Cardiac Path Flashcards by Sarah Meadows

p-Anti Neutrophil Cytoplasmic Antibodies target?

Myeloperoxidase

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c-Anti Neutrophil Cytoplasmic Antibodies target?

Proteinase-3 (PR3)

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Pathogenesis of Kawasaki disease

Autoantibodies against endothelial cell and smooth muscle cell
react against vessel wall and cause inflammation and vessel wall damage
(type II hypersensitivity)

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Pathogenesis of Polyarteritis nodosa (associated with Hepatitis B)

Deposition of immune complexes
(type II hypersensitivity)

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Pathogenesis of Giant cell arteritis and Takayasu
arteritis

T cell mediated

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Giant cell Arteritis commonly involves which arteries?

Temporal artery

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Takayasu Arteritis commonly involves which artery?

Aortic arch and great vessels

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Polyarteritis Nodosa commonly involves which arteries?

Medium sized arteries of kidney > heart > liver > gastrointestinal tract

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Kawasaki disease primarily involves which arteries?

Coronary arteries (medium)

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Buerger’s Disease most commonly involves which arteries?

Tibial and radial arteries (extending into veins and nerves)

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WEGENER’S GRANULOMATOSIS pathogenesis

c-ANCA/PR3-ANCA

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pathogenesis

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MICROSCOPIC POLYANGITIS pathogenesis

p-ANCA/MPO-ANCA

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What condition(s) cause concentric hypertrophy?

HTN, Aortic Stenosis

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What condition(s) cause Eccentric Hypertrophy?

Aortic Regurgitation

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What is Cor Pulmonale?

R. sided heart failure due secondary to COPD, pulmonary HTN, or asthma

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Which type of backward heart failure:
• Systemic venous congestion
• Distended neck vein
• Enlarged tender liver
• Pedal edema

Right Ventricular Failure

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Which type of forward heart failure:
• Dyspnea due to pulmonary edema

Right Ventricular Failure

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Which type of forward heart failure:
• Fatigue
• Shock
• Syncope

Left Ventricular Failure

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Which type of backward heart failure:
• Dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea (PND)

Left Ventricular Failure

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Pathogenesis of Ischemic Heart Disease (IHD)

Chronic progressive atherosclerotic narrowing of the epicardial coronary arteries

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Pathogenesis of Stable (typical) angina

Due to reduction of coronary perfusion because of fixed stenosis – No myocardial necrosis

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Pathogenesis of unstable (crescendo) angina

Induced by disruption of plaque with superimposed thrombosis and possibly vasospasm

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Pathogenesis of Prinzmental angina

Mechanism not clear but it occurs due to coronary artery spasm producing transient squeezing chest pain

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Which type of infarction can also occur with Cocaine abuse?

Transmural Infarction

Diagnosis of MI A. Most sensitive and specific marker B. Normally not detectable in circulation C. Rises in 3-12 hrs, peaks at 12-48 hrs. and persists for 5-14 days

Troponins (I and T)

Diagnosis of MI Rises in 3-12 hrs., Peaks at 18-24 hrs. and disappears by 48-72 hrs. Useful for detection of reinfarction

Creatine Kinase isoenzymes (CK-MB)

Diagnosis of MI Rises in 24 hrs., peaks at 3-6 days and returns to baseline within 8-12 day

Lactate dehydrogenase (LDH)

In adults what is the most common cause of Sudden Cardiac Death?

CAD

In younger victims what is the most common cause of sudden cardia death?

Cardiomyopathy and myocarditis

What is the ultimate mechanism of SCD?

lethal arrhythmia - left ventricular fibrillation

What is the ultimate mechanism of SCD?

lethal arrhythmia - left ventricular fibrillation

Does hyaline or hyperplastic arteriosclerosis cause retinal damage?

Hyperplastic Arteriolosclerosis > cotton wool spools

Does hyaline or hyperplastic arteriosclerosis cause retinal damage?

Hyperplastic Arteriolosclerosis > cotton wool spools

Acute Cor Pulmonale is due to ?

Due to massive pulmonary emboli Right ventricle is dilated but no hypertrophy

Chronic Cor Pulmonale is due to ?

• COPD – Most common cause • Others – Idiopathic pulmonary fibrosis, cystic fibrosis or marked obesity

Cor Bovinum (cow's heart) is seen in which pathology?

