Cardiology- Pathology Flashcards
1
Q
Describe persistent truncus arteriosus
A
Failure of truncus arteriosus to divide into pulm trunk and aorta; R to L shunt
2
Q
Describe transposition of great vessels
A
Aorta leaves RV, pulm trunk leaves LV; separation of pulm and systemic circulation
3
Q
What is the cause of transposition of great vessels
A
Failure of aorticopulmonary septum to spiral
4
Q
Describe tricuspid atresia
A
abscence of tricuspid valve and hypoplastic RV
5
Q
What two defects are required for viability of tricuspid atresia
A
ASD and VSD
6
Q
What is the underlying defect of tetralogy of fallot
A
Displacement of infundibular septum
7
Q
What are 4 defects associated with tetralogy of fallot
A
- pulmonary infundibular stenosis
- RVH (boot-shaped heart)
- overriding aorta
- VSD
8
Q
A boot-shaped heart on CXR is assoc with what congenital heart defect
A
RVH, tetraology of fallot
9
Q
Describe Total anomalous pulmonary venous return (TAPVR)
A
Pulmonary veins drain into R heart circulation; R to L shunt
10
Q
What is the most common congenital heart defect
A
VSD
11
Q
What congenital heart defect is associated with maternal diabetes?
A
Transposition of great vessels
12
Q
What congenital heart defect is associated with fetal alcohol syndrome?
A
VSD
13
Q
What septum is usually defective in an ASD?
A
Septum secundum
14
Q
What cardiac defect is associated with congenital rubella?
A
PDA, septal defects, pulm artery stenosis
15
Q
If uncorrected, can result in late cyanosis of the lower extremities
A
PDA
16
Q
What causes Eisenmenger syndrome
A
Uncorrected L to R shunt
Pulm HTN
RVH
R to L shunt
17
Q
Presents as late cyanosis, clubbing, polycythemia
A
eisenmenger syndrome
18
Q
What aspect of the defect distinguishes infantile from adult type coarctation of the aorta
A
Infantile: proximal to ductus arteriosus
Adult: distal to ligamentum arteriosus
19
Q
Infantile coarctation is associated with what chromosomal abnormality?
A
Turner syndrome
20
Q
Presents with notching of the ribs, hypertension of the upper extremities, weak, delayed pulses of lower extremities
A
Coarctation of the aorta
21
Q
Cardiac defects associated with 22q11 syndromes
A
truncus arteriosus, ToF
22
Q
Cardiac defects associated with Down syndrome
A
ASD, VSD, AV septal defect (every kind of septal defect!)
23
Q
What is corneal arcus
A
lipid deposits in the cornea
24
Q
What are xanthomas
A
plaques of lipd-laden histiocytes
25
What is fibromuscular dysplasia? What is systemic consequence?
Dysplasia of renal arteries; common cause of hypotension in young adults
26
What is severe hypertension
>180/120
27
What is Monckeberg arteriosclerosis
calcification of the media of arteries; usually radial or ulnar
28
What are the 2 causes of hyaline arteriosclerosis? Describe finding
essential hypertension and DM
| thickening of small arteries
29
What is the cause of hyperplastic arteriosclerosis? What is the histologic finding?
Severe hypertension
| "onion skinning"
30
Atherosclerosis vs arteriosclerosis
Arteriosclerosis: small blood vessels, hardening of arteriolar wall; thickening of wall
atherosclerosis: elastic arteries, large and medium-sized muscular arteries; deposits
31
What are the four most common arteries involved in atherosclerosis
Abdominal aorta
coronary artery
popliteal artery
carotid artery
32
What is the most common cause of abdominal aortic aneurysm?
Atherosclerosis (hypertensive male smoker)
33
What are the common causes of thoracic aortic aneurysms (3)?
Cystic medial degeneration due to hypertension
Marfan syndrome
Tertiary syphilis (obliterative endarteritis of vasa vasorum)
34
Presents with tearing chest pain of sudden onset, radiating to the back; may have unequal BP in arms
Aortic dissection
35
What are the worst complications of Aortic dissection
pericardial tamponade, aortic rupture
36
What ECG findings are indicative of stable angina
ST depression
37
How much occlusion is necessary for symptoms?
70%
38
What is Prinzmetal angina?
Episodes of chest pain associated with coronary artery spasm; assoc with tobacco, cocaine, triptans
39
What are ECG findings with Prinzmetal angina
transient ST elevation
40
What is Unstable/crescendo angina?
