Cardiovascular System Flashcards
AAA
abdominal aortic aneurysm
risk factors
Age>65yrs, Male, Smoking
cardiac tamponade
Becks Triad:
1- Increase JVP
2- Hypotension
3- Muffled heart sounds
Kartagner Syndrome
Immotile cilia due to AR microtubular defect in dynein arm (dyenin powers intracellular vesicle transport).
Patients present as:
- Infertility
- Situs inversus
- Chronic sinusitis
- Bronchiectisis
Kawasaki disease
Spiking Fever for 5 days or more.
Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue (Strawberry tounge), hand-foot changes
(mucocutaneous lymph node syndrome,
treat with IVIG and aspirin)
Whipple disease
(Tropheryma whipplei)
Arthralgias, adenopathy, cardiac and neurological symptoms, diarrhea
Sheehan syndrome
(severe postpartum hemorrhage
leading to pituitary infarction)
No lactation postpartum, absent menstruation, cold intolerance
postpartum hemorrhage in pituitary, no LH or FSH = no periods, hyperplasia infarcts; no prolactin = no milk
Osler-Weber-Rendu syndrome
Hereditary hemorrhagic telangiectasia
Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria.
Carney Complex
Classically Traid of:
- Cardiac Myxoma
- Perioral Melanosis
(fancy way of saying hyperpigmentation) - Endocrine Hypersecretion
(classically bilateral pigmented zona fasiculata hyperplasia resulting in Cushing syndrome, but can also be Hyperthyroidism or Growth Harmone)
Holosystolic Murmurs AKA Pansystolic Murmurs
1- Mitral regurgitation (mitral insufficiency; MR)
2- Tricuspid regurgitation (tricuspid insufficiency; TR);
3- Ventricular septal defect (VSD).
Mid-Systolic Murmurs
(Crescendo-Decrescendo Systolic)
1- Aortic stenosis (AS)
2- Hypertrophic obstructive cardiomyopathy (HOCM)
3- Pulmonic stenosis (PS)
Diastolic Opening Snap Murmur
Mitral stenosis (MS) à has diastolic opening snap,
followed by a mid-late decrescendo diastolic murmur
Mid-Systolic click Murmur
MVP (Mitral valve prolapse)
Continuous Machine Like Murmur
PDA
Aka Pansystolic - Pandiastolic
Also described as to and fro murmur.
Murmur with Fixed S2 Splitting
ASD (Atrial Septal Defect)
Holo-diastolic / Pan-diastolic Murmur
1- Aortic regurgitation (aortic insufficiency; AR)
2- Pulmonic regurgitation (pulmonic insufficiency; PR)
Pan-diastolic and loudest in early-diastole
Classically AR (decrescendo
holo-diastolic murmur)
Principle regarding heart murmurs
All will get worse / more prominent with more volume in the heart, however,
MVP and HOCM are the odd ones out; they’ll get worse with less volume in the heart.
Kid with SCD, Fever, Tachycardia presents with a Murmur
Transient, functional high-flow murmur secondary to tachycardia à murmur will subside once HR returns to baseline.
No cardiac abnormality involved.
Aortic Stenosis
- Mid-systolic (crescendo-decrescendo systolic)
- Murmur classically at 2nd intercostal space, right sternal border, with radiation to the carotids;
- Classically presents as: “ S A D “
Syncope , Angina , Dyspnea. - Has slow-rising pulse (“pulsus parvus et tardus”)
- Usually causes Concentric Hypertrophy due to pressure overload.
- Can be seen with normal aging or bicuspid aortic valve.
Maneuvers that decrease blood in the heart
Valsalva; standing up from seated position; sitting up from supine position;
administration of nitrates any of these will cause MVP + HOCM to get worse;
all other murmurs will soften or not change.
Maneuvers that increase blood in the heart
Lying down; leg raise while supine; squatting; handgrip
SVC syndrome
Superior vena cava syndrome
Flushing of face + Congestion of neck veins.
Caused by pancoast tumor (Adenocarcinoma of Lungs)
Lyme Disease
Caused by Borrelia Burgdorferi, a spirochete transmitted by Ixodes tick in Northeast, Mid west, and West coast.
