Cardio Flashcards
When does autoregulation of coronary blood flow breakdown?
> 75%
> 90% stenosis may be what?
Insufficient at rest
When does most perfusion of coronary artery occur?
Diastole
What is stable angina?
Not getting worse predictable effects!
Unstable angina/
Unpredictable coronary artery spasm-
Crescendo angina is bad because?
pain at rest, unpredictable getting worse
What is ACS not acronym actual conditions?
Acute MI +/- ST elevation crescendo angina
STEMI affects what parts of heart?
Full thickness myocardium necrosis “transmural”
NSTEMI is physiologically what?
Partial block to a coronary artery sub-endocardial
After X weeks you cannot tell how old an infarct is?
4 around
creatine kinase type thats mostly cardiac?
MB type
Complications of MI?
Arrhythmia, rupture, infarct extension, aneurysm
What is dresslers syndrome?
secondary pericarditis due to cardiac injury
Mural thrombus?
Thrombus or thrombi that adhere to vessel wall
LDL receptor gene frequency>
1/500
Apolipoprotein B frequency?
1/1000
When to start worrying about sustained BP?
Sys = >140 Dia = >90
Causes of secondary HTN?
Cushings, phaeochromocytoma,
What does HTN do to kidneys?
Slow decline in renal function :(
Cerebral problems with HTN?
Haemmhorage and berry aneurysms
Hypertensive crisis talk?
> 180/120 quick onset, organ damage and stroke risk!
Pulmonary hypertension?
++ blood pressure in pulmonary artery
Pulmonary hypertension causes?
Many loss of vasculature, idiopathi, or secondary to left failure
What can pulmonary HTN cause?
Right heart failure
Left or right failure causing oedema?
Right venous return
Where is renin released from?
Juxtaglomerular apparatus
What does renin do?
Angiotensinogen to angiotensin I
Angiotensin II cause what to be released?
Aldosterone = bp higher
Where is angiotensin I converted?
Lungs
What is conns syndrome
Excess aldosterone from “somewhere”
Conns syndrome most likely cause?
Adrenocortical adenoma
Conns syndrome biochem?
+aldosterone -renin -K+
Phaeochromocytoma symptoms?
HTN, nervousness, sweating, flushing, headaches, pallor
Phaeochromocytoma ?
Adrenal medulla tumour
24 hr urine collection for diagnosis of what?
Phaeochromocytoma adrenaline metabolites
Difference between cushings syndrome and disease?
Syndrome is by any steroid you have taken etc disease = pituatary lesion usually
Cause of cushings disease?
Adrenacortico neoplasm, or pituatary adenoma (80%) cases
Which cancer may produce adrenacorticotopic hormone?
Small cell lung producing ACTH
Left sided heart failure?
Congestion, PND, dyspnoea, orthopnoea,,cyanosis
Right sided heart failure?
Ascites, congestive splenomegaly, transudates and pleural effusion
BOXCAR nuclei consistent with what finding in autopsy?
Congestive heart failure
70% of all valvular heart disease involves which?
Aortic and mitral
Mitral stenosis is associated with what?
Rheumatic fever
Aortic stenosis can cause hypertrophy of what?
Left ventricle in abscence of HTN
What is mitral annular calcification?
Calcification of mitral skeleton- usually no dysfunction, may be regurg
Causes of Aortic regurg?
Rheumatic, infectious, dilatation syphillis or rheumatoid arth)
Mitral regurg (prolapse) causes?
Infection, fen Phen, Pappillary muscle problems, mitral ring calcification
WHat does myxomatous mean?
Weakening of connective tissue
MVP is more common in which sex?
Women
Mid systolic click characteristic of what?
MVP
Holosystolic murmur of MVP present only is what ?
There is regurg
What is tetrology of fallot?
Right ventricular hypertrophy, overriding aorta, VSD, pulmonary stenosis
Which chromosome important for heart development
22
Characteristics of L-R shunts?
All D’s in names, no cyanosis, pulmonary hypertention- significant = irreversible.
Characteristics of R-L shunts ?
All T’s in name, cyanosis (blue baby) Venous emboli become systemic (paradoxical)
Most common congenital heart defect?
VSD often with fallot
Continuous machine like murmur?
PDA
> 1/3 AVSD seen in ?
Downs
R-L from what?
