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Pathoma > Chapter 8: High Yield Cardiac > Flashcards

Chapter 8: High Yield Cardiac Flashcards

1
Q

Chest pain <20 min. With exertion. EKG shows ST-segment depression

A

Stable angina.

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2
Q

Episodic chest pain unrelated to exertion - due to coronary artery vasospasm. EKG shows ST-segment ELEVATION due to transmural ischemia.

A

Prinzmetal angina

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3
Q

Occlusion of the left anterior descending artery (LAD) leads to infarction of the _____ [2].

A

Anterior wall and anterior septum of the LV. Most commonly involved artery in MI (45%).

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4
Q

Occlusion of right coronary artery (RCA) leads to infarction of the ______[3].

A

Posterior wall, posterior septum, papillary muscles of the LV.

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5
Q

Occlusion of the left circumflex artery leads to infarction of the ____[1].

A

lateral wall of the LV.

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6
Q

Gold standard laboratory test for MI

A

Troponin I. Levels rise 2-4 hrs after infarction, peak at 24 hrs, return to nml in 7-10 days. CK-MB is useful for detecting reinfarction (rise 4-6 hrs after infarction, peak at 24, return to nml in 72 hrs).

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7
Q

Left-sided heart failure tx

A

ACE inhibitor

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8
Q

‘Nutmeg’ liver, JVD, Dependent pitting edema.

A

Right sided heart failure

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9
Q

Hemosiderin-laden macrophages in the alveoli, dyspnea, paroxysmal nocturnal dyspnea, orthopnea

A

Left-sided heart failure

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10
Q

Eisenmenger syndrome

A

A left-to-right shunt reverses. Increased flow through the pulmonary circulation results in hypertrophy of pulmonary vessels and pulmonary htn. leads to late cyanosis with right ventricular hypertrophy, polycythemia, and clubbing.

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11
Q

A congenital left-to-right shunt. most common congenital heart defect. associated with fetal alcohol syndrome. Large defects can lead to Eisenmenger syndrome.

A

Ventricular Septal Defect. tx = surgical closure

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12
Q

Left-to-right shunt and split S2 on auscultation. Gives paradoxical emboli

A

Atrial Septal Defect (ASD). most common type is OSTIUM SECUNDUM. OSTIUM PRIMUM type is associated with DOWN SYNDROME

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13
Q

Holosystolic “MACHINE-LIKE” murmur.

A

PDA. Associated with CONGENITAL RUBELLA. Left-right shunt between aorta and pulmonary artery. Can lead to Eisenmenger syndrome, resulting in lower extremity cyanosis.

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14
Q

Treatment of a PDA

A

Indomethacin - decreases PGE.

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15
Q

Right-to-left shunt
Stenosis of the right ventricular outflow tract; right ventricular hypertrophy; VSD; and an aorta that overrides the VSD. “Boot-shaped” heart on x-ray

A

Tetralogy of Fallot. Pt learns to squat in response to a cyanotic spell; increases arterial resistance –> decreases shunting and allows more blood to reach the lungs

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16
Q

What disease is associated with Transposition of the Great Vessels

A

Maternal Diabetes

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17
Q

Single, large vessel arising from both venticles.

A

Truncus arteriosus

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18
Q

Location of coarctation of the aorta in the infantile form. _____ Disorder association?

A

Coarction lies after the aortic arch, but BEFORE the PDA. Associated with a PDA, and TURNER SYNDROME. Presents as lower extremity cyanosis in infants at birth

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19
Q

HTN in the upper extremities, hypotension with weak pulses in the lower extremities. Notching on the ribs. Associated with?

A

Adult form of coarctation of the aorta. Lies after the aortic arch. Get collateral circulation across intercostal arteries. ASSOCIATED WITH BICUSPID AORTIC VALVE

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20
Q

Jones Criteria

A

For dx of Acute Rheumatic Fever:
1. Evidence of prior group A beta-hemolytic strept infection (elevated ASO or anti-DNase B titers).
2. Minor criteria: fever and elevated ESR.
3. Major:
J: Joint - Migratory polyarthritis.
O: Heart. Endocarditis [mitral valve - small vegetations leading to regurgitation. Myocarditis with ASCHOFF BODIES (ANITSCHKOW CELLS) Pericarditis - leading to friction rub and chest pain
N: Nodels [Subcutaneous nodules
E: Erythema marginatum [annular, nonpruritic involving trunk and limbs]
S: Sydenham chorea [rapid, involuntary muscle movements]

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21
Q

Systemic complication of pharyngitis due to group A Beta-hemolytic strep. Children 2-3 weeks after strep pharyngitis. Caused by molecular mimicry –> BACTERIAL M PROTEIN.

