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Cardiac - Path Flashcards

1
Q

What organism most often causes myocarditis?

Shows what on histo?

A

Coxsackie A and B

Lymphocytic infiltrate in the myocardium

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2
Q

ASD causes what?
Results in what?

What is an important complication?

A

Left to Right shunt
Split S2 on auscultation

Paradoxical emboli (can go to brain)

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3
Q

What is the most common cause of death in the acute phase of acute rheumatic fever?

A

Myocarditis

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4
Q

What are the 2 types of aortic dissection and what is their treatment?

A

A - involves ascending aorta, can cause AR/tamponade
Tx: surgery

B - ONLY descending aorta, below l. Arteriosum
Tx: Beta blockers, vasodilators

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5
Q

What does tetralogy of Fallot cause?

A 
PROVe
Pulmonary infundibular stenosis 
RVH
Overriding aorta
VSD
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6
Q

The RCA supplies what important structures?

Leads to what?

A

SA and AV nodes

Bradycardia
MI due to heart block

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7
Q

Most common signs of RHF?

A

HM (nutmeg liver)
JVD
Peripheral Edema

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8
Q

AS may lead to what?

A

Concentric hypertrophy
S4 heart sound
Hemolytic anemia

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9
Q

What causes concentric LV hypertrophy?

A

HTN

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10
Q

How does MR affect afterload?

EF?

A

Decreases it

Increased but lower forward SV

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11
Q

Day 4-7 post MI involves primarily what cells present?

What is the major complication that may result?

A

Macrophages

Rupture of ventricular free wall –> cardiac tamponade
Rupture of interventricular septum –> shunt
Rupture of papillary muscle –> mitral insufficiency

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13
Q

What is asymptomatic at birth but causes a holosystolic murmur?

Shows what CF?

A

PDA

LE cyanosis

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14
Q

What is associated w/Transposition of Great Vessels?

Presents how?

Treat how?

A

Maternal diabetes

Early cyanosis at birth

PGE to maintain a PDA

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15
Q

Young athlete collapsing and dying due to ventricular arrhythmia is due to what?

A

Hypertrophic cardiomyopathy

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16
Q

What angina causes ST elevation?

A

Prinzmetal

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17
Q

What presents w/weak UE pulses, fever, night sweats and increased ESR?

Labs show what?

Tx?

A

Takayasu arteritis

Thickening and narrowing of aortic arch and prox great vessels

Corticosteroids

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18
Q

What presents as a murmur over the apex that radiates to the left axilla?

A

MR

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19
Q

3 main CFs of AS?

A

Syncope
Angina
Dyspnea on exertion

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22
Q

What is Kussmaul sign?

Indicates what?

A

Inc in JVP on inspiration instead of a normal DEC

Constrictive pericarditis, restrictive cardiomyopathy, RA or ventricular tumor

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23
Q

Hereditary hemorrhagic telangeictasia called what?

CFs?

A

Osler-Weber-Rendu

Telangeictasias, epistaxis, AVMs, GI bleeding, hematuria, skin discoloration

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24
Q

What angina causes ST depression?

A

Stable, unstable

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25
Q

What is a b9 hamartoma of cardiac muscle called?

Assoc w/what?

Arises where?

A

Rhabdomyoma, #1 in children

Tuberous sclerosis

Ventricle

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26
Q

Dilated cardiomyopathy causes what dysfunction?

Leads to what?

Complications?

A

Systolic dysfx

Biventricular CHF

MR and TR leading to arrhythmia

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27
Q

What causes scarring of the aortic valve and fusion of the commissures?

A

Chronic rheumatic heart disease

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29
Q

What sites commonly metastasize to the heart?

Causes what?

A

Breast, lung, melanoma and lymphoma

Pericardial effusion

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30
Q

What is Kussmaul’s sign?

A

When you breathe in, jugular veins Decrease distention but in RHF JVD increases

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31
Q

What is the most common primary cardiac tumor in adults? Mal or B9?

