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Cardiology > Pathophysiology > Flashcards

Pathophysiology Flashcards

1
Q

Acronym for Causes of Bradycardia (10)

A

DIVISIONS

  1. Drugs - ABCD
  2. Ischaemia
  3. Vagal Hypertonia
  4. Infection
  5. Sick Sinus Syndrome
  6. Infiltration
  7. “O”
  8. Neuro
  9. Septal defect
  10. Surgery or catheterisation
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2
Q

Drugs that cause Bradycardia (4)

A

Drugs:

  1. Antiarrhythmics - Amiodarone
  2. B-Blockers
  3. CCBs - Verapamil
  4. Digoxin
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3
Q

Ischaemic cause of bradycardia (1)

A
  1. Inferior MI
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4
Q

Vagal causes of Bradycardia (3)

A
  1. Atheltes
  2. Vasovagal syncope
  3. Carotid Sinus Syndrome
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5
Q

Infective causes of bradycardia (3)

A
  1. Viral Myocarditis
  2. Rheumatic Fever
  3. Infective Endocarditis
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6
Q

Infiltrative causes of Bradycardia (5)

A
  1. Amyloid
  2. Sarcoid
  3. Autoimmune complex deposition
  4. Haemachromatosis
  5. Muscular Dystrophy
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7
Q

Electrolyte / endocrine causes of bradycardia (3)

A
  1. HypOthyroidism
  2. HypOkalaemia (can also be hyper)
  3. HypOthermia
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8
Q

Neuro causes of bradycardia (1)

A
  1. Raised ICP
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9
Q

Classification of Bradycardias (4)

A
  1. Sinus brady
  2. First degree Heart Block (PR > 200ms)
  3. Second Degree Heart Block (mobitz 1 and 2 and 2:1)
  4. Complete heart block
    - Junctional = Narrow QRS @ 50 bpm
    - Ventricular = Broad QRS @ 40 bpm
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10
Q

Causes of Pericarditis (12)

A

Infx
1. Viral - coxsackie
2. TB

Infartction
3. MI - Early 1-3 days = fibrinous
4. MI - Late (wks to months) - Dressler’s (autoimmune)

Damage
5. Trauma
6. Radiotherapy

Infiltration:
7. SLE
8. RA
9. Amyloid
10 Cancer - Breast and lung

Endocrine
11. Hypothyroidism
12. Uraemia

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11
Q

4 Hs and 4 Ts of Cardiac Arrest (8)

A

Ts

  1. Toxins
  2. Thrombus
  3. Tension Pneumothorax
  4. Tamponade

Hs

  1. Hypoxia
  2. Hypovolaemia
  3. Helectrolytes - HyperK, HypoK, HypoGlucose, HypoCa, Acidaemia
  4. Hypothermia
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12
Q

Conditions associated with increase risk of Aortic Dissection (7)

A
  1. HTN - main one
  2. Trauma
  3. Bicuspid Aortic Valve
  4. Collagen disorders - Ehlers-Danlos and Marfan’s
  5. Turner’s and Noonan’s
  6. Pregnancy
  7. Syphilis
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13
Q

Classify Aortic Dissections (2 systems, 5 pieces of info to recall)

A

Stanford Classification System:
1. Type A: Ascending Aorta - 2/3 cases
2/ Type B: Descending aorta distal to left subclavian - 1/3 cases

DeBakey Classification System
3. Type 1: starts in ascending and goes to arch or beyond

  1. Type 2: starts and ends inside the ascending
  2. Type 3: starts in descending and extends distally
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14
Q

Complications of Aortic Dissection (5)

A

Backwards Tear:
1. MI if Right Coronary Involved
2. Aortic Regurg / incompetence

Forwards Tear
3. Unequal Arm pulses and BP

  1. Stroke
  2. Renal Failure
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15
Q

Causes of Aortic Regurg due to Valve Disease (6)

A

Chronic:
1. Rheumatic Fever - LEDCs

  1. Calcific Valve Disease
  2. Connective Tissue diseases - SLE, RA
  3. Bicuspid Aortic Valve

Acute:
5. Infective Endocarditis
6. Proximal Aortic Dissection

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16
Q

Causes of Aortic Regurg due to Aortic Root Disease (6)

A

Chronic:
1. Bicuspid Valve

  1. Spondyloarthropathies
  2. HTN
  3. Syphilis
  4. Marfan’;s or Ehler-Danlos

Acute:
6. Aortic Dissection

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17
Q

Causes of Aortic Stenosis (5)

