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CPR 1st half > Cardiac Pathology > Flashcards

Cardiac Pathology Flashcards

1
Q

how to treat congestive heart failure?

A

ACE inhibitor

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1
Q

VSD

A

defect in ventricular septum causing left to right shunt most common associated with alcoholism some can close on own or surgery

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2
Q

loeffler syndrome can cause cardiomyopathy. what is Loeffler syndrome?

A

fibrosis + eosinophilia

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2
Q

microangiopathic hemolytic anemia

A

rbc are damaged due to flowing through a stenotic aorta and create schistocytes

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3
Q

st segment depression indicates… st segment elevation indicates…

A

subendocardial ischemia transmural ischemia

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4
Q

MI

A

necrosis of cardiac myocytes due to rupture of plaque with thrombosis and complete occlusion of a coronary artery

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5
Q

tricuspid atresia

A

RV is hypoplastic since tricuspid valve failed to develop properly assocatiated with ASD –> right to left shunting early cyanosis

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5
Q

rhabdomyoma

A

benign hamartoma (excess normal tissue) of cardiac muscle - usually ventricle common in children, associated with tuberous sclerosis

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6
Q

transposition of great vessels

A

pulmonary artery arises from LV and aorta arises from RV = two separate parallel circuits blood doesn’t mix associated with maternal diabetes; cyanotic at birth results in RV hypertrophy and LV atrophy

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6
Q

endocarditis labs?

A

+ blood culture anemia of chronic disease = decreased {hb, MCV, TIBC, iron, and % saturation] increased ferritin

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6
Q

what do you diagnose rheumatic fever with?

A

jones criteria = prior exposure to group A beta hemolytic strep +minor and major criteria

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7
Q

endocarditis

A

inflammation of cardiac valve endocardium from bacterial infection

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8
Q

common cause of sudden cardiac death?

A

ventricular arrhythmia, due to acute ischemia

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9
Q

tetralogy of fallot

A

4 defects lead to right to left shunting bypassing lungs and leads to early cyanosis boot shaped heart on xray helps patients to squat –> increases arterial resistance, reduces shunting and allows more blood to reach lungs

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10
Q

who is a typical hypertrophic cardiomyopathy patient? what is the biopsy like?

A

young athlete myofiber hypertrophy and disarray

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10
Q

staphylococcus aureus

A

IV drug abusers, high virulence infects normal valves, usually tricuspid –> large vegetations that destroy the valve (acute endocarditis)

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10
Q

chronic rheumatic heart disease

A

valve scarring due to rheumatic fever, results in stenosis and classic fish mouth appearance usually mitral valve, thickened chordae tendinae and cusps if aortic valve –> fusion of the commissures can be complicated by infections (endocarditis)

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11
Q

how to treat dilated cardiomyopathy?

A

heart transplant

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12
Q

treat transposition of great vessels?

A

pGe given until surgery to keep PDA open arterial switch surgery or creation of shunt

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13
Q

notching of ribs on xray

A

indicates collateralization of intercostal arteries, usually seen with coarctation of the aorta

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14
Q

4 aspects of tetralogy of fallot

A
  1. r ventricular outflow stenosis 2. R ventricular hypertrophy 3. VSD 4. aorta that overrides the VSD
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14
Q

jones criteria

A

prior exposure to group A beta hemolytic strep (elevated ASO or antiDNase B titers) +minor and major criteria minor = elevated ESR and fever major = migratory polyarthritis, pancarditis, subcutaneous nodules, erythema marginatum, Sydenham chorea

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16
Q

how MI progresses

A

initially subendocardial necrosis of less than half of myocardial thickness = ekg st depression then, severe ischemia leads to transmural necrosis = ekg st segment elevation

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17
Q

swelling/pain in a large joint that resolves in days and moves to another joint

A

migratory polyarthritis

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19
Q

metastasis

A

metastatic, more common in heart than primary tumors, usually from lung or breast carcinoma, melanoma, or lymphoma involves pericardium –> pericardial effusion

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19
Q

pericarditis

A

friction rub and chest pain

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21
Q

what causes contraction band necrosis

A

due to ca influx and hypercontraction after opening a vessel that had been blocked

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23
Q

treatment for MI (6 options)

A

aspirin/heparin - limits thrombosis O2 - minimizes ischemia nitrates - vasodilation B blocker - slows HR and decreases O2 demand, less risk of arrhythmia ACE inhibitor - decreases LV dilation fibrinolysis/angioplasty - opens blocked vessels

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24
Q

what bacteria causes underlying colorectal carcinoma?

