Cardio Flashcards
1
Q
ST segment depression
A
Stable and unstable angina (subendocardial ischemia)
Initial phase of MI
2
Q
ST segment elevation
A
Prinzmetal angina
3
Q
Coronary vasospasm
A
Prinzmetal angina
Cocaine
Emboli
Kawasaki disease
4
Q
Perfusion of papillary muscles
A
RCA
5
Q
Contraction band necrosis
A
Reperfusion injury after cardiac necrosis 4-12 hours due to calcium influx and hypercontraction
6
Q
Abs against pericardium
A
Dressler syndrome
7
Q
Stage of MI with pericarditis with friction rub
A
1-3 days - neutrophil invasion
8
Q
Stage of MI with rupture of wall leading to cardiac tamponade
A
4-7 days with macrophage infusion
9
Q
Nutmeg liver
A
Right sided heart failure
10
Q
Boot-shaped heart and assoc. signs
A
Tetralogy of Fallot - PROVeS Pulmonary valve stenosis Right ventricular hypertrophy Overriding aorta VSD Squat during cyanotic spell
11
Q
Shunt reversal
A
Eisenmenger syndrome - Congenital defects
12
Q
fetal alcohol syndrome and Eisenmenger or trisomy 13, 18, 21
A
Ventricular septal defect (VSD)
13
Q
Down syndrome and paradoxical emboli (assoc and then most common)
A
Atrial septal defect (ASD) - ostium primum
Ostium secundum most common
14
Q
congenital rubella, holosystolic “machine-like” murmur, Eisenmenger, lower extremity cyanosis
A
Patent ductus arteriosus
15
Q
Maternal diabetes, administration of PGE
A
transposition of great vessels
16
Q
Turner syndrome, lower extremity cyanosis
A
Infantile coarctation of the aorta - assoc with PDA
17
Q
Bicuspid aortic valve, upper extremity hypertension, lower extremity hypotension
A
Adult coarctation of the aorta - NOT assoc with PDA
18
Q
notching of ribs on x-ray
A
adult coarctation of aorta - NOT assoc with PDA
19
Q
molecular mimicry, M protein, group A Beta-hemolytic strep
A
rheumatic fever
20
Q
migratory joint pain, pancarditis, rash on trunk and limbs, chorea
A
acute rheumatic fever
21
Q
Aschoff bodies (disease and location)
A
Acute rheumatic fever - myocardium
22
Q
Anitschkow cells (morphology and disease)
A
Caterpillar - Acute rheumatic fever
23
Q
“Fish mouth” valve - which one and disease
A
mitral valve most common - Chronic Rheumatic fever
24
Q
Fusion of commissures of aortic valve
A
Chronic Rheumatic fever
25
Systolic ejection click and crescendo-decrescendo murmur
aortic stenosis
26
LV hypertrophy, syncope with exercise, hemolytic anemia - disease and most common cause
aortic stenosis - "wear and tear"
27
water-hammer pulse, Quincke pulse, increased pulse pressure, eccentric hypertrophy, LV dilation
Aortic regurgitation (pulse pressure: difference between systolic and diastolic - diastolic dec due to regurg and systolic inc due to inc. stroke vol)
28
Marfan syndrome, Ehlers Danlos, myxoid degeneration, mid-systolic click
mitral valve prolapse
29
c-ANCA, granulomas with giant cells, sinusitis, hematuria
Wegener's granulomatosis
30
Left flank pain, pulsatile mass in abdomen (disease, where, complication)
Triple A - below renal a's, above bifurcation - hemiparesis
31
"tree bark" (disease, location, common finding)
Syphilitic aortic aneurysm (treponema pallidum) - ascending aorta - cor bovinum (LV hypertrophy)
32
"tearing" anterior chest pain, radiates down back (disease, common pts, associations, complication)
Aortic dissection - Marfan's, males with hypertension, pregnancy, berry aneurysm - NOT atherosclerosis - rupture into body cavity, if rupture back through intima -> double barreled
33
Smoker with polycystic kidney disease, terrible headache with diplopia (disease, common location, late sequelae)
Berry aneurysm - circle of willis (ICA or anterior communicating) - noncommunicating hydrocephalus
34
wavy fibers
6-24 hours post MI
35
granulation tissue and fibrosis post MI (time frame and type of tissue)
Granulation: 7-10 days (red border) type III collagen
Fibrosis: months - type I collagen
36
small friable masses, what lab tests?
