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CRRAB FINAL REVIEW > Cardiac Path- Wittrack > Flashcards

Cardiac Path- Wittrack Flashcards

1
Q

Dilated cardiomyopathy

A

Dilation of all four chambers of the heart Impaired contractility of one or both ventricles = systolic disfunction (decreased LV ejection fraction)

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2
Q

Common causes of dilated cardiomyopathy

A

Alcohol abuse Beriberi Coxsackie B Cocaine Chagas Doxorubicin Pregnancy!

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3
Q

Hypertrophic Cardiomyopathy

A

Massive hypertrophy of the left ventricle Usually due to a genetic mutation in sarcromere proteins Autosomal dominant

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4
Q

What is the most common cause of sudden death in young athletes?

A

Hypertrophic Cardiomyopathy

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5
Q

Restrictive Cardiomyopathy

A

Decreased compliance of the ventricular endomyocardium that restricts filling during diastole

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6
Q

What are some causes of restrictive cardiomyopathy?

A

Amyloidosis, sarcoidosis, endocardial fibroelastosis, Loeffler syndrome Presents as congestive heart failure Classic finding is low voltage EKG with diminished QRS amplitude

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7
Q

Difference between primary and secondary cardiomyopathy?

A

Primary = disease limited to heart Secondary = associated with systemic disorders

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8
Q

In what cardiac disease would you see impaired LV filling/relaxation with a preserved LVEF Thickened LV Normal to reduced LV chamber size

A

Hypertrophic cardiomyopathy

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9
Q

In what cardiac disease would you see usually non-dilated, non-hypertrophic ventricles but still have a diastolic LV dysfunction?

A

Restrictive cardiomyopathy

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10
Q

What are common sources of clinically significant valve disease in developed countries?

A

Calcific aortic stenosis Mitral valve prolapse

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11
Q

What are common sources of clinically significant valve disease in developing countries?

A

Rheumatic fever valvulitis (with multiple valve involvement)

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12
Q

What are almost all cases of mitral stenosis due to?

A

Rheumatic Fever

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13
Q

What is systolic click murmur syndrome?

A

Due to mitral valve prolaspe

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14
Q

What is mitral valve prolapse?

A

Ballooning of mitral valve into left atrium during systole Due to myxoid degeneration (accumulation of ground substance) of the valve making it floppy

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15
Q

What is calcific aortic stenosis?

A

Narrowing of aortic valve orifice Aging-related atherosclerosis of aortic valve cusps with secondary nodular calcification

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16
Q

What is a major cause of human mortality in developed countries?

A

Acquired heart disease -dominated by atherosclerotic coronary artery disease associated with ischemic heart effects

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17
Q

What >95% of ischemic heart disease due to?

A

Coronary atherosclerosis

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18
Q

NON-STEMI

A

Subendocardial infarction

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19
Q

STEMI

A

transmural infarction

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20
Q

What does the extend of infarction depend on?

A

The amount of collateral circulation

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21
Q

Which site is a most likely site for visceral cancer metastases?

A

Pericardium

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22
Q

What are primary tumors of the heart?

A

RARE! Atria myxomas (left atrium) Rhabdomyomas Cardia Sarcomas

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23
Q

Troponin

A

Elevated in MI with-in 2-4 hours Peaks at 48 hours Persists 7-10 days

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24
Q

CK-MB

A

elevated in myocardial necrosis but less specific than troponin

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25
Q

D-dimer

A

Produced by fibrinolysis/clot dissolution Markedly elevated in pulmonary embolism. deep venous thrombosis (DVT)

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26
Q

Hemoglobin Level

A

Severe anemia (especially if due to acute hemorrhage or hemolysis) can precipitate dyspnea or aggravate underlying CAD or heart failure

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27
Q

BNP

A

Secreted by ventricles in response to ventricular failure/ excess myocardial stretching Heart failure

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28
Q

What is Dressler’s Syndrome

A

Autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)

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29
Q

What is your first consideration of bloody pericaridal fluid?

A

Malignancy (Per witrack)

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30
Q

Fibrinous pericarditis

A

Dressler syndrome Uremia Radiation LOUD friction rub

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31
Q

Serous Pericarditis

A

usual viral pericarditis Often resolves spontaneously Non-infectious inflammatory diseases like RA or SLE

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32
Q

Suppurative/purulent pericarditis

A

Bacterial infections: Staph Aureus Strep pneumonia H. influenza N. meningitidis Rare now with antibiotics Usually concurrent infection like meningitis

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33
Q

How much fluid in the pericardial sac would indicate large risk for tamponade?

A

200-300 cc acutely or >1000 cc chronically Increases pressure on heart and impairs cardiac filling/flow

34
Q

What circumstances are likely to cause FATAL cardiac tamponade?

A

Retrograde AORTIC DISSECTION with intrapericardial rupture Rupture AMI Penetrating chest wounds

35
Q

What are symptoms for cardiac tamponade?

A

Hypotension Soft or absent heart sounds Jugular venous distension Maybe other signs of HF

36
Q

Treatment for cardiac tamponade?

