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Pathoma > Cardio > Flashcards

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

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2
Q

nitroglycerin

A

vasodilate arteries AND veins

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3
Q

unstable angina

A

at rest, rupture of thrombosis, incomplete occlusion, reversible, ST depression, relieved by NG

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4
Q

prinzmetal angina

A

coronary artery vasospasm, episodic, unrelated to exertion, ST elevation (transmural), relieved by NG or CCB

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5
Q

myocardial infarction

A

greater than 20 minutes, pain in left arm/jaw, complete occlusion, not relieved by NG

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6
Q

parts of heart affected by LAD

A

left anterior wall and anterior portion of IV septum

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7
Q

parts of heart affected by right coronary artery

A

left posterior wall and posterior portion of IV septum

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8
Q

parts of heart affected by left circumflex

A

lateral wall of LV

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9
Q

characteristics of troponin

A

rises 2-4 hours, peaks at 24, stays high for 7-10 days

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10
Q

characteristics of CK-MB

A

rises 4-6 hours, peaks at 24, falls at 72, good for detecting reocclusion

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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
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12
Q

contraction band necrosis

A

calcium returns after MI resulting in contraction, dense pink lines, myocytes with no nuclei

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13
Q

MI at 4-24 hours

A

coagulative necrosis (nuclear changes), dark discoloration, arrhythmias

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14
Q

MI at 1-3 days

A

neutrophils, yellow pallor, fibrinous pericarditis - inflammation goes to pericardium, chest pain and friction rub

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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

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16
Q

MI at 1-3 weeks

A

granulation tissue, fibroblast collagen and blood vessels, RED BORDER from outside of tissue

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17
Q

MI at months

A

white fibrotic scar, risk for aneursym - Dressler syndrome

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18
Q

one day, one week, one month for MI

A

coagulative necrosis - one day - inflammation (neutrophils then macrophages) - week - granulation tissue - month - scar

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19
Q

rupture of papillary muscle is cause by infarction of what vessel

A

RCA - leads to mitral insufficiency

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20
Q

dressler syndrome

A

pericardial antigens exposed after MI, autoimmune pericarditis, weeks are MI

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21
Q

congestive heart failure

A

when heart fails to pump appropriately

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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
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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

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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

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25
Q

mainstay treatment of CHF

A

ACE inhibitor to block downward spiral of symtopms

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26
Q

major cause of right heart failure

A

left side failure

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27
Q

causes of right heart failure

A
  • 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
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28
Q

clinical features of right heart failure

A

any backup to right heart

  • JVD
  • painful hepatosplenomegaly
  • cardiac cirrhosis
  • pitting edema
  • nutmeg liver
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29
Q

most common congenital heart defect

A

ventricular septal defect

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30
Q

association with VSD

A

fetal alcohol syndrome

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31
Q

features of VSD

A

left to right shunt, pulmonary hypertension, eventual reversal of shunt leading to cyanosis

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32
Q

eisenmenger syndrome

A

when left to right shunt reverses to right to left shunt - right ventricular hypertrophy, polycythemia from hypoxia leading to EPO release, clubbing from cyanosis

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33
Q

most common type of ASD

A

ostium secundum

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34
Q

association of ASD

A

down syndrome - ostium primum

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35
Q

features of ASD

A

left to right shunt in atrium, more volume in right side, delayed closure of pulmonic valve, S2 split, paradoxical embolus

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36
Q

associated with PDA

A

congenital rubella

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37
Q

features of PDA

A

pulmonary hypertension, leading to reversal of shunt, cyanosis in lower extremity later in life - machine like murmur

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38
Q

holosystolic machine like murmur

A

PDA

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39
Q

treatment of PDA

A

indomethacin (NSAIDs) - decreases PGEEE (KEEPS it open) – leading to closure

  • Endomethacin ends patency
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40
Q

four problems in Tetralogy of Fallot

A
  • stenosis of RV outflow tract (PPulmonary stenosis)
  • Right ventricular hypertrophy
  • Overriding aorta
  • VSD

