Cardio Flashcards
1
Q
stable angina
A
chest pain on exertion, >70 stenosis, reversible injury to myocytes, left arm or jaw, ST segment depression, subendocardial ischemia, relieved by NG
2
Q
nitroglycerin
A
vasodilate arteries AND veins
3
Q
unstable angina
A
at rest, rupture of thrombosis, incomplete occlusion, reversible, ST depression, relieved by NG
4
Q
prinzmetal angina
A
coronary artery vasospasm, episodic, unrelated to exertion, ST elevation (transmural), relieved by NG or CCB
5
Q
myocardial infarction
A
greater than 20 minutes, pain in left arm/jaw, complete occlusion, not relieved by NG
6
Q
parts of heart affected by LAD
A
left anterior wall and anterior portion of IV septum
7
Q
parts of heart affected by right coronary artery
A
left posterior wall and posterior portion of IV septum
8
Q
parts of heart affected by left circumflex
A
lateral wall of LV
9
Q
characteristics of troponin
A
rises 2-4 hours, peaks at 24, stays high for 7-10 days
10
Q
characteristics of CK-MB
A
rises 4-6 hours, peaks at 24, falls at 72, good for detecting reocclusion
11
Q
treatment of MI
A
- aspirin/heparin - limit thrombosis
- O2 - minimize ischemia
- nitrates - vasodilation arteries and veins
- beta blocker - slow HR, less arrythmia
- ACE inhibitor - decrease LV dilatation, block constriction of arterioles, don’t increase blood volume
12
Q
contraction band necrosis
A
calcium returns after MI resulting in contraction, dense pink lines, myocytes with no nuclei
13
Q
MI at 4-24 hours
A
coagulative necrosis (nuclear changes), dark discoloration, arrhythmias
14
Q
MI at 1-3 days
A
neutrophils, yellow pallor, fibrinous pericarditis - inflammation goes to pericardium, chest pain and friction rub
15
Q
MI at 4-7 days
A
macrophages (eat up debris), yellow pallor, rupture of ventricular wall or septum (shunt) leads to tamponade - or rupture of papillary muscle
16
Q
MI at 1-3 weeks
A
granulation tissue, fibroblast collagen and blood vessels, RED BORDER from outside of tissue
17
Q
MI at months
A
white fibrotic scar, risk for aneursym - Dressler syndrome
18
Q
one day, one week, one month for MI
A
coagulative necrosis - one day - inflammation (neutrophils then macrophages) - week - granulation tissue - month - scar
19
Q
rupture of papillary muscle is cause by infarction of what vessel
A
RCA - leads to mitral insufficiency
20
Q
dressler syndrome
A
pericardial antigens exposed after MI, autoimmune pericarditis, weeks are MI
21
Q
congestive heart failure
A
when heart fails to pump appropriately
22
Q
causes of left sided CHF
A
- ischemia - leads to defective pumping
- hypertension - concentric LVH, heart dealing with stress, hard to oxygenate wall
- dilated cardiomyopathy - stretched muscle doesn’t work
- MI - nonfunctional
- restrictive - cant pump
23
Q
clinical features of left sided failure
A
pulmonary congestion - blood goes back, dyspnea (blood in lungs), paradoxical nocturnal dyspnea, orthopnea, crackles, heart failure cell - from macrophages
24
Q
consequence of left heart failure (BP)
A
decreased forward perfusion, activation of renin-angio system, increase in TPR and blood volume (makes worse) - treat with ACE inhibitor
25
mainstay treatment of CHF
ACE inhibitor to block downward spiral of symtopms
26
major cause of right heart failure
left side failure
27
causes of right heart failure
- left failure
- left to right shunt (too much blood on right side)
- chronic lung disease, blood vessels constrict in hypoxia, increase resistance against right heart *cor pulmonale*
28
clinical features of right heart failure
any backup to right heart
- JVD
- painful hepatosplenomegaly
- cardiac cirrhosis
- pitting edema
- nutmeg liver
29
most common congenital heart defect
ventricular septal defect
30
association with VSD
fetal alcohol syndrome
31
features of VSD
left to right shunt, pulmonary hypertension, eventual reversal of shunt leading to cyanosis
32
eisenmenger syndrome
when left to right shunt reverses to right to left shunt - right ventricular hypertrophy, polycythemia from hypoxia leading to EPO release, *clubbing* from cyanosis
33
