Cardio Pathology Flashcards
Name the tetralogy of falot
Due to displacement of infundibular septum. “PROVe”
Stenotic Pulmonary artery
Right ventricular hypertrophy “Boot shaped”
Overriding aorta
Ventricular septal defect
Patient is presenting with late cyanosis what is occuring?
Likely a left to right shunt.
Pt is presenting with cyanosis early on in childhood what issue is occuring?
Likely a right to left shunt in the heart.
Think of the following
1 truncus arteriosis (one trunk)
2 Transposition (2 switched vessels)
3 Tricuspid atresia (3 = tri)
4 Tetralogy of Fallot (4 = tetra)
5 TAPVR (5 letters in the name) Total anomalous pulmonary venous return (pulmonary veins draining into the inferior vena cava instead of the left atrium)
What is the most common congenital cardiac defect?
Ventricular septal defect. Will remain asymptomatic for most of life. May self resolve or lead to left ventrical hypertrophy.
Patient is presenting with a very loud S1 and a wide fixed split S2.
Atrial septal defect.
What is the normal heart shunting in fetal life?
Normally is a right to left shunt with the fetal umbilical vein bringing oxygenated blood into the body.
Describe Eisenemnger syndrome
This occurs if the left to right shunt is not corrected, the shunt will eventually become a right to left from compensation leading to late cyanosis, clubbing, and polycythemia.
Patient is presenting with hyertension in the upper extremities and a weak delayed pulse in the lower extremities. Pt shows notched rib appearance on X-ray.
coarcation of the aorta!!
The aorta is narrowing at the insertion of the ductus arteriosis.
What constitutes as hypertension?
Systolic >140
Diastolic > 90
What constitutes as a hypertensive emergency?
Systolic >180
Diastolic >120
With end organ damage.
When looking at the kidney if you see a string of beads appearance what should you be thinking?
Renal artery stenosis likely to cause excessive release of renin leading to secondary hypertension.
When looking at the cornea you notice a light blue ring encircling the iris.
This is corneal arcus and is a sign of hyperlipidemia.
What is Monckeberge arteriosclerosis?
Caciification of the internal elastic lamina and media of arteries leading to vascular stifening without obstruction.
Will have a “Pipestem” appearance on X-ray. Does not obstruct blood flow as the intima is not involved.
Foam cells and fatty streaks in the vasculature are signs of what disorder?
Atherosclerosis. Or cholesterol fat accumulation in the arteries.
Thoracic aortic aneurysm is classically related to which microorganism?
Third degree Syphillis.
Which portion of the aorta is a Sanford Type A aortic dissection relating to?
The ascending aorta. May extend to the aortic aorta or descending aorta.
Only treatment here is surgery,
What portion of the aorta is a Sanford Type B aortic dissection relating to?
This relates to the descending aorta and or aortic arch. It spares the ascending aorta.
Treat with beta blockers and then vasodilaters.
What is stable angina?
this is a type of chest pain that is exertional and goes away with rest.
What is variant (prinzmetal) angina?
This is an arterial spasm usually brought on by a trigger and presenting with ST elevation.
Chest pain with ST depression and NO cardiac markers is a sign of what?
Unstable angina.
NSTEMI will present with cadiac markers.
Is noted with increased chest pain at rest.
What determins if a myocardial infarction presents with an elevated ECG ST segment vs a depressed ST segment?
Elevated ST segments will be shown with transmural infarcts (STEMI).
Subendocardial will display ST depression (NSTEMI) Cardiac biomarkers are diagnostic here.
What type of necrosis is seen with myocardial infarctions?
Coaguable necrosis.
What is the most specific cardiac marker for MI?
Tropinin 1 elevated 4 hours afterwords and remaining elevated for 7-10 days.
Which cardiac markr is useful for diagnosing reinfarction as levels return to normal after 48 hours?
CK-MB
ECG localization of an inferior Right coronary arter ifnarction would be seen across which leads?
II, III , and aVF.
What is dresslers syndrome?
An autoimmune disorder resulting in fibrinous pericarditis. Can be seen several weeks following an MI,
Sudden death in young athletes?
Hypertrophic cardiomyopathy.
What is typically the cause of right sided heart failure?
It is usually secondary to left sided heart failure. Isolated right sided failure can be due to cor pulmone.
Presence of hemosiderin laden macrophages in the lungs.
These are also known as heart failure cells seen with pulmonary edema due to left sided heart failure.
When do you see nutmeg liver?
Hepatomegally most commonly seen with right sided heart failure. This is due to blood back up in the hepatic portal vein.
Jugular distension is most commonly seen in which type of heart faiure?
Right sided the blood gets backed up into the external jugular vein.
What is the most common cause of acute vs subacute bacterial endocarditis?
Acute is seen with S. aureus.
