CV Flashcards
What acute cardiac condition?
ST Elevation
Acute MI
What acute cardiac condition?
Q waves
old MI
Localize the infarction: heart location? vessel?
Leads I and aVL
Lateral MI
Left circumflex a.
Localize the infarction: heart location? vessel?
Leads V5-6:
Lateral MI
L circumflex a.
Localize the infarction: heart location? vessel?
Leads V1-4:
Lateral MI
Proximal L anterior descending a. (LAD)
Localize the infarction: heart location? vessel?
Leads V3-4
Lateral MI
distal LAD
Localize the infarction: heart location? vessel?
Leads V1-6, I, aVL
Anterolateral MI
L main coronary a
Localize the infarction: heart location? vessel?
Leads II, III, aVF
Inferior MI
R coronary a
Transplant rejection of which organ?
systolic dysfunction; dyspnea on exertion
cardiac
Transplant rejection of which organ?
interstitial lymphocytic infiltrate and damaged myocytes
cardiac
what type of transplant rejection rxn?
gross mottling & cyanosis
Arterial fibrinoid necrosis & capillary thrombotic occlusion
hyperacute
onset: min-hr
etio: preform recipient Abs against graft Ag
what type of transplant rejection rxn?
cellular: lymphocytic interstitial infiltrate & endothelitis
Humoral: C4d deposition, neutrophilic infiltrate, necrotizing vasculitis
acute
onset: <6mo
etio: mainly cell-mediated; also exposure to donor Ag induce activation of naive immune cells
what type of transplant rejection rxn?
Vascular wall thickening & luminal narrowing
Interstitial fibrosis & parenchymal atrophy
chronic
onset: mo-yrs
etio: low-grade immune response refractory to immunosuppression – mixed cell-mediated and humoral
what type of collagen subtypes?
Skin, bone, tendon, ligaments, dentin, cornea, blood vessels, scar tissue
type I
Assoc dz: osteogenesis imperfecta
what type of collagen subtypes?
cartilage, vitreous humor, nucleus pulposis
Type II
Assoc dz: skeletal dysplasias
what type of collagen subtypes?
Skin, lungs, intestines, blood vessels, bone marrow, lymphatics, granulation tissue
Type III
Assoc dz: vascular Ehlers-Danlos syndrome (Type IV)
what type of collagen subtypes?
Basement membrane
Type IV
Assoc dz: alport syndrome
Time after MI?
Morph: no visible change
0-4 hrs
Time after MI?
morph: wavy fibers w/ narrow, elongated myocytes
4-12 hrs
Etio: Digestion of cyto organelles, denaturation of protein, loss of RNA
Time after MI?
Morph: Myocyte hypereosinophilia w/ pyknotic (shrunken) nuclei
12-24 hrs
Time after MI?
Morph: Coagulation necrosis (loss of nuc/striation), prominent neutrophilic* infiltrate.
1-3 days
etio: Tissue response to proinflammatory cytokines (IL6/8) = neutrophils infiltrate the border»_space; migrate to central portion of infarct»_space; neutrophils phagocytize death myocytes release lysosomal enz, ROS, cytokines (IL1, TNF-a) = prevent pathogen/ facilitate wound healing.
Time after MI?
Morph: Disintegration of dead neutrophils/ myofibers, macrophage* infiltration at border areas
3-7 days
etio: Macrophage* infiltrate, phagocytize dead myocytes/ neutrophils»_space; formation of granulation tissue by producing IL-1, TGF-B
Time after MI?
Morph: Robust phagocytosis of dead cells by macrophages; beginning formation of granulation* tissue at margins
7-10 days
Etio: Macrophage infiltrate, phagocytize dead myocytes/ neutrophils»_space; formation of granulation tissue by producing IL-1, TGF-B
Time after MI?
Morph: Well dev granulation tissue with neovascularization*
10-14 days
Etio: Fibroblast proliferation, collagen deposition, neovascularization of granulation tissue
Time after MI?
Morph: Progressive collagen deposition & scar formation
2-8 weeks
etio: Collagen remodeling, fibroblast diff into myofibroblasts drive the formation of scar tissue
endurance or strength training athlete’s heart?
incr LV cavity size (eccentric hypertrophy)
incr RV cav size
incr diastolic filling and stroke vol
unchanged LV ejection fraction
endurance
endurance or strength training athlete’s heart?
