cardio first aid Flashcards
(220 cards)
1
Q
umbilical vein
A
ligamentum teres hepatis
2
Q
umbilic arteries
A
medial umbilical ligaments
3
Q
ductus arteriosus
A
ligamentum arteriosum
4
Q
ductus venosus
A
ligamentum venosum
5
Q
foramen ovale
A
fossa ovalis
6
Q
allantois
A
urachus-median umbilical ligamnt
7
Q
notochord
A
nucleus pulposus of intervertebral disc
8
Q
where do you see increased pulse pressure?
A
hyperthyroidism, AR, arteriosclerosis, obstructive sleep apnea, increased sympathetic tone, exercise (transient)
9
Q
where do you see decreased pulse pressure?
A
AS, cardiogenic shock, cardiac tamponade, advanced heart failure
10
Q
contractility increases with
A
catecholamines
increased intracellular Ca2+
decreased extracellular Na+
digitalis
11
Q
contractility decreases with
A
beta1 blockade heart failure with systolic dysfunction acidosis hypoxia and hypercapnea non-dihydropyridine ca2+ channel blockers
12
Q
SV inreases with
A
anxiety
exercise
pregnancy
13
Q
myocardial oxygen demand increases with
A
afterload
contractility
HR
ventricular diameter
14
Q
venodilators effect what cardiac output variable?
A
decrease preload (nitroglycerin is an example)
15
Q
vasodilators effect what cardiac output variable?
A
decrease afterload (eg. Hydralazine)
16
Q
ACE inhibiors and ARBs effect what cardiac output variable?
A
decrease preload and afterload
17
Q
how is ejection fraction effected by heart failure
A
decreased in systolic heart failure but normal in diastolic heart failure
18
Q
what increases venous return
A
fluid infusion
sympathetic activity
19
Q
what decreases venous return
A
acute hemorrhage
spinal anesthesia
20
Q
what increases TPR?
A
vasopressors
21
Q
what decreases TPR?
A
exercise, AV shunt
22
Q
S1
A
MV and TV closure
loudest at mitral area
23
Q
S2
A
AV and PV closure
loudest at left sternal border
24
Q
S3
A
early diastole during rapid ventricular illing
patho: MR, CHF, dilated ventricles
normal: children, pregnant women
25
S4
late diastole
high atrial pressure
patho: ventricular hypertrophy
26
a wave
atrial contraction
27
c wave
RV contraction, closed TV bulging into atrium
28
x descent
atrial relaxation and downward displacement ofclosed tricuspid valve during ventricular contraction
absent in tricuspid regurgitation
29
v wave
increased right atrial pressure dur to filling against closed tricuspid valve
30
y descent
blood flow from RA to RV
31
aortic area sounds
systolic murmur
aortic stenosis
flow murmur
aortic valve sclerosis
32
pulmonic area sounds
systolic ejection murmur
pulmonic stenosis
flow murmur
33
what causes normal splitting?
inspiration causes a drop in intrathoracic pressure causing increased venous return to the RV which increases the RV stroke volume. Ejection time of the RV increases leading to delayed closure of the pulmonic valve. There is decreased pulmonary impedence meaning that there is increased capacity of the pulmonary circulations allowing for the delayed closure of the pulmonic valve
34
when do you see wide splitting
pulmonic stenosis and RBBB
35
when do you see fixed splitting
ASD
36
when do you see paradoxical splitting
delayed LV emptying like in AS and LBBB
37
left sternal border sounds
diastolic murmurs: aortic regurgitation and pulmonic regurgitation
systolic murmurs: hypertrophic cardiomyopathy
38
tricuspid area sounds
pansystolic murmur: tricuspid regurgitation, VSD
| diastolic murmur: tricuspid stenosis, ASD
39
mitral area sounds
systolic: mitral regurgitation
diastolic: mitral stenosis
40
how does inspiration effect heart sounds/
increase intensity of right heart sounds
41
how does hand grip effect heart sounds
increasing systemic vascular resistance causes increased intensity of MR, AR, VSD
decreased intensity of AS, hypertrophic cardiomyopathy murmurs
MVP: has increased intensity and later onset of click/murmur
42
how does valsalva and standing affect heart sounds?
