly increases

Which patient has the greatest risk for ventricular free-wall rupture following myocardial infarction?

A. Elderly, first large anterior MI
B. Young, recurrent small NSTEMI
C. LV hypertrophy, normal pressure
D. Small posterior subendocardial MI

Which additional clinical feature increases the risk of ventricular free-wall rupture after myocardial infarction?

A. Left ventricular hypertrophy
B. Hypertension
C. Young age
D. Recurrent prior infarctions

A patient suddenly deteriorates several days after MI. Echocardiography reveals an acute ventricular septal defect. What hemodynamic abnormality should result?

A. Right-to-left atrial shunt
B. Left-to-right atrial shunt
C. Right-to-left ventricular shunt
D. Left-to-right ventricular shunt

Several days after myocardial infarction, a patient suddenly develops severe pulmonary edema and a new systolic murmur. Papillary muscle rupture is suspected. Which valvular abnormality results?

A. Acute mitral regurgitation
B. Acute aortic regurgitation
C. Mitral stenosis
D. Aortic stenosis

Imaging after an MI demonstrates a contained ventricular rupture. The wall of the outpouching consists only of epicardium and adherent parietal pericardium. Which lesion is present?

A. True ventricular aneurysm
B. Infarct expansion
C. False aneurysm
D. Mural thrombus

Months after a transmural myocardial infarction, imaging demonstrates a ventricular aneurysm whose wall contains scarred myocardial tissue. Which diagnosis is most likely?

A. False aneurysm
B. True ventricular aneurysm
C. Acute free-wall rupture
D. Ventricular septal rupture

During healing after a large myocardial infarction, the necrotic ventricular wall progressively stretches, becomes thinner, and dilates. Which complication is being described?

A. Ventricular remodeling
B. True aneurysm formation
C. Papillary muscle dysfunction
D. Infarct expansion

A patient develops a mural thrombus overlying a large myocardial infarction. Which combination best explains why the thrombus formed?

A. Stasis plus endocardial injury
B. Hypertension plus vasospasm
C. Tachycardia plus hypotension
D. Fibrosis plus pericardial inflammation

Months after an MI, the noninfarcted myocardium becomes hypertrophied and the ventricle progressively dilates. This process ultimately contributes to worsening heart failure. What is it called?

A. Infarct expansion
B. Myocardial rupture
C. Ventricular remodeling
D. Mural thrombosis

A patient has a large anterior transmural myocardial infarction. Which group of complications is particularly associated with this infarct location?

A. Conduction block, RV involvement
B. Rupture, expansion, thrombus, aneurysm
C. Vasospasm, VSD, pericarditis
D. Bradycardia, RV failure, embolization

A patient survives a myocardial infarction and asks what most strongly determines long-term prognosis. Which two factors are most important according to these notes?

A. Infarct pain and troponin peak
B. Age and CK-MB concentration
C. Infarct location and hypertension
D. LV function and remaining obstruction

A patient has a posterior transmural myocardial infarction. Which complications should clinicians particularly anticipate based on this infarct location?

A. Free-wall rupture and aneurysm
B. Expansion and mural thrombus
C. Conduction block and RV involvement
D. Tamponade and false aneurysm

Which list contains recognized major complications that may follow myocardial infarction?

A. Arrhythmia, rupture, remodeling, pericarditis
B. Endocarditis, myocarditis, aortic dissection
C. Pneumonia, stenosis, vasculitis, fibrosis
D. Amyloidosis, tamponade, myocarditis, stenosis

A patient with a history of multiple prior myocardial infarctions develops gradually worsening congestive heart failure despite compensatory cardiac changes. Which diagnosis best explains this progression?

A. Acute myocarditis
B. Chronic ischemic heart disease
C. Restrictive cardiomyopathy
D. Acute pericarditis

What is the major mechanism by which chronic ischemic heart disease eventually produces congestive heart failure?

A. Recurrent vasospasm without injury
B. Progressive valvular calcification
C. Accumulated infarction and poor compensation
D. Isolated atrial conduction disease

A patient with longstanding chronic ischemic heart disease undergoes cardiac imaging. Which combination of structural findings is most characteristic?

A. Cardiomegaly, LV hypertrophy, LV dilation
B. RV hypertrophy, small LV cavity
C. Atrial dilation without ventricular change
D. Normal heart size, thick pericardium

Which vascular abnormality commonly accompanies the structural cardiac changes seen in chronic ischemic heart disease?

A. Coronary vasculitis
B. Coronary atherosclerosis
C. Pulmonary artery stenosis
D. Aortic dissection

Histologic examination of myocardium from a patient with chronic ischemic heart disease would most likely demonstrate which combination?

A. Hypertrophy, vacuolization, fibrosis
B. Neutrophils, granulomas, calcification
C. Amyloid, edema, eosinophils
D. Myocyte necrosis, no fibrosis

In chronic ischemic heart disease, myocardial vacuolization is particularly associated with which region?

A. Epicardium
B. Right atrium
C. Subendocardium
D. Pericardium

According to these notes, which process is the most common underlying cause of cardiac rhythm disorders?

A. Ischemic injury
B. Congenital valve disease
C. Pericardial inflammation
D. Pulmonary hypertension

An arrhythmia that occurs intermittently is described as ______.

An arrhythmia originating in either atrium is classified as ______.

First-degree heart block is characterized by prolongation of the _____ interval.

Second-degree heart block involves _____ failure of atrioventricular impulse transmission.

Third-degree heart block represents _____ failure of atrioventricular conduction.

A patient develops damage to the sinoatrial node and subsequently becomes bradycardic because another cardiac pacemaker assumes control. Which disorder is most likely?

A. Atrial fibrillation
B. Sick sinus syndrome
C. Third-degree block
D. Long QT syndrome

What is the underlying abnormality in sick sinus syndrome described in these notes?

A. AV nodal fibrosis
B. Ventricular channel mutation
C. SA nodal damage
D. Atrial wall rupture

A patient has an irregular atrial rhythm caused by atrial myocytes depolarizing independently and sporadically rather than through coordinated atrial activation. Which arrhythmia is present?

A. Atrial fibrillation
B. Sinus bradycardia
C. First-degree block
D. Ventricular tachycardia

A young patient develops a serious arrhythmia despite having no evidence of structural heart disease. A primary abnormality of cardiac ion-channel function is suspected. Which category best describes this disorder?

A. Cardiomyopathy
B. Channelopathy
C. Pericarditis
D. Atherosclerosis

A patient with congenital long QT syndrome is at increased risk for life-threatening ventricular arrhythmias. Which electrophysiologic abnormality explains this risk?

A. Shortened atrial depolarization
B. Prolonged ventricular repolarization
C. Accelerated AV conduction
D. Reduced atrial refractoriness

A 66-year-old man with severe coronary atherosclerosis suddenly collapses and dies before reaching the hospital. Which mechanism most commonly causes sudden cardiac death in this setting?

A. Acute valvular obstruction
B. Lethal cardiac arrhythmia
C. Ventricular wall rupture
D. Progressive pericardial effusion

A patient dies suddenly after an episode of acute myocardial ischemia. Which underlying disease accounts for most cases of sudden cardiac death?

A. Coronary artery disease
B. Pulmonary hypertension
C. Mitral valve disease
D. Viral myocarditis

_______ fibrillation is the major lethal arrhythmia associated with sudden cardiac death in these notes.

Which sequence best describes the most common pathway leading to sudden cardiac death?

A. Hypertension → dilation → rupture
B. Ischemia → fibrosis → tamponade
C. Vasculitis → thrombosis → embolism
D. CAD → ischemia → lethal arrhythmia

A patient with longstanding systemic hypertension develops progressive structural changes in the heart. Which chamber initially bears the major chronic pressure overload?

A. Left ventricle
B. Right ventricle
C. Left atrium
D. Right atrium

Chronic systemic hypertension forces the left ventricle to pump against persistently elevated pressure. Which structural adaptation is most characteristic?

A. Eccentric LV hypertrophy
B. Concentric LV hypertrophy
C. Isolated RV dilation
D. Left atrial hypertrophy

Histologic examination of the left ventricle in systemic hypertensive heart disease reveals enlarged cardiac myocytes. Which cellular dimension is particularly increased?

A. Longitudinal myocyte length
B. Nuclear longitudinal diameter
C. Myocyte transverse diameter
D. Sarcomere resting length

A patient with longstanding hypertension has a thickened, stiff left ventricular wall despite preserved systolic contraction. Which functional abnormality is expected early?

A. Impaired diastolic filling
B. Increased ventricular compliance
C. Enhanced diastolic relaxation
D. Reduced atrial filling pressure

Why does systemic hypertensive heart disease eventually produce left atrial enlargement?

A. RV dilation compresses atrium
B. Mitral stenosis develops first
C. Coronary flow increases markedly
D. LV filling becomes impaired

Which sequence best describes progression of systemic hypertensive heart disease?

A. LV dilation → RV hypertrophy → AF
B. Pressure overload → concentric LV hypertrophy
C. LA enlargement → LV pressure overload
D. RV hypertrophy → LV wall thinning

A patient with chronic pulmonary hypertension develops structural changes in the right side of the heart. Which term describes this form of hypertensive heart disease?

A. Cor pulmonale
B. Chronic ischemic disease
C. Systemic hypertensive cardiomyopathy
D. Dilated left cardiomyopathy

Which hemodynamic abnormality is responsible for development of cor pulmonale?

A. Systemic arterial hypertension
B. Left atrial hypertension
C. Pulmonary hypertension
D. Coronary venous hypertension

A patient develops an abrupt severe increase in pulmonary arterial pressure. Which right ventricular response is expected in acute cor pulmonale?

A. Concentric LV hypertrophy
B. Right ventricular dilation
C. Left atrial enlargement
D. Right ventricular hypertrophy

A patient has longstanding pulmonary hypertension from chronic pulmonary vascular disease. Which cardiac adaptation is most characteristic?

A. Acute RV dilation
B. Concentric LV hypertrophy
C. Left atrial dilation
D. Right ventricular hypertrophy

Two patients develop cor pulmonale. Patient 1 has a sudden rise in pulmonary arterial pressure, whereas Patient 2 has years of pulmonary hypertension. Which pairing is correct?

A. Acute dilation; chronic hypertrophy
B. Acute hypertrophy; chronic dilation
C. Acute LV; chronic RV dilation
D. Acute LA; chronic LV hypertrophy

Which finding most strongly distinguishes systemic hypertensive heart disease from cor pulmonale?

A. Presence of myocardial hypertrophy
B. Chronic pressure overload
C. Predominant left ventricular involvement
D. Eventual chamber enlargement