B. X Flashcards
Congenital heart defects arise when
Week 3-8
Most Congenital heart defects are _____
Sporadic
Congenital heart defects often result in
Shunting btw. left and right
What is the most common Congenital heart defects?
VSD Ventricular Septal Defect
VSD Ventricular Septal Defect results in
Left-to-right shunt
Large VSD can lead to
Eisenmenger syndrome
Eisenmenger syndrome=
Pulmonary HTN
Reverse of flow
Cynaosis
Congenital heart defects (8)
VSD ASD PDA Tetralogy of fallot Transposition of the great vessels Truncus arteriosus Tricuspid atresia Coarctation of the aorta
ASD most common type
Ostium secundum
ASD ostium primum is associated with
Down syndrome
ASD result in
Left-to-right shunt
Split of S2 on auscultation
Paradoxial emboli
PDA=
Failure of ductus arteriosus to close
PDA is associated with
Congenital rubella
PDA results in
Left-to-right shunt btw. aorta and pulmonary artery
What maintains patency of ductus arteriosus?
PGE
What can lower PGE
Indomethacin
Tetralogy of fallot=
- Stenosis of right vent. outflow tract
- RVH
- VSD
- Aorta that overrides the VSD
Tetralogy of fallot results in
Right-to-left shunt
Early cyanosis
Tetralogy of fallot treatment
Patient squat in order to increase arterial resistance
Transposition of the great vessels characterized by
Pulmonary artery arising from left vent. and aorta arising from right vent.
Transposition of the great vessels is associated with
Maternal diabetes
Transposition of the great vessels present with
Early cyanosis
Transposition of the great vessels treatment
Creating of a shunt in order for the blood to mix and surgery
Transposition of the great vessels results in
RVH
Left vent. atrophy
Truncus arteriosus=
Single large vessel arising from both vent.
Tricuspid atresia=
Tricuspid valve orifice fails to develop
Right vent. is hypoplastic
Coarctation of the aorta=
Narrowing of the aorta
Coarctation of the aorta is devided to
Infantile
Adult
Infantile Coarctation of the aorta is associated with
PDA
Turner syndrome
Adult Coarctation of the aorta, coarctaition lies
After to aortic arch
Adult Coarctation of the aorta present with
HTN in upper extermitis
Hypotension in lower extermitis
How can we discover clacified aortic valve?
Chest radiograph/autopsy
Calcium deposits usually affect the
Leaflets of the aortic valve
Mitral valve prolapse may be seen in what syndrome?
Marfan
Mitral valve prolapse AKA
Click-murmur syndrome
Valvular lesions generally result in (2)
Stenosis
Regurigation
Valvular disorders (7)
Acute rheumatioc fever Chronic rheumatioc fever Aortic stenosis Aortic regurgitation Mitral valve prolapse Mitral regurgitation Mitral stenosis
Rheumatioc fever order of valve affecting
Mitral
Aortic
Tricuspid
What is the consequence of Chronic rheumatioc fever
Valve scarring
Stenosis
“Fish mouth”
Chronic rheumatioc fever leads to thickening of the
Chordae tendineae
Complication of Chronic rheumatioc fever
Infectious endocarditis
Atherosclerosis=
Intimal plaque that obstructs blood flow
Atherosclerosis consist of
Necrotic lipid core (cholesterol)
Fibromuscular cap
FIbrous cap contains
Smooth muscle cell
MPH
Lymphocytes
Collagen
Necrotic center contains
Smooth muscle cell MPH Foam cells Lymphocytes Cholesterol crystals Calcium Cell debris
Atherosclerosis involves
Large and medium vessels
Atherosclerosis-
Which vessels are commonly affected
Abdominal aorta
Coronary a
Popliteal a
Internal carotis a
Atherosclerosis modifiable risk factors
HTN
Hypercholesterolemia
Smoking
Diabetes
Atherosclerosis non-modifiable risk factors
Age
Gender (Estrogen is protective)
Genetics
Atherosclerosis pathogenesis
- Endot. damage
- Lipids leak into intima
- Lipids are oxidize
- Consumed by MPH
- Result in foam cells
- Inflammation and healing- SMC prolif. and EC matrix deposition
Atherosclerosis morphologic stages
- Fatty streaks
2. Atheroma
Fatty streaks=
Flat yellow lesion of the intima consist of Lipid-laden MPH
Atherosclerosis complication (4)
- Meidum vessels stenosis
- Plaque rupture and thrombosis
- Plaque rupture with embolization
- Aneurysm
Acute rheumatic fever myocardial inflammatory lesions are called
Aschoff bodies
Aschoff bodies=
Collection of lymphocytes, plasma cells, Anitschkow cells (pulp activated MPH)
In rheumatic fever, the Ab which the immune system generates against the M proteins may cross react with
Heart muscle cell protein myosin
Most common cause of endocarditis
Strep. viridans
Strep. viridans infects previously
Damaged valves
Endocarditis results in
Small vegetations that do not destroy the valve
What is the most common cause in IVDU?