valsalva then standing decreases venous return
it decreases intensity of most murmurs including AS
it increases intensity of hypertrophic cardiomyopathy murmur
MVP: decreased murmur intensity and earlier onset of click/murmur
43
how does rapid squatting effect heart sounds?
it causes increased venous return and increased preload. The afterload also increases with prolonged squatting
this causes a decreased intensity of hypertrophic cardiomyopathy murmurs
increased intensity of AS murmurs
MVP: increased murmur intensity and later onset of click/murmur
44
what are the systolic heart sounds?
AS, PS, MR, TR, VSD
45
what are the diastolic heart sounds?
AR, PR, MS, TS
46
speed of conduction of the cardiac cells
purkinge > atria > ventricles > AV node
47
pacemaking capability of cardiac cells
SA > AV > bundle of his > purkinge/ventricles
48
what causes torsades de points
drugs, decreased K+, decreased Mg2+
49
how do you treat torsades de pointes
magnesium sulfate
50
what meds prolong QT?
```
sotalol
risperidone
macrolodes
chloroquine
preotease inhibitors
quinidine
thiazide
```
51
what is romano ward syndrome
AD
congenital long QT syndrome
purely cardiac phenotype
52
what is jervell and lange-nielsen syndrome?
AR
congenital long QT syndrome
also sensorineural deafness
53
what is Wolff-Parkinson white syndrome?
ventricular pre-excitation
abnormal fast accessory conduction pathway from atria to ventricle that bypasses the rate slowing AB node
ventricles partially depolarize earier
delta wave appearance with shortened PR on ECG
leads to reentry circuit --> supraventricular tachycardia
54
what is ANP
released from atrial myocytes in response to increased blood volumeand atrial pressure. It causes vasodilation and decreased Na reabsorption at the renal collecting tubule. It constricts efferent renal arterioles and dilates afferent arterioles via cGMP promoting diuresis and leading to aldosterone escape mechanism
55
what is BNP
released from ventricular myocytes in response to increased tension. Has longer half life than ANP, used for diagnosing heart failure
recombinant form: nesirtide is used for treatment of heart failure
56
what do the receptors on the aortic arch respond to and how is the information transmitted?
only increased BP
| via the vagus to solitary nucleus in medulla
57
what do the receptors on the carotid sinus respond to and how is the information transmitted?
both increased and decreased BP
| via the glossopharyngeal to solitary nucleus of medulla
58
describe the baroreceptor response to hypotension
the decreased arterial pressure leades to decreased stretch and decreased afferent baroreceptor firing.
This leads to increased efferent sympathetic firing and decreased efferent parasympathetic stimulation leading to vasoconstriction increased HR, increased contractility, and increased BP. this response is important in severe hemorrhage
59
what is carotid massage?
it is the increased pressure on the carotid sinus that leads to increased stretch, increased afferent baroreceptor firing and then to increased AV node regractory period which decreases HR
60
what is the cushing reaction?
it is the triad of hypertension, bradycardia, and respiratory depression
the increased intracranial pressure causes constriction of the arterioles and leads to cerebral ischemia and reflex sympathetic and increase in perfusion pressure. There is increased stretch and reflex baroreceptor induced bradycardia
61
what stimulates the chemoreceptors in the carotid and aortic bodies?
decreased PO2
increased PCO2
decreased pH
62
what stimulates the central chemoreceptors
pH and PCO2 changes of the brain interstitial fluid. These are influenced by arterial CO2 and do not directly respond to PO2
63
what does PCWP approximate?
left atrial pressure
| measured with pulmonary artery catheter (Swan-Ganz)
64
autoregulation of the heart
local metabolites, CO2, adenosine, NO
65
autoregulation of the brain
local metabolites, CO2
66
autoregulation of the kidneys
myogenic and tubuloglomerular feedback
67
autoregulation of the lungs
hypoxia induced vasoconstriction
68
autoregulation of the skeletal muscle
local metabolites, lactate, adenosine, K+, H+, CO2
69
autoregulation of the skin
sympathetic stimulation
70
what causes edema?