ASO titres for acute rheumatic fever
37
thickening of chordae tendenae
Chronic Rheumatic fever
38
female in 20s, mid systolic click and murmur, polycystic kidney disease, asymptomatic (disease and outcome)
Myxomatous degen of mitral valve - sudden cardiac death
39
large friable masses on mitral valve, high grade fever (disease and other signs)
acute bacterial endocarditis with strep veridans - Roth spots in retina, osler nodes, janeway lesions, splinter hemorrhages
40
patchy necrosis, inc CK-MB, arrythmia, diarrhea, friction rub, myocytes retain nuclei (disease, histo findings, and bugs (3) )
viral myocarditis, basophilic infiltrates (lymphocytes NOT PMNs), Coxsakie B, enterovirus, trypanosoma cruzi
41
mutations in sarcomere proteins (name and part of cardiac cycle affected)
Hypertrophic cardiomyopathy - diastolic
42
Assoc with Chaga's, eclampsia, alcohol, cocaine (name, part of cardiac cycle affected, complication)
Dilated cardiomyopathy - systolic - decreased ejection fraction and beri beri
43
amyloid, hemochromatosis, Loeffler's (disease and part of cardiac cycle affected)
restrictive cardiomyopathy - diastolic
44
anterosuperior displacement of the infundibular septum
Tetrology of fallot
45
tet spell, squatting
tetrology of fallot
46
patent foramen ovale
Atrial septal defect (ASD)
47
triple bypass - arteries bypassed
LAD, R. coronary, left circumflex
48
scalloped internal elastic lamina
muscular artery
49
muscular arteries esp. renal and ulnar Dystrophic calcification of tunica media
Does not occlude the lumen
Medial calcific sclerosis a.k.a. Mockenberg sclerosis
50
atheromas in intima - name of pathology, vessels affected
atherosclerosis - major vessels
51
fatty streaks - age first seen, leads to what, in what vessels?
10
atherosclerosis
large vessels
52
thickening of arterioles: what compound, name of disease, primary cause, and major complication?
hyaline
hyaline arteriosclerosis
diabetes mellitus
chronic renal failure, glomerular scarring
53
onion skinning: disease and major cause
```
Hyperplastic Arteriosclerosis
malignant hypertension (210/120)
```
54
granulomatous inflammation, female over 50, jaw claudication, facial pain, polymyalgia rheumatica. What size vessel, risk of what without treatment, describe lesions.
large vessels: carotid
risk of blindness (ophthalmic a. involvement)
segmental lesions, must take long segment
(Temporal (giant cell) arteritis
55
young asian female, granulomatous inflammation, visual symptoms, retinal hemorrhage, hemiparesis. Give most common finding.
Weak/absent pulse in upper extremity
"pulseless disease"
Takayasu Arteritis
56
young adults, hypertension, abdominal pain with melena, neurologic problems, skin lesions, "string of pearls" appearance on imagine. What is found in serum? what sized vessel and where? what system is spared?
HBsAg (Hep B)
medium sized vessel - branch points
LUNG
Polyarteritis Nodosa (PAN)
57
Asian child < 4, fever, conjunctivitis, rash on palms and soles, enlarged cervical lymph nodes, kid has MI. How to treat, why is this strange?
IVIG and ASPIRIN (opposite of treatment for viral infection which it mimics. Treating viral infeciton with aspirin in kids leads to Reye's)
58
raynaud phenomenon, fingers and toes of ulceration and gangrene, instep claudication. What is the leading cause of this disease? What size vessel?
heavy smoking
medium
(Buerger)
59
middle aged male with sinusitis, hemoptysis, and hematuria. What is found in serum and on histo?
c-ANCA
nectrotizing granulomas
Wegener granulomatosis (we-C-ener)
60
necrotizing inflammation in lung and kidney. What is found in serum? What is absent?
p-ANCA
granulomas
Microscopic Polyangiitis
61
eosinophils, lungs and heart affected, asthma, granulomas. What is in serum?
p-ANCA
| Churg-Strauss
62
child presents with palpable purpura on butt and legs, GI pain and bleeding. What is the cause and the initial trigger?
IgA immune complex deposition
| occus after upper respiratory tract infection
63
What is considered HTN?
140/90
64
how does ATII act and what does it do?
raises BP
contracts arteriole s. muscle (inc vasc peripheral resistance)
promotes adrenal release of aldosterone (salt resorption)
65
young female presents with HTN and unilateral renal atrophy, most common cause?
Fibromuscular dysplasia: irregular thickening of large/med arteries, esp renal
66
what is malignant HTN?
