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Pathology Flashcards

0
Q

Aortic stenosis

A

Diamond shaped (crescendo decrescendo) systolic murmur, elderly due to calcinosis of aortic leaflets, PE shows diminished carotid pulse during systole called pulsus parvus et tardus

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1
Q

Kawasaki presentation

A

Persistent fever, bilateral conjunctivitis, lymphadenopathy, cutaneous involvement (rash from extremities to trunk), CORONARY artery aneurysm
give child aspirin

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2
Q

Drugs causing QT prolongation (torsades de pointes)

A

Quinidine, procainamide, disopyramide, ibutilide, dofetilide, sotalol, TCAs, phenothiazines

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3
Q

22q11 syndromes

A

TOF, aortic arch anomalies, truncus arteriosus

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4
Q

Down syndrome

A

ASD, VSD, AV septal defect (endocardium cushion defect), regurgant AV valves

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5
Q

Congenital Rubella

A

PDA, septal defects, pulmonary artery stenosis

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6
Q

Turner syndrome

A

Coarctation of the aorta

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7
Q

Marfans syndrome

A

Cystic medial necrosis of aorta, aortic insufficieny and dissection

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8
Q

Infant of diabetic mother

A

Transposition of the great vessels

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9
Q

Tuberous sclerosis

A

Valvular obstruction due to cardiac rhabdomyoma

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10
Q

Friedreichs ataxia

A

Hypertrophic cardiomyopathy

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11
Q

Uncorrected PDA

A

Late cyanosis in LOWER extremities only, UE is spared

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12
Q

Prognosis of TOF

A

Severity of pulmonary stenosis

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13
Q

Abnormal neural crest migration

A

TOF, transposition of great vessels, persistent truncus arteriosus

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14
Q

Anterosuperior displacement of infundibular septum

A

TOF

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15
Q

Failure of aorticopulmonary septum to spiral

A

Transposition of great vessels

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16
Q

Atheroma

A

Plaque in small blood vessel

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17
Q

Xanthoma

A

Plaques or nodules composed of lipid-laden histiocytes in skin especially eyelids (xanthelasma)

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18
Q

Tendinous xanthoma

A

Lipid deposit in tendon, especially Achilles

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19
Q

Corneal arcus

A

Lipid deposit in cornea

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20
Q

Arteriosclerosis

A

Hardening of arteries

Monckeberg, arteriolosclerosis, atherosclerosis

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21
Q

Monckeberg

A

Calcification in the media of the arteries, especially radial or ulnar. Benign (intima not involved); does not obstruct blood flow

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22
Q

Arteriolosclerosis

A

2 types:

1) hyaline- eosiniohilic thickening of small aa. in non malignant (essential) HTN or DM
2) hyperplastic- onion skinning due to malignant HTN (>180/120)

