Cardiovascular - First Aid Flashcards
1
Q
The truncus arteriosus gives rise to…
A
the ascending aorta and pulmonary trunk.
2
Q
The bulbus cordis gives rise to…
A
outflow track of left and right atria.
3
Q
The primitive atria gives rise to…
A
the trabeculated part of left and right atria.
4
Q
The primitive ventricle gives rise to…
A
the trabeculated part of the left and right ventricles.
5
Q
The primitive pulmnoary vein gives rise to…
A
the smooth part of the left atrium.
6
Q
The left horn of the sinus venous gives rise to the…
A
coronary sinus.
7
Q
The right horn of the sinus venous gives rise to…
A
the smooth part of the right atrium.
8
Q
The right common cardinal vein and right anterior cardinal vein give rise to…
A
the SVC.
9
Q
In the vertebrate embryo, the heart is…
A
the first functional organ and it beats spontaneously by week 4.
10
Q
In week 4 of gestation, the primitive heart tube will…
A
loop to establish left-right polarity.
11
Q
A defect in left-right dynein can lead to..
A
dextrocardia (as seen in Kartagener).
12
Q
The foramen ovale closes soon after….
A
birth due to increased LA pressure.
13
Q
A patent foramen ovale is caused by…
A
failure of the septum primum and septum secundum to fuse after birth; most left untreated.
14
Q
Patent foramen ovale can lead to…
A
paradoxical emboli (venous thromboemboli that enter the systemic arterial circulation).
15
Q
Ventricular Septal Defect (VSD) most commonly occurs in..
A
the membranous septum.
16
Q
Babies with VSD are…
A
acyanotic at birth due to left to right shunt.
17
Q
Outflow tract is formed when truncus arteriosus rotates and neural crest and endocardial cell migrations lead to…
A
truncal and bulbar ridges that spiral and fuse to form the aorticopulmonary septum.
18
Q
Conotruncal abnormalities include:
A
- transposition of the great vessels 2. tetralogy of fallot 3. persistent truncus arteriosus
19
Q
The aortic and pulmonary valves are derived from…
A
endocardial cushions of the outflow tract.
20
Q
The mitral and tricuspid valves are derived from…
A
fused endocardial cushions of the AV canal.
21
Q
Fetal erythropoesis occurs in:
A
- Yolk Sac (3-8 wks) 2. Liver (6 wks - birth) 3. Spleen (10-28 wks) 4. Bone marrow (18 wks to adult)
22
Q
Fetal Hb (HbF)
A
alpha2gamma2
23
Q
Adult Hb (HbA)
A
alpha2beta2
24
Q
HbF has higher affinity for oxygen due to…
A
less avid binding of 2,3-BPG. This allows HbF to extract oxygen from maternal Hb across the placenta.
25
Highest concentration of O2 in the fetal circulation is in...
the umbilical vein. PO2 = 30 mmHg 80% saturated w/ O2
26
Blood entering the fetus through the umbilical vein is conducted via the...
ductus venosus into the IVC to bypass the hepatic circulation.
27
Most highly oxygenated blood reaching the heart via the IVC is...
diverted through the foramen ovale and pumped out the aorta to teh head and body.
28
Deoxygenated blood entering the RA from the SVC goes:
RA --\> RV --\> main PA --\> PDA --\> descending aorta
29
PDA is kept open in the fetal period due to...
high fetal pulmonary artery resistance due partly to low O2 tension.
30
At birth, when the infant takes their first breath...
decreased resistance in the pulmonary circulation causes increased left atrial pressure vs. right atrial pressure clossing the foramen ovale.
31
The ductus arteriosus closes due to...
increase in O2 and decrease in prostaglandins (from placental separation).
32
PDA is kept open medically with...
PGE1 and PGE2.
33
The umbilical vein becomes the...
ligamentum teres hepatis contained in the falciform ligament.
34
Umbilical arteries become...
medial umbilical ligaments
35
ductus arteriosus becomes...
ligamentum arteriosum
36
ductus venosus becomes...
ligamentum venosum
37
foramen ovale becomes...
fossa ovalis
38
allantois becomes...
urachus-median umbilical ligament; urachal cyst or sinus is a remnant
39
Notochord becomes...
nucleus pulposus of intervertebral disc
40
SA and AV nodes are supplied by...
the RCA and infarct may cause bradycardia or heart block.
41
The acute marginal artery supplies...
the RV.
42
The posterior decending artery supplies...
the posterior third of the interventricular septum and posterior walls of ventricles.
43
The LAD supplies...
the anterior 2/3 of the interventricular septum, anterior papillary muslce and anterior surface of the left ventricle.
44
The left circumflex coronary artery supplies...
the lateral and posterior walls of the LV.
45
Right-dominant circulation
PDA arises from RCA
46
Left-dominant circulation
PDA arises from LCX
47
Coronary artery occlusion most commonly occurs in the....
