Cardiovascular Miscellany I Flashcards
Cardiac Raynaud
coronary artery hyper-reactivity of sufficient duration (20-30 minutes)–can lead to variant angina
Prinzmetal angina
characterized by 5-15 minute episodes of angina pectoris AT REST (usually between midnight and early morning in association with ST-segment elevation)
What causes prinzmetal angina?
Vascular smooth muscle hyper-reactivity central to pathogenesis
Epidemiology of prinzmetal angina.
Japanese, <50 y/o, SMOKING (large risk factor)
Contraction Band Necrosis
transverse bands of hyper-contracted sarcomeres
What causes contraction band necrosis?
When cardiac myocytes run out of energy and are exposed to calcium, actin-myosin interactions are enhanced resulting in hypercontraction or a agonal titanic state of un-relaxable sarcomeres
In what 2 situations do you see contraction band necrosis?
May be due to repurfusion of dead myocardium or coronary artery vasospasm
What is another name for Takotsubo cardiomyopathy?
“broken heart syndrome”
Takotsubo cardiomyopathy
Coronary artery vasospasm due to emotional stress that can cause myocardial ischemia, MI, or sudden cardiac death.
Stasis Dermatitis
Erythematous, scaling, and eczematous patches or plaques affecting the lower extremities (meidal ankle most commonly involved) due to persistent edema from incompetent varicose vein valves
Varicose Ulcers
secondary ischemic skin ulceration due to persistent edema from incompetent varicose vein valves that had poor wound healing and superimposed infection
Esophageal Varices
liver cirrhosis leading to portal vein hypertension opens the porto-systemic shunts and increases blood flow into veins at the gatro-esophageal junction.
Caput medusae
liver cirrhosis leading to portal vein hypertension leads to increased blood flow into periumbilical veins of the abdominal wall
Hemorrhoids
increased blood flow to anorectal junction that results from prolonged pelvic vascular congestion associate with pregnancy or straining to defecate
Trosseau syndrome
venous thrombi may result from elaboration of procoagulant factors from malignant tumors—causing a hypercoagulable state that can manifest as evanescent thromboses in different vascular beds at different times
What is the most important risk factor for DVT?
Prolonged immobilizaiton leading to venous stasis is most important risk factor
Epidemiology of DVT.
COMMON 400,000/year, higher in men, increase with age
DVT is associated with what?
Can be associated with cancer (hypercoagulable state), hospitalization, surgery, and major trauma
Where do pulmonary emboli come from?
proximal thrombosis which is above popliteal vein
Diagnostics of DVT.
erythemia (SP), superficial venous dilation (SP), calf/ankle swelling (SN), swelling of entire leg (SP)
D-dimer is one of the best tests!
Homan sign.
pain in the calf on forceful and abrupt dorsiflexion of the patient’s foot at the ankle while the knee is extended (BAD test for DVT- you can dislodge thrombus)
What neoplasms commonly lead to SVC syndrome.
bronchogenic carcinoma or mediastinal lymphoma
Symptoms of SVC syndrome.
o Obstruction produces clinical complex of marked dilation of veins of head, neck, and arms (associated with cyanosis)
o Pulmonary vessels can be compressed—leading to respiratory distress
What neoplasms commonly lead to IVC syndrome.
hepatocellular carcinoma and renal cell carcinoma