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23
Q

Atherosclerosis

A

Fibrous plaques and atheromas form in INTIMA of arteries

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24
Atherosclerosis location
Abdominal aorta> coronary artery> popliteal artery> carotid artery
25
Atherosclerosis progression
1. Endothelial cell dysfunction 2. macrophage and LDL accumulation 3. foam cell formation 4. fatty streaks 5. smooth m. Cell migration (PDGF, FGF), proliferation, ECM deposition 6. fibrous plaques 7. complex atheromas
26
Angina
No symptoms until more than 75% occluded
27
Abdominal aorta aneurysm
Atherosclerosis, HTN male smoker
28
Thoracic aortic aneurysm
HTN, Marfan's, tertiary syphillis
29
Tearing chest pain radiating to the back
Aortic dissection
30
Aortic dissection
HTN= greatest risk factor! Caused by intimal tear creating a false lumen CT shows double barrel aorta CXR shows mediastinal widening Can result in pericardial tamponade, aortic rupture, death
31
Aortic dissection-- type A (proximal brachiocephalic trunk)
Right arm BP 120/60 | Left arm BP 220/130
32
Stable angina
Secondary to atherosclerosis, ST depression, no thrombus, relieved by rest
33
Prinzmetals variant
Secondary to coronary artery spasm (cocaine use), ST elevation
34
Unstable/crescendo angina
THROMBOSIS with incomplete coronary artery occlusion; ST depression
35
Coronary steal syndrome
Vasodilator may aggravate ischemia by shunting blood away from area of critical stenosis to an area of higher perfusion (nitroglycerin tab)
36
MI
Most due to acute thrombosis due to coronary atherosclerosis with COMPLETE occlusion of coronary artery and myocyte necrosis (within 5 minutes), initially ST depression and can progress to ST elevation with transmural necrosis
37
Sudden cardiac death
Most due to fatal arrhythmia (v fib) ---associated with CAD
38
Chronic ischemic heart disease
Progressive to CHF over many years due to chronic ischemic myocardial damage;
39
MI 0-4 hrs
Gross- none LM- none Risk- arrhythmia, CHF, cardiogenic shock
40
MI 4-12 hrs
Gross- dark mottling, pale with tetrazoleum stain LM- early coagulation necrosis, edema, hemorrhage, WAVY fibers Risk- arrhythmia
41
MI 12-24 hrs
Gross- dark mottling, pale with tetrazoleum stain LM- CONTRACTiON bands from reperfusion injury, release necrotic cell enzymes, NEUTROPHIL migration Risk- arrhythmia
42
MI 1-3 days
Gross- hyperemia LM- coagulative necrosis, acute inflammation, neutrophil migration Risk- fibrinous pericarditis
43
MI 3-14 days
Gross- hyperemic border, yellow brown softening LM- macrophage followed by granulation tissue Risk- free wall rupture leading to tamponade, papillary m. Rupture, ventricular aneurysm, inter ventricular septal rupture due to macrophages that have degraded important structural components
44
MI 2 weeks to several months
Gross- gray white LM- scar Risk- dressler syndrome
45
Transmural infarct
Increased necrosis, affects entire wall, ST elevation, Q waves
46
Subendocardial infarcts
Ischemic necrosis of less than 50% of ventricle wall | ST depression
47
DX MI
``` Gold standard= EKG in first 6 hrs Order of enzymes= TCA Troponins--stay high for 7-10 days, specific for MI CK-MB-- non specific, show reinfarction AST-- last to rise ``` Pathological Q waves= transmural infarct
48
Anterior wall infarct
LAD | V1-V4
49
Anteroseptal wall infarct
LAD | V1-V2
50
Anterolateral wall infarct
LCX | V4-V6
51
Lateral wall infarct
LCX | I, aVL
52
Inferior wall infarct
RCA | II, III, aVF
53
Dilated Cardiomyopathy
Most common due to ECCENTRIC hypertrophy, Systolic dysfunction - if familial due to mutation in dystrophin gene -ABCCCD Alcohol abuse, wet Beriberi, Coxsackie B myocarditis, chronic Cocaine use, Chagas disease, Doxorubicin toxicity, hemochromatosis, peripartum cardiomyopathy - S3 dilated heart RX: Na restriction, diuretics, ACE inhibitors, digoxin, heart transplant
54
Hypertrophic cardiomyopathy
Diastolic dysfunction concentric hypertrophy (added in parallel) ****proximity of hypertrophied interventricular septum to mitral leaflet obstructs outflow tract, resulting in systolic murmur and syncopal episode Most are familial ( B-myosin light chain mutation) , Friedreichs ataxia Sudden death in athletes Normal sized heart, S4, apical impulse, systolic murmur RX: B blocker or verapamil to decrease work of heart
55
Restrictive cardiomyopathy
Diastolic dysfunction, less compliant, problem with filling - causes include sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, Lofflers syndrome (endomyocardial fibrosis with eosinophils), hemochromatosis (dilated CM too)
56
Diastolic heart failure
Increased LVEDP | Normal LVEDV, normal EF
57
Systolic heart failure
Increased LVEDP, LVEDV | Decreased EF
58
Pulmonary edema
Decreases lung compliance Acutely- transudation of fluid, non-inflammatory Chronic- hemosiderin laden macrophages "heart failure cells"
59
Bacterial Endocarditis
FROM JANE ``` Fever Roth spots Osler's nodes Murmur Janeway lesion Anemia Nail bed hemorrhage Emboli -mitral valve most frequent - triscupid valve=IV Drug abusers (s aureus, pseudomonas, candida) Acute- s aureus on normal valves Subacute- strep viridans from dental procedure on diseased valves -due to malignancy, hypercoagulable state, SLE, S bovis (colon cancer), ```
60
Rheumatic fever
After strep pyogenes - immune mediated damage--type II hypersensitivity, AB to M protein, not a direct effect of bacteria - early deaths due to myocarditis - late sequelae include heart disease mitral>aortic>tricuspid, early is regurgitation late is stenosis - Aschoff bodies (Granulomatous with giant cells), Anitschkows cells (histiocytes), elevated ASO
61
Rheumatic fever symptoms
``` FEVERSS Fever Erythema marginatum Valvular damage ESR increase Red hot joints Subcutaneous nodules St virus dance (chorea) ```
62
Fibrinous pericarditis
Dressers, uremia, radiation | -immunologic
63
Serous pericarditis
Viral pericarditis, non infectious inflammatory (RA, SLE) | -immunological
64
Suppurative/purulent pericarditis
Bacterial infections (pneumococcus, streptococcus)
65
Cardiac tamponade
Findings= hypotension, increased JVD, muffled heart sounds (TRIAD) and increased HR Pulsus paradoxus
66
Pulsus paradoxus
Decrease in amplitude of systolic BP by >10 during inspiration Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
67
Syphilitic heart disease
3' syphillis Disrupts vasa vasorum, atrophy of vessel, dilation of aorta, calcification of aortic root,more bark, aneurysm thoracic aorta
68
Kussmauls sign
Increase in JVP on inspiration instead of normal decrease Seen with constrictive pericarditis, restrictive cardiomyopathy, right sided heart tumors, cardiac tamponade

Cardio Drugs (7 decks)

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