A
  1. Degenerative Calcification
  2. Bicuspid Valve
  3. William’s Syndrome (Supravalvular AS)
  4. Post-rheumatic Disease
  5. HOCM causing subvalvular occlusion of Aortic outflow
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18
Q

Classification of AF (4)

A
  1. First detected episode
  2. If more than 2 episodes and episodes self terminate within 7 days = paroxysmal
  3. Persisten AF if not self terminating
  4. Permanent if refractory to cardioversion in which case - rate control and anticoagulate
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19
Q

Atrial Flutter (2)

A
  1. A form of SVT
  2. Ventricular rate dependent on degree of AV block eg atrial rate usually around 300 so an AV block of 2:1 means a vent rate of 150
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20
Q

Atrial Myxoma (4)

A
  1. Most common primary cardiac tumour
  2. Females > Males
  3. 75% in left atrium
  4. Attached to Fossa Ovalis
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21
Q

Causes of raised pro-BNP (3)

A
  1. Left Ventricular Strain - ischaemia or valvular disease
  2. Heart Failure
  3. Reduced excretion in Kidney Failure
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22
Q

Effects of BNP on the body (4)

A
  1. Diuretic and Natriuretic
  2. Vasodilator
  3. Suppresses sympathetic tone
  4. Suppressed RAAS
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23
Q

Brugada Syndrome (2)

A
  1. AD inherited sodium channel defect (SNC5A) resulting in dysfunctional cardiac myocyte action potentials
  2. Higher risk of VT/VF and Sudden Cardiac Death
24
Q

Buerger’s Disease (1)

A
  1. Smoking causes a small and medium vessel vasculitis affecting the hands and feet (distal vasculature)
25
Q

Causes of raised BNP (11)

A
  1. Left Ventricular Strain or hypertrophy
  2. Ischaemia
  3. Tachycardia
  4. Right ventricular overload
  5. Hypoxaemia including PE
  6. GFR <60 = reduced clearence
  7. Sepsis
  8. COPD
  9. Diabetes
  10. Age >70
  11. Liver cirrhosis
26
Q

Things that decrease BNP (6)

A
  1. Obesity
  2. Diuretics
  3. ACEis
  4. BBs
  5. ARBs
  6. Aldosterone antagonists
27
Q

Conditions associated with Coarctation of the Aorta (4)

A
  1. Turner’s
  2. Bicuspid Aortic Valve
  3. Berry Aneurysms
  4. Neurofibromatosis
28
Q

Causes of Dilated Cardiomyopathy (DCM) (9)

A
  1. Idiopathic - Most common
  2. Myocarditis - Coxsackie B, HIV, Chagas, Diptheria
  3. IHD
  4. Peripartum
  5. HTN
  6. Iatrogenic - DOXORUBICIN
  7. Substances: Alcohol and Cocaine
  8. Inherited - AD inherited genetic predisposition or specific disease like Duchenne Muscular Dystrophy
  9. Infiltrative - Hameachromatosis, sarcoidosis
29
Q

Pathophysiology of DCM (3)

A
  1. Dilated ventricles all floppy and shit so can’t contract fully anymore to empty chamber = systollic dysfunction
  2. All 4 chambers are dilated but the LV is worse than RV
  3. Sarcomeres added in series - eccentric hypertrophy
30
Q

Eisenmenger’s Syndrome (9)

A
  1. An unresolved Left to Right shunt eg VSD, ASD, Patent Ductus Arteriosis reuslts in oxygenated blood entering the Right side of the heart.
  2. This means more blood volume is trying to get through the lungs bc you have all the normal Right sided circulating volume + the extra mixed in blood from the higher pressure left side
  3. This increases pressures and congestion in the pulmonary vasculature as simply more blood cells try to squeeze through it per unit time
  4. This increases pulmonary pressure (pul HTN) and causes microvascular damage and remodelling of these vessels
  5. Over time this worsens and causes a gradually more restricted and high pressure pulmonary system
  6. If left long enough this causes pressures in the RV to rise sufficiently to overcome the pressures from the left circulation which REVERSES the shunt to be a R-L shunt
  7. This sends deoxygenated blood round the body = cyanosis, clubbing and polycythaemia as the body tries to up its red blood cells to combat hypoxaemia
  8. Increasing red blood cells only worsens the congesiton in lungs, this is a death spiral
  9. Lung AND Heart transplant is only option
31
Q

Causes of Acute Heart Failure (4)

A
  1. MI / ACS
  2. HTN crisis
  3. Acute Arrhythmia
  4. Valvular Disease - AS

all causing acute hypoperfusion or reduction in CO

32
Q

Causes of HF-rEF / Systollic Dysfunction (4)

A
  1. IHD
  2. Dilated Cardiomyopathy
  3. Myocarditis
  4. Arrhythmias

Think of this a sa large floppy, thin walled dilated ventricle with a subsequently larger lumen - meaning even if contractility wasn’t impaired (which it often is) the walls could never contract enough anyway to empty the newly enlarged chamber = a lower percetnage of blood is ejected = a reduced EF.