Forms what, where?

Causes what?

A

Myxoma, B9

Pedunculated mass in the LA

syncope

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32
Q

Reactive histiocytes w/slender wavy nuclei are what?

Associated with what?

A

Anitschkow cells

Myocarditis

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33
Q

What provides evidence for a previous group A beta-hemolytic strep infection?

A

ASO or anti-DNase B titers

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34
Q

Mitral stenosis can result in what 3 major sequellae?

A

Pulmonary congestion
Pulmonary HTN and eventually RHF
AFib –> inc risk of mural thrombi

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35
Q

AS causes chronically what problems?

A

Inc pressures in LV and LA dilation hypertrophy

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36
Q

Ventricular apical ballooning due to increased sympathetic stimulation is what?

A

Takotsubo cardiomyopathy (Broken hearT)

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37
Q

What causes thickening of chordae tendinae and cusps?

With involvement of what valve?

A

Chronic rheumatic heart disease

Mitral

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38
Q

Kussmaul’s sign is most commonly found in what?

What else?

A

Chronic constrictive pericarditis

RHF, restrictive cardiomyopathy, tricuspid stenosis

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39
Q

What kind of valve defect leads to a wide pulse pressure?

Called what?

A

AR

Water-Hammer pulse

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41
Q

What is a blowing, decrescendo diastolic murmur?

Best heard where?

A

AR

Left sternal border in 3/4th ICS

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42
Q

What are the 3 major complications of AS?

A

Concentric LVH
Angina andy syncope w/exercise
Microangiopathic hemolytic anemia

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43
Q

What can papillary muscle rupture after a MI cause?

Gets louder when?

A

MR

Squatting or expiration

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44
Q

MI usually involves what?

What is spared?

A

LV

RV and both atria

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45
Q

What is the most common type of ASD?

A

Optimum secundum

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46
Q

What is usually due to rupture of atherosclerotic plaque w/thrombosis and INCOMPLETE occlusion of a coronary artery?

A

Unstable angina

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47
Q

What is the main feature of hypertrophic cardiomyopathy?

A

Diastolic dysfx (ventricle cannot fill)

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48
Q

How does acute MR affect LV EDV?

What else does it do?

A

Increases

Increases preload

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49
Q

What produces an opening snap followed by a diastolic rumble?

A

MS

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51
Q

What does the AS murmur sound like?

Where?

A

Harsh crescendo-decrescendo holosystolic murmur

Right sternal border

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53
Q

What is hypertrophic cardiomyopathy?

Usually due to what?

A

Hypertrophy of LV

Sarcomere proteins (AD)

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55
Q

How does mitral stenosis present as a murmur?

Best heard where?

A

Mid-diastolic rumbling murmur preceded by opening snap

Apex of left sternal border

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57
Q

What is a PDA assoc with?

A

Congenital rubella

58
Q

PAN associated w/what?

Histopath shows what?

Tx?

A

HepB

Transmural inflammation w/fibrinoid necrosis

corticosteroids, cyclophosphamide

59
Q

Occlusion of the RCA leads to infarction of what?

A

Posterior wall
Posterior septum
Papillary muscles of the LV

60
Q

Rupture of papillary muscle and chordae tendinae causes what?

When?

A

MR

3-14 days post MI

62
Q

What murmur radiates to the carotid arteries?

63
Q

With stable angina, what area is the most susceptible to ischemic damage?

Shows what on EKG?

A

Subendocardial

ST-segment depression

64
Q

What is episodic chest pain unreleated to exertion?

Due to what?

A

Prinzmetal

Vasospasm of coronary artery

66
Q

Common complications of coarctation of the aorta?

A

HF
Inc risk of cerebral hemorrhage (berry aneurysm)
Aortic rupture
Endocarditis

67
Q

What is the key finding in the adult form of coarctation of the aorta?
Where is the coarctation?