Mnemonic: PROVe

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41
Q

clinical features of tetralogy of Fallot

A

right to left shunt, cyanosis in newborns, squatting decreases shunt, boot shaped heart

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42
Q

way to treat transposition of great vessels

A

PGE - KEEPs the ductus arteriosus open

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43
Q

association with transposition of great vessels

A

maternal diabetes - failure of spiral of septum

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44
Q

infantile coarctation of aorta

A
  • associated with PDA
  • **distal to aortic arch, proximal to PDA
  • right to left shunt - cyanosis
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45
Q

association with PDA

A

Turners syndrome

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46
Q

adult form of coarctation

A

no PDA, hypertension in UE, hypotension in LE

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47
Q

association of adult aortic coarcation

A

bicuspid aortic valve - rib notching

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48
Q

acute rheumatic fever

A
  • group A strep
  • 2-3 weeks post strep
  • bacterial M protein mimics human tissue
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49
Q

Jones criteria from rheumatic fever

A
  • strep infection - ASO or anti-DNase titers
  • minor (fever and ESR)
  • major - see other
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50
Q

Major Jones criteria

A 
J - joint, migratory polyarthritis
O - heart - pancarditis
N - nodules in skin
E - erythema marginatum
S - syndecema chorea - involuntary movements
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51
Q

valve effected in rheumatic fever

A

usually mitral, sometimes aortic leads to regurgitation

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52
Q

Aschoff body

A

chronic inflammation, giant cells, fibrinoid material - seen in myocarditis of acute rheumatic fever

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53
Q

Anitschkow cells

A

reactive histiocytes with wavy nuclei (caterpillar nucleus) in myocarditis in acute rheumatic fever

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54
Q

most common cause of death in acute rheumatic fever

A

myocarditis

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55
Q

pericarditis in acute rheumatic fever

A

friction rub

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56
Q

features of chronic rheumatic fever

A

stenosis of mitral valve, thickening of chordae tendineae and cusps - complication is endocarditis

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57
Q

fusion of commisures

A

in chronic rheumatic fever, scarring fish mouth appearance

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58
Q

main cause of aortic stenosis

A

wear and tear, calcification, older patients

59
Q

association of bicuspid valve disease

A

aortic stenosis, early in life

60
Q

how to tell chronic rheumatic disease from normal aortic stenosis

A

rheumatic disease always has mitral stenosis too and fusion of commisures - not seen in wear and tear

61
Q

sounds of aortic stenosis

A

systolic ejection click followed by crescendo-decrescendo murmur

62
Q

complication of aortic stenosis

A
  • concentric LVH
  • angina and syncope on exercise
  • microangiopathic hemolytic anemia
63
Q

cause of aortic regurg

A

dilation of aortic root allowing for backflow

  • can be from aneurysm, pulling on aortic root
  • valve damage from infectious endocarditis
64
Q

sounds in aortic regurg

A

early blowing diastolic murmur

65
Q

feature of aortic regurg

A

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
Q

eccentric hypertrophy seen in….

A

volume overload - aortic regurgitation or dilated cardiomyopathy

67
Q

associated with mitral valve prolapse

A

Marfans and Ehlers Danlos syndromes

68
Q

sounds of mitral valve prolapse

A

mid systolic click followed by regurg murmur

69
Q

sounds of mitral valve regurg

A

holosystolic “blowing” murmur - louder with squatting and expiration

70
Q

chronic vs acute rheumatic disease effects on mitral valve

A

acute - regurgitation

chronic - stenosis - due to cusps scarring together

71
Q

sounds to mitral stenosis

A

opening snap followed by diastolic rumble

72
Q

afib with mural thrombus is associated with….

