Cardiac Tumors and Misc. Flashcards Preview

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Flashcards in Cardiac Tumors and Misc. Deck (53):
1

cardiac Raynaud

blood vessel hyper-reactivity causing vasospasm

2

Takotsubo cardiomyopathy

broken heart syndrome
vasospasm caused by extreme stress (emotional), myocardial ischemia, MI, or sudden death due to arrhythmia

3

prinzmetal angina

less than 50, Japan
variant angina
episodes of angina pectoris at rest
ST elevation

4

contraction band necrosis

reperfusion of dead myocardium, coronary artery vasospasm
cardiac myocytes that run out of ATP and then are exposed to an influx of Ca: enhances actin-myosin interaction causing hyper contraction and cells that cannot relax

5

venous stasis dermatitis

female, standing, obesity, Hx DVT, farm. Hx of venous disease
erythematous, scaling, eczematous patches affecting lower extremities
HEMOSIDERIN accumulation
MEDIAL ANKLE

6

venous stasis ulcers

MEDIAL ANKLE over perforating vein (along great or small saphenous vein)
irregular border, tender, shallow, exudative, granulation base

7

esophageal varices

increased blood flow to the veins of the gastro-esophageal junction

8

caput medusae

dilation of periumbilical veins of the abdominal wall

9

hemorrhoids

increased blood flow in veins of rectum

10

Trousseau syndrome

migratory thrombophlebitis
malignant tumors secrete procoagulant factors causing thrombosis

11

inferior vena cava syndrome

neoplasms or thrombus that compress or invade inferior vena cava
hepatocellular and renal cell carcinoma grow in veins: can occlude
Sx: lower extremity edema, distention of superficial collateral veins of lower abdomen

12

deep vein thrombosis

common, increases if male and older
can be fatal if embolizes
association: cancer, hospital, surgery
proximal: popliteal and above, associated with pulmonary emboli
distal: calf
Dx: asymmetry between legs over 2 cm, D dimer
PROLONGED IMMOBILIZATION

13

Homans sign

forcefully dorsiflex foot
calf pain: + for DVT
not very sensitive
can send embolus to lung

14

superior vena cava

neoplasms compress or invade superior vena cava
ex: bronchogenic carcinoma or mediastinal lymphoma
marked dilatation of veins in head, neck, arms associated with cyanosis

15

chylothorax

lymph from digestive system accumulates in pleural cavity causing pleural effusion

16

Sturge-Weber syndrome

encephalotrigeminal angiomatosis
facial port wine nevi, ipsilateral venous angiomas in corticol leptomeninges
mental retardation, seizures, hemiplegia, radiopacities of skull

17

Osler-Weber-Rendu disease

autosomal dominant
hereditary hemorrhagic telangiectasia (present at birth and wide distribution)
mutation in TGF-B pathway in endothelial cells
Sx: epitaxis, GI bleed hematuria when lesions rupture

18

hemangioma

tumor of blood vessels

19

pyogenic granuloma

granulation tissue type hemangioma

20

lymphangioma

lymph tumor

21

bacillary angiomatosis

looks like Kaposi
Cause: Bartonella Henselae (cat scratch)

22

Kaposi sarcoma

HHV-8
tumors on the borderline of benign and malignant
viral G protein induces VEGF, viral cyclin D drives proliferation, multiple KSHV proteins inhibit p53

23

angiosarcoma

cancer of lining of blood vessels

24

stent

tube put inside some tubular structure in the body to keep it open

25

portal hypertension

leads to opening of portal systemic shunt
increased flow in veins causes: esophageal varices, hemorrhoids, caput medusae
cause: liver cirrhosis
ESOPHAGEAL VARICES prone to rupture

26

Classic Kaposi sarcoma

Mediterranean, Middle Eastern, Eastern European, older men
associated with malignancy or altered immunity
asymptomatic red-purple plaques in distal lower extremities that spread proximally, localized to skin\red-purple macules composed of dilated irregular endothelial cell lined vascular spaces with lymphocytes, plasma cells, macrophages-> larger raised plaques spread proximal with spindle cells, extravasated erythrocytes, hemosiderin-laden macrophages-> nodules with hemorrhage
Tx: radiation and chemo
good prognosis

27

Endemic African Kaposi sarcoma

younger than 40
indolent or aggressive course

28

Transplant-associated Kaposi

solid organ transplants with T cell immune suppression
aggressive involving lymph nodes, mucosa, viscera
Tx: attenuation of immunosuppresion at risk of organ rejection

29

AIDS associated Kaposi

2-3% of AIDS patients
involves lymph nodes and disseminates to viscera early in course
Tx: anti-retrovirals

30

arterial ulcers

painful, punched out or stellate, surrounding skin is red and taut
ulcer is pale or has black or yellow eschar

