First Aid Cardiovascular Flashcards
congenital rubella –>
VSD PDA pulmonary artery stenosis deafness congenital cataracts
down syndrome –>
ASD
VSD
FAS –>
VSD
PDA
ASD
TF
Maternal DM I –>
TGA
Marfan syndrome –>
MVP
thoracic aortic aneurysm and dissection
aortic regurg
prenatal lithium exposure –>
Ebstein anomaly (tricuspid valve displaced)
Turner syndrome –>
bicuspid aortic valve
coarctation of aorta
Williams syndrome –>
supravalvular aortic stenosis
22q11 syndromes –>
PTA
TF
(neural crest cells)
Eisenmenger syndrome
uncorrected L –> R shunt (VSD, ASD, PDA) –> increased pulmonary blood flow –> pathologic remodeling of vasculature–> pulmonary arterial HTN –> RVH –> becomes R –> L shunt –> late cyanosis, clubbing, polycythemia
Kartagener syndrome
primary ciliary dyskinesia
triad: infertility, chronic sinusitis, s_____
defect in left-right dynein (involved in L/R asymmetry) can lead to DEXTROCARDIA
bulbar and truncal ridges derive from
neural crest cells
xanthoma
plaques or nodules composed of LIPID-LADEN HISTIOCYTES in skin and eyelids
xanthelasma
xanthoma in eyelid
tendinous xanthoma
lipid deposit in tendon (often Achilles)
corneal arcus
lipid deposit in cornea
common in elderly –> arcus senilis
earlier in life in hypercholesterolemia
definition of arteriosclerosis
hardening of arteries
arterial wall thickening and loss of elasticity
arteriolosclerosis
arteriosclerosis of small arteries and arterioles
two types of arteriolosclerosis
- HYALINE thickening of vessel walls in essential HTN or DM (pink highlighter around arteriole on histology)
- HYPERPLASTIC “onion skinning” in severe HTN with proliferation of SM cells
Monckeberg arteriosclerosis
Medial calcific sclerosis uncommon affects medium-sized arteries calcification of elastic lamina of arteries --> vascular stiffening w/o obstruction intima NOT involved does NOT obstruct blood flow
highlighter pink around arteriole lumen on histology slide
hyaline arteriolosclerosis
onion skinning appearance on histology slide
hyperplastic arteriolosclerosis
definition of atherosclerosis
disease of elastic arteries and large-medium0sized muscular arteries
form of arteriosclerosis (hardening/arterial wall thickening) caused by BUILD UP OF CHOLESTEROL PLAQUES
modifiable risk factors for atherosclerosis
smoking
HTN
hyperlipidemia
DM
non-modifiable risk factors for atherosclerosis
age
sex (increased in men and postemenopausal women)
family hx
complications of atherosclerosis
aneurysms ischemia infarcts peripheral vascular disease (PAD) thrombus emboli
location of atherosclerosis
abdominal aorta > coronary artery > popliteal artery > carotid artery
symptoms of atherosclerosis
angina
claudication
*may be asymptomatic
atherosclerosis progression (pathophysiology)
inflammation important in pathogenesis**
endothelial cell dysfxn –> macrophage and LDL accumulation –> foam cell formation –> fatty streaks –> SM cell migration (involves PDGF and FGF), proliferation, extracellular matrix deposition –> fibrous plaque –> complex atheromas
define aortic aneurysm
localized pathologic dilatation of the aorta
thoracic or abdominal
AAA risk factors
associated with ATHEROSCLEROSIS hx of tobacco use increased age male sex family hx
Thoracic aortic aneurysm risk factors
associated with CYSTIC MEDIAL DEGENERATION
HTN
bicuspid aortic valve
connective tissue disease (Marfan syndrome)
tertiary syphilis (obliterative endarteritis of the vasa vasorum)
relate tertiary syphilis and vasculature
obliterative endarteritis of the vasa vasorum
aortic dissection associations
(longitudinal intimal tear forming false lumen)
HTN
bicuspid aortic valve
inherited connective tissue disorders (eg Marfan)
types of aortic dissection
Stanford type A (proximal):
- involves Ascending aorta
- may extend to arotic arch or descending aorta
- tx is surgery
Standford type B (distal):
- involves descending aorta and/or aortic arch
- no ascending aorta involvement
- tx with beta-blockers then vasodilators
aortic dissection complications
rupture
pericardial tamponade
death