33
Q

Causes of HF-pEF / Diastollic Dysfunction (4)

A
  1. HOCM
  2. Restrictive Cardiomyopathy
  3. Cardiac tamponade
  4. Constrictive Pericarditis

The ejection fraciton is preserved bc this is a thickening or restriciton of relaxation of the ventricular wall, so the lumen is either the same or smaller and the contractility may not be super impaired so its easier to eject all the lumen even though the actual myocardium is dysfunctional, or think of it as a failure of the walls to relax due to some internal or external restriciton eg tamponade - meaning the lumen is still filled fully - thus preservin the ejection fraction

34
Q

Define High-output HF and give 6 causes (7)

A
  1. Normal heart can’t perfuse body enough (usually a blood or structural issue not associated with actual cardiac function)

Causes:
2. Anaemia

  1. AV Malformation
  2. Paget’s Disease
  3. Pregnancy
  4. Thyrotoxicosis
  5. Thiamine Deficiency (wet beri beri)
35
Q

Define HTN according to NICE (2)

A
  1. Clincal reading >140/90

or

  1. 24 hr average of >135/85
36
Q

List 4 Renal causes of HTN (4)

A
  1. Glomerulonephritis
  2. Chornic Pyelo
  3. Adult PKD
  4. Renal Artery Stenosis

Think overactivation of RAAS

37
Q

List 6 Endocrine causes of HTN (6)

A
  1. Primary hyperaldosteronism
  2. Phaeochromocytoma
  3. Cushing’s
  4. Liddle’s Syndrome
  5. Congeital Adrenal Hyperplasia (11-B-Hydroxylase deficiency
  6. Acromegaly
38
Q

List 5 “other” causes of HTN (non-renal, non-endocrine) (5)

A
  1. Gluccocorticoids
  2. NSAIDS
  3. Pregnancy
  4. Coarctation of Aorta
  5. COCP
39
Q

HOCM (5)

A
  1. Auosomal Dominant
  2. B-myosin or myosin binfing protein c dysfunction
  3. Results in predominantly diastolic dysfunction
  4. Myofibrillar hypertrophy with chaotic and disorganised fashion myocytes (dissaray) and fibrosis on biopsy - probably dont memorise this
  5. Septal outgrowth obstructs Aortic outflow causing a functional Aortic Stenosis - if dehydrated or volume deplete then this can be a total block = SDC sudden cardiac death
40
Q

Risk Factors for Infective Endocarditis (6)

A
  1. Most important is previous IE
  2. Rheumatic valve disease
  3. Presthetic valves
  4. Congential heart defects
  5. IVDUs - typically hitting the tricuspid > mitral
  6. Recent Piercings
41
Q

Causes of Infective Endocarditis (4 bacteria, 2 non infective)

A
  1. Staph Aureus - now most common, IVDUs
  2. Strep Viridans - sepcifically Strep mitis and sanguinis, both linked to poor dental hygeine
  3. Coagulase-negative Staph like Staph Epidermidis - Prosthetic valve surgery for first 2 months post op - then most common S.Aureus again
  4. Strep Bovis - associated with colorectal cancer

Non-Infective
5. SLE - Libman-Sacks

  1. Malignancy: Marantic endocarditis
42
Q

Culture-negative causes of Infective Endocaritis (5)

A
  1. Prior Antibiotic therapy
  2. Coxiella Burnetii
  3. Bartonella
  4. Brucella
  5. HAECK - Haemophillus, Actinobacillus, cadiobacterium, eikenella, kingella

Probably dont memorise this haha - included for completeness

43
Q

Congenital Causes of Long QT sydnrome (3)

A
  1. Long QT 1, 2 and 3 (alpha subunit of slow delayed Potassium cannels defective)
  2. Jervell-Lange-Nielson sudnrome (potassium channels and deafness)
  3. Romano-Ward Syndrome (no deafness)
44
Q

Non-congenital or iatrogenic causes of Long QTc syndrome (7)

A

Electrolytes:
1. Hypocalcaemia
2. Hypokalaemia
3. hypomagnesaemia

  1. MI
  2. Myocarditis
  3. Hypothermia
  4. SAH
45
Q

Risk Factors for Mitral Regurgitation (7)

A
  1. Female
  2. Low BMI
  3. Age increased
  4. Renal impairment
  5. MI
  6. Mitral stenosis or prolapse
  7. Collagen disorders
  8. IE
46
Q

Cause of Mitral Stenosis (1)

A
  1. Rheumatic Fever, Rheumatic Fever, Rheumatic Fever

dont bother withtthte rare shit

47
Q

Post-MI Complications (and brief Mx plan) (10)

A
  1. Cardiac Arrest
  2. Cardiogenic Shock
  3. Chronic HF
  4. Tachyarrhythmias - commonly VT, most common cause of Death following MI
  5. Bradyarrhythmias - if Inferior MI = more likely as supplies AVN
  6. Pericarditis (acute and dressler’s)
  7. Left Ventricular Aneurysm - increased stroke risk, anticoagulate
  8. Left Ventricular Wall Rupture - 1-2 wks after, present with acute HF secondary to Tamponade - urgent pericardiocentesis and thoracotomy
  9. VSD - 1st week - urgent surgery
  10. Acute Mitral Regurgitaiton - infero-posterior MIs = papillary muscle rupture / ischaemia - emergency surgery
48
Q

Causes of Myocarditis (6)

A
  1. Viral - coxsackie B
  2. Bacteria - Diptheria, Clostridia
  3. Spirochetes - Lyme Disease
  4. Protozoa - Chagas, toxoplasmosis
  5. AI
  6. Drugs - Doxorubicin
49
Q

Causes of Orthostatic Hypotension

A
  1. Age
  2. Neurodegenerative disorders
  3. Diabetes
  4. HTN
  5. Iatrogenic - A-blockers for BPH
50
Q

Pathophysiology of Rheumatic Fever

A
  1. 2-4 wks immune repsonse to a Strep. Pyogenes infection
  2. B and T cells produce IgG and M and CD4+ T Cells are activated

causing a

  1. Type 2 hypersensitivity reaciton of cross-reactivity between Antibodies against M protein on Strep Pyogenes and myocytes in arteries smooth muscle
  2. Aschoff bodies describes granulomatous nodules seen in RF
51
Q

Causes of Reflex / neural Syncope (3)

A
  1. Vagal tone increase - emotion, pain, stress “fainting”
  2. Situational and reproducible - Cough, Micturition, GI
  3. Carotid Sinus Syncope
52
Q

Causes of Orthostatic Syncope (4)

A
  1. Primary autonomic failure in degenerative Neuro disorders like parkinsons / Lewy Dimentia
  2. Secondry autonomic failure - DM neuropathy, amyloidosis, uraemia
  3. Drugs - Diuretics, A-Blockers, Alcohol, Vasodilators
  4. Hypovolaemia - Bleeds, diarrhoea
53
Q

Causes of Cardiac Syncope (3)

A
  1. Arrhythmias - Brady (sick sinus, AV conduction disorders), Tachy (SVT or VT)
  2. Structural - Valves, myopathy, HOCM, MI
  3. PE
54
Q

Takayasu’s Arteritis (3)

A
  1. Large Vessel Arteritis causing
  2. Loss of limb pulse due to aortic occlusion
  3. Commoner in 10-40 y/o females and Asians
55
Q

Causes of VSD (5 congenital, 1 acquired) (6)

A

Congenital associations
1. Downs

  1. Edwards
  2. Patau
  3. Cri-du-Chat
  4. Infections (TORCH)

Acquired:
6. Post MI

56
Q

Complications of a VSD (5)

A
  1. Aortic Regurgitation due to strucutral failure
  2. Infective Endocarditis
  3. Eisenmenger’s

4.RHF

  1. Pulmonary Hypertension - contraindicates getting pregnant
57
Q

Wolf-Parkinson-White Syndrome (2)

A
  1. Basically an AVRT due to reentry of the action potential into the atria from an accessory pathway off the end of one of the ventricular fasicular fibres (congenital) causing retriggering of atria
  2. AFib can quickly degenerate into VF as this does not slow down conduction

Cardiology (8 decks)

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