A

Pericardiocentesis

37
Q

What is constrictive pericarditis? Symptoms? Treatment?

A

Impaired ventricular filling caused by thickened/contracted pericardial scar up 1 cm thick Symptoms: RIGHT heart failure Increased JVD Peripheral Edema Abdominal discomfort Weakness/fatigue (may mimic restrictive CM) Requires pericardial resection

38
Q

Which primary cardiac tumor is associated with syncope due to obstruction of the mitral valve?

A

Myxoma! Usually found in LEFT ATRIUM attached to the valve of the fossa ovalis

39
Q

Which primary cardiac tumor is associated with tuberous sclerosis and arises in the ventricle?

A

Rhabdomyoma Most common primary cardiac tumor in CHILDREN

40
Q

Are metastasis or primary tumors most common in the heart?

A

Metastatic! Usually from melanoma or lymphoma

41
Q

What is the primary cause of a thoracic aortic aneurysm?

A

Tertiary Syphillis

  • Endarteritis of vaso vasorum
  • luminal narrowing
  • Decreased flow/ 02 to vaso vasorum
  • Atrophy of vessel wall
42
Q

What are the symptoms of an aortic anuerysm rupture?

A

Rupture > 5 cm

Hypotension

Pulsatile Abdominal Mass

Flank Pain

43
Q

What is the primary cause of an abdominal aortic aneurysm?

A

ATHEROSCLEROSIS

  • Thickens vessel wall
  • Decreased O2 perfursion to media and adventia
  • Atrophy of vessel wall
  • Dilation

Usually male smokes > age 60 w/ hypertension

44
Q

Describe the pathology on Aortic Dissection

A

Intimal tear with dissection of blood through the media of the aortic wall

  • Need 2 things
    • High Pressure –> proximal 10 cm of the aorta
    • Pre-existing weakness in vessel wall
      • Hypertension causes hyaline arteriolosclerosis of vaso vasorum
      • Decreased blood flow causes atropy
      • OR a connective tissue disorder
45
Q

Why is a Type A aortic dissection more leathal than Type B?

A

Type A is of the ascending aorta

Blood can flow in the pericardial sac

Increased fluid/blood in pericardial sac

CARDIAC TAMPONADE

SUDDEN DEATH

46
Q

54 year old female

Headache

Visual Distrubances

Jaw Claudication

Flu-like symptoms

Polymyalgia Rheumatic

Elevated ESR

What is it?

A

Most likely Giant Cell (Termoral) Arteritis

47
Q

How do you diagnose and treat Giant Cell (Temporal) Arteritis?

A

Temporal artery biopsy!

Negative biospy does NOT rule out disease (because it is segmental- could have just gotten a segment w/out disease)

Treat with corticosteroids

48
Q

Why do you want to treat a patient with corticosteroids AS SOON as you suspect Giant Cell/ Temporal arteritis?

A

High risk of BLINDNESS w/ out treatment!!!!

49
Q

What is the most common vasculitis in older adults?

A

Giant cell/ temporal arteritis

50
Q

Middle-aged male with sinusitis or nasopharyngeal ulceration, hemoptysis with bilateral nodular lung infiltrates, and hematuria due to rapidly progressive glomerulonephritis

A

Granulomatosis with polyangitis/ Wegener Granulomatosis

(Small vessel vasculitis)

51
Q

Differential diagnosis for pulmonary hemorrhage + rapidly progressive glomerulonephritis?

A

ANCA-associated vasculitis

Goodpasture’s

SLE

52
Q

What is the number on ecause of morbidity and mortality in developed countries?

A

Coronary artery disease and stroke

53
Q

Name 5 mechanisms for vascular disease

A
  • Lumen stenosis = atherosclerosis, HTN, diabetes, vasculitis
  • Sudden lumen occlusion = thrombosis, embolism, wall dissection
    • Great majority of acute/catastrophic events (MI, Stroke, PE)
  • Vascular wall weakening/ Aneurysmal dilation
  • Vasculitis
  • Extrinisc vascular compression = compartment syndrome
    • Vena cava syndrome = SVC compression from surrounding malignant mediatinal adenopathy (usually lung cancer)
54
Q

Which vein is the source of the majority of the clinically significant/ fatal pulmonary emboli?

A

iliofemoral veins

55
Q

What clues might indicate secondary hypertension (as to primary)?

A
  • Severe/resistant hypertension despite multiple antihypertensives
  • Acute BP rise in a patient with previously stable BP
  • Age < 35 years, non-obese, non-black patient with no apparent risk factors
  • Malignant/accelerated hypertension w/end organ damage, retinal heorrhage/papilledema
  • Hypertension onset before puberty
56
Q

What is the most common potentially correctable cause of secondary hypertension?

A

Renal artery stenosis!

(Probably from atherosclerosis > age 55)

57
Q

What are two potential causes of secondary hypertension?

A

Renal artery Stenosis

Fibromuscular Dysplasia (young white women)

CLUES:

Increase creatinine

Proteinuria

Atrophic kidney

Abdominal bruit

58
Q

What is fibromusclar dysplasia?