Angina increasing in frequency or at rest; thrombosis with incomplete occlusion
41
ECG findings for unstable angina
ST depression
42
Coronary steal syndrome
vessels are maximally dilated at baseline distally to the coronary stenosis
Vasodilators dilates only normal vessels and shunts blood to wellperfused areas
43
Most common cause of sudden cardiac death
lethal arrythmia
44
ECG findings after MI
Transmural: ST elevation
Subendocardial: ST depression
45
3 most commonly occluded coronary arteries
LAD>RCA>circumflex
46
Dressler syndrome
autoimmune phenomenon; fibrinous pericarditis several weeks post-MI
47
What time point post MI do you see gross findings of dark mottling, pale with tetrazolium staining?
4-12h
48
What time point post MI do you see gross findings of hyperemia?
1-3d
49
What time point post MI do you see gross findings of a hyperemic border with central yellow-brown softening?
3-14d
50
What time point post MI do you see gross findings of gray-white tisseu with recanalized artery?
>2 weeks
51
What causes contraction bands and what time are they seen?
12-24h post MI
| from reperfusion injury (Ca2+ back)
52
```
Describe the immune cell/ Healing process for an MI
Hours
Days
Weeks
A month
```
Hours- Coagulative necrosis
Days- Neutrophils then macrophages
Weeks- granulation tissue
A month- scar tissue
53
At what time point post MI is the heart susceptible to wall rupture and aneurysm?
3-14 d (macrophages eat up dieing tissue)
54
What markers are used to diagnose MI and what timepoints are the elevated?
Troponin I: 4hr to 7-10 days
CK-MB: returns to normal in 48h
good for diagnosing reinfarct
55
What leads are changed for an MI of the anterior wall?
V1-V4 (LAD)
56
What leads are changed for an MI of the lateral wall?
I, aVL (LCX)
57
What leads are changed for an MI of the inferior wall?
II, III, aVF (RCA)
58
Which types of cardiomyopathy (3) cause systolic vs diastolic dysfunction?
Cystolic: Dilated
Diastolic: Hypertrophic, restrictive
59
What are the auscultatory findings for dilated vs hypertrophic cardiomyopathy
Dilated: S3
Hypertrophic: S4, systolic murmur
60
What type of cardiac defect is a common cause of sudden death in young althletes?
Hypertrophic Cardiomyopathy
61
What is the defect and inheritance of hypertrophic cardiomyopathy?
b-myosin heavy chain
| autosomal dominant
62
What is Loffler syndrome?
at type of restrictive/infiltrative cardiomyopathy
| endomyocrdial fibrosis with prominent eosinophilic infiltrate
63
What is the presentation/ECG finding of restrictive cardiomyopathy?
CHF, low-voltage ECG
64
Describe the gross and molecular findings of hypertrophic cardiomyopathy?
Gross: concentric hypertrophy of ventricles
Microscopic: myofibrillar disarray and fibrosis
65
What type of hypertrophy is seen in dilated cardiomyopathy?
Eccentric hypertrophy (sarcomeres added in series)`
66
What infectious etiologies are causes of dilated cardiomyopathy?
Coxsackie B virus myocarditis
| Chagas disease
67
Compare EF, contractility and compliance in systolic vs diastolic dysfunction
Systolic: Low EF and contractility
Diastolic: normal EF and contractility; decr compliance
68
What are hemosiderin-laden macrophages a sign of?
Pulmonary edema, LH failure
69
What are signs of Left heart failure (3)
Pulmonary edema
orthopnea
paroxysmal nocturnal dyspnea
70
What are signs of right heart failure (3)
Hepatomegaly (nutmeg liver)
Peripheral edema
JVD
71
What 4 treatments decrease mortality in CHF?
ACE inh, bblock, ang II R block, spironolactone
72
What do Roth spots, Osler nodes, and Janeway lesions indicate and describe each?
Bacterial endocarditis
Roth spots: round white spots on retina, surrounded by hemorrhage
Osler nodes: tender raised lesions on finger or toe pads
Janeway: small, painless, erythematous lesions on palm or sole
73
What is the main causative organism of acute endocarditis
S. aureus
74
What is the main causative organism of subacute endocarditis
viridans streptococci
75
What is the most common causative organism seen with prosthetic valves?
S. epidermidis
76
What type of endocarditis indicates colon cancer
S. bovis
77
What type of hypersensitivity is associated with rheumatic fever and what is causative antigen?
Type II hypersensitivity
| M protein
78
What organisms are associated with culture negative endocarditis?
