Uworld Pathophysio Cardio Flashcards
—– shock can present with either hyper- or hypothermia. The initial disturbance is peripheral vasodilation leading to decreased systemic vascular resistance, decreased central venous pressure, and decreased pulmonary capillary wedge pressure. A compensatory increase in sympathetic drive causes an increase in cardiac output; the resulting high flow rates lead to incomplete oxygen extraction in the tissues, resulting in high mixed venous oxygen saturation.
Septic
This presentation of hypotension, tachycardia, jugular venous distension with clear lungs, and pulsus paradoxus (manifesting as loss of palpable pulse during inspiration) is consistent with —–. This is most likely due to the patient’s recent viral illness causing viral pericarditis with significant pericardial fluid accumulation
cardiac tamponade
Severe —- typically presents with right-sided heart failure. Patients can have distended jugular veins, pulsatile and tender hepatomegaly, abdominal distension with ascites, and lower extremity edema. The lungs are clear on auscultation in the absence of concomitant left-sided heart disease. Cardiac examination typically reveals a holosystolic murmur best heard at the left lower sternal border; the murmur intensifies with maneuvers that increase right ventricular preload (eg, deep inspiration, leg raise).
tricuspid regurge
Permanent pacemaker placement can cause —- because the right ventricular lead passes through the tricuspid valve orifice and can disrupt valve closure.
TR
Calcification and thickening of the pericardium are common features of constrictive —- on CT. Clinical findings include slowly progressive dyspnea, peripheral edema, and ascites.
pericarditis
The ventricular myocardium secretes —– in response to the ventricular stretch and strain that typically occurs with volume overload. BNP, along with atrial natriuretic peptide secreted by the atrial myocardium, stimulates vasodilation and salt and water excretion to help relieve volume overload.
brain natriuretic peptide (BNP)
Eccentric ventricular hypertrophy results in a dilated cavity with relatively thin ventricular walls due to the addition of myocardial contractile fibers in series in response to chronic volume overload. Chronic aortic regurgitation can result from —– dilation and is a common cause of eccentric hypertrophy.
aortic root
Renal infarction presents with flank pain, hematuria, elevated lactate dehydrogenase, and a wedge-shaped kidney lesion on CT scan. The most common cause of renal infarction is systemic —–, often due to thrombus formation during atrial fibrillation. The brain and kidneys are more likely than other organs to suffer embolic infarctions because they are perfused at a higher rate.
thromboembolism
This young patient’s repeated episodes of palpitations are suggestive of paroxysmal supraventricular tachycardia, and the physician suspects Wolff-Parkinson-White (WPW) syndrome. WPW syndrome is caused by an accessory conduction pathway (bundle of Kent) that allows electrical conduction impulses to bypass the —- node and cause preexcitation of the ventricles. This preexcitation leads to characteristic findings on baseline ECG, including a shortened PR interval (often <0.12 seconds), early upslope of the QRS complex (delta wave), and a widened QRS complex.
atrioventricular
Early disseminated Lyme disease can have cardiac involvement (Lyme carditis) that most commonly manifests with varying degrees of —- block. Patients may be asymptomatic, but those with complete AV conduction block are likely to have dyspnea, lightheadedness, or syncope
atrioventricular (AV) conduction
patient with recurrent episodes of syncope while shaving most likely has carotid sinus hypersensitivity (CSH). When carotid sinus baroreceptors detect increased blood pressure, the brainstem responds by increasing parasympathetic tone (slows the heart rate) and reducing sympathetic tone (induces vasodilation). In some individuals, especially elderly men, the carotid sinus baroreceptors become overly sensitive to tactile stimulation, triggering an exaggerated vasovagal response with marked peripheral vasodilation (ie, decreased ——).
systemic vascular resistance
decreased pulmonary capillary wedge pressure (PCWP) and increased right atrial pressure (RAP), indicate impaired blood flow from the —– to the left side of the heart (right-sided heart failure). Common causes of right-sided heart failure include obstruction of pulmonary circulation (eg, pulmonary arterial hypertension, pulmonary embolism) and right ventricular infarction (likely in this patient due to multiple cardiovascular risk factors)
right ventricle
—– disease) is a segmental, inflammatory vasculitis that affects the small- and medium-sized arteries and veins of the distal extremities with inflammatory, intraluminal thrombi and sparing of the vessel wall. It is usually seen in young, heavy smokers, and can present with digital ischemia and ulceration, extremity claudication, Raynaud phenomenon, and superficial thrombophlebitis.
Thromboangiitis obliterans (Buerger
This patient has chronic constitutional and pulmonary symptoms associated with patchy lung infiltrates/cavitation and laboratory findings of glomerulonephritis (hematuria, increased creatinine). These findings are suggestive of granulomatosis with polyangiitis (GPA), a small vessel vasculitis associated with antineutrophilic cytoplasmic antibodies (ANCA). Patients with GPA generally present with weeks or months of constitutional symptoms (eg, arthralgias, fatigue, low-grade fever, weight loss) and manifestations in the following areas:
Upper airway: otitis media, nasal crusting/ulcers, rhinorrhea
Lower airway: hoarseness, cough, stridor, hemoptysis, pulmonary infiltrates
Kidney: rapidly progressive glomerulonephritis
Laboratory evaluation frequently shows anemia of chronic disease due to elevated levels of inflammatory cytokines and renal insufficiency due to glomerulonephritis (eg, microscopic hematuria, red cell casts, negative nitrate/bacteriuria).
histopathology will show a necrotizing arteritis with granulomatous inflammation (eg, epithelioid histiocytes, multinucleated giant cells) and a mixture of surrounding inflammatory cells. Veins and capillaries are also frequently affected.
Signs of —- include jugular venous distension, muffled heart sounds, and hypotension (Beck triad), as well as reduced point of maximal impulse, cool extremities, and clear lungs.
tamponade
The most common histologic findings in —–related aortic root disease include fragmentation and loss of the elastic lamellae with fibrosis and cystic medial degeneration (replacement of collagen, elastin, and smooth muscle by a basophilic mucoid extracellular matrix with irregular fiber cross-linkages and cystic collections of mucopolysaccharide). Cystic medial degeneration also occurs with normal aging, but is accelerated in —- syndrome.
Marfan
Hypertrophic cardiomyopathy is a common cause of sudden cardiac death (SCD) in young adults. Histologic features include cardiomyocyte hypertrophy and myofiber disarray with increased interstitial fibrosis. The structural disarray creates a substrate for —– that can lead to SCD.
ventricular arrhythmia (eg, ventricular tachycardia, ventricular fibrillation) that can lead to SCD.
Hypertension is the single most important risk factor for the development of intimal tears leading to —–. Hypertension, smoking, diabetes mellitus, and hypercholesterolemia are all major risk factors for atherosclerosis, which predisposes more to aortic aneurysm formation.
aortic dissection