Assoc w/what?

A

HTN in UE, hypoTN and weak pulses in LE
Distal to aortic arch

Bicuspid aortic valve

68
Q

What is decreased compliance of the ventricular endomyocardium caused by?

Does what?

A

Restrictive cardiomyopathy

Restricts filling during diastole

69
Q

What has a boot-shaped heart on xray?

A

Tetralogy of Fallot

70
Q

What organism causes endocarditis in pts w/underlying colorectal carcinoma?

A

Staph bovis

71
Q

How do you treat PDA?

Via what mechanism?

A

Indomethacin

Decreases PGE

72
Q

Define aortic regurgitation

A

Backflow of blood from the aorta into the LV during DIASTOLE

74
Q

What are foci of chronic inflammation, giant cells, and fibrinoid material called?
What else do they contain?

Assoc w/what?

A

Aschoff bodies
Anitschkow cells

Myocarditis

75
Q

Calcification of internal elastic lamina and media of arteries leads to what? Called what?

What appearance on xray?

A

Vascular stiffening w/out obstruction, Monckeberg sclerosis

Pipestem

76
Q

What causes MVP?

Associated w/what?

A

Myxoid degeneration

Marfan, Ehlers-Danlos

77
Q

What valve is most commonly involved from bacterial endocarditis?

PE findings?

A

1 - Fever, Splinter hemorrhages, Osler, Janeway, Roth spots

Mitral

78
Q

Kawasaki disease complications?

A

Coronary artery aneurysm, thrombosis, rupture

79
Q

What is endomyocardial fibrosis w/an eosinophilic infiltrate and eosinophilia called?

Causes what?

A

Loeffler syndrome

Restrictive cardiomyopathy

80
Q

What is the mechanism behind the presence of “heart failure cells”?

What are they?

A

Bursting of small congested capillaries due to pulmonary congestion from LHF

Hemosiderin-laden macrophages

81
Q

What causes a hyperdynamic circulation?

Due to what?

A

AR

Increased pulse pressure

82
Q

What leads show a posterior infarct?

A

V1-V3 ST Depression w/tall R waves

83
Q

What is arcus senilis?

A

Lipid deposit in the cornea in elderly pts

84
Q

What causes a holosystolic, blowing murmur?

85
Q

Janeway or Osler are painful?

A

Osler

Ouch ouch osler

86
Q

Optimum primum is assoc w/what?

A

Down syndrome

87
Q

Chronic rheumatic heart disease leads to what?

Can lead to what?

A

Mitral stenosis

LA dilation –> AFib or mural thrombus formation (can cause ischemic stroke)

88
Q

Biopsy showing myofiber hypertrophy w/disarray is characteristic of what?

A

Hypertrophic cardiomyopathy

89
Q

Chronic ischemic heart disease progresses to what?

90
Q

What closes a PDA?

What keeps it open?

A

Indomethacin

PGE2

91
Q

Occlusion of the Left circumflex artery leads to infarction of what?

A

Lateral wall of LV

92
Q

Aortic regurgitation causes what kind of murmur?

A

Early, Blowing diastolic murmur

93
Q

How does restrictive cardiomyopathy present?

A

CHF w/low voltage EKG and diminished QRS amplitude

94
Q

Babies w/coarctation present how?

Associated w/what?

A

LE cyanosis

Turner syndrome

95
Q

What kind of murmur is heard w/AS?

A

Systolic ejection click followed by crescendo-decrescendo murmur

96
Q

Main treatment of CHF?

97
Q

What are the 3 main CF of congestion due to RHF?

A

Jugular venous distention
Painful HSM –> nutmeg liver
Pitting edema (INC hydrostatic pressure)

98
Q

What does cystic medial degeneration cause?

A

Thoracic aortic aneurysm

99
Q

What organism commonly causes endocarditis in IV drug users?

