Cardiac - Path Flashcards by Daniel Coquyt

What organism most often causes myocarditis?

Shows what on histo?

Coxsackie A and B

Lymphocytic infiltrate in the myocardium

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ASD causes what?
Results in what?

What is an important complication?

Left to Right shunt
Split S2 on auscultation

Paradoxical emboli (can go to brain)

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What is the most common cause of death in the acute phase of acute rheumatic fever?

Myocarditis

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What are the 2 types of aortic dissection and what is their treatment?

A - involves ascending aorta, can cause AR/tamponade
Tx: surgery

B - ONLY descending aorta, below l. Arteriosum
Tx: Beta blockers, vasodilators

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What does tetralogy of Fallot cause?

PROVe
Pulmonary infundibular stenosis 
RVH
Overriding aorta
VSD

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The RCA supplies what important structures?

Leads to what?

SA and AV nodes

Bradycardia
MI due to heart block

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Most common signs of RHF?

HM (nutmeg liver)
JVD
Peripheral Edema

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AS may lead to what?

Concentric hypertrophy
S4 heart sound
Hemolytic anemia

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What causes concentric LV hypertrophy?

HTN

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How does MR affect afterload?

EF?

Decreases it

Increased but lower forward SV

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Day 4-7 post MI involves primarily what cells present?

What is the major complication that may result?

Macrophages

Rupture of ventricular free wall –> cardiac tamponade
Rupture of interventricular septum –> shunt
Rupture of papillary muscle –> mitral insufficiency

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What is asymptomatic at birth but causes a holosystolic murmur?

Shows what CF?

PDA

LE cyanosis

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What is associated w/Transposition of Great Vessels?

Presents how?

Treat how?

Maternal diabetes

Early cyanosis at birth

PGE to maintain a PDA

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Young athlete collapsing and dying due to ventricular arrhythmia is due to what?

Hypertrophic cardiomyopathy

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What angina causes ST elevation?

Prinzmetal

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What presents w/weak UE pulses, fever, night sweats and increased ESR?

Labs show what?

Tx?

Takayasu arteritis

Thickening and narrowing of aortic arch and prox great vessels

Corticosteroids

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What presents as a murmur over the apex that radiates to the left axilla?

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3 main CFs of AS?

Syncope
Angina
Dyspnea on exertion

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What is Kussmaul sign?

Indicates what?

Inc in JVP on inspiration instead of a normal DEC

Constrictive pericarditis, restrictive cardiomyopathy, RA or ventricular tumor

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Hereditary hemorrhagic telangeictasia called what?

CFs?

Osler-Weber-Rendu

Telangeictasias, epistaxis, AVMs, GI bleeding, hematuria, skin discoloration

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What angina causes ST depression?

Stable, unstable

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What is a b9 hamartoma of cardiac muscle called?

Assoc w/what?

Arises where?

Rhabdomyoma, #1 in children

Tuberous sclerosis

Ventricle

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Dilated cardiomyopathy causes what dysfunction?

Leads to what?

Complications?

Systolic dysfx

Biventricular CHF

MR and TR leading to arrhythmia

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What causes scarring of the aortic valve and fusion of the commissures?

Chronic rheumatic heart disease

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What sites commonly metastasize to the heart? Causes what?

Breast, lung, melanoma and lymphoma Pericardial effusion

What is Kussmaul's sign?

When you breathe in, jugular veins Decrease distention but in RHF JVD increases

What is the most common primary cardiac tumor in adults? Mal or B9? Forms what, where? Causes what?

Myxoma, B9 Pedunculated mass in the LA syncope

Reactive histiocytes w/slender wavy nuclei are what? Associated with what?

Anitschkow cells Myocarditis

What provides evidence for a previous group A beta-hemolytic strep infection?

ASO or anti-DNase B titers

Mitral stenosis can result in what 3 major sequellae?

Pulmonary congestion Pulmonary HTN and eventually RHF AFib --> inc risk of mural thrombi

AS causes chronically what problems?

Inc pressures in LV and LA dilation hypertrophy

Ventricular apical ballooning due to increased sympathetic stimulation is what?

Takotsubo cardiomyopathy (Broken hearT)

What causes thickening of chordae tendinae and cusps? | With involvement of what valve?

Chronic rheumatic heart disease | Mitral

Kussmaul's sign is most commonly found in what? What else?