LAD.
48
Coronary blood flow peaks in...
early diastole.
49
The most posterior part of the heart is...
the LA; enlargment can cause dysphagia or hoarseness.
50
CO =
SV x HR
51
MAP (mean arterial pressure) =
CO x TPR Also, MAP = 2/3 diastolic pressure + 1/3 diastolic pressure
52
Pulse pressure =
systolic pressure - diastolic pressure
53
Pulse pressure is proportional to...
SV and inversely proportional to arterial compliance.
54
SV =
EDV - ESV.
55
During the early stages of exercise, CO is maintained by...
increased HR and increased SV.
56
During the late stages of exercise, CO is maintained by...
increased HR only, the SV plateaus.
57
Diastole is preferentially shortened with...
increased HR leading to less filling time which decreases CO.
58
Increased pulse pressure is seen in (5):
1. hyperthyroidism 2. aortic regurgitation 3. arteriosclerosis 4. obstructive sleep apnea 5. exercise
59
Decreased pulse pressure is seen in (4):
1. aortic stenosis 2. cardiogenic shock 3. cardiac tamponade 4. advanced heart failure
60
Stroke volume is increased by...
increased contractility, increased preload and decreaed afterload.
61
Contractility increases with:
1. catecholamines 2. increased intracellular calcium 3. decreased extracellular sodium 4. digitalis
62
Catecholamines increase contractility by...
increasing the activity of the Ca2+ pump in the SR
63
Digitalis increases contractility by...
blocking the Na/K pump leading to increased intracellular sodium leading to decreased Na/Ca exchange leading to increased intracellular Ca
64
Contractility decreases with (5):
1. beta1-blockade (decreased cAMP) 2. heart failure with systolic dysfunciton 3. acidosis 4. hypoxia/hypercapnea 5. non-dihydropyridine Calcium channel blockers
65
Preload is approximated by..
ventricular EDV; it depends on venous tone and circulating blood volume.
66
Preload can be decreased with...
VEnodilators. (nitroglycerin)
67
Afterload is approximated by...
MAP.
68
The LV compensates for increased afterload by...
thickening to decrease wall tension.
69
Afterload is decreased with...
Vasodilators (Hydralazine).
70
Both preload and afterload are decreased by...
ACE inhibitors and ARBs.
71
Left ventricular EF is an index of...
ventricular contractility. Normal EF is \> 55%.
72
EF is decreased in...
systolic heart failure and normal in diastolic heart failure.
73
Total resistance of vessels in series
TR = R1 + R2 + R3
74
Total resistance of vessels in parallel
1/TR = 1/R1 + 1/R2 + 1/R3
75
Viscosity depends mostly on...
hematocrit.
76
Viscosity increases in...
-polycythemia -hyperproteinemic states -aHereditary spherocytosis
77
Viscosity decreases in...
anemia.
78
Resistance is directly proportional to...
viscosity and vessel length and inversely proportional to the radius to the 4th power.
79
Most of the TPR is accounted for by...
arterioles which regulate capillary flow.
80
Positive Inotropes
catecholamines, digoxin
81
Negative Inotropes
heart failure, narcotic overdose
82
Things that increase volume, venous tone
fluid infusion, sympathetic activity
83
Things that decrease volume, venous tone
acute hemorrhage, spinal anesthesia
84
Things that increase TPR
vasopressors
85
Things that decrease TPR
exercise, AV shunt
86
S1
mitral and tricuspid valve closure; loudest at mitral area
87
S2
aortic and pulmonary valve closure; loudest at left sternal border
88
S3
in early diastole during rapid ventricular filling phase; associated with incresed filling pressures (MR, HCR) and is more common in dilated ventricles
89
S4
in late diastole; high atrial pressure; associated with ventricular hypertrophy; left atrium must push against the stiff LV wall
90
Normal splitting
Inspiration leads to a drop in intrathoracic pressure leading to an increase in venous return to the RV. Increased RV stroke volume leads to increased RV ejection time leading to delayed closure of the pulmonary valve.
91
Normal splitting is also contributed to by...
decreased pulmonary impedance.
92
Wide splitting is seen in conditions that...
delay RV emptying (pulmonic stenosis, right bundle branch block)
93
Fixed splitting is seen in...
ASD which leads to a left to right shunt which leads to increased RA and RV volumes which leads to increased flow through the pulmonic valve such that regardless of breath, pulmonic closure is greatly delayed.
94
Paradoxical splitting is seen in conditions that...
delay LV (aortic stenosis, left bundle branch block).
95
In paradoxical splitting, the normal order of valve closure is...
reversed so that P2 sound occurs before delayed A2 sound. Therefore, on inspiration, P2 closes later and moves closer to A2 (paradoxical).