Incr LV wall thickening (concentric hypertrophy)
no RV change
unchanged diastolic filling
LV ejection fraction unchanged or slightly incr
strength training
What antiarrhythmic drug?
Stimulates A1 Rs on surface of cardiac cells»_space; activate K channel»_space; incr K conductance»_space; membrane AP remain negative for longer period
adenosine
*Transient slowing of sinus rate and incr AV nodal conduction delay
What antiarrhythmic drug?
Inhibit Na/K ATPase pump in myocardial cells»_space; incr IC Na»_space; incr IC Ca++ conc
*AV node inh
Digoxin
*Antiarrhythmic
Incr cardiac contractility»_space; subsequent decr in ventr filling P
What antiarrhythmic drug?
Class III anti-arrhythmic drugs
*Block K channels = inhibit outward K current during phase 3 of AP
Amiodarone, sotalol, dofetilide
*Prolonged repol and total AP duration
What antiarrhythmic drug?
Class II antiarrhythmic
Rapid-acting, short-duration B-blocker
Esmolol
Slow rate of discharge of sinus or ectopic pacemakers, incr refractory period of AV node
What antiarrhythmic drug?
Class IA
Inh Na-dependent (phase 0) depol/slow conduction
Procainamide, quinidine
What antiarrhythmic drug?
Class IB
Inh Na-dependent (phase 0) depol/slow conduction
Lidocaine
What antiarrhythmic drug?
Class IC
Inh Na-dependent (phase 0) depol/slow conduction
Flecainide
What antiarrhythmic drug?
L-type Ca channels blocker
- affect phase 2 of cardiac nonpace maker AP
- affect phase 0 of pacemake
Verapamil
Diltiazem
*Reduce cardiac contractility
Slow sinus rate, prolong conduction thru AV node
which aortic arch?
part of maxillary a.
first
which aortic arch?
hyoid a.
stapedial a.
second
which aortic arch?
common carotid a.
proximal internal carotid a.
third
which aortic arch?
L: aortic arch (*Aortic coartation)
R: prox R subclavian a.
fourth
which aortic arch?
prox pulm a
L: ductus arteriosus
Sixth
Which conduction system of the heart?
3rd degree AV block
ECG with wide* QRS complex
bundle branches
Purkinje system
*widen QRS compare to AV node and His bundle (narrowed QRS)
Which conduction system of the heart?
3rd degree AV block
ECG with narrow* QRS complex
AV node
bundle of HIS
*SA nodes doesn’t work appropriately = AV block
This embryo structure gives rise to what?
cardinal veins
SVC - superior vena cava
This embryo structure gives rise to what?
truncus arteriosus
pulm trunk
ascending aorta
This embryo structure gives rise to what?
endodermal foregut
esophagus
This embryo structure gives rise to what?
fusion of embryonic R and L dorsal aortas
descending aorta
Murmur describe what heart condition?
holosytolic @ LLSB
VSD
*murmur intensify with hand grip
Murmur describe what heart condition?
decrescendo early diastolic murmur
@ LSB
Aortic regurgitation
*intensify with hand grip
Murmur describe what heart condition?
crescendo-decrescendo systolic murmur
Aortic stenosis
*decreases with handgrip
Murmur describe what heart condition?
faint systolic murmur @ LUSB
wide and fixed splitting S2
atrial septal defect
Murmur describe what heart condition?
systolic ejection murmur @ LMSB
hypertrophic cardiomyopathy
*handgrip decreases murmur
Murmur describe what heart condition?
continuous flow murmur @ LUSB or posterior interscapular region
patent ductus arteriosus
aneurysm or dissection?
intact intima
aneurysm
aneurysm or dissection?
intimal tear
dissection
This morph describe which cardiac condition?
myxomatous degeneration
cystic medial degeneration
*Aortic aneurysm
*Assoc with marfan syndrome - CT disruption
This morph describe which cardiac condition?
intimal atheromas
atherosclerosis
This morph describe which cardiac condition?
granulomatous inflammation of the media and fragmentation of internal elastic lamina
Giant cell arteritis
This morph describe which cardiac condition?