ischemic heart disease manifestations
angina coronary steal syndrome myocardial infarction sudden cardiac death chronic ischemic heart disease
symptoms of MI
diaphoresis nausea vomiting severe retrosternal pain pain in L arm and /or jaw SOB fatigue
commonly occluded coronary arteries
LAD > RCA > circumflex
gross, microscopic, and complications of MI @ 0-4 hrs
none
none
arrhythmia
HF
cardiogenic shock
gross, microscopic, and complications of MI @ 4-24 hrs
dark mottling; pale with tetrazolium stain
early coagulative necrosis,
release of necrotic cell contents into blood
edema
hemorrhage
wavy fibers
neutrophils appear
*reperfusion injury may cause contraction bands (due to free radical damage)
arrhythmia
HF
cardiogenic shock
gross, microscopic, and complications of MI @ 1-3 days
hyperemia, pale
extensive coagulative necrosis
tissue surrounding infarct shows acute inflammation with neutrophils
postinfarction fibrinous pericarditis
gross, microscopic, and complications of MI @ 3-14 days
hyperemic border; central yellow-brown softening
maximally yellow and soft by 10 days
macrophages
then granulation tissue at margins
free wall rupture LV pseudoaneurysm (risk of rupture)
free wall rupture –>
- tamponade
- papillary muscle rupture –> mitral regurg
- interventricular septal rupture due to marcophage-mediated strux degradation
gross, microscopic, and complications of MI @ 2 weeks to several months
recanalized artery
grey-white
contracted scar complete
Dressler syndrome
HF
arrhythmias
true ventricular aneurysm (risk of mural thrombus)
gold standard of MI diagnosis within first 6 hours
EKG
diagnosis of MI
- EKG changes
- cardiac troponin
- CK-MB
EKG changes in MI
can include:
- ST elevation (STEMI, transmural infarct)
- ST depression (NSTEMI, subendocardial infarct)
- hyperacute (peaked) T wave
- T-wave inversion
- new LBBB
- pathologic Q waves/poor R wave progression
types of infarcts and characteristics
transmural
- increased necrosis
- affects entire wall
- ST elevation, Q waves
subendocardial
- ischemic necrosis of
troponin I
rises after 4 hours
up for 7-10 days
more SPecific (rule IN) than other protein markers
CK-MB
rises after 6-12 hours
found in myocardium predominantly but also released from skeletal muscle
useful: diagnosing reinfarction following acute MI
levels return to normal after 48 hours
ST elevations or Q waves in V1-V2 indicates…
anteroseptal (LAD) infarct
ST elevations or Q waves in V3-V4 indicates…
anteroapical (distal LAD) infarct
ST elevations or Q waves in V5-V6 indicates…
anterolateral (LAD or LCX) infarct
ST elevations or Q waves in I, aVL indicates…
lateral (LCX) infarct
ST elevations or Q waves in II, III, aVF indicates…
inFerior (RCA) infarct
MI complications
cardiac arrhythmia LV failure --> pulmonary edema cardiogenic shock ventricular free wall rupture ventricular pseudoaneurysm formation true ventricular aneurysm postinfarction fibrinous pericarditis Dressler syndrome
unstable angina/NSTEMI tx
anti-coagulation (heparin) anti-platelet (aspirin + clopidogrel) beta-blocker ACE inhibitor statins
symptom control with:
nitroglycerin
morphine
STEMI tx
anti-coagulation (heparin) anti-platelet (aspirin + clopidogrel) beta-blocker ACE inhibitor statins *REPERFUSION THERAPY MOST IMPORTANT (PC intervention over fibrinolysis)
symptom control with:
nitroglycerin
morphine
dilated cardiomyopathy mnemonic
most common (90%) SYSTOLIC DYSFUNCTION
ABCCCD alcohol abuse wet beriberi coxsackie b virus myocarditis chronic cocaine use chagas disease doxorubicin toxicity \+ hemochromatosis sarcoidosis peripartum cardiomyopathy
dilated cardiomyopathy tx
Na+ restriction ACE inhibitor beta-blocker diuretics digoxin ICD heart transplant
hypertrophic cardiomyopathy tx
cessation of high-intensity athletics
beta-blocer or non-dihydropyridien Ca2+ channel blocker
ICD if patient is high risk
hypertrophic cardiomyopathy characteristics
DIASTOLIC DYSFUNCTION
60-70% of cases are familial, AUTOSOMAL DOMINANT
can be assoc with Friedreich ataxia
–> syncope during exercise and may lead to death in young athletes due to ventricular arrhythmia
- marked vetnricular hypertrophy, often septal predominancy
restrictive/infiltrative cardiomyopathy characteristics
DIASTOLIC DYSFUNCTION
major causes: sarcoidosis amyloidosis postradiation fibrosis endocardial fibroelastosis Loffler syndrome hemochromatosis (also dilated cm)
classic LHF
pulmonary edema
orthopnea
paroxysmal nocturnal dyspnea
classic RHF
peripheral edema
hepatomegaly (nutmeg liver)
jugular venous distention
systolic dysfunction pathophysiology
reduced EF
increased EDV
decreased contractility (often secondary to ischemia/MI or dilated cardiomyopathy)
diastolic dysfunction pathophysiology
preserved EF
normal EDV
decreased compliance (often secondary to myocardial hypertrophy)
most common cause of RHF is…
LHF
isolated RHF is usually due to…
cor pulmonale
HF tx
decrease mortality:
ACE inhibitors or ARBs
beta-blockers (except in acute decompensated HR)
spironolactone
symptom relief:
thiazide or loop diuretics
improved symptoms and mortility:
hydralazine with nitrate therapy
sudden cardiac death most commonly due to…
associated with…
lethal arrhythmia (ventricular fibrillation)
CAD (70% of cases)
cardiomyopathy (hypertrophic, dilated)
hereditary ion channelopathies (eg long QT syndrome, Brugada syndrome)
define chronic ischemic heart disease
progressive onset of HF over many years due to chronic ischemic myocardial damage
types of shock
hypovolemic
cardiogenic
obstructive
distributive
hypovolemic shock
by hemorrhage, dehydration, burns
skin: clammy, cold
DECREASED CVP/PRELOAD**
decrased CO
increased SVR/afterload
hypovolemic shock tx
IV fluids
cardiogenic shock
acute MI
HF
valvular dysfunction
arrhytmia
skin: cold, clammy
increased CVP/preload
DECREASED CO**
increased SVR/afterload
cardiogenic shock tx
inotropes
diuresis
obstructive shock
cardiac tamponade
PE
skin: cold, clammy
increased CVP/preload
DECREASED CO**
increased SVR/afterload
obstructive shock
relieve obstruction
distributive shock
sepsis
CNS injury
anaphylaxis
skin: warm, dry
decreased CVP/preload
increased CO
DECREASED SVR/AFTERLOAD**
distributive shock tx
pressors, IV fluids
systemic inflammatory response syndrome
>2: fever/hypothermia tachycardia tachypnea leukocytosis/leukopenia
first sign of shock
tachycardia
end result of shock
multiple organ dysfunction syndrome (MODS)
cardiac tumors
myxomas
rhabdomyomas
most common heart tumor is a metastasis
myxoma
most common primary cardiac tumor in adults
90% occur in LA
“ball valve” obstruction in LA
associated with multiple syncopal episodes
early diastolic “tumor plop” sound
rhabdomyomas
most freq primary cardiac tumor in children
associated with tuberous sclerosis
Kussmaul sign pathophys
increase in JVP on inspiration instead of a normal decrease
*inspiration –> negative intrathoracic pressure not transmitted to heart –> impaired filling of RV –> blood backs up into venae cavae –> JVD
Kussmaul sign seen in…
constrictive pericarditis
restrictive cariomyopathies
RA/RV tumors
Large-vessel vasculitis
Temporal (giant cell) arteritis
Takayasu arteritis
Medium-vessel vasculitis
Polyarteritis nodosa Kawaskai disease Buerger disease (thromboangiitis obliterans)
Small-vessel vasculitis
Granulomatosis with polyangiitis (Wegener)
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Henoch-Schonlein purpura (HSP)
Temporal (giant cell) arteritis
usually elderly females
unilateral HA (temporal artery)
jaw claudication
most commonly affects branches of carotid artery
may lead to –> blindness due to opthalmic arter occlusion
associated with polymyalgia rheumatica (PMR)
focal granulamtous inflammation
increased ESR
Temporal (giant cell) arteritis tx
high-dose corticosteroids (prior to temporal artery biopsy to prevent blindness)
Takayasu arteritis
usually asian female
Takayasu arteritis tx
corticosteroids
polyarteritis nodosa
young adults
hepatitis b seropositivity in 30%
fever weight loss malaise HA GI: abdominal pain, melena HTN neuralgic dysfxn cutaneous eruptions renal damage
