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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
metastasis
metastatic, more common in heart than primary tumors, usually from lung or breast carcinoma, melanoma, or lymphoma involves pericardium --\> pericardial effusion
19
pericarditis
friction rub and chest pain
21
what causes contraction band necrosis
due to ca influx and hypercontraction after opening a vessel that had been blocked
23
treatment for MI (6 options)
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
24
what bacteria causes underlying colorectal carcinoma?
streptococcus bovis
26
left sided heart failure
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
27
sudden cardiac death
unexpected death due to cardiac disease without symptoms or less than an hr after they present
27
inflammation of cardiac valve endocardium from bacterial infection
endocarditis
28
janeway lesions osler nodes
j - nontender, erythematous on palms and soles o - tender lesions on fingers and toes
28
what increase risk of chronic rheumatic heart disease?
re-exposure to group A beta hemolytic strep results in relapse of acute phase and increases risk
29
differences between dilated, hypertrophic, and restrictive cardiomyopathy
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
aschoff bodies
foci of chronic inflammation
32
coarctation of the aorta
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
unstable angina
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
prinzmetal angina
episodic chest pain unrelated to exertion due to coronary a vasospasm ekg st segment elevation treat: nitroglycerin or ca ch blockers
36
what to treat angina with?
a vasodilator --\> nitroglycerin
37
PDA
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
right sided heart failure
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
anitschkow cells
histiocytes with slender wavy nuclei, giant cells, and fibrinoid material
41
reperfusion injury
return of oxygen creates free radicals and further damages myocytes
42
two injuries to be careful of when opening blocked vessels (angioplasty)
reperfusion injury and contraction band necrosis
43
mitral valve prolapse
mitral valve balloons into LA in systole due to myxoid degeneration (accumulated ground substance makes it floppy) midsystolic click with regurgitation murmur
44
mitral regurgitation
back flow from LV to LA during systole usually due to mitral valve prolapse holosystolic blowing murmur leads to left sided heart failure
45
aortic stenosis
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
myxoma
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
stable angina
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
libman sacks endocarditis
sterile vegetations associated with SLE on mitral valve --\> regurgitation
49
acute rheumatic fever
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
clinical features of endocarditis?
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
morphologic changes (macro and micro) after MI
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
eisenmenger syndrome
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
ASD
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
three types of cardiac tumors
myxoma rhabdomyoma metastasis
56
mitral stenosis
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
5 negative blood cultures?
HACEK haemophilus actinobacillus cardiobacterium eikenella kingella
59
truncus arteriosus
truncus fails to divide --\> one vessel arising from both ventricles mixing of blood and early cyanosis
60
staphylococcus epidermidis
prosthetic valves, endocarditis
61
streptococcus viridans
most common cause of endocarditis, low virulence infects damaged valves --\> subacute endocarditis (vegetations that wont destroy valve
62
most common bacterial cause of endocarditis?
streptococcus viridans
63
symptoms of MI
severe pain longer than 20 min radiates to left arm/jaw, diaphoresis, dyspnea not relieved by nitroglycerin
64
what do you treat a PDA with and why? when would you not?
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
nonbacterial thrombotic endocarditis
due to sterile vegetations that arise from hypercoagulable state or underlying adenocarcinoma on mitral valve --\> mitral regurgitation
67
lab tests for MI
troponin 1 and creatine kinase MB (ckMB) both peak at 24 hrs
68
heart failure cells
hemosiderin laden macrophages
69
small vegetations along lines of closure causing regurgitation
endocarditis
70
what is CHARGE and whats it associated w?
coloboma, heart, atresia choanae, retardation genital and ear defomations vsd, asd, pda, tetralogy of fallot
71
fetal alcohol syndrome is associated with,...
AS, PDA
72
big difference between aortic stenosis and rheumatic fever.....in rheumatic fever you see--\>
commissural fusion! (of leaflets)
73
mid systolic click + regurgitations murmur?
MVP
74
CKmB/toponin marker indicates
MI troponin lasts longer
75
sudden cardiac death can be caused by
hypertrophic cardiomyopathy (young people, athletes) CAD (older people)
76
reperfusion of ischemically damaged muscle cells causes...
fibers to die in a maximally contracted state = contraction band necrosis
77
pulmonary edema indicates...
left sided heart failure backs up into pulmonary circuit = heavy wet lungs
78
troponins are
regulatory proteins for the contractile proteins actin and myosin
79
in hypertrophic cardiomyopathy, free wall vs ventricular septum?
asymmetric thickening --\> septum thickens more than the free wall
80
treatment for hypertrophic cardiomyopathy
limited strenuous exercise and use of adrenergic blockers
81
main gene defect of hypertrophic cardiomyopathy
beta myosin chain in sarcomere genes
82
concentric hypertrophic cardiomyopathy is caused by
systemic HTN
83
myofiber disarray in histology indicates
hypertrophic cardiomyopathy (HCM)
84
dilated cardiomyopathy, in contrast to hypertrophic, ...
walls atrophy instead of hypertrophy chambers are dilated
85
distended neck veins paroxysmal nocturnal dyspnea lung rales edema indicate....
fluid in lungs

CPR 1st half (11 decks)

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