concentric lamellar reduplication of the intimal smooth m cells (onion skinning)
hyperplastic arteriosclerosis of renal arterioles
*assoc with malignant HTN
Give rise to what ECG rhythm?
abn conduction in areas of ischemic ventricular scarring
monomorphic ventricular tach
reg rhythm
wide QRS complexes (rhythm originate below AV node)
Give rise to what ECG rhythm?
atrial remodeling ectopic foci in pulm vein ostia
afib
irreg rhythm, no P wave
narrow QRS complexes
Give rise to what ECG rhythm?
degen of SA node
sick sinus syndrome (>65yo)
sinus bradycardia w/ sinus pauses and sinus arrest
*sometimes sinus tach
Give rise to what ECG rhythm?
delayed repol of ventricular cardiomyocytes
torsade de pointes
~polymorphic ventricular tachycardia
oscillate wide QRS complexes
Give rise to what ECG rhythm?
abn conduction thru AV nodes
narrow QRS complex tachyC w/ reg rhythm, nonvisible P wave
paroxysmal supraventricular tachycardia
*AV nodal reentrant tachycardia (AVNRT)
Murmur assoc with what cardiac condition?
S3 gallop
MR, HF
Murmur assoc with what cardiac condition?
S4, low freq diastolic sound
during atrial kick of ventricular diastole
hypertrophic cardiomyopathy or concentric L ven hypertrophy
*reflect stiff ventricular wall, HTN, aortic stenosis
Murmur assoc with what cardiac condition?
mid-systolic click
mitral valve prolapse
*d/t sudden tensing of chordae tendineae
Murmur assoc with what cardiac condition?
Opening snap, early diastolic after S2
mitral/tricuspid stenosis
*shorter S2 opening snap interval = more severe mitral stenosis
Murmur assoc with what cardiac condition?
widened splitting of S2
Accentuated by inspiration = incr venous return to the R side of heart
pulmonic valve stenosis = delays pulmonic valve closure
Anatomical location of saphenous vein?
just inferolateral to the pubic tubercle
What is the preferred vessel for bypass grafting of LAD a. of the heart?
- L internal mammary (thoracic) a.
2. great saphenous vein (when mult a./vessels other than LAD require revascularization)
Common location of surgeons access to the great saphenous vein
- medial leg
- femoral triangle of upper thigh (less common) - near point of saphenous v. termination.
*Femoral triangle border: inguinal L (superior), sartorius m (lat), adductor longus m (medially).
MC location of peripheral a. aneurysm?
popliteal a. aneurysm
*Anatomy: in popliteal fossa ( popliteal a./v., tibial n.)
Which vitamin deficiency?
beriberi (peripheral neuropathy, HF
Wernicke-Korsakoff syndrome
Thiamine (B1)
primary fx: decarboxylation of a-keto acid (carbohydrate metabolism)
Which vitamin deficiency?
Cheilosis, stomatitis, glossitis
Normocytic anemia
Riboflavin (B2)
Primary fx: mito redox rxn (FMN, FAD)
Which vitamin deficiency?
Pellagra (dermatitis, dementia, diarrhea)
Niacin (B3)
Primary fx: redox rxn (NAD/NADP)
Which vitamin deficiency?
Distal paresthesia (rare)
Pantothenic acid (B5)
Primary fx: acetylation rxn (CoA)
Which vitamin deficiency?
peripheral neuropathy
Cheilosis, stomatitis, glossitis
pyridoxine (B6)
Primary fx: transamination of AA (AA syn)
Which vitamin deficiency?
Dermatitis, conjunctivitis, alopecia, neurologic changes
Biotin (B7)
Primary fx: Carboxylase rxn (CO2 carrier)
Which vitamin deficiency?
Megaloblastic anemia
Neural tube defects (fetus)
Folate (B9)
Primary fx: hydroxymethyl/formyl carrier (purine and thymine syn)
Which vitamin deficiency?
Megaloblastic anemia
Neurologic deficit
Cobalamin (B12)
Primary fx: isomerase & methyltransferase cofactor (DNA & methionine syn)
Which vitamin deficiency?
