Diseases of Organ Systems CARDIOVASCULAR - 34% Flashcards
What is cyanotic heart disease due to?
Right to left shunt in the heart
What is acyanotic heart disease due to?
Left to right shunt in the heart as in: VSD, ASD, PDA VSD = ventricular septum defect (most common congenital heart disease 30%) ASD = atrial septum defect (failure of the ostium secundum to close PDA = patent ductus arteriosus (should close shortly after birth)
What is the most common congenital heart disease?
Ventricular septum defect (30% of congenital heart disease). Causes acyonotic heart disease
What is the most common cyanotic congenital heart disease?
Fallot’s tetralogy
What is Fallot’s tetralogy?
- Pulmonary stenosis 2. Ventricular septal defect 3. Right ventricular hypertrophy 4. Overriding (dextro-position) aorta
What is transition of the great vessels of the heart?
Aorta is connected to the right ventricle and the pulmonary trunk to the left ventricle
- an uncommon cause of congenital cyanotic heart disease
What is coarctation of the aorta
Narrowing of the arch of the aorta near the ligament upon arteriosum
Rheumatic fever is due to
post-strep infection
What is rheumatic fever characterized by
aschoff bodies (granulomas with giant cells), antischkow cells and MacCallum’s patches (in left atrium)
What is Jones major criteria in diagnosing rheumatic fever?
SPECS
- Sydenham’s chorea
- Polyarthritis
- Erythema marginatum
- Carditis
- Subcutaneous nodules
What is endocarditis and what can cause it?
Inflammation of the endocardium (affecting the valves)
- streptococcus pyogenes, streptococcus viridans, staphylococcus aureus
What is subacute bacterial endocarditis and what is it a sequele of?
Infection of previously damaged valves
- rheumatic fever (S. Viridans)
What are the signs of subacute bacterial endocarditis?
Fever, new mumur, splinter hemorrhages, olser’s nodes and Janeway nodules
What is acute bacterial endocarditis?
infection of previously healthy valves
What is libman sacks endocarditis? What is it associated with?
Sterile (non-infective) endocarditis of pulmonary and tricuspid valves seen in SLE (systemic lupus erythmatosus)
What is syphilitic aortitis? What does it lead to?
Treponema pallidum infection often affecting the arch of the aorta leading to aortic aneurysm, aortic stenosis, angina pectoris
What is a thrombus
a clot formed within an atherosclerotic vessel with lines of Zahn
What is an embolism?
a dislodged mass of undissolved material in blood vessel traveling in the blood
What are signs of an arterial embolism?
Painful, pale, pulseless, perishingly cold limb
What is arteriosclerosis?
Thickening of the arteries with loss of elasticity and contractility due to infiltration of the tunica intima by collagen and smooth muscle fibers
What is atherosclerosis
lipid/calcium deposits in tunica intima
What are risk factors for atherosclerosis?
Cigarette smoking, fatty diet, obesity, hypertension, diabetes and homocysteinemia and high LDL
How does atherosclerosis progress?
subendothelial fatty streak ->fibrosis -> atheroma -> rupture with eventual occlusion or embolus formation
What causes ischemic heart disease and what does it lead to?
Coronary atherosclerosis
- angina, myocardial infarction, congestive heart failure
What is angina pectoris
A reversible inadequately perfumed myocardium that is relieved by rest
What is prinzmetal angina? What causes it?
Angina that occurs at rest
- coronary artery spasm
What is myocardial infarction
ischemic necrosis of myocardium due to blocked coronary artery, mainly the lest anterior descending artery
*pain is not relieved by rest
What does myocardial infarction release?
Cardiac enzymes such as troponin and creatine kinase - myocardial band and lactic dehydrogenase
What is an aneurysm?
localized dilation of an artery. Can be congenital or acquired
What is an abdominal aortic aneurysm due to? What are the signs?
atherosclerosis
- pulsatile abdominal mass with a bruit and LBP
What is a dissecting aneurysm? What pathologies is it associated with?
intraluminal tearing of the ascending thoracic aorta
- Marfan’s, Ehlers-Danlos syndromes, longstanding hypertension
What is syphilitis aneurysm?
Results from tertiary syphilis and mainly affects the arch of the aorta
What is a berry aneurysm?
Congenital weaknesses that only present in the 3rd decade and onwards that commonly affects the anterior part of the circle of Willis
What is a berry aneurysm associated with? what might it cause in young adults?
Adult polycystic disease of the kidney
- subarachnoid hemorrhage
What are the signs of a berry aneurysm?
severe sudden headache,neck stiffness, loss of consciousness
How is hypertension diagnosed?
>140/90 on 3 or more occasions
What is the most common type of hypertension? What are the risk factors?
essential (unknown) - 95%
- family history, high salt intake, stress, obesity
What type of hypertension accounts for 5% of hypertension? what causes it?
secondary
- unilateral artery stenosis, hyperthyroidism, Cushing’s, pheochromocytoma
What is malignant hypertension?
rapidly progressing with severe vascular damage
- ma lead to early death from a stoke or heart failure
What causes congestive heart failure?
Coronary artery disease, hypertension, valvular heart disease, congenital heart disease or cardiomyopathy
What is cardiomyopathy? What causes it? What are the three types?
disease myocardium
- alcohol, pregnancy, viral infection
- dilated (most common), hypertrophic, restrictive (rare)
What is Cor pulmonale? What causes it?
right heart failure
- COPD, pulmonary embolism
When does cardiac tamponade occur?
when the heart is compressed due to excess fluid in pericardial sac
What is Beck’s triad and what is it for?
3 H’s
- hypotension, heart sounds are distant, high venous pressure
- cardiac tamponade
What causes peripheral vascular disease? How does it present?
atherosclerotic narrowing of large arteries
- intermittent claudication. Pain in calves on walking and relieved by rest
What is Virchow’s triad? What is it for?
3 V’s
- viscosity (increased clotting which may be related to contraceptive pill), venous stasis, vessel wall damage
- deep vein thrombosis may present with painful swollen leg
What is a pulmonary embolism? what does it cause? What are the signs?
related to DVT in leg or pelvis when a piece of the clot breaks off (embolus), travels to the inferior vena cava into the heart, up the plenary trunk, concludes the pulmonary arteries or smaller branch,
- causes ventilation/perfusion mismatch
- shortness of breath, pleuritic chest pain and hemoptysis (caugh blood)
What are varicose veins? what may they lead to?
tortuous dilated superficial veins
- thrombophlebitis
What is thrombophlebolitis? what might is lead to? What are the signs
inflammation in the vein wall
- thrombosis
- swollen tender superficial cord under the skin
What is Raynaud’s? what are the signs? Who get’s it?
Decreased blood flow triggered by cold and emotion
- vasospasm (white), cyanosis (blue), vasodilation (red)
- young females with no known cause
What can Raynaud’s phenomenon be secondary to?
SLE, atherosclerosis, scleroderma
- may be part of CREST (calcinosis cutis, raynaud’s Phenomenon, esophageal dysfunction, scleroderma, telangiectasia)
What does CREST stand for?
calcinosis cutis, Raynaud’s phenomenon, Esophageal dysfunction, Scleroderma, Telangiectasia
What is polyertritis nodosa? what does it affect? What might it be associated with?
- What are the signs?
inflammation due to a type II hypersensitivity reaction. Affects medium size arteries, 30% are seropositive for Hep B
- fever, joint, abdominal pains and palpable purpura
What is thromboangitis obliterans (Buerger’s disease)? Who get’s it?
Intermittent claudication and weakened distal pulses due to idiopathic segmental inflammation of medium size arteries and veins
- male smokers between 20 and 40 years
What is temporal arteritis? who get’s it? What can it cause?
Localized giant cell inflammation in small arteries like branches of the ICA and vertebral arteries. Associated with elevated ESR
- in elderly
- may cause blindness if not treated promptly
What is Takayasu’s arteritis? what are the signs? Who is it more common in?
Pulseless disease
- due to inflammation of the aorta: possible autoimmune
- absent pulses, mainly in upper limbs
- Asian females <40
