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Cardiovascular II > Pericardium diseases and cardiac neoplasms > Flashcards

Pericardium diseases and cardiac neoplasms Flashcards

1
Q

Chronic pericardial effusion

A

<500 mL and globular enlargement of heart shadow on CXR

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2
Q

Pericardial fluid under pressure leading to impaired diastolic filling of ventricles and elevated venous pressures

A

Cardiac tamponade

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3
Q

Scarred, rigid pericardium leading to impaired diastolic filling of ventricles, SV, and decreased CO

A

Constrictive pericarditis

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4
Q

Pressure tracing change in cardiac tamponade

A

Flattening of y descent

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5
Q

Decrease of SBP by >10 mmHg during normal inspiration, seen in cardiac tamponade

A

Pulsus paradoxus

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6
Q

How to check for pulsus paradoxus

A

Find highest pressure at which first Korotkoff sound is heard. Then further deflate until sound is Korotkoff is heard in inspiration and expiration. Should be <10 mmHg difference.

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7
Q

Clinical features of acute pericarditis

A

Fever
Severe CP, retrosternal
Sharp, pleuritic, and positional CP
Pericardial friction rub

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8
Q

Movement of inflamed pericardial layers against one another heard on auscultation when pt leans forward and exhales.

A

Pericardial friction rub

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9
Q

EKG findings in pericarditis

A

Diffuse ST segment elevation in majority of leads

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10
Q

Possible cause of serous pericarditis

A

Rheumatic fever
SLE
Scleroderma
Tumors
Infection of tissues contiguous to pericardium
Uremia

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11
Q

Exudate in serous pericarditis

A

Thin fluid secreted by mesothelial cells. Contains lymphocytes.

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12
Q

Possible causes of fibrinous and serofibrinous pericarditis

A

Acute MI
Dressler syndrome
Uremia
Rheumatic fever
SLE
RA
Trauma

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13
Q

Most frequent types of pericarditis

A

Fibrinous and serofibrinous

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14
Q

Exudate in fibrinous pericarditis

A

Contains plasma proteins, including fibrinogen.

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15
Q

Grossly rough, granular, dry, and shaggy appearance of pericardium

A

Fibrinous pericarditis

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16
Q

Exudate in purulent or suppurative pericarditis

A

Thin and cloudy to frank pus
400-500 mL

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17
Q

Complication of purulent or suppurative pericarditis

A

Constrictive pericarditis

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18
Q

Exudate in hemorrhagic pericarditis

A

Blood mixed with a fibrinous or suppurative effusion

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19
Q

Most common cause of hemorrhagic pericarditis

A

Spread of malignant neoplasm to pericardial space

TB

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20
Q

Causes of chronic constrictive pericarditis

A

TB
Remote history of idiopathic or viral acute pericarditis
Prior radiation to L chest

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21
Q

Pathogenesis of chronic constrictive pericarditis

A

Fluid undergoes organization and then fusion of pericardial layers. Followed by fibrous scar formation, which may calcify.

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22
Q

Clinical features of chronic constrictive pericarditis

A

Reduced CO –> fatigue, hypotension, and reflex tachycardia
Elevated systemic venous pressures
Pulsus paradoxus, not prominent
Kussmaul sign

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23
Q

Paradoxical increase in JVP during inspiration

A

Kussmaul sign

24
Q

Clinical findings of elevated systemic venous pressures

A

Jugular venous distension
Hepatomegaly with ascites
Peripheral edema

25
Q

Most common primary tumor of the adult heart

A

Myxomas

26
Q

Benign neoplasm of the heart that arises from primitive multipotent mesenchymal cells.

A

Myxomas

27
Q

Conditions associated with myxomas

A

McCune-Albright syndrome
Carney complex

28
Q

Syndrome characterized by activating mutations in GNAS1 gene that encode a subunit of G protein

A

McCune-Albright syndrome

29
Q

Syndrome characterized by mutations in PRKAR1A that encodes a regulatory subunit of cAMP dependent protein kinase

A

Carney complex

30
Q

Cause of fever and weight loss in myxoma

A

Production of IL-6

31
Q

Clinical features of myxoma

A

Early diastolic tumor plop sound
Syncope

32
Q

Most common locations of myxoma

A

90% in atria, L>R

33
Q

Position where myxoma may obstruct mitral flow more easily

A

Upright positon

34
Q

Platypnea

A

Dyspnea that improves with laying flat

35
Q

Single, sessile or pedunculated lesion in the LA. May be a globular hard mass mottled with hemorrhage OR a soft, translucent, papillary or villous lesion with gelatinous appearance.

A

Myxoma

36
Q

Microscopy of LA mass shows stellate or globular cells embedded within an abundant acid mucopolysaccharide ground substance. With peculiar vessel-like or gland-like structures

A

Myxoma

37
Q

Most frequent primary tumor of pediatric heart

A

Rhabdomyoma

38
Q

Obstruction of a valvular orifice or cardiac chamber discovered in first year of life. Associated with tuberous sclerosis in 50% of cases.

A

Rhabdomyoma

39
Q

TSC1 or TSC2 expression absent leading to myocyte overgrowth.

A

Rhabdomyoma associated with tuberous sclerosis

40
Q

Frequent major features of tuberous sclerosis

A

Facial angiofibromas
Hypomelanotic macules
Cortical tubers
Subependymal nodules

41
Q

Common major features of tuberous sclerosis

A

Retinal hamartomas
LAM
Renal AML
Cardiac rhabdomyomas

42
Q

Uncommon major features of tuberous sclerosis

A

Shagreen patches
Ungual fibromas
Subependymal giant cell tumors

43
Q

Frequent minor features of tuberous sclerosis

A

Multiple pits in dental enamel
Hamartomatous rectal polyps

44
Q

Common minor features of tuberous sclerosis

A

Bone cysts
Cerebral white matter radial migration lines
Multiple renal cysts
Gingival fibromas

45
Q

Uncommon minor features of tuberous sclerosis

A

Confetti skin lesions
Retinal achromatic patches

46
Q

Cause of carcinoid heart disease

A

Bioactive compounds (like serotonin) released by carcinoid tumors

47
Q

Reason that carcinoid heart disease typically only occurs when there is a massive hepatic metastatic burden

A

Liver normally metabolizes circulating mediators before they reach the heart

48
Q

Pearl white fibrosis of the tricuspid valve with tricuspid regurgitation. Increased plasma levels of serotonin.

A

Carcinoid heart disease

49
Q

Reason that L heart is protected in carcinoid heart disease

A

Mediators are degraded in pulmonary vascular bed

50
Q

Serotonin metabolite excreted in urine in carcinoid syndrome

A

5-HIAA

51
Q

Single most important long-term limitation of cardiac transplant

A

Allograft arteriopathy

52
Q

Late, progressive, diffusely stenosing intimal proliferation in the coronary arteries leading to ischemic injury. Caused by production of growth factors that promote intimal smooth muscle cell recruitment and proliferation with ECM synthesis

A

Allograft arteriopathy in heart transplant

53
Q

Complications of allograft arteriopathy in heart transplant

A

Silent MI
Progressive CHF
Sudden cardiac death

54
Q

Timeframe for development of allograft arteriopathy in heart transplant pts

A

Within 10 yrs

55
Q
A

Cardiovascular II (29 decks)

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