CARDIOLOGY- Pathology Flashcards
1
Q
Characteristics “Blue babies”
A
Right to left shunt, Early cyanosis
2
Q
When is often diagnose right to left shunt?
A
Prenatally or become evident immediatly after birth
3
Q
What is the treatment for right to left shunt?
A
Ussually require urgent surgical correction and/or maintenance of a Patent Ductus arterious
4
Q
Right to left shunt diseases
A
The 5Ts:
- Truncus arteriosus (1 vessel)
- Tansposition (2 swithced vessels)
- Tricuspid atresia (3= Tri)
- Tetralogy of Fallot (4=Tetra)
- TAPVR (5 letters)- Total Anomalous Pulmonary Venous Return
5
Q
What happens in Persistent truncus arteriosus?
A
Failure of truncus arteriosus to divide into pulmonary trunk and aorta
6
Q
What do most patients with persistent truncus arteriosus have?
A
Ventricular Septal Defect
7
Q
What is wrong in D transposition of great vessels
A
Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)
8
Q
What is the result of D transposition of great vessels?
A
Separation of systemic and pulmonary circulations
9
Q
This is the prognosis of D transposition of great vessels?
A
Not compatible with life unless a shunt is present to allow mixing of blood (eg VSD, PDA, or patent foramen ovale)
10
Q
Which is the reason of D transposition of great vessels?
A
Due to failure of the aorticopulmonary septum to spiral
11
Q
Without treatment how is the life expectancy for D transposition of great vessels?
A
Without surgical intervention, most infants die within the first few months of life
12
Q
Which problems are found in Tricuspid atresia?
A
Absence of tricuspid valve and hypoplastic RV
13
Q
What is required in Tricuspid atresia for viability?
A
Both Ventricular Septal Defect and Atrial Septal Defect
14
Q
What causes Tetalogy of Fallot?
A
By anterosuperior displacement of the infundibular septum
15
Q
Most common cause of early childhood cyanosis
A
Tetralogy of Fallot
16
Q
Characteristics of Tetralogy of Fallot
A
Pulmonary infundibular stenosis
Right Ventricular Hypertrophy
Overriding aorta
Ventricular Septal Defect
17
Q
What is most important determinant for prognosis in Tetralogy of Fallot?
A
Pulmonary infundibular stenosis
18
Q
In Tetrallogy of Fallot what causes right to left flow across Ventricular Septal defect?
A
Pulmonary stenosis
19
Q
Clinical manifestation of Pulmonary stenosis causing right to left flow across Ventricular Septal defect
A
Early cyanotic “tet spells,” Right Ventricular Hypertrophy
20
Q
What does Squatting manuever causes in patients with Tetrallogy of Fallot?
A
↑ systemic vascular resistance, ↓right to left shunt, improves cyanosis
21
Q
Treatment for Tetrallogy of Fallot
A
Early surgical correction
22
Q
What happens in Total Anomalous Pulmonary Venous Return?
A
Pulmonary veins drain into right heart circulation (SVC, coronary sinus)
23
Q
Which cardiac anomallies are associated to Total Anomalous Pulmonary Venous Return? which is the benefit?
A
Atrial Septal Defect, and sometimes Patent Ductus arteriosus
Allow for right to left shunting to maintain cardiac output
24
Q
Characteristics “blue kids”
A
Left to right shunt- Late cyanosis
25
Name all Left to right shunt diseases
Ventricular Septal Defect
Atrial Septal Defect
Patent Ductus arteriosus
26
In order, which are the most frequent causes of Left to right shunt diseases
Ventricular Septal Defect >Atrial Septal Defect >Patent Ductus arteriosus
27
Most common congenital cardiac defect
Ventricular Septal Defect
28
Which are the clinical manifestations of Ventricular Septal Defect?
Asymptomatic at birth, may manifest weeks later or remain asymptomatic thoughout life
29
Which is the prognosis of Ventricular Septal Defect?
Most self resolve
30
Which is the risk of Larger lessions of Ventricular Septal Defect?
May lead to LV overload and heart failure
31
During ausculation what is heard in Atrial Septal defect?
Loud S1: wide , fixed split S2
32
Where does Atrial Septal defect ussualy occurs?
In septum secundum
33
Which could be the symptoms of Atrial Septal defect?
Range from none to Heart Failure
34
This is the difference between Atrial Septal defect and Patent foramen ovale
Distinct form patent foramen ovale in that septa are missing tissue rather than unfused
35
In Fetal period which shunt is consider normal?
Right to left
36
What happens in neonatal period if there is a patent ductus arteriosus?
↓ Lung resistance → shunt becomes left to right → progressive Right Ventricular hyperthrophy and /or Left Ventricle Hypertrophy and heart failure
37
Which murmur is associated to Patent ductus arteriosus?
Machine like murmur
38
What maintains patency in patent ductus arteriosus?
PGE synthesis and low O2 tension
39
What could be the result of uncorrected Patent ductus arteriosus?
Can result in late cyanosis in the lower extremities (differential cyanosis)
40
Which drug helps in Patent ductus arteriosus?
Indomethacin
41
When is recommended to administer PGE to keep open a Patent ductus arteriosus?
May be necessary to sustain life in conditions such as transposition of great vessels
42
When is Patent Ductus consider normal? When does it close?
PDA is normal in utero and normally closes only after birth
43
What is Eisenmenger syndrome?
Uncorrected left to right shunt (VSD, ASD, PDA)
44
Which is the pathophysiology of Eisenmenger syndrome?
↑ Pulmonary blood flow → pathologic remodeling of vasculature → pulmonary arteriolar hypertension → Right ventricle Hypertrophy occurs to compensate → Shunt becomes rigth to left
45
What does Eisenmenger syndrome clinicaly causes?
