Cardio Flashcards
QT prolonging meds
some risky meds can prolong QT - sotalol, risperidone (antipsychotics), macrolides, chloroquine, protease inhibitors (-navir), quinidine (class 1a, also class III), thiazides
Romano-Ward Syndrome
congenital long QT syndrome
- AD, pure cardiac phenotype
Jervell and Lange-Nielsen syndrome
congenital long QT syndrome
- AR, sensorineural deafness
ANP/BNP mechanism of diuresis
causes vasodilation and decreased Na reabsorption in renal collecting tubule
- constricts efferent arterial and dilates afferent via cGMP
nesiritide
recombinant form of BNP for treatment of heart failure
Cushing reaction
- triad of HTN, bradycardia and resp depression
- mediated by baroreceptors
- increased ICP –> constricts arterioles –> cerebral ischemia and reflex sympathetic increase in perfusion pressure –> increased stretch, –> baro-receptor induced bradycardia
aortic arch baroreceptors
respond ONLY to increased BP
carotid baroreceptors
respond to increased and decreased BP
peripheral chemoreceptors
stimulated by dec PO2, inc PCO2, and dec pH
central chemoreceptors
stimualted by inc PCO2, dec pH only
Monckeberg (medial calcific sclerosis)
uncommon calcification in the media of the arteries, esp radial/ulnar
- usually benign “pipestem” arteries on xray
- does not obstruct blood flow, intima not involved
arteriolosclerosis
common - two types
- hyaline: thickening of small arteries in HTN or diabetes
- hyperplastic: “onion-skinning” in severe HTN, can cause acute renal failure with “flea bitten” appearance
atherosclerosis mechanism and location
- endothelial cell dysfunction –> macrophage and LDL accumulation –> foam cell formation –> fatty streaks –> smooth muscle cell migration (PDGF and FGF), proliferation and ECM deposition –> fibrous plaque –> complex atheromas
- abdominal aorta > coronary arter > pop >carotid
variant angina (Prinzmetal)
- angina at rest due to coronary vasospasm with transient ST elevation
- triggers: tobacco, cocaine, triptans
- treat with CCBs, nitrates, smoking cessation
coronary steal syndrome
- distal to coronary stenosis, vessels are maximally dilated at baseline, so the addition of vasodilator (dipyridamole, rgadenoson) dilates normal vessels and shunts to well perfused areas –> decreased flow and ischemia of the post-stenotic region
MI (0-4hr)
minimal change on light microscope
- complications include: arrhythmia, HF, cardiogenic shock and death
MI (4-12hr)
- light microscope: early coagulative necrosis, release of necrotic cell content into blood, edema, hemorrhage, wavy fibers
- complications include: arrhythmia, HF, cardiogenic shock, death
MI (12-24hr)
- light microscope: neutrophil migration starts. reperfusion injury may cause contraction bands (due to free radical damage), early coagulative necrosis
- complications include: arrhythmia, HF, cardiogenic shock, death
MI (1-3days)
- light microscope: extensive coagulative necrosis, tissue surrounding the infarct shows acute inflammation with neutrophils
- complications include: fibrinous pericarditis
MI (3 - 14 days)
- light microscope: macrophages, then granulation tissue at margins
- complications include: free wall rupture –> tamponade. papillary muscle rupture –> MR. intraventricular septal rupture due to macrophage-mediated structural degradation. LV pseudoaneurysm.
MI (2 weeks - several months)
- light microscope: contracted scar complete (collagen deposition)
- complications include: Dressler syndrome, HF, arrthymias, true ventricular aneurysm (dyskinesia)
leads with Q waves in inferior MI
II, III, avF
inFerior - RCA
leads with Q waves in lateral wall MI
I,avL
Lateral wall MI - LCX
Dressler syndrome
AI phenomenon resulting in fibrinous pericardiitis (several weeks post-MI)
causes of dilated cardiomyopathy
ABCCCD
Alcohol, wet beriberi, Coxsackie virus, Cocaine, Chagas disease, Doxorubicin
treatment for dilated cardiomyopathy
Na restriction, ACEi, beta blockers, diuretics, digoxin, ICD, heart transplant
treatment for HCM
beta blocker and non-dihydropyridine CCB
ICD in high risk patients
stop high-intensity athletics
medications that decrease mortality in CHF
ACEi, B blockers, ARBs and spironolactone
“heart failure cells”
hemosiderin laden macrophages in the lungs
- turn dark blue with Prussian blue staining
findings in bacterial endocarditis
FROM JANE
fever, roth spoits, osler nodes, murmur, janeway lesions, anemia, nail-bed hemorrhages, emboli
subacute v. acute v. culture neg endocarditis (which bug?)
acute - staph aureus
subacute - strep viridans
neg - coxiella burnetii and bartonella spp
IV drug abusers get endo with which bugs? prosthetic valves?
