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Classic Presentations > CARDIO > Flashcards

CARDIO Flashcards

1
Q

Congenital Heart Path

Comp?

A

COMP = Infective Endocarditis

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2
Q

Aortitis (Vasa Vasorum destruction)

Etiology?

A

ET:

- 3ry Syphilis

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3
Q

Transposition of the Great Arteries

Mech, Imaging (CLUE)?

A

MECH:
Failure of fetal AP Septum to SPIRAL (during septation of TA).

IMAGING (Echo) = “Aorta ant to Pulm art”

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4
Q

Preductal Coarctation of the Aorta

Seen In?

A

SEEN IN:

- Turner’s Sx

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5
Q

Bicuspid Aortic Valve

Seen In (2), Comp?

A

SEEN IN:

  • Turner Sx
  • Adult / Postductal Coarctation of Aorta

COMP:
- Aortic dissection

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6
Q

Aortic Aneurysm

Etiology, Causes by Location (3)?

A

ET = atrophy + weakening of vessel wall (comp of Ath plaque).

CAUSES:

  • Marfan Sx (Ascending Aorta)
  • Tertiary Syphilis (Arch of Aorta)
  • Atherosclerosis (Descending + Ab Aorta)
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7
Q

Aortic Dissection

Causes (3), Pres (2), Imaging (CXR)?

A

CAUSES:

  • Pregnancy (double plasma vol -> weakening of aorta)
  • Ehler-Danlos (collagen defect)
  • Marfan (fibrillin defect = weakened elasticity of aorta)

PRES:

  • “Tearing pain radiating to back”
  • Diminished left pulse vs right

CXR: Widening of aortic knob.

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8
Q

Ruptured Abdominal Aortic Aneurysm

Pres (Triad)?

A

PRES:

  1. Sudden-onset severe L flank pain (aorta is retroperitoneal)
  2. Hypotension
  3. Pulsatile mass
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9
Q

Deep Venous Thrombosis (DVT)

Etiology (Virchow’s Triad), Pres (1 sign), Comp,
Prevention / RX?

A

Virchow’s Triad:
1. Stasis
2. Endothelial damage (b/c exposed collagen triggers
Clotting Cascade)
3. Hypercoagulability

Pulmonary embolus.

PRES:
- Homan’s Sign: Dorsiflexion of foot -> tender calf muscle

PREV + RX:

  • Heparin (short-term prevention + acute management)
  • Warfarin (long-term prevention)
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10
Q

Peripheral Vascular Disease

Etiology?

A

ET:
- Atherosclerotic plaques in Lower Extremity art ->
Impaired bl flow + Ischemia

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11
Q

Vasculites

Def’n, HS Type, Mech (location in vessel + 4 types of changes), Comp?

A

Group of disorders that DESTROY BL VESSELS by infl.
Both arteries + veins affected = ‘Arteritis’ + ‘Phlebitis’.

Type 3 HS.

MECH: Changes occur in WALLS of vessels and include:

  • Thickening
  • Narrowing
  • Scarring
  • Weakening

COMP:
- Coronary art vasospasm

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12
Q

Temporal (Giant Cell) Arteritis

Vessel, Pres (Epi + Triad), Comp (2)?

A

Temporal art. (Incl its branches, eg opthalmic art)

Granulomatous vasculitis.

PRES: Elderly Females

  1. Unilateral headache (Temporal art)
  2. Visual disturbances on same side as headache (Opthalmic art)
  3. Jaw claudication / pain (Temporal art)

COMP:

  • Polymyalgia Rheumatica
  • Irreversible ipsilateral Blindness (due to thrombosis / occlusion of Opthalmic art)
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13
Q

Takayasu’s Arteritis (“Pulseless Dz”)

Vessel, Pres (Epi)?

A

Aortic Arch. (Incl its branch points)

PRES: Young, Far-Eastern woman

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14
Q

Polyarteritis Nodosa

Mech of Vasculitis, Path (2), RX (2)?

A

THINK: p-anca, hepBsag, kidney, heart + infarct

Fibrinoid + necrotizing vasculitis. IC-mediated.
Involving multiple organs, however SPARING the LUNGS.

PATH:

  • Multiple aneurysms
  • Constrictions / spasms

RX: ** Fatal if not treated **

  • Cyclophosphamide
  • Corticosteroids
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15
Q

Kawasaki Dz

Vessel, Pres (Epi + 3), Comp?

A

Coronary art.