Subacute is seen with viridians
What is tricuspid valve endocarditis most commonly associated with?
IV drug abuse.
Most commonly the mitral valve is affected by endocarditis.
Rheumatic fever displays which type of hypersensitivity?
Type II immune related where antibodies directed to M protein of S pyogenes cross react with the tricuspid valve.
Treat wth penicillin.
An ECG showing low voltage QRS and electrocal alternans with Beck’s triad of hypotension, distended neck veins, and distant heart sounds should point you in which direction?
Cardiac tamponade.
Look for the pulsus paradoxis where the amplitude of systolic blood pressure drops more than 10 mmHg with inspiration.
“Tree Bark Aorta”
Tertiary syphilis leading the calcification of the aortic root.
Can lead to anyeurism, or aortic insuffiicency.
What is the most common primary cardiac tumor in adults?
A myxoma commonly described as a ball valve obstruction in the left atria.
rhabdomyomas is the most frequent cardiac tumor in children.
What is Kusmauls sign?
Increase in Jugular venous pressure on inspiration instead of the normal decrease.
Seen in constrictive pericarditis, or right atrial/ventricular tumors.
Bacillary angiomatosis is related to which microbe and what sets it apart from kaposi sarcoma?
Caused by Bartonella heneslae infections.
It is set apart by having a neutrophilic infiltrate.
Kaposis sarcoma has a lymphoctyic infiltrate.
What infiltrate is seen in kaposis sarcoma?
KS has a lymphocytic infiltrate.
What is tricuspid atresia?
Absence of the tricuspid valve and hypoplastic RV
Requires both ASD and VSD for viability.
What keeps the ductus arteriosis patent in utero?
It is kept open via prostaglandins.
If the child is born with a patent ductus arteriosis, it can be closed by use of an NSAID to block the prostaglandins such as endomethacin.
turners syndrome
Bicuspid aortic valve
Coarcation of the aorta
Ebstein anaomoly
Seen in infants that have been exposed to lithium
22q11 syndromes
truncus arteroisus
Tetralogy of fallot
Plaques or nodules filled with lipid-laden histiocytes in the skin
Xanthomas
Monkberg arteriosclerosis
Uncommon effecting the medium sized arteries
Calcification of internal elastic lamina of the arteries leading to vascular stiffening without obstruction.
Look for the pipestem appearance on X-ray.
This does not disrupt blood flow through the arteries.
Difference between arteriosclerosis and atherosclerosis
Arteriosclerosis is hardening of the arteries with arterial wall thickening and loss of elasticity. (Arterioslcerosis vs monckeberg)
Atherosclerosis is disease of teh elastic arteries and large-medium sized muscular arteries. Typically due to a build up of cholesterol plaques.
What is inmportant in the pathogenesis of atherosclerosis?
Inflammation leading to endothelial dysfunction and macrophages accumulating LDL becoming goam cells.
Fatty streaks are seen on the vascular walls and smooth muscle migrates to the walls to try and repair.
Sudden onset tearing chest pain radiating to the back with uneven BP in both arms.
Aortic dissection.
ST elevation with heart pain can be
MI
or
Prinzmetal angina.
Differentiate between the two with carciac markers in the blood.
difference between ST elevation and ST depression with cardiac markers.
Both mean there is an MI when cardiac markers are present.
(Stable angina can raist ST and unstable can depress but no markers)
ST elevation is with a transmural infarction.
ST depressions occur with a sub endocardial infarction.
What is dresslers syndrome?
2 weeks to several months after an MI Scar tissue forms causing a rubbing sound on auscultation.
It is driven by an autoimmune reaction
Give a general treatment to acute coronary syndrome
NSTEMI + Unstable angina
Anticoagulation (heparin)
Antiplatelet therapy (aspirin + Clopidogrel)
Which heart sound is related to a dilated cardiomyopathy?
S3
What type of hypertrophy is seen with dilated cardiomyopathy?
Eccentric lenghtening added in series
What heart sound is found in hypertrophic cardiomyopathy?
S4
Leads to sudden death in young athletes
hypertrophic cardiomyopathy
Highly genetic.
What is lofflers syndrome related to?
Restrictive cardiomyopathy.
Diastolic dysfunction ensues and ECG may display low voltage despite having a thick myocardium.
Roth spots on the retina, janeway lesions on the palm or sole, osler nodes on the finger or toe pads and splinter nail hemorages are all signs of what disorder?
All signs of bacterial endocarditis.
Sharp pain upon inspiration releived by sitting up and leading forward. Frictional rub and widespread ST segment elevations or depressions.
Sign of acute pericarditis.
Most commonly viral (Coxsackie) or SLE
Radiation therapy and rheumatoid arthritis or uremia can cause it as well.
Raynoud phenomenon color change
White
Blue
REd
Treat with calcium channel blockers.