increased capillary pressure (heart failure)
decreased plasma proteins (nephrotic syndrome, liver failure)
increased capillary permeability (toxins, infections, burns),
increased interstitial fluid colloid osmotic pressure (lymphatic blockage)
71
what are the causes of right to left shunting
```
truncus arteriosus
transposition of the great vessels
tricuspid atresia
tetralogy of fallot
total anomalous pulmonary venous return
```
72
how do you treat right to left shunts
surgical or maintenance of PDA
73
persistent truncus arteriosus
fulture of TA division
| accompanied by VSD
74
D-transposition of great vessels
separation of the systemic and pulmonary circulations
not compatible with life
failure of AP septum spiral
needs surgery and presence of shunting to allow blood mixing
75
tricuspid atresia
absence of tricuspid valve and hypoplstic RV
| requires ASD and VSD for viability
76
tetralogy of fallot
anterosuperior displacement of the infundibular septum
1. pulmonary infundibular stenosis
2. RVH
3. overriding aorta
4. VSD
77
how does squatting improve cyanosis in tet.
increased SVR leads to decreased right to left shunting and improves cyanosis
78
what is the treatment for tet
surgery
79
what do you see on CXR in tet
boot shaped heart
80
total anomalous pulmonary venous return
pulmonary veins drain into right heart circulation
| associated with ASD and sometimes PDA to allow right to left shunting to maintin CO
81
What are the causes of left to right shunting?
VSD, ASD, PDA, eisenmenger syndrome
82
VSD
asymptomatic usually , may self resolve
| larger lesions may lead to LV overload and heart failure
83
ASD
loud S1 and wide fixed split of S2
septum secundum defect
symptoms: none to heart failure
different than patent foramen ovale because septa are missing tissue rather than unfused
84
PDA
fetally: right to left
with decreased lung resistance the shunt becomes left to right
can lead to RVH, LVH or heart failure
machine like murmur - continuous
maintained patency with PGE and low O2 tension
can result in cyanosis in the lower extremities
85
what opens and closes PDA?
indomethacin closes, PGE opens
86
eisenmenger syndrom
uncorrected LtoR shunting leads to increased pulmonary blood flow and pathologic remodeling of vasculature leading to pulmonary arteriolar hypertension
RVH occurs to compensate the the shunt bcomes right to left
causes late cyanosis, clubbing and polycythemia
87
coartation of the aorta associations
bicuspid aortic valve and other heart defects
88
what is the infantile type of coarctation of the aorta
aorta narrowing is proximal to insertion of the ductus arteriosus
associated with turner syndrome
closure of ductus arteriosus (can reverse with PGE2)
89
what is the adult type of coarctation of the aorta
aorta narrowing is distal to ligamentum arteriosum
associated with notching of the ribs (collageral circulation), HTN in the upper extremities and weak, delayed pulses in the lower extremities
90
22q11 syndromes
truncus arteriosus, tetralogy of Fallot
91
down syndrome
ASD, VSD, AV septal defect (endocardial cushion defect)
92
congenital rubella
septal defects, PDA, pulmonary artery stenosis
93
turner syndrome
bicuspid aortic vavlve, coarctation of the aorta (preductal)
94
marfan syndrome
MVP, thoracic aortic aneurysm and dissection, aortic regurgitation
95
infant of diabetic mother
transposition of great vessels
96
xanthomas
plaques or nodules composed of lipid laden histiocytes in the skin - eyelids
97
tendinous xanthoma
lipid deposits in tendon (esp achilles)
98
corneal arcus
lipid deposits in cornea, early in life wit hypercholesterolemia, or in elderly
99
monckeberg
```
medial calcific sclerosis
calcification in the media of the arteries, radial and ulnar,
benign
pipestem areteries on x ray
does not obstruct blood flow
intima not involved
```
100
arteriolosclerosis
common
two types: hyaline (thickening of the small arteries in essential HTN or DM) and hyperplastic ("onion skinning" in severe HTN)