A

Acute Rheumatic Fever

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22
Q

Stenosis with “FISH-MOUTH” appearance. Usually mitral valve - thickening of chordae tendineae and cusps. Occasionally aortic valve leading to fusion of the commisures.

A

Chronic Rheumatic Heart Disease. Complication = infectious endocarditis

23
Q

Systolic ejection click followed by a crescendo-decrescendo murmur.

A

Aortic stenosis May lead to CONCENTRIC left ventricular hypertrophy, angina and syncope with exercise, and Microangiopathic hemolytic anemia [schistocytes]

24
Q

Early, blowing diastolic murmur. Hyperdynamic circulation due to increased pulse pressure. Presents with bounding pulse [WATER-HAMMER PULSE], Pulsating nail bed [QUINCKE PULSE], and head bobbing.

A

Aortic Regurgitation. Results in LV dilation and ECCENTRIC hypertrophy

25
Q

Mid-systolic click followed by a regurgitation murmur. Louder with squatting.

A

Mitral Valve prolapse. Due to myxoid degeneration of the valve.

26
Q

Holosystolic “blowing” murmur. Louder with squatting and expiration.

A

Mitral Regurgitation. Results in volume overload and left-sided heart failure. Usually arises as a complication of mitral valve prolapse, LV dilation, ect

27
Q

Opening snap followed by diastolic rumble

A

Mitral stenosis [usually due to chronic rheumatic valve diseae] Volume overload leads to dilation of the left atrium; Right-sided heart failure; A-fib

28
Q

Most common cause of endocarditis. Results in small vegetations (subacute endocarditis)

A

Streptococcus viridans. infects previously damaged valves.

29
Q

Most common cause of endocarditis among IV drug users. Targets tricuspid resulting in large vegetations that destroy the valve (acute endocarditis)

A

Staph. aureus

30
Q

What is Staph epidermidis associated with

A

endocarditis of prosthetic valves

31
Q

If the patient has endocarditis and underlying colorectal carcinoma, what bug do they have

A

Steptococcus bovis

32
Q

Endocarditis with negative blood cultures

A

HACEK organisms (difficult to grow) Haemophilus, Actinobacillus, Cardibacterium, Eikenella, Kingella

33
Q

Janeway lesions

A

Erythematous non-tender lesions on palms and soles –> Bacterial endocarditis

34
Q

Osler nodes

A

Tender lesions on fingers or toes –> bacterial endocarditis

35
Q

Splinter hemorrhages in nail bed

A

Due to embolization of septic vegetations in endocarditis

36
Q

Sterile vegetations that arise in association with a hypercoagulable state or underlying adenocarcinoma. Arise on mitral valve along lines of closure and result in mitral regurgitation

A

Nonbacterial Thrombotic Endocarditis

37
Q

Sterile vegetations that arise in association with SLE. Vegetations are present on the surface and undersurface of the mitral valve and result in mitral regurgitation.

A

Libman-Sacks endocarditis

38
Q

Pt presents with CHF. Find low-voltage EKG with diminished QRS amplitude

A

Restrictive Cardiomyopathy

39
Q

Benign mesenchymal tumor with gelatinous appearance and abundant ground substance on histo. Forms a pedunculated mass in the L atrium that causes syncope due to obstruction of the mitral valve

A

Myxoma

40
Q

Benign hamartoma of Cardiac muscle. Associated with tuberous sclerosis. Usually in ventricle.

A

Rhabdomyoma.

41
Q

“Holosystolic, high-pitched blowing murmur”

A

Mitral/tricuspid regurgitation

42
Q

Crescendo-decrescendo systolic ejection murmur following ejection click

A

Aortic stensosis

43
Q

Holosystolic, harsh-sounding murmur. located at tricuspid area.

A

VSD

44
Q

Late systolic crescendo murmur with midsystolic click. best heard over apex. Loudest at S2.

A

MVP

45
Q

Immediate high-pitched “blowing” diastolic murmur with a wide pulse pressure.

A

aortic regurg. can get bounding pulses and head bob

46
Q

Follows opening snap. Delayed rumbling late diastolic murmur.

A

Mitral stenosis

47
Q

Continuous machine-like murmur

A

PDA. loudest at S2

48
Q

PCWP > LV diastolic pressure

A

Mitral stenosis

49
Q

Infant of a diabetic bother

A

Transposition of great vessels

50
Q

V1-V4

A

anterior wall - LAD

51
Q

V1, V2

A

anterior septal - LAD

52
Q

V4-V6

A

Anterolateral - LCX

53
Q

I, aVL

A

Lateral wall - LCX

54
Q

II, III, aVF

A

Inferior wall - RCA

Pathoma (15 decks)

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