Erythema Migrans (Target shaped lesion ; Bulls Eye lesion) is first symptom.
After several weeks of dissemination;
- Neurological Symptoms: Cranial Nerve Palsy , Bells Palsy.
- Heart block (AV block).
- Arthritis (follows after months to years) due to immune complex type III hypersenstivity.
Tx: Doxycycline.
Cardiac Murmurs concept
Flow through the effected valve:
- ↑Blood Flow = ↑Intensity of Murmur.
- ↓ Blood flow = ↓ Intensity of Murmur.
Preload & Afterload can be changed by manuevers and can affect the murmurs:
- Inspiration & Rapid squatting >↑ intra thoracic pressure > ↑Venous return > ↑ Preload >↑Right sided murmur.
- Handgrip, Valsalva ↑ Afterload > ↓Intensity of the murmur ( VSD, MR, AR ).
Cardiac Action potential
Wolf-Parkinson-White syndrome
(WPW-Syndrome)
- Due to presence of accessory pathway conduction (bundle of kent).
- Shortened PR-interval, Widened QRS complex.
- Delta wave.
- Most common type of ventricular pre-excitation syndrome.
- No AV nodal delay for diastolic filling.
1st Degree Heart Block
- Benign & Asymptomatic
- Increase PR-interval (>200msec)
2nd Degree Heart Block (Type-I)
Mobitz type-I (Wenckebach) :
- Gradual prolongation of PR-interval until u get a P-wave which is not followed by QRS complex (Dropped beat).
2nd Degree Heart Block (Type-II)
Mobitz type-II :
- No prolongation of PR-interval
- Beat is dropped
- Problem in Bundle of His (fibrotic changes)
- Tx: Pacemaker
3rd Degree Heart Block
(Complete AV-block)
- Complete dissosiation of Atria & Ventricles.
- No synchronization between atria & ventricles.
- Ventricles are responding to Ectopic beats.
- Atria and Ventricles depolarize together and create P-wave on QRS or P-wave on T-wave.
- One of the HY cause of 3rd degree block is Lyme disease caused by Borriela Burdogferi.
Chagas Disease
Caused by Protozoa Trypanasoma Cruzii endemic to south america with reduvid bug (Kissing bug) as vector, it can also be transmitted person to person.
- Preferentially infects heart and myenteric nerves. Causing:
> Dilated Cardiomyopathy
> Heart failure
> Arrhythmias
Also assocaited with:
> Myocarditis
> Megaesophagus with achalasia
> Megacolon
Its one of the bugs that can cause heart block.
Give the classic tetrad of IgA vasculitis (Henoch-Schonlein purpura).
- Palpable purpura without thrombocytopenia or coagulopathy (typically over the posterior lower extremities and buttocks)
- Arthritis/arthralgia
- Abdominal pain (due to localized bowel wall inflammation; patients are at risk of intussusception)
- Kidney disease (hematuria +/- proteinuria)
A young adult who smokes and has painful ulcers with dry gangrene on the toes but normal pulses in the foot most likely has?
Buerger disease (thromboangiitis obliterans).
Histopathology reveals segmental inflammatory intramural thrombi of medium and small vessels
A 55-year-old woman presents with unilateral headache, transient vision loss, and jaw claudication. What is the diagnosis?
Giant cell arteritis.
The screening test for this condition is (erythrocyte sedimentation rate [ESR]). A (temporal artery biopsy) is typically obtained to confirm the diagnosis.
Eosinophilic granulomatosis with polyangiitis
AKA Churg Strauss
- Asthma (Late Onset), sinusitis
- Peripheral neuropathy (mononeuropathy multiplex , Wrist drop)
- Subcutaneous nodules or purpura
- Eosinophilia
- Antibodies against Neutrophil MPO (p-ANCA Pattern)
The heart, gastrointestinal system, and kidneys can also be involved. IgE levels are elevated.
Cardiac Action potential
Granulomatous with Polyangitis (GPA)
Systemic necrotizing granulomatous vasculitis affected small and medium vessels.
