Pathology_Nichols_HighYield Flashcards
mainly associations/buzz words some questions (169 cards)
1
Q
what disease favors the base of the heart and commonly involves the conduction system?
A
cardiac sarcoidosis
1
Q
acutely, how much fluid can the pericardium accommodate without clinically significant increase in pressure
A
up to 200 ml >200 will rapidly increase pressure
2
Q
head bobbing with each pulse (de Musset sign)
A
aortic regurgitation
2
Q
in the early subacute phase of an un-reperfused MI, put the infiltrating cells in temporal order
A
lymphocytes (day 2) macrophages (day 3) fibroblasts (day 4)
3
Q
acute childhood disease of medium arteries (commonly coronary)
A
Kawasaki disease
4
Q
hyperdynamic bounding, but rapidly collapsing pulse (Corrigan pulse)
A
aortic regurgitation
4
Q
palpable purpura
A
vasculitis
4
Q
prototype restrictive cardiomyopathy
A
amyloidosis
5
Q
is infective endocarditis destructive?
A
yes can cause perforation of a valve, abscesses, fibrotic scarring or calcification
5
Q
blindness seen in?
A
temporal (giant cell) arteritis
5
Q
where are cardiac myxoma typically located?
A
90% in the atria (72% in LA)
6
Q
concentric LVH
A
hypertensive heart disease
6
Q
connective tissue disorders (Marfans, Ehrlos Danlos) associated with?
A
MVP
aneurysms
aortic dissection (Marfan)
7
Q
Acute HF Profile A: warm and dry, associated with?
A
transient myocardial ischemia or HF from lung disease
7
Q
systemic lupus erythematosus
A
Libman-Sacks endocarditis
7
Q
Roth spots
A
IE
7
Q
mutation in ryanodine receptor (RyR)
A
familial catecholeminergic polymorphic ventricular tachycardia
7
Q
most common cause of sudden death in young athletes (< 35)
A
hypertrophic cardiomyopathy
8
Q
hibernating myocytes
A
chronic myocardial ischemia
9
Q
constrictive pericarditis seen with? what type of pericarditis?
A
bacterial infections (typically staph aureus, strep pneumonia)
fibrinous (fibrinous and fibrous adhesions and organization with fibroblasts)
10
Q
what is the major determinant of aortic aneurysm rupture?
A
diameter of aorta
10
Q
this disease is 100% associated with smoking
A
Buerger disease (thromboangiitis obliterans)
11
Q
normal LA pressure?
A
8 mmHg
12
Q
vegetations on both sides of valve seen in?
A
Libman-Sacks endocarditis
14
LV end diastolic volume
150 ml
14
cystic medial (tunica media) degeneration
aortic aneurysm
15
clinical manifestations of HF seen when reduction of SV \> \_\_\_%
\>25% reduction (e.g. from 100ml to 75ml)
15
isolated right HF due to?
pulmonary disease (called cor pulmonale)
16
mucocutaneous lymph node syndrome is AKA?
Kawasaki disease
17
associated with malignant tumors (especially mucinous adenocarcinomas)
marantic endocarditis
17
janeway lesions
IE
18
2 main complications of marantic endocarditis
systemic emboli
infection (converts it to infective endocarditis)
18
intermittent claudication
peripheral artery disease
19
Jones criteria used to dx?
Rheumatic heart disease
19
features of a vulnerable plaque
large atheroma and thin fibrous cap
19
when reversal of obstruction fails to restore blood flow into myocardium injured by that obstruction, called?
no-reflow phenomenon
19
acute pericarditis is most commonly due to what?
viruses
most commonly Coxsackie virus (group B) or echovirus
21
heart failure cells
hemosiderin-laden macrophages
22
JVD increased with inspiration (Kussmaul's sign)
cardiac amyloidosis
23
LV end diastolic pressure
10 mmHg
24
how to dx all peripheral vascular diseases?
H&P
25
myxomatous mitral valve
MVP
25
frequent causative agent in subacute bacterial endocarditis
strep viridans
25
in pericardial effusion, what do you see on ECG?
decreased voltage of QRS
electrical alternans
26
thin wavy myocytes
seen in the acute phase (1-3 days) of an un-reperfused MI
28
most common cardiac hemodynamic disorder
heart failure
29
How does CRP level relate to atherosclerosis?