101
what are the types of arteriosclerosis
monckeberg and arteriolosclerosis
102
describe the progression of atherosclerosis
endothelial dysfunction leads to macrophafe and LDL accumulation. Foam cell formation --> fatty streaks --> smooth muscle cell migration + proliferation + ECM deposition --> fibrous plaques --> complex atheromas
103
common locations of atherosclerosis
abdominal aorta> coronary artery > popliteal artery > carotid artery
104
difference in abdominal and thoracic aortic aneurysm presentations
abdominal is associated with atherosclerosis and more often in HTN males smokers > 50yrs
thoracic: cystic medial degeneration due to HTN in older patients, Marfans, tertiary syphillis
105
what is aortic dissection
longitudinal intraluminal tear forming a false lumen that can be limited to ascending or propogate to descending aorta
106
what are aortic dissections asscoatied with
HTN, bicuspid aortic valve, inherited connective tissue disorders (marfans)
107
how does aortic dissection present
tearing chest pain of sudden onset radiating to the back
possible unequal BP in arms
mediastinal widening on CXR
can lead to pericardial tamponade, aortic rupture, death
108
what is angina
chest pain from ischemic myocardium secondary to coronary artery narrowing or spasm
no myocardia necrosis
109
what is stable angina
exertional chest pain
often secondary to atherosclerosis
ECG: ST depression
resolves with rest
110
what is variant or prinzmetal angina?
occurs at rest secondary to coronary artery spasm
ECG: transient ST elevation
triggers: tobacco, cocaine, triptans
tx: Ca2+ channel blockers, nitrates, smoking cessation
111
what is unstable/crescendo angina?
thrombosis with incomplete coronary artery occlusion
| ECG: ST depression
112
coronary steal syndrome
distal to coronary stenosis
maximally dilated vessels
vasodilators (dipyridamole, regadenoson) dilates normal vessels and shunts blood toward well-perfused areas. This leads to decreased flow and ischemia in the post stenotic region
used in pharmacologic stress tests
113
MI
acute thrombosis due t coronary artery atherosclerosis with complete occlusion of coronary artery and myocyte necrosis
114
SCD
within 1 hour of symptoms, lethal arrhythmias, CAD, cardiomyopathy, hereditary ion channelopathies (long QT)
115
chronic ischemic heart disease
progressive onset of CHF over many years due to chronic ischemic myocardial damage
116
commonly occluded coronary arteries
LAD > RCA > circumflex
117
symptoms of MI
diaphoresis, nausea, comiting, severe retrosternal pain, pain in left arm and jaw, shortness of breath, fatigue
118
What do you see on ECG in Mis
ST elevations if transmural
ST depression if subendocardial
pathologic Q waves if evolving or old transmural infarcts
119
what are the biomarkers that you use in MI evaluation
cardiac troponin I rises after 4 hours and is increased for 7 to 10 days, more specific than other protein markers
CK-MB is good for reinfarction diagnosis because it returns to normal after 48 hours. Also released from skeletal muscle
120
where do you see q waves if the infarct is in the anterior wall (LAD)?
V1-V4
121
where do you see q waves if the infarct is in the anteroseptal (LAD)?
V1-V2
122
where do you see q waves if the infarct is in the anterolateral (LAD or LCX)?
V4-V6
123
where do you see q waves if the infarct is in the lateral wall (LCX)?
I, aVL
124
where do you see q waves if the infarct is in the inferior wall (RCA)?
II, III, aVF
125
when is the greatest risk of having a ventricular free wall rupture?
6-14 days postinfarct
126
when is the greatest risk of having ventricular pseudoaneurysm formation?
1 week post MI
127
what do you see with ventricular pseudoaneurysm formation?
decreased CO, risk of arrhythmia, embolus from mural thrombus
128
when is the greatest risk of having postinfarction fibrinous pericarditis?