210/120
67
Common risk factors for atherosclerosis. modifiable and nonmodifiable
Modifiable: HTN, hypercholesterolemia, smoking, diabetes
Nonmodifiable: older age, males and postmenopausal females, genetics
68
pink hyaline deposition in arterioles. 2 causes and what it can lead to
benign HTN and diabetes
| chronic renal failure
69
woman comes in for mammography you find lots of thin, wirey opacities, should you be concerned?
no, Monckeberg medial calcific sclerosis, nonobstructive calcification of medium arteries
70
pt. with chronic hypertension presents with tearing chest pain that radiates to the back, name the pathological appearance of the affected vessel and most common cause of death
hyaline atherosclerosis of vasa vasorum
| cardiac tamponade
71
man dies from aneurysm, autopsy shows "tree-bark" appearance of aorta. Major complication and major association
dilation of aortic valve root -> aortic regurg
| tertiary syphilis
72
male smoker over 60 presents with flank pain, hypotension, and pulsatile mass in abdomen. Rupture is common at what size and name common complication
>5cm
| compression of local structures like ureter
73
someone who has worked with polyvinyl chloride for many years shows proliferation of endothelial cells. name 3 common sites. should you be concerned?
skin, breast, liver
| yes, highly aggressive malignancy
74
older eastern european male presents with purple patches and nodules on his skin. they are non-blanching. This condition is associated with what disease?
HHV-8
75
endothelial stimulation vs. endothelial activation
stimulation: rapid, reversible
activation: altered gene expression, protein synthesis, no NO production, loss of anti-coag properties
76
lipoprotein (a) what is it, what does it do?
altered LDL -> atherogenic
77
statins 2 fold mechanism
inhibits cholesterol syn
| reduces CRP
78
toll like receptors TLRs: what do they do generally?
increase inflammation
79
4 features of vulnerable plaque
Large core
thin cap
inflammation/foam cells in cap
matrix metalloproteases
80
extravascular hematoma that communicates with intravascular space
false/pseudoaneurysm
81
2 genetic diseases leading to medial weakening of blood vessels
marfan's
| polycystic kidney disease
82
fibrillin-1 gene, disease and chromosome
marfans
| 15
83
unhappy asian kid, rash palms and soles of feet, pathogenesis?
autoantibodies against endothelium
84
instep claudication, microabcesses
Buerger's
85
normal heart weights:
male: 300g
female: 250g
86
most blood flow to myocardium through coronaries is during what phase of heart cycle?
diastole
87
elevation of what biomarker indicates higher risk of death from heart failure?
BNP - brain natriuretic protein
88
male, <65, alcoholic, Q waves, cardiomegaly indicate heart failure of what cycle?
systolic
89
>70, female, HTN, LVH indicate heart failure of what cycle?
diastolic
90
q waves indicate what?
prior MI
91
alveolar hemosiderosis indicates what?
left heart failure "heart failure cells"
92
what % is considered critical stenosis in coronaries
75%
93
is sudden cardiac death due to complete or incomplete obstruction of coronaries?
incomplete due to arrhythmias
94
what do endothelins do?
vasoconstriction
95
angina that occurs at rest with ST segement elevation is caused by what?
Prinzmetal
| coronary artery spasm
96
angina that occurs with physical activity is due to?
stable agina
| fixed stenosis
97
angina that progressively increases in frequency is caused by what?
unstable angina
| disruption of plaque, superimposed thrombosis
98
major cause of MI?
rupture of plaque with thrombosis
| NOT STENOSIS!! 85% of pts have less than 70% stenosis
99
is the prognosis of MI patient better for a healthy athlete who has an MI after exercising, or an obese man who has an MI watching a football game on his couch?
better for obese man, less metabolic demand for O2 if MI occurs at rest, longer time for ischemia to develop
100
wavefront phenomenon, what is it and significance
progression of myocardial necrosis from subendocardial to transmural seems to occur in waves spreading to larger area
sig: to mature to transmural infarct takes 3-6 hours, can save lots of heart wall if dealt with soon enough
101
which direction does heart scarring occur?
outside to inside
102
what kind of necrosis in MI?
coagultion - all blood vessels
103
time frame of troponin release following MI. Detectable, peak, lasts how long?
seen at 2-4 hours
peak at 48 hours
lasts 7-10 days
104
time frame of CK-MB release following MI. Detectable, peak, lasts how long?
seen at 2-4 hours
peaks at 24 hours
gone by 72 hours (3 days)
105
is heparin sufficient treatment post MI?
no, it is not thrombolytic, need to give something to break down clot (streptokinase)
106
which plaque responds best to balloon angioplasty and why? eccentric or concentric?
eccentric: more prone to break and rupture at 1 place, less likely to hemorrhage
107
explain negative remodeling
after angioplasty, media and adventitia get stretched -> fibrosis, scar contracts, narrows lumen
108
why is internal mammary (thoracic) artery good for bypass?
atherosclerosis is rare
| own vasovasorum and lymph drainage
109
most common cause of sudden cardiac death and how soon does death occur after onset of symptoms?
