Cardiac Flashcards
EKG of stable angina would show
ST depression (subendocardial ischemia)
EKG of stable angina would show
ST depression (subendocardial ischemia)
EKG of Prinzmetal Angina would show
ST elevation (transmural ischemia)
Most common artery causing an MI
Left anterior descending (LAD)
LAD supplies
Apex, anterior left ventricle, one third of the anterior right ventricle, anterior 2/3 of the intraventricular septum
Right coronary a. supplies
remaining 2/3 of anterior right ventricle, posterior right ventricle, posterior half of left ventricle, posterior 1/3 of interventricular septum
Left circumflex a. supplies
lateral wall of the LV
Cardiac enzymes elevated in MI
Troponin I, CK-MB
After an MI, Troponin I peaks at
24 hours
After an MI, Troponin I begins to rise at
2-4 hours
After an MI, Troponin I returns to baseline by
7-10 days
After an MI, CK-MB peaks at
24 hours
After an MI, CK-MB begins to rise at
4-6 hours
After an MI, CK-MB returns to baseline by
72 hours
CK-MB help detect
re-infarction that occurs days after an initial MI
Contraction band necrosis is seen after
returned blood/Ca2+ entry into dead myocytes after MI followed by angioplasty, causes contraction
Reperfusion injury results from
returning of O2 to irreversibly damaged myocytes resulting in the generation of free radicals
Key events seen 4-24 hours after MI
Coagulative necrosis –> arrhythmia
Key events seen 1-3 days after MI
Neutrophil infiltration of acute inflammation –> fibrinous pericarditis
Key events seen 4-7 days after MI
Macrophage infiltration of acute inflammation –> rupture of ventricle wall
Key events seen 1-3 weeks after MI
Granulation tissue (emerging red border)
Key events seen Months after MI
Fibrosis –> aneurysm, mural thrombus, Dressler Syndrome
Scarring after MI contains primarily
Type I collagen
Sudden cardiac death is typically due to
severe atherosclerosis
LSHF causes edema in the _________ causing
lungs, PND, orthopnea, crackles
Heart failure cells are
hemosiderin-laden macrophages
Heart failure cells are seen with what condition/s
LSHF
Nutmeg Liver is seen with what condition/s
RSHF
Nutmeg Liver is due to congestion of
central veins of the liver
What congenital heart defect results typically from fetal EtOH syndrome?
Ventricular Septal Defects
Eisenmenger Syndrome
late-stage VSD; R->L Shunt; RV hypertrophy, cyanosis, polycythemia, clubbing
What congenital heart defect may be associated w/ Down’s Syndrome?
Atrial Septal Defect
What PE finding is associated w/ Atrial Septal Defect?
Split S2 (due to high BV in RA and delayed closure of pulmonic valve)
Significant risk involved w/ Atrial Septal Defect?
paradoxical embolus
What congenital heart defect may be associated w/ Congenital Rubella?
Patent Ductus Arteriosus (PDA)
What PE finding is associated w/ Patent Ductus Arteriosus (PDA)?
holosystolic machine-like murmur
Patent Ductus Arteriosus (PDA) + pHTN resulting in Eisenmenger Syndrome would have what PE finding?
Cyanosis of the LE
Treatment for Patent Ductus Arteriosus (PDA)?
Indomethacin (decreases PGE)
4 Key findings w/ Tetralogy of Fallot
P: Pulmonary stenosis R: RV hypertrophy O: Overriding aorta V: VSD
Clinical presentation of Tetralogy of Fallot
cyanotic baby, relieved by squatting
Key X-ray finding of Tetralogy of Fallot
boot-shaped heart
What congenital heart defect may be associated w/ maternal diabetes?
