cardio Flashcards
5 Ts of congenital heart disease?
Truncus Transposition Tricuspid Tetralogy TAPVR
cause of truncus?
failure of aorticopulmonary septum formation
usually accompanying VSD
cause of TGA?
failure of aorticopulmonary septum spiralling
what do you need for viability in tricuspid atresia?
ASD and VSD
ASD vs PFO?
ASD: missing tissue in ostium secundum > ostium primum
PFO: failure of fusion
congenital heart defect in infants of diabetic mothers?
TGA
cardiac defect in Williams syndrome?
supravalvular aortic stenosis
types of arteriolosclerosis?
hyaline: thickening of vessel walls
hyperplastic: onion skinning and proliferation of smooth mm cells - severe HTN
calcification of arterial elastic lamina?
Monckeberg medial calcific sclerosis
vascular stiffening without obstruction
“pipestem” on XR
pathogenesis of atherosclerosis?
endothelial cell dysfn –> macrophage and LDL accumulation –> foam cell formation –> fatty streaks –> PDGF, FGF, smooth mm cell migration –> proliferation, ECM deposition –> fibrous plaque –> complex atheromas
MC locations of atherosclerotic plaque?
abdominal aorta > coronary a > popliteal a > carotid a
risk factors for thoracic aortic aneurysm?
cystic medial degeneration
HTN, bicuspid aortic valve, CT disease, tertiary syphilis
how to treat types of aortic dissection?
A: surgery
B: BBs then vasodilators
tx of prinzmetal angina?
CCBs, nitrates, smoking cessation
changes 4-24 hr post-MI?
early coag necrosis, edema, hemorrhage, wavy fibers, neutrophils
dark mottling; pale with tetrazolium stain
** reperfusion injury may cause contraction bands (free radical damage)
complications 2-24 hr post-MI?
arrhythmia, HF, cardiogenic shock
changes 1-3 days post-MI?
coagulative necrosis, acute inflammation with neutrophils
hyperemia
complications 1-3 days post-MI?
postinfarction fibrinous pericarditis
changes 3-14 days post-MI?
macrophages –> granulation tissue at margins
hyperemic border with central yellow-brown softening
complications 3-14 days post MI?
free wall rupture
papillary mm rupture
IV septum rupture (from macrophage-mediated structural degradation)
LV pseudoaneurysm
changes 2 wks - months post-MI?
completed contracted scar
gray-white tissue
complications 2 wks - months post-MI?
Dressler syndrome
HF
arrhythmias
true ventricular aneurysm
Dressler syndrome?
autoimmune rxn post-MI –> fibrinous pericarditis several weeks after
causes of dilated cardiomyopathy?
alcohol beriberi cocaine chagas doxorubicin hemochromatosis sarcoid peripartum
beta-myosin heavy chain mutation?
familial hypertrophic cardiomyopathy
Friedrich ataxia cardiac issues?
hypertrophic cardiomyopathy
tx of hypertrophic cardiomyopathy?
stop high-intensity athletics
BBs or CCBs
ICD if high risk
causes of restrictive infiltrative cardiomyopathy?
sarcoidosis amyloidosis postradiation fibrosis endocardial fibroelastosis Loffler hemochromatosis
endomyocardial fibrosis with eosinophilic infiltrate?
Loffler syndrome
which mx affect mortality in heart failure?
ACEis, ARBs
BBs
spironolactone
select patients: hydralazine with nitrate
MC pathogen in acute endocarditis?
S aureus
MC pathogen in subacute endocarditis?
viridans strep
pathogens in tricuspid valve endocarditis?
S aureus
Pseudomonas
Candida
pathogens in culture negative endocarditis?
Coxiella
Bartonella
HACEK
Aschoff bodies?
granuloma with giant cells - assoc with rheumatic fever
Anitschkow cells?
enlarged macrophages with ovoid wavy rod-like nucleus
assoc with rheumatic fever
syphilitic heart disease?
disruption of vasa vasorum of aorta –> atrophy of vessel wall and dilatation of aorta/valve ring
calcification of aortic root and ascending aortic arch
“tree bark” appearance of aorta
myxoma?
MC primary cardiac tumor
90% in atria (usually L)
multiple syncopal episodes
diastolic “tumor plop” sound
rhabdomyoma?
most frequent primary cardiac tumor in children
assoc with tuberous sclerosis
blood vessel malignancy, elerly, sun-exposed areas?
angiosarcoma
assoc with radiation therapy and chronic postmastectomy lymphedema
very aggressive and difficult to resect
benign capillary skin papules in AIDS patients?
bacillary angiomatosis
caused by Bartonella henselae infx
** neutrophilic infiltrate (vs Kaposi)
benign capillary hemangioma of elderly?
cherry hemangioma
does not regress
cavernous lymphangioma of neck?
cystic hygroma
assoc with Turner
red-blue painful tumor under fingernails?
glomus tumor
benign
from modified smooth mm cells of thermoregulatory glomus body
endothelial malignancy of skin, mouth, GI tract, resp tract?
Kaposi - assoc with HHV8 and HIV
** lymphocytic infiltrate (vs bacillary angiomatosis)
polypoid capillary hemangioma, can ulcerate/bleed?
pyogenic granuloma
assoc with trauma and pregnancy
benign capillary hemangioma of infancy?
strawberry hemangioma
rapid growth, regresses spontaneously by 5-8 yo
tx of Raynaud?
CCBs
old lady with unilateral headache and jaw claudication?
temporal arteritis
steroids and temporal artery biopsy
younger Asian lady with fever, night sweats, arthritis, myalgias, weak upper extremity pulses?
Takayasu arteritis
granulomatous thickening and narrowing of aortic arch and prox great vessels
tx: steroids
young adults with fever, weight loss, malaise, HTN,neurologic dysfunction, cutaneous eruptions, renal damage?
PAN
30% HBV seropositive
renal and visceral vessels - NOT pulmonary aa
immune complex mediated
tx: steroids, cyclophosphamide
tx of Kawasaki?
IVIG and aspirin
smoker, young male, intermittent claudication, digit autoamputation, Raynaud?
Buerger disease
segmental thrombosing vasculitis
tx: smoking cessation
upper resp tract and lower respiratory tract sx, hematuria, urine RBC casts?
Wegener’s: focal necrotizing vasculitis, necrotizing granulomas in lung/airway, necrotizing glomerulonephritis
- PR3-ANCA/c-ANCA
- tx: cyclophosphamide, steroids
lung, kidneys, skin involvement; glomerulonephritis and palpable purpura?
Microscopic polyangiitis
presentation like GPA but w/o nasopharyngeal involvement
no granulomas
MPO-ANCA/p-ANCA
tx: cyclophosphamide, steroids
asthma, sinusitis, skin nodules, peripheral neuropathy?
Churg Strauss
can also involve heart, GI, kidneys
MPO-ANCA/p-ANCA
increased IgE
palpable purpura, arthralgia, abdominal pain?
Henoch Schonlein purpura
follows URI
IgA immune complex deposition
associated with Berger disease (IgA nephropathy)
