patho Flashcards
what does diGeorge syndrome (thyamic aplasia) 22q deletion cause?
immunodeficiency, hypocalcemia, and conotruncal heart defects(ToF, TA, ToGV)
what usually accompanies PTA?
VSD
is ToGV compatible with life?
no unless a shunt is present(VSD, PDA, PFO or ASD)
tricuspid atresia viability requires ?
R2L(ASD) and L2R(VSD or PDA)
m\c cause of blue babies?
ToF
associations of TAPVR?
ASD and sometimes PDA (R2L)
Ebstein anomaly?
TR, WPW, right HF
large VSD complications?
LV overload and HF
PDA complicates as
RVH and\or LVH and HF
what causes differential cyanosis?
PDA
eisenmenger syndrome presents as
late cyanosis, clubbing, and PV
complications of coarctation of aorta
HF, berry aneurysms, aortic rupture, and possible endocarditis
fetal alchoholic syndrome
ASD, PDA, “VSD”, ToF
congenital rubella
PDA, pulmonary artery stenosis, and septal defects
Down syndrome
endocardial cushion defect(AV septal defect). VSD, ASD
maternal DM
ToGV and VSD
prenatal lithium exposure
ebstein anomaly
turner syndrome
Bicuspid Aortic valve, coarctation of aorta
Williams syndrome
supravalvuar aortic stenosis
HTN emergency EOD
Neuro: stroke, papilledema, enceohalopathy, retinal hemorrhage and exudate. CVS; MI, HF, aortic dissection renal; AKI uterus; eclampsia hemato: MAHA
HTN complicates to
CVS; CAD, LVH, HF, Aortic aneurysm and dissection, and “ Afib
brain; stroke
CKD
retinopathy
pipestem appearance on x-ray
monckeberg sclerosis
if a known aortic aneurysm becomes painful
leaking, repture, or dissecting
thoracic aortic aneurysms required
cystic media necrosis (HTN, Marfan, 3 syphilis, turner “bicuspid aortic valve)
aortic repture
at isthmus due to trauma and\or decelerating injuries
differential blood pressure between arms
aortic dissection
management of stanford A &B AD
type A; surgery
type B; medical beta blockers then vasodialators
Left main occlusion
ST‐elevation aVR
Diffuse ST depressions
Posterior PDA
- Anterior ST depressions with standard leads
* ST-elevation in posterior leads (V7‐V9)
Cautions
• Beta blockers with Inferior MI (stimulates vagal nerve)
Bradycardia and AV block can develop
don’t give • Nitrates if RCA causes RV infarction why
- RV infarction → ↓ preload
* Nitrates ↓ preload→ hypotension
what causes prinzmetal angina
smoking, cocaine, alcohol, triptans.
what vasodilators can trigger coronary steal syndrome
dipyridamole and regadenoson
what are the causes of sudden cardiac deathes
1-CAD in 70%
2-HCM
3-channelopathies (lond GT and brugada)
implant ICD
Ischemic Pathologic Changes
• Zero to 4 hrs No changes! • 4 – 24 hrs Gross: apperars dark mottling and pale with tetrazolium stain Micro: edema, hemorrhage, and wavy fibers • 1-3 days Gross: Hyperemia Micro:central necrosis with Surrounding tissue inflammation • 3 – 14 days Gross: Central yellow-brown softening with hyperemic borders Micro: MP then Granulation tissue • 2 weeks to months Gross: Gray-white scar Micro: contracted Scar
ECG localization
anteroseptal (LAD) V1 & V2 anteroapical (distal LAD) V3 & V4 Anterolateral (LAD or LCX) V5 & V6 Lateral (LCX) I and aVL inferior (RCA) II, II, and aVF posterior (PDA) V7 & V8 with tall R and ST deprisson in V1-V3
MR after MI
occurs 2-7 days due to PM muscle rupture PDA supply
VSD after MI
3-5 days macrophages
complications of pseudoaneurysms
arrhythmia, CO decreases, mural thrombi
tamponade and free wall rupture after MI
5-14 days
LVH and previous MI are protective
true aneurysms
dyskinasia (outward contraction
what can cause LVF and pulmonary edema postMI
infarction, VSD, tamponade, MR
Fabry disease
• Lysosomal storage disease • Deficiency of α-galactosidase A • Accumulation of ceramide trihexoside causes Restrictive Heart Disease • Neuropathy, skin lesions, lack of sweat • Left ventricular hypertrophy
Loeffler’s syndrome
• Eosinophilic infiltration of myocardium
Common mode of death
• Acute phase
Myocarditis (often asymptomatic)
• Chronic phase
Endomyocardial fibrosis and myocyte death
Can see restrictive heart disease
Thrombus formation common (embolic stroke)
• Primary HES
Neoplastic disorder
Stem cell, myeloid, or eosinophilic neoplasm
• Secondary HES
Reactive process
Eosinophilic overproduction due to cytokines
Occurs in parasitic infections (ascaris lumbricoides)
Some tumors/lymphomas
• Friedreich Ataxia
- Autosomal recessive CNS disease
- Trinucleotide repeat disorder
- Spinocerebellar symptoms
- Often have concentric left ventricular hypertrophy
- Also septal hypertrophy
• Pompe Disease
- Glycogen storage disease (develops in infancy)
- Acid alpha-glucosidase deficiency
- Enlarged muscles, hypotonia
- Cardiac enlargement
iv drug abusers endocarditis
s aureus, Pseudomonas, and candida
tertiary syphilis valve disease
calcific aortic root, ascending, descending and the arch
tree bark appearance of aorta (causes aneurysms)
pulsus paradoxus
in tamponade,asthma, OSA, pericarditis and croup.
what presentation is characteristic for myocarditis
persistent tachycardia out proportion to fever
tuberous sclerosis
Autosomal dominant genetic syndrome
• Mutation in TSC1 or TSC2 gene
• TSC1: Hamartin
• TSC2: Tuberin
• Mutations → widespread tumor formation (Rhabdomyomas)
• Seizures – most common presenting feature
• “Ash leaf spots”: Pale, hypopigmented skin lesions
• Facial skin spots (angiofibromas)
• Mental retardation
Takayaso presents as
fever, night sweat, arthritis, myalgia, skin nodules, and ocular disturbances
Kawasaki (mucocutaneous lymph node syndrome)
CRASH and Burn give IVIgG and ASA(affects coronaries)
PAN
Fever, wt loss. malaise, headache GI; melena and pain renal'; HTN and artery spasm and microaneurysms neurological dysfunction cutaneous eruption fibrinoid necrosis with string of pearls
EGPA (CSD)
asthma, skin nodules, sinusitis, peripheral neuropathy.
GI, Renal(Paci-immune GN), Heart,
GPA triad
focal Necrotizing vasculitis
necrotizing granuloma in lung and URT
necrotizing GN
triad of HSP
palpable purpura
arthralgia
GI pain and intussusception
associated with IgA nephropathy (Buerger disease)
MPA
Pauci-immune GN, palpable purpura, and lung involvement
mixed cryoglobulinemia triad
palpable purpura, arhtralgia, and weakness
peripheral neuropathy and GN
Behcet syndrome
HLA-B51, HSV and parvovirus
mouth, genital, ulcers
erythema nodosum, uveitis
leukocytoclastic vasculitis (cutaneous small vessel vasculitis
7-10 days after drugs(penicillin, cephalosporins, phenytoins or allopurinol), HCV, HIV
no visceral involvement
immune-complex
late involvement indicates systematic vasculitis
HHT (OSler-Weber-REndu)
skin telengactasia
mucus membrane: epistaxis, GI bleed, hematuria
AVMs
