Heart Flashcards
Three mechanisms that initially maintain cardiac output in HF
1) Frank-Starling, 2) hypertrophy and/or dilation, 3) neurohormonal (adrenergic, RAAS, and ANP)
Effect of pressure overload
Parallel formation of new sarcomeres = hypertrophy (lalaki to cope)
Effect of volume overload
Series formation of new sarcomeres = dilation (dadami to cover greater volume)
Common causes of left-sided HF
Ischemic heart disease, HTN, aortic and mitral valve diseases, primary myocardial diseases
Common causes of right-sided HF
Left-sided HF (most common) and cor pulmonale
Organ more affected by left-sided HF than right-sided HF
Lungs
Organs hypoperfused by left-sided HF
Kidneys (prerenal azotemia) and brain (hypoxic enceph)
More prominent finding in right-sided HF due to third spacing
Effusions and ascites
Most common genetic cause of congenital heart disease
Trisomy 21
Marks the irreversibility of CHD lesions
Pulmonary HTN
Most common type of ASD
Ostium secundum (90%)
ASD adjacent to AV valves
Ostium primum
Associated with ostium primum
AV valve defects and VSD
ASD near the entrance of the SVC
Sinus venosus
Clinical findings pointing to ASD
Widely fixed split S2 (due to prolonged ejection of RV and increased blood flow across PV), and murmur (pulmonic stenosis-like due to increase blood flow across PV)
Most common congenital heart defect
VSD
Most common type of VSD
Perimembranous (90%), other types include infundibular and muscular
Cut-off size for VSD that would determine if clinically symptomatic or well-tolerated
> 10 mm
T or F: Small muscular VSDs are more likely to close than membranous
True
Vast majority of VSDs that close do so before age __
Four years of age
Adult remnant of PDA
Ligamentum arteriosum
Embryonic structure represented by median umbilical ligament
Urachus
Embryonic structure represented by medial umbilical ligament
WALA (mediaNNNN ang urachus)
CHD associated with continuous, machinery-like murmur
PDA
Administered to infants relying on PDA to survive other CHDs
PGE2 (alprostadil), a prostaglandin analogue (vs indomethacin, which can be used to close the PDA)
Most common cyanotic heart disease overall
TOF
Most common cyanotic heart disease in newborns
TGA
Defect causing TOF
Anterosuperior displacement of infundibular septum
Components of TOF
RVH, VSD, overriding aorta, pulmonary outflow obstruction
Couer en sabot
Boot-shaped heart on CXR
The degree of ___ determines clinical consequences
PS (if mild, “pink TOF” that acts like VSD; if considerable, then classic TOF with tet spells)
Epidemiologic profile of patients with TGA
Infant of diabetic mothers and male (3:1)
Frequently associated abnormalities in TGA necessary for survival
PFO, ASD, PDA (50% also have VSD)
Radiographic appearance of TGA
Egg on a string or apple on a stem
Location of infantile coarctation of the aorta
Tubular hypoplasia proximal to the PDA (preductal)
Location of adult coarctation of the aorta
Coarctation opposite the ligamentum arteriosum distal to arch vessels (postductal)
Associated genetic syndrome with infantile coarctation of the aorta
Turner syndrome
Clinical findings of infantile coarctation
Lower extremity cyanosis
Clinical findings of adult coarctation
Upper extremity hypertesion with rib notching on CXR
Most common cause of ischemic heart disease
Atherosclerosis of epicardial coronary arteries
Earliest detectable feature of myocyte necrosis
Sarcolemmal membrane disruption, leading to myocardial proteins in the blood
Length of time to loss of contractility in IHD
<2 mins
Length of time to loss of irreversible cell injury in IHD
20-40 mins
Three patterns of infarction
Transmural, subendocardial, multifocal microinfarction
Pattern of infarction leading to regional permanent occlusion that occurs in STEMI
Transmural
Pattern of infarction leading to transient or partial occlusion or global hypotension (circumferential) occuring in NSTEMI
Subendocardial
Most commonly involved coronary arteries in MI
LAD > RCA > L circumflex
Gross morphology of infarcts after 2-3 hours
Triphenyltetrazolium chloride pale zone
Gross morphology of infarcts after 12-24 hours
Reddish-blue (stagnated, trapped blood) or dark mottling, with conversion to pale tan, soft infarct
Gross morphology of infarcts after 10-14 days
Bounded by hyperemic zone of granulation (conversion to fibrous scar)
Microscopic morphology of infarcts after 6-12 hours
Ischemic coagulative necrosis
Microscopic morphology of infarcts after 1-3 days
