Cardiopathology Flashcards by Phil son

Hyaline Arteriolosclerosis causes? What is the MOA?

Benign HTN=>forces protein into the wallDM=>NEG of basement=>protein goes into vesel wall

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Hyperplastic arteriolosclerosis is due to? MOA?

Malignant HTN=>High BP forces walls to thicken to contain BP

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Fibrinoid Necrosis ARF w. flea bitten appearance (pinpoint hemorrhage) Cause?

Hyperplastic arteriolosclerosis

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Glomeular scarring and shrunken kideny, MOA?

Hyaline arteriolosclerosis

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Do Fatty Streaks predict where the atherosclerosis will happen?

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What are the modifiable risk factors of atherosclerosis?

Smoking, HTN, Hyperlipidemia, DM

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MOA of Atherosclerosis?

Endothelial cell dysfunction=>macrophage and LDL accumulation=>foam cell formation=>fatty streaks=>smooth muscle cell migration (involves PDGF and FGF), proliferation, and extracellular matrix deposition=>fibrous plaque=>complex atheromas

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Patients with atherosclerosis are symptomatic when the stenosis reaches?

70%

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MC location of atherosclerosis, name 4 places?

Abdominal aorta>coronary artery>popliteal artery>carotid artery

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Abdominal Pain and/or back pain is indicative of what in an aortic aneuyrsm?

Immiment rupture, leaking, dissection

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Which aneurysm is associated with atherosclerosis?

Abdominal aortic aneurysm

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An abdominal aorta >5cm will lead to what?

rupture

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Which aneurysm is associated with cystic medial degeneration?

Thoracic Aortic Aneurysm

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Where is abdominal aortic aneurysm most commonly found?

Below Renal Artery and above the aortic bifurcation

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What two diseases are historically associated with thoracic aortic aneurysm?

Marfan and syphilis

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In syphilitic aneurysm-> what is the cause? And what appearance of the aorta do you get?

Obliterative endarteritis of the vasa vasorum

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Aortic Dissection is ripping through what wall?

Media wall

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MCC of death in aortic dissection?

Pericardial tamponade

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Aortic Dissections are due to what two preexisting conditions?

Needs lots of pressure=>why it is found in proximal 10 cm of the aorta2. Needs pre-existing weakness of media=>MCC HTN

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Stanford A involves? Stanford B involves?

Ascending aorta; Bottom aorta

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Subendothelial infarction shows what on ECG?

ST segment depression

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Prinzmetal or Variant Angina on ECG?

Transient ST elevation

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Sudden Cardiac death is most commonly due to?

Lethal arrythmia

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Explain 1 day, 1 week and 1 month

CN (arrythmia, and dark discolaration at 1 dayNeutrophils, macrophages=>inflammation (Yellow) and rupture/pericarditis 1 weekGT=Red a couple of weeks to monthScarring=>White (type 1 collagen) 1-6 months

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Most sensitive and specific cardiac enzyme?

Troponin I

Troponin I rises after how many hours? For how long?CK-MB rises after? For how long?

Troponin: Rises after 4 hours and stays up for 7-10 daysCK-MB rises after 6-12 hours

CKMB is most useful in dx-ing what?

Reinfarction

Anteromedial and Anteroseptal is shown in which leads?

V1-V4

Lateral wall MI Lead? What is main artery supplying this wall?

I, avL; V5 and V6LCX

Inferior wall MI Leads? What artery supplies this wall?

II, III avFRCA

Autoimmune phenomenon resulting in fibrinous pericarditis? When do you see this?

Dressler Syndrome (6-8 weeks)

Reperfusion therapy is most important in STEMI (PCI>fibrinolysis) but it can cause two problems. What are these two problems?

1. Contraction band necrosis (Ca2+ reenters the cell and causes contraction=>dense pink lines)2. Reperfusion injury=>generates free radicals (O2)

MC Cardiomyopathy? What kind of a cardiomyopathy is this?

Dilated Cardiomyopathy; Systolic Cardiomyopathy

Dilated cardiomyopathy Causes?

Alcohol abuse+wet BeriberiCox B virus (MC)Cocaine useChagas diseaseDoxorubicinhaving a Cid cardiomyopathy (pregos)

Findings of Cardiomyopathy?

S3, systolic regurgitant murmur (mitral/tricuspid regurg)

Hypertrophic Cardiomyopathy MCC? What kind of a defect is this disease?

AD B-myosin Heavy chain; diastolic

Hypertrophic Cardiomyopathy Findings?

S4, systolic regurg (mitral regurg)

What will you see in a bx of patient with Hypertrophic cardiomyopathy?

Bx: Myofibrillar disarray and fibrosis

Restrictive cardiomyopathy what kind of a disease is it? What are major causes?

Diastolic Dysfunction-Osis

Restrictive cardiomyopathy in kids is due to?

Endocardial fibroelastosis-thick elastic tissue

Endomyocardial fibrosis with a prominent eosinophilic infiltrate. What is this describing?

Loeffler syndrome

What will you see in the ECG of Restrictive Cardiomyopathy?

Low voltage ECG+Diminished QRS

Hemachromatosis can cause what two cardiomyopathy?

Restrictive and Dilated Cardiomyopathy

Left Heart Failure signs?

Orthopnea, PND, Pulmonary Edema

Right Heart Failure signs?

Hepatosplenomegaly (nutmeg liver), JVD, Peripheral edema

Hypovolemic Shock, what happens to the Skin, Preload, CO and Afterload?

Skin=cold; Decreased Preload=>Decreased CO=>Increased SVR

In cardiogenic or obstructive shock, what happens to the Skin, Preload, CO and Afterload?

Skin=> Cold; CO=>decreased SVR=>increased Preload=>increased

In distributive (septic) shock, what happens to the Skin, Preload, CO and Afterload?

Skin-warm=>SVR=>Decreased; Preload=>Decreased but CO increases (tachycardia)

First sign of shock?

Tachycardia

Bacterial endocarditis MC symptom?

Fever

What do you see in a patient with bacterial endocarditis?

FROM JANEFeverRoth spotOsler Nodes (Ouch)MurmurJaneway lesionsAnemia of Chronic DiseaseNail-bed hemorrhageEmboli

SubAcute is caused by what organism? MOA? Small or large vegetations? Low or High Virulence? What profession does it MC-ly affect?

Viridans StrepMOA: Affects previously damaged valvesSmaller VegetationsLow VirulenceDental proceduresMCC overall

Acute is caused by what organism? MOA? Small or large vegetations? Low or High Virulence? What profession does it MC-ly affect?

S. AureusLarge VegetationsTricuspid valveIV drug userHigh Virulence

With Strep Bovis what should you look for?

CRC

S. Epi affects?

prosthetic valves

If Culture is Neg in Bacterial Endocarditis, what organisms should you suspect?

HACEKHaemophilus,Actinobacillus, Cardiobacterium, Eikenella,Kingella

Rheumatic Fever is caused by?

Group A Strep=rheumAtic fever

Rheumatic Fever affects what kind of heart valves?

High PressureMitral>Aortic

With an early lesion of rheumatic fever, what valvular disorder do you commonly see first? With Late?

Early: Mitral valve regurgLate: Mitral Stenosis (takes a long time to calcify the valve)

MOA of Rheumatic Fever? HSR?

Molecular Mimicry; M protein cross reacts with self-antigenType II HSR

Rheumatic Fever is associated with 3 Findings?

1. Aschoff Bodies2. Anitschkow cells (wavy ovoid rod-like nucleus macrophages)3. Elevated ASO titers

Explain the JONES criteria

JointHeartNodules in skinErythema marginatumSydenham chorea

In Cardiac Tamponade, what are the findings?

Beck's Triad (Hypotension, distended neck veins and distant heart sounds)

Apatient with ball valve obstruction in left atrium and has multiple syncopal episodes. What is the Dx? Where is this pathology's origin

Myxomas; mesechymal origin

A 80 year old white female is diagnosed with a very aggressive blood vessel malignancy. What is this most likely to be associated with?

Vinyl chloride (PVC)

Strawberry hemangioma vs Cherry Hemangioma

``` Cherry Hemangioma (Cling on) Strawberry Heamngioma goes away (strawberry is for "babies") ```

An 70 y/o Eastern European Male w/hx of AIDS and transplant has a purple plaque in the skin and mouth. What is agent causing this problem?

Kaposi Sarcoma; HHV-8=>invasion of endothelial cells

AIDS patient with Abdominal Pain and hemorrhagic lesions?

HHV-8 kaposi sarcoma

Rhabdomyomas are associated with?

Children and TSC

In chronic Rheumatic fever=> what happens to the valves?

Fusion of commisures=>fish mouth

Atherosclerosis can do what to the kidneys and its arteries? What should you avoid?

Renal Artery Stenosis Unilateral atrophy of affected kidney ACE inhibitors

Pulmonary edema can lead to what kind of cells forming?

HF (hemosiderin-ladin macrophages)

End result of SHOCK?

Multiple organ dystfunction syndrome

In what disease, do you lean forward to make the pain go away and there is friction rub?

Acute Pericarditis

Kussmaul sign?

Increased JVP on inspiration

Do Kaposi Sarcomas blanch

Smoking increases risk for ischemic disease how?

1. Promotes atherosclerosis | 2. promotes aggregation

Rheumatic Fever MCC of Death?

Myocarditis

Dynamic Left Ventricle outflow obstruction?

Hypertrophic cardiomyopathy