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Step 1 > Pathology - cardiac > Flashcards

Pathology - cardiac Flashcards

1
Q

Right-to-left shunts in early cyanotic babies

A 
5 T's
Truncus arteriosus (1 vessel)
Transposition (2 switched vessels)
Tricuspid atresia (3 = tri)
Tetralogy of Fallot (4 = tetra)
TAPVR (anomalous pulmonary venous return) (5 letters)

Generally caused by defects in aorticopulmonary septum (derived from neural crest)

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2
Q

Tetralogy of Fallot pathology

A

Caused by anterosuperior displacement of the infundibular septum

Four defects: pulmonary stenosis, RVH, overriding aorta, VSD

Pulm stenosis causes right-to-left shunting across VSD and RVH

Squatting increases systemic resistance, decr. R-to-L shunt, improves cyanosis

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3
Q

Late cyanosis in babies

A

VSD > ASD > PDA

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4
Q

ASD pathology

A

usually ostium secundum defects

distinct from PDA: pathology is missing tissue rather than unfused septa

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5
Q

End-stage effects of Eisenmenger syndrome

A

Late cyanosis, clubbing**, polycythemia

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6
Q

Associations with coarctation of the aorta

A

Bicuspid aortic valve, Turner syndrome (45 X)

aortic narrowing near insertion of ductus arteriosis (juxtaductal)

Look for delayed pulses in the lower extremities

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7
Q

Hypertension pathology

A

Primary (essential) - 90%, related to incr. CO or TPR

Secondary - 10%, related to renal/renovascular dz, primary hyper-aldosterone

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8
Q

Cause of hypertension in young woman

A

Fibromuscular dysplasia - string of beads in renal artery

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9
Q

Hypertensive nephropathy

A

Renal arterial hyalinosis

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10
Q

Evidence of end-organ damage in hypertensive emergency

A

Encephalopathy, stroke, retinal hemorrhages/exudates, papilledema, MI, HF, aortic dissection, kidney injury, MAHA, eclampsia

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11
Q

Hyperlipidemia signs

A

Xanthoma/xanthelesma - lipid-laden histiocytes in the skin

Tendinous xanthoma - seen particularly in Achilles

Corneal arcus - common in elderly

All appear in familial hypercholesterolemia

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12
Q

Arteriosclerosis

A

Arterial wall thickening and loss of elasticity

Includes arteriolosclerosis and medial calcific sclerosis

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13
Q

Arteriolosclerosis (two types)

A

Hyaline - thickening of vessel walls, seen in essential HTN/DM

Hyperplastic - proliferation of smooth muscle cells (onion skinning), seen in severe HTN

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14
Q

Medial calcific sclerosis

A

calcification of elastic lamina or arteries

Leads to vascular stiffening without obstruction

Intima not involved!

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15
Q

Atherosclerosis pathology progression

A

endothelial cell dysfunction –> macrophage/LDL accumulation –> foam cell formation –> fatty streaks –> smooth muscle migration (PDGF/FGF), ECM deposition –> fibrous plaque –> complex atheroma –> arterial occlusion or plaque rupture

Look for cholesterol crystals

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16
Q

Aortic aneurysm (abdominal vs. thoracic)

A

Localized pathologic dilatation of aorta

Abdominal: assoc. with atherosclerosis, older men

Thoracic: cystic medial degeneration, assoc. with bicuspid aortic valve, Marfan, tertiary syphillis (obliterative endarteritis)

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17
Q

Aortic dissection

A

intimal tear forming a false lumen

end results: rupture, pericardial tamponade, death

Type A: Ascending aorta, proximal, treat with surgery

Type B: involves descending aorta, treat with b-blockers then vasodilators

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18
Q

Coronary steal syndrome

A

phenomenon where administration of vasodilators (CCBs) dilates normal vessels and shunts blood to well-perfused areas, leading to decreased flow and ischemia in post-stenotic region

