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CRRAB FINAL REVIEW > Cardiac Path- Wittrack > Flashcards

Cardiac Path- Wittrack Flashcards

1
Q

Dilated cardiomyopathy

A

Dilation of all four chambers of the heart Impaired contractility of one or both ventricles = systolic disfunction (decreased LV ejection fraction)

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2
Q

Common causes of dilated cardiomyopathy

A

Alcohol abuse Beriberi Coxsackie B Cocaine Chagas Doxorubicin Pregnancy!

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3
Q

Hypertrophic Cardiomyopathy

A

Massive hypertrophy of the left ventricle Usually due to a genetic mutation in sarcromere proteins Autosomal dominant

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4
Q

What is the most common cause of sudden death in young athletes?

A

Hypertrophic Cardiomyopathy

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5
Q

Restrictive Cardiomyopathy

A

Decreased compliance of the ventricular endomyocardium that restricts filling during diastole

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6
Q

What are some causes of restrictive cardiomyopathy?

A

Amyloidosis, sarcoidosis, endocardial fibroelastosis, Loeffler syndrome Presents as congestive heart failure Classic finding is low voltage EKG with diminished QRS amplitude

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7
Q

Difference between primary and secondary cardiomyopathy?

A

Primary = disease limited to heart Secondary = associated with systemic disorders

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8
Q

In what cardiac disease would you see impaired LV filling/relaxation with a preserved LVEF Thickened LV Normal to reduced LV chamber size

A

Hypertrophic cardiomyopathy

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9
Q

In what cardiac disease would you see usually non-dilated, non-hypertrophic ventricles but still have a diastolic LV dysfunction?

A

Restrictive cardiomyopathy

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10
Q

What are common sources of clinically significant valve disease in developed countries?

A

Calcific aortic stenosis Mitral valve prolapse

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11
Q

What are common sources of clinically significant valve disease in developing countries?

A

Rheumatic fever valvulitis (with multiple valve involvement)

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12
Q

What are almost all cases of mitral stenosis due to?

A

Rheumatic Fever

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13
Q

What is systolic click murmur syndrome?

A

Due to mitral valve prolaspe

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14
Q

What is mitral valve prolapse?

A

Ballooning of mitral valve into left atrium during systole Due to myxoid degeneration (accumulation of ground substance) of the valve making it floppy

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15
Q

What is calcific aortic stenosis?

A

Narrowing of aortic valve orifice Aging-related atherosclerosis of aortic valve cusps with secondary nodular calcification

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16
Q

What is a major cause of human mortality in developed countries?

A

Acquired heart disease -dominated by atherosclerotic coronary artery disease associated with ischemic heart effects

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17
Q

What >95% of ischemic heart disease due to?

A

Coronary atherosclerosis

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18
Q

NON-STEMI

A

Subendocardial infarction

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19
Q

STEMI

A

transmural infarction

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20
Q

What does the extend of infarction depend on?

A

The amount of collateral circulation

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21
Q

Which site is a most likely site for visceral cancer metastases?

A

Pericardium

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22
Q

What are primary tumors of the heart?

