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Rapid Review Step 1 > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

AAA

A

abdominal aortic aneurysm
risk factors
Age>65yrs, Male, Smoking

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2
Q

cardiac tamponade

A

Becks Triad:

1- Increase JVP
2- Hypotension
3- Muffled heart sounds

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3
Q

Kartagner Syndrome

A

Immotile cilia due to AR microtubular defect in dynein arm (dyenin powers intracellular vesicle transport).
Patients present as:

  • Infertility
  • Situs inversus
  • Chronic sinusitis
  • Bronchiectisis
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4
Q

Kawasaki disease

A

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)

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5
Q

Whipple disease

A

(Tropheryma whipplei)
Arthralgias, adenopathy, cardiac and neurological symptoms, diarrhea

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6
Q

Sheehan syndrome

A

(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

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7
Q

Osler-Weber-Rendu syndrome

A

Hereditary hemorrhagic telangiectasia
Telangiectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria.

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8
Q

Carney Complex

A

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)
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9
Q

Holosystolic Murmurs AKA Pansystolic Murmurs

A

1- Mitral regurgitation (mitral insufficiency; MR)
2- Tricuspid regurgitation (tricuspid insufficiency; TR);
3- Ventricular septal defect (VSD).

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10
Q

Mid-Systolic Murmurs
(Crescendo-Decrescendo Systolic)

A

1- Aortic stenosis (AS)
2- Hypertrophic obstructive cardiomyopathy (HOCM)
3- Pulmonic stenosis (PS)

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11
Q

Diastolic Opening Snap Murmur

A

Mitral stenosis (MS) à has diastolic opening snap,
followed by a mid-late decrescendo diastolic murmur

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12
Q

Mid-Systolic click Murmur

A

MVP (Mitral valve prolapse)

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13
Q

Continuous Machine Like Murmur

A

PDA
Aka Pansystolic - Pandiastolic
Also described as to and fro murmur.

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14
Q

Murmur with Fixed S2 Splitting

A

ASD (Atrial Septal Defect)

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15
Q

Holo-diastolic / Pan-diastolic Murmur

A

1- Aortic regurgitation (aortic insufficiency; AR)
2- Pulmonic regurgitation (pulmonic insufficiency; PR)

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16
Q

Pan-diastolic and loudest in early-diastole

A

Classically AR (decrescendo
holo-diastolic murmur)

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17
Q

Principle regarding heart murmurs

A

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.

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18
Q

Kid with SCD, Fever, Tachycardia presents with a Murmur

A

Transient, functional high-flow murmur secondary to tachycardia à murmur will subside once HR returns to baseline.
No cardiac abnormality involved.

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19
Q

Aortic Stenosis

A
  • 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.
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20
Q

Maneuvers that decrease blood in the heart

A

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.

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21
Q

Maneuvers that increase blood in the heart

A

Lying down; leg raise while supine; squatting; handgrip

22
Q

SVC syndrome

A

Superior vena cava syndrome
Flushing of face + Congestion of neck veins.
Caused by pancoast tumor (Adenocarcinoma of Lungs)

23
Q

Lyme Disease

A

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.

24
Q

Cardiac Murmurs concept

A

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 ).
25
Q

Cardiac Action potential

A
26
Q

Wolf-Parkinson-White syndrome
(WPW-Syndrome)

A
  • 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.
27
Q

1st Degree Heart Block

A
  • Benign & Asymptomatic
  • Increase PR-interval (>200msec)
28
Q

2nd Degree Heart Block (Type-I)

A

Mobitz type-I (Wenckebach) :

  • Gradual prolongation of PR-interval until u get a P-wave which is not followed by QRS complex (Dropped beat).
29
Q

2nd Degree Heart Block (Type-II)

A

Mobitz type-II :

  • No prolongation of PR-interval
  • Beat is dropped
  • Problem in Bundle of His (fibrotic changes)
  • Tx: Pacemaker
30
Q

3rd Degree Heart Block
(Complete AV-block)

A
  • 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.
31
Q

Chagas Disease

A

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.

32
Q

Give the classic tetrad of IgA vasculitis (Henoch-Schonlein purpura).

A
  1. Palpable purpura without thrombocytopenia or coagulopathy (typically over the posterior lower extremities and buttocks)
  2. Arthritis/arthralgia
  3. Abdominal pain (due to localized bowel wall inflammation; patients are at risk of intussusception)
  4. Kidney disease (hematuria +/- proteinuria)
33
Q

A young adult who smokes and has painful ulcers with dry gangrene on the toes but normal pulses in the foot most likely has?

A

Buerger disease (thromboangiitis obliterans).

Histopathology reveals segmental inflammatory intramural thrombi of medium and small vessels

34
Q

A 55-year-old woman presents with unilateral headache, transient vision loss, and jaw claudication. What is the diagnosis?

A

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.

35
Q

Eosinophilic granulomatosis with polyangiitis

AKA Churg Strauss

A
  1. Asthma (Late Onset), sinusitis
  2. Peripheral neuropathy (mononeuropathy multiplex , Wrist drop)
  3. Subcutaneous nodules or purpura
  4. Eosinophilia
  5. Antibodies against Neutrophil MPO (p-ANCA Pattern)

The heart, gastrointestinal system, and kidneys can also be involved. IgE levels are elevated.

36
Q

Cardiac Action potential

A
37
Q

Granulomatous with Polyangitis (GPA)

A

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.

38
Q

Dressler syndrome

A

Chest pain, pericardial effusion/friction rub, persistent fever following MI
(autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)

39
Q

Pulmonary HTN

A
  • 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.
40
Q

Infective Endocarditis

A

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
41
Q

Left Heart Failure (LHF)

A
  • 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

42
Q

Right Heart Failure (RHF)

A
  • Presents as systemic findings – i.e., jugular venous distension (JVD) & peripheral edema
  • Hx of Pulmonary HTN
  • Jugular Venous distention
  • Pulmonary Edema
43
Q

Congestive Heart Failure (CHF)

A
  • 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.
44
Q

Cor Pulmonale

A
  • 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.
45
Q

Atrial Septal Defect (ASD)

A
  • Fixed splitting of S2
  • ASDs can sometimes be responsible for “paradoxical emboli,” where a DVT leads to stroke.
46
Q

Granulomatosis with polyangiitis

A
  • 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
47
Q

Eosinophilic granulomatosis with polyangiitis

A
  • AKA Churg Strauss
  • Presents as combo of asthma + eosinophilia +/- head-itis.
  • Associated with pANCA and anti-myeloperoxidase (anti-MPO) antibodies.
48
Q

Microscopic polyangiitis

A
  • Will just present as hematuria in a patient who is pANCA / anti-MPO (+).
  • Similar to Wegener, can cause RPGN.
49
Q

Hyperchylomicronemia
(AR)

A

Deficiency of lipoprotein lipase or Apolipoprotein C-II

  • Increase Chylomicrons + TGAs.
  • Pancreatitis (abdo, not chest, pain).
  • Xanthomas.
  • Plasma appears “creamy
50
Q

Hypercholesterolemia
(AD)

A

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
51
Q

Hypertriglyceridemia
(AD)

A

Increase Hepatic production of VLDL

  • Increase TGAs.
  • Pancreatitis.

Rapid Review Step 1 (24 decks)

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