Chronic constrictive pericarditis RHF, restrictive cardiomyopathy, tricuspid stenosis

What kind of valve defect leads to a wide pulse pressure? Called what?

AR Water-Hammer pulse

What is a blowing, decrescendo diastolic murmur? Best heard where?

AR Left sternal border in 3/4th ICS

What are the 3 major complications of AS?

Concentric LVH Angina andy syncope w/exercise Microangiopathic hemolytic anemia

What can papillary muscle rupture after a MI cause? Gets louder when?

MR Squatting or expiration

MI usually involves what? What is spared?

LV RV and both atria

What is the most common type of ASD?

Optimum secundum

What is usually due to rupture of atherosclerotic plaque w/thrombosis and INCOMPLETE occlusion of a coronary artery?

Unstable angina

What is the main feature of hypertrophic cardiomyopathy?

Diastolic dysfx (ventricle cannot fill)

How does acute MR affect LV EDV? What else does it do?

Increases Increases preload

What produces an opening snap followed by a diastolic rumble?

What does the AS murmur sound like? Where?

Harsh crescendo-decrescendo holosystolic murmur Right sternal border

What is hypertrophic cardiomyopathy? Usually due to what?

Hypertrophy of LV Sarcomere proteins (AD)

How does mitral stenosis present as a murmur? Best heard where?

Mid-diastolic rumbling murmur preceded by opening snap Apex of left sternal border

What is a PDA assoc with?

Congenital rubella

PAN associated w/what? Histopath shows what? Tx?

HepB Transmural inflammation w/fibrinoid necrosis corticosteroids, cyclophosphamide

Occlusion of the RCA leads to infarction of what?

Posterior wall Posterior septum Papillary muscles of the LV

Rupture of papillary muscle and chordae tendinae causes what? When?

MR 3-14 days post MI

What murmur radiates to the carotid arteries?

With stable angina, what area is the most susceptible to ischemic damage? Shows what on EKG?

Subendocardial ST-segment depression

What is episodic chest pain unreleated to exertion? Due to what?

Prinzmetal Vasospasm of coronary artery

Common complications of coarctation of the aorta?

HF Inc risk of cerebral hemorrhage (berry aneurysm) Aortic rupture Endocarditis

What is the key finding in the adult form of coarctation of the aorta? Where is the coarctation? Assoc w/what?

HTN in UE, hypoTN and weak pulses in LE Distal to aortic arch Bicuspid aortic valve

What is decreased compliance of the ventricular endomyocardium caused by? Does what?

Restrictive cardiomyopathy Restricts filling during diastole

What has a boot-shaped heart on xray?

Tetralogy of Fallot

What organism causes endocarditis in pts w/underlying colorectal carcinoma?

Staph bovis

How do you treat PDA? Via what mechanism?

Indomethacin Decreases PGE

Define aortic regurgitation

Backflow of blood from the aorta into the LV during DIASTOLE

What are foci of chronic inflammation, giant cells, and fibrinoid material called? What else do they contain? Assoc w/what?

Aschoff bodies Anitschkow cells Myocarditis

Calcification of internal elastic lamina and media of arteries leads to what? Called what? What appearance on xray?

Vascular stiffening w/out obstruction, Monckeberg sclerosis Pipestem

What causes MVP? Associated w/what?

Myxoid degeneration Marfan, Ehlers-Danlos

What valve is most commonly involved from bacterial endocarditis? PE findings?

Mitral #1 - Fever, Splinter hemorrhages, Osler, Janeway, Roth spots

Kawasaki disease complications?

Coronary artery aneurysm, thrombosis, rupture

What is endomyocardial fibrosis w/an eosinophilic infiltrate and eosinophilia called? Causes what?

Loeffler syndrome Restrictive cardiomyopathy

What is the mechanism behind the presence of "heart failure cells"? What are they?

Bursting of small congested capillaries due to pulmonary congestion from LHF Hemosiderin-laden macrophages

What causes a hyperdynamic circulation? Due to what?

AR Increased pulse pressure

What leads show a posterior infarct?

V1-V3 ST Depression w/tall R waves

What is arcus senilis?

Lipid deposit in the cornea in elderly pts

What causes a holosystolic, blowing murmur?

Janeway or Osler are painful?

Osler Ouch ouch osler

Optimum primum is assoc w/what?

Down syndrome

Chronic rheumatic heart disease leads to what? Can lead to what?

Mitral stenosis LA dilation --> AFib or mural thrombus formation (can cause ischemic stroke)

Biopsy showing myofiber hypertrophy w/disarray is characteristic of what?