1 hr
| ischemic heart disease (obstructive disease leading to diffuse myocardial dysfunction)
110
what causes death in sudden cardiac death? SCD
cause: lethal arrhythmia from 80-90% critical stenosis of one or more coronaries
111
does stress /sex increase risk of SCD?
no, even coupled with coronary artery disease
112
state 1A of arrhythmia, timing and what happens
2-10 min post occlusion
| altered extracellular K+ -> cells re-exciting prematurely
113
state 1B of arrhythmia, timing and what happens
18-30 min
depression of excitability of epicardial cells, electrical signals at border of ischemic zone leads to unequal stretching
114
"box-car" shaped nuclei (rectangular) are found in what pathology?
ventricular hypertrophy in cardiomyocytes
115
most common cause of cor pulmonale?
COPD
116
what causes acute cor pulmonale? findings of RV?
pulmonary embolism
| RV is dilated but not hypertrophic
117
marathon runner drops dead suddenly, what does his hear look like? what part of cycle involved?
hypertrophic cardiomyopathy
| diastolic
118
myofiber disarray, abnormally branching myocytes, interstitial fibrosis, small vessel disease myocyte diameter is 45
hypertrophic cardiomyopathy
119
alcohol and viral myocarditis can lead to what cardiomyopathy?
dilated
120
find apple green birefringence in cardiomyocytes, this can lead to what cardiomyopathy? what heart cycle is affected?
restrictive (amyloid)
| Diastolic
121
hyperkeratosis of palms and soles, triangle of dysplasia, young adults, fibrofatty replacement of cardiac tissue with thinning. defect in what? What part of heart is affected? Name of condition?
desmosomal adhesion proteins
affects RV
arrhythmogenic right ventricular cardiomyopathy ARVC
122
karate kid drops dead after being hit in chest, name of disease, and what part of heart cycle was affected
commotio cordis
| T wave upstroke
123
right sided, plaque like fibrosis
carcinoid disease
124
which type of valve requires anticoagulation therapy?
mechanical
125
subacute endocarditis has what kind of prognosis? what organism? what kind of valve does it affect?
good
strep viridans
native valve
126
HACEK organisms causing endocarditis are common in what age group?
infants and immunocompromised children
127
bulky friable vegetations and ring abcesses in perivalvular myocardium common on what valve from what cause?
tricuspid, IV drug abuse
128
splinter hemorrhages, roth spots indicate what?
peripheral emboli from infective endocarditis
129
growths of fibrin and delicate layers of aggregated platelets on ventricular side of mitral valve. what type of endocarditis, what disease, and what are they made of?
Libman-Sacks endocarditis (noninfective)
SLE - lupus
LSE -> SLE
immune complexes
130
viral myocarditis can lead to what kind of acquired response?
cytotoxic T cell autoimmune
131
epicardial rosary lesions from what organism? disease? heart consequence?
trypanosoma cruzi
chagas
dilation
132
young healthy woman been hiking for 2 weeks, presents with bundle branch block. bug? disease?
```
borrelia burgdorferi (rickettsia)
lyme carditis
```
133
asteroid bodies, thymoma
giant cell myocarditis
134
most common congenital heart disease in kids?
VSDs (42%)
135
coarctation of aorta has higher risk in patients with that genetic abnormality?
turner syndrome
136
most common congenital abnormality in adults
ASD
137
down's is assoc most commonly with what congenital heart abnormality?
VSD
138
explain eisenmenger complex
left to right shunt eventually causes pulmonary HTN from pulmonary vessel hypertrophy, increased pressure in RV reverses shunt to R to L -> cyanosis
139
swiss cheese muscular heart
VSD
140
what keeps PDA open?
prostaglandin E
141
what closes PDA?
indomethacin
142
aorta receives blood from both ventricles
truncus arteriosus
143
baby is born pink, but turns blue in 15 hours when ductus closes, why?
pulmonary valve atresia, no connection between RV and lungs
144
hypoplasia of left ventricle and aorta
aortic valve atresia, no outflow from LV
145
hypoplasia of aortic arch and LV hypertrophy
congenital aortic stenosis
146
baby born blue, most common cause?
