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Step I > CV path > Flashcards

CV path Flashcards

1
Q

R -> L shunt

A

early cyanosis, blue baby

urgent surgical correction and/or maintenance of PDA

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2
Q

R -> L shunt causes

A 
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)
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3
Q

D-transposition of great vessels

A

not compatible w/life w/o shunt (VSD, PDA, PFO)

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4
Q

tricuspid atresia

A

absence of tricuspid valve and hypoplastic RV

requires both ASD and VSD for viability

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5
Q

tetralogy of fallot

A

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

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6
Q

TAPVR

A

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

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7
Q

L->R shunt

A

late cyanosis -> blue kids

VSD>ASD>PDA

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8
Q

VSD

A

MC congenital cardiac defect
most self resolve
if large enough may lead to LV overload and HF

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9
Q

ASD

A

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

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10
Q

PDA

A

assocaited with continuous machine like murmur

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11
Q

eisenmenger syndrome

A

uncorrected L->R shunt -> increased pulmonary flow -> pulmonary HTN -> RVH occurs to compensate -> shunt becomes R -> L -> cyanosis, clubbing, polycythemia

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12
Q

coarctation of aorta

A

bicuspid aortic valve
turners
HTN in upper extremities and weak pulse in lower
erosion of ribs by collateral aa

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13
Q

alcohol exposure in utero

A

VSD
PDA
ASD
tetralogy of fallot

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14
Q

congenital rubella

A

septal defects
PDA
pulmonary a stenosis

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15
Q

downs

A

AV septal defect (endocardial cushion defect)
ASD
VSD

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16
Q

DM

A

transposition of great vessels

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17
Q

marfans

A

MVP
thoracic aortic aneurysm and dissection
aortic regurg

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18
Q

prenatal lithium exposure

A

ebstein anomaly

septal and post leaflets of tricuspid displaced toward apex

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19
Q

turners

A

bicuspid aortic valve

coarctation of aorta

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20
Q

williams syndrome

A

supravalvular aortic stenosis

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21
Q

22q11

A

truncus arteriosis

tetraology of fallot

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22
Q

mockenberg

A 
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
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23
Q

obliterative endarteritis of vasa basorum

A

thoracic aortic aneurysm d/t tertiary syphilis

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24
Q

aortic dissection

A

intimal tear

associated w/HTN, bicuspid aortic valve, inherited CT dis

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25
Q

Stanford type A aortic dissection

A

proximal
involves ascending aorta
surgery

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26
Q

stanford type B aortic dissection

A

distal
involves descending aorta and/or arch
ascending aorta NOT involved
Tx medically w/beta blockers, then vasodilators

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27
Q

prinzmental angina

A 
aka variant
secondary to coronary a spasm 
transient ST elevation 
triggers: tabacco, cocaine, triptans 
Tx: CCBs, nitrates, smoking cessation
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28
Q

coronary steal

A

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

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29
Q

MI

A

LAD>RCA>circumflex

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30
Q

MI gross 0-4 hrs

A

none

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31
Q

MI light 0-4 hrs

A

none

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32
Q

MI complications 0-4 hrs

A

arrhythmia
HF
cardiogenic shock

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33
Q

MI 4-24 hr gross

A

dark mottling

pale w/tetrazolium stain

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34
Q

MI 4-24 hr light

A

early coagulative necrosis
release of necrotic cell contnets into blood
edema
hemorrhage
wavy fivers
neutros
reperfusion injury may cause contraction bands

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35
Q

MI 4-24 hrs complications

A

arrhythmia
HF
cardiogenic shock

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36
Q

MI 1-3 days gross

A

hyperemia

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37
Q

MI 1-3 days light

A

extensive coagulative necorsis

acute inflammation w/neutros

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38
Q

MI 1-3 days complications

A

post MI fibrinous pericarditis

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39
Q

MI 3-14 days gross

A

hyperemic border around central yellow-brown softening

maximally yellow and soft by 10 days

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40
Q

MI 3-14 days light

A

macros

granulation tissue at margins

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41
Q

MI 3-14 days complications

A

free wall rupture -> tamponade; papillary mm rupture -> mitral regurg -> interventricular septal rupture d/t macro mediated degradation
LV pseudoaneurysm

