8. Cardiac Pathoma

Question 1

Whats an Aortic Dissection

What disorders are prone for Dissections Most common Cause of death

Answer 1

When a rip in the INTIMA of a vessel causes blood to penetrate and create a lumen between intima and media

Literally rips through and dissects the two layers due to Pre-existing weakens of the media (HTN)Connective tissue disorders (Marfan Syndrome)Cardiac tamponade

Question 2

Thoracic AneurysmWhat dz most commonly leads to it whats the most common clinical presentatoin

Answer 2

Balloon like dilation of the aorta. must have weakness in the wall Tertiary syphilis - caused by endarteritis of vaso casorum (prevents nutrients to the wall of vessels so it atrophies)Pulsatile abdominal mass

Question 3

Chest pain that arises with exertion or stress is ____ What dz commonly leads to it Whats the most common presentatoin

Answer 3

Stable angina

atherosclerosis- not enough blood getting to the heart so it becomes hypoxic/ischemic

Chest pain that radiates to left arm or jaw -St depression Tx- rest or Nitroglycerin

Question 4

Chest pain that occurs at rest is ____What causes it? Tx?

Answer 4

Unstable anginaRupture of atherosclerotic plaque with thrombosis and incomplete occlusion of the coronary artery-Nitroglycerin high risk of MI

Question 5

Vasospasm of the coronary artery?Tx

Answer 5

Prinzmetal anginatx-CCB’s or Nitrates

Question 6

Difference between myocardial infarct (MI) and unstable angina

Answer 6

MI has Thrombosis of a Plaque with complete occlusion. also has IRREVERSIBLE damage to myocytes

unstable angina has about 80% occlusion

Question 7

Which chamber of the Heart does MI mostly occur? Which coronary artery usually gets occluded

Answer 7

LEFT VENTRICLE1-Left anterior descending (LAD) anterior wall and atrial septum necrosis2. Right coronary artery-poserior wall of heart

Question 8

ST elevation MI (STEMI)What type of infarct thickness?

Answer 8

TransmuralFull thickness

Question 9

non ST elevation MI (NSTEMI) thickness?

Answer 9

subendocardial infarcts

Question 10

Which enzymes are indicative of an MI

Answer 10

TROPONINrises at 2-4hrspeaks at 24 hrselevated for a weekCK-MBrises and goes down quicklycan be used to determine multiple infarcts

Question 11

Which cardiac enzyme is used to determine multiple infarcts

Answer 11

CK-MBbecause it rises and galls quicker than TROPONIN

Question 12

Tx for Myocardial infarction

Answer 12

Aspirin/Heparin (to prevent further clotting)Supp. O2NitroglycerinBeta Blockers

Question 13

What is the progression of an MI (days weeks months)

Answer 13

1 day / 1 week / 1 monthcoagulative necrosis (dead cells) / Neutrophils and macrophages / granulation tissue and scar

Question 14

Type of pericarditis that occurs 6 weeks after an infarct due to autoantibodies against the pericardium

Answer 14

Dresslers Syndrome

Question 15

Whats congestive heart failure mainstay treatment?

Answer 15

When the heart fails to pump appropriately (usually backs into the lungs) Tx-ace inhibitors

Question 16

Hemosiderin-laden macrophages

Answer 16

Heart failure cells found in lungs with pulmonary edema

Question 17

Whats the most common congenital heart defect and what syndrome is it associated with

Answer 17

Ventricular septal defect (VSD) associated with FETAL ALCOHOL SYNDROME

Question 18

What is the mnemonic for left to right shunt yes right to left?

Answer 18

(R)ight to (L)eft shunts are eaRLy cyanosis(L)eft to (R)ight occur LateR cyanosis

Question 19

What is atrial septum defect? what defect causes this

Answer 19

defect in the septum between atriumsOsmium secundum defects

Question 20

Holocystolic machine like murmur cyanosis of lower extremities How do you treat thisWhat disorder is it associated with

Answer 20

Patent ductus arteriousus PDAfailure of ductus arterioles to close cyanosis of lower extremitiesTx-ENDomethacin ends PDACongenital rubella

Question 21

Tetralogy of Fallot

Answer 21

R–>L shuntmost common cause of eaRLy cyanosis (fixed with squatting)Pulmonary stenosisBoot shaped heart (hypertrophy)Overriding aorta/VSD

Question 22

Transposition of the Great vessels?What dz is it associated with

Answer 22

Failure of the aorticopulmonary system to spiral (they swap places)Maternal diabets

Question 23

What is rheumatic fever? What is it usually caused by?