Late cyanosis, clubbing and polycythemia
46
At what age does Eisenmenger syndrome onsets?
Varies
47
Which types of coarctation of the aorta exist?
Infantile type
| Adult type
48
In which associated situations is coarctation of the aorta seen?
Associated with bicuspid aortic valve, other heart defects
49
What is wrong in Coarctation of the Aorta infantile type?
Aorta narrowing is proximal to insertion of the ductus arteriosus (preductal)
50
Which pathology is associated to Coarctation of the Aorta?
Turner Syndrome
51
What happens in Coarctation of the aorta in adult type?
Aorta narrowing is distal to ligamentum arteriosum (postductal)
52
Coarctation of the aorta can be associated to these findings
Notching of the ribs (collateral circulation), hypertension in upper extremities, and weak, delayed pulses in lower extremities (radiofemoral delay)
53
Which genetic disorders and diseases have congenital cardiac defect associated?
```
22q11 syndrome
Down syndrome
Congenital Rubella
Turner Syndrome
Marfan Syndrome
Infant of Diabetic Mother
```
54
Which congenital cardiac defect might 22q11 syndrome have?
Truncus arteriosus, Tetralogy of Fallot
55
Down syndrome patients they could have these congenital cardiac defect
ASD, VSD, AV septal defect (endocardial cushion defect)
56
Congenital Rubella might present with these congenital cardiac defect
Septal defects, PDA, pulmonary artery stenosis
57
Which congenital cardiac defect are associated to Turner Syndrome?
Bicuspid aortic valve, coarctation of aorta (preductal)
58
Name congenital cardiac defect associated to Marfan syndrome
Mitral valve prolapse, thoracic aortic aneurysm and dissection, aortic regurgitation
59
Which congenital cardiac defect is associated to Infant of Diabetic mother?
Transposition of great vessels
60
What is hypertension?
Defined as a systolic BP > 140 and or diastolic BP > 90 mmHg
61
Name risk factors for Hypertension
↑ Age, obesity, diabetes, smoking, genetic, black> white> asian
62
Most common cause of Hypertension
Is 1º (essential)
63
What is related to Essential Hypertension?
Related to ↑ Cardiac Output or ↑Total Peripheric Resistance
64
Which is the cause of the remaining 10% of hypertension?
Mostly 2º to renal disease, including fibromuscular dysplasia in young patients
65
What is Hypertensive emergency?
Severe hypertension (> 180/120 mmHg) with evidence of acute, ongoing target organ damage (eg papilledema, mental status changes)
66
What does Hypertension predisposes?
```
Atherosclerosis
Left Ventricle Hypertrophy
Stroke
Cardiac Heart Failure
Renal Failure
Retinopathy
Aortic dissection
```
67
Which is a cause of hypertension in younger patients?
"String of beads" apperance of the renal artery in fibromuscular dysplasia
68
What is seen in Hypertensive nephrophaty?
Renal Arterial Hyalinosis
69
Hyperlipidemia Signs
Xanthomas
Tendinous Xanthoma
Corneal Arcus
70
What are Xanthomas?
Plaques or nodules composed of lipid laden histiocytes in the skin
71
What is Xanthelasma?
Xanthomas especially the eyelids
72
What are Tendinous xanthoma?
Lipid deposit in tendon
73
Which tendon is the most common to have Tendinous xanthoma?
Achilles
74
What is the corneal arcus?
Lipid deposit in cornea
75
If Corneal arcus appears early in life, you must suspect...
Hypercholesterolemia
76
Which patients is common to see Corneal Arcus?
In eldery (Arcus senilis)
77
Which are the types of Arteriosclerosis?
Monkeberg
| Arteriolosclerosis
78
Which is the common type of Arteriosclerosis?
Arteriolosclerosis
79
How else is Monkeberg Arteriosclerosis known?
Medial calcific sclerosis
80
What happens in Monkeberg Arteriosclerosis?
Calcification in the media of the arteries
81
Which arteries are more common affected in Monkeberg Arteriosclerosis?
Radial
| Ulnar
82
How are Monkeberg Arteriosclerosis classified?
Ussually benign
83
How are Monkeberg Arteriosclerosis visualized? What do you see?
Pipestem arteries on the x ray
84
Why is Monkeberg Arteriosclerosis benign?
Because intima is not involved
85
Which are the types of Arteriolosclerosis
Hyaline
| Hyperplastic
86
What could be seen in microscope with Hyaline Arteriolosclerosis?
Thickening of small arteries
87
Which diseases are associated to Hyaline Arteriolosclerosis?
Essential hypertension or Diabetes
88
Hyperplastic Arteriolosclerosis presents this characteristic in microscope
Onion Skinning
89
When is Hyperplastic Arteriolosclerosis seen?
Severe hypertension
90
What ha[[ems om Atherosclerosis?
Disease of Elastic Arteries and large and medium sized muscular arteries
91
How are the risk of Atherosclerosis classified?
Modifiable
| Non modifiable
92
Which are modifiable Atherosclerosis risk factors?
Smoking, hypertension, hyperlipidemia, diabetes
93
Non modifiable Risk factors of Atherosclerosis
Age, sex (Increased in men and postmenopausal women) and family history
94
What is important in the progression of Atherosclerosis in its pathogenesis?
Inflammation
95
Which is the progression of Atherosclerosis?