PRES: Asian Children

  • Mucocutaneous infl
  • Desquamation of skin
  • Lymphadenopathy

COMP = MI!

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16
Q

Buerger Disease (Thromboangitis Obliterans)

Location Affected, Mech of Vasculitis, Causes, Pres (2 Epi + 1)?

A

Digits (fingers + toes).

Acute Infl -> Autoinfarction / Autoamputation / Gangrene.

CAUSES:
- Smoking

PRES: Males, Heavy Smokers
- Raynaud’s Phenomenon

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17
Q

Microscopic Polyangitis

Locations Affected (3), Mech of Vasculitis, Ab, RX (2)?

A
  • Skin (palpable purpura)
  • Lungs
  • Kidneys (pauci-immune glomerulonephritis / RPGN)

Necrotizing vasculitis.

AB:
- p-ANCA: correlate with disease activity

RX:

  • Corticosteroids
  • Cyclophosphamide
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18
Q

Wegener Granulomatosis (Granulomatosis with Polyangitis)

Mech of Vasculitis (2), Pres (4 Locations), Ab, RX?

A

Granulomatous infl + Necrotizing vasculitis.

PRES:

  • Nose:
    • “Saddle nose” deformity
    • Chronic Sinusitis
  • Ears:
    • Mastoiditis
    • Otitis Media
  • Lung: Nodular masses. URIs (-> cough, hemoptysis, dyspnea).
  • Kidneys:
    • Hematuria
    • RBC Casts

AB:
- c-ANCA / PR3-ANCA

RX = Cyclophosphamide

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19
Q

Churg-Strauss Sx

Mech of Vasculitis, Ab (2)?

A

Granulomatous vasculitis with EOSINOPHILS. Involving multiple organs.

AB:

  • MPO-ANCA / p-ANCA
  • IgE ↑
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20
Q

Angina

Path, Pres, 2 Subtypes?

A

PATH: Atherosclerotic plaque in Coronary art -> Impaired bl flow -> Ischemia.

PRES = Chest pain on exertion

Stable Angina (chest pain with moderate exertion) ;
Unstable Angina (chest pain with minimal exertion)
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21
Q

Acute MI #1

Def’n, Mech (2)?

A

Necrosis of cardiac myocytes, usually in ventricles.

MECH:

    • THROMBUS (group of platelets bound together with fibrin)
  • Coronary art vasospasm
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22
Q

Acute MI #2

Classic Pres (5)?

A 
PRES:
- SUBSTERNAL "crushing chest pain" lasting > 20 mins and
   "radiating to L arm and/or jaw"
- Dyspnea
- Diaphoresis
- Fatigue
- Nausea + Vomiting

** NOT relieved by Nitro **

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23
Q

Acute MI #3

Cardiac Enzymes↑(6), Dx (1 + 2 special circumstances)?

A

ENZ:

  • AST ** Nonspecific **
    • CKMB (EARLY: rises after 6 hrs, peaks at 24 hrs, lasts for 48 h)
  • Myoglobin (EARLY) ** Nonspecific **
  • LD1 > LD2 = ‘LDH Flip’ (18 hrs, peaks at 3 days, lasts for 7 days)
  • LD1 + LD5 (MI compounded with LIVER CONGESTION)
    • Troponin I (EARLY: rises after 4 hrs, peaks at 24 hrs, lasts for 7 days)

DX:

  • EKG (however only 80% sensitivity): ST elevation + new q wave
  • Dx of p/t that comes in 2-3 days after symptoms: ‘LDH Flip’
  • Dx of Reinfarction: CK-MB (b/c levels return to normal after 48 h)
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24
Q

Acute MI #4

General Comp + their Conseq (11, incl 3 ruptures)?

A

COMP: ALL can result in Hypotension
- Reperfusion injury
- Bradycardia / Tachycardia (RV inf wall MI)
- Arrhythima (common in 1st few days) ->
- Embolus (from mural thrombus)
- Ventricular Aneurysm (“systolic bulge of pericardium”)
- Cardiogenic Shock
- LHF (incl Pulm Edema)
- Dressler’s Sx
- Post-Infarct Fibrinous Pericarditis
- Extension of Infarct / Reinfarction
- Ruptures: ** Heart softest = greatest chance of rupture b/w 3-7 days (-> hemopericardium) **
- Ventricular wall -> Cardiac Tamponade
(Several days after. “Sudden loss of pulse”.)
- Septum / Valve -> “New onset of murmur (M.R)” +
“Pulm congestion” +
VSD (Step-Up in O2 Sat from R.A to R.V)
- Papillary muscle -> Mitral Regurg

25
Q

Acute MI #5- Bradycardia COMP

2 Types?

A
  • Sinus Bradycardia (ischemia of SA node)

- 3rd Degree / Complete AV Block (“cannon A waves”)

26
Q

LAD MI

Infarct Type, Pres (3), Comp?