Acute inflammation with PMNs
Microscopic morphology of infarcts after 3-7 days
Macrophages
Microscopic morphology of infarcts after 1-2 weeks
Granulation tissue
Most sensitive and specific cardiac troponins
Trop T and trop I
Cardiac biomarker used to assess reinfarction
CK-MB
Cardiac biomarkers that peak within 24 hours
Trop I and CK-MB
Cardiac biomarkers that return to normal in 5-10 days
Trop I
Cardiac biomarkers that return to normal in 48-72 hours
CK-MB
Fibrinous pericarditis post MI
Dressler syndrome
Unexpected death from cardiac causes either without symptoms or within 1 to 24 hours of symptom onset
Sudden cardiac death
Most common cause of sudden cardiac death
CAD (80%)
Most common mechanism of sudden cardiac death
Arrhythmia (asystole or v fib)
Most common cause of arrhythmia
Ischemic injury
Earliest change seen in left-sided HHD
Increase in transverse diameter of myocytes, leading to variable cell or nuclear enlargement with interstitial fibrosis
Seen in acute cor pulmonale from left-sided HHD
RV dilation
Seen in chronic cor pulmonale from left-sided HHD
RV hypertrophy, dilation, and possible R-sided HF
Most common cause of MVP
Unknown
Most common known cause of MVP
Fibrillin-1 gene defect (Marfan’s)
In MVP, marked thickening of spongiosa with deposition of mucoid material
Myxomatous degeneration
Antibodies and CD4 T cells directed vs streptococcal M proteins also recognize cardiac self-antigens
Molecular mimicry
Composed of T-cells, plasma cells, and macrophages
Aschoff body (seen in RF)
Plump, activated macrophages with condensed chromatin pattern (“slender wavy ribbon”), also known as caterpillar cells
Anitschkow cells
Most commonly involved valve in RHD
Mitral > aortic > tricuspid >pulmonic
Calcification and fibrous bridging of valvular commisures seen in RHD
Fish mouth or button hole deformity
Small vegetations along lines of closure overlying foci of fibrinoid necrosis seen in RHD
Verrucae
Subendocardial irregular thickenings due to regurgitant jets seen in RHD
MacCallum plaques
Hallmark of infective endocarditis
Vegetations
Common organisms in acute IE
Staph aureus (also in IV drug users), damage more pronounced
Common organisms in subacute IE
Viridans strep and HACEK organisms
Most commonly affected valves in IE
Aortic and mitral
Two kinds of non-infective vegetations
Nonbacterial thrombotic endocarditis (NBTE) or marantic endocarditis, and Libman-Sacks endocarditis (in SLE)
Consequence of IE vegetations
Septic embolus
Associated with marantic endocarditis
Systemic hypercoagulable states, mucinous adenoCA, endocardial trauma
Three broad categories of cardiamyopathies
Dilated CM, hypetrophic CM, restrictive CM
Dysfunction in dilated CM
Systolic (impaired contractility)
Dysfunction in hypertrophic CM and restrictive CM
Diastolic (impaired compliance)
Genetic neurological disease associated with hypertrophic CM
Friedreich ataxia
Other associated causes of hypetrophic CM
Friedreich ataxia, storage diseases, infant of diabetic mothers
Causes of restrictive CM
Amyloidosis, radiation-induced fibrosis, endomyocardial fibrosis
Most common viral causes of myocarditis
Coxsackie A and B, enteroviruses
Parasitic causes of myocarditis
T. cruzi (Chagas disease) and Trichinella spiralis
Most common helminthic cause of myocarditis
Trichinella spiralis
Most common primary cardiac tumor in adults
Myxoma
Most common primary cardiac tumor in children
Rhabdomyoma
Location of myxoma
LA > RA
Location of rhabdomyoma
Ventricles
Conditions associated with myxoma
McCune-Albright and Carney complex
Condition associated with rhabdomyoma
Tuberous sclersosis
Number of mxyoma
Usually solitary
Number of rhabdomyoma
Usually multiple
Thin strands of cytoplasm from nucleus to nuclear membrane, found in rhabdomyoma
Spider cells
Beck’s triad of cardiac tamponade
Hypotension, engorged neck veins, muffled heart sounds
Radiographic appearance of pericardial effusion
Water-bottle appearance
Most common type of acute pericarditis
Fibrinous/serofibrinous
Most common cause of hemorrhagic pericarditis
Neoplasms
Most common cause of caseous pericarditis
TB
Two types of chronic pericarditis
Adhesive mediastinopericarditis, constrictive pericarditis
Clinical findings of adhesive mediastinopericarditis
Systolic retraction of the rib cage and diaphragm, pulsus paradoxus
Clinical findings of constrictive pericarditis
Diastolic dysfunction
Clinical findings of acute pericarditis
Pericardial friction rub, chest pain relieved when leaning forward