1 to 3 days post-MI
129
what is dressler syndrome?
autoimmune thing that results in fibrinous pericarditis several weeks post-MI
130
what are the types of cardiomyopathies?
dilated cardiomyopathy
hypertrophic cardiomyopathy
restrictive/infiltrative cardiomyopathy
131
causes of dilated cardiomyopathy
```
idiopathic
congenital
alcohol abuse,
wet Beri beri
Coxsackie B
chronic cocaine
chagas
doxorubicin toxicity
hemochromatosis
peripartum cardiomyopathy
```
132
dilated cardiomyopathy findings
heart failure
S3
dilated heart on echo
balloon appearance of heart on CXR
133
treatment of dilated cardiomyopathy
```
Na+ restriction
ACE inhibitors
beta blockers
diuretics
digoxin
ICD
heart transplant
```
134
causes of hypertrophic cardiomyopathy
familial (AD), sometimes friedreich ataxia
| athletes
135
hypertrophic cardiomyopathy findings
S4
| systolic murmur
136
treatment of hypertrophic cardiomyopathy
cessation of high intensity athletics
beta-blockers or non-dihydropyridine calcium channel blockers (verapamil)
ICD
137
causes of restrictive/infiltrative cardiomyopathy
```
sarcoidosis
amyloidosis
postradiation fibrosis
endocardial fibroelastosis
loffler syndrome
hemochromatosis
```
138
what is loffler syndrome
endomyocardial fibrosis with prominent eosinophillic infiltrate
139
what is CHF
cardiac pump dysfunction
symptoms: dyspnea, orthopnea, fatigue, rales, JVD, pitting edema
right heart failure often with left heart failure
140
systolic dysfunction CHF
low EF, poor contractility, secondary to ischemic heart disease or DCM
141
diastolic dysfunction
normal EF and contractility, impaired relaxation, decreased compliance
142
isolated right heart failure is usually due to?
cor pulmonale
143
what drugs are used in CHF?
ACE inhibitors, beta blockers (except acute decompensated), Ang II receptor blockers, spiranolactone
thiazide or loop diuretics for symptomatic relief
hydralazine and nitrate therapy for symptoms and increased mortality
144
what causes cardiac dilation
greater ventricular EDV
145
what causes dyspnea on exertion?
failure of CO to increase during exercise
146
what are symptoms of left heart failure
pulmonary edema
orthopnea
PND
147
pulmonary edema
increased pulmonary venous pressure leads to pulmonary venous distention and trsudation of fluid
presence of hemosiderin-laden macrophages in the lungs
148
orthopnea
shortness of breath when supine becaouse of increased venous return from redistribution of blood exacerbating pulmonary vascular congestion
149
PND
breathless awakening from sleep: increased venous return from redistribution of blood, reabsorption of edema
150
what are symptoms of right heart failure
hepatomegaly
peripheral edema
JVD
151
symptoms of bacterial endocarditis
```
fever
new murmur
roth spots (round white spots on retina surrounded by hemorrhage)
osler nodes
janeway lesions
anemia
splinter hemorrhages
```
152
cause of acute endocarditis
s. aureus (leads to large vegetations on previously normal valves)
rapid onset
153
cause of subacute endocarditis
ciridans streptococci
smaller vegetations on congenitally abnormal or diseased valves
gradual onset
sequela of dental procedures
154
cause of culture negative bacterial endocarditis
coxiella burnetti and bartonella
155
non bacterial causes of endocarditis
```
malignancy
hypercoagulable state
lupus
s. bovis in colon cancer
s.epidermidis on prosthetic valves
```
156
what valve is most commonly effectd in bacterial endocarditis?
mitral
157
what causes tricuspid valve endocarditis?
IV drug abuse, s. aureus, pseudomonas, candida
158
what are complications of bacterial endocarditis
chordae rupture
glomerulonephritis
supporative pericarditis
emboli
159
what causes rheumatic fever
s.pyogenes
160
what valves are effects in rheumatic fever?
mitral > aortic >> tricuspid
161
what are the early and late lesions associated with rheumatic fever?
early: MR, late: mitral stenosis
162
what histological and clinical features are present in rheumatic fever?
```
aschoff bodies (granulomas with giant cells)
anitschkow cells (enlarged macrophages with ovoid wavy, rod like nucleus)
increased ASO titers
```
163
what type of immune mediated hypersensitivