Nichols- Vasculitis & Complications of MI

Question 1

Vasculitis is obviously the inflammation of blood vessels. What is the most common cause?

Answer 1

Autoimmune

Question 2

What are the two divisions of vasculitis?

Answer 2

1. Non-infectious (primary)

2. Infectious

Question 3

Common fungal cause of infectious vasculitis?

Answer 3

Aspergillus

Question 4

Common bacterial cause of infectious vasculitis?

Answer 4

Pseudomonas

Question 5

Common viral cause of infectious vasculitis?

Answer 5

Cytomegalovirus

Question 6

Primary vasculitis is mediated by what cells?

Answer 6

T cell mediated immune response to vascular antigens –> recruit macrophages that “chew up” the elastic lamina of the vessel –> inflammation –> antibody mediated attack

Question 7

Main sign of a vasculitis?

Answer 7

Palpable purpura

Question 8

This vasculitis is an acute necrotizing inflammatory disease of the smallest vessels (arterioles, capillaries, venules)

Answer 8

Hypersensitivity angiitis

Question 9

Hypersensitivity angiitis on the skin is called?

Answer 9

Leudocytoclastic vasculitis

Question 10

Hypersensitivity angiitis on the internal organs is called?

Answer 10

Microscopic polyangiitis

Question 11

Describe the pathogenesis of Hypersensitivity angiitis

Answer 11

infiltration of blood vessels by neutrophils –> breakdown of vessels (leukocytoclasia) –> dispersed nuclear dust

Question 12

A good bit of the time, Hypersensitivity angiitis can come from?

Answer 12

Side effects of a drug

Question 13

This vasculitis is a granulomatous inflammatory disease of medium/large arteries (especially in the head)

Answer 13

Temporal (giant cell) arteritis

Question 14

Presentation of Temporal (giant cell) arteritis?

Answer 14

Old white women

Question 15

Pathology of Temporal (giant cell) arteritis?

Answer 15

Chronic granulomatous inflammation with multinucleated giant cells that destroy the internal elastic lamina –> intimal thickening –> cell proliferation & luminal stenosis

Question 16

Signs/symptoms of Temporal giant cell arteritis?

Answer 16

Headache, vision probs, jaw claudication

Question 17

Temporal giant cell arteritis is assc with?

Answer 17

Polymyalgia rheumatica, a chronic inflammatory disease of muscles

Question 18

Temporal giant cell arteritis major complication?

Answer 18

Blindness

Question 19

How do you diagnose Temporal giant cell arteritis?

Answer 19

ESR & biopsy

Question 20

How do you treat temporal giant cell arteritis?

Answer 20

aspirin & steroids

Question 21

This vasculitis presents in young Asian children. It is a primary vasculitis of the coronary arteries with 20% aneurysm formation

Answer 21

Kawasaki disease

Question 22

Pathogenesis of Kawasaki?

Answer 22

Immune reaction to ubiquitous RNA virus

Question 23

Pathology of Kawasaki?

Answer 23

Endothelial necrosis with transmural inflammation

Question 24

Signs/symptoms of Kawasaki?

Answer 24

Persistent high fever, conjunctivitis, skin erythema, cervical lymphadenopathy, STRAWBERRY TONGUE

Question 25

There are 7 complications that can result from MI. What the fudge are they?

Answer 25

1. Arrhythmia
2. Heart Failure
3. Mural thrombus formation
4. Cardiac rupture
5. Pericarditis
6. Aneurysm
7. Papillary muscle

Question 26

How common are cardiac arrhythmias in MI?

Answer 26

Very very common.. almost always happen

Question 27

Dyspnea, crackles, and a third heart sound would lead you to believe that ______ is assc with MI

Answer 27

heart failure

Question 28

If over 40% of the LV is infarcted, what will patient present with?

Answer 28

Cardiogenic shock

Question 29

Where does a mural thrombus usually embolize to?

Answer 29

Brain or kidney

Question 30

Cardiac rupture of the free wall of the heart leads to?

Answer 30

Cardiac tamponade

Question 31

Cardiac rupture of the IV septum leads to?

Answer 31

left –> right shunt

Question 32

What day post MI is cardiac rupture most likely to happen?

Answer 32

5 days post MI

Question 33

How long post MI does pericarditis occur?

Answer 33

2-4 days

Question 34

Its been 6 weeks since Mr. Jone’s MI. He presents with an autoimmune disease against his pericardium. Whats the diagnosis?

Answer 34

Dressler syndrome

Question 35

Why can ventricular aneurysms happen post MI?

Answer 35

Because the scar tissue is thinner than the previous heart tissue was.. this happens months post MI

Question 36

Ruptured papillary muscle post MI leads to?

Answer 36

Mitral regurgitation