Tetralogy of fallot
147
most common primary cardiac tumor, how do you find it?
cardiac myxoma
| calcify and see on x-ray
148
pedunculated mass in left atrium
cardiac myxoma
149
most common systemic disorder associated with pericarditis
uremia
150
blood between layers of tunica media, no dilation
aortic dissection
151
mediastinal widening
aortic dissection
152
african woman, worst head ache of life, diplopia, common place and late sequelae
circle of willis
| noncommunicating hydrocephalus from scarring of meninges
153
Nutmeg liver
Right sided heart failure
154
Boot-shaped heart and assoc. signs
```
Tetralogy of Fallot - PROVeS
Pulmonary valve stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
Squat during cyanotic spell
```
155
Shunt reversal
Eisenmenger syndrome - Congenital defects
156
fetal alcohol syndrome and Eisenmenger or trisomy 13, 18, 21
Ventricular septal defect (VSD)
157
Down syndrome and paradoxical emboli (assoc and then most common)
Atrial septal defect (ASD) - ostium primum
| Ostium secundum most common
158
congenital rubella, holosystolic "machine-like" murmur, Eisenmenger, lower extremity cyanosis
Patent ductus arteriosus
159
Maternal diabetes, administration of PGE
transposition of great vessels
160
Turner syndrome, lower extremity cyanosis
Infantile coarctation of the aorta - assoc with PDA
161
Bicuspid aortic valve, upper extremity hypertension, lower extremity hypotension
Adult coarctation of the aorta - NOT assoc with PDA
162
notching of ribs on x-ray
adult coarctation of aorta - NOT assoc with PDA
163
molecular mimicry, M protein, group A Beta-hemolytic strep
rheumatic fever
164
migratory joint pain, pancarditis, rash on trunk and limbs, chorea
acute rheumatic fever
165
Aschoff bodies (disease and location)
Acute rheumatic fever - myocardium
166
Anitschkow cells (morphology and disease)
Caterpillar - Acute rheumatic fever
167
"Fish mouth" valve - which one and disease
mitral valve most common - Chronic Rheumatic fever
168
Fusion of commissures of aortic valve
Chronic Rheumatic fever
169
Systolic ejection click and crescendo-decrescendo murmur
aortic stenosis
170
LV hypertrophy, syncope with exercise, hemolytic anemia - disease and most common cause
aortic stenosis - "wear and tear"
171
water-hammer pulse, Quincke pulse, increased pulse pressure, eccentric hypertrophy, LV dilation
Aortic regurgitation (pulse pressure: difference between systolic and diastolic - diastolic dec due to regurg and systolic inc due to inc. stroke vol)
172
Marfan syndrome, Ehlers Danlos, myxoid degeneration, mid-systolic click
mitral valve prolapse
173
c-ANCA, granulomas with giant cells, sinusitis, hematuria
Wegener's granulomatosis
174
Left flank pain, pulsatile mass in abdomen (disease, where, complication)
Triple A - below renal a's, above bifurcation - hemiparesis
175
"tree bark" (disease, location, common finding)
Syphilitic aortic aneurysm (treponema pallidum) - ascending aorta - cor bovinum (LV hypertrophy)
176
"tearing" anterior chest pain, radiates down back (disease, common pts, associations, complication)
Aortic dissection - Marfan's, males with hypertension, pregnancy, berry aneurysm - NOT atherosclerosis - rupture into body cavity, if rupture back through intima -> double barreled
177
Smoker with polycystic kidney disease, terrible headache with diplopia (disease, common location, late sequelae)
Berry aneurysm - circle of willis (ICA or anterior communicating) - noncommunicating hydrocephalus
178
wavy fibers
6-24 hours post MI
179
granulation tissue and fibrosis post MI (time frame and type of tissue)
Granulation: 7-10 days (red border) type III collagen
Fibrosis: months - type I collagen
180
small friable masses, what lab tests?