Staph. aureus
Staph. aureus Endocarditis results in
Large vegetationsthat destroy the valve
Staph. epidermidis is associated with
Endocarditis of prosthetic valves
Negative culture Endocarditis is associated with what organisms
HACEK
Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
How can we detect bacterial Endocarditis in imaging?
Transesophageal echocardiogram
Nonnacterial thrombotic endocarditis is due to
Sterile vegetations that arise in association with hypercoagulable state / adenocarcinpma
SLE associated Endocarditis
Libman-Sack Endocarditis
In what case can we see vegetations in both sides of the heart valve?
Libman-Sack Endocarditis
Define cardiomyopathy
Myocardial disease that result in cardiac dysfunction
Dilated cardiomyopathy=
Dilation of all 4 chambers of the heart
What is the most commn form of cardiomyopathy
Dilated cardiomyopathy
Dilated cardiomyopathy results in
Systolic disfunction (vent. cant pump)
Most common origin of Dilated cardiomyopathy
Idiopathic Genetics Myocarditis (Coxsackie A/B) Alcohol Drugs Pregnancy
Hypertrophic cardiomyopathy=
Massive hypertrophy of the left ventricle
Hypertrophic cardiomyopathy is usually due to
AD Genetic mutation in sarcomere proteins
Hypertrophic cardiomyopathy clinical features
Decreased CO
Sudden death dur to arrhythmia
Syncope with exercise
Hypertrophic cardiomyopathy- why do we see Decreased CO?
Ventricles cannot fill
Restrictive cardiomyopathy=
Decreased compliance of the vent. endomyocardium that restricts filling during diastole
Restrictive cardiomyopathy causes (5)
Amyloidosis Sarcoidosis Hemochromatosis Endocardial fibroelastosis Loeffler syndrome
Restrictive cardiomyopathy presents as
Congestive heart failure
Most common cause of Myocarditis
Coxsackieviruses A/B
CMV
HIV
Influenza virus
Non-viral myocarditis causes
Trypanosoma cruzi
Toxoplasma gondii
Trichomonas spirallis
Borrelia burgdorferi
Non-infectious causes of Myocarditis
SLE
Drugs HSN
Myocarditis microscpically appearance
Edema
Inflammatory infiltrates
Myocyte injury
Lymphocytic infiltrate
Vasculitis=
Vessel wall inflammation
Most common pathogenic mechanisms of vasculitis are (2)
Immune mediated inflammation
Direct vascular invasion by infectious pathogens
Large vessel vasculitis 2
Temporal Giant cell arteritis
Takayasu arteritis
TG!! Like Tia and Guy
Medium vessel vasculitis 3
Polyarthritis nodosa
Kawasaki disease
Burger disease
PiKaBu!!!
Small vessel vasculitis 4
Wegener granulomatosis
Microscopic polyangitis
Churg-strauss syndrome
Henoch-Schonlein purpura
Temporal Giant cell arteritis involves which arteries?
Carotid s branches
What is the most common cause of vasculitis in older adults >50
Temporal Giant cell arteritis
Temporal Giant cell arteritis presets as
Headach (temporal a involvment)
Vision symp,
Jaw claudicayion
Temporal Giant cell arteritis is a _______ vasculitis
Granulomatous
Temporal Giant cell arteritis lesion are segmental/non-segmental
Segmental
Temporal Giant cell arteritis biopsy reveals
Inflamed vessel wall with giant cells and intimal fibrosis
Temporal Giant cell arteritis treatment
Corticosteroids
Takayasu arteritis is a _____ arthritis
Granulomatous
Takayasu arteritis clasically involves
Aortic arch at branch points
Takayasu arteritis is present in what population
Adult < 50
Young asian female
Takayasu arteritis presents as
Visual and neurological symp. with weak or absent pulse in the upper extremities
Takayasu arteritis is also called
Pulseless disease
Which arthritis causes weak or absent pulse in the upper extremities?
Takayasu arteritis
Takayasu arteritis treatment
Corticosteroids
Polyarthritis nodosa=
Necrotizing vasulitis
Which organ is spared in Polyarthritis nodosa
Lungs
Polyarthritis nodosa common in what population
Young adults
Polyarthritis nodosa symp.
HTN (renal artery)
Melena (mesenteric a)
Skin lesion
Neurologic disturbance
Polyarthritis nodosa is associated with what Ag
HBsAg
What kind of lesions are present in Polyarthritis nodosa
Varying stages
Imaging appearance of Polyarthritis nodosa
String of pearls
Why do we see String of pearls in Polyarthritis nodosa
Necrosis that heals with fibeosis
Which vasculitis classicaly affects asian children < 4 years old
Kawasaki disease
Kawasaki disease symp.
Fever
Conjunctvitis
Rash on palms and soles
Enlarged cervical lymph nodes
Kawasaki disease commonly involves which artery?
