Cardio Exam 4 Flashcards
(128 cards)
1
Q
Assc diseases with congenital valvular disease
A
Patent ductus arteriosus
aortic coarctation
2
Q
Path of MVP
A
expansion of spongiosa
disruption of fibrosa
3
Q
Risk of mitral annular calcification
A
thrombi/infective carditis formation
4
Q
Subacute infective endocarditis with colon cancer
A
strep bovis
5
Q
Prosthetic valve early infective endocarditis
A
staph epidermidis
6
Q
Peripheral manifestations of infective endocarditis
A
Roth spots Osler nodes Janeway lesions splinter hemorrhages mycotic aneurysm
7
Q
IV drug users acute bacterial endocarditis location and bug
A
R side of heart
S. aureus
8
Q
Assc with nonbacterial thrombotic endocarditis
A
adenocarcinoma-> hypercoaguable state
9
Q
Libman Sacks endocarditis cause and histo
A
SLE
esoinophilic/granular verrucae
10
Q
Bugs to tx with aminoglycosides
A
pseudomonas aeruginosa enterobacteriaceae gram (-) with gentamicin due to + charge
11
Q
Most common subacute IE bug
A
viridans strept
12
Q
Abiotrophia Granulicatella growth and assc
A
needs L-cysteine or Vit B6
URT/urogenital/GI infection
prone to systemic embolization
13
Q
IE with negative blood cultures
A
HACEK bugs
14
Q
Coxsackie virus with myocarditis
A
cleaves dystrophin with viral protease 2A
decreases contractility
15
Q
Parvovirus B19 with myocarditis
A
replicates in endothelial cells slap cheek (5th disease) maculopapular rash
16
Q
Corynebacterium diptheriae with myocarditis
A
toxins A and B, B allows entry, A inhibits EF2
Also conjunctivitis/pharyngeal membrane and bull neck
17
Q
Borrelia burgdorferi with myocarditis
A
tick is vector
damage from macrophages killing spirochetes
18
Q
Trypanosoma cruzi with myocarditis
A
kissing bugs (reduviids) are vector
rash/edema around eye (Romano’s sign)
T cell lysis of myocytes where it replicates
19
Q
X-linked dilated cardiomyopathy gene
A
dystrophin gene mutation
20
Q
Arrhythmogenic RV cardiomyopathy path and gene
A
severely thinned (with fat) RV defect of cell adhesion proteins in desomosomes
21
Q
Naxos syndrome
A
arrhythmogenic RV cardiomyopathy
kyperkeratosis
plakoglobin gene mutation
22
Q
Hypertrophic cardiomyopathy path and gene
A
haphard disarray of myocytes
sarcomeric genes
23
Q
Endomyocardial fibrosis assc
A
children/young adults in tropical areas
24
Q
Loeffler endomyocarditis
A
endomyocardial fibrosis
lg mural thrombi with eosinophilic inflitrate
25
Amyloidosis dx and histo
stains with congo red (fluoresces green)
| beta sheet folding of proteins
26
Senile cardiac amyloidosis deposition
transthyretin
27
Impact of hemachromatosis on heart
iron deposition causes ROS to damage myocardium
| results in systolic dysfunction
28
Atrial myxoma
in adults
| ball valve obstruction
29
Types of myocarditis (4)
lymphocytic
hypersensitivity (drug induced, increased eosinphils)
giant cell (rapid and fatal)
Chagas disease
30
Rhabdomyoma histo and demographic
in children
| spider cells
31
Most common type of cardiac cancer
metastasis:
lungs/breast
melanoma
lymphoma/leukemia
32
Impact of carcinoid syndrome on heart
increased vasoactive amines (5HT) cause plaques on R sided valves
33
Phospholamban and role in increased HR
normally blocks SERCA (Ca2+ reuptake)
phosphorylated by PKA-> allows faster reuptake
with increased HR, need faster relaxation
done by phosphorylating phospholamban
34
Causes of paradoxical S2 splitting
During expiration, aortic closes later
LBBB
aortic stenosis
anything slowing L ventricular emptying
35
Cause of fixed S2 splitting
atrial septal defect hallmark
36
Chronic mitral regurg sound
holosystolic murmur
| louder with squat/isometric contraction
37
Acute mitral regurg sound
early systolic decrescendo
38
Mitral valve prolapse sound
midsystolic click
| late systolic murmur
39
Triad of tricuspid regurg
Carvallo's sign (louder with inspiration)
pulsatile JVD
pulsatle liver
40
Ventricular septal defect sound
harsh holosystolic murmur
41
Aortic stenosis sound
systolic crescendo-decrescendo
42
Hypertrophic cardiomyopathy sound
from dynamic obstruction