Coxiella burnetti, Bartonella sp
79
What are the causes of fibrinous pericarditis? (3)
Dressler syndrome (post MI)
uremia
radiation
80
What causes serous pericarditis?
viral pericarditis
81
What causes suppurative pericaraditis?
bacterial infxn
82
What is associated with ECG changes of widespread ST-segment elevation and/or PR depression?
pericarditis
83
What is pulsus paradoxus?
Decr amplitude of systolic BP by >10mmHg during inspiration
84
What is Kussmaul sign?
Incr JVP on inspiration; indicative of limited RV filling
85
What valves are affected by Rheumatic fever?
mitral>aortic>>tricuspid
86
What are Aschoff bodies and Anitschkow cells associated with?
Rheumatic fever
87
What is Beck's triad? What disease does it indicate?
Hypotension
Distended neck veins
Distant heart sounds
88
What is associated with ECG findings of low-voltage QRS and electrical alterans
Cardiac tamponade
89
Where do myxomas commonly occur?
atria
90
What cardiac defect is associated with tuberous sclerosis?
Rhabdomyomas
91
Compare Raynaud disease vs Raynaud syndrome
Disease: primary, idiopathic
Syndrome: secondary to a disease process, eg SLE, CREST
92
What ages are strawberry vs cherry hemangiomas seen?
Strawberry: children, regress by 5-8y
Cherry: elderly, does not regress
93
What chromosomal abnormality is cystic hygroma associated with?
Turner syndrome (cavernous lymphangioma of the skin)
94
What populatio are bacillary angiomatoses seen in and what is the causative organism?
AIDS
| Bartonella henselae
95
What cells do glomus tumors arise from?
| Where are they located?
smooth muscle cells of the glomus body
| underneath fingernails
96
What malignancy is associated with persistent lymphedema (eg post-radical mastectomy)?
Lymphangiosarcoma
97
What organ other than the skin can one find hemangiomas and angiosarcomas?
Liver
98
How does one distinguish a purpura from a hemangioma?
Hemangioma blanches on compression
99
What systems other than the skin are Kaposi sarcoma associated with?
GI tract, respiratory tract
100
What blood vessels does temporal arteritis most commonly effect?
Branches of he carotid artery (temporal, ophthalmic)
101
What disease presents with unilateral headache and jaw claudication?
Temporal arteritis
102
What population is most commonly affected by Takayasu arteritis
Asian females, <40
103
What disease presents with weak upper extremity pulses, fever, night sweats, arthritis, myalgias, skin nodues, and ocular disturbances?
Takayasu arteritis
104
What are the histologic/ gross findings of Takayasu arteritis?
Granulomatous thinckening and narrowing of the aortic arch
105
What population typically gets polyarteritis nodosa (age and exposure)
Young adults, Hep B+
106
What vessels are most commonly involved in polyarteritis nodosa? What is usually spared?
Involved: renal (HTN), visceral
Spared: lung
muscular arteries
107
What is the immune mechanims of polyartertitis nodosa?
Immune complex mediated
108
What population is Kawasaki disease seen in?
Asian children < 4 years old
109
What vascular disease is associated with fever, cervical lymphadenitis, conjuctival injectin, strawberry tongue, and hand-foot erythema
Kawasaki disease
110
What is the most dangerous complication of Kawaski disease?
coronary artery aneurysm and thrombosis (MI, rupture)
111
What population is Buerger disease associated with?
Heavy smoker males <40y
112
Describe buerger disease
necrotizing vasculitis of the digits
113
What organs are typically involved in Graunlomatosis with polyangitis?
nasopharynx (perforation septum, sinusitis)
Lung (hemoptysis, dyspnea)
kidney (hematuria, RBC casts)
114
What presents with the triad of:
- focal necrotizing vasculitis
- necrotizing granuloma of the lung and upper airway
- necrotizing glomerulonephritis
Graunlomatosis with polyangitis
115
How is microscopic polyangitis distinguished from Graunlomatosis with polyangitis?
No nasopharyngeal involvement
| No granulomas
116
What presents with asthma, sinusitis, palpable purpura, peripheral neuropathy?
Churg-Strauss syndrome
117
What is the underlying immune cause of Henoch-schonlein purpura?
IgA complex deposition
118
What is usually the inciting event for Henoch-schonlein purpura?
URI
119
What presents with
Palpable purpura of bottocks/legs
arthralgias
adominal pain and melena
Henoch-schonlein purpura