Carotid
Kawasaki disease treatment
Aspirin
IVIG
Which medium vessels vasculitis is self limited
Kawasaki disease
Buerger disease=
Necrotizing vasculitis involving digits
Buerger disease involves the
Digits
Buerger disease presents as
Ulceration, gangrene and autoamputation of fingers and toes
Which phenomenon is often present with Buerger disease
Raynaud
Raynaud phenomeno=
Spasm of arteries cause episodes of reduced blood flow.
Typically, the fingers
Buerger disease is highly associated with
Smoking
אתה מחזיק את הסיגריות באצבעות
Wegener granulomatosis involves which vessels
Nasopharynx
Lungs
Kidneys
lassic presentation of Wegener granulomatosis
Middle aged male with sinusitis, hemoptysis and hematuria
Serum levels of ____ correlate with Wegener granulomatosis
c-ANCA
Wegener granulomatosis treatment
Cyclophosphamide steroids
Microscopic polyangitis involves
Multiple organs
Microscopic polyangitis involves especially
Lung
Kidney
What is the difference btw Microscopic polyangitis and Wegener granulomatosis?
Microscopic polyangitis doesnt involve the nasopharynx
Serum levels of ____ correlate with Microscopic polyangitis
p-ANCA
p-ANCA + vasculitis
Microscopic polyangitis
Churg-Strauss syndrome
Churg-strauss syndrome=
Necrotizing granulomatous inflammation with eosinophils
Churg-strauss syndrome involves mostly
Lung
Heart
What is often present in Churg-strauss syndrome
Asthma
Peripheral eosinphilia
Serum levels of ____ correlate with Churg-strauss syndrome
p-ANCA
What is the most common vasculitis in children?
Henoch-Schonlein purpura
Henoch-Schonlein purpura=
Vasculitis due to IgA immune complex deposition
Henoch-Schonlein purpura treatment
Mostly self limited
Henoch-Schonlein purpura symptoms
Palpable purpura on buttocks and legs
GI pain and bleeding
Hematuria (IgA nephropathy)
Leading cause of death in US
Ischemic Heart Disease
MI=
Necrosis of cardiac myocytes
MI happens usually due to
Rupture of an atherosclerotic plaque with thrombosis and comlete occlusion of a coronary artery
MI symp.
Crushing chest pain
Sweating
Dyspnea
Infarction usually involves ___
Left vent.
What is the most common involved artery in MI
LAD
LAD-> where is the MI?
Ant wall and septum of LV
Initial phase of infarction leads to ______ necrosis
Subendocardial
Continued ischemia leads to _____ necrosis
Transmural
MI cardiac enzymes
Troponin I peak at 24 hours post MI
CK-MB
MI treatment
Aspirin O2 Nitrates (vasodilation) B-blockers (lowering HR) ACE inhibitors (decreases LV dilation)
Gross change in MI + Which cells are present?
<4 h
None None Cardiogenic shock CHF Arrhythmia
Gross change in MI + Which cells are present + complication
4-24 h
Dark discolaration
Coagulative necrosis
Arrhythmia
Gross change in MI + Which cells are present + complication
1-3 d
Yellow pallor
Neut.
Fubrinous pericarditis
Gross change in MI + Which cells are present + complication
4-7 d
Yellow pallor
MPH
Rupture of wall
Gross change in MI + Which cells are present + complication
1-3 w
Red border
Granulation tissue, collage, blood vessels
Gross change in MI + Which cells are present + complication
1 month
White scar
Fibrosis
Aneurysm
Types of angina
Stable
Unstable
Prinzmetal
Angina is due to
Atherosclerosis of coronary a > 70%
Stable angina arises when
Exortion or emotional stress
ECG of stable angina
STD due to subendothelial ischemia
Stable angina is relived with
Rest
Nitroglycerin
Unstable angina is usually due to
Rupture of atherosclerotic plaque and thrombosis and incomplete occlusion of a coronary artery
Prinzmetal angina=
Episodic chest pain due to coronary artery vasospasm
Prinzmetal angina ECG shows
STE due to transmural ischemia
Most common etiology of sudden cardiac death
Acute ischemia
Fetal ventricular arrhythmia
CHF occurs when
The heart cannot generate sufficient output to meet metabolic demands of the tissues
Left CHF is due to
Ischemia Hypertension Dilated cardiomyopathy MI Restrictive cardiomyopathy
Clinical features in LCHF are due to
Decreased forward perfusion
Pulmonary congestion
Pulmonary congestion leads to
Pulmonary edema
Pulmonary edema leads to
Dyspnea
Small alveolar capiilaries may burst ->Intraalveolar hemorrhage -> Laden MPH
In Left sided heart failur, decreased flow to kidneys cause
Activation of renin-angiotensin mechanism
Right sided heart failure is most commonly due to
Left sided heart failure
But also
Left to right shunt
Chronic lung disease
What chronic disease causes Right sided heart failure
Chronic lung disease (cor-pulmonale)
Right sided heart failure symp.
Jugular venous distension
Hepatosplenomegaly (nutmag liver)
Pitting edema