96
Aortic area murmurs
Systolic 1. aortic stenosis 2. flow murmur 3. aortic valve sclerosis
97
Left sternal border murmurs
Systolic 1. Hypertrophic cardiomyopathy Diastolic 1. aortic regurgitation 2. pulmonic regurgitation
98
Pulmonic area murmurs
Systolic 1. pulmonic stenosis 2. flow murmur
99
Tricuspid area murmurs
Pansystolic 1. tricuspid regurgitation 2. VSD Diastolic 1. tricuspid stenosis 2. ASD
100
Mitral area murmurs
Systolic 1. mitral regurgitation Diastolic 1. mitral stenosis
101
ASD commonly presents with...
a pulmonary flow murmur (increased flow through the pulmonic valve) and a diastolic rumble (increased flow across the tricuspid).
102
Blood flow across the actual ASD does...
not cause a murmur bc there is no pressure gradient.
103
Inspiration maneuver will...
increase the intensity of the right heart sounds.
104
Hand grip (increases systemic vascular resistance) which will...
increase intensity of MR, AR, and VSD murmurs decrease the intensity of AS, hypertrophic cardiomyopathy murmurs
105
Valsalva (standing decreases venous return) will...
decrease intensity of most murmurs increase intensity of the hypertrophic cardiomyopathy murmur
106
Rapid squatting (increases venous return, increases preload, increases afterload)
decreases intensity of hypertrophic cardiomyopathy murmur increases intensity of AS murmur
107
Mitral Regurgitation murmur
-holosystolic, high-pitched "blowing murmur" -loudest at apex, radiates toward axilla
108
MR murmur is enhanced by...
maneuvers that increase TPR (squatting, hand grip).
109
MR is often due to...
ischemic heart disease, MVP or LV dilation.
110
Tricuspid regurgitation murmur
-holosystolic, high-pitched "blowing murmur" -loudest at tricuspid and radiates to the right sternal border
111
TR murmur is enhanced by...
maneuvers that increase RA return (inspiration).
112
TR is commonly caused by...
RV dilation.
113
Rheumatic fever and endocarditis can cause either...
MR or TR.
114
Aortic Stenosis murmur
-crescendo-decrescendo systolic ejection murmur -loudest at base; radiates to carotids -pulsus parvus et tardus
115
Aortic stenosis can lead to...
Syncope, Angina and Dyspnea on exertion
116
Aortic stenosis is often due to...
age-related calcific aortic stenosis or bicuspid aortic valve.
117
VSD murmur
-holosystolic, harsh sounding murmur -loudest at tricuspid area -accentuated with hand grip maneuver due to increased afterload
118
Mitral valve prolapse murmur
-late systolic crescendo murmur with midsystolic click -best heard over apex and just before S2
119
MVP can predispose to...
infective endocarditis.
120
MVP can be caused by...
myxomatous degeneration, rheumatic fever or chordae.
121
MVP occurs earlier with...
maneuvers that decrease venous return (standing or valsalva).
122
Aortic regurgitation murmur
-high pitched "blowing" early diastolic decrescendo murmur -wide pulse pressure
123
Aortic regurgitation can present with...
boudning pulses and head bobbing.
124
AR is often due to...
aortic root dilation, bicuspid aortic valve, endocarditis or rheumatic fever.
125
Aortic regurgitation murmur is increased during...
hand grip. Vasodilators decrease the intensity of the murmur.
126
Mitral stenosis murmur
-follows opening snap due to abrupt halt in leaflet motion in diastole after rapid opening due to fusion of the leaflets -delayed rumbling late diastolic murmur
127
With mitral stenosis, a decreased interval between S2 and the opening snap correlates with...
increased severity.
128
MS often occurs secondary to...
rheumatic fever. Can lead to LA dilatation.
129
MS murmur is enhanced by...
maneuvers that increase LA return (expiration).
130
PDA murmur
-continuous machine-like murmur -loudest at S2 -best heart at left infraclavicular area
131
PDA is often due to...
congenital rubella or prematurity.
132
T wave inversion may indicate...
recent MI.
133
U wave is caused by...
hypokalemia and bradycardia.
134
Speed of conduction
Purkinje \> atria \> ventricles \> AV node
135
Pacemaker potential
SA \> AV \> bundle of His/purkinje/ventricles
136
Torsades de pointes is...
polymorphic ventricular tachycardia characterized by shifting sinusoidal waveforms on ECG.
137
Torsades de pointes can progress to...
ventricular fib.
138
A predisposing factor for Torsades is...
long QT interval.
139
Torsades is caused by...
drugs, decreased K, decreased Mg.
140
Treatment of Torsades is with...
magnesium sulfate.
141
Congenital long QT is an...
inherited disorder of myocardial repolarization typically due to ion channel defects.