A

Pale Infarct.

PRES:

  • ‘Classic’ MI Pres
  • Heart Block (most of conduction bundles in Ant 2/3 of IV septum = supplied by LAD)
  • Mural thrombi

COMP:
- Rupture -> Hemopericardium (Day 3 or 4- “chest pain, muffled heart sounds, neck vein distension”)

27
Q

RCA MI

Path / Pres (2)?

A

PRES:

  • AV Node dysfunction -> Sinus Bradycardia + Atypical chest pain (eg epigastric pain, mimics GERD)
  • Posteromedial papillary muscle dysfunction -> Mitral Regurg that arises b/w days 3-7
28
Q

Post-Infarction Fibrinous Pericarditis

Etiology, Pres (2, based on timing), RX?

A

ET: Transmural infarct

PRES: “3-component Friction Rub” that can occur 2 times post-MI:

1) 1st week: Chest pain- relieved when leaning fwd / worse when leaning back
2) 6 wks: Fever + Muscle aches/pains (Dressler’s Sx: auto-ab against pericardial tis)

RX: NSAIDs

29
Q

Coronary art Vasospasm

Causes (4)?

A

CAUSES:

  • Cocaine use
  • Emboli
  • Variant / Prinzmetal Angina
  • Vasculites
30
Q

Dilated / Congestive Cardiomyopathy

Def’n, Etiologies (9: “ABCCCDD” + 2), Mech (3 steps),
Pres, Findings (1 + Imaging),
Comp (2)?

A

Dilation of all 4 heart chambers. Effusions at both lung bases.

ET:

  • Alcohol abuse
  • Wet Beriberi
  • Chagas dz
  • Coxsackie B virus Myocarditis
  • Cocaine abuse
  • Doxorubicin toxicity
  • Duchenne Muscular Dystrophy
  • Hemochromatosis
  • Peripartum Cardiomyopathy (6 wks postpartum)

MECH = ECCENTRIC hypertrophy (sarcomeres added in series) ->
Ventricles unable to pump ->
SYSTOLIC dysfunction.

PRES = HF

FINDINGS:

  • S3
  • “Balloon” appearance of heart on CXR / Dilated heart on U/S

COMP:

  • Mitral / Tricuspid Regurg
  • Arrhythmia
31
Q

Hypertrophic Cardiomyopathy

Location, Mech (5 steps), Inher, Genetics, Pres (3), Findings (2)?

A

LV

MECH:
CONCENTRIC hypertrophy (sarcomeres added in parallel) ->
Hypertrophied IV SEPTUM ->
Outflow obstruction thr Mitral valve + Altered conduction bundles ->
Ventricles unable to fill + Conduction defects ->
DIASTOLIC dysfunction + Conduction defects.

AD. 60-70% cases familial.

β-myosin heavy chain mutation in sarcomere proteins.

PRES:

  • Conduction defects
  • Sudden death in young athletes (due to ventricular arrhythmia)
  • Dyspnea
  • Syncope (esp with exercise)

FINDINGS: * Normal-sized heart *

  • S4 + Aortic Regurg
  • Apical impulses
32
Q

Restrictive / Obliterative Cardiomyopathy

Etiologies (6), Pres, EKG (2)?

A

ET: “oses”

  • Amyloidosis
  • Sarcoidosis
  • Post-Radiation fibrosis
  • Endocardial Fibroelastosis (fibrosis in endocardium of “young child”)
  • Hemochromatosis
  • Loffler’s Sx (fibrosis with prominent “eosinophilic infiltrate”)

PRES = LHF

EKG:

  • Low-Voltage EKG
  • ↓QRS amplitude
33
Q

Cardiac Dilation

Cause?

A

CAUSE =↑Ventricular EDV

34
Q

Shock

3 Types + Causes of each, Conseq of all (2)?

A

CARDIOGENIC Shock: Loss of myocardial CONTRACTILITY -> HF.

HYPOVOLEMIC Shock: Hypovolemia due to BL LOSS.