Transposition of great vessels
Treatment for Transposition of great vessels
PGE
Tricuspid Atresia is almost always seen in association w/
ASD and an aplastic RV
Location of an infantile Coarctation of the Aorta
distal to arch, proximal to PDA
Key PE finding of infantile Coarctation of the Aorta
LE cyanosis
What congenital heart defect may be associated w/ Turner’s Syndrome?
infantile Coarctation of the Aorta
Key PE finding of adult Coarctation of the Aorta
UE HTN and LE hypotension
Key X-ray finding of adult Coarctation of the Aorta
Notching of the ribs due to collateral circulation
Diagnosis of Acute Rheumatic Fever first involves establishing
evidence of a previous GAS infection w/ high ASO or DNase B titers
Acute Rheumatic Fever results from
molecular mimicry from M proteins produced by a previous GAS infection (pharyngitis) 2-3 weeks prior
JONES criteria for Acute Rheumatic Fever findings
Migratory polyarthritis, pancarditis, nodules, erythema marginatum, Syndenham chorea
Pancarditis due to Acute Rheumatic Fever
Endocarditis: vegetations on mitral valve -> mitral regurgitation Myocarditis: Aschoff bodies w/ Anitschkow cells Pericarditis: friction rub
Chronic Rheumatic Valvular Disease affects which valves
Mitral stenosis (thickening of chord tendineae) and occasionally Aortic valve stenosis (fusion of commissures)
Bicuspid aortic valve increases risk of ________?
Aortic stenosis
Aortic stenosis may arise as a complication of
Chronic Rheumatic Valvular Disease (fusion + mitral stenosis)
Key finding of Aortic Stenosis on PE exam?
systolic ejection click followed by a crescendo-decrescendo murmur
Typical presentation of pts w/ Aortic Stenosis?
angina, syncope w/ exercise
Lab findings w/ Aortic Stenosis?
Schistocytes due to Microangiopathic hemolytic anemia
What heart condition may result from Syphilitic aneurysm?
Aortic Regurgitation
Aortic Regurgitation most commonly arises as a result of
aortic root dilatation
Key finding of Aortic Regurgitation on PE exam?
Early, blowing diastolic murmur + Hyperdynamic circulation
Describe the Early, blowing diastolic murmur + Hyperdynamic circulation Sx w/ aortic regurg.
Bounding pulses, pulsatile nail bed, head bobbing
What heart condition may result from Marfan’s or Ehler-Danlos?
Mitral Valve Prolapse
Key finding of Mitral Valve Prolapse on PE exam?
Mid-systolic click ( +/- regurgitation murmur)
Key finding of Mitral Regurgitation on PE exam?
holosystolic “blowing” murmur
Key finding of Mitral Stenosis on PE exam?
opening snap, followed by a diastolic rumble
What heart condition may result from Acute Rheumatic Fever?
Mitral Regurgitation
What heart condition may result from Chronic Rheumatic Valvular Disease?
Mitral Stenosis
Most likely etiologic agent causing endocarditis in a previously injured heart (acute rheumatic fever)?
Strep viridans
Most likely etiologic agent causing endocarditis in a IV drug user?
S. aureus
Most likely etiologic agent causing endocarditis in a pt w/ a prosthetic valve?
Staph epidermidis
Strep bovis is associated w/
Endocarditis w/ underlying colorectal carcinoma
Presentation of pt w/ endocarditis?
Fever, murmur, janeway lesion, osler nodules, anemia of chronic disease (microcytic)
What heart condition is associated w/ SLE?
Libman-Sacks Endocarditis
Biopsy finding of valve in Libman-Sacks Endocarditis would show?
vegetations on BOTH SIDES of valves
Nonbacterial Thrombotic Endocarditis arises due to
hypercoagulable state affecting mitral valve
Dilated Cardiomyopathy leads to
biventricular CHF
Causes of Dilated Cardiomyopathy
Genetic mutation, Coxsackie A or B virus, EtOH use, doxorubicin, cocaine, pregnancy
Genetic mutations in the sarcomere proteins causes?
Hypertrophic Cardiomyopathy
Most common cause of sudden death in young athletes?
Hypertrophic Cardiomyopathy
Key pathology findings w/ Hypertrophic Cardiomyopathy
myofiber hypertrophy w/ disarray
Common causes of Restrictive Cardiomyopathy?
Amyloidosis, sarcoidosis, hemochromatosis, endocardial fibroelastosis (children), Loeffler Syndrome
Key finding on EKG of Restrictive Cardiomyopathy?
low-voltage EKG w/ diminished QRS
Myxoma originates from
mesenchymal tissue
Myxoma is most common in what pt population
adults
Myxoma features and location
pedunculated tumor in L. atrium