ASO titres for acute rheumatic fever
181
thickening of chordae tendenae
Chronic Rheumatic fever
182
female in 20s, mid systolic click and murmur, polycystic kidney disease, asymptomatic (disease and outcome)
Myxomatous degen of mitral valve - sudden cardiac death
183
large friable masses on mitral valve, high grade fever (disease and other signs)
acute bacterial endocarditis with strep veridans - Roth spots in retina, osler nodes, janeway lesions, splinter hemorrhages
184
patchy necrosis, inc CK-MB, arrythmia, diarrhea, friction rub, myocytes retain nuclei (disease, histo findings, and bugs (3) )
viral myocarditis, basophilic infiltrates (lymphocytes NOT PMNs), Coxsakie B, enterovirus, trypanosoma cruzi
185
mutations in sarcomere proteins (name and part of cardiac cycle affected)
Hypertrophic cardiomyopathy - diastolic
186
Assoc with Chaga's, eclampsia, alcohol, cocaine (name, part of cardiac cycle affected, complication)
Dilated cardiomyopathy - systolic - decreased ejection fraction and beri beri
187
amyloid, hemochromatosis, Loeffler's (disease and part of cardiac cycle affected)
restrictive cardiomyopathy - diastolic
188
anterosuperior displacement of the infundibular septum
Tetrology of fallot
189
tet spell, squatting
tetrology of fallot
190
patent foramen ovale
Atrial septal defect (ASD)
191
triple bypass - arteries bypassed
LAD, R. coronary, left circumflex
192
scalloped internal elastic lamina
muscular artery
193
muscular arteries esp. renal and ulnar Dystrophic calcification of tunica media
Does not occlude the lumen
Medial calcific sclerosis a.k.a. Mockenberg sclerosis
194
atheromas in intima - name of pathology, vessels affected
atherosclerosis - major vessels
195
fatty streaks - age first seen, leads to what, in what vessels?
10
atherosclerosis
large vessels
196
thickening of arterioles: what compound, name of disease, primary cause, and major complication?
hyaline
hyaline arteriosclerosis
diabetes mellitus
chronic renal failure, glomerular scarring
197
onion skinning: disease and major cause
```
Hyperplastic Arteriosclerosis
malignant hypertension (210/120)
```
198
granulomatous inflammation, female over 50, jaw claudication, facial pain, polymyalgia rheumatica. What size vessel, risk of what without treatment, describe lesions.
large vessels: carotid
risk of blindness (ophthalmic a. involvement)
segmental lesions, must take long segment
(Temporal (giant cell) arteritis
199
young asian female, granulomatous inflammation, visual symptoms, retinal hemorrhage, hemiparesis. Give most common finding.
Weak/absent pulse in upper extremity
"pulseless disease"
Takayasu Arteritis
200
young adults, hypertension, abdominal pain with melena, neurologic problems, skin lesions, "string of pearls" appearance on imagine. What is found in serum? what sized vessel and where? what system is spared?
HBsAg (Hep B)
medium sized vessel - branch points
LUNG
Polyarteritis Nodosa (PAN)
201
Asian child < 4, fever, conjunctivitis, rash on palms and soles, enlarged cervical lymph nodes, kid has MI. How to treat, why is this strange?
IVIG and ASPIRIN (opposite of treatment for viral infection which it mimics. Treating viral infeciton with aspirin in kids leads to Reye's)
202
raynaud phenomenon, fingers and toes of ulceration and gangrene, instep claudication. What is the leading cause of this disease? What size vessel?
heavy smoking
medium
(Buerger)
203
middle aged male with sinusitis, hemoptysis, and hematuria. What is found in serum and on histo?
c-ANCA
nectrotizing granulomas
Wegener granulomatosis (we-C-ener)
204
necrotizing inflammation in lung and kidney. What is found in serum? What is absent?
p-ANCA
granulomas
Microscopic Polyangiitis
205
eosinophils, lungs and heart affected, asthma, granulomas. What is in serum?
p-ANCA
| Churg-Strauss
206
child presents with palpable purpura on butt and legs, GI pain and bleeding. What is the cause and the initial trigger?
IgA immune complex deposition
| occus after upper respiratory tract infection
207
What is considered HTN?
140/90
208
how does ATII act and what does it do?
raises BP
contracts arteriole s. muscle (inc vasc peripheral resistance)
promotes adrenal release of aldosterone (salt resorption)
209
young female presents with HTN and unilateral renal atrophy, most common cause?
Fibromuscular dysplasia: irregular thickening of large/med arteries, esp renal
210
what is malignant HTN?