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42
Q

MI 2 wks- 2mo gross

A

recanalized aa

gray-white scar

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43
Q

MI 2wks-2mo light

A

contracted scar complete

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44
Q

MI 2wk-2mo complications

A 
dressler syndrome
HF
arrhythmias 
true ventricular aneurysm 
risk of mural thrombus
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45
Q

Dx of MI first 6 hrs

A

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

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46
Q

cardiac troponin I

A

rises after 4hrs and is high for 7-10 days

most specific

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47
Q

CK-MB

A

rises after 6-12 hrs

return to normal in 48hrs

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48
Q

transmural infarcts

A

ST elevation
increased necrosis
affects entire wall

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49
Q

subendocardial infarcts

A

d/t ischemic necrosis

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50
Q

anteroseptal MI

A

LAD

V1-2

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51
Q

anteroapical MI

A

distal LAD

V3-4

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52
Q

anterolateral MI

A

LAD or LCX

V5-6

53
Q

lateral MI

A

LCX

I, aVL

54
Q

inferior MI

A

RCA

II, III, aVF

55
Q

dresseler syndrome

A

autoimmune phenomenon resulting in fibrinous pericarditis
fever
pain

56
Q

Tx of unstable angina and/or NSTEMI

A 
anticoagulate 
antiplatelet
beta blockers
ACEIs
statins
nitro and morphine
57
Q

STEMI

A

same as NSTEMI plus reperfusion therapy

58
Q

dilated cardiomyopathy

A

MC cardiomyopathy

often idiopathic or familiar

59
Q

causes of dilated cardiomyopathy

A 
ABCCD
alcohol
wet Beriberi
Coxsackie B virus myocarditis
Chagas disease
Doxorubicin toxcicity 
hemochromatosis
sarcoidosis
peripartum cardiomyopathy
60
Q

findings of dilated cardiomyopathy

A 
HF
S3
systolic regurgitant murmur
systolic dysfnx 
dialated heart of ECG
ballon appearance on CXR
61
Q

Tx of dilated cardiomyopathy

A 
Na restriction
ACEI
BB
diuretics 
digoxin
ICD
heart transplant
62
Q

hypertrophic cardiomyopathy

A

60-70% familial AD (beta-myosin mutation)
associated w/Friedreich ataxia
syncope during exercise and SCD

63
Q

findings of hypertrophic cardiomyopathy

A

S4
systolic murmur
mitral regurg
diastolic dysfunction

64
Q

Tx of hypertrophic cardiomyopathy

A

no high- intensity activity
BB
nondihydropyridine CABs
ICD if pt at high risk

65
Q

obstructive hypertrophic cardiomyopathy

A

asymmetric septal hypertrophy and systolic ant motion of mitral valve -> outflow obstruction -> dyspnea and syncope

66
Q

restrictive/infiltrative cardiomyopathy causes

A 
sarcoidosis
amyloidosis
postradiation fibrosis
endocardial fibroelastosis (young kids)
loffler syndrome
hemochromatosis
67
Q

restrictive/infiltrative cardiomyopathy

A

diastolic dysfunction

low ECG despite thick myocardium

68
Q

loffler syndrome

A

endomyocardial fibrosis w/prominent eosinophilic infiltrate

69
Q

systolic dysfnx

A

reduced EF
increased EDV
decreased contractility
often secondary to ischemia/MI or dilated cardiomyopathy

70
Q

diastolic dysfnx

A

preserved EF
normal EDV
decreased compliacne
often secondary to myocardial hypertrophy