Scurvy (perifollicular hemorrhage, gingivitis, muscle pain)
Ascorbic acid (C)
Primary fx: hydroxylation of proline & lysine (collagen syn)
Common occlusion site of thigh claudication? (4)
ipsi external iliac a.
common femoral
superficial femoral
profunda femoris a.
Common occlusion site of impotence/ gluteal claudication?
Aortoiliac occlusion
*Leriche syndrome
Also diminishes blood flow to the internal pudendal and gluteal branches of the internal iliac a.
This morphology describe the hallmark of which vascular disease?
Granulomatous inflammation of the arterial media
Temporal (giant cell) arteritis
- MC form of systemic vasculitis in adults
- > 50yo
- sx: headache, facial pain, jaw claudication, visual loss.
This morphology describe the hallmark of which vascular disease?
Hyaline arteriolosclerosis - homogenous deposition of hyaline material in the intima and media of small arteries and arterioles
typical in HTN, DM
- underlying structure intact
- thickened intima = narrowed blood vessel lumen
This morphology describe the hallmark of which vascular disease?
Medial band-like calcifications
Medial calcific sclerosis (Monckeberg arteriosclerosis)
- Calcified deposits in muscular a.
- common in >50yo
- Palpable in PE, visible in radio
- Asx, do not narrow vessel lumen.
CV defects are associated with what genetic dz?
endocardial cushion defects (ostium primum atrial septal defects, regurgitant AV valves
Down syndrome
CV defects are associated with what genetic dz?
Tetralogy of Fallot
Interrupted aortic arch (more severe than aortic coarctation)
DiGeorge syndrome
CV defects are associated with what genetic dz?
Hypertrophic cardiomyopathy
Friedreich ataxia
CV defects are associated with what genetic dz?
Situs Inversus
Kartagener syndrome
*rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis
CV defects are associated with what genetic dz?
Cystic medial necrosis (aortic dissection & aneurysm)
Mitral valve prolapse
Marfan syndrome
CV defects are associated with what genetic dz?
Valvulvar obstruction d/t cardiac rhabdomyomas
Tuberous sclerosis
CV defects are associated with what genetic dz?
Aortic coartation
Bicuspid aortic valve
turner syndrome (45 X,O)
L atrial enlargement (d/t MS, MR) can cause what GI condition?
dysphagia through external compression of esophagus
*Anatomy of heart
Epinephrine MOA (3)
B1 sti = incr HR, contractility»_space; incr SBP
B2 sti = skm. - vasodilation, decr DBP
A1 sti = sm m. in skin/viscera - incr PVR = incr DBP
Atropine MOA
Competitive antagonist of cholinergic M2 in heart»_space; block PNS vagal influence
= incr HR
Isoproterenol MOA
Nonselective B-adrenergic agonist»_space; sti both sm m. B2 Rs & cardiac B1 R»_space; vasodilation & incr HR, contractility
*Decr DBP, inr HR
Phentolamine MOA
nonspec a-1 & a-2 blocker
*Profound fall in DBP, reflex tachC
Phenylephrine MOA
Selective a-adrenergic agonist
Incr SBP and DBP, ~reflex bradyC
ECG:
Holiday heart syndrome
afib
*absence P waves, irregularly irregular rhythm with varying R-R intervals
Histology describe which vascular disease?
necrotizing arteritis and focal collections of epithelioid histiocytes
granulomatosis with polyangiitis (GPA)
(+) ANCA, cavitary lung lesion
- dx by bx
sx: - upper resp (sinusitis/otitis), saddle-nose deformity, crusting/ulcers, rhinorrhea
- lower resp (lung nodules/cavitation), hoarseness, cough, stridor, hemoptysis, pulm infiltrates
- renal (rapidly progressive glomerulonephritis);
- skin (livedo reticularis, nonhealing ulcers)
*Contrast with PAN (polyarteritis nodosa) = (-) ANCA, spared lung, affect kidney
Histology describe which vascular disease?
Fibrinoid degeneration of the medium sized vessel wall with luminal narrowing
PAN (polyarteritis nodosa)
*affect kidney, spared lungs
Histology describe which vascular disease?
necrotizing granuloma with a predominance of eosinophils
Churg-strauss (eosinophilic granulomatosis with polyangiitis)
*Chronic asthmas, assoc renal insuf
Histology describe which vascular disease?