142
2 types of Congenital long QT syndrome
1. Romano-Ward Syndrome 2. Jervell and Lange-Nielsen Syndrome
143
Romano-Ward Syndrome features
-congenital long QT -autosomal dominant -pure cardiac phenotype
144
Jervell and Lange-Nielsen syndrome features
-congenital long QT -autosomal recessive -sensorioneural deafness
145
Wolff-Parkinson-White (WPW) Syndrome is the most common type of...
ventricular pre-excitation syndrome. There is an abnormal fast accessory conduction pathway from the atria to ventricle that bypasses the rate-slowing AV node.
146
As a result of the accessory pathway in WPW, ventricles begin to...
partially depolarize earlier, giving rise to the characteristic delta wave with shortened PR interval on ECG.
147
WPW may result in...
a reentry circuit leading tosupraventricular tachycardia.
148
A. fib ECG
no discrete P waves erratic baseline (irregularly irregular)
149
A. fib can result in...
atrial stasis and lead to thromboembolic stroke.
150
Treatment for A. fib includes...
rate control, anticoagulation, and possible pharmacolgical or electrical cardioversion.
151
Atrial flutter is....
a rapid succession of identical back-to-back atrial depolarization waves. "sawtooth appearance"
152
Pharmacologic conversion to sinus rhythm for atrial flutter
-class IA, IC or III antiarrhythmics
153
Rate control for atrial flutter
beta-blocker or calcium channel blocker
154
Definitive treatment for atrial flutter is...
catheter ablation
155
V. fib ECG
completely erratic with no identifiable waves.
156
V. fib will cause...
fatal arrhythmia w/o immediate CPR and defibrillation
157
1st degree AV block
-PR interval prolonged (\> 200 ms) -benign/asymptomatic -No treatment
158
2nd degree AV block - Mobitz type I
-progressive lengthening of the PR interval until a beat is dropped -usually asymptomatic
159
2nd degree AV block - Mobitz type II
-dropped beats that are not preceded by a change in the length of the PR interval -usually 2:1 per block -may progress to 3rd degree -treated with pacemaker
160
3rd degree AV block
-atria and ventricles beat independently of each other -both P waves and QRS complexes are present (no relation to each other) -atrial rate faster than ventricular -treated with pacemaker -can be due to lyme disease
161
Atrial natriuretic peptide (ANP) is released from...
atrial myocytes in response to increased blood pressure and atrial pressure.
162
ANP causes...
vasodilation and decreased sodium reabsorption at the renal collecting tubule. It constricts the efferent renal arterioles and dilates the afferent arterioles via cGMP, promoting diuresis and "aldosterone escape".
163
B-type natriuretic peptide is released from..
ventricular myocytes in response to increased tension. It has similar physiologic action to ANP with a longer half-life.
164
BNP blood test is used for diagnosing...
heart failure (good negative predictive value)
165
Nesiritide is...
a recombinant form of BNP used to treat HF.
166
Aortic arch receptors transmits signals via...
the vagus nerve to the solitary nucleus of the medulla and responds to increased bp only.
167
Carotid sinus recptors transmit singals via...
the glossopharyngeal nerve to teh solitary nucleus of medulla. It responds to both increased and decreased blood pressure.
168
Cushing Reaction
increased intracranial pressure constricts arterioles leading to cerebral ischemia and reflex sympathetic increase in pefusion pressure leading to increased stretch and baroreceptor mediated bradycardia.
169
Peripheral chemoreceptors are stimulated by...
decreased PO2 (less than 60), increased PCO2 and decreased pH of blood.
170
Central chemoreceptors are stimulated by...
changes in pH and PCO2 of brain interstiatial fluid.
171
Organ with largest share of systemic CO
liver
172
Organ with highest blood flow per gram of tissue
kidney
173
Pulmonary capillary wedge pressure is a good approximation of...
left atrial pressure.
174
In mitral stenosis, PCWP is...
greater than LV diastolic pressure.
175
Factors determining autoregulation in the heart
-local metabolites - CO2, adenosine, NO
176
Factors determining autoregulation in the brain
local metabolites - CO2
177
Factors determing autoregulation in the kidneys
myogenic and tubuloglomerular feedback
178
factors determining autoregulation in the lungs
hypoxia causes vasoconstriction
179
Factors determining autoregulation in the skeletal muscle
lactate, adenosine, K+, H+, CO2
180
factors determining autoregulation in the skin
sympathetic stimulation
181
Kf =
filtration constant (capillary permeability)
182
Jv (net fluid flow) =
(Kf)(Pnet)
183
Pnet (net filtration pressure) =
(Pc - Pi) - (pic - pii)
184
Increased capillary pressure can be caused by...
heart failure.
185
Decreased plasma proteins can be due to...
nephrotic syndrome or liver failure.
186
Increased capillary permeability can be caused by...
toxins, infxns, burns.