210/120
211
Common risk factors for atherosclerosis. modifiable and nonmodifiable
Modifiable: HTN, hypercholesterolemia, smoking, diabetes
Nonmodifiable: older age, males and postmenopausal females, genetics
212
pink hyaline deposition in arterioles. 2 causes and what it can lead to
benign HTN and diabetes
| chronic renal failure
213
woman comes in for mammography you find lots of thin, wirey opacities, should you be concerned?
no, Monckeberg medial calcific sclerosis, nonobstructive calcification of medium arteries
214
pt. with chronic hypertension presents with tearing chest pain that radiates to the back, name the pathological appearance of the affected vessel and most common cause of death
hyaline atherosclerosis of vasa vasorum
| cardiac tamponade
215
man dies from aneurysm, autopsy shows "tree-bark" appearance of aorta. Major complication and major association
dilation of aortic valve root -> aortic regurg
| tertiary syphilis
216
male smoker over 60 presents with flank pain, hypotension, and pulsatile mass in abdomen. Rupture is common at what size and name common complication
>5cm
| compression of local structures like ureter
217
someone who has worked with polyvinyl chloride for many years shows proliferation of endothelial cells. name 3 common sites. should you be concerned?
skin, breast, liver
| yes, highly aggressive malignancy
218
older eastern european male presents with purple patches and nodules on his skin. they are non-blanching. This condition is associated with what disease?
HHV-8
219
endothelial stimulation vs. endothelial activation
stimulation: rapid, reversible
activation: altered gene expression, protein synthesis, no NO production, loss of anti-coag properties
220
lipoprotein (a) what is it, what does it do?
altered LDL -> atherogenic
221
statins 2 fold mechanism
inhibits cholesterol syn
| reduces CRP
222
toll like receptors TLRs: what do they do generally?
increase inflammation
223
4 features of vulnerable plaque
Large core
thin cap
inflammation/foam cells in cap
matrix metalloproteases
224
extravascular hematoma that communicates with intravascular space
false/pseudoaneurysm
225
2 genetic diseases leading to medial weakening of blood vessels
marfan's
| polycystic kidney disease
226
fibrillin-1 gene, disease and chromosome
marfans
| 15
227
unhappy asian kid, rash palms and soles of feet, pathogenesis?
autoantibodies against endothelium
228
instep claudication, microabcesses
Buerger's
229
normal heart weights:
male: 300g
female: 250g
230
most blood flow to myocardium through coronaries is during what phase of heart cycle?
diastole
231
elevation of what biomarker indicates higher risk of death from heart failure?
BNP - brain natriuretic protein
232
male, <65, alcoholic, Q waves, cardiomegaly indicate heart failure of what cycle?
systolic
233
>70, female, HTN, LVH indicate heart failure of what cycle?
diastolic
234
q waves indicate what?
prior MI
235
alveolar hemosiderosis indicates what?
left heart failure "heart failure cells"
236
what % is considered critical stenosis in coronaries
75%
237
is sudden cardiac death due to complete or incomplete obstruction of coronaries?
incomplete due to arrhythmias
238
what do endothelins do?
vasoconstriction
239
angina that occurs at rest with ST segement elevation is caused by what?
Prinzmetal
| coronary artery spasm
240
angina that occurs with physical activity is due to?
stable agina
| fixed stenosis
241
angina that progressively increases in frequency is caused by what?
unstable angina
| disruption of plaque, superimposed thrombosis
242
major cause of MI?
rupture of plaque with thrombosis
| NOT STENOSIS!! 85% of pts have less than 70% stenosis
243
is the prognosis of MI patient better for a healthy athlete who has an MI after exercising, or an obese man who has an MI watching a football game on his couch?
better for obese man, less metabolic demand for O2 if MI occurs at rest, longer time for ischemia to develop
244
wavefront phenomenon, what is it and significance
progression of myocardial necrosis from subendocardial to transmural seems to occur in waves spreading to larger area
sig: to mature to transmural infarct takes 3-6 hours, can save lots of heart wall if dealt with soon enough
245
which direction does heart scarring occur?
outside to inside
246
what kind of necrosis in MI?
coagultion - all blood vessels
247
time frame of troponin release following MI. Detectable, peak, lasts how long?
seen at 2-4 hours
peak at 48 hours
lasts 7-10 days
248
time frame of CK-MB release following MI. Detectable, peak, lasts how long?
seen at 2-4 hours
peaks at 24 hours
gone by 72 hours (3 days)
249
is heparin sufficient treatment post MI?
no, it is not thrombolytic, need to give something to break down clot (streptokinase)
250
which plaque responds best to balloon angioplasty and why? eccentric or concentric?
eccentric: more prone to break and rupture at 1 place, less likely to hemorrhage
251
explain negative remodeling
after angioplasty, media and adventitia get stretched -> fibrosis, scar contracts, narrows lumen
252
why is internal mammary (thoracic) artery good for bypass?
atherosclerosis is rare
| own vasovasorum and lymph drainage
253
most common cause of sudden cardiac death and how soon does death occur after onset of symptoms?