Proliferation of irreg shaped glands and pleomorphic cells
Adenocarcinoma of lung
- Older patient
- Normocytic anemia, cough, SOB, WL
Rx for Paroxysmal supraventricular tachycardia
Adenosine
(Stimulates A1 Rs on surface of cardiac cells»_space; activate K channel»_space; incr K conductance»_space; membrane AP remain negative for longer period)
*Transient slowing of sinus rate and incr AV nodal conduction delay
Rx for Supraventricular Tachyarrhythmia
Digoxin
Inhibit Na/K ATPase pump in myocardial cells»_space; incr IC Na»_space; incr IC Ca++ conc
*AV node inh
*Enhance vagal tone
= Antiarrhythmic
Incr cardiac contractility»_space; subsequent decr in ventr filling P
Rx?
Manage ST-elevation MI when PCI not avail in time
Alteplase
*Fibrinolytic agent
Assoc PE condition/aus/ECG/maneuver?
- Cardiac tamponade
- Asthma/ chronic obstructive pulm dz (less common)
Constrictive pericarditis
Pulsus paradoxus
Inspiration cause drop in sys pulse P
*Pericardial fluid accum w/ late diastolic collapse of R atrium
Assoc PE condition/aus/ECG/maneuver?
~Cardiac tamponade
Electrical alternans
Beat to beat variation in QRS complex amp on ECG (variation in electrical signal)- d/t swinging motion of the heart in pericardial fluid
*contrast with pulsus alternan in severe LV sys dysfx (aus- beat to beat variation in pulse)
Assoc PE condition/aus/ECG/maneuver?
Severe LV sys dysfx
Pulsus alternans
aus: Beat-beat variation in pulse amp
*contrast with electrical alternans in cardiac tamponade (beat to beat variation in ECG - electrical signal)
Assoc PE condition/aus/ECG/maneuver?
Severe sys dysfx & high SVR»_space; accentuated diastolic dicrotic wave after dicrotic noth
Dicrotic pulse
2 distinct peak pulse - 1 during sys and 1 during diastole
Assoc PE condition/aus/ECG/maneuver?
Aortic regurgitation
High output HF (thyrotoxicosis, arteriovenous fistula)
Hyperkinetic pulse
Rapidly rising amp (d/t rapid ejection of large stroke vol against decr afterload)
Assoc PE condition/aus/ECG/maneuver?
Fixed LV outflow tract obstruction
Valvular aortic stenosis
Pulsus parvus et tardus
- Slow rising, low amp pulse (d/t diminished stroke vol - pulsus parvus; and prolonged LV ejection time - pulsus tardus)
Important ECG SE in these drugs?
quinidine, sotalol
macrolides, fluoroquinolones
methadone, haloperidol
torsade de pointes: polymorphic ventricular tach - QRS complexes of varying amp and cycle length - appearance that the tip of QRS complex is twisting around the ECG baseline
Embryological defect associate with what condition/syndrome?
deviation of infundibular septum (ant and cephalad deviation of infundibular septum)
VSD with overriding aorta
R ventricular outflow obstruction»_space; sys murmur
- squats to incr peripheral SVR & decr R to L shunt
- tetralogy of Fallot
Embryological defect associate with what condition/syndrome?
anomalous pulmonary venous return
R atrial/ventrical dilation
R to L atrial shunt
oxy/deoxy blood from pulm/venous sys flow into R atrium
Embryological defect associate with what condition/syndrome?
failed fusion of superior and inferior endocardial cushions
endocardial cushion defect of AV septum/valves (mitral/tricuspid)
- initial as atrial defect and/or VSD with L to R shunt
- overtime, incr R sided blood flow»_space; pulm HTN = EISENMENGER SYNDROME
Embryological defect associate with what condition/syndrome?
linear dev of aorticopulmonary septum in utero
transposition of the great arteries
Associated Heart condition:
TTR (transthyretin) gene mutation
TTR misfold = produce amyloid protein = infiltrates the myocardium (infiltrative cardiomyopathy) = decompensated CHF
what murmur assoc with head bobbing (de Musset sign)?
AR
*d/t forceful pulsations in Intracranial a.
Chronic transmural inflammation of the aorta is assoc with vascular condition?
AAA
» inflammation»_space; release MMP/ elastase > degrade ECM/ elastin/collagen»_space; weakening and progressive expansion of aortic wall
Cystic medial necrosis is assoc with what vascular dz?
Marfan syndrome (*predispose to ascending aortic aneurysm/ dissection)
*Loss of smooth m/collagen/elastic tissue with formation of cystic mucoid spaces in the aortic media.
Assoc condition?
intimal tear in the aortic wall
Aortic dissection
*Diastolic decrescendo murmur at the RSB
Assoc condition?
Vasa vasorum endarteritis (endarteritis obliterans) in the thoracic aorta
thoracic aortic aneurysm cause by syphilis
cor pulmonale
RV failure d/t incr pulm vascular resistance
Kussmaul sign
paradoxical increase in jugular venous P on inspiration (cardiac tamponade/restriction)
*normal inspiration would cause decrease in jugular venous P
Histology describe what CV disease/condition?
Amorphous ECM with scattered stellate of globular myxoma cells w/in abundant mucopolysaccharide (myxoid) ground substance containing chondroitin sulfate and hyaluronic acid
+ hemosiderin laden macrophage (d/t tumor high vascularity-hemorrhage)
*can embolize
Cardiac myxoma in L atrium
*lipomas = second MC primary cardiac neo, rarely embolize
Histology describe what CV disease/condition?
malignant vascular spindle cells
primary cardiac angiosarcoma
*usually R atrium (rare)
Histology describe what CV disease/condition?
malignant epithelial cells with necrotic debris
secondary involvement of the heart from metastatic malignancy (melanoma, lung cancer, breast cancer)
*usually locate at pericardium
Cromolyn sodium Inhibit what process in chronic asthma?
inhibits mast cell degranuation and release histamine/leukotrienes
*chronic asthma management
corticosteroid role in ___ degranuation in asthma/COPD control
eosinophils
B-adrenergic agonists effect on bronchial?
bronchial smooth m. dilation
*Gs»_space; AC»_space; IC cAMP conc incr
TTN gene mutation = assoc with what CV disease?
DCM (dilated cardiomyopathy)
TTN gene encodes for sarcomere protein titin == mutation results absence of complete titin proteins = myocardial dysfx
*AD, incomplete penetrance
NOTCH1 gene = assoc what CV dz?
familial bicuspid aortic valve dz
hemosiderin-laden macrophage (siderophages) = MC assoc with what CV dz?
*golden-brown cytoplasmic granules
heart failure
what CV disease?
carbon-laden macrophage
coal’s worker’s pneumoconiosis
Red man syndrome
Which med induce? MOA?
vancomycin induced
mediated by histamine release non-IgE mediated mast cell degranulation.
Ablation procedure for which CV condition?
interatrial septum near opening of coronary sinus
AV node - persistent Afib
Radiofrequency Ablation procedure for which CV condition?
between tricuspid valve and IVC opening
Atrial flutter
Radiofrequency Ablation procedure for which CV condition?
L atrium near the opening of pulm v.
ectopic afib
*prevent recurrent afib
Radiofrequency Ablation procedure for which CV condition?
upper part of crista terminalis near SVC opening
SA node - Afib
Exudate or Transudate? Cause?
Low LDH
Low protein
transudate
HF
Exudate or Transudate? Cause?
High protein lvs
high LDH
exudate
d/t inflam, infection, malignancy
Exudate or Transudate? Cause?
high amylase
exudate
d/t pancreatitis, pancreatic pseudocyst, esophageal rupture
Exudate or Transudate? Cause?
high leukocyte count
exudate
d/t complicated parapneumonic effusion, some type of malig pleural effusion
Exudate or Transudate? Cause?
low glucose
exudate
d/t malig or infection (bac/neutrophils/malig cells consum glu),
SE of which ABx?
ototoxicity, nephrotoxicity
gentamicin (aminoglycoside ABx)
SE of which ABx?
red man syndrome (RMS)
rapid infusion of vancomycin (non Ig-E mediated)
- inhibit cell wall syn (bind D-ala-D-ala terminus)
- resolve if infuse at slower rate.
SE of which ABx?
megaloblastic anemia, thrombocytopenia, leukopenia, toxic epidermal necrosis
trimethoprim-sulfamethoxazole
CV dx?
Marfanoid body habitus
+AD, normal intellect, aortic root dilation, upward lens dislocation
Marfan syndrome
CV dx?
Marfanoid body habitus
+AR, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion
Homocystinuria
What cause unopposed a-adrenergic stimulation?
pre-tx of B antagonist before a-adrenergic antagonist
Dx?
inflammatory intraluminal thrombi w/ vessel wall sparing, extension into contigious v. and n.
*highly cellular, containing neutrophils, multinucleated giant cells)
thromboangiitis obliterans (buerger dz)
- <45yo, M
- digital ischemic ulcerations, limb claudication, Raynaud phenomenon, superficial thrombophlebitis
Etio: segmental small & medium sized vessel vasculitis, likely trigger by tobacco smoke
Dx?
Granulomatous inflammation of media
> 50yo, UL headache, jaw claudication, transient vision loss
Giant cell arteritis (temporal arteritis)
Dx?
Granulomatous inflammation of media
- younger women, Asian descent
- diminished pulses accom angina and/or carotid artery pain
Takayasu arteritis
Dx?
transmural inflammation of arterial wall with fibrinoid necrosis
- affect small/medium sized arteries
- fever, HTN, abd pain, cutaneous lesions (nodules, livedo reticularis)
systemic vasculitis
PAN (polyarteritis nodosa)
watershed areas
GI: splenic flexure; rectosigmoid junction
Brain: area between ACA, MCA, PCA
Dressler syndrome
postcardiac injury syndrome
autoimmune-mediated pericarditis
*likely provoked by Ag exposed or created by infarction/necrosis of the cardiac m.
Diagnosis:
granulomatous inflammation of arterial media
transmural fibrous thickening, narrowing of lumen
predominantly affects the aorta/branches
Takayasu arteritis
- F, Asian, <40yo
- Fever, WL, fatigue
- arterio-occlusive: claudiation, BP discrepancies, bruits, pulse deficits
- visual/neurologic deficits, arthralgias, myalgias)
- elevate CRP, ESR
Preventive med for dilated cardiomyopathy in anthracyclines
Dexrazoxane
(chelating agent = block formation o iron-assoc free radicals + inh formation of anthracycline-topoisomerase II complexes in healthy cardiomyocytes
vascular or immunologic phenomena?
Janeway lesions (macular, erythematous, nontender* lesions on pals and soles)
vascular
vascular or immunologic phenomena?
Osler nodes: painful*, violaceous nodules seen on the fingertips/toes
immunology
vascular or immunologic phenomena?
Roth spots: edematous/ hemorrhagic lesions of the retina
immunologic
vascular or immunologic phenomena?
mycotic aneurysm: dilation of an arterial wall due to infection
vacular
Dx:
brown grannular deposits in myocytes (prussian blue stain)
skin appears darkly tanned
sinus node dysfx, a/ven arrhythmias, sudden cardiac death.
abn diastolic relaxation of LV
Cardiac hemochromatosis
- HFE protein
- excess intestinal Fe absn»_space; deposiion of ferritin, hemosiderin, free iron in myocardium»_space; oxidative inj to myocytes
- cardiomyopathy: early diastolic LV dysfx (restrictive pattern)»_space; later cardiac remodeling/dilated cardiomyopathy
Dx:
profound BL sensorineural hearing loss + congenital long QT syndrome
*predispose to syncope, sudden cardiac death
Jarwell and Lange-Nielsen syndrome
AR, mutation of KCNQ1, KCNE1»_space; alpha and beta subunits of voltage gated K channels
ECG changes:
Brugada syndrome, AD
mutation in cardiac Na or L type Ca channel
pseudo R bundle branch block
ST segment elevation V1-3
*incr risk of ventricular tachyarrhythmias and sudden cardiac death
Hydroxyurea function in fetal Hgb
incr Hgb production»_space; improve O2 carrying capacity of blood in sickle cell anemia
Dx:
Fibrinoid necrosis - cell death and excessive fibrin deposition w/in arteriolar walls - visible as circumferential, amorphous, pink material with smudged, necrotic endothelial cells that lack cytologic detail
hypertensive emergency
Dx
hyperplastic arteriosclerosis
onion skin
hypertensive nephrosclerosis (long term essential HTN)
- interstitial fibrosis, tubular atrophy, varying degrees of glomerulosclerosis (focal/global)
- hyaline arteriosclerosis
Result of which dz process?