A

mitral stenosis from volume overload

73
Q

S viridans in endocarditis

A

causes infectious endocarditis, low virulence, small vegetations, will not destroy valve

74
Q

S aureus in endocarditis

A

most common in IV drug abuse, normal valves, high virulence - acute endocarditis

75
Q

S epidermidis in endocarditis

A

in prosthetic valves

76
Q

S bovis in endocarditis

A

in colorectal carcinoma**

77
Q

HACEK organisms

A

negative blood culture endocarditis

  • hemophilus
  • actinobacillus
  • cardiobacterium
  • eikenella
  • kingella
78
Q

endocarditis symptoms

A

fever, murmur, *Janeway lesions, *Osler nodes (ouch ouch), splinter hemmhorages

79
Q

lab findings in endocarditis

A

positive blood cultures, anemia of chronic disease, TEE can detect lesions

80
Q

nonbacterial thrombotic endocartitis

A
  • hypercoagulable state
  • **underlying adenomcarcinoma
  • on mitral valve
  • **along line of closure
81
Q

Libman-Sacks endocarditis

A

sterile vegetations from SLE

  • both surfaces
  • mitral regurg
82
Q

most common cardiomyopathy

A

dialated

83
Q

features of dilated cardiomyopathy

A
  • systolic dysfunction
  • mitral and tricuspid regurg (stretch valves)
  • arrhythmia (stretch conduction system)
84
Q

causes of dilated cardiomyopathy

A
  • mutation (autosomal dominant)
  • myocarditis (coxsackie) from lymphocyte
  • alcohol
  • drugs (doxorubicin/cocaine)
  • ** pregnancy
85
Q

most common cause of hypertrophic cardiomyopathy

A

genetic mutation in **sarcomere proteins (AD)

86
Q

clinical features of hypertrophic cardiomyopathy

A
  • decreased cardiac output (diastolic dysfunction)
  • ventricular arrhythmias
  • syncope with exercise
87
Q

biopsy findings in hypertrophic cardiomyopathy

A

**myocyte disarray

88
Q

features of restrictive cardiomyopathy

A

decreased compliance, restricted filling during diastole

89
Q

causes of restrictive cardio myopathy

A
  • amyloidosis
  • sarcoidosis
  • hemochromatosis - iron
  • endocardial fibroelastosis (kids), fibrosis in endocardium
  • Loeffler syndrome = eosinophilic, fibrosis of heart tissue
90
Q

EKG findings in restrictive cardiomyopathy

A

diminished voltage and low QRS

91
Q

myxoma

A

mesenchymal proliferation (no division of cells), gelatinous appearance, ground substance, most common in adults

92
Q

myxoma features

A

can block mitral valve, syncope due to obstruction

93
Q

rhabdomyoma

A

benign hamartoma of cardiac muscle, in children in ventricle

94
Q

association with rhadomyoma

A

tuberous sclerosis

95
Q

most common location of metastasis in heart

A

pericardium

96
Q

temporal/giant cell arteritis

A

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
Q

Takayasu arteritis

A

same disease at giant cell arteritis

  • younger adult (asian)
  • aortic arch branch point
    • pulseless disease
  • high ESR
  • treatment is steriod
98
Q

polyarteritis nodosa

A

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
Q

association with polyarteritis nodosa

A

HBsAg

100
Q

Kawasaki disease

A

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
Q

main vessel in Kawasaki disease

A

coronary artery - can have MI or aneurysm

102
Q

buerger disease

A

medium vessel vasculitis

  • digits ulceration gangrene
  • ***smoking disease
  • raynaud phenomenon
103
Q

granulomatosis with polyangiitis

A
  • small vessel vasculitis
  • nasopharynx, lungs and kidneys (C shaped)
  • *** C-ANCA
  • RPGN
  • large necrotizing granulomas
  • treat with cyclophosphamide
104
Q

vasculitis with c-ANCA

A

granulomatosis with polyangiitis

105
Q

microscopic polyangiitis

A

small vessel vasculitis

  • lung and kindey (no nose or granulomas**)
  • p-ANCA
106
Q

vasculitis with p-ANCA

A

microscopic polyangiitis

Churg-Strauss syndrome

107
Q

Churg-Strauss syndrome

A

small vessel vasculitis

  • **eosinophils
  • *asthma
  • has granulomas
108
Q

Henoch Schonlein purpura

A

small vessel vasculitis

  • IgA complex deposition
  • children
  • palpable* purpura
  • kidney (IgA nephropathy*) or GI
  • after URI (mucosa)***
109
Q