71
Q

what improves mortality in HF pt

A

hydralazine eith nitrate therapy

72
Q

signs of L HF

A

orthopnea
paroxysmal nocturnal dyspnea
pulmonary edema

73
Q

signs of R HF

A

hepatomegaly (nutmeg liver)
JVD
peripheral edema

74
Q

hypovolemic shock

A 
d/t hemorrhage, dehydration, burns
skin cold and clammy
CVP/preload very decreased
CO decreased
SVR/afterload increased 
Tx fluids
75
Q

cardiogenic shock

A 
d/t acute MI, HF, valvular dysfnx, arrhythmia
skin cold and clammy
CVP/preload increased
CO  very decreased
SVR/afterload increased
Tx inotropes, diuresis
76
Q

obstructive cardiogenic shock

A 
d/t tamponade, PE
skin cold and clammy
CVP/preload increased
CO  very decreased
SVR/afterload increased
Tx inotropes, diuresis
77
Q

distributive shock

A 
d/t sepsis, CNS injury, anaphylaxis
skin warm and dry
CVP/preload decreased 
CO increased
SVR/afterload very decreased 
Tx pressors, fluid
78
Q

bacterial endocarditis

A 
FROM JANE
fever
Roth spots
Osler nodes
Murmur (new)
Janeway lesions 
Anemia 
Nail-bed hemorrhage
Emboli
79
Q

roth spots

A

round white spots on retina surrounded by hemorrhage

80
Q

osler nodes

A

tender raised lesions on finger or toe pads

81
Q

janeway lesions

A

small painless erythematous lesions on palm or sole

82
Q

acute bacterial endocarditis

A

S. aureus

83
Q

subacute bacterial endocarditis

A

viridans

84
Q

prosthetic valve endocarditis

A

S. epidermis

85
Q

nonbacterial endocarditis

A

aka marantic/thrombotic
secondary to malignancy
hypercoaguable state
lupus

86
Q

IV drug abuse endocarditis

A

tricuspid
S. aureus
pseudo
candida

87
Q

culture neg endocarditis

A

coxiella burnetti
bartonella
HACEK

88
Q

HACEK

A

Haemophilus
actinobacillus
cardiobacterium eikenella
kingella

89
Q

RF murmurs

A

early MR late MS

90
Q

jones criteria

A 
Joint
carditis 
Nodules in skin (subQ)
Erythema marginatum
Sydenham chorea
91
Q

cardiac tamponade

A

Beck’s triad
increased HR
pulsus paradoxus
low voltage QRS and electrical alterans

92
Q

becks triad

A

hypotension
distended neck vv
distant heart sounds

93
Q

pulsus peridoxus

A 
decrease in amplitude of systolic BP by >10mmHg during inspiration 
cardiac tamponade
asthma
obstructive sleep apnea
pericarditis 
croup
94
Q

syphilitic heart disease

A

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

95
Q

myxomas

A

MC primary cardiac tumor in adults
90% in atria
ball valve obstruction -> multiple sycopal episodes
diastolic tumor ‘plop’ sound

96
Q

rhabdomyomas

A

MC cardiac tumor in kids

tuberous sclerosis

97
Q

kussmaul sign

A

increased JVP on inspiration instead of normal decrease

seen with constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumorjs

98
Q

angiosarcomas

A 
rare blood vessel malignancy 
head, neck, breast areas
usually in elderly on sunexposed areas
associated w/radiation, postmastectomy lymphedema, 
poor prognosis
99
Q

hepatic angiosarcomas

A

vinyl chloride and arsenic exposure

poor prognosis

100
Q

bacillary angiomatosis

A 
benign capillary skin papules 
AIDS
Bartonella henselae infections
frequently mistaken for kaposi sarcoma 
neutros
101
Q

cherry hemangioma

A

benign capillary hemangioma of elderly

does not regress

102
Q

cystic hygroma

A

cavernous lymphangioma of neck

turners

103
Q

glomus tumor

A

bengin painful, red/blue tumor under fingernails

arises from modified smooth mm cells of thermoregulatory glomus body

104
Q

kaposi sarcoma

A 
endothelial malignancy 
skin (MC), mouth, GI, respiratory tract
HHV-8
HIV
frequently mistaken for bacillary angiomatosis, but lymphocytic infiltrate
105
Q

pyogenic granuloma

A

polypoid capillary hemangioma
ulcerates and bleeds
associated w/trauma and prego

106
Q

strawberry hemangioma

A

benign capillary hemagioma of infancy
appears in first few wks of life
grows rapidly and regresses spontaneously by 5-8