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19
Q

Pathologic evolution of MI

4-24 hrs

A

early coagulative necrosis, neuts appear, contraction bands with reperfusion

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20
Q

Pathologic evolution of MI

1-3 days

A

Extensive coagulative necrosis

Tissue surrounding infarct shows acute inflammation with neutrophils

Watch for pericarditis

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21
Q

Pathologic evolution of MI

3-14 days

A

Macrophages, then granulation tissue (thus, mac-mediated structural degradation)

Watch for free wall rupture (tampondade), pap muscle rupture (MR), septal rupture

LV pseudoaneurysm also appears

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22
Q

Pathologic evolution of MI

2 weeks - months

A

Contracted scar

Dressler syndrome: post-MI pericarditis (pleuritic chest pain, pericardial rub/effusion), autoimmune reaction to myocardial neo-antigens

True ventricular aneurysm (risk of mural thrombus)

23
Q

MI diagnosis (ECG, markers)

A

ECG: gold standard in first 6 hours

troponin-I: rises after 4 hours, high for 7-10 days, more specific

CK-MB: rises after 6-12 hours (returns to normal in 48 hrs), found in myocardium, can be released from skeletal muscle, useful for reinfarction

24
Q

Transmural vs. subendocardial infarcts

A

Transmural: incr. necrosis, affects entire wall, ST elevation

Subendocardial: less than 50% of wall affected, especially vulnerable to ischemia, ST depression

25
Q

Dilated cardiomyopathy

A

Eccentric hypertrophy (cells added in series)

Alcohol, wet Beriberi, Coxsackie b, Cocaine use, Chagas, Doxorubicin tox

Look for S3, balloon appearance on CXR

Tx: Na restriction, ACEis, BBs, diuretics

26
Q

Hypertrophic cardiomyopathy

A

Mostly familial (B-myosin heavy chain mutation)

Assoc. with Friedrich ataxia

Look for S4, mitral regurg (impaired valve closure)

Tx: BBs, CCBs (verapimil), ICD if high-risk

Path: myofibrillar disarray and fibrosis

can be obstructive

27
Q

Restrictive/infiltrative cardiomyopathy

A

Sarcoid/amyloid, postradiation fibrosis, hemochromatosis

Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate)

Leads to diastolic dysfunction

28
Q

Systolic vs. diastolic dysfunction

A

systolic: reduced EF, incr. EDV, decr. contractility
diastolic: preserved EF, normal EDV, decr. compliance

29
Q

Decreased mortality in HF

A

ACEis/ARBs

BBs

Spironolactone

30
Q

Hemosiderin-laden macrophages in the lungs

A

Sign of pulmonary edema

31
Q

Four types of shock

A

Hypovolemic (decr. preload)
Cardiogenic (decr. CO)
Obstructive (decr. CO)
Distributive (decr. SVR)

32
Q

Bacterial endocarditis findings

A

Fever
Roth spots (white spots on retina)
Osler nodes (finger/toe pads),
Mitral valve/murmur

Janeway lesions (red lesions on palms/soles)
Anemia
Nail splinter hemorrhages
Emboli

33
Q

acute endocarditis etiology

A

S. aureus (high virulence)

Rapid onset, large vegetations on normal valves

34
Q

chronic endocarditis etiology

A

viridans streptococci

Smaller vegetations on damaged valves

Dental procedure sequela

35
Q

tricuspid valve endocarditis

A

S. aureus, Pseudomonas, Candida

36
Q

culture negative endocarditis

A

Coxiella, Bartonella, HACEK (h. flu, actinobacillus, cardiobacterium, eikenella, kingella)

37
Q

Rheumatic fever

A

Consequence of pharyngeal infection with GABHS, type II hypersensitivity (Abs to M protein cross-react)

Early: MVR, progresses to MS

Joints (migratory polyarthritis)
Heart sign
Nodules
Erythema marginatum
Sydenham chorea