A

streptococcus bovis

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26
Q

left sided heart failure

A

due to: ischemia, HTN, dilated cardiomyopathy, infarction, restricted cardiomyopathy –>decreased forward perfusion, pulmonary congestion –> pulmonary edema –> dyspnea, orthopnea, crackles (rales) cappilaries may burst –> intraalveolar hemorrhage with hemosiderin laden macrophages decreased flow to kidneys –> activation of renin-angiotensin –> fluid retention makes CHF worse

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27
Q

sudden cardiac death

A

unexpected death due to cardiac disease without symptoms or less than an hr after they present

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27
Q

inflammation of cardiac valve endocardium from bacterial infection

A

endocarditis

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28
Q

janeway lesions osler nodes

A

j - nontender, erythematous on palms and soles o - tender lesions on fingers and toes

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28
Q

what increase risk of chronic rheumatic heart disease?

A

re-exposure to group A beta hemolytic strep results in relapse of acute phase and increases risk

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29
Q

differences between dilated, hypertrophic, and restrictive cardiomyopathy

A

dilated is most common = dilation of all 4 chambers –> systolic dysfunction and biventricular CHF hypertrophic = LV hypertrophy due to AD mutation of sarcomere proteins restrictive = decreased compliance of ventricular endomyocardium that restricts filling in diastole

30
Q

aschoff bodies

A

foci of chronic inflammation

32
Q

coarctation of the aorta

A

narrowed aorta infant form - associated with PDA after aortic arch and before PDA –> cyanosis at birth adult form - no PDA, associated with bicuspid aortic valve, after aortic arch, presents as HTN in upper extremities and hypotension in lower extremities with weak lower pulses, collateralization from intercostal arteries creates notching of ribs in xray

33
Q

unstable angina

A

chest pain from rest due to rupture of plaque with thrombosis and incomplete occlusion of coronary a could progress to MI ekg st segment depression treat nitroglycerin

34
Q

prinzmetal angina

A

episodic chest pain unrelated to exertion due to coronary a vasospasm ekg st segment elevation treat: nitroglycerin or ca ch blockers

36
Q

what to treat angina with?

A

a vasodilator –> nitroglycerin

37
Q

PDA

A

patent (open) ductus arteriosus causes left to right shunt from aorta into pulmonary artery –> recirculation asymptomatic at birth with machine like murmur but could lead to eisenmenger/lower extremity cyanosis associated with rubella treat w indomethacin

39
Q

right sided heart failure

A

caused by left sided HF, left to right shunt, cor pulmonale (chronic lung disease) congestion –> JVD, hepatosplenomegaly with nutmeg liver –> cardiac cirrhosis and pitting edema due to increase hydrostatic pressure

40
Q

anitschkow cells

A

histiocytes with slender wavy nuclei, giant cells, and fibrinoid material

41
Q

reperfusion injury

A

return of oxygen creates free radicals and further damages myocytes

42
Q

two injuries to be careful of when opening blocked vessels (angioplasty)

A

reperfusion injury and contraction band necrosis

43
Q

mitral valve prolapse

A

mitral valve balloons into LA in systole due to myxoid degeneration (accumulated ground substance makes it floppy) midsystolic click with regurgitation murmur

44
Q

mitral regurgitation

A

back flow from LV to LA during systole usually due to mitral valve prolapse holosystolic blowing murmur leads to left sided heart failure

45
Q

aortic stenosis

A

narrowed due to wear and tear (fibrosis and calcification) >60 yo, if there is also mitral stenosis and fusion of aortic commissure –> it is rheumatic disease not wear and tear systolic ejection click + crescendo decrescendo murmur

46
Q

myxoma

A

benign mesenchymal tumor gelatinous with lots of ground substance common in adults ex: pedunculated mass in left atrium that causes syncope due to mitral valve obstruction

47
Q

stable angina

A

chest pain from exertional/emotional stress due to atherosclerosis of arteries (70% stenosis) less than 20 min, radiates to left arm/jaw diaphoresis and shortness of breath ekg st segment depression rest or nitroglycerin to treat

48
Q

libman sacks endocarditis

A

sterile vegetations associated with SLE on mitral valve –> regurgitation

49
Q

acute rheumatic fever

A

systemic complication of pharyngitis due to group A beta hemolytic strep (strep throat) children a few weeks after strep due to molecular mimicry - bacteria M protein resembles human proteins

51
Q

clinical features of endocarditis?