crescendo-decrescendo
louder with valsalva/standing/amyl nitrate
43
Major criteria for infective endocarditis
```
+ blood cultures (at least 2)
endothelial involvment (via echo/new regurg)
```
44
Minor criteria for IE
```
predisposition
fever over 100.4
vascular phenomena
immuno phenomena
echo
microbiologic evidence (not proof)
```
45
Syncope cause with prolonged standing, emotional stress, or warm environment
neurocardiogenic syncope
46
Syncope with neck irritation and qualifiers
carotid sinus hypersensitivity
cardioinhibitory with pause over 3 sec
vasodepressor with decrease of 50mmHg without bradycardia
47
Syncope from cough, micturition, defecation, valsalva, deglutition
situational syncope
48
Syncope preceded by tongue/tonsillar pain
glossopharyngeal neuralgia
49
Cause of syncope with particular arm use
subclavian steal syndrome
50
Orthostatic hypotension numbers
over 20mmHg SBP or 10mmHg DBP change within 3 minutes of standing
51
Syncope with movement
atrial myxoma
52
Strept pyogenes lab identification
PYR +
bacitracin sensitive
beta hemolytic
53
Blood labs for S. pyogenes
ASO titer
| anti DNase B test
54
Major Jones criteria for rheumatic fever
```
Joint pain
Heart
Nodules in sub q
Erythema marginatum
Syndeham's chorea
```
55
Cause of Syndeham's chorea in RF
cross rxn of antistrept Abs with basal ganglia
56
Hypertrophy type with aortic stenosis
concentric
57
Hypertrophy type with aortic regurg
eccentric
58
Mitral regurg sound and things to increase
holosystolic blowing
| squat/expiration
59
Mitral stenosis sound
opening snap
| diastolic rumble
60
Peripheral indication of aortic regurg
parvus et tardus (slow rising pulse)
61
Aortic regurg sound
early diastolic decrescendo
62
Causes of wide S2 splitting
RBBB
| pulmonic stenosis
63
Aortic insufficiency sound and what increases sound
early diastolic decrescendo
| increases with expiration/leaning forward
64
Other murmurs assc with Aortic regurg
systolic ejection murmur
| Austin Flint murmur (diastolic rumble)
65
Signs assc with aortic regurg (7)
Duroziez sign- systolic cephalad, diastolic murmur caudad
Wide pulse pressure
Quincke's pulse-phasic blanching of nails
Hill sign-popliteal over 60mmHg greater than brachial
Corrigan pulse-abrupt upstroke and fall of pulse
Traube sign-pistol shot sound over femoral
Mueller sign-pulsating uvula
66
Cause of pulmonic regurg
pulmonary HTN or valve deformity
67
Graham Steell murmur
assc with pulmonic regurg
early diastolic decrescendo murmur
high pitched
increases with inspiration
68
Pulmonic insufficiency with valve deformity sound
mid diastolic crescendo-decrescendo
| low pitched
69
Mitral stenosis sound and way to increase sound
mid diastolic click with rumble
| L lateral recumbent position
70
Beck's triad and what it indicates
hypotension
JVD
distant heart sounds
cardiac tamponade
71
Exaggerated pulsus paradoxus
greater than 10mmHg between expiration and inspiration SBP
| sign of cardiac tamponade
72
Kussmaul sign
Increased JVD with inspiration
| cardiac tamponade or constrictive pericarditis
73
3 modes of echocardiography
M-Mode display (for thickness)
2D imaging
Doppler (for velocity/pressure changes)
74
Pulsed vs continuous doppler echo
pulsed-senses low gradients, max 2m/s
| continuous-high gradients
75
Viral cause of dilated cardiomyopathy
echovirus
| coxsackie B virus
76
Dilated cardiomyopathy pathology cascade
myocyte degeneration
decreased CO
NE early and angiotensin II late to compensate
cause LV remodeling
77
Major criteria for heart failure (6)
```
paroxysmal noctural dyspnea
JVD
acute pulmonary edema
CVP>16cm H20
hepatojugular reflex
S3
```
78
Tx for dilated cardiomyopathy
diuretics + ACE-I's
| metoprolol or carvedilol
79
Benefit of digoxin with DCM
inhibits sympathetics (NE)
80
Presentation of hypertrophic cardiomyopathy
dyspnea
angina
syncope
81
Sound heart with HCM
S4
82
Drug tx for HCM
beta blockers/CCB's/disopyramide
amiodarone for arrhythmia
AVOID nidfedipine
83
Primary and secondary cardiac amyloidosis
1-monoclonal light chain
| 2-fragments of serum amyloid A protein