CRP is secreted by cells within plaques and can activate endothelial cells leading to a prothrombic state
CRP independently predicts risk of MI, stroke, PAD, sudden cardiac death
30
what are typical symptoms and signs of aortic aneurysms?
usually none
31
Constitutional risk factors for atherosclerosis
genetics
Age
gender (premenopausal women protected by estrogen)
31
5 P's ? associated with?
pain, pallor, paralysis, paresthesia, pulselessness
acute arterial occlusion
32
genetic defects in myocyte contractile apparatus
hypertrophic cardiomyopathy
33
4 profiles of acute HF
Profile A: warm and dry
Profile B: warm and wet
Profile C: cold and wet
Profile L: cold and dry
34
most common complication of MVP
regurgitation
35
midsystolic click
MVP
36
type B aortic dissection involves?
involves the descending aorta
38
amount of blood ejected from the ventricle
stroke volume
39
signs of right HF?
volume overload:
JVD
lower leg edema
liver congestion
RUQ discomfort
ascites
39
Virchow's triad
endothelial injury
hypercoagulability
abnormal blood flow (stasis or turbulence)
39
most common cause of sudden death in athletes \> 35
atherosclerotic cardiovascular disease
40
true aneurysm
outpouching of all 3 layers (intima, media, adventitia)
41
common symptoms of HF
dyspnea fatigue
42
most common cause of sudden cardiac death
coronary artery disease (80%)
44
systolic ejection click
aortic stenosis
45
polymyalgia rheumatica associated with?
temporal (giant cell) arteritis
47
Acute HF Profile L: cold and dry, associated with?
decompensated HF with low C.O. too sudden to have caused fluid retention in response
L is for Low C.O. ?
49
chronic rheumatic disease is associated with ____ whereas acute rheumatic disease with \_\_\_
stenosis
regurgitation
50
sudden cardiac death due to abnormal cardiac signaling often due to
ventricular tachyarrhythmia
52
elongated and thin chordae tendinae, prone to rupture
MVP
53
normal stroke volume
100 ml
54
double apical impulse
hypertrophic cardiomyopathy
55
In cardiac tamponade, a Swan-Ganz right heart catheterization will show what?
increased and equalized RA and LA pressures
56
segmental transmural chronic granulomatous inflammation seen in?
temporal (giant cell) arteritis
57
summation gallop
when both S3 and S4 are present with tachycardia (S3 and S4 overlap) can be seen in hypertensive heart disease
59
LV end systolic volume
50 ml
61
5 major factors determining the heart's function as a pump?
preload
afterload
contractility
ventricular compliance
heart rhythm
62
benign gelatinous mesenchymal neoplasm of the endocardium
cardiac myxoma
63
how to diagnose acute pericarditis?
2 of the following:
typical chest pain (sharp substernal pleuritic positional)
pericardial friction rub
ECG: diffuse ST elevation
pericardial effusion
64
4 chamber dilatation
idiopathic dilated cardiomyopathy
65
flash pulmonary edema
seen when a mitral valve papillary muscle ruptures leading to rapid mitral regurgitation, increased LA pressure, pulmonary congestion/edema
66
MI first affects what region?
subendocardial
67
cardiac tamponade is what kind of syndrome?
functional
68
How much pericardial fluid is normally in the pericardium?
15-50 ml
69
rank the incidence of infection, marantic endocarditis, and rheumatic heart disease for the valves
mitral (116mm Hg) \> aortic (72) \> tricuspid (24) \> pulmonary (5)
incidence related to resting pressure on the closed valve
70
edema and rash involving palms and soles of feet
Kawasaki disease
72
RV systolic pressure
25 mmHg
73
radiograph showing bilateral pulmonary hilar lymphadenopathy
cardiac sarcoidosis
74
in cardiac tamponade, what is both therapeutic and diagnostic?
pericardiocentesis
76
LV systolic pressure
130 mmHg
77
thromboangiitis obliterans AKA?
