CV path Flashcards
R -> L shunt
early cyanosis, blue baby
urgent surgical correction and/or maintenance of PDA
R -> L shunt causes
5 T's Truncus arteriosus (1 vessel) Transposition (2 switched vessels) Tricuspid atresia (3=Tri) Tetrology of Fallot (4=tetra) TAPCR (5 letters in name)
D-transposition of great vessels
not compatible w/life w/o shunt (VSD, PDA, PFO)
tricuspid atresia
absence of tricuspid valve and hypoplastic RV
requires both ASD and VSD for viability
tetralogy of fallot
d/t anterosuperior displacement of infundibular septum
MCC of early childhood cyanosis
PROVe
Pulmonary infundibular stenosis (prognostic)
Right ventricular hypertrophy (boot shape on CXR)
Overriding aorta
VSD
TAPVR
total anomalous pulmonary venous return
pulmonary vv drain into right heart circulation
associated with ASD and PSD to allow for R->L shunting to maintain CO
L->R shunt
late cyanosis -> blue kids
VSD>ASD>PDA
VSD
MC congenital cardiac defect
most self resolve
if large enough may lead to LV overload and HF
ASD
loud S1
wide fixed split of S2
ostium secundum defects most common (isolated)
ostium primum defects (other cardiac anomalies)
distinct from foramen ovale in that septa are missing rather then unfused
PDA
assocaited with continuous machine like murmur
eisenmenger syndrome
uncorrected L->R shunt -> increased pulmonary flow -> pulmonary HTN -> RVH occurs to compensate -> shunt becomes R -> L -> cyanosis, clubbing, polycythemia
coarctation of aorta
bicuspid aortic valve
turners
HTN in upper extremities and weak pulse in lower
erosion of ribs by collateral aa
alcohol exposure in utero
VSD
PDA
ASD
tetralogy of fallot
congenital rubella
septal defects
PDA
pulmonary a stenosis
downs
AV septal defect (endocardial cushion defect)
ASD
VSD
DM
transposition of great vessels
marfans
MVP
thoracic aortic aneurysm and dissection
aortic regurg
prenatal lithium exposure
ebstein anomaly
septal and post leaflets of tricuspid displaced toward apex
turners
bicuspid aortic valve
coarctation of aorta
williams syndrome
supravalvular aortic stenosis
22q11
truncus arteriosis
tetraology of fallot
mockenberg
medial calcific sclerosis uncommon affects medium sized aa calcification of elastic lamina of aa -> vascular stiffening w/o obstruction pipestem appearance on XRAY does NOT obstruct blood flow intima NOT involved
obliterative endarteritis of vasa basorum
thoracic aortic aneurysm d/t tertiary syphilis
aortic dissection
intimal tear
associated w/HTN, bicuspid aortic valve, inherited CT dis
Stanford type A aortic dissection
proximal
involves ascending aorta
surgery
stanford type B aortic dissection
distal
involves descending aorta and/or arch
ascending aorta NOT involved
Tx medically w/beta blockers, then vasodilators
prinzmental angina
aka variant secondary to coronary a spasm transient ST elevation triggers: tabacco, cocaine, triptans Tx: CCBs, nitrates, smoking cessation
coronary steal
distal to coronary stenosis vessels maximally dilated at baseline
administration of vasodilators dialtes normal vessels and shunts blood toward well-perfused ares -> decreased flow to heart
used in pharm stress test
MI
LAD>RCA>circumflex
MI gross 0-4 hrs
none
MI light 0-4 hrs
none
MI complications 0-4 hrs
arrhythmia
HF
cardiogenic shock
MI 4-24 hr gross
dark mottling
pale w/tetrazolium stain
MI 4-24 hr light
early coagulative necrosis
release of necrotic cell contnets into blood
edema
hemorrhage
wavy fivers
neutros
reperfusion injury may cause contraction bands
MI 4-24 hrs complications
arrhythmia
HF
cardiogenic shock
MI 1-3 days gross
hyperemia
MI 1-3 days light
extensive coagulative necorsis
acute inflammation w/neutros
MI 1-3 days complications
post MI fibrinous pericarditis
MI 3-14 days gross
hyperemic border around central yellow-brown softening
maximally yellow and soft by 10 days
MI 3-14 days light
macros
granulation tissue at margins
MI 3-14 days complications
free wall rupture -> tamponade; papillary mm rupture -> mitral regurg -> interventricular septal rupture d/t macro mediated degradation
LV pseudoaneurysm
MI 2 wks- 2mo gross
recanalized aa
gray-white scar
MI 2wks-2mo light
contracted scar complete
MI 2wk-2mo complications
dressler syndrome HF arrhythmias true ventricular aneurysm risk of mural thrombus
Dx of MI first 6 hrs
EKG gold standard
ST elevation (transmural) or depression (subendo)
hyperacute/peaked T waves