107
Q

secondary causes of Raynauds

A

SLE
CREST
CT disease

108
Q

Tx of raynauds

A

CABs

109
Q

large vessel vasculitis

A

temporal

takayasu

110
Q

temporal/giant cell arteriits

A 
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
111
Q

takayasu arteritis presentation

A

usually asian females

112
Q

takaysu path and Tx

A

granulomatous thickening and narrowing of arotic arch and proximal great vessels
Tx corticosteroids

113
Q

medium vessel vasculitis

A

polyarteritis nodosa
kawasaki disease
buerger disease

114
Q

polyarteritis nodosa presenation

A 
young adults
hepB seropositive (30%)
fever 
weight loss
malaise
HA
GI: pain, melena
HTN 
neuro dysfnx
cutaneous eruptions
renal damage
115
Q

polyarteritis nodosa path

A

renal and visceral vessels, not pulmonary aa
IC mediated
trasmural inflammation -> fibrinoid necrosis
innumerable renal microaneurysms and spasms
Tx corticosteroids, cyclophosphamide

116
Q

kawasaki disease

A

asian kids

117
Q

kawasaki complications and Tx

A

coronary a aneurysms, thrombosis, or rupture -> death

Tx IV IG and aspirin

118
Q

buerger disease

A

aka throboangiitis obliterans
heavy smokers
males gangrene, autoamputation, superficial nodular phlebitis
raynauds

119
Q

small vessel vasculitis

A

granulomatosis w/polyangitis (wegener)
microscopic polyangiitis
eosinophilic granulomatosis w/polyangiitis (churg-strauss)
henoch-schonelein purpura

120
Q

granulomatosis w/polyangitis presentation

A

wegners
URT: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
LRT: hemoptysis, cough, dyspnea
renal: hematuria, red cell casts

121
Q

granulomatosis w/polyangitis path

A

triad: focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, necrotizing glomerulonephritis
PR3-ANCA/c-ANCA/anti-proteinase3
CXR large nodular densities

122
Q

granulomatosis w/polyangitis Tx

A

cyclophosphamide

corticosteroids

123
Q

microscopic polyangitis presentation

A

necrotizing vasculitis commonly involving lung, kidneys, and skin
pauci-immune glomerulonephritis and palpable purpura
presents like granulomatosis w/polyangitis, but not nasopharyngeal involvement

124
Q

microscopic polyangitis path

A

NO granulomas

MPO-ANCA/p-ANCA/anti-myeloperoxidase

125
Q

microscopic polyangitis Tx

A

cyclophosphamide

corticosteroids

126
Q

eosinophilic granulomatosis w/polyangiitis presentation

A 
aka churg strauss
asthma
sinusitis 
skin nodules or purpura
peripheral neuropathy (wrist/foot drop)
heart, GI, kidneys (pauci-immune glomerulonephritis)
127
Q

eosinophilic granulomatosis w/polyangiitis path

A

granulomatous, necrotizing vasculitis w/eos
MPO-ANCA/p-ANCA/anti-myeloperoxidase
increased IgE

128
Q

henoch-schonlein purpura presentation

A

MC childhood systemic vasculitis
often follows URI
triad: palpable purpura on buttocks and legs, arthralgias, GI pain

129
Q

henoch-schonlein purpura path

A

casculitis secondary to IgA ICs

associated w/IgA nephropathy/Bergers disease

Step I (22 decks)

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