A

RARE! Atria myxomas (left atrium) Rhabdomyomas Cardia Sarcomas

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23
Q

Troponin

A

Elevated in MI with-in 2-4 hours Peaks at 48 hours Persists 7-10 days

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24
Q

CK-MB

A

elevated in myocardial necrosis but less specific than troponin

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25
D-dimer
Produced by fibrinolysis/clot dissolution Markedly elevated in pulmonary embolism. deep venous thrombosis (DVT)
26
Hemoglobin Level
Severe anemia (especially if due to acute hemorrhage or hemolysis) can precipitate dyspnea or aggravate underlying CAD or heart failure
27
BNP
Secreted by ventricles in response to ventricular failure/ excess myocardial stretching Heart failure
28
What is Dressler's Syndrome
Autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)
29
What is your first consideration of bloody pericaridal fluid?
Malignancy (Per witrack)
30
Fibrinous pericarditis
Dressler syndrome Uremia Radiation LOUD friction rub
31
Serous Pericarditis
usual viral pericarditis Often resolves spontaneously Non-infectious inflammatory diseases like RA or SLE
32
Suppurative/purulent pericarditis
Bacterial infections: Staph Aureus Strep pneumonia H. influenza N. meningitidis Rare now with antibiotics Usually concurrent infection like meningitis
33
How much fluid in the pericardial sac would indicate large risk for tamponade?
200-300 cc acutely or \>1000 cc chronically Increases pressure on heart and impairs cardiac filling/flow
34
What circumstances are likely to cause FATAL cardiac tamponade?
Retrograde AORTIC DISSECTION with intrapericardial rupture Rupture AMI Penetrating chest wounds
35
What are symptoms for cardiac tamponade?
Hypotension Soft or absent heart sounds Jugular venous distension Maybe other signs of HF
36
Treatment for cardiac tamponade?
Pericardiocentesis
37
What is constrictive pericarditis? Symptoms? Treatment?
Impaired ventricular filling caused by thickened/contracted pericardial scar up 1 cm thick Symptoms: RIGHT heart failure Increased JVD Peripheral Edema Abdominal discomfort Weakness/fatigue (may mimic restrictive CM) Requires pericardial resection
38
Which primary cardiac tumor is associated with syncope due to obstruction of the mitral valve?
Myxoma! Usually found in LEFT ATRIUM attached to the valve of the fossa ovalis
39
Which primary cardiac tumor is associated with tuberous sclerosis and arises in the ventricle?
Rhabdomyoma Most common primary cardiac tumor in CHILDREN
40
Are metastasis or primary tumors most common in the heart?
Metastatic! Usually from melanoma or lymphoma
41
What is the primary cause of a thoracic aortic aneurysm?
Tertiary Syphillis * Endarteritis of vaso vasorum * luminal narrowing * Decreased flow/ 02 to vaso vasorum * Atrophy of vessel wall
42
What are the symptoms of an aortic anuerysm rupture?
Rupture \> 5 cm Hypotension Pulsatile Abdominal Mass Flank Pain
43
What is the primary cause of an abdominal aortic aneurysm?
ATHEROSCLEROSIS * Thickens vessel wall * Decreased O2 perfursion to media and adventia * Atrophy of vessel wall * Dilation Usually male smokes \> age 60 w/ hypertension
44
Describe the pathology on Aortic Dissection
Intimal tear with dissection of blood through the media of the aortic wall * Need 2 things * High Pressure --\> proximal 10 cm of the aorta * Pre-existing weakness in vessel wall * Hypertension causes hyaline arteriolosclerosis of vaso vasorum * Decreased blood flow causes atropy * OR a connective tissue disorder
45
Why is a Type A aortic dissection more leathal than Type B?
Type A is of the ascending aorta Blood can flow in the pericardial sac Increased fluid/blood in pericardial sac CARDIAC TAMPONADE SUDDEN DEATH
46
54 year old female Headache Visual Distrubances Jaw Claudication Flu-like symptoms Polymyalgia Rheumatic Elevated ESR What is it?
Most likely Giant Cell (Termoral) Arteritis
47
How do you diagnose and treat Giant Cell (Temporal) Arteritis?
Temporal artery biopsy! Negative biospy does NOT rule out disease (because it is segmental- could have just gotten a segment w/out disease) Treat with corticosteroids
48
Why do you want to treat a patient with corticosteroids AS SOON as you suspect Giant Cell/ Temporal arteritis?
High risk of BLINDNESS w/ out treatment!!!!
49
What is the most common vasculitis in older adults?
Giant cell/ temporal arteritis
50
Middle-aged male with sinusitis or nasopharyngeal ulceration, hemoptysis with bilateral nodular lung infiltrates, and hematuria due to rapidly progressive glomerulonephritis
Granulomatosis with polyangitis/ Wegener Granulomatosis (Small vessel vasculitis)
51
Differential diagnosis for pulmonary hemorrhage + rapidly progressive glomerulonephritis?
ANCA-associated vasculitis Goodpasture's SLE
52
What is the number on ecause of morbidity and mortality in developed countries?
Coronary artery disease and stroke
53
Name 5 mechanisms for vascular disease
* Lumen stenosis = atherosclerosis, HTN, diabetes, vasculitis * Sudden lumen occlusion = thrombosis, embolism, wall dissection * Great majority of acute/catastrophic events (MI, Stroke, PE) * Vascular wall weakening/ Aneurysmal dilation * Vasculitis * Extrinisc vascular compression = compartment syndrome * Vena cava syndrome = SVC compression from surrounding malignant mediatinal adenopathy (usually lung cancer)