most common type of ASD
ostium secundum
34
association of ASD
down syndrome - ostium primum
35
features of ASD
left to right shunt in atrium, more volume in right side, **delayed closure of pulmonic valve**, S2 split, paradoxical embolus
36
associated with PDA
congenital rubella
37
features of PDA
pulmonary hypertension, leading to reversal of shunt, cyanosis in lower extremity *later in life* - machine like murmur
38
holosystolic machine like murmur
PDA
39
treatment of PDA
indomethacin (NSAIDs) - decreases PGEEE (KEEPS it open) -- leading to closure
- Endomethacin ends patency
40
four problems in Tetralogy of Fallot
- stenosis of RV outflow tract (PPulmonary stenosis)
- Right ventricular hypertrophy
- Overriding aorta
- VSD
Mnemonic: PROVe
41
clinical features of tetralogy of Fallot
right to left shunt, cyanosis in newborns, squatting decreases shunt, **boot shaped heart**
42
way to treat transposition of great vessels
PGE - KEEPs the ductus arteriosus open
43
association with transposition of great vessels
maternal diabetes - failure of spiral of septum
44
infantile coarctation of aorta
- associated with PDA
- **distal to aortic arch, proximal to PDA
- right to left shunt - cyanosis
45
association with PDA
Turners syndrome
46
adult form of coarctation
no PDA, hypertension in UE, hypotension in LE
47
association of adult aortic coarcation
bicuspid aortic valve - rib notching
48
acute rheumatic fever
- group A strep
- 2-3 weeks post strep
- bacterial M protein mimics human tissue
49
Jones criteria from rheumatic fever
- strep infection - ASO or anti-DNase titers
- minor (fever and ESR)
- major - see other
50
Major Jones criteria
```
J - joint, migratory polyarthritis
O - heart - pancarditis
N - nodules in skin
E - erythema marginatum
S - syndecema chorea - involuntary movements
```
51
valve effected in rheumatic fever
usually mitral, sometimes aortic leads to regurgitation
52
Aschoff body
chronic inflammation, giant cells, fibrinoid material - seen in myocarditis of acute rheumatic fever
53
Anitschkow cells
reactive histiocytes with wavy nuclei (caterpillar nucleus) in myocarditis in acute rheumatic fever
54
most common cause of death in acute rheumatic fever
myocarditis
55
pericarditis in acute rheumatic fever
friction rub
56
features of chronic rheumatic fever
stenosis of mitral valve, thickening of chordae tendineae and cusps - complication is endocarditis
57
fusion of commisures
in chronic rheumatic fever, scarring *fish mouth* appearance
58
main cause of aortic stenosis
wear and tear, calcification, older patients
59
association of bicuspid valve disease
aortic stenosis, early in life
60
how to tell chronic rheumatic disease from normal aortic stenosis
rheumatic disease always has mitral stenosis too and fusion of commisures - not seen in wear and tear
61
sounds of aortic stenosis
systolic ejection click followed by crescendo-decrescendo murmur
62
complication of aortic stenosis
- concentric LVH
- angina and syncope on exercise
- microangiopathic hemolytic anemia
63
cause of aortic regurg
dilation of aortic root allowing for backflow
- can be from aneurysm, pulling on aortic root
- valve damage from infectious endocarditis
64
sounds in aortic regurg
early blowing diastolic murmur
65
feature of aortic regurg
blood goes back, widens pulse pressure, bounding pulses, pulsating nail bed, head bobbing *hyperdynamic circulation*
- caused by increase in systolic pressure and decrease in diastolic pressure
66
eccentric hypertrophy seen in....
volume overload - aortic regurgitation or dilated cardiomyopathy
67
associated with mitral valve prolapse
Marfans and Ehlers Danlos syndromes
68
sounds of mitral valve prolapse
mid systolic click followed by regurg murmur
69
sounds of mitral valve regurg
holosystolic "blowing" murmur - louder with squatting and expiration
70
chronic vs acute rheumatic disease effects on mitral valve
acute - regurgitation
| chronic - stenosis - due to cusps scarring together
71
sounds to mitral stenosis
opening snap followed by diastolic rumble
72
afib with mural thrombus is associated with....