A

Common cause for secondary hypertension

  • Narrowing of medium-sized arterial lumens by usually medial fibroplasia of unknown causes
  • Usually affects renal and cerebral vessels
  • Affects young to middle-aged women
59
Q

“String of beads” angiographic appearance and bruits over some arterial segments?

A

Fibromuscular Dysplasia

Common in young white women

Cause for seconary hypertension

TX: revascularization via surgery or angioplasty

60
Q

Young adult with refractory or malignant hypertension or stroke?

A

Consider Fibromuscular Dysplasia!!!

61
Q

What is the most common congenital cardiovascular cause of secondary high blood pressure?

A

COARTCTATION of aorta!

Associated with Turner Syndrome

Upper extremity high bloodpressure w/ lower extremity hypotension

Rib nothcing on CXR

**Left arm pressure/pulse may be diminished if coarctation proximal to left subclavian artery

62
Q

Sequelae of chronic hypertension?

A

High risk for systemic atherosclerosis

Thoracic aortic aneurysms and aortic dissection

63
Q

Palpable purpura suggests which vasculitis….

A

Henoch-Schonlein Purpura

or

Microscopic Polyangiitis

64
Q

Pulmonary/renal syndromes suggest which vasculitis…

(hemoptysis/ pulmonary infiltrates / glomerulonephritis)

A

Wegener’s granulomatosis (c-ANCA)

Microscopic Polyangiitis (p-ANCA)

65
Q

Headache, scalp pain, and visual symptoms suggest which vasculitis?

A

Giant Cell (temporal arteritis)

66
Q

How do you distinguish Wegener’s Granulmatosis from Microscopic Polyangitis?

A

Wegeners = cANCA

Micro= pANCA

Both have renal and pulmonary involvement

Micro does NOT have nasopharyngeal involvemnt and NO granulomas present

67
Q

What is the most common vasculitis in children?

A

Henoch-Schonlein Purpura

Vasculitis due to IgA immune complex deposition

Disease is self-limited, but may reoccur (steroids if severe)

68
Q

Churg-Strauss Sydrome

A

Small vessel vasculitis

p-ANCA
many organs (espeically heart and lungs)

Asthma and eosinophilla

69
Q

What are the four vasculitisis with T-lymphocyte response with granuloma formation?

A

Giant Cell

Takayasu arteritis

Wegener’s

Churg-Stauss

70
Q

What is required for diagnosis of most vasculitis types?

A

Tissue Biopsy!!!!

ERS/C-reactive protein

Serum creatinine/UA

Antibodies

Chest XRAY/CT

71
Q

Large Vessel vasculitic diseases?

A

Giant Cell Arteritis

Takaysau’s Artertitis

72
Q

Elderly female with….

Unilateral headache

Jaw claudication

Scalp pain

Visual Disturbances

Polymyalgia rheumatica

Elevated ESR

A

Temporal Giant Cell Arteritis

73
Q

40 year old ASIAN female

Absent pulses in upper extremities

Visual and neurological symptoms

Elevated ESR

A

Takayasu Arteritis

Large Vessel

Classically involves aortic arch at branch points

Treatment is corticosteroids

74
Q

A young adult with

Hep B seropositivity

Abdominal pain and GI bleeding

High blood pressure

Skin rash

A

Polyarteritis Nodosa

Medium arteries

Neutrophilic vasculitis w. aneruysm formation

Positive assoication with Hep B

Treat w/ corticosteroids and cyclophosphamide

75
Q

4 year old asian child presents with

Hand and foot erythema

Enlarged cervical lymphnodes

A

Kawaski disease

May develope coronary artery aneurysm, thrombosis that leads to MI and ruputres

Treat with IVIg and Aspirin

Disease is self-limited

76
Q

What is Virchow’s triad of DVTs?

A

Impeded venous circulation

Hypercoagulability

Endothelial injury/dysfunction

77
Q

What virus is Kaposi Sarcoma associated with?

A

HHV-8

78
Q

Clinically, how can you differentiate between a hemangioma or a Kaposi sarcoma?

A

The Hemangioma will blanch (because the blood is contained in blood vessels) and a Kaposi Sarcoma will not blanch because blood is not in a vascular channel

79
Q

MI complications with in 1 day?

A

Arrhythmias

Cardiogenic Shock

Heart Failure

Sudden Death

80
Q

MI complications with-in 1-3 days

A

Fibrinous Pericarditis

Only in transmural infarct

Caused by neutrophil invasion/ inflammation of necrotic tissue

81
Q

MI complications 3 days- 2 weeks

A

Macrophages! Clear debris/structural degredation

Tissue at it’s weakest…..

Ventricular free wall rupture –> cardiac tamponde

Papillary rupture –> mitral insufficiency

Septal rupture –> ventral septal defect

Mural thrombis ( “Plugs” hole in myocardium = time bomb)

82
Q

MI complications after months?

A

Scar formation

Dresseler’s syndrome

LV anyuersm

Chronic Heart failure

CRRAB FINAL REVIEW (12 decks)

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