Tx: penicillin

38
Q

Acute pericarditis

A

Sharp pain, aggravated by inspiration

Causes: coxsackie, idiopathic, autoimmune (Dressler, SLE, RA), radiation therapy

39
Q

Tamponade findings

A

Equilibration of diastolic pressure in all four chambers

Beck triad: hypotension, distended neck veins, distant heart sounds

low-voltage QRS and electrical alternans

40
Q

Cardiac tumors

A

Myxomas - ball valve obstruction in left atrium, early diastolic tumor plop sound

Rhabdomyomas - Most frequent primary tumor in children (assoc. with tuberous sclerosis)

41
Q

Kussmaul sign

A
  • increase in JVP with inspiration (normally there’s a decrease)

Impaired filling of RV with inspiration due to constrictive pericarditis, restrictive cardiomyopathies, right atrial/ventricular tumors

42
Q

Vascular tumors assoc. with elderly

A

Angiosarcoma - rare, malignancy, if hepatic then assoc. with vinyl chloride/arsenic, very aggressive

Cherry hemangioma - benign, capillary, does not regress

43
Q

Vascular tumors assoc. with AIDS

A

Bacillary angiomatosis - capillary skin papules, caused by Bartonella henselae, neutrophilic infiltrate

Kaposi sarcoma - endothelial malignancy, assoc. with HHV-8, HIV, lymphocytic infiltrate

44
Q

Vascular tumors assoc. with pregnancy or childhood

A

Pyogenic granuloma - pregnancy, can ulcerate and bleed

Strawberry hemangioma - grows rapidly, regresses spontaneously by 5-8 yo

45
Q

Raynaud phenomenon

A

decr. blood flow to skin due to arteriolar vasospasm in response to cold/stress

syndrome occurs when 2ry to SLE, CREST, mixed connective tissue dz

Tx: CCBs

46
Q

Large-vessel vasculitis

A

Temporal arteritis - elderly females, can lead to blindness due to ophthalmic artery occlusion, assoc. w/ polymyalgia rheumatica

Takayasu arteritis - aortic arch syndrome, weak UE pulses, granulomatous thickening of aortic arch

47
Q

Medium-vessel vasculitis

A

Polyarteritis nodosa - young adults, Hep B, const. sx, renal/visceral vessels (microaneurysms), immune complex mediated, tx: cyclophosphamide

Kawasaki dz - CRASH and burn (conjunctiva, rash, adenopathy, strawberry tongue, hand-foot changes, fever, can develop coronary artery aneurysms

Beurger dz - heavy smokers under 40, male, intermittent claudication, loss of digits, often seen w/ Raynaud, tx = quit smoking!

48
Q

ANCA assoc vasculitidies

A

GPA (c-ANCA, anti PR3) - nasal septum perforation, chronic sinusitis, hemoptysis, hematuria, red cell casts, large pulmonary nodules on CXR

Microscopic polyangiitis (p-ANCA, anti MPO) - necrotizing vasculitis involving lungs, kidneys, skin. No nasal involvement.

EGPA (p-ANCA, anti MPO) - asthma, sinusitis, peripheral neuropathy, look for eosinophilia

49
Q

Henoch-Schonlein Purpura

A

Follows URI, triad: skin (palpable purpura), arthralgias, GI (ab pain)

secondary to IgA complex deposition, assoc with IgA nephropathy

50
Q

Familial chylomicronemia syndrome

A

Type 1
defect in lipoprotein lipase and ApoC-II

risk of pancreatitis

51
Q

Familial hypercholesterolemia

A

Type 2a
defect in LDL receptor, ApoB-100
(lack of uptake by liver –> incr. LDL serum)
premature coronary artery disease

52
Q

Familial dysbetalipoproteinemia

A

Type 3
ApoE defect

premature coronary artery disease

53
Q

Familial hypertriglyceridemia

A

Type 4

ApoA-V defect

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