Calcific uremic arteriolopathy (calciphylaxis)
» severe skin ischemia & necrosis
*Histo: superficial arteriolar calcification, subintimal fibrosis, thrombosis
*affect only smaller vessels
advanced chronic kidney disease
Assoc dz:
Monckeberg sclerosis
calcified atherosclerotic plaque
- diffuse medial calcification of small/ medium sized arteries.
- calcification: blue to violet irregular deposits on hematoxylin-eosin stains
Assoc dz process:
Migratory thrombophlebitis
Trousseau syndrome
visceral cancer (*pancreas, colon, lung) - ~adenocarcinoma
*hypercoagulability»_space; thromboplastin like substance»_space; chronic intravascular coagulations»_space; disseminate/migrate
what type of systemic embolization?
6Ps: pain, pallor, poikilothermia (coolness to touch), paresthesia, paralysis, reduced/absent pulse
atrial myoma - mucopolysaccharride rich stroma - myxoma cells
chagas dz is assoc with what AD CV dz/condition
DCM (dilated cardiomyopathy)
TTN gene mutations = sarcomere titin
(protoxoan parasite = Trypanosoma cruzi)
*South America
Dx:
Aschoff body/ giant cell
*new holosystolic murmur
Acute rheumatic carditis
*bacterial infection = untx group A streptococcal pharyngeal infection
*MR»_space; MS (fibrous scar)
Rx for:
pulm HTN, peripheral vascular dz, Raynaud syndrome.
Prostacyclin, epoprostenol
vasodilation and antithromboxane A2
Diagnosis:
accumulation of amorphous substance in interstitial space
cardiac amyloidosis
- older pt (>60yo)
- early: restrictive pattern, stiff/no sign thickened
- later: diastolic dysfx
- normal LV cavity size, overall LV mass normal
Diagnosis:
distorted myocardial structure and myofibril disarray
HCM (hypertrophic cardiomyopathy)
Diagnosis:
increase of individual myocardial fiber length more than width
athlete’s heart
Diagnosis:
myocardial atrophy and replacement with fibrous fatty tissue
arrhythmogenic RV cardiomyopathy
- AD, mutation of cardiac desmosomes (cell junction)
- affect RV»_space; ven arrythmias/ RV failure
- if LV involved = eccentric enlargement w/ incr LV cavity size
respond to which dz/condition:
subendocardial replacement fibrosis
after viral myocarditis»_space; dilated cardiomyopathy
Which cancer drug toxicity?
patchy cardiomyocyte necrosis»_space; death w/ diffuse myocardial fibrosis
Anthracycline induced cardiotoxicity
*Doxorubicin
Which cancer drug toxicity?
reduced cardiomyocyte contractility w/ no fibrosis
trastuzumab
(monoclonal Ab = breast cancer meds)
*MOA: blocks downstream signaling»_space; cellular proliferation»_space; encourages malignant cell apoptosis.
Diagnosis:
intermittent obstruction of submucosal v. at the muscularis propria of the GI tract - gen GI bleeding
Bx: dilated small vessels lined by thin-walled endothelium;
angiodysplasia
Complication of which infectious dz? syndenham chorea (restlessness, purposeless jerking movement 3mo after sore throat)
group A beta-hemolytic streptococcal infection
- acute rheumatic fever
- MS
which valve is affected:
in verrucous (libman sacks) endocarditis
thickened valve leaflets (mitral/aortic) w/ mult small vegetations on both surfaces
*sterile vegetations/ sterile platelet thhrombi interwtwined with strands of fibrin, immune complexes, mononuclear cells.
Diagnosis:
Needle shaped cholesterol clefts occluding arterioles with multinucleated giant cells.
atheroembolization
*risk of kidney injury
Diagnosis:
Egg on string
transposition of great arteries