187
Increased interstitial fluid colloid osmotic pressure can be caused by...
lymphatic blockage. q
188
22q11 Syndrome (Digeorge) is associated with...
truncus arteriosus and tetralogy of fallot
189
Down Syndrome is associated with...
ASD, VSD, and AV septal defect (endocardial cushion defect)
190
Congenital rubella is associated with...
septal defects, PDA and pulmonary artery stenosis.
191
Turner syndrome is associated with...
bicuspid aortic valve and coarctation.
192
Marfan is associated with...
MVP, thoracic aortic aneurysm and dissection, and aortic regurgitation.
193
The infant of a diabetic mother is at increased risk for...
transposition of the great vessels.
194
Hypertensive emergency
-severe hypertension (\>180/120) -acute ongoing target organ damage (papilledema, mental status changes)
195
HTN predisposes to..
atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy and aortic dissection.
196
Primary HTN is related to...
increased CO and TPR.
197
Secondary HTN is due to...
renal disease, including fibromuscular dysplasia (in younger pts).
198
On angiogram, fibromuscular dysplasia is shown as...
"string of beads" of the renal artery.
199
Xanthomas are...
plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids.
200
Tendinous xanthoma is seen in...
the achilles (lipid deposit).
201
Corneal arcus is...
lipid depsoit in the cornea that appears early in life with hypercholesterolemia. Common in elderly.
202
Monckeberg Arteriosclerosis is...
calcification in the media of the arteries (esp radial or ulnar).
203
Monckeberg arteriosclerosis shows...
"pipestem" arteries on x-ray.
204
Monckeberg arteriosclerosis does not...
obstruc blood flow and intima is not involved.
205
Arteriolosclerosis is either...
hyaline or hyperplastic.
206
Hyaline arteriolosclerosis is...
thickening of small arteries in essential HTN or DM.
207
Hyperplastic arteriolosclerosis is...
"onion skinning" seen in severe HTN.
208
Modifiable risk factors for atherosclerosis
-smoking -HTN -hyperlipidemia -diabetes
209
Nonmodifiable risk factors for atherosclerosis
-age -sex (increased in men and postmenopausal women) -FHx
210
Progression of Atherosclerosis
endothelial cell dysfunction --\> macrophage and LDL accumulation --\> foam cell formation --\> fatty streaks --\> smooth muscle migration, proliferation and ECM deposition --\> fibrous plaques --\> complex atheromas
211
Compolications of atherosclerosis (6)
1. aneurysms 2. ischemia 3. infarcts 4. peripheral vascular disease 5. thrombus 6. emboli
212
Symptoms of atherosclerosis
-angina -claudication
213
Abdominal aortic aneurysm occurs more frequently in...
hypertensive male smokers older than 50.
214
Abdominal aortic aneurysm is associated with..
atherosclerosis.
215
Thoracic aortic aneurysm is associated with...
cystic medial degeneratio ndue to HTN or Marfan and tertiary syphilis.
216
Aortic dissection is a...
longitudinal intraluminal tear forming a false lumen.
217
Aortic disseciton is associated with...
HTN, bicuspid aortic valve, and inherited CT disorders.
218
Aortic dissection can present with...
tearing chest pain, with sudden onset, radiation to the back and +/- unequal BP in arms.
219
CXR of aortic dissection shows...
mediastinal widening.
220
Aortic dissection results in...
pericardial tamponade, aortic rupture and death.
221
Angina is usually due to...
ischemic myocardium secondary to coronary artery stenosis or spasm.
222
Stable Angina is usually secondary to...
atherosclerosis.
223
Stable angina presents with...
exertional chest pain (ST depression) that resolves with rest.
224
Variant angina (Prinzmetal) occurs at rest secondary to...
coronary artery spasm. Tranisent ST elevation.
225
Triggers of variant angina are...
tobacco, cocaine, triptans.
226
Treat variant angina with...
calcium channel blockers, nitrates and smoking cessation.
227
Unstable/crescendo angina is due to...
thrombosis with incomplete coronary artery occlusion; ST depression on ECG.
228
Unstable angina presents with...
increased frequency/intensity of chest pain and at rest
229
Coronary steal syndrome occurs...
distal to coronary stenosis and the vessels are maximally dilated at baseline.
230
In coronary steal syndrome, administration of vasodilators (dipyridamole, regadenoson) dilates...
normal vessels and shunts blood toward well-perfused areas leading to decreased flow and ischemia in the poststenotic region.
231
MI is most often due to...
acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary artery and myocte necrosis.
232
If MI is transmural, ECG will show...
ST elevation.
233
If MI is subendocardial, ECG may show...
ST depressions.
234
Sudden Cardiac Death is...
death from cardiac causes within 1 hr of onset of symptoms, most commonly due to a lethal arrhythmia.
235
Sudden cardiac death is associated with...
CAD, cardiomyopathy and hereditary ion channelopathies.
