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(DIT) Rapid Fire + 4/5 Stars > Heart Pathology > Flashcards

Heart Pathology Flashcards

1
Q

Arteriosclerosis

A

Hardening of arteries

Medial calcific sclerosis – Monckeberg

  • calcification in media of artery
  • elderly
  • arteries of extremities
  • does not obstruct blood flow – benign
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2
Q

Arteriolosclerosis

A

Hyaline thickening of arterioles

Essential HTN and DM w/o hyperlipidemia

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3
Q

Atherosclerosis

A

Fibrous plaques and atheromas of intima of arteries

Accumulation of fatty materials in walls of arteries

Causes:
HTN
high LDL, low HDL
DM
Smoking
FHx
Sedentary lifestyle
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4
Q

Occlusion of RCA

A

-> arrhythmias

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5
Q

Occlusion of LAD

A

Anterior wall MI

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6
Q

Pathogenesis of atherosclerosis

A
  1. Endothelial dysfunction -> increased vascular permeability, leukocyte adhesion, and thrombosis
  2. Accumulation of lipoproteins – in vessel wall, mostly LDL
  3. Monocyte adhesion to endothelium – migration of monocytes into intima, transform to macrophages and foam cells (full of lipid)
  4. Factor release – activated platelets, macrophages, inflammatory mediators
  5. Sm.m. proliferation – migration of sm.m. cells into intima (normally only in media)
    Lipid accumulation – extracellularly and w/in macrophages and sm.m. cells – if disrupted -> thrombi
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7
Q

Abdominal aortic aneurysm

A

Caused by atherosclerotic plaque compressing underlying media
Nutrient and waste diffusion compromised
Media generates and necroses -> atertial wall weakness

Mean over 50, smokers

Pulsating mass in abdomen

Complications:

  • rupture -> fatal hemorrhage
  • embolism from atheroma
  • obstruction of branch vessel
  • impingement on adjacent structure (ureter)

Known AAA – U/S every 6 mo

Tx: surgical repair if over 5.5 cm or if rapidly enlarging (0.5 cm in 6 mo or 1 cm in year)

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8
Q

Deadly causes of acute chest pain

A

“if you’re DUMPT you’re heartbroken”

aortic Dissection
Unstable angina
MI
Tension pneumo
PE
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9
Q

Ischemic heart disease

A

Inadequate O2 supply relative to demand

MC: atherosclerosis

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10
Q

Prinzmetal angina

A

Occurs at rest
Not assoc w/ exertion
d/t coronary artery spasm

younger

EKG change: ST segment elevation

Tx: dihydropyradine CCB (nifedipine)

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11
Q

Angina (except treatment)

A

Retrosternal pain, pressure, radiates to neck, jaw, shoulder

SOB, diaphoresis
Women may only have fatigue

Narrowing of at least 75% coronary a.
-can’t accommodate by dilating anymore

CP d/t myocardial ischemia
Primary cause atherosclerosis
Worse overtime

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12
Q

Stable vs unstable angina

A

Stable:
Predictable: with increased activity, resolves w/ rest
EKG change: ST depression or elevation

Unstable:
Increased frequency and increased severity
Unpredictable
Pain at rest

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13
Q

Targets to improve angina

A

Goal: decrease myocardial O2 demand

Factors increasing O2 demand:
Preload
BP
Contractility
Ejection time
HR
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14
Q

Statins

A

HMG-CoA inhibitors

Lovastatin
Pravastatin
Simvastatin
Atorvastatin
Rosuvastatin

Best effect on LDL/cholesterol

Inhibit denovo cholesterol production
-> increased cell surface LDL receptors, causing LDL to be internalized out of circulation, dropping plasma LDL levels

Increases HDL
Lowers TGs

AE:
Hepatotoxicity – check LFTs before prescribing and as sx present
Myalgias -> myositis -> rhabdomyolysis
-measure CDK

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15
Q

Niacin

A

Increases HDL, lowers LDL

SE:
Flushing – 45%
-reduced w/ aspirin 30 min prior, remaining on drug and avoiding other causes (etOH, hot beverages)

Rash
Pruritis

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16
Q

Fibrates

A

Gemifibrozil
Fenofibrate

Lower TGs – best effect on TG/VLDL

AE:
Myositis
Myalgias
Hepatotoxicity – elevated LFTs
Increased cholesterol gallstones

Dangerous to use w/ statin -> increased risk of myositis

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17
Q

Omega 3 fatty acids

A

Fish oil – Salmon, halibut – cold water fish
Flax seed oil

Lower TG

No SE

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18
Q

Bile Acid binding resins

A

Cholestyramine
Colestipol
Colesevelam

Prevent reabsorption of bile acids

Cause GI upset, decreased fat soluble vit absorption
-rarely cause cholesterol gallstones