Hypertrophic cardiomyopathy

Chronic ischemic heart disease progresses to what?

CHF

What closes a PDA? What keeps it open?

Indomethacin PGE2

Occlusion of the Left circumflex artery leads to infarction of what?

Lateral wall of LV

Aortic regurgitation causes what kind of murmur?

Early, Blowing diastolic murmur

How does restrictive cardiomyopathy present?

CHF w/low voltage EKG and diminished QRS amplitude

Babies w/coarctation present how? Associated w/what?

LE cyanosis Turner syndrome

What kind of murmur is heard w/AS?

Systolic ejection click followed by crescendo-decrescendo murmur

Main treatment of CHF?

ACEI

What are the 3 main CF of congestion due to RHF?

Jugular venous distention Painful HSM --> nutmeg liver Pitting edema (INC hydrostatic pressure)

What does cystic medial degeneration cause?

Thoracic aortic aneurysm

What organism commonly causes endocarditis in IV drug users? Affects what valve preferentially?

Staph aureus Tricuspid

Mitral valve prolapse causes what kind of murmur?

Mid-systolic click followed by regurgitation murmur

What is the gold-standard for MI diagnosis? Peaks when? Returns normal when?

Troponin I 24 hours 7-10 days

What leads show a LCX infarct?

I, aVL

What is a congenital heart defect that causes late cyanosis, clubbing, and polycythemia? Mechanism?

Eisenmenger syndrome Uncorrected L-->R shunt that eventually becomes R-->L shunt

What leads show a RCA infarct? What direction is the infarct?

II, III, aVF Inferior

Myocytes adding in series means what?

LV Eccentric hypertrophy

Most common signs of LHF?

Orthopnea (SOB while supine) PND Pulmonary edema

What is the result of fibrosis and calcification and presents in late adulthood (> 60)? What increases the risk/hastens onset?

Aortic Stenosis Bicuspid aortic valve (should be 3 cusps normally)

What leads show a LAD infarct?

V1-V6

What congenital defects are assoc w/DiGeorge syndrome?

Truncus arteriosus | tetralogy of Fallot

Occlusion of the LAD leads to infarction of what areas?

Anterior wall | Anterior septum of LV

Coarctation of the aorta is what? Infantile form?

Narrowing of the aorta Coarctation lies distal to the aortic arch but before PDA

Chronic rheumatic valve disease causes what? Acute?

MS MR

ECG changes w/pericarditis?

ST segment elevation and/or PR depression

What causes aortic regurgitation?

Aortic root dilation | Syphilitic aneurysm

What occurs as a result of Tricuspid Atresia? Associated w/what?

RV is hypoplastic ASD and Right to left shunt

What ion influxes during reperfusion of damaged cells of the heart? Causes what?

Calcium Contraction band necrosis

What makes up Beck's triad? Indicates what?

Hypotension Distended neck veins Distant heart sounds Cardiac tamponade

What defines HTN?

systole > 140 | Diastole > 90

What causes notching of the ribs on xray? Due to what?

Coarctation of the aorta - adult form Intercostal artery engorgement

What can be useful to detect reinfarction of MI?

CK-MB

Endocarditis preferentially impacts what valve? Causing what?

Mitral valve Vegetations leading to mitral valve regurgitation

Endocarditis w/negative blood cultures indicates what? CFs?

HACEK organisms Fever, murmur, Janeway lesions, Osler nodes, ACD

What congenital heart defect can lead to paradoxical emboli? Due to what?

ASD Ostium secundum most common

What are the 5 R-->L shunts>

1. Truncus arteriosus 2. Transposition of great vessels 3. Tricuspid atresia 4. Tetralogy of Fallot 5. TAPVR

What are common causes of dilated cardiomyopathy?

``` Genetic mutation Myocarditis Alcohol and drugs (doxorubicin) Pregnancy Hemochromatosis ```

When do you see dark discoloration of the heart? What is happening?

4-24 hours Coagulative necrosis

What is the most common congenital heart defect, causes what? Assoc w/what?

VSD, causes Left to Right shunt fetal alcohol syndrome

Neutrophil influx after MI can cause what complication? Presents how?

Fibrinous pericarditis Friction rub

Occlusion of what artery leads to rupture of papillary muscle?

RCA

What does an EKG show on prinzmetal angina? Due to what?

ST elevation Transmural ischemia