236
Chronic ischemic heart disease is...
progressive onset of CHF over many yrs due to chronic ischemic myocardial damage.
237
Most commonly occluded arteries in MI
LAD \> RCA \> circumflex
238
Cardiac troponin I rises after...
4 hrs and is increaesd for 7-10 days after MI. More specific than other protein markers.
239
CK-MB is predominantly found in...
the myocardium but can also be released from skeletal muscle.
240
CK-MB is useful in diagnosing...
reinfaction following acute MI bc levels return to normal after 48 hours.
241
ECG changes of MI
-ST elevation (transumral) -ST depresion (subendocardial) -pathologic Q waves (old transmural)
242
Anterior wall infarct (LAD) is seen in leads...
V1-V4.
243
Anteroseptal infarct (LAD) is seen in leads...
V1-V2.
244
Anterolateral infarct (LAD or LCX) is seen in leads...
V4-V6.
245
Lateral wall infarct (LCX) is seen in leads...
I, aVL.
246
Inferior wall infarct (RCA) is seen in leads...
II, III, aVF.
247
Cardiac arrhythmia is...
an important cause of death before reaching the hospital; common in first few days after MI.
248
Ventricular free wall rupture leads to...
cardiac tamponade.
249
Papillary muscle rupture leads to....
mitral regurgitation.
250
Interventricular septum ruptur leads to...
VSD.
251
Greatest risk of wall/septum rupture and papillary muslce rupture after MI is...
6-14 days postinfarct.
252
Greatest risk of ventricular pseudoaneurysm formation is...
1 wk post-infarct. It leads to decreased CO, risk of arrhtyhmia, and embolus from mural thrombus.
253
Risk of postinfarction fibrinous pericarditis is greatest...
1-3 days post-MI.
254
Dressler syndrome is...
an autoimmune phenomenon resulting in fibrinous pericarditis (seen several weeks post-MI).
255
Dilated cardiomyopathy is often idiopathic or congenital but other causes include...
-Alcohol abuse -Beriberi -Coxsackie B virus myocarditis -Cocaine use -Chagas disease -Doxorubicin toxicity -hemochromatosis -peripartum cardiomyopathy
256
Findings of Dilated cardiomyopathy
-HF -S3 -dilated heart on echocardiogram -balloon appearance of heart on CXR -systolic dysfunction (decreased EF) -eccentric hypertrophy
257
Treatment of dilated cardiomyopathy
-Na restriction -ACE inhibitors -Beta-blockers -diuretics -digoxin -implantable carioverter defibrillator -heart transplant
258
Hypertrophic cardiomyopathy is usually...
familial, AD and due to a beta-myosin heavy-chain mutation.
259
Hypertrophic cardiomyopathy can be assocaited with...
Friedreich ataxia
260
Hypertrophic cardiomyopathy is a cause of...
sudden death in young athletes due to ventricular arrhythmia.
261
Findings of Hypertrophic cardiomyopathy
-S4 -systolic murumur -diastolic dysfunction -often septal predominance of hypertrophy -myofibrillar disarray and fibrosis
262
Obstructive HCM is when...
the hypertrophied septum is too close to teh anterior mitral leaflet leading to outlet obstruction leadin gto dyspnea and possible syncope.
263
Treatment of HCM
-cessation of high-intensity athletics -beta-blocker or calcium channel blocker -ICD
264
Major causes of restrictive/infiltrative cardiomyopathy include...
sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, Loffler syndrome and hemochromatosis.
265
Loffler syndrome is...
endomyocardial fibrosis with a prominent eosiniophilic infiltrate.
266
Restrictive cardiomyopathy leads to...
diastolic dysfunction. There can be low-voltage ECG despite a thick myocardium.
267
CHF is a clinical syndrome of...
cardiac pump dysfunction. Symptoms include dyspnea, orthopnea, and fatigue. Signs include rales, JVD and pitting edema.
268
Systolic dysfunction features
-low EF -poor contractility -often secondary to ischemic heart disease or DCM
269
Diastolic dysfunction features
-normal EF and contractility -impaired relaxation -decreased compliance
270
Right heart failure most often results from...
left heart failure.
271
Isolated right heart failure is due to...
cor pulmonale.
272
Drugs that decrease the mortality of CHF
-ACE inhibitors -beta-blockers -AngII receptor blockers -spironolactone
273
In CHF, thiazides and loop diuretics are mainly used for...
symptomatic relief.
274
Hydralazine with nitrate therapy improves...
both symptoms and mortality in some CHF pts.
275
In pulmonary edema, an increased pulmonary venous pressure leads to...
pulmonary venous distention and transudation of fluid.
276
Pulmonary edema has the presence of...
hemosiderin-laden macrophages (heart failure cells) in the lungs.
277
Orthopnea is...
shortness of breath when supine due to increased venous return exacerbating the pulmonary congestion.