T wave inversion
new LBBB
pathologic Q waves
poor R wave progression (evolving or old transmural infarct
cardiac troponin I
rises after 4hrs and is high for 7-10 days
most specific
CK-MB
rises after 6-12 hrs
return to normal in 48hrs
transmural infarcts
ST elevation
increased necrosis
affects entire wall
subendocardial infarcts
d/t ischemic necrosis
anteroseptal MI
LAD
V1-2
anteroapical MI
distal LAD
V3-4
anterolateral MI
LAD or LCX
V5-6
lateral MI
LCX
I, aVL
inferior MI
RCA
II, III, aVF
dresseler syndrome
autoimmune phenomenon resulting in fibrinous pericarditis
fever
pain
Tx of unstable angina and/or NSTEMI
anticoagulate antiplatelet beta blockers ACEIs statins nitro and morphine
STEMI
same as NSTEMI plus reperfusion therapy
dilated cardiomyopathy
MC cardiomyopathy
often idiopathic or familiar
causes of dilated cardiomyopathy
ABCCD alcohol wet Beriberi Coxsackie B virus myocarditis Chagas disease Doxorubicin toxcicity hemochromatosis sarcoidosis peripartum cardiomyopathy
findings of dilated cardiomyopathy
HF S3 systolic regurgitant murmur systolic dysfnx dialated heart of ECG ballon appearance on CXR
Tx of dilated cardiomyopathy
Na restriction ACEI BB diuretics digoxin ICD heart transplant
hypertrophic cardiomyopathy
60-70% familial AD (beta-myosin mutation)
associated w/Friedreich ataxia
syncope during exercise and SCD
findings of hypertrophic cardiomyopathy
S4
systolic murmur
mitral regurg
diastolic dysfunction
Tx of hypertrophic cardiomyopathy
no high- intensity activity
BB
nondihydropyridine CABs
ICD if pt at high risk
obstructive hypertrophic cardiomyopathy
asymmetric septal hypertrophy and systolic ant motion of mitral valve -> outflow obstruction -> dyspnea and syncope
restrictive/infiltrative cardiomyopathy causes
sarcoidosis amyloidosis postradiation fibrosis endocardial fibroelastosis (young kids) loffler syndrome hemochromatosis
restrictive/infiltrative cardiomyopathy
diastolic dysfunction
low ECG despite thick myocardium
loffler syndrome
endomyocardial fibrosis w/prominent eosinophilic infiltrate
systolic dysfnx
reduced EF
increased EDV
decreased contractility
often secondary to ischemia/MI or dilated cardiomyopathy
diastolic dysfnx
preserved EF
normal EDV
decreased compliacne
often secondary to myocardial hypertrophy
what improves mortality in HF pt
hydralazine eith nitrate therapy
signs of L HF
orthopnea
paroxysmal nocturnal dyspnea
pulmonary edema
signs of R HF
hepatomegaly (nutmeg liver)
JVD
peripheral edema
hypovolemic shock
d/t hemorrhage, dehydration, burns skin cold and clammy CVP/preload very decreased CO decreased SVR/afterload increased Tx fluids
cardiogenic shock
d/t acute MI, HF, valvular dysfnx, arrhythmia skin cold and clammy CVP/preload increased CO very decreased SVR/afterload increased Tx inotropes, diuresis
obstructive cardiogenic shock
d/t tamponade, PE skin cold and clammy CVP/preload increased CO very decreased SVR/afterload increased Tx inotropes, diuresis
distributive shock
d/t sepsis, CNS injury, anaphylaxis skin warm and dry CVP/preload decreased CO increased SVR/afterload very decreased Tx pressors, fluid
bacterial endocarditis
FROM JANE fever Roth spots Osler nodes Murmur (new) Janeway lesions Anemia Nail-bed hemorrhage Emboli
roth spots
round white spots on retina surrounded by hemorrhage
osler nodes
tender raised lesions on finger or toe pads
janeway lesions
small painless erythematous lesions on palm or sole
acute bacterial endocarditis
S. aureus
subacute bacterial endocarditis
viridans
prosthetic valve endocarditis
S. epidermis
nonbacterial endocarditis
aka marantic/thrombotic
secondary to malignancy
hypercoaguable state
lupus
IV drug abuse endocarditis
tricuspid
S. aureus
pseudo
candida
culture neg endocarditis
coxiella burnetti
bartonella
HACEK
HACEK
Haemophilus
actinobacillus
cardiobacterium eikenella
kingella
RF murmurs
early MR late MS
jones criteria
Joint carditis Nodules in skin (subQ) Erythema marginatum Sydenham chorea
cardiac tamponade
Beck’s triad
increased HR
pulsus paradoxus
low voltage QRS and electrical alterans
becks triad
hypotension
distended neck vv
distant heart sounds
pulsus peridoxus
decrease in amplitude of systolic BP by >10mmHg during inspiration cardiac tamponade asthma obstructive sleep apnea pericarditis croup
syphilitic heart disease
tertiary