Tetralogy,transposition, truncus, tricuspis atresia
What is endocarditis?
colonisation and or invasion of heart valves or chamber by microbe
Prognosis for acute endocarditis?
Poor, highly virulent organism, often fatal and requires surgery.
Sub-acute infective endocarditis prognosis?
Lower virulent organisms, less destructive often cured with antibiotics, but can be a wax and wane course
Common causes of infective endocarditis?
MVP, stenosis, artificaila valves, bicuspid AV
Most common organism causing endocarditis?
Strep viridans (from mouth ) 50-60%
Staph aureus endocarditis common in which group of people?.
IV drug users
prosthetic valves often infect with what?
s. epidermis (coag negative)
Strep bovis prompts what?
bowel cancer investigation
Characteristics of vegetations in acute IE?
Single, multiple bulky and friable
% of left heart IE with murmurs?
90%
pneumonic for IE?
FRoth spots OM JANE
Marantic endocarditis aka?
NBTE non bacterial
Non bacterial endocarditis occurs in who?
Debilitated patients usually
What are vegetation sin non infective endocarditis like?
Small, sit on valve leaflets, minimal local effect
SLE is associated with what type of endocarditis?
Libman -sacks
In libman sacks endocarditis which valves are affected?
Mitral and tricuspid
Characteristic of vegetation in libman sacks?
Small warty and pink vegetations often on under surfaces
What is diagnostic histologically for rheumatic fever?
Aschoff bodies in all layers
Classical valve changes in rheumatic fever?
Mitral- called vurrucae vegetation (virtually only cause of mitral stenosis)
Fishmouth abnormality associated with what?
Mitral stenosis of rheumatic fever
What criteria are used to diagnose rheumatic fever?
Jones
Pericarditis causative organims?
Coxsackie virus, bacteria etc
Acute pericarditis is more …
inflamed (serous, purulent etc)
Chronic pericarditis characteristic?
Adhesive
Serous pericarditis causes?
Non infectious usually
Serofibrinous pericarditis causes?
Acute MI, dresslers
Cheesy pericarditis in what infections?
TB
Pain associated with pericarditis?
Pleuritic, relieved by sitting forwards
Complication of pericarditis?
Pericardial effusion
Main causes of dilated cardiomyopathy?
Genetics, cytoskeletal protein mutation-
alcohol and chemo too
Age of dilated cardiomyopathy?
young usually 20-50 bad survival
5 year survival of dilated cardiomyopathy?
25%
Hypertrophic myopathy is what?
Hypertrophy in absence of obvious cause, diastolic dysfunction with preserved systolic
Histological hypertrophy?
Disarray of myocytes
Is hypertrophic cardiomyopathy genetic?
Yes 100%
Murmur in cardiomyopathy?
Systolic ejection
n atheletes can be caused by what?
Hypertrophic and or arrythmogenic right ventricular cardiomyopathy
Restrictive cardiomyopathy affects what part of heart?
Myocardium is non compliant decrease in ventricular compliance
Cause of arrythmogenic right ventricular cardiomyopathy?
Fibrofatty replacement if right ventricle- disorder of cell-cell desmosomes exercise = detachment and death of cells
Myocarditis infective causes?
Coxsackie, chaga disease (south america), diptheria borellia (lymes)
Histology of vasculitis?
Blue dots in blood vessel
Most common form of vasculitis?
Giant cell arteritis
Pathology of giant cell artertitis?
Chronic granulamatous, large to medium arteries- esp in head
Importance of recognising temporal arteritis?
Can involve opthalmic artery = blindness :(
Morphology of GCA?
Intimal thickening, ganulamatoud inflammation, multinucleated giant cells
Classic symptoms of temporal arteritis?
pain tneder temporal region, and jaw claudication (paind on eating in temples)
How much artery to sample with temporal artery?
2-3cm!
Main risk factor for rupture of AAA
Size >6cm
What is a dissecting aneurysm?
Tear in wall, blood tracks between layers
Dissecting aneurysm symptoms?
Tearing pain radiating to left shoulder
What is charcot bouchard aneurysm?
Occur in intracerebral cappilaries in hypertensive disease
Tertiary syphillis can cause what aneurysms?
Ascending thoracic aneurysm
False aneurysm?
Blood filled space around a vessel, usually following traumatic rupture or perforating injury