278
Bacterial endocarditis presents with...
fever, new murmur, Roth spots, Osler nodes, Janeway lesions, anemia, and splinter hemorrhages.
279
Acute bacterial endocarditis is due to...
S. aureus; large vegetations on previouisly normal valves.
280
Subacute bacterial endocarditis is due to...
viridans streptococci; smaller vegetations on congenitally abnormal valves; sequela of dental procedures
281
Culture negative bacterial endocarditis is most likely due to...
Coxiella burnetii and Bartonella.
282
Endocarditis may also be nonbacterial secondary to...
malignancy, hypercoagulable state or lupus. \*S. bovis present in colon cancer. \*\*S. epidermidis present on prosthetic vavles.
283
The most commonly involved valve in endocarditis is...
the mitral valve.
284
Involvement of the tricuspid valve with endocarditis is associated with...
IV drug abuse; S. aureus, Pseudomonas and Candida.
285
Complications of bacterial endocarditis
-chordae rupture -glomerulonephritis -suppurative pericarditis -emboli
286
Rheumatic fever is a consequence of...
pharyngeal infection with group A beta-hemolytic streptococci.
287
Rheumatic fever casues early death due to...
myocarditis.
288
Late sequelae of rheumatic fever includes rheumatic heart disease which affects the valves in this order....
mitral \> aortic \> tricuspid. (high pressure valves are affected most)
289
Early lesion of rheumatic fever is...
mitral valve regurgitation. Late lesion is mitral stenosis.
290
Rheumatic fever is assocaited with...
Aschoff bodies (granuloma with giant cells) Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus) increased ASO titers
291
Rheumatic fever is not a direct effect of the bacteria. It is...
immune mediated (type II HSR). There are antibodies to M protein that cross react with self-antigens.
292
Acute pericarditis commonly presents with...
sharp pain, aggravated by inspiration adn relieved by sitting up or leaning forward. Friction rub.
293
ECG changes of acute pericarditis include...
ST segment elevation and/or PR depression.
294
Fibrinous acute pericarditis is caused by...
Dressler syndrome, uremia, radiation. Presents with a loud friction rub.
295
Serous pericarditis is...
viral pericarditis; noninfectious inflammatory diseases
296
Suppurative/purulent pericarditis
usually caused by bacterial infections (pneumococcus, strep)
297
Cardiac tamponade is...
compression of the heart by fluid in the pericardium leading to decreased CO.
298
Cardiac tamponade displays equibrilation of...
diastolic pressure in all 4 quadrants.
299
Findings of cardiac tamponade
-Beck triad (hypotension, distended neck veins, distant heart sounds) -increased HR -pulsus paradoxus -Kussmaul sign
300
ECG of cardiac tamponade shows...
low voltage QRS and electrical alternans
301
Pulsus paradoxus is..
decrease in amplitude of systolic blood pressure by more than 10 mmHg during inspiration.
302
Pulsus paradoxus is seen in...
cardiac tamponade, asthma, OSA, pericarditis and croup.
303
Tertiary syphilis disrupts the vasa vasorum of the aorta with consequent...
atrophy of the vessel wall and dilation of the aorta and valve ring.
304
Syphilitic heart disease may display...
calcification of the aortic root an dascending aortic arch. This leads to "tree bark" appearnce of the aorta.
305
Syphilitic heart disease may result in...
aneurysm of the ascending aorta or aortic insufficiency.
306
The most common primary cardiac tumor in adults is...
myxoma. 90% occur in the atria.
307
Myxomas are usually described as....
a "ball valve" obstruction in the LA associated with multiple syncopal episodes.
308
The most frequent primary cardiac tumor in children is...
a rhabdomyoma associated with tuberous sclerosis.
309
The Kussmaul sign is...
increase in JVP on inspiration instead of a normal decrease.
310
Increased JVP upon inspiration can occur when the negative intrathoracic pressure is not...
transmitted to the heart and there is impaired filling of the RV leading to backup of blood in the vena cava leading to JVD.
311
Kussmaul sign may be seen with...
constrictive pericarditis, restrictive cardiomyopathies, and right atrial or ventricular tumors.
312
The raynaud phenomenon is called Raynaud syndrome when....
secondary to a disease process sucha as mixed CT disorder, SLE or CREST syndrome.
313
Strawberry hemangioma is a...
benign capillary hemangioma of infancy.
314
Strawberry hemangioma appears in...
the first few wks of life, grows rapidly and regresses spontaneously at 5-8 yrs.
315
Cherry hemangioma is...
a benign capillary hemangioma of the elderly. They do not regress.
316
Pyogenic granulmona is...
a polypoid capillary hemangioma that can ulcerate and bleed.
317
Pyogenic granuloma is associated with...
trauma and pregnancy.
318
A cystic hygroma is...
a cavernous lymphangioma of the neck.