IV - s. aureus, pseudomonas, candida
prosthetics - s. epidermidis
rheumatic fever findings
- mitral > aortic»_space; tricuspid
- mitral valve regug –> stenosis
- Aschoff bodies, Anitschkow cells, increased ASO titers
- antibodies to M protein cross-react with self antigens
pulsus paradoxus
decrease in amplitude of SBP by >10mm Hg during inspiration
- seen in cardiac tamponade, asthma, OSA, pericarditis and croup
syphillitic heart disease
calcification of the aorta with atrophy –> dilation of the aorta and valve ring
leads to aneurysm, aortic insufficiency
“tree bark” appearance
rhabdomyomas
most frequent primary cardiac tumor in children (associated with tuberous sclerosis)
Kussmal sign
increased JVP on inspiration due to constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors
pyogenic granuloma
polypoid capillary hemangioma that can ulcerate and bleed
associated with trauma and pregnancy
cystic hygroma
cavernous lymphangioma of the neck, associated with Turner syndrome
glomus tumor
benign, painful, red-blue tumor under fingernails. arises from modified smooth muscle cells of the glomus body
bacillary angiomatosis
benign capillary skin papules found in AIDS patients caused by Bartonella
angiosarcoma
rare blood vessel malignancy typically in the head, neck and breasts.
Usually in the elderly in sun-exposed areas. Associated with radiation/arsenic exposure.
Aggressive, difficult to resect 2/2 delay in diagnosis.
lymphangiosarcoma
lymphatic malignancy associated with persistent lymphedema (eg post-radical mastectomy)
Kaposi’s sarcoma
endothelial malignancy most commonly of the skin, but also mouth, GI tract, and resp tract
- associated with HHV8 and HIV
Temporal (giant cell) arteritis
large vessel vasculitis that affects elderly females (>50)
- unilat headache, jaw claudication, visual disturbances, associated with polymyalgia rheumatica
- most commonly affects branches of the carotid artery, focal granulomatous inflammation (segmental), inc ESR
- treat with high dose corticosteroids/temp art biopsy
takayasu arteritis
large vessel vasculitis, asian females <40, weak upper extrem pulses, fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances
- granulomatous thickening/narrowing of aortic arch and prox great vessels, ESR, treat with corticosteroids
- basically same path as TGCA, but aortic arch involvement instead of carotid
polyarteritis nodosa
med vessel vasculitis, young adults, hep B 30%, HTN, neuro dysfunction, cutaneous eruptions, renal damage, and non-spec symptoms
- SPARES the lungs
- immune complex, transmural inflamm, fibrinoid necrosis (pink walls), microaneurysms and spasm (“string of pearls”)
- corticosteroids, cyclophosphamide
kawasaki disease
- asian kids < 4 years old
- fever, cervical lymphadenitis, conjunctival injection, changes in lips (strawberry tongue), hand/foot erythema, desquamating rash
- treat with IVIG/aspirin
- can develop coronary artery aneurysms
Buerger disease
- med vessel vasculitis in heavy smoking men < 40 (India, Japan, Israel)
- claudication and gangrene, raunauds, auto-amp of digits
- segmental thrombosing vasculitis that extends into continguous veins/nerves
- treat with smoking cessation
Wegener (granulomatosis with polyangiitis)
- small vessel vasculitis: URT (nasal septum, chronic sinusitis, OM, mastoiditis), LRT (hemoptysis, cough, dyspnea), renal (hematuria, RBC casts)
- triad: focal necrotizing vasculitis, necrotizing granulomas in lung/upper airway, necrotizing glomerulonephritis
- “WeCeners”: C distribution of oropharynx, lungs and kindeys, C-ANCA, cyclophosphamide treatment
microscopic polyangiitis
- small vessel vasculitis involving lung, kidneys, skin with pauci-immune GN and palpable purpura
- similar to Wegener but…. no nasopharyngeal involvement, no granulomas, p-ANCA
- treat with cyclophosphamide and corticosteroids
Churg-Strauss Syndrome
- small vessel vasculitis
- adult onset asthma, sinusitis, palpable purpura, peripheral neuropathy
- can also involve heart, GI, kidneys
- similar to MPA but….granulomatous, asthma, eosinophilia
- MPO-ANCA/p-ANCA, inc IgE
Henoch-Schonlein Purpura
most commonly childhood vasculitis, follows URI
- triad: palpable purpura, arthragias, abdominal pain
- vasculitis 2/2 IgA complex deposition, associated with IgA nephropathy and can progress to acute GN
- usually self-limited