Endothelial cell dysfunction → macrophage and LDL accumulation → foam cell formation → fatty streaks → smooth muscle cell migration (involves PDGF ans FGF), proliferation , and extracellular matrix deposition → fibrous plaque → complex atheromas
96
Complications of Atherosclerosis
Aneurysms, ischemia, infarctsm peripheral vascular disease, thrombus, emboli
97
Frequent locations of Atherosclerosis
Abdominal Aorta > coronary artery > popliteal artery > carotid artery
98
Symptoms of Atherosclerosis
Angina, Claudication, but can be asymptomatic
99
What is an Aortic Aneurysm?
Localized pathologic dilation of the Aorta
100
When does a Aortic Aneurysm causes pain?
Sign of leaking, dissection or imminent rupture
101
Which factor is associated to Abdominal aortic aneurysm?
Atherosclerosis
102
With which patients is more frequently seen Abdominal Aortic aneurism?
Occurs more frequently in hypertensive male smokers > 50 years old
103
Which diseases are associated to Thoracic aortic aneurysm?
Asociated with cystic medial degeneration due to hypertension (older patients) and Marfan syndrome (younger patients)
104
Historically with which diseases is Thoracic aortic aneurysm associated?
With 3º syphilis (obliterative endarteritis of the vasa vasorum)
105
What is Aortic dissection?
Longitudinal intraluminal tear forming a false lumen
106
What is associated to Aortic dissection?
Hypertension, bicuspid aortic valve, and inherited connective tissue disorders (eg. Marfan, syndrome)
107
Which clinical manifestations does Aortic dissection has?
Tearing chest pain, of sudden onset, radiating to the back +/- markedly unequal BP in arms
108
Which study helps to see Aortic Dissection? What does it shows?
CXR shows mediastinal widening
109
Where is the false lumen found in Aortic dissection?
Can be limited to the ascending aorta, or propagate from the descending aorta
110
Which could be the complications of Aortic dissection?
Pericardial tamponade, aortic rupture and death
111
Possible Ischemic heart disease manifestations
```
Angina
Coronary steal syndrome
Myocardial infarction
Sudden cardiac death
Chronic ischemic heart disease
```
112
What is Angina?
Chest pain due to ischemic myocardium secondary to coronary artery narrowing or spasm; no myocyte necrosis
113
How is Angina classified?
Stable
Variant Angina
Unstable/crescendo
114
Which is the usual cause of Stable angina?
Usually secondary to atherosclerosis
115
How is stable angina manifested? How does it get better?
Exertional chest pain in classic distribution, resolving with rest
116
What is ussually seen in ECG in Stable angina?
Ussually with ST depression on ECG
117
How else is Varina angina known?
Prinzmetal
118
When does variant angina starts? why?
Occurs at rest secondary to coronary artery spasm
119
What is seen on the ECG in variant angina (Prinzmetal)?
Transient ST elevation on ECG
120
Which are the possible triggers of Prinzmetal angina?
Tobacco, cocainem triptans, but trigger is often unknown
121
Which is the treatment for Variant angina (Prinzmetal)?
With calcium channel blockers, nitrates and smoking cessation
122
Which is the cause of Unstable/ crescendo angina?
Thrombosis with incomplete coronary artery occlusion
123
What is seen in ECG in Unstable/ crescendo angina?
ST depression
124
Clinical presentation of Unstable/ crescendo angina
Increased in frequency or intensity of chest pain; any chest pain at rest
125
What happens in Coronary steal syndrome?
Distal to coronary stenosis, vessels are maximally dilated at baseline
126
What is the treatment for Coronary steal syndrome?
Administration of vasodilators
127
Name vasodilators use for Coronary steal syndrome
Dypiridamole
| Regadenoson
128
Which is the purpose to give Vasodilators in Coronary steal syndrome?
Dilates normal vessels and shunts blood toward well perfused areas → ↓ flow and ischemia in the poststenotic region
129
What helps to study Coronary steal syndrome?
Pharmacologic stress test because (Dilates normal vessels and shunts blood toward well perfused areas → ↓ flow and ischemia in the poststenotic region)
130
What happens during a myocardial infarction?
Most often acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary arteryand myocyte necrosis
131
Which are the possible findings in ECG in myocardial infarction?
If transmural, ECG will show ST elevations; if subendocardial, ECG may show ST depressions
132
What makes the diagnosis of myocardial infarction?
Cardiac biomarkers
133
When do we consider Sudden cardiac death?
Death from cardiac causes within 1 hour of onset of symptoms
134
Most common reason of Sudden cardiac death
Lethal arrhytmia (eg vantricular fibrilation)
135
Causes associated to Sudden cardiac death
CAD- coronary artery disease (up to 70% of cases)
Cariomyopathy (hypertrophic, dilated)
Heredtary ion channelopathies (eg Long QT syndrome)
136
What could be the result of Chronic ischemic heart disease?
Progressive onset of CHF over many years due to chronic ischemic myocardial damage
137
Which is the order of frequency of occluded coronary arteries?
LAD (left anterior descending) > RCA > circumflex
138
Symptoms of Myocardial infarction
Diaphoresis, nausea, vomiting,severe retrosternal pain, pain in the left arm and/ or jaw, shortness of breath, fatigue
139
Which are the gross and light microscopic changes in MI during the first 4 hours?
None
140
Compliations of MI during the first 4 hours
Arrythmia, HF, cardiogenic schock, death
141
During the first 24 hours these are gross changes in MI
Ocluded artery
Infarct
Dark mottling; pale with tetrazolium stain
142
Light microscope changes in MI during the 4- 12 hrs
Early Coagulative necrosis, release of necrotic cell contents into blood: edema, hemorrhage, wavy fibers
143
Which are the risk of MI during the first 24 hours?
Arrythmia, HF, cardiogenic schock, death
144
When do MI changes start?
From the 4th hour
145
What happens in MI during the 12-24 hours in light microscope?
Neutrophil migration starts
146
Which risk does reperfusion has during MI?
Reperfusion injury may cause contraction bands (due to free radical damage)
147
At this point of MI happens extensive coagulative necrosis
1-3 days
148
What else is found in ligth microscope during MI in day 1-3?
Tissue surrounding infarct shows acute inflamation with neutrophils
149
Possible complications of MI found in 1-3 days
Fibrinous pericarditis
150
Hyperemia is the gross finding seen during which day of MI?
1-3 days
151
What is seen in gross in days 3-14 in MI?
Hyperemic border; central yellow brown softening
152
When is commonly seen Maximal yellow and soft in MI?
By 10 days
153
Macrophages, then granulation tissue at margins are present during these days of MI
3-14 days
154
Possible Complications of MI during day 3-14
Free wall rupture → tamponade papillary muscle rupture → mitral regurgitation ; interventricular seotal rupture due to macrophage- mediated structural degradation
155
Which MI complication found in days 3-14 is consider "time bomb"?
LV pseudoaneurys (mural thrombus "plugs" hole in myocardium)
156
Gross findigs in MI after 2 weeks to several months
Recanalized artery
| Gray white myocardial zone
157
When do we expect to see Contracted scar completed in MI?
2 weeks to several months
158
Complication of MI during 2 weeks to several months
Dressler syndrome
HF
Arrythmias
True ventricular aneurysm (outward bulge during contraction, dyskinesia)
159
What is Dressler syndrome?
Is a type of pericarditis, inflammation of the sac surrounding the heart (pericardium)
Autoimmune phenomenom resulting in fibrinous pericarditis
160
Which is the gold standard of MI during the first 6 hours?
ECG
161
When does Cardiac Troponin I rises?
After 4 hours
162
How much time does Troponin I stays elevated durin MI?
7- 10 days
163
Which is the most specific protein marker during MI?
Cardiac Troponin I
164
Biomarker predominantly found un myocardium but can also be released fro skeletal muscle
CK-MB
165
Which is the use for CK-MB?
Diagnosing reinfarction following acute MI
166
Why is CK-MB usefull in Diagnosing reinfarction following acute MI?
Because levels return to normal after 48 hours
167
Which ECG changes could be seen in MI?
ST elevation
ST depression
Pathologic Q waves
168
MI that present ST elevation
ST segment elevation myocardial infarction
| Acute Transmural infarct
169
Which MI is presented with ST depression?
Subendocardial infarct
170
When do we find Pathologic Q waves?
Evolving or old transmural infarct
171
Types of infarcts
Transmural infarcts
| Subendocardial infarcts
172
Characteristics of Transmural infarcts
↑ necrosis
| Affects entire wall
173
How is Transmural infarct found in ECG?
ST elevation
| Q waves
174
When is consider a Subendocardial infarct?
Due to ischemic necrosis of < 50% of ventricle wall
175
Which structure of heart is especially vulnerable to ischemia?
Subendocardium
176
Which ECG is found in Subendocardium Infarct
ST depression
177
Which artery is related to Anterior wall infarction?
Left Anterior Descending Artery
178
Lead that show Q waves in Anterior wall infarction
V1-V4
179
Artery that irrigates Anteroseptal structure
Left Anterior Descending Artery
180
Leads hat show Anteroseptal infarction
V1-V2
181
Who irrigates Anterolateral wall of the heart?
Left Anterior Descending Artery
| Left Circumflex
182
If there is a Anterolateral infarction which leads indicate the infarction?
V4-V6
183
Which artery irrigates Lateral wall of the heart?
Left circumflex
184
These leads indicate a Lateral wall infarction
I, aVL
185
Which wall does Right Coronary artery irrigates?
Inferior wall
186
Which leads indicate a right coronary territory infarction?
II, III, aVF
187
MI complications
```
Cardiac Arrythmia
LV failure and pulmonary edema
Cardiogenic shock
Ventricular free wall rupture
Ventricular pseudoaneurysm formation
Postinfarction fibrinous pericarditis
Dressler syndrome
```
188
Important cause of death before reaching hospital as MI complication
Cardiac Arrhythmia
189
When is common to see Cardiac Arrhythmia as MI complication?
In first few days
190
When can cardiogenic shock happen as MI complication?
Large infarct- high risk of mortality
191
Which is the pathogenic of Ventricular free wall rupture as MI complication?
Ventricular free wall rupture→ Cardiac tamponade; papilary muscle rupture→ several mitral regurgitation; and interventricular septum rupture → VSD
192
When is the greatest risk of Ventricular free wall rupture as MI complication?
6-14 days postinfarct
193
Which are the complications of Ventricular pseudoaneurysm formation?
↓ Cardiac output, risk of arrhytmia, embolus form mural thrombus
194
When is the greatest risk of Ventricular pseudoaneurysm formation after MI?
1 week post MI
195
When can Postinfarction fibrinous pericarditis happens?
1-3 days post MI
196
What is Dressler syndrome?
Autoimmune phenomenom resulting in fibrinous pericarditis
197
When is expected to possible see Dressler syndrome?
Several weeks post MI
198
Which is the most common cardiomyopathy
Dilated cardiomyopathy
199
From all cardiomyopathies which percentage represents Dilated cardiomyopathy?
90% of cases
200
Which are the often causes of Dilated cardiomyopathy?
Idiopathic or congenital
201
Other etiologies of Dilated cardiomyopathy are...
```
Alcohol abuse
Wet Beriberi
Cosackie B virus myocarditis
chronic Cocaine use
Chagas disease
Doxurubicin toxicity
hemochromatosis
peripartum cardiomyopathy
```
202
Which are the findings of Dilated cardiomyopathy?
Heart failure
S3
Dilated heart on echocardiogram
Ballon apperance of heart on CXR
203
Which is the treatment for Dilated cardiomyopathy?
Na+ restriction, ACE inhibitors, β blockers, diuretics, digoxin, implatable cardioverter defibrilator (ICD), heart transplant
204
Which are possible consequences of Dilated cardiomyopathy?
```
Systolic dysfunction ensues
Eccentric hypertrophy (sarcomers added in series)
```
205
Which is the most common cause of Hypertrophic cardiomyopathy?
60-70 % of cases are familial
206
The familial cases of Hypertrophic cardiomyopathy which inheritance mode do they follow?
Autosomal dominant
207
Which is the possible cause of Autsomal dominant Hypertrophic cardiomyopathy?
commonly a β- myosin heavy chain mutation
208
Rarely with which other disease is Hypertrophic cardiomyopathy associated?
Friedreich ataxia
209
Cause of sudden death in young athletes
Hypertrophic cardiomyopathy
210
Which is the cause of sudden death in young athletes due to Hypertrophic cardiomyopathy?
Ventricular arrhytmia
211
Possible findings in Hypertrophic cardiomyopathy
S4, systolic murmur
212
Treatment for Hypertrophic cardiomyopathy
Cessation of high intensity athletics, use of β blocker or non dihdropyridine calcium channel blockers
213
If a patient is at high risk for Hypertrophic cardiomyopathy what is the alternative treatment?
Implantable cardioverter defibrillators
214
What occurs afterwards Hypertrophic cardiomyopathy?
Diastolic dysfunction ensues
215
Which are possible consequences of Hypertrophic cardiomyopathy?
Marked ventricular hypertrophy, often septal predominance. Myofibrillar disarray and fibrosis
216
Pathogenesis of Obstructive Hypertrophic cardiomyopathy (subset)
Hypertrophied septum too close to anterior mitral leaflet → outflow obstruction → dyspnea, possible syncope
217
Which kind of hypertrophy is seen in Hypertrophic cardiomyopathy?
Concentric Hypertrophy
218
How else is Restrictive cardiomyopathy known?
Infiltrative
219
Name the major causes of Restrictive/Infiltrative cardiomyopathy
```
Sarcoidosis
Amyloidosis
Postradiation Fibrosis
Endocardial fibroelastosis
Loffler syndrome
Hemochromatosis
```
220
Which patient are at higher risk to develope Endocardial fibroelastosis?
Young children
221
What is the Loffler syndrome?
Endomyocardial fibrosis with a prominent eosinophilic infiltrate
222
Hemochromatosis is associated to these cardiomyopathies
Restrictive/ infiltrative cardiomiopathy
| Dilated cardiomiopathy
223
What occurs afterwards Restrictive/ infiltrative cardiomyopathy?
Diastolic dysfunction
224
Which ECG problem is seen in Restrictive/ infiltrative cardiomiopathy?
Low voltage ECG despite thick myocardium (especially amyloid)
225
Clinical syndrome of cardiac pump dysfunction
Congestive Heart failure
226
Symptoms of Congestive Heart failure
Dyspnea, orthopnea and fatigue
227
Signs of Congestive Heart failure
Rales, JVD, and pitting edema
228
Which manifestations can Congestive Heart failure has?
Systolic dysfunction
| Diastolic dysfunction
229
What is found in Systolic dysfunction of Congestive heart failure?
Low EF, poor contractility
230
Which is the often cause of Systolic dysfunction in Congestive Heart failure?
Secondary to ischemic heart disease or Dilated cardiomyopathy
231
Which are the findings in diastolic dysfunction of Congestive heart failure?
Normal EF and contractility
| Impaired relaxation, Decrease compliance
232
Which is the common cause of Right heart failure?
Most often results from left heart failure
233
Which is the caused of isolated Right heart failure?
Ussually to cor pulmonale
234
Which drugs decreased the risk of mortality in Congestive Heart failure?
ACE inhibitors, β blockers, angiotensin II receptor blockers, and spironolactone
235
Which drugs don't help during decompensated Congestive Heart Failure?
ACE inhibitors and β blockers
236
Whic is the cause of Cardiac dilation in Congestive Heart Failure?
Greater ventricular end diastolic volume
237
Cause of dyspnea on exertion in Congestive Heart Failure
Failure of Cardiac Output to ↑ during excercise
238
Characteristics of Left heart failure
Pulmonary edema
Orthopnea
Paroxysmal nocturnal dyspnea
239
Which is the pathogenesis in Pulmonary edema caused by left heart failure?
↑ pulmonary venous pressure → pulmonary venous distention and transudation of fluid
240
Which microscopic characteristic does Pulmonary edema caused by left heart failure has?
Presence of hemosiderin laden macrophages ("heart failure cells") in the lungs
241
Clinical manifestation of Orthopnea
Shortness of breath when supine
242
Pathogenesis in Orthopnea caused by left heart failure
↑ Venous return from redistribution of blood (immediate gravity effect) exacerbates pulmonary vascular congestion
243
Clinical manifestation of Paroxysmal nocturnal dyspnea
Breathless awakening from sleep
244
Pathogenesis in Paroxysmal nocturnal dyspnea caused by left heart failure
↑ Venous return from redistribution of blood, reabsorption of edema, etc
245
Manifestations of right heart failure
Hepatomegaly (nutmeg liver)
Peripheral edema
Jugular distention
246
Pathogenesis of Hepatomegaly caused by right heart failure
↑ Central venous pressure → ↑ resistance to portal flow. Rarely leads to "cardiac cirhosis"
247
Which is the explantion of Peripheral edema caused by right heart failur?
↑ Venous pressure→ Fluid transudation
248
Why does Yugular venous distention occurs in right heart failure?
↑ Venous pressure
249
Which drugs just give symptomatic relief in CHF?
Thiazide or loop diuretics
250
Which is the most common symptom of Bacterial endocarditis
Fever
251
Symptoms of Bacterial endocarditis
```
Fever
New murmur
Roth spots
Osler nodes
Janeway lesions
Anemia
Splinter hemorrgages on nail bed
```
252
What are the Roth spots?
Round white spots on retina surrounded by hemorrhage
253
What are the Osler nodes?
Tender raised lesions on finger or toe pads
254
What are the Janeway lesions?
Small, painless , erythematous lesions on palm or sole
255
What is needed to diagnos Bacterial endocarditis?
Multiple blood cultures necessary
256
How is Bacterial endocarditits classified?
Acute
Subacute
Culture negative
257
Which bacteria causes acute Bacterial endocarditis?
S. Aureus (high virulence)
258
How is Acute Bacterial endocarditis caused by S. Aureus seen?
Large vegetations on previously normal valves
259
How is the onset of Acute Bacterial endocarditis caused by S. Aureus?
Rapid onset
260
Who causes Subacute Bacterial endocarditis ?
Viridians Streptococi (low virulence)
261
Which are the damage caused by Subacute Bacterial endocarditis ?
Smaller vegetations on congenital abnormal or diseased valves
262
In which cases do we see Subacute Bacterial endocarditis?
Sequela of dental procedures
263
Which complication can be seen as sequela of dental procedures?
Subacute Bacterial endocarditis
264
How is the onset in subacute Bacterial endocarditis ?
Gradual onset
265
Who causes culture negative Bacterial endocarditis?
Most likely Coxiella burnetii and Bartonella spp
266
Name other non bacterial causes of Endocarditis
Malignancy
Hypercoagulable state
Lupus (marantic/ thrombotic endocarditis)
267
Which bacteria is present in cancer colon?
S. bovis
268
Which bacteria could be found in prosthetic valves?
S. epidermidis
269
Which valve is most frequently involved in Bacterial endocarditis?
Mitral valve
270
If tricuspid valve endocarditis is seen, what is associated?
IV drug abuse
271
Which valve suffering endocarditis is associated to IV drug abuse?
Tricuspid
272
Bacterias Associated to Tricuspid valve endocarditis?
S. aureus
Pseudomonas
Candida
273
Complications of Bacterial endocarditis
Chordae rupture
Glomerulonephritis
Suppurative pericarditis
Emboli
274
How is Rheumatic fever adquired?
A consequence of pharyngeal infection with group A β hemolytic streptococci
275
Which is the risk of Rheumatic Fever?
Early deaths due to myocarditis
276
Late sequale of Rheumatic Fever
Rheumatic heart disease
277
In Rheumatic heart disease, in order who are the most affected valves?
Affects heart valves- mitral > aortic>> tricuspid
| (high pressure affected most
278
Early lesion seen in Rheumatic Fever
Mitral Regurgitation
279
Late lesion in Rheumatic Fever
Mitral Stenosis
280
Which findings are associated to Rheumatic Fever?
Aschoff bodies
Anistschkow cells
↑ ASO titers
281
What are Aschoff bodies?
Granuloma with giant cells
282
What are the Anistschkow cells?
Enlarged macrophages with ovoid, wavy, rod like nucleus
283
Which are the causes of Rheumatic fever?
A consequence of pharyngeal infection
| Immune madiated not a direct effect of Bacteria
284
Who is responsable of immune mediated Rheumatic fever?
Type II hypersensitivity
285
Which is the pathogenesis in Immune mediated who Rheumatic fever?
Antibodies to M protein cross react with self antigens
286
Findings in Rheumatic fever
```
FEVERSS
Fever
Erythema marginatum
Valvular damage (vegetation and fibrosis)
ESR ↑
Red hot joints (migratory polyarthritis)
Subcutaneous nodules
St. Vitus' dance (Sydenham chorea)
```
287
In which disease do we see St. Vitus' dance?
Sydenham chorea
288
Clinical presentation of acute pericarditis
Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward
289
How is Acute pericarditis presented?
Friction Rub
290
ECG changes in Acute pericarditis
Widespread segment elevation and/or PR depression
291
Types of Acute pericarditis
Fibrinous
Serous
Supurative/ purulent
292
Who are the cause of Fibrinous Acute pericarditis
Dressler syndrome, uremia, radiation
293
How is Fibrinous Acute pericarditis presented?
Loud friction rub
294
Causes of Serous Acute pericarditis
Viral pericarditis
| Noninfectious inflammatory diseases
295
How is viral pericarditis treated?
Often resolves spontaneously
296
Causes of Noninfectious inflammatory diseases of Serous pericarditis
Rheumathoid arthritis
| SLE
297
Who causes Supurative/ purulent Acute pericarditis?
Ussually caused by bacterial infections (eg. Pneumococcus, Streptococcus)
298
Why is Supurative/ purulent Acute pericarditis nowdays rare?
Rare now with antibiotics
299
What is cardiac tamponade?
Compression of heart by fluid in pericardium
300
Which fluids can cause cardiac tamponade?
Blood, effussions
301
Which is the result of Cardiac tamponade?
Leading to ↓ Cardiac Output
302
What happens during cardiac tamponade?
Equilibration of diastolic in all 4 chambers
303
Findings in Cardiac tamponade
Beck triad
↑ Heart Rate
Pulsus paradoxus
Kussmaul sign
304
What does Beck triad has?
Hypotension
Distended neck veins
Distant heart sounds
305
What does ECG in Acute pericarditis?
Shows low voltage QRS and electrical alternans (due to "swinging" movement of the heart in large effusion)
306
What is the Pulsus paradoxus?
↓ amplitude of systolic blood pressure by > 10 mmHg during inspiration
307
Which cases present pulsus paradoxus?
```
Cardiac Tamponade
Asthma
Obstructive sleep apnea
Pericarditis
Croup
```
308
Which syphilis causes syphilitic heart disease?
3º syphilis
309
Which is the pathogenesis of 3º syphilis in syphilitic heart disease?
Disrupts the vasa vasorum of the aorta with consequent atophy of the vessel wall and dilation of the aorta and valve ring
310
What can be seen in syphilitic heart disease?
Calcification of the aortic root and ascending aortic arch
311
What does syphilitic heart disease leads to?
"Tree bark" appearance of the aorta
312
Which could be the results of syphilitic heart disease?
In aneurysm of the ascending aorta or aortic arch and aortic insufficiency
313
Which are the most common heart tumors?
Is a metastastis (eg. from melanoma, lymphoma)
314
Most common primary cardiac tumor in adults
Myxomas
315
Where is the most common site of heart myxomas
90% occur in the atria (mostly left atrium)
316
How are cardiac myxomas described?
As a "ball valve" obstruction in the left atrium
317
Clinical findings caused by cardiac myxomas
Associated with multiple syncopal episodes
318
Most frequent primary tumor in children
Rhabdomyomas
319
Which disease is associated to Rhabdomyomas heart tumor?
Tuberous sclerosis
320
What is identified in Kussmaul sign?
↑ in Jugular venous pressure on inspiration instead of a normal ↓
321
How is Jugular Vein distenssion produced with inspiration?
Inspiration → negative intrathoracic pressure not transmitted to heart → impaired filling of right ventricle → blood backs up into venae cavae→ Jugular Vein Distenssion
322
When is Kussmaul sign seen?
Constrictive pericarditis
Restrictive cardiomyopathies
Right atrial or ventricular tumors
323
What is Raynaud phenomenon
↓ blood flow to skin due to arteriolar vasospasm in response to cold temperature or emotional stress
324
Where are the most often sites of Raynaud phenomenon presentation?
Most often in the fingers and toes
325
When do we call Raynaud disease?
When Primary (Idiopathic)
326
When is called Raynaud syndrome?
When secondary to a disease process
327
Which diseases are related to Raynaud syndrome?
Such as mixed connective tissue disease, SLE or CREST (limited form of systemic sclerosis) syndrome
328
Which vessels are affected in Raynaud phenomenon?
Affects small vessels
329
Vascular tumors
```
Strawberry hemangioma
Cherry hemangioma
Pyogenic granuloma
Cystic hygroma
Glomus tumor
Bacillary angiomatosis
Angiosarcoma
Lymphangiosarcoma
Kaposi sarcoma
```
330
Characteristics of Strawberry hemangioma
Benign capillary hemangioma of infancy
331
Which is the incidence of Strawberry hemangioma?
1/200 birhts
332
When is the age of apperance of Strawberry hemangioma?
Appears in first few weeks of life
333
Which is the normal evolution of Strawberry hemangioma?
Grows rapidly and regresses spontaneously at 5-8 years old
334
Benign capillary hemangioma of the elderly
Cherry hemangioma
335
Expected evolution of Cherry hemangioma
Does not regress. Frequency increases with age
336
Characteristics of Pyogenic granuloma
Polypoid capillary hemangiomathat can ulcerate and bleed
337
What is associated to Pyogenic granuloma?
With trauma and preganancy
338
Cavernous lymphangioma of the neck
Cystic Hygroma
339
Which disease is associated to Cystic Hygroma?
Turner syndrome
340
What is Glumous tumor?
Benign, painful, red blue tumor under fingernails
341
From where does Glomus tumor arises?
Arises from modified smooth muscle cells of glomus body
342
Benign capillary skin papules found un AIDS patients
Bacillary angiomatosis
343
Who causes Bacillary angiomatosis?
Bartonella henselae infections
344
With wich other Vascular tumor is Bacillary angiomatosis mistaken?
Kaposi sarcoma
345
What is Angiosarcoma?
Rare blood vessel malignancy
346
Typical Sites of Angiosarcoma apperance
In the head, neck, and breast areas
347
Who are at higher risk for Angiosarcoma?
Usually in eldery, on sun exposed areas
348
What is associated to Angiosarcoma?
Associated with radiation therapy and arsenic exposure
349
Why does Angiosarcoma has very bad prognosis?
Verry agresive and dificult to resect due to delay in diagnosis
350
What is Lymphangiosarcoma?
Lymphatic malignancy associated with persistent lymphedema
351
Example of Lymphangiosarcoma patients who are at higher risk
Post radical mastectomy
352
What is Kaposi sarcoma? where does it commonly appear?
Endothelial malignancy most commonly of the skin, but also mouth, GI tract and respiratoy tract
353
Viruses associated to Kaposi sarcoma
HHV-8 and HIV
354
Which vascular tumor is frequently mistaken with Kaposi sarcoma?
Bacillary angiomatosis
355
How are Vasculitis classified?
Large vessel vasculitis
Medium vessel vasculitis
Small vessel vasculitis
356
Large vessel vasculitis
Temporal (giant cell) arteritis
| Takayasu arteritis
357
Who are mainly affected by Temporal (giant cell) arteritis?
Eldery females
358
Clinical manifestation of Temporal arteritis
Unilateral headache (temporal artery), jaw claudication
359
Which is the highest risk of Temporal arteritis?
May lead to irreversible blindness
360
Which is the reason of irrevesible blindness caused by Temporal arteritis?
Due to opthalmic artery occlusion
361
Which disease is associated to Temporal arteritis?
Polymyalgia rheumatica
362
Which are the most commonly affected arteries in Temporal arteritis?
Branches of carotid artery
363
In light microscope what is seen in Temporal arteritis?
Focal granulomatous inflammation
364
Which labs are affected in Temporal arteritis?
↑ ESR
365
Which is the treatment for Temporal arteritis?
Treat with high dose corticoesteroids prior to temporal artery biopsy to prevent vision loss
366
Main affected by Takayasu arteritis
Asian females < 40 years old
367
Clinical presentation of Takayasu arteritis
"Pulseless disease" (weak upper extremity pulses), fever, night sweats, arthtis, myalgias, skin nodules, ocular disturbances
368
Pathology findings in Takayasu arteritis
Glanulomatous thickening and narrowing of aortic arch and proximal great vessels
369
Treatment for Takayasu arteritis
Corticoesteroids
370
Lab studies altered in Takayasu arteritis
↑ ESR
371
Medium vessel vasculitis
Polyarteritis nodosa
Kawasaki disease
Buerger disease
372
Group of age who present Polyarteritis nodosa?
Young adults
| Hepatitis B seropositivity in 30% of patients
373
Clinical presentation of Polyarteritis nodosa
Fever, weight loss, malaise, headache
GI: abdominal pain, melena
Hypertension, neurologic dysfunction
Cutaneous eruptions, renal damage
374
Which are the commonly vessels affected by Polyarteritis nodosa?
Typically involves renal and visceral vessels, no pulmonary arteries
375
How is Polyarteritis nodosa consider?
Immune complex mediated
376
Pathology of Polyarteritis nodosa
Transmural inflammation of the arterial wall with fibrionid necrosis
377
In Polyarteritis nodosa what is found on arteriogram?
Innumerable microaneurysms and spasm
378
What is the treatment for Polyarteritis nodosa?
Corticoesteroids, cyclosphosphamide
379
Kawasaki disease principally affects...
Asian children <4 years old
380
Which are clinical manifestations of Kawasaki disease?
Fever, cervical lymphadenitis, conjunctival injection, changes in lips/oral mucosa ("stawberry tongue"), hand foot erythema, desquamating rash
381
Which are the risk of Kawasaki disease?
May develop coronary artery aneurysms, thrombosis → MI, rupture
382
How is Kawasaki disease treated?
Treat with IV immunoglobulin and aspirin
383
Alternative name for Buerger disease
Thromboangiitis obliterans
384
Patients how have increased rik for Buerger disease
Heavy smokers, males <40 years old
385
Clinical presentation of Thromboangiitis obliterans
Intermittent claudication may lead to gangrene, autoamputation of digits, superficial nodular phlebitis
386
What else is often present in Buerger disease?
Raynaud phenomenom
387
Pathology of Thromboangiitis obliterans
Segmental thrombosing vasculitis
388
How is Buerger disease treated?
Smoking cessation
389
Small cell vasculitis
Granulomatosis with polyangiitis
Microscopic polyangiitis
Churg Strauss syndrome
Henoch Schonlein purpura
390
Alternative name for Granulomatosis with polyangiitis
Wegner
391
Lower respiratory tract manifestations of Wegner disease
Hemoptysis, cough, dyspnea
392
Upper respiratory tract of Granulomatosis with polyangiitis
Upper respiratory tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
393
Renal manifestations of Wegner disease
Hematuria, red cell casts
394
Triad in Granulomatosis with polyangiitis
Focal necrotizing vasculitis
Necrotizing granulomas in the lung and upper airway
Necrotizing glomerulonephritis
395
Which labs help in the diagnosis of Wegner disease?
PR3- ANCA/ cANCA (anti-proteinase 3)
396
Which other study helps to study Wegner disease?
CXR
397
What could be found in CXR in Granulomatosis with polyangiitis?
Large nodular densities
398
How is Wegner disease treatred?
Cyclophosphamide, corticoesteroids
399
What is Microscopic polyangiitis?
Necrotizing vasculitis
400
Which orgnas are commonly involved in Microscopic polyangiitis?
Lung, kidneys, and skin
401
What could be found in Microscopic polyangiitis?
Pauci immune glomerulonephritis and palpablepurpura
402
Which is the presentation of Microscopic polyangiitis?
Similar to granulomatosis with polyangiitis but without nasopharyngeal involvement
403
Labs for Microscopic polyangiitis
MPO-ANCA/p-ANCA (antimyeloperoxidase)
404
Treatment for Microscopic polyangiitis
Cyclophosphamide and corticosteroids
405
Clinical presentation of Churg Strauss syndrome
Asthma,sinusitis, palpable purpura, peripheral neuropathy (eg. wrist/foot drop)
406
What else can Churg Strauss syndrome present?
Involve heart, GI, kidneys (pauci immune glomerulophritis)
407
Pathologic findings in Churg Strauss syndrome
Granulomatous, necrotizing vasculitis with eosinophilia
408
Labs in Churg Strauss syndrome
MPO- ANCA/ p-ANCA, ↑ IgE level
409
Most common childhood systemic vasculitis
Henoch Schonlein purpura
410
Commonly what precedes Henoch Schonlein purpura
Upper Respiratory tract Infection
411
Classic triad of Henoch Schonlein purpura
Skin: palpable purpura on buttocks/ legs
Arthralgias
GI: abdominal pain, melena, multiple lesions of same age
412
What is the cause of Henoch Schonlein purpura?
Vasculitis secondary to IgA complex deposition
413
Which disease is associated to Henoch Schonlein purpura?
With IgA nephropathy