Buerger disease
79
proportion of end dyastolic volume ejected
ejection fraction
81
Pancarditis
Rheumatic heart disease (inflammation of endo, myo, and epicardium)
82
boxcar nuclei
hypertensive heart disease
82
molecular mimicry
rheumatic heart disease
83
Modifiable risk factors for atherosclerosis
"SHODDY"
Smoking
HTN
Obesity
Diabetes
Dyslipidemias
84
frequent causative agent in acute bacterial endocarditis
staph aureus
85
pulsus paradoxus seen in? what is it?
cardiac tamponade
an exaggeration of the normal decrease in blood pressure with inspiration (\>10 mmHg systolic decrease in BP)
86
tx of cardiac myxoma? effective?
surgical excision yes, it's curative
88
thickening and fusion of chord tendinae
mitral stenosis
89
most common cause of mitral regurgitation?
MVP
90
hypercoagulable states are precursors to this...
marantic endocarditis
91
most common disease of the pericardium?
acute pericarditis
92
tx for Buerger's disease
smoking cessation
93
strawberry tongue
Kawasaki disease
94
what are the signs of cardiac tamponade?
Becks Triad:
JVD
hypotension
muffled heart sounds
95
what can be used to estimate the amount of pericardial effusion and also distinguish cardiomegaly from pericardial effusion?
Echo
97
false aneurysm
contained (by the adventitia or thrombus) ruptures of the intima and media (sometimes adventitia)
99
crescendo-decrescendo systolic murmur
aortic stenosis
hypertrophic cardiomyopathy (also described as being rough and at the left sternal border)
100
what is the worst complication of atherosclerosis?
superimposed thrombosis
101
chronically, how much fluid can the pericardium accommodate without clinically significant increase in pressure
2000ml (2L)
103
Aschoff bodies and anitschkow cells
Rheumatic heart disease
104
diastolic decrescendo murmur
aortic regurgitation
105
type A aortic dissection involves?
involves ascending aorta and or arch more common and serious
106
stunned myocytes
acute myocardial ischemia
107
signs of acute pericarditis?
pericardial friction rub (classically triphasic: atrial and ventricular systole and rapid filling phase of early systole)
widespread ST elevation
leukocytosis
elevated troponin
108
myocyte disarray
hypertrophic cardiomyopathy
110
normal ejection fraction
67%
112
Acute HF Profile B: warm and wet, associated with?
volume overload with maintenance of perfusion to extremities
114
contraction band necrosis
seen in the acute phase of an un-reperfused MI
115
tx for Kawasaki disease?
aspirin and IVIG
117
S3 gallop seen in?
HF
idiopathic dilated cardiomyopathy
118
how can you differentiate hypovolemic shock due to hemorrhage from acute HF due to myocardial ischemia? Why is this important?
central venous pressure:
CVP is elevated in HF and low in hypovolemic shock
opposite tx:
tx for HF is diuresis tx for hypovolemia is fluids
119
Acute HF Profile C: cold and wet, associated with?
volume overload w/o perfusion to extremities
120
Raynauds phenomenon seen in?
Buerger disease (thromboangiitis obliterans)
121
markers for MI
troponin I
CK-MB
122
enlarged firm tan waxy heart
cardiac amyloidosis
123
what is elevated in aneurysms and mediates continuous remodeling in arteries?
matrix metalloproteinases (MMPs)
124
\> ____ minutes of ischemia leads to infarction
\>20 minutes
126
Group A, beta-hemolytic strep pharyngitis associated with?
Rheumatic heart disease
127
myocytolysis
chronic myocardial ischemia
128
osler nodes
IE
129
slitlike fishmouth
mitral stenosis
130
\_\_\_\_ is primarily a disease of young african americans who present with arrhythmias
cardiac sarcoidosis
131
non-bacterial thrombotic endocarditis AKA
marantic endocarditis
132
most common cause of MI
coronary atherosclerosis (90%)
133
specific symptoms of HF
paroxysmal nocturnal dyspnea orthopnea
135
apical holosystolic murmur
mitral regurgitation
136
what disease presents with nonspecific symptoms and signs of HF?
idiopathic dilated cardiomyopathy
138
2 main complications of infectious endocarditis (IE)
HF
septic emboli
139
what disease is a diagnosis of exclusion?
idiopathic dilated cardiomyopathy
140
what tx can save patients from blindness in temporal (giant cell) arteritis?
steroids
141
most common cause of right HF
left HF
142
steps in the response to injury hypothesis in atherosclerosis
1: injury to endothelial cells
2: accumulation of lipid (LDL) in the tunica intima
3: Leukocyte and smooth muscle recruitment into the tunica intima
4: Foam cell formation
5: ECM deposition
143
S4 gallop seen in?
