Cardio Path Flashcards
Right to left shunts
Tetrology of Falot Transposition of great vessels Persistent Truncus arteriosus Tricuspid atresia Total Anomalous pulmonary venous return (TAPVR)
Left to right shunts
VSD > ASD > PDA
Close PDA
Indomethacin
Eisenmenger’s Syndrome
uncorrected ASD, VSD, PDA causes shunt reversal due to PHTN
L to R –> R to L
Causes clubbing, cyanosis, polycythemia
Tetrology of Falot
PROVe
Pulmonary stenosis
RVH
Over-riding Aorta
VSD
why do tetrology of falot pts. squat?
Increase TPR –> decreases shunt so that blood goes to lungs and is oxygenated
combats cyanosis
D-Transposition of the great vessels
Failure of aorticopulmonary septum to spiral
Aorta attached to RV
Pulmonary a attached to LV
Must have shunt to be compatible with life
Coarctation of aorta associated with
Turner Syndrome–infantile
Bicuspid Aortic Valve–Adult
Infantile coarctation of aorta
stenosis proximal to insertion of ductus arteriosus
Adult coarctation of aorta
Stenosis distal to insertion of ductus arteriosus
Rib notching–collateral circulation of vertebral aa.
HTN in UE
Weak pulses in LE
Why is PDA kept open?
Low O2 tension
PGE synthesis
PDA Heart sound
machine like murmur
Rx’s for open/close PDA
Open–PGE
Close–Indomethacin
22q11 mutation associated with
Truncus arteriosus
Tet of fallot
Down syndrome associated with
ASD
VSD
AV septal defect (endocardil cushion)
Turner Syndrome associated with
Coarctation–preductal
Marfan Syndrome associated with
Aortic insufficiency and dissection
Infant of diabetic Mom
Transposition of great vessels
HTN
> 140/90
Malignant HTN
> 180/120
∆ in pressure is what mediates the damage
Xanthelasma
Lipid laden macrophages deposited in skin of eylids
sign of hyperlipidemia
Arcus Senilis
Lipid deposition in cornea
Tendinous Xanthoma
Lipid deposition in tendons–achilles #1
Monckeberg arteriosclerosis
Calcifications in the media of aa.
radial and ulnar especially
DOE NOT obstruct flow
Thickening of small arteries due to essential HTN or DM
Hyaline Arteriolosclerosis
Onion skinning of arteries due to malignant HTN
Hyperplastic arteriolosclerosis
Fibrous plaques and atheromas in INTIMA of large/medium arteries
Atherosclerosis
narrows lumen
Mediators of Smooth mm. migration in atherosclerosis
PDGF
FGF
Atherosclerosis most common locations
bifurcations
- Abdominal Aorta
- coronary aa.
- popliteal aa.
- carotid aa.
Hypertensive Marfan with a history of sexual promiscuity and multiple syphilis infections COD
Thoracic Aortic Aneurysm
Longitudinal intramural tear forming a false lumen of aorta
Aortic Dissection
Aortic Dissection presentation
Tearing feeling radiating to back
mediastinal widening on CT
Pericardial tamponade, aortic rupture, death
Atherosclerosis
ST depression on EKG
retrosternal pain with exertion
Stable angina
CP at rest ST elevation (Not MI)
Prynzmetal angina
coronary vasospasm
Thrombosis with incomplete coronary artery stenosis
ST depression
Worsening CP with minimal exertion
Unstable/crescendo angina
Basically an MI that hasn’t infarcted
Coronary Steal Syndrome
vasodilator aggrevates ischemia by taking blood flow from stenosis to an area of higher profusion
Pressure gradient
Sudden Cardiac Death
Death from Cardiac causes w/in 1 hour of onset
lethal arrhythmia–most common
Chronic Ischemic Heart disease
progressive onset of CHF due to chronic ischemic myocardial damage
MI ∆’s 4-12 hrs
Early Coag necrosis
edema
hemorrhage
wavy fibers
Risk of Arrhythmia
MI ∆ 12-24 hrs.
Contraction bands
release of necrotic contents into blood
Neutrophils start to invade
Arrhythmia risk
MI ∆ 1-3 days
Neutrophils
extensive coag necrosis
acute inflammation
risk of fibrinous pericarditis
MI ∆ 3-14 Days
Macrophages
granulation tissue at margins (red border)
Risk of free wall rupture
2+ weeks post MI ∆’s
gray/white gross appearance
Contracted scar complete
risk of Dressler’s Syndrome
Dx reinfaction
CK-MB
returns to normal in 48 hrs. where trops stay up for 7-10 days
MI with lots of necrosis
entire wall effected
ST elevation
Transmural
MI with < 50% ischemic necrosis of ventricle wall
ST depression of EKG
Subendocardial infarct