319
Cystic hygroma is associated with..
Turner syndrome.
320
Glomus tumor is...
a benign, painful, red-blue tumor under the fingernails.
321
Glomus tumor arises from...
modified smooth muscle cells of the glomus body.
322
Bacillary angiomatosis is...
a benign capillary skin papules found in AIDS pts.
323
Bacillary angiomatosis is caused by...
Bartonella henselae.
324
Angiosarcoma is a...
blood vessel malignancy typically occuring int he head, neck and breast. Usually in elderly on sun-exposed areas.
325
Angiosarcoma is associated with...
radiation and arsenic.
326
Angiosarcoma is difficult to resect due to...
delay in diagnosis.
327
Lymphangiosarcoma is...
a lymphatic malignancy associated with peristent lymphedema (post-radical mastectomy).
328
Kaposi sarcoma is...
an endothelial malignancy of the skin, but also the mouth, GI tract and respiratory tract.
329
Kaposi sarcoma is associated with...
HHV-8 and HIV.
330
Bacillary angiomatosis is often mistaken for...
Kaposi sarcoma and vice versa.
331
Temporal (Giant Cell) Arteritis Features
-elderly females -unilateral headache, jaw claudication -branches of carotid a -focal granulomatous inflammation
332
Temporal arteritis may lead to...
irreversible blindness due to ophthalmic artery occlusion.
333
Temporal arteritis is asscoaited with...
polymyalgia rheumatica.
334
Temporal arteritis is treated with...
high-dose corticosteroids prior to temporal artery biopsy to prevent vision loss.
335
Takayasu arteritis features
-asian females less than 40 -pulseless disease -fever -night sweats -arthritis -myalgias -skin nodules -ocular disturbances -granulomatous thickening and narrowing of aortic arch
336
Polyarteritis nodosa features
-young adults -Hep B -fever, weight loss, malaise, HA -abdomainal pain, melena -HTN, neurologic dysfunction, cutaneous eruptions, renal damage
337
Polarteritis nodosa typically involves...
renal and visceral arteries (not pulmonary).
338
Polarteritis nodosa is mediate by...
immune complex. There is transmural inflammation of the arterial wall with fibrinoid necrosa.
339
On arteriogram, polyarteritis nodosa displays...
innumerable microaneurysms and spasm.
340
Polyarteritis nodosa is treated with...
corticosteroids and cyclophosphamide.
341
Kawasaki disease features
-asian children \< 4 -fever, cervical lymphadenitis, conjunctival injection, strawberry tongue, hand-foot erythema, desquamating rash
342
Kawasaki diseaes may develop...
coronary artery aneurysms with thrombosis leading to MI or rupture.
343
Kawasaki should be treated with...
IV immunoglobulin and aspirin.
344
Buerger disease features
-heavy smokers, males \< 40 -intermittent claudication leading to gangrene, autoamputation of digits -nodular phlebitis -segmental thrombosin vasculitis
345
Buerger disease often also presents with..
raynaud phenomenon.
346
Treat Buerger disease with...
smoking cessation.
347
Wegener's granulomatosis with polyangiitis features
-upper respirator tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis -lower respirator tract: hemoptysis, cough, dyspnea -renal: hematuria, red cell casts \*PR3-ANCA/c-ANCA
348
Triad of Wegener's granulomatosis
-focal necrotizing vasculitis -necrotizing granulomas in the lung and upper airways -necrotizing glomerulonephritis
349
CXR of Wegener's shows...
large nodular densities.
350
Treat Wegener's with...
cyclophosphamide and corticosteroids.
351
Microscopic polyangiitis is...
necrotizing vasculitis involving the lungs, kidneys, and skin with pauci-immune glomerulonephritis and palpable purpura.
352
Microscopic polyangiitis presents similarly to...
granulomatosis with polyangiitis (Wegener's) but without the nasopharyngeal involvement. No granulomas. \*\*MPO-ANCA/p-ANCA
353
Treat Microscopic polyangiitis with...
cyclophosphamide and corticosteroids.
354
Churg-Strauss syndrome presents with...
asthma, sinusitis, palpable purpura and peripheral neuropathy. Can also involve the heart, GI and kidneys.
355
Pathology of Churg-Strauss
granulomaotus, necrotizing vasculitis with eosinophilia
356
Labs of Churg Strauss
-MPO-ANCA/p-ANCA -increased IgE
357
The most common childhood systemic vasculitis is...
Henoch-Schonlein purpura and it often follows a URI. Associated with IgA nephropathy.
358
Classic triad of Henoch-Schonlein purpura is...
1. Skin (palpable purpura on buttocks/legs) 2. Arthralgias 3. GI (abdominal pain, melena, multiple lesions of the same age)
359
The vasculitis of Henoch-Schonleinpurpura is secondary to...
IgA deposition.