SEPTIC Shock: Loss of VASCULAR TONE due to infl / infection.

CONSEQ:

  • Hypotension
  • ↓organ perfusion
35
Q

Dyspnea on Exertion

Cause?

A

CAUSE = Failure of CO to↑during exercise

36
Q

Congestive Heart Failure (CHF)

Def’n, Mech (Starling’s Law + 1), Pres (3), Comp?

A

Failure of heart to pump out enough blood.

MECH:
Starling’s Law: Force of CONTRACTION directly proportional to length of muscle fiber up until a certain limit.
Beyond this limit muscles undergo dilatation and failure.
-↑venous pressure

PRES:

  • Dyspnea
  • Fatigue
  • S3

COMP:
- 2ry Hyperaldosteronism

37
Q

Systolic CHF

Def’n, Causes?

A

Low EF heart failure.

CAUSES:
- IHD / MI

38
Q

Diastolic CHF

Def’n, Causes, Findings?

A

Normal EF,↓ventricular Compliance heart failure.

CAUSES:
- Long-standing Htn

FINDINGS:
- S4

39
Q

↑Venous Pressure

Conseq (4), Seen In?

A 
CONSEQ:
-↑CENTRAL venous pressure ->↑resistance to portal flow ->
   Hepatomegaly / Nutmeg Liver
-↑PULM venous pressure -> Pulm Edema
- Peripheral Edema
- Jugular Venous Distention (JVD)

SEEN IN:
- HF

40
Q

Orthopnea + Paroxysmal Nocturnal Dyspnea

Def’n, Mech, Seen In?

A

Shortness of breath when supine / Breathless awakening from sleep.

MECH:
Pulm vascular congestion EXACERBATED by↑venous return
(due to redistribution of blood from ‘immediate gravity effect’).

SEEN IN:
- LHF

41
Q

LHF

Mech (3), Path (2), Causes (2 general), Pres (2)?

A

MECH:

  • ↑Preload
  • ↑Afterload
  • ↓Contractility (multiple infarcts -> fibrous tis)

PATH: Clinical features due to↓forward perfusion:

  • > pulmonary congestion
  • > ↓bl flow to kidneys -> Activation of RAA Sys -> Fluid retention

CAUSES:

  • Htn / Ischemia / MI
  • Cardiomyopathy (Dilated or Restrictive)

PRES:

  • Pulm Edema
    • > Dyspnea
    • > PND + Pillow Orthopnea
    • > Bilat basal crackles
    • > Blood-tinged frothy sputum (chronic LHF)
  • ‘Pulsus Alternans’
42
Q

RHF

Mech, Causes (3), Pres (5)?

A

MECH: RH can’t get bl thr the pulm vessels.

CAUSES:

  • LHF
  • L-to-R shunt
  • Cor Pulmonale

PRES:

  • JVD
  • Ascites
  • Hepatomegaly (painful) + ‘Nutmeg Liver’
  • Pitting Edema of lower ext
  • ‘Pulsus Paradoxus’
43
Q

High-Output HF

Mech, Causes (3)?

A

MECH: ↑Venous Return -> Heart gives up.

CAUSES: (ALL↑Venous Return)

  - ↓TPR
        - Vasodilation of peripheral arterioles
              - Septic Shock
              - Thiamine def
              - Hydralazine
  - ↑Sym activity /↑Contractility
        - Hyperthyroidism / Graves 
  - AV Fistula
44
Q

Bacterial Endocarditis

Def’n, Causes / Assoc (4),
H-S Type, Pres (4)?

A

Mitral valve w big bulky vegetations + ruptured chordae tendinae.

CAUSES / ASSOC:

  • IV drug abuse (Tricuspid Valve)
  • Sequela of dental procedures (Strep viridans)
  • Prosthetic heart valves (Staph epidermidis)
  • Patients with underlying Colorectal Carcinoma (Strep bovis)

Type III H-S (IC vasculitis).

PRES:

  • Fever
  • Glomerulonephritis
  • Roth Spots (Eye)
  • “Splinter hemorrhages in fingernails”:
    • Painless = Janeway Lesion
    • Painful = Osler Nodes
45
Q

Libman-Sacks Endocarditis

Def’n, Ab, Seen In?

A

WART-like sterile vegetations on both sides of heart valve.

AB:
- ANA

SEEN IN:
- SLE

46
Q

Acute Rheumatic Fever

MC Valve Involved, Path, Pres (Jones Criteria: 6)?