Assosiated with c-ANCA (cytoplasmic anti neutrophil cytoplasmic antibody).
GPA most commonly infects Sinopulmonary tract, Kidneys and Skin.
Can present as:
Sinusitis, Otitis Media, Mastoditis, Nasal ulceration w Epitaxis, Hemoptysis, Cough.
Hematuria increase risk of RPGN and Renal failure.
Fever, Wt.loss and fatigue are constitutional symptoms.
Dressler syndrome
Chest pain, pericardial effusion/friction rub, persistent fever following MI
(autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)
Pulmonary HTN
- Progressive Dyspnea
- Loud Pulmonic Component of S2 (Left upper sternal border)
- Hereditary form of Pulmonary atrial HTN (PAH) is due to AD inactivating mutation of BMPR2 gene, predisposing the patient to excessive endothelial injury & smooth muscle proliferation.
Infective Endocarditis
Pneumonic “FROM JANE”
- F = Fever
- R = Roth Spot
- O = Osler Nodes
- M = Murmur
- J = Janeway Lesions
- A = Anemia
- N = Nail bed hemorrhage (Splinter hemorrhage)
- E = Emboli
- Digital Clubbing may also be seen
Left Heart Failure (LHF)
- Presents as pulmonary findings (i.e., pulmonary edema, dyspnea, orthopnea, paroxysmal nocturnal dyspnea).
- If there is left heart pathology, PCWP is high
- Hx of Long standing uncontrolled HTN
- Dyspnea
- Orthopnea
- Pulmonary Crackles
LHF → ↑ Diastolic filling pressure → Pulmonary HTN → Rt. Heart Failure
Right Heart Failure (RHF)
- Presents as systemic findings – i.e., jugular venous distension (JVD) & peripheral edema
- Hx of Pulmonary HTN
- Jugular Venous distention
- Pulmonary Edema
Congestive Heart Failure (CHF)
- Congestive heart failure = left heart failure + right heart failure.
- The most common cause of right heart failure is left heart failure.
- In congestive heart failure, we’ll see both left- and right-heart failure findings – i.e., patient will have dyspnea, JVD, and peripheral edema.
- PCWP is elevated in these patients, since the left heart has pathology.
Cor Pulmonale
- Cor pulmonale is defined as right-heart failure due to a pulmonary cause.
- Cor pulmonale will be a patient who has JVD and peripheral edema in the setting of obvious and overt lung disease
- A loud P2 and tricuspid regurgitation are HY findings in cor pulmonale.
Atrial Septal Defect (ASD)
- Fixed splitting of S2
- ASDs can sometimes be responsible for “paradoxical emboli,” where a DVT leads to stroke.
Granulomatosis with polyangiitis
- AKA Wegener granulomatosis.
- Triad of:
1) Hematuria,
2) Hemoptysis,
3) “Head-itis” – i.e., any problem with the head, such as nasal septal perforation, mastoiditis, sinusitis, otitis. - Associated with cANCA and anti-proteinase3 (anti-PR3) antibodies
Eosinophilic granulomatosis with polyangiitis
- AKA Churg Strauss
- Presents as combo of asthma + eosinophilia +/- head-itis.
- Associated with pANCA and anti-myeloperoxidase (anti-MPO) antibodies.
Microscopic polyangiitis
- Will just present as hematuria in a patient who is pANCA / anti-MPO (+).
- Similar to Wegener, can cause RPGN.
Hyperchylomicronemia
(AR)
Deficiency of lipoprotein lipase or Apolipoprotein C-II
- Increase Chylomicrons + TGAs.
- Pancreatitis (abdo, not chest, pain).
- Xanthomas.
- Plasma appears “creamy
Hypercholesterolemia
(AD)
Deficiency (heterozygous) or absence (homozygous) of LDL receptor or Apo B-100
- Increase LDL.
- LDL usually 700-1000 in homozygotes, with
MI in teens (answer = absence of functional LDL receptor). - Xanthomas
Hypertriglyceridemia
(AD)
Increase Hepatic production of VLDL
- Increase TGAs.
- Pancreatitis.
