Rest of Cardio PATHOMA Flashcards
What pathology has the greatest association with VSD?
FETAL ALCOHOL SYNDROME
What pathology has the greatest association with a FORAMEN PRIMUM ASD?
DOWN SYNDROME
Describe the pathophysiology of a paradoxical embolus that arises with ASD.
What is the most common etiology of a paradoxical embolus?
Paradoxical embolus (DVT) that arises in the RIGHT SIDE but crosses over and ends up in the LEFT SIDE because of the ASD -> Can lodge in the brain
PATENT FORAMEN OVALE is the most common etiology of paradoxical embolus
Which infection is most commonly associated with a PATENT DUCTUS ARTERIOSUS?
CONGENITAL RUBELLA
What pathology is associated with TRANSPOSITION OF GREAT VESSELS?
MATERNAL DIABETES
AORTICOPULMONARY SEPTUM SIMPLY DOES NOT FORM (always has VSD)
PERSISTENT TRUCUS ARTERIOSUS
FAILURE OF AORTICOPULMONARY SEPTUM TO SPIRAL 180, associated with MATERNAL DIABETES
TRANSPOSITON OF GREAT ARTERIES
MACHINE LIKE MURMUR, loudest at S2, CONGENITAL RUBELLA, DUCTUS ARTERIOSUS does NOT close
PATENT DUCTUS ARTERIOSUS
PERSISTENCE OF FORAMEN OVALE, Fixed Split S2
ASD SECONDUM
NCC Migratory defect, failure of septum primum to fuse with endocardial cushions, Association with DOWN SYNDROME
ASD PRIMUM
Describe how TRICUSPID ATRESIA results in EARLY CYANOSIS. Which septal defect is it associated with?
TRICUSPID ATRESIA: Atretic tricuspid valve + Hypoplastic RV
ASD**
RA->LA shunt = CYANOSIS
Which congenital heart defect is associated with INFANTILE AORTA COARCTATION? What is the classic location of an AORTA COARCTATION? How does this clinically manifest?
PDA** Infantile coarctation (narrowing) of aorta located **Distal to aortic arch, Proximal to PDA = classic location
Clinically manifests as LE CYANOSIS at birth
De-oxygenated blood -> RA -> RV -> PDA -> Down to Lower extremities = LE cyanosis
Brain and UE supplied by the 3 branches of the aorta before the PDA (brachiocephalic trunk, subclavian artery, common carotid)
Which congenital heart defect is greatly associated with TURNER SYNDROME?
INFANTILE AORTA COARCTATION distal to the aortic arches and proximal to the PDA
Is ADULT AORTA COARCTATION associated with a PDA?
NO
What is the classic location of an ADULT AORTA COARCTATION?
KEY FINDING: Would pt have HTN or hypotension in UE? What about in LE?
Distal to the aortic arch
- Coarctation distal to aortic arch -> INCREASED Blood volume to the aorta arch -> HTN in UE
- DECREASED blood volume distal to aorta arch due to coarctation -> HYPOTENSION in LE
Which heart defect is ADULT AORTA COARCTATION most associated with?
BICUSPID AORTIC VALVE
What is the classic X-ray finding of AORTA COARCTATION? Why does this occur?
NOTCHING OF RIBS: Due to dvlm of collateral circulation across the intercostal arteries
Coarctation distal to the aortic arch -> INCREASED VOLUME at the aorta arch -> Dvlm of collaterals to try to bypass the narrowing - one of the collaterals = intercostal arteries at rib surface -> Compress surface of bone -> Engorgement of arteries creates NOTCHING
2 CARDIAC SX ASSOCIATIONS WITH SYPHILIS
- Aortitis -> resulting in AORTIC REGURGITATION
2. Thoracic aortic ANEURYSM
ASCHOFF BODIES is a hallmark finding of what?
What is the ASCHOFF BODY made of?
RHEUMATIC FEVER MYOCARDITIS - FATAL
ASCHOFF BODY = FIBRINOID (Collagen) + GIANT CELLS + ANITSCHKOW cells (Reactive histiocytes with slender, wavy nuclei)
Which valve is most commonly involved with RHEUMATIC FEVER (Group A strep)? If another valve is also involved in addition to the first, what is also involved?
MITRAL VALVE - most commonly involved
AORTIC VALVE if another is involved
FISH MOUTH APPEARANCE OF AORTIC VALVE resulting in AORTIC STENOSIS is a complication of what pathology?
FISH MOUTH - Due to fusion of commissures of aortic valve, resulting in AORTIC STENOSIS = Complication of CHRONIC RHEUMATIC HEART DISEASE
Which valvular defect increases the risk of and hastens the onset of AORTIC STENOSIS?
BICUSPID AORTIC VALVE
How does one distinguish AORTIC STENOSIS resulting from age-related CALCIFICATIONS and as a result of CHRONIC RHEUMATIC FEVER DISEASE?
CALCIFICATIONS:
1) AS can exist by itself.
2) NO fusion of commissures, just calcifications from wear/tear
CHRONIC RHEUMATIC FEVER DISEASE:
1) AS does not exist by itself. ALWAYS have MITRAL STENOSIS BEFORE and IN CONJUNCTION with AS
2) AS results from a FUSION OF COMMISSURES (Fish mouth appearance)
Which hematological disorder can arise as a complication of AORTIC STENOSIS?
MICROANGIOPATHIC HEMOLYTIC ANEMIA - RBCs get damaged while crossing through calcified valve -> SCHISTOCYTES
What is the most common cause of AORTIC REGURGITATION? What are three less common etiologies of AR?
ISOLATED AORTIC ROOT DILATION = most common cause
- Aortic root dilation - Syphilitic aneurysm of the thoracic aorta (Pulls on the aortic root)
- Aortic root dilation - Aortic dissection
- Infectious endocarditis
Which murmur INTENSIFIES with sudden squatting + expiration?
MITRAL REGURGITATION severity dependent on regurg fraction = regurg volume/LV stroke volume
Sudden Squatting: Increase preload (Increase venous return) + Increase afterload -> Increase LVV -> Increase regurgitant volume -> Increase SEVERITY of murmur
Expiration: Increase LAV -> Increase LVV -> Increase regurgitant volume
Rheumatic fever most commonly involves the MITRAL VALVE. Which murmur is associated with ACUTE rheumatic fever? Which murmur is associated with CHRONIC rheumatic fever?
ACUTE RF: Mitral REGURG
CHRONIC RF: Mitral STENOSIS and(or) AORTIC STENOSIS (due to fusion of commissures)
Which arrhythmia can be caused by LYME DISEASE?
3rd DEGREE COMPLETE HEART BLOCK
Which congenital heart defect is most associated with PRENATAL LITHIUM EXPOSURE? What is this pathology? What murmurs is this associated with?
EBSTEIN ANOMALY - Displacement of TRICUSPID VALVE LEAFLETS downward into RV -> Artificially “ATRIALIZES” the ventricle - Associated with TR, HF
What are the EKG changes of PERICARDITIS?
ST segment elevation + PR segment depression (LEADS I and II)
What type of arrhythmia is BRUGADA SYNDROME?
BRUGADA SYNDROME = Autosomal dominant disorder of VENTRICULAR TACHYARRHYTHMIA
EKG Pattern: Pseudo RBBB (Slurred S in lateral leads, Rabbit ears in V1-V2) + ST elevation in V1-V3
What are the 5 drugs that cause PROLONGED QT (Prolonged ventricular repolarization)?
A - anti-arrhythmics (IA, III) B - antiBiotics (MACROLIDES) C - antiPSYchotics (HALOPERIDOL) D - antiDepressants (TCAs) E - antiEmetics (ONDANSETRON)
What is ROMANO-WARD SYNDROME? Does this also have CNS defects?
Autosomal Dominant form of CONGENITAL LONG QT syndrome (inherited disorder of myocardial repolarization)
NO CNS - No sensorineural deafness, purely cardiac phenotype
What is JERVELL and LANGE-NIELSON SYNDROME?
Autosomal Recessive form of CONGENITAL LONG QT SYNDROME (inherited disorder of myocardial repolarization)
YES, sensorineural deafness as well
What are the organisms responsible for ENDOCARDITIS with NEGATIVE blood cultures?
HACEK
Haemophilus, Actinobacillus, Cardiobacterium, Eikenalla, Kingella
You diagnose a pt with Streptococcus bovis endocarditis. What is the next screening test you should order?
COLORECTAL CARCINOMA