Syphilitic Aneurysm -Fibrosis of the vascular wall "tree bark appearance” -Wrinkling of aortic intima due to secondary atherosclerosis may narrow or occlude coronary ostia -Aortic valve ring dilation → valvular insufficiency -Aortic valvular insufficiency→ massive hypertrophy of left ventricle referred as (cow’s heart)

Which aneurysm is associated w/ autosomal dominant polycystic kidney disease (ADPKD)

Berry Aneurysms

Osler's nodes, Janeway lesions, Roth spots are uncommon but pathognomonic for _____?

Infective endocarditis

Osler's nodes, Janeway lesions, Roth spots are uncommon but pathognomonic for _____?

Infective endocarditis

What type of hypersensitivity is Rheumatic fever?

Type 2 Hypersensitivity

Which valves are usually involved with Endocarditis?

Mitral and Aortic

Which valve is usally involved wtih Acute Rheumatic Fever?

Mitral Valve

Which valve is usally involved wtih Acute Rheumatic Fever?

Mitral Valve

• Distinctive lesions in the heart – Aschoff bodies (pathognomonic feature) • Composed of foci of T lymphocytes, occasional plasma cells, and plump activated macrophages called Anitschkow cells • Small (1-2 mm) vegetations overlying these foci plus along lines of closure: Verrucae This is seen in which condition?

Acute Rheumatic Fever

Triad associated w/ mitral valve prolapse

1.) scoliosis 2.) high arched palate 3.) Mital Valve prolapse

Triad associated w/ mitral valve prolapse

1.) scoliosis 2.) high arched palate 3.) Mital Valve prolapse

INFECTED VEGETATIONS is composed of?

FIBRIN DEPOSITION + PLATELET AGGREGATION + MICROBIAL PROLIFERATION

What is the most common cause of arrhythmias?

Ischemic Heart Disease that either directly causes damage to the conduction tissue or causes a dilation of the heart walls and alters electrical conduction

Certain maneuvers like Valsalva maneuver and carotid massage could be helpful in diagnosing with arrhythmia?

Supraventricular arrhythmia

Sudden Cardiac Death Definition Cause Management

Definition: sudden death due to fatal arrhythmia Cause: Most important = acute coronary syndrome; younger patients = non-atherosclerotic conditions Management: pacemaker or automatic cardioverter defibrillator

Sinus bradycardia

Rate < 60/min

Sinus tachycardia

Rate >100/min

First-degree atrioventricular block EKG findings Cause

a. ECG:prolongedPRinterval>0.2sec(200ms). b. Causes: excess vagal tone, aging, ischemia, cardiomyopathy If R is far for P then you have first degree

Second-degree block - TypeI(MobitzI/Wenckebach) - atrioventricular block EKG findings Cause

i. ECG: progressive prolongation of the PR interval until a beat is dropped ii. Block is above the bundle of His iii. Causes: myocardial infarction, digitalis toxicity, excess vagal tone etc. Longer, longer, longer drop! then you have wenkebach

Second degree - (MobitzII) block atrioventricular block EKG findings Cause

i. ECG: sudden occurrence of blocked beat without progressive prolongation of PR interval. ii. Block is below the bundle of His iii. Causes: myocardial infarction, degeneration of His-Purkinjee system iv. Can present with sudden asystole or ventricular tachycardia or fibrillation that causes circulatory arrest (Adam-Stoke syndrome)

Third-degree block atrioventricular block EKG findings Cause

a. ECG: all p waves are blocked and ventricles driven by an ectopic focus. No correlation between P waves and QRS complex b. Causes: degenerative changes, infarction, any infectious of inflammatory processes, digitalis toxicity c. Common to seeAdam-Stokesyndrome

ECG: regular rhythm with usually a 2:1 block i.e. atrial beats at around 250/min and ventricles beats at 125/min. so every 3rd P wave gets conducted. The classic description is for the flutter waves is ‘saw-tooth appearance’. Causes: alcohol, COPD, thyrotoxicosis, pulmonary embolism etc.

Atrial Flutter

ECG will show wide, bizarre QRS complexes and the rate is usually >120/min.

VENTRICULAR TACHYCARDIA - Monomorphic type

EKG shows aternating and undulating rotations of the QRS complexes around the baseline

VENTRICULAR TACHYCARDIA - Polymorphic / Torsade de Pointes type

ECG: Rapid ventricular rate > 200/min, irregularly irregular (QRS) fibrillation waves. Clinical Presentation: Sudden Cardiac Death, Asystole Causes: Ischemic Heart disease (Post-MI), Valvular Heart disease, Myocarditis and also other arrhythmias may transform/evolve into VF

VENTRICULAR FIBRILLATION (VF):