54
Which vein is the source of the majority of the clinically significant/ fatal pulmonary emboli?
iliofemoral veins
55
What clues might indicate secondary hypertension (as to primary)?
* Severe/resistant hypertension despite multiple antihypertensives * Acute BP rise in a patient with previously stable BP * Age \< 35 years, non-obese, non-black patient with no apparent risk factors * Malignant/accelerated hypertension w/end organ damage, retinal heorrhage/papilledema * Hypertension onset before puberty
56
What is the most common potentially correctable cause of secondary hypertension?
Renal artery stenosis! (Probably from atherosclerosis \> age 55)
57
What are two potential causes of secondary hypertension?
Renal artery Stenosis Fibromuscular Dysplasia (young white women) CLUES: Increase creatinine Proteinuria Atrophic kidney Abdominal bruit
58
What is fibromusclar dysplasia?
Common cause for secondary hypertension * Narrowing of medium-sized arterial lumens by usually medial fibroplasia of unknown causes * Usually affects renal and cerebral vessels * Affects young to middle-aged women
59
"String of beads" angiographic appearance and bruits over some arterial segments?
Fibromuscular Dysplasia Common in young white women Cause for seconary hypertension TX: revascularization via surgery or angioplasty
60
Young adult with refractory or malignant hypertension or stroke?
Consider Fibromuscular Dysplasia!!!
61
What is the most common congenital cardiovascular cause of secondary high blood pressure?
COARTCTATION of aorta! Associated with Turner Syndrome Upper extremity high bloodpressure w/ lower extremity hypotension Rib nothcing on CXR \*\*Left arm pressure/pulse may be diminished if coarctation proximal to left subclavian artery
62
Sequelae of chronic hypertension?
High risk for systemic atherosclerosis Thoracic aortic aneurysms and aortic dissection
63
Palpable purpura suggests which vasculitis....
Henoch-Schonlein Purpura or Microscopic Polyangiitis
64
Pulmonary/renal syndromes suggest which vasculitis... (hemoptysis/ pulmonary infiltrates / glomerulonephritis)
Wegener's granulomatosis (c-ANCA) Microscopic Polyangiitis (p-ANCA)
65
Headache, scalp pain, and visual symptoms suggest which vasculitis?
Giant Cell (temporal arteritis)
66
How do you distinguish Wegener's Granulmatosis from Microscopic Polyangitis?
Wegeners = cANCA Micro= pANCA Both have renal and pulmonary involvement Micro does NOT have nasopharyngeal involvemnt and NO granulomas present
67
What is the most common vasculitis in children?
Henoch-Schonlein Purpura Vasculitis due to IgA immune complex deposition Disease is self-limited, but may reoccur (steroids if severe)
68
Churg-Strauss Sydrome
Small vessel vasculitis ``` p-ANCA many organs (espeically heart and lungs) ``` Asthma and eosinophilla
69
What are the four vasculitisis with T-lymphocyte response with granuloma formation?
Giant Cell Takayasu arteritis Wegener's Churg-Stauss
70
What is required for diagnosis of most vasculitis types?
Tissue Biopsy!!!! ERS/C-reactive protein Serum creatinine/UA Antibodies Chest XRAY/CT
71
Large Vessel vasculitic diseases?
Giant Cell Arteritis Takaysau's Artertitis
72
Elderly female with.... Unilateral headache Jaw claudication Scalp pain Visual Disturbances Polymyalgia rheumatica Elevated ESR
Temporal Giant Cell Arteritis
73
40 year old ASIAN female Absent pulses in upper extremities Visual and neurological symptoms Elevated ESR
Takayasu Arteritis Large Vessel Classically involves aortic arch at branch points Treatment is corticosteroids
74
A young adult with Hep B seropositivity Abdominal pain and GI bleeding High blood pressure Skin rash
Polyarteritis Nodosa Medium arteries Neutrophilic vasculitis w. aneruysm formation Positive assoication with Hep B Treat w/ corticosteroids and cyclophosphamide
75
4 year old asian child presents with Hand and foot erythema Enlarged cervical lymphnodes
Kawaski disease May develope coronary artery aneurysm, thrombosis that leads to MI and ruputres Treat with IVIg and Aspirin Disease is self-limited
76
What is Virchow's triad of DVTs?
Impeded venous circulation Hypercoagulability Endothelial injury/dysfunction
77
What virus is Kaposi Sarcoma associated with?
HHV-8
78
Clinically, how can you differentiate between a hemangioma or a Kaposi sarcoma?
The Hemangioma will blanch (because the blood is contained in blood vessels) and a Kaposi Sarcoma will not blanch because blood is not in a vascular channel
79
MI complications with in 1 day?
Arrhythmias Cardiogenic Shock Heart Failure Sudden Death
80
MI complications with-in 1-3 days
Fibrinous Pericarditis Only in transmural infarct Caused by neutrophil invasion/ inflammation of necrotic tissue
81
MI complications 3 days- 2 weeks
Macrophages! Clear debris/structural degredation Tissue at it's weakest..... Ventricular free wall rupture --\> cardiac tamponde Papillary rupture --\> mitral insufficiency Septal rupture --\> ventral septal defect Mural thrombis ( "Plugs" hole in myocardium = time bomb)
82
MI complications after months?
Scar formation Dresseler's syndrome LV anyuersm Chronic Heart failure

CRRAB FINAL REVIEW (12 decks)

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