disrupts vasa vasorum of aorta -> atrophy of vessel wall and dilation of aorta and valve ring -> thoracic aneurysm
calcification in aortic root -> tree bark appearance
myxomas
MC primary cardiac tumor in adults
90% in atria
ball valve obstruction -> multiple sycopal episodes
diastolic tumor ‘plop’ sound
rhabdomyomas
MC cardiac tumor in kids
tuberous sclerosis
kussmaul sign
increased JVP on inspiration instead of normal decrease
seen with constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumorjs
angiosarcomas
rare blood vessel malignancy head, neck, breast areas usually in elderly on sunexposed areas associated w/radiation, postmastectomy lymphedema, poor prognosis
hepatic angiosarcomas
vinyl chloride and arsenic exposure
poor prognosis
bacillary angiomatosis
benign capillary skin papules AIDS Bartonella henselae infections frequently mistaken for kaposi sarcoma neutros
cherry hemangioma
benign capillary hemangioma of elderly
does not regress
cystic hygroma
cavernous lymphangioma of neck
turners
glomus tumor
bengin painful, red/blue tumor under fingernails
arises from modified smooth mm cells of thermoregulatory glomus body
kaposi sarcoma
endothelial malignancy skin (MC), mouth, GI, respiratory tract HHV-8 HIV frequently mistaken for bacillary angiomatosis, but lymphocytic infiltrate
pyogenic granuloma
polypoid capillary hemangioma
ulcerates and bleeds
associated w/trauma and prego
strawberry hemangioma
benign capillary hemagioma of infancy
appears in first few wks of life
grows rapidly and regresses spontaneously by 5-8
secondary causes of Raynauds
SLE
CREST
CT disease
Tx of raynauds
CABs
large vessel vasculitis
temporal
takayasu
temporal/giant cell arteriits
usually elderly females u/l HA and jaw claudication may lead to irreversible blindness d/t opthalmic a occlusion associated w/polyarthritis rheumatica focal granulomatous inflammation Tx w/high dose corticosteroids
takayasu arteritis presentation
usually asian females
takaysu path and Tx
granulomatous thickening and narrowing of arotic arch and proximal great vessels
Tx corticosteroids
medium vessel vasculitis
polyarteritis nodosa
kawasaki disease
buerger disease
polyarteritis nodosa presenation
young adults hepB seropositive (30%) fever weight loss malaise HA GI: pain, melena HTN neuro dysfnx cutaneous eruptions renal damage
polyarteritis nodosa path
renal and visceral vessels, not pulmonary aa
IC mediated
trasmural inflammation -> fibrinoid necrosis
innumerable renal microaneurysms and spasms
Tx corticosteroids, cyclophosphamide
kawasaki disease
asian kids
kawasaki complications and Tx
coronary a aneurysms, thrombosis, or rupture -> death
Tx IV IG and aspirin
buerger disease
aka throboangiitis obliterans
heavy smokers
males gangrene, autoamputation, superficial nodular phlebitis
raynauds
small vessel vasculitis
granulomatosis w/polyangitis (wegener)
microscopic polyangiitis
eosinophilic granulomatosis w/polyangiitis (churg-strauss)
henoch-schonelein purpura
granulomatosis w/polyangitis presentation
wegners
URT: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
LRT: hemoptysis, cough, dyspnea
renal: hematuria, red cell casts
granulomatosis w/polyangitis path
triad: focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, necrotizing glomerulonephritis
PR3-ANCA/c-ANCA/anti-proteinase3
CXR large nodular densities
granulomatosis w/polyangitis Tx
cyclophosphamide
corticosteroids
microscopic polyangitis presentation
necrotizing vasculitis commonly involving lung, kidneys, and skin
pauci-immune glomerulonephritis and palpable purpura
presents like granulomatosis w/polyangitis, but not nasopharyngeal involvement
microscopic polyangitis path
NO granulomas
MPO-ANCA/p-ANCA/anti-myeloperoxidase
microscopic polyangitis Tx
cyclophosphamide
corticosteroids
eosinophilic granulomatosis w/polyangiitis presentation
aka churg strauss asthma sinusitis skin nodules or purpura peripheral neuropathy (wrist/foot drop) heart, GI, kidneys (pauci-immune glomerulonephritis)
eosinophilic granulomatosis w/polyangiitis path
granulomatous, necrotizing vasculitis w/eos
MPO-ANCA/p-ANCA/anti-myeloperoxidase
increased IgE
henoch-schonlein purpura presentation
MC childhood systemic vasculitis
often follows URI
triad: palpable purpura on buttocks and legs, arthralgias, GI pain
henoch-schonlein purpura path
casculitis secondary to IgA ICs
associated w/IgA nephropathy/Bergers disease