84
Cardiac amyloidosis appearance on echo
speckling
85
Tx for aortic stenosis and possible increased risk
surgery is only definitive
| increased risk with mitral regurg (doubles)
86
Drugs for aortic regurg
nifedipine
87
Aortic regurg surgery indication
LV ef less than 55%
| Size >55mm systole, >75mm diastole
88
Contraindications for acute aortic regurg
beta blockers
| IABP
89
Drugs for mitral stenosis
diuretics- for dyspnea
beta blockers- for Vent rate
anticoagulation
90
Contraindications for percutaneous intervention of MS
extensive valve calcification
| mitral regurg
91
Chronic vs acute Mitral regurg
chronic-LA hypertrophy, decreased CO, fatigue
| acute-normal LA, increased pulmonary venous P, pulmonary edema
92
Acute mitral regurg drug tx
IV diuretics
| IV vasodilators
93
Chronic mitral regurg drug tx
vasodilators only if HTN present
94
Another name for MVP
Barlow syndrome
95
IMA use for CABG
LAD
96
Graft closure rates
saphenous 50% open at 10 yrs
| IMA 95% open at 10 yrs
97
Post op risk of CABG and prophylaxis for it
A fib
| beta blockers
98
Tx for A. fib post CABG
beta blockers
| anticoagulants past 48 hrs
99
Benefits of mechanical valve replacement
last longer
| but needs anticoagulants
100
Benefits of bioprosthetic valve replacement
no need for anticoagulants
| replaced after 10-15 yrs
101
Greater demo benefited by multivalve surgery
elderly and high risk pts
102
Acute pericarditis tx for viral
NSAIDS
| corticosteroids/colchicine for refractory
103
Acute pericarditis post MI caution
avoid corticosteroids/NSAIDS
| use ASA
104
Ewart's sign
dullness to percussion over angle of L scapula
| sign of pericardial effusion
105
Pericardial effusion and EKG
low voltage
| electrical alternans
106
Ventricular interdependence and pericardial effusion
Bulging of septum into LV causes decreased CO with pericardial effusion (during inspiration)
Causes exaggerated pulsus paradoxus
107
Cardiac cath finding in both pericardial effusion and constrictive pericarditis
equal diastolic P in all chambers of heart
108
Pericardial knock
early diastolic sound from abrupt cessation of ventricular filling
109
Constrictive pericarditis and pulsus paradoxus
not present
| but increases JVD with inspiration
110
Constrictive pericarditis and cardiac cath finding
dip and plateau in diastole of both ventricles
111
Causes of pericardial effusion beside pericarditis
cardiac rupture
| myxedema
112
Cardiac tamponade sx
Beck's triad: hypotension, JVD, distant heart sound
dyspnea
diaphoresis
pericardial pain
113
Cardiac tamponade signs on EKG
low voltage
| electrical alternans
114
Cause of primary pericarditis
viral origin
115
Causes of secondary pericarditis
metastasis
cardiac disease
surgical procedure
116
Serous pericarditis cause and histo finding
noninfectious: autoimmune, tumors, uremia
| epipdercardial fat
117
Fibrinous/serofibrinous pericarditis
sandy heart surface (bread and butter)
fibrinous exudate
seen in MI
118
Purulent/suppurative pericarditis
due to infection (pneumonia/lymphatic/hematoginous spread)
creamy, yellow exudate
causes scarring
119
Hemorrhage pericarditis
commonly caused by metastases
also TB caused
blood in pericardium
120
Caseous pericarditis
TB, TB and more TB
| absolutely no JBeebs
121
Chronic/healed pericarditis
fibrous thickening
stringy adhesions
no impact on fxn
122
Adhesive mediastinopericarditis
adherence of outer pericardium to mediastinal structures
| increases stress/workload of heart
123
Constrictive pericarditis
visceral/parietal fusion (dense)
cannot increase CO
TB/radiation/surgery/metastasis caused
wt loss/fatigue/edema
124
Rheumatoid arthritis on the heart
serous or fibrinous pericarditis
125
Acute Rheumatic fever
group A strep
| pharyngitis -> RF -> chronic heart disease
126
Acute RF histo
Aschoff bodies with Antischkow myocytes (long thin nucleus)
127
Rheumatic MVP
commissural fusion/fish mouth look
| thick/short chordae tendineae
128
Chronic RF valve disease histo and impact on valve
lymphocytes
| extensive calcification