two causes of renal artery stenosis

A 
atherosclerosis
fibromuscular dysplasia (young females)
110
Q

4 modifiable risk factors for atherosclerosis

A
  1. hypertension
  2. high cholesterol
  3. smoking
  4. diabetes
111
Q

hyaline arteriolosclerosis

A

proteins leaking into vessel wall

  • vascular thickening
  • *benign hypertension
  • *diabetics
  • glomerular scaring -> renal failure
112
Q

hyperplastic arteriolosclerosis

A

hyperplasia of smooth muscle

  • *onion skinning
  • consequence of malignant hypertension***
  • fibrinoid necrosis
  • flea bitten kidney
113
Q

monchenberg medial calcific sclerosis

A

calcium in vessels, can show up on mammography, not clinically important

114
Q

aortic dissection requires what two things…

A
  1. lots of stress

2. preexisting weakness of media

115
Q

common causes of weakness in media

A
  1. HTN

2. collagen disorders

116
Q

weakness in aortic wall classically seen in….

A

tertiary syphilis from end arteritis

*tree bark appearence

117
Q

presentation triad of AAA rupture

A

hypotension, pulsatile abdominal mass, flank pain

118
Q

angiosarcoma

A

malignany proliferation of endothelial cells

119
Q

association with andiosarcoma

A

PVC exposure* and arsenic

120
Q

kaposi sarcoma association

A

HHV 8 - endothelial cells

HIV, transplants, Eastern European males

121
Q

tricuspid atresia

A

hypoplastic RV, requires ASD and VSD for viability

122
Q

cause of tetralogy of Fallot

A

anterosuperior displacement of infundibular septum

123
Q

Ebstein anomaly

A

displacement of tricuspid valve leaflets downard, atrializing the ventricles

  • leads to right HF
  • *lithium exposure
124
Q

alcohol exposure congenital defects

A

VSD, PDA, ASD, tetralogy of Fallot

125
Q

congenital rubella congenital defects

A

PDA, pulmonary artery stenosis, septal defects

126
Q

down syndrome congenital defects

A

endocardial cushion defect, VSD, ASD

127
Q

diabetic mother congenital defects

A

transposition of great vessels

128
Q

marfan congenital defects

A

MVP, dissection, aortic regurg

129
Q

lithium exposure congenital defects

A

Ebstein anomaly

130
Q

Turner syndrome congenital defects

A

bicuspid aortic valve, coarctation of aorta

131
Q

Williams syndrome congenital defects

A

supravalvular aortic stenosis

132
Q

corneal arcus

A

lipid deposit in cornea - sign of hyperlipidemia, common in elderly

133
Q

association with cystic medial degeneration

A

thoracic aortic aneurysm

134
Q

coronary steal syndrome

A

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
Q

causes of dilated cardiomyopathy on First Aid

A 
ABCCCD
Alcohol
wet Beriberi
Coxsackie
cocaine
Chagas
Doxorubicin
136
Q

Takotsubo cardiomyopathy

A

ventricular apical ballooning due to increased sympathetic stimulation (stress)

137
Q

association with Friedrich ataxia

A

hypertrophic cardiomyopathy

138
Q

loffler syndrome

A

endomyocardial fibrosis with prominent eosinophilic infiltrate

139
Q

causes of restrictive cardiomyopathy on First Aid

A 
Puppy LEASH
Post radiation fibrosis
Loffler syndrome
Endocardial fibroelastosis
Amyloidosis
Sarcoidosis
Hemochromatosis
140
Q

orthopnea

A

shortness of breath when supine, increase venous return makes left heart failure worse

141
Q

roth spots

A

white spots on retina from endocartitis

142
Q

relief of pericarditis

A

sitting up or leaning forward

143
Q

pulsus paradoxus

A

lower amplitude in systolic BP during inspiration - seen in cardiac tamponade, asthma, apnea, percarditis

Pathoma (11 decks)

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