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19
Q

Ezetimibe

A

Prevents cholesterol reabsorption at small intestine brushborder

SE: increased LFT, diarrhea

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20
Q

Effects of Nitrates and Beta blockers on EDV (preload)

A

Nitrates: decrease – relaxes venous system

B-blockers: no effect

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21
Q

Effects of Nitrates and Beta blockers on BP

A

Nitrates: decreases - preload

B-blockers: decreases - afterload

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22
Q

Effects of Nitrates and Beta blockers on Contractility

A

Nitrates: indirectly slight increase

B-blockers: decreases

Net effect – no change

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23
Q

Effects of Nitrates and Beta blockers on HR

A

Nitrates: increases

B-blockers: decreases (stronger)

Net effect - decreases

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24
Q

Effects of Nitrates and Beta blockers on ejection time

A

Nitrates: decreases

B-blockers: increases

Net effect – no change

25
Q

Effects of Nitrates and Beta blockers on myocardial O2 demand or consumption

A

Nitrates: decreases - preload

B-blockers: decreases – HR, contractility, afterload

26
Q

Hypertrophic obstructive Cardiomyopathy (aka hypertrophic cardiomyopathy, aka idiopathic hypertrophic subaortic stenosis)

A

MC sudden death in young healthy athletes

Hereditary - 50% AD

Disordered hypertrophy of LV - not parallel myocytes

Enlarged ventricular septum obstructs aortic valve leaflets - blood can’t get out

Apical impulse enlarged and diffuse

S4 heart sound - stiff ventricle
Systolic murmur - louder w/ valsava
-decreases preload –> worsening of LV outflow tract obstruction
softer w/ squatting - increased afterload, less obstruction

Volume depleted –> decreased preload –> death

Tx: 
b-blocker
non-dihydropyridine CCB - verapamil
--> prolonged diastole to increase ventricular filling
Restrict physical exertion
Avoid volume depletion
27
Q

Dilated cardiomyopathy

A

MC 90%

heart dilates - myocytes in series instead of parallel
Round, globular shape

S3 herat sound

apical impulse displaced laterally

Causes:
chronic myocardial ischemia
hemachromatosis
anthracyclines - Doxorubicin, daunorubicin
Chronic cocaine and etOH use (B1 def)
Wet beriberi (b1 def)
Chagas dz - Trypanosoma cruzi
Mycarditis from Coxsackie B virus
28
Q

Restrictive cardiomyopathy

A

deposition in myocardium disrupts diastolic function

“LEASH”
Loffler syndrome - fibrosis, eosinophil infiltration (Ascaris lumbercoides)
Endocardial fibroelastosis - congenital, thick fibroelastic tissue
Amyloidosis
Sarcoidosis - granulomas
Hemochromatosis (MC w/ dilated CM)

Also radiation tx –> fibrosis

29
Q

Myocarditis

A

generalized inflammation of the myocardium - not result from ischemia

MC cause: Coxsackie B virus

Histo: diffuse interstitial infiltrate of lymphocytes w/ myocyte necrosis

30
Q

Causes of Infectious endocarditis - bacterial

A

BLOOD CX BEFORE ABX

75%:
S. aureus - 30% acutely ill
-large vegetations on previously normal valves

Viridans strep - 20-30% subacute illness

  • smaller vegetations on previously damaged valves
  • dental procedures

Enterococci - 10%
-some VRE

Coagulase neg Staph (S. epidermidis) 5-10%
-IV drug user

S. bovis - assoc w/ colon CA

31
Q

Infectious endocarditis in IV drug user

A

Coagulase neg Staph (S. epidermidis) 5-10%
-IV drug user

More likely to have fungal endocarditis - Candida albicans

32
Q

Culture negative endocarditis causes

A 
HACEK
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Now MC causes are intracellular organisms:
Coxiella brunetti
Bartonella spp.
Brucella spp.

33
Q

Typical S/S of endocarditis

A

Fever, chills, weakness, anorexia

New regurgitation murmur or HF

  • MV most common - left sided
  • Tricupsid MC in IV drug users –> septic pulmonary infarcts

Splinter hemorrhages in fingernails

Osler nodes - painful red nodules on finger and toe pads

Janeway lesions - painless erythematous macules on palms and soles

Roth spots - retinal hemorrhages w/ clear central area - rare

34
Q

Signs of embolism

A

Brain infarct -> focal neuro defects
Renal infarct –> hematuria
splenic infarct –> abdominal or shoulder pain

35
Q

Systemic immune reaction to endocarditis

A

glomerulonephritis

arthritis

36
Q

Complications of infective endocarditis

A 
Embolic
glomerulonephritis
structural damage to valves
valvular regurgitation or stenosis
rupture chordae tendinae
acute MR or TR
Suppurative pericarditis
37
Q

Libman-sacks endocarditis

A

SLE causes LSE

sterile vegetations on BOTH sides of valve simultaneously

38
Q

Marantic endocarditis

A

Metastatic cancer cells

platelet-fibrin aggregates in hypercoaguable states

39
Q

Cardiac tamponade

A

excessive fluid in space between myocardium and pericardium

  • blood, pericardial effusion
  • -> compresses heart, can’t fill during diastole

Causes decreased CO, equilibration of pressures in all chambers

Leads to:
Hypotension
increased venous pressure, JVD
distant heart sounds
increased HR
Pulsus paradoxus

EKG: electrical alternans - alternating amplitude of QRS complexes - tall –> tiny –> tall
(can’t r/o tamponade if not present on EKG)

40
Q

Pulsus paradoxus

A

Exaggerated decrease in amplitude of SBP during inspiration - >10mmHg
-decreased capacity of LV

Normal up to 10 mmHg

Causes:
Cardiac tamponade
Asthma
Croup
OSA
Severe COPD
Rarely pericarditis
41
Q

Causes of fibrinous pericarditis

A

uremia
RA
Dressler syndrome

42
Q

Causes of serous pericarditis

A

noninfectious inflammatory dz
lupus
rheumatic fever

43
Q

Suppurative pericarditis

A

infection of pericardium

44
Q

Causes of hemorrhagic pericarditis

A

TB

melanoma - mets to heart

45
Q

Acute pericarditis

A

Pleuritic CP

  • sharp
  • worse w/ inspiration
  • better sitting up and leaning forward

distant heart sounds
friction rub
diffuse ST elevation
diffuse PR depression

can either resolve w/o scarring or cause chronic constrictive pericarditis

46
Q

Chronic constructive pericarditis

A

Lupus

Kussmaul sign - JVD w/ inspiration

47
Q

Diagnostic criteria for rheumatic fever

A
  1. evidence of grp A strep infection - elevated ASO titer
  2. 2 major criteria or 1 major and 2 minor criteria

“Jones Criteria”

48
Q

Major criteria for Jones criteria

A

Joints - migratory polyartheritis
Heart - pancarditis - peri/myo/endocarditis
Nodules - subcutaneous, painless
Erythema marginatum - serpiginous skin rash - ring like, comes and go
Sydenham chorea - chorea of face, tongue, upper limb

49
Q

Minor criteria for Jones criteria

A

“PEACE”

Prolonged PR interval
Elevated temperature (fever)
Arthralgia
elevated Crp or Esr (counts as 1)

50
Q

Rheumatic heart disease

A

autoimmune

d/t Grp A beta-hemolytic strep (S. pyogenes)
–> type II HSR - Ab attack heart

51
Q

Scarlet fever

A

widespread sandpaper rash all over body

toxin mediated

active infection

52
Q

Post-strep glomerulonephritis

A

type III HSR - immune complexes

hematuria, proteinuria, renal insufficiency

1-6 wks after

53
Q

Acute rheumatic fever

A

Type II HSR

2-4 weeks after pharyngitis

54
Q

Kussmaul’s sign

A

JVD during inspiration d/t decreased capacity of RV

caused by constrictive pericarditis&raquo_space;tamponade

55
Q

Syphilitic heart disease

A

disrupt vasovasorum

dilation of aorta and aortic valve ring

Aortic regurg d/t dilation of aortic root

Aortic stenosis

Thoracic aortic aneurysm

Calcification of aorta
-tree bark appearance of inner surface of aorta

56
Q

Tuberous sclerosis tumor associations

A

Rhabdomyoma
angiomyolipoma - renal tumor
Astrocytoma

57
Q

Metastatic tumors to heart

A

MC overall type of cardiac tumors

Melanoma
lymphoma

58
Q

Myxoma

A

MC primary cardiac tumor in adults

Left atrial myxoma

  • ball of tissue in atrium acts as ball valve
  • -> obstruction of mitral valve –> syncopal episodes

can flip into LV during diastole –> early diastolic sound
-“tumor plop”

59
Q

Rhabdomyoma

A

MC primary cardiac tumor in kids

assoc w/ tuberous sclerosis

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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