Affects what valve preferentially?

A

Staph aureus

Tricuspid

100
Q

Mitral valve prolapse causes what kind of murmur?

A

Mid-systolic click followed by regurgitation murmur

101
Q

What is the gold-standard for MI diagnosis?

Peaks when?
Returns normal when?

A

Troponin I

24 hours
7-10 days

102
Q

What leads show a LCX infarct?

103
Q

What is a congenital heart defect that causes late cyanosis, clubbing, and polycythemia?

Mechanism?

A

Eisenmenger syndrome

Uncorrected L–>R shunt that eventually becomes R–>L shunt

104
Q

What leads show a RCA infarct?

What direction is the infarct?

A

II, III, aVF

Inferior

105
Q

Myocytes adding in series means what?

A

LV Eccentric hypertrophy

106
Q

Most common signs of LHF?

A

Orthopnea (SOB while supine)
PND
Pulmonary edema

107
Q

What is the result of fibrosis and calcification and presents in late adulthood (> 60)?

What increases the risk/hastens onset?

A

Aortic Stenosis

Bicuspid aortic valve (should be 3 cusps normally)

108
Q

What leads show a LAD infarct?

109
Q

What congenital defects are assoc w/DiGeorge syndrome?

A

Truncus arteriosus

tetralogy of Fallot

110
Q

Occlusion of the LAD leads to infarction of what areas?

A

Anterior wall

Anterior septum of LV

111
Q

Coarctation of the aorta is what?

Infantile form?

A

Narrowing of the aorta

Coarctation lies distal to the aortic arch but before PDA

112
Q

Chronic rheumatic valve disease causes what?

Acute?

113
Q

ECG changes w/pericarditis?

A

ST segment elevation and/or PR depression

114
Q

What causes aortic regurgitation?

A

Aortic root dilation

Syphilitic aneurysm

115
Q

What occurs as a result of Tricuspid Atresia?

Associated w/what?

A

RV is hypoplastic

ASD and Right to left shunt

116
Q

What ion influxes during reperfusion of damaged cells of the heart?

Causes what?

A

Calcium

Contraction band necrosis

117
Q

What makes up Beck’s triad?

Indicates what?

A

Hypotension
Distended neck veins
Distant heart sounds

Cardiac tamponade

118
Q

What defines HTN?

A

systole > 140

Diastole > 90

119
Q

What causes notching of the ribs on xray?

Due to what?

A

Coarctation of the aorta - adult form

Intercostal artery engorgement

120
Q

What can be useful to detect reinfarction of MI?

121
Q

Endocarditis preferentially impacts what valve?

Causing what?

A

Mitral valve

Vegetations leading to mitral valve regurgitation

122
Q

Endocarditis w/negative blood cultures indicates what?

CFs?

A

HACEK organisms

Fever, murmur, Janeway lesions, Osler nodes, ACD

123
Q

What congenital heart defect can lead to paradoxical emboli?

Due to what?

A

ASD

Ostium secundum most common

124
Q

What are the 5 R–>L shunts>

A
  1. Truncus arteriosus
  2. Transposition of great vessels
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. TAPVR
125
Q

What are common causes of dilated cardiomyopathy?

A 
Genetic mutation
Myocarditis
Alcohol and drugs (doxorubicin)
Pregnancy
Hemochromatosis
126
Q

When do you see dark discoloration of the heart?

What is happening?

A

4-24 hours

Coagulative necrosis

127
Q

What is the most common congenital heart defect, causes what?

Assoc w/what?

A

VSD, causes Left to Right shunt

fetal alcohol syndrome

128
Q

Neutrophil influx after MI can cause what complication?

Presents how?

A

Fibrinous pericarditis

Friction rub

129
Q

Occlusion of what artery leads to rupture of papillary muscle?

130
Q

What does an EKG show on prinzmetal angina?

Due to what?

A

ST elevation

Transmural ischemia

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