A

fever (bacteremia) murmur (vegetations) Janeway lesions (erythematous nontender lesions on palms/soles) osler nodes (tender lesions on fingers and toes) nail splinter hemorrhages eye roth spots (embolization of septic vegetation)

52
Q

morphologic changes (macro and micro) after MI

A

macro - none, dark discolored, yellow pallor, yellow pallor, red border granulation tissue, white scar micro none, coagulative necrosis, neutrophils, macrophages, granulation tissue with fibroblasts, collagen, and blood vessels, then fibrosis

53
Q

eisenmenger syndrome

A

late cyanosis increased pressure of the blood flow in the lung becomes so great that the direction of blood flow through the shunt reverses. Oxygen-poor (blue) blood from the right side of the heart flows into the left ventricle and is pumped to your body, making it so that you don’t receive enough oxygen to all your organs and tissues

54
Q

ASD

A

defect in atria septum that causes left to right shunt and split S2 (increase blood on right side delays pulmonary valve closure) usually issue with ostium secundum primum is associated with down syndrome (trisomy 21)

54
Q

three types of cardiac tumors

A

myxoma rhabdomyoma metastasis

56
Q

mitral stenosis

A

narrowed mitral valve due to chronic rheumatic valve disease –> dilated left atrium opening snap + diastolic rumble leads to –> pulmonary congestion and HTN, edema, right sided heart failure

57
Q

5 negative blood cultures?

A

HACEK haemophilus actinobacillus cardiobacterium eikenella kingella

59
Q

truncus arteriosus

A

truncus fails to divide –> one vessel arising from both ventricles mixing of blood and early cyanosis

60
Q

staphylococcus epidermidis

A

prosthetic valves, endocarditis

61
Q

streptococcus viridans

A

most common cause of endocarditis, low virulence infects damaged valves –> subacute endocarditis (vegetations that wont destroy valve

62
Q

most common bacterial cause of endocarditis?

A

streptococcus viridans

63
Q

symptoms of MI

A

severe pain longer than 20 min radiates to left arm/jaw, diaphoresis, dyspnea not relieved by nitroglycerin

64
Q

what do you treat a PDA with and why? when would you not?

A

indomethacin it decreases PGe allowing PDA to close you would not do this if there is another defect like transposition of the great vessels

65
Q

nonbacterial thrombotic endocarditis

A

due to sterile vegetations that arise from hypercoagulable state or underlying adenocarcinoma on mitral valve –> mitral regurgitation

67
Q

lab tests for MI

A

troponin 1 and creatine kinase MB (ckMB) both peak at 24 hrs

68
Q

heart failure cells

A

hemosiderin laden macrophages

69
Q

small vegetations along lines of closure causing regurgitation

A

endocarditis

70
Q

what is CHARGE and whats it associated w?

A

coloboma, heart, atresia choanae, retardation genital and ear defomations

vsd, asd, pda, tetralogy of fallot

71
Q

fetal alcohol syndrome is associated with,…

A

AS, PDA

72
Q

big difference between aortic stenosis and rheumatic fever…..in rheumatic fever you see–>

A

commissural fusion! (of leaflets)

73
Q

mid systolic click + regurgitations murmur?

A

MVP

74
Q

CKmB/toponin marker indicates

A

MI

troponin lasts longer

75
Q

sudden cardiac death can be caused by

A

hypertrophic cardiomyopathy (young people, athletes)

CAD (older people)

76
Q

reperfusion of ischemically damaged muscle cells causes…

A

fibers to die in a maximally contracted state = contraction band necrosis

77
Q

pulmonary edema indicates…

A

left sided heart failure

backs up into pulmonary circuit = heavy wet lungs

78
Q

troponins are

A

regulatory proteins for the contractile proteins actin and myosin

79
Q

in hypertrophic cardiomyopathy,

free wall vs ventricular septum?

A

asymmetric thickening –> septum thickens more than the free wall

80
Q

treatment for hypertrophic cardiomyopathy

A

limited strenuous exercise and use of adrenergic blockers

81
Q

main gene defect of hypertrophic cardiomyopathy

A

beta myosin chain in sarcomere genes

82
Q

concentric hypertrophic cardiomyopathy is caused by

A

systemic HTN

83
Q

myofiber disarray in histology indicates

A

hypertrophic cardiomyopathy (HCM)

84
Q

dilated cardiomyopathy, in contrast to hypertrophic, …

A

walls atrophy instead of hypertrophy

chambers are dilated

85
Q

distended neck veins

paroxysmal nocturnal dyspnea

lung rales

edema

indicate….

A

fluid in lungs

CPR 1st half (11 decks)

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