Answer 23

occurs 2-3 weeks after strep throat (alpha-beta hemolytic streptococci) M- proteinJONES criteria which is joints, heart problems, nodules, erythema marginatum, s-chorea arthritis, pan(all layers)carditis (mitral valve), subQ nodules, rash, rapid movement

Question 24

Jones criteria whats it used to diagnosis

Answer 24

joints, heart problems, nodules, erythema marginatum, s-chorea arthritis, myocarditis (mitral valve), subQ nodules, rash, rapid movement

Question 25

Aortic Valve Stenosishow do you get it? What cardiopathy and other symptoms does it lead to?

Answer 25

Narrowing of the aortic valve Systolic ejection click followed by crescendo- decrescendo murmur”wear and tear of valve” -presents in late adult hoodor when you have a bicuspid valve instead of (tri)leads to Left ventricular hypertrophySADScope, Angina, and Dyspnea on exertion

Question 26

Aortic Regurgitation why does it happen?

Answer 26

“blowing murmur”Back flow of blood from aorta into LV during diastoleAortic root DILATION or valve problemsHyperdynamic circulation (bounding pulse, pulsating nail bed, head bobbing)

Question 27

What is hyper dynamic circulation and what causes it?

Answer 27

Seen in aortic regurgitationBounding pulse, pulsating nail bed, head bobbingthe regurg increases the volume of the next stroke in LV so it keeps adding and adding pressure

Question 28

Mitral valve prolapse

Answer 28

ballooning of the mitral valve into left atrium during systoleMyxoid degeneration of the valve (floppy)*mid systolic click* like a parachute

Question 29

Mitral Stenosiswhat happens to the atrium

Answer 29

Narrowing of the mitral valve, usually due to rheumatic valve dzOpening snap followed by a rumble LA overload- pulmonary congestion (edema)

Question 30

Which organism causes Endocarditis (low virulence)

Answer 30

S viridiansmost common cause of endocarditis, infects previously damaged valvesresults in small vegetations that don’t destroy valves

Question 31

Which organism is the most common cause of (acute) Endocarditis in IV drug users and which valve is involved

Answer 31

S. Aureus (acute)Large vegetations on normal valves Most commonly Tricuspid

Question 32

Which organism causes Endocarditis of prosthetic valves?

Answer 32

S. Epidermidis

Question 33

Which organism causes Endocarditis with underlying colorectal cancer

Answer 33

S. Bovis

Question 34

Endocarditis with Negative Blood cultures

Answer 34

HACEKHaemophilus, actinobacilus(aggregatibacter, Cardiobacterium, Eikenella, Kingella)

Question 35

Clinical features of endocarditis

Answer 35

Fever, murmur, Janeway lesions(painless on palm or sole), Osler (ouch) nodes (painful on fingers or toes)

Question 36

endocarditis with nodules on both sides of the valveAnd what is it associated with

Answer 36

Libman-Sacks EndocarditisSLEmitral valve

Question 37

Dilated Cardiomyopathy (most common cardiomyopathy)What causes ittx-

Answer 37

Dilation of all 4 chamberssystolic dysfunction (dilated so it can’t contract properly), valve regurgitationABCCCD + palcohol abuse, Beri beri, COXSACKE, cocaine use, Chagas, Doxorubicin toxicity and pregnancyTransplant

Question 38

Hypertrophic Cardiomyopathywhats a huge problem with this

Answer 38

Hypertrophy of left ventricle commonly due to genetic mutations in Sarcomere proteinDecreased cardiac output due to the heart being so tight. (it can’t dilate to get blood in)Can lead to SUDDEN DEATH due to ventricular arrhythmia myofibrillar disarray

Question 39

Restrictive cardiomyopathywhat are the causes

Answer 39

Decreased compliance of ventricles (won’t dilate so you have a diastolic problemssarcoidosis, fibrosis, endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children), hematochromatosisLOFFLER SYNDROME- endomyocardial fibrosis with a prominent eosinophilic infiltrate

Question 40

Loffler syndrome and does it lead to

Answer 40

endomyocardial fibrosis with a prominent eosinophilic infiltrateleads to restrictive cardiomyopathy

Question 41

Myxomaswere does it usually occur (which valve)

Answer 41

Most common primary cardiac tumor in ADULTSUsually occurs in the left atrium and causes syncope described as “Ball valve” obstruction

Question 42

Rhabdomyoma

Answer 42

most common primary cardiac tumor in CHILDREN associated with tuberous sclerosis