Cardiovascular Flashcards
1
Q
stable angina (reversible injury) at what level of stenosis?
A
> 70% stenosis of coronary arteries due to atherosclerosis
2
Q
what is the hallmark of reversible injury?
A
cellular swelling
3
Q
characteristics of stable angina?
A
<20 minutes
radiates to left arm/jaw
diaphoresis
SOB
4
Q
stable angina tx?
A
rest
nitroglycerin
5
Q
ST-segment depression represents?
A
subendocardial ischemia
6
Q
unstable angina (reversible injury) pathogenesis?
A
rupture of plaque –>
thrombosis and incomplete occlusion
7
Q
prinzmetal angina (reversible injury)?
A
vasospasm of a coronary artery ST elevation (transmural ischemia) due to complete occlusion via vasospasm clamp-down
8
Q
episodic chest pain unrelated to exertion?
A
Prinzmetal angina
9
Q
Prinzmetal angina tx?
A
NG
CCB
10
Q
complete occlusion of coronary artery and necrosis of myocytes (>20min)
A
MI
ddx: vasospasm, emboli, vasculitis (Kawasaki)
11
Q
characteristics of MI?
A
crushing chest pain >20min radiates to left arm/jaw diaphoresis dyspnea (pulm congestion) no relief from NG
12
Q
troponin levels:
starts/peaks/returns
A
2-4h post-MI
peaks at 24
normal by 7-10 days
13
Q
CK-MB levels:
starts/peaks/returns
A
4-6h post-MI
peaks at 24h
returns by 72h
good for dx reinfarction
14
Q
MI tx
A
aspirin & heparin supplemental O2 nitrates B-blocker (slow HR) ACE-i
15
Q
contraction bands due to?
A
reperfusion of Ca2+ causing contraction
16
Q
reperfusion injury would cause?
A
a continued rise in cardiac enzyme levels, and necrosis
17
Q
coagulative necrosis sign?
A
removal of nucleus
18
Q
post-MI:
1 day
1 week
1 month
A
1 day: coagulative necrosis
>1d: inflammation until 1 wk
>1wk: granulation tissue
1 month: scar
19
Q
post-MI: 4-24h
A
dark discoloration
coagulative necrosis
arrhythmia
20
Q
<4 hours post-MI
A
no gross/microscopic changes
21
Q
post-MI: 1-3d
A
yellow pallor
neutrophils
friction rub (pericarditis due to neutrophil inflammation)
22
Q
post-MI: 4-7d
A
yellow pallor macrophages (eat up debris) free wall rupture (due to MP's) tamponade septal rupture --> shunt pap muscle rupture (RCA)
23
Q
post-MI: 1-3 wks
A
red border
granulation tissue
fibroblasts/collagen/vessels
24
Q
post-MI: months
A
white scar fibrosis aneurysm mural thrombus Dressler (pericardial antigen exposure --> autoimmune pericarditis)
25
what only happens with transmural infarcts?
fibrinous pericarditis
26
fatal ventricular arrhythmia without sx or <1h after sx onset
sudden cardiac death
27
causes of sudden cardiac death
atherosclerosis #1
| MVP, cardiomyopathy, cocaine
28
special cells seen in pulmonary congestion
heart failure cells
due to capillary rupture
iron accum. in MP's
29
CHF forward effects
RAAS activation
tx: ACE-i (do not want to up TPR)
prevent downward spiral
30
Features of R-heart failure
JVD
Painful HSM --> "cardiac cirrosis"
Nutmeg liver
Pitting edema
31
cardiac congenital defect sweet spot
weeks 3-8
| most are sporadic
32
most common heart defect?
| associated with?
VSD
| fetal alcohol syndrome
33
what size defect to expect with early presentation? can lead to what syndrome?
large defect, greater extent
Eisenmenger
these require surgery
34
characteristics of Eisenmenger's
RVH
polycythemia (hypoxemia)
clubbing
35
defect assoc. w/down syndrome
ostium primum
36
most common type of ASD
ostium secundum
37
sound assoc. w/ASD?
split S2
38
PDA assoc. w/what disease?
congenital Rubella
39
characteristics of PDA
distal to arch
holosystolic "machine-like" murmur
can lead to Eisenmenger --> reversal of shunt to R->L and since it is distal to the arch results in LE edema
40
action of Indomethacin
decreases PGE
| closes PDA
41
Tetralogy of Fallot
Pulm. artery stenosis (prognosis)
RVH
Overriding aorta
VSD
leads to early cyanosis
tx: squatting
42
Tetralogy on X-ray?
Boot shaped heart
43
Transposition of the Vessels Tx?Assoc. w/what maternal disease?
Maintain PDA (give PGE)
Create ASD or VSD
*maternal diabetes
44
Conditions that cause early cyanosis
Tetralogy
Transposition
Truncus persistant
Tricuspid atresia
45
Tricuspid atresia
Tricuspid valve doesn't form
RV doesn't receive blood --> becomes hypoplastic
Compatible only if assoc. ASD
46
Coarctation: infantile v. adult
Infantile: distal to arch, proximal to PDA; LE cyanosis b/c pulmonary circuit is low pressure due to PDA
Adult: no PDA, distal to arch; HTN of the upper extremities, hypotension of the LE
47
Infantile coarctation assoc with?
Turner syndrome
48
Adult coarctation assoc. with?
*Bicuspid aortic valve
| Also notching of ribs
49
acute rheumatic fever
group A B-strep
kids 2-3wks post-throat
bacterial M protein mimicry
50
ARF: Jones criteria
Evidence of prior infection: ASO or anti-DNase B titer
Minor crit: fever, ESR
Major crit: JONES
51
JONES criteria
```
J: joint (migratory arthritis)
O: heart (pancarditis)
N: nodules in skin
E: erythema marginatum (annular rash)
S: sydenham chorea
```
JNES resolve with time, no sequelae; not so with O
52
ARF pancarditis
Endocarditis: vegetations on MV (rarely AV) causing regurg.
*Myocarditis: Aschoff bodies (giant cells and fibrinoid/collagen material) *most common COD in ARF
Pericarditis: friction rub
53
Anischkow cells
Histiocytes with "caterpillar nuclei" within Aschoff bodies
54
Chronic re-exposure to GAS
Can lead to chronic rheumatic valvular disease: scarring --> fusion of commissures ("fish mouth appearance") --> stenosis of MV, thickening of chordae
55
distinguish rheumatic valve disease from "wear and tear"
coexisting mitral stenosis and *fusion* of aortic valve (because RHD always starts with mitral, so cannot have only aortic and RHD) also no fusion in normal wear/tear
56
3 complications of aortic valve stenosis?
concentric LVH
angina/syncope w exercise
microangiopathic hemolytic anemia (due to blood flowing across calcified valves)
57
most common cause of aortic regurg?
aortic root dilation
syphilitic aneurysm
infective endocarditis
58
early blowing diastolic murmur
bounding pulses, pulsating nail bed
head bobbing (hyperdynamic circulation)
aortic regurgitation
59
treatment of AR
valve replacement once LV dysfunction develops
60
hallmark sound of MR
mid-systolic click followed by murmur
61
MR murmur intensifies when?
squatting or expiration
62
Acute rheumatic disease causes?
| Chronic rheumatic disease causes?
Mitral regurg
| Mitral stenosis
63
MS complications
LA dilation
Pulmonary congestion/HTN
Atrial fibrillation
Mural thrombi
64
most common overall cause of endocarditis
S. viridans
low virulence
only damaged valves
small vegetations that don't destroy valve
65
most common cause of endocarditis in IV drug users
S. aureus
high virulence
normal valves (tricuspid)
large vegetations that destroy valve
66
endocarditis w prosthetic valves
| endocarditis w colorectal carcinoma
S. epidermidis
| S. bovis
67
endocarditis w negative cultures
HACEK
68
complications of septic emboli
```
Janeway lesions (non-tender)
Osler nodes (painful on fingers/toes)
Splinter hemorrhages
```
69
best way to detect valvular lesions
TEE
70
2 causes of nonbacterial thrombotic endocarditis
sterile lesions on MV via:
hypercoag state
adenocarcinoma
71
sterile vegetations on both sides of valve?
Libman-Sacks
| Assoc w SLE --> MV regurg
72
cardiomyopathy sequelae
dilated heart --> systolic dysfxn
| MV/TV regurg and arrhythmia
73
most common causes of cardiomyopathy
```
idiopathic
genetic
myocarditis
alcohol
drugs (doxorubicin/cocaine)
pregnancy
```
74
dilated cardiomyopathy tx?
transplant
75
hypertrophic CM
dominant
sarcomere protein mutations
LVH
syncope w exercise
76
hypertrophic CM biopsy
myofiber hypertrophy with disarray
77
restrictive CM
| causes (which one in kids?)
decreased compliance --> diastolic problem
Amyloidosis
sarcoidosis
hemochromatosis
endocardial fibroelastosis (kids)
Loeffler syndrome (eos inflammation --> fibrosis)
78
restrictive CM presentation
low voltage EKG
| diminished QRS amplitude
79
benign mesenchymal proliferation w gelatinous appearance
myxoma
abundant GROUND SUBSTANCE
mesenchyme b/c this is only part of heart tissue that can grow
80
most common primary cardiac tumor in adults?
myxoma
81
pedunculated mass in left atrium, blocking the mitral valve
myxoma --> syncope via obstruction of MV
82
most common cardiac tumor in children
| benign hamartoma
rhabdomyoma
83
rhabdomyoma associated w?
| arises where?
tuberous sclerosis
| ventricle
84
heart is common site of met for which tumors?
melanoma
lymphoma
breast/lung carcinoma
85
secondary cardiac tumors (metastases) involve what?
pericardium --> effusion