1 hr
| ischemic heart disease (obstructive disease leading to diffuse myocardial dysfunction)
254
what causes death in sudden cardiac death? SCD
cause: lethal arrhythmia from 80-90% critical stenosis of one or more coronaries
255
does stress /sex increase risk of SCD?
no, even coupled with coronary artery disease
256
state 1A of arrhythmia, timing and what happens
2-10 min post occlusion
| altered extracellular K+ -> cells re-exciting prematurely
257
state 1B of arrhythmia, timing and what happens
18-30 min
depression of excitability of epicardial cells, electrical signals at border of ischemic zone leads to unequal stretching
258
"box-car" shaped nuclei (rectangular) are found in what pathology?
ventricular hypertrophy in cardiomyocytes
259
most common cause of cor pulmonale?
COPD
260
what causes acute cor pulmonale? findings of RV?
pulmonary embolism
| RV is dilated but not hypertrophic
261
marathon runner drops dead suddenly, what does his hear look like? what part of cycle involved?
hypertrophic cardiomyopathy
| diastolic
262
myofiber disarray, abnormally branching myocytes, interstitial fibrosis, small vessel disease myocyte diameter is 45
hypertrophic cardiomyopathy
263
alcohol and viral myocarditis can lead to what cardiomyopathy?
dilated
264
find apple green birefringence in cardiomyocytes, this can lead to what cardiomyopathy? what heart cycle is affected?
restrictive (amyloid)
| systolic
265
hyperkeratosis of palms and soles, triangle of dysplasia, young adults, fibrofatty replacement of cardiac tissue with thinning. defect in what?
desmosomal adhesion proteins
affects RV
arrhythmogenic right ventrciular cardiomyopathy ARVC
266
karate kid drops dead after being hit in chest, name of disease, and what part of heart cycle was affected
commotio cordis
| T wave upstroke
267
right sided, plaque like fibrosis
carcinoid disease
268
which type of valve requires anticoagulation therapy?
mechanical
269
subacute endocarditis has what kind of prognosis? what organism? what kind of valve does it affect?
good
strep viridans
native valve
270
HACEK organisms causing endocarditis are common in what age group?
infants and immunocompromised children
271
bulky friable vegetations and ring abcesses in perivalvular myocardium common on what valve from what cause?
tricuspid, IV drug abuse
272
splinter hemorrhages, roth spots indicate what?
peripheral emboli from infective endocarditis
273
growths of fibrin and delicate layers of aggregated platelets on ventricular side of mitral valve. what type of endocarditis, what disease, and what are they made of?
Libman-Sacks endocarditis (noninfective)
SLE - lupus
LSE -> SLE
immune complexes
274
viral myocarditis can lead to what kind of acquired response?
cytotoxic T cell autoimmune
275
epicardial rosary lesions from what organism? disease? heart consequence?
trypanosoma cruzi
chagas
dilation
276
young healthy woman been hiking for 2 weeks, presents with bundle branch block. bug? disease?
```
borrelia burgdorferi (rickettsia)
lyme carditis
```
277
asteroid bodies, thymoma
giant cell myocarditis
278
most common congenital heart disease in kids?
VSDs (42%)
279
coarctation of aorta has higher risk in patients with that genetic abnormality?
turner syndrome
280
most common congenital abnormality in adults
ASD
281
down's is assoc most commonly with what congenital heart abnormality?
VSD
282
explain eisenmenger complex
left to right shunt eventually causes pulmonary HTN from pulmonary vessel hypertrophy, increased pressure in RV reverses shunt to R to L -> cyanosis
283
swiss cheese muscular heart
VSD
284
what keeps PDA open?
prostaglandin E
285
what closes PDA?
indomethacin
286
aorta receives blood from both ventricles
truncus arteriosus
287
baby is born pink, but turns blue in 15 hours when ductus closes, why?
pulmonary valve atresia, no connection between RV and lungs
288
hypoplasia of left ventricle and aorta
aortic valve atresia, no outflow from LV
289
hypoplasia of aortic arch and LV hypertrophy
congenital aortic stenosis
290
baby born blue, most common cause?
Tetralogy of fallot
291
most common primary cardiac tumor, how do you find it?
cardiac myxoma
| calcify and see on x-ray
292
pedunculated mass in left atrium
cardiac myxoma
293
most common systemic disorder associated with pericarditis
uremia
294
blood between layers of tunica media, no dilation
aortic dissection
295
mediastinal widening
aortic dissection
296
african woman, worst head ache of life, diplopia, common place and late sequelae
circle of willis
| noncommunicating hydrocephalus from scarring of meninges