Hypertensive heart disease
aortic stenosis
hypertrophic cardiomyopathy
144
increased ESR seen in?
IE
temporal (giant cell) arteritis
145
RA pressure
3 mmHg
146
\_\_\_\_ is primarily a disease of older adults who present with HF
cardiac amyloidosis
147
what are some features of the late subacute phase of an un-reperfused MI?
angiogenesis
proliferation of fibroblasts
formation of granulation tissue
replacement of granulation tissue with fibrous collagen scar
148
normal PR interval time?
120-200 ms
149
define a 1st degree AV block
PR interval \>200ms with all impulses reaching the ventricles (all fascicles intact)
150
normal QRS time
_\<_ 100 ms
151
normal QTc?
what signals dangerous heart disease?
_\<_ 440 ms
\>440 ms
152
most common cause of prolonged QT interval?
myocardial ischemia
153
the ____ artery supplies the anterior LV and blockage can cause abnormalities in electrical leads \_\_\_\_
LAD
V1-V4
154
the ____ artery supplies the lateral LV and blockage can cause abnormalities in electrical leads \_\_\_\_
L circumflex
V5-V6
155
the ____ artery supplies the inferior LV and blockage can cause abnormalities in electrical leads \_\_\_\_\_
R coronary a.
II, III, aVF
156
acute blockage of a major epicardial coronary a can lead to what EKG changes?
later, a transmural MI can lead to what EKG changes?
elevation of ST segment and an inverted T wave
pathologic Q wave (large, long, deep negative deflection of QRS)
157
sinus tachycardia is physiological and starts in the _____ and never exceeds \_\_\_\_
SA node
220 impulses/min minus persons age
158
atrial fibrillation rate? EKG findings?
60-220
no P waves
159
atrial flutter rate? EKG findings? Results from?
~150/min
2 P waves for each QRS
reentry around tricuspid valve
160
supraventricular tachycardia usually due to? responds to?
reentry in RA near AV node
valsalva maneuver, carotid sinus massage, facial of ice water
161
2 types of ventricular tachyarrythmias?
v tachycardia
v fibrillation
162
ventricular tachycardia on EKG? types? can degenerate to?
wide QRS (\>120 ms), rate \<200/min
monomorphic or polymorphic
v fib (occurs more in polymorphic)
163
tx for v fib?
electrical defibrillation
164
Congenital long QT syndrome characteristically shows...
torsades de pointe
165
Type 1 Congenital long QT syndrome due to mutations in? result?
gene for a Ik subunit (K+ channel)
decreased outward K+ current --\> impaired repolarization --\> prolonged QT interval --\> EAD from multiple foci
166
Brugada syndrome:
common in?
defect in?
result?
EKG?
young asian males
Na+ channels
decreased Na+ inflow --\> decreased duration of AP
persistently elevated ST segments and inverted T wave in leads V1-V3, with V Fib
167
Familial catecholeminergic polymorphic V tach
mutation in? result?
presents with?
1st manifestation?
EKG?
Tx?
RyR --\> triggered activity from DAD
life threatening v tach or v fib during emotional or physical stress
syncope
normal QT interval
B-Blockade or implanted defibrillator
168
Myocarditis
usually from?
2 phases?
gross pathology?
90% recover, 10% progress to \_\_\_
viral: Parvovirus B19, HHV6
early: direct viral infection of myocyes; late: autoimmune attack of myocytes
pale mottled flabby dilated heart w/ multifocal interstitial inflammation
chronic dilated cardiomyopathy
169
RV cardiomyopathy
mutations in?
mechanism?
disease begins where?
characterized by?
results in?
EKG?
Dx?
Tx?
desmosomal proteins
2 hit mechanism
RV apex
fatty replacement of myocytes --\> lymphocyte infiltration --\> fibrous scarring
reentrant v tach from RV
inverted T wave in leads V1-V3 and epsilon wave
Echo
implanted defibrillator