A

Mitral Valve > Aortic Valve

PATH: Post-Pharyngitis. Culture NEGATIVE (immunologic mech) = sterile vegetations.

PRES: Jones Criteria:

  • Young person, post-pharyngitis
  • Polyarthritis + Nodules on joint surfaces
  • Erythema Marginatum
  • Rales in lungs + Dyspnea
  • Mitral Regurg murmur + Friction Rub + Endocarditis and Myocarditis
  • Syndham’s Chorea (LATE)
47
Q

Constrictive Pericarditis

Causes (3), Assoc, Pres, Comp

A

CAUSES:

  • Coxsackie virus
  • Previous cardiac surgery (U.S)
  • TB (3rd World)

ASSOC:
- Lupus

PRES:
- Pericardial Knock on inspiration

COMP:
- Cardiac Tamponade

48
Q

Cardiac Tamponade

Cause, Assoc, Pres (Beck Triad), ECHO (2), RX?

A

CAUSE: Pericarditis -> Pericardial Effusion

ASSOC:
- Lupus

PRES: Beck Triad

  1. Hypotension +…
    • Pulsus Paradoxus: radial pulse↓on inspiration
  2. Distended neck veins (Kussmaul’s Sign)
  3. Muffled heart sounds

ECHO:

  • Pericardial fluid accumulation
  • Collapse of R.A

RX: Pericardiocentesis

49
Q

Myxomas

Def’n, Location, Pres (Epi + 1)?

A

Benign mesenchymal cardiac tumor. “Ball-valve obstruction” in L.A.

90% occur in Atria (MC = L.A).

PRES: MC 1ry cardiac tumor in Adults
- Syncope (due to obstruction of mitral valve)

COMP:
- Embolization (soft tumors w small pieces inside them)

50
Q

Rhabdomyomas

Def’n, Location, Assoc, Pres (Epi)?

A

Benign HAMARTOMA of cardiac muscle.

Usually occur in Ventricles.

ASSOC:
- Tuberous Sclerosis

PRES: MC 1ry cardiac tumor in Children

51
Q

Carcinoid Heart Dz

Def’n (incl Location + Mech), Causes, Pres (2: valvular)?

A

R-sided valvular fibrosis due to↑COLLAGEN.

CAUSES:
- Carcinoid Tumor / Carcinoid Sx

PRES:

  • Tricuspid regurg
  • Pulm Valve stenosis
52
Q

Sturge-Weber Dz

Def’n, Pres (CLUE + 4)?

A

Congenital vascular disorder that affects small / capillary-sized vessels.

PRES:

  • “Port-Wine stain”: trigeminal nerve distribution
  • IPSILATERAL leptomeningeal angiomas (= AV malformation on same side of brain)
  • Slight mental retardation
  • Seizures
  • Early-Onset Glaucoma
53
Q

Strawberry vs Cherry Hemangioma

Def’n of both, Differences (3)?

A

Benign capillary hemangiomas.

  • Age of Onset: Infancy (first few wks of life) vs Elderly
  • Course + Regression: Grows rapidly + regresses spontaneously vs
    NO regression
  • Frequency: 1/200 births vs↑Freq with age
54
Q

Pyogenic Granuloma

Def’n, Assoc (2)?

A

Polypoid capillary hemangioma that can ulcerate + bleed.

ASSOC:

  • Pregnancy
  • Trauma
55
Q

Lymphangiosarcoma

Def’n?

A

Lymphatic malignancy associated with persistent lymphedema

eg post-radical mastectomy

56
Q

Cystic Hygroma

Def’n, Assoc?

A

Cavernous lymphangioma of neck.

ASSOC:
- Turner Sx

57
Q

Torsades de Pointes

Def’n, Causes (2 + 2), Pres on EKG, RX?

A

V-Tach that can progress to V-Fib.

CAUSES:

  • Anything that prolongs QT interval:
    • Congenital Long QT Sx
    • Drugs (Antiarrhythmics- Class IA + Class III)
  • ↓Ca
  • ↓Mg

PRES ON EKG:
- “Shifting” sinusoidal waveforms

RX:
- Mg Sulfate

58
Q

Pulsus Paradoxus

Def’n, Seen In (4)?

A

Exaggerated drop ( > 10 mmHg) in SYS bp during INSP.

SEEN IN:

    • Cardiac Tamponade
  • Constrictive Pericarditis
  • Asthma (severe) / COPD
  • Hypovolemic Shock

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