31

cardiac arrhytmia

disturbance in electrical signaling for coordinated cardiac myocyte contraction

32

long QT syndromes

phase 2
early after-depolarization
left ventricle
causes: ischemic heart disease, low K, Ca, Mg, chanelopathy, etc.
complication: ventricular tachycardia
presents in childhood: syncope or sudden death

33

Brugada syndrome

autosomal dominant: Na channel blunted: shortened or failed AP
young asian males
phase 2
re-entry
right ventricle
present at 40 yrs: syncope or sudden cardiac death due to ventricular tachycardia esp. in SLEEP
abnormal EKG at rest
elevated ST descending with upward convexity to inverted T wave in V1-V3
Tx: ICD

34

catecholeminergic polymorphic ventricular tachycardia

genetic
phase 4
delayed after-afterdepolarization
left ventricle
mutations in RYANODINE receptor: high cystolic Ca leaked from SR, get PVT with high levels of catecholamines
present in childhood: syncope, sudden cardiac death due to ventricular tachycardia during extreme PHYSICAL or EMOTIONAL STRESS
Tx: ICD or beta blockers

35

cardiomyopathy

diverse group of heart disease primarily involving myocardium
classified by function and structure: can move from one functional category to another

36

dilated cardiomyopathy

impaired contractility and systolic function
when structural classification: idiopathic (some due to myocarditis or alcohol)

37

hypertrophic cardiomyopathy

when structural classification: autosomal dominant
impaired compliance and diastolic function
Do NOT confuse with hypertensive heart disease

38

restrictive cardiomyopathy

impaired compliance and diastolic function
cause: amyloidosis (and others)

39

alcoholic cardiomyopathy

dilated cardiomyopathy due to alcohol

40

arrhymogenic right ventricular cardiomyopathy

disease due to mutations in genes encoding desmosomal proteins
second hit: enteric viral infection of right heart
re-entrant ventricular tachycardia originating from right ventricle related to abnormalities in myocyte adhesion
FATTY replacement of myocytes
EKG: epsilon wave (notch in terminal QRS most prominent in V1
Tx: ICD

41

myocarditis

infectious agents and/or inflammatory processes primarily target myocardium
VIRAL most common
can occur in Lyme disease
can get hypersensitivity myocarditis
complications: acute HF and dilated cardiomyopathy
Sx: asymptomatic to dyspnea, fatigue, pain, fever, arrhythmia, etc.

42

cardiac myxomas

rare, females, left atrium
benign gelatinous mesenchymal neoplasms of the endocardium
Sx: dyspnea, cough, transient neurological symptoms fatigue, FEVER (produce IL-6)
signs: loud S1, diastolic rumble, diastolic tumor plop, holosystolic murmur
other: orthopnea, hemoptysis, syncope
complication: mitral obstruction, embolization, MI, sudden death
Dx: echo
Tx: surgical excision

43

rhabdomyomas

most frequent pediatric heart tumor, preferentially in ventricles
most regress spontaneously
discovered in 1st year due to obstruction in heart
cause:
1. sporadic mutation
2. tuberous sclerosis with mutations in TSC1/2 (hamartin and tuberin) tumor suppressor genes that inhibit mTOR
SPIDER cells

44

most common primary sites of cardiac metastases

lung and breast, melanomas, leukemias, lymphomas
retrograde lymphatic extension hematagenous seeding, direct contiguous extension, venous extension
usually silent or nonspecific features: defect in contractility or compliance

45

heart transplant rejection

lots of inflammatory cells
arteriopathy is the most important limitation (will need new transplant eventually): inflammatory cells attack intima and thicken it
dx: endomyocardial biopsy
tx: more immunosuppression
complication: silent MI (denervated)

46

ventricular tachycardia adults

cause: ischemic heart disease (old MI)
re-entry around scar, usually monomorphic
complicatoin: sudden death

47

normal QT

less than or equal 440ms

48

congenital long QT syndrome type 1 (LQT1)

loss of function in depolarizing outward K channel (Iks)

49

congenital long QT syndrome type 2 (LQT2)

loss of function in depolarizing outward K channel (Ikr)

50

congenital long QT syndrome type 3 (LQT3)

inward Na channel fails to close or inactivate (Ina)

51

torasades de pointes

polymorphic ventricular tachycardia typical of congenital long QT syndrome
early after depolarization from multiple sites
twisted ribbon
Tx: ICD

52

asteroid body

cytoplasmic inclusion in giant cells of granulomas
seen in: SARCOIDOSIS, TB, leprosy, fungal infection, schistosomiasis, foreign body

53

cardiac sarcoidosis

noncaseating granulomas in heart
favors base of heart and often involves conduction system
complications: arrhythmias, HF, sudden death