mitral stenosis from volume overload
73
S viridans in endocarditis
causes infectious endocarditis, low virulence, small vegetations, will not destroy valve
74
S aureus in endocarditis
most common in IV drug abuse, normal valves, high virulence - acute endocarditis
75
S epidermidis in endocarditis
in prosthetic valves
76
S bovis in endocarditis
in colorectal carcinoma**
77
HACEK organisms
negative blood culture endocarditis
- hemophilus
- actinobacillus
- cardiobacterium
- eikenella
- kingella
78
endocarditis symptoms
fever, murmur, *Janeway lesions, *Osler nodes (ouch ouch), splinter hemmhorages
79
lab findings in endocarditis
positive blood cultures, anemia of chronic disease, TEE can detect lesions
80
nonbacterial thrombotic endocartitis
- hypercoagulable state
- **underlying adenomcarcinoma
- on mitral valve
- **along line of closure
81
Libman-Sacks endocarditis
sterile vegetations from SLE
- both surfaces
- mitral regurg
82
most common cardiomyopathy
dialated
83
features of dilated cardiomyopathy
- systolic dysfunction
- mitral and tricuspid regurg (stretch valves)
- arrhythmia (stretch conduction system)
84
causes of dilated cardiomyopathy
- mutation (autosomal dominant)
- myocarditis (coxsackie) from lymphocyte
- alcohol
- drugs (doxorubicin/cocaine)
- ** pregnancy
85
most common cause of hypertrophic cardiomyopathy
genetic mutation in **sarcomere proteins (AD)
86
clinical features of hypertrophic cardiomyopathy
- decreased cardiac output (diastolic dysfunction)
- ventricular arrhythmias
- syncope with exercise
87
biopsy findings in hypertrophic cardiomyopathy
**myocyte disarray
88
features of restrictive cardiomyopathy
decreased compliance, restricted filling during diastole
89
causes of restrictive cardio myopathy
- amyloidosis
- sarcoidosis
- hemochromatosis - iron
- endocardial fibroelastosis (kids), fibrosis in endocardium
- Loeffler syndrome = eosinophilic, fibrosis of heart tissue
90
EKG findings in restrictive cardiomyopathy
diminished voltage and low QRS
91
myxoma
mesenchymal proliferation (no division of cells), gelatinous appearance, ground substance, most common in adults
92
myxoma features
can block mitral valve, syncope due to obstruction
93
rhabdomyoma
benign hamartoma of cardiac muscle, in children in ventricle
94
association with rhadomyoma
tuberous sclerosis
95
most common location of metastasis in heart
pericardium
96
temporal/giant cell arteritis
older females, branches of carotid,
- *jaw claudication/temporal headache* - blindness
- ESR over 100
- granulomatous vasculitis
- segmental lesions (long biopsy)
- giant cells
- **treatment with steroid to prevent blindness
97
Takayasu arteritis
same disease at giant cell arteritis
- younger adult (asian)
- aortic arch branch point
- * pulseless disease
- high ESR
- treatment is steriod
98
polyarteritis nodosa
medium vessel vasculitis
- necrotizing
- ***spares the lung
- depends on artery involved (hypertension, melena, skin lesions)
- **HBsAg association
- string of pearls, different ages of lesions
99
association with polyarteritis nodosa
HBsAg
100
Kawasaki disease
young asian medium vessel vasculitis
- rash on palms and soles (kid on kawasaki motorcycle)
- non specific symptoms
- **coronary artery
- treatment is aspirin (usually don't do this), inhibits COX - TXA2
101
main vessel in Kawasaki disease
coronary artery - can have MI or aneurysm
102
buerger disease
medium vessel vasculitis
- digits ulceration gangrene
- ***smoking disease
- raynaud phenomenon
103
granulomatosis with polyangiitis
- small vessel vasculitis
- nasopharynx, lungs and kidneys (C shaped)
- *** C-ANCA
- RPGN
- large necrotizing granulomas
- treat with cyclophosphamide
104
vasculitis with c-ANCA
granulomatosis with polyangiitis
105
microscopic polyangiitis
small vessel vasculitis
- lung and kindey (no nose or granulomas**)
- p-ANCA
106
vasculitis with p-ANCA
microscopic polyangiitis
| Churg-Strauss syndrome
107
Churg-Strauss syndrome
small vessel vasculitis
- **eosinophils
- *asthma
- has granulomas
108
Henoch Schonlein purpura
small vessel vasculitis
- IgA complex deposition
- children
- palpable* purpura
- kidney (IgA nephropathy*) or GI
- after URI (mucosa)***
109
two causes of renal artery stenosis
```
atherosclerosis
fibromuscular dysplasia (young females)
```
110
4 modifiable risk factors for atherosclerosis
1. hypertension
2. high cholesterol
3. smoking
4. diabetes
111
hyaline arteriolosclerosis
proteins leaking into vessel wall
- vascular thickening
- *benign hypertension
- *diabetics
- glomerular scaring -> renal failure
112
hyperplastic arteriolosclerosis
hyperplasia of smooth muscle
- *onion skinning
- consequence of malignant hypertension***
- fibrinoid necrosis
- flea bitten kidney
113
monchenberg medial calcific sclerosis
calcium in vessels, can show up on mammography, not clinically important
114
aortic dissection requires what two things...
1. lots of stress
| 2. preexisting weakness of media
115
common causes of weakness in media
1. HTN
| 2. collagen disorders
116
weakness in aortic wall classically seen in....
tertiary syphilis from end arteritis
*tree bark appearence
117
presentation triad of AAA rupture
hypotension, pulsatile abdominal mass, flank pain
118
angiosarcoma
malignany proliferation of endothelial cells
119
association with andiosarcoma
PVC exposure* and arsenic
120
kaposi sarcoma association
HHV 8 - endothelial cells
| HIV, transplants, Eastern European males
121
tricuspid atresia
hypoplastic RV, requires ASD and VSD for viability
122
cause of tetralogy of Fallot
anterosuperior displacement of infundibular septum
123
Ebstein anomaly
displacement of tricuspid valve leaflets downard, atrializing the ventricles
- leads to right HF
- *lithium exposure
124
alcohol exposure congenital defects
VSD, PDA, ASD, tetralogy of Fallot
125
congenital rubella congenital defects
PDA, pulmonary artery stenosis, septal defects
126
down syndrome congenital defects
endocardial cushion defect, VSD, ASD
127
diabetic mother congenital defects
transposition of great vessels
128
marfan congenital defects
MVP, dissection, aortic regurg
129
lithium exposure congenital defects
Ebstein anomaly
130
Turner syndrome congenital defects
bicuspid aortic valve, coarctation of aorta
131
Williams syndrome congenital defects
supravalvular aortic stenosis
132
corneal arcus
lipid deposit in cornea - sign of hyperlipidemia, common in elderly
133
association with cystic medial degeneration
thoracic aortic aneurysm
134
coronary steal syndrome
vessels are dilated at baseline distal to blockage. vasodilators shunts blood to well perfused areas, away from stenosed vessels leading to ischemia
- use vasodilators in stress tests
135
causes of dilated cardiomyopathy on First Aid
```
ABCCCD
Alcohol
wet Beriberi
Coxsackie
cocaine
Chagas
Doxorubicin
```
136
Takotsubo cardiomyopathy
ventricular apical ballooning due to increased sympathetic stimulation (stress)
137
association with Friedrich ataxia
hypertrophic cardiomyopathy
138
loffler syndrome
endomyocardial fibrosis with prominent eosinophilic infiltrate
139
causes of restrictive cardiomyopathy on First Aid
```
Puppy LEASH
Post radiation fibrosis
Loffler syndrome
Endocardial fibroelastosis
Amyloidosis
Sarcoidosis
Hemochromatosis
```
140
orthopnea
shortness of breath when supine, increase venous return makes left heart failure worse
141
roth spots
white spots on retina from endocartitis
142
relief of pericarditis
sitting up or leaning forward
143
pulsus paradoxus
lower amplitude in systolic BP during inspiration - seen in cardiac tamponade, asthma, apnea, percarditis
