Pathology Flashcards
L to R shunts
late cyanosis “ blue kids
what is the frequency of L to R shunts?
VSD>ASD>PDA
VSD
most common congenital cardiac defect
asymptomatic at birth, may manifest weeks later or remain asymptomatic throughout life
Most self resolve
larger lesions may lead to LV overload and HF
ASD
defect in interatrial septum
loud S1
wide, fixed split S2
Ostium secundum defects most common and usually occur as isolated findings
this is different than patent foramen ovale, in that it is not a problem in not fusing but rather the septa is missing tissue
PDA
in the fetal period, the shunt is R to L which is normal
in the neonatal period, you have a decrease in lung resistance so the shunt becomes L to R causing progressive RVH and/or LVH and HF
wide fixed split S2, loud S1
ASD
continuous machine like murmur
PDA
how do you keep a PDA open?
maintained by PGE synthesis and low O2 tension
how do you close a PDA?
indomethacin
Where is a PDA heard best?
left infraclaviular region with max intensity at S2 (inspiratory splitting ofS2)
PDA is associated with what maternal condition
Maternal Rubella (maculopapular rash begins in face and spreads down the body)
Eisenmenger syndrome
Uncorrected L to R shunt (VSD ASD PDA) –> increase in pulmonary blood flow –> pathologic remodeling of vasculature –> pulmonary arterial hypertension
RVH occurs to compensate, the shunt then becomes right to left
What do you see in Eisenmenger syndrome?
late cyanosis, clubbing, and polycythemia
COA
aortic narrowing near insertion of ductus arteriosus (“juxtaductal”)
COA
aortic narrowing near insertion of ductus arteriosus (“juxtaductal”)
COA is associated with
bicuspid aortic valve, other heart defect and Turner syndrome
what will you see in COA?
hypertension in upper extremities and weak, delayed pulse in lower extremities (brachial-femoral delay)
with age, collateral arteries erode ribs (notched appearance on CXR)
what are 2 consequences of COA
bacterial endocarditis, cerebral hemorrhage
what defect will you have from Alcohol exposure in utero (F.A.S)?
VSD, ASD, PDA, TOF
what defect will you have from congenital rubella?
septal defects, PDA, Pulmonary artery stenosis
what defect will you have from Down Syndrome
AV septal defect (endocardial cushion defect), VSD, ASD
what defect will you have from infant of diabetic mother
Transposition of great vessels
what congenital defect will you have from Marfan Syndrome
MVP, thoracic aortic aneurysm and dissection, aortic regurgitation
what congenital defect will you have from Prenatal lithium exposure
Ebstein anomaly
what congenital defect will you have from Turner syndrome
Bicuspid aortic valve, COA
what congenital defect will you have from Turner syndrome
Bicuspid aortic valve, COA
what congenital defect will you have from Wlliams Syndrome
supravalvular aortic stenosis
what congenital defect will you have from 22q11 syndromes
Truncus arteriosus, TOF
hypertension
defined as persistent systolic BP > 140 mmHg and/or diastolic BP > 90 mmHg
what are the risk factors of hypertension
increase age, obesity, diabetes, physical inactivity, excess salt intake, excess alcohol intake, family history; black> white>asian
what are the risk factors of hypertension
increase age, obesity, diabetes, physical inactivity, excess salt intake, excess alcohol intake, family history; black> white>asian
primary htn (essential) is related to an increase in
CO or TPR
when is secondary HTN seen
renal/renovascular disease (fibromuscular dysplasia, usually found in younger women) and primary hyperaldosteronism
hypertensive urgency
severe hypertension without acute end organ damage
hypertensive urgency BP
> 180/>120
hypertensive emergency
severe ht. with end organ damage
what are some examples of hypertensive emergency
stroke, encephalopathy, papilledema, MI, HF, aortic dissection, kidney injury, microangiopathic hemolytic anemia, eclampsia, retinal hemorrhages and exudates
hypertension predisposes to
CAD, LVH, HF, afib, aortic aneurysm, stoke, chronic kidney disease, retinopathy
isolated systolic hypertension
systolic pressure is increased while diastolic is not; after age 50, caused by age related decrease in the compliance of aorta and its proximal major branches (ex:aortic stiffening)
isolated systolic hypertension
systolic pressure is increased while diastolic is not; after age 50, caused by age related decrease in the compliance of aorta and its proximal major branches (ex:aortic stiffening)
what are signs of hyperlipidemia
xanthomas, tendinous xanthoma, corneal arcus
xanthomas
plaques or nodules composed of lipid-laden histiocytes in skin
where do you normally find xanthomas, and what is a name for it?
on the eyelids, xanthelasma
tendinous xanthoma
lipid deposit in tendon
where do you normally find a tendinous xanthoma
achilles
corneal arcus
lipid deposits in cornea
corneal acrus is most common in
common in elderly! (arcus senilis), but appears earlier in life in hypercholesterolemia
arteriosclerosis
hardening of the arteries, with arterial wall thickening and loss of elasticity
arteriolosclerosis
affects the small arteries and arterioles
what are the two types of arteriolosclerosis
hyaline (thickening of vessel walls in essential hypertension or diabetes mellitus)
hyperplastic (onion skinning in severe hypertension with proliferation of smooth muscle cells)
hyaline arteriolosclerosis
(thickening of vessel walls in essential hypertension or diabetes mellitus)
hyperplastic arteriolosclerosis
(onion skinning in severe hypertension with proliferation of smooth muscle cells)
hyperplastic arteriolosclerosis
(onion skinning in severe hypertension with proliferation of smooth muscle cells)
Monckeberg (medial calcific sclerosis)
affects medium sized arteries
calcification of elastic lamina of arteries –> vascular stiffening without obstruction
what do you see on an X-ray of someone with Monckeberg
pipestem appearance
which is common, arteriolosclerosis or Monckeberg
arteriolosclerosis
do you see an obstruction in Monckeberg?
no! does not obstruct blood flow, and the intimate is not involved
Atherosclerosis
disease of elastic arteries (large) and large and medium sized muscular arteries
caused by buildup of cholesterol plaques
What are risk factors for atherosclerosis
modifiable: smoking, hypertension, hyperlipidemia, diabetes
nonmodifiable: age, sex (increase in men and postmenopausal women), family hx
what is important in the pathogenesis of atherosclerosis
inflammation
what is the pathogenesis of atherosclerosis?
endothelial cell dysfunction –> macrophage and LDL accumulation –> foam cell formation –>fatty streaks –> smooth muscle cell migration (involves PDGF and FGF) –>proliferation, and extracellular matrix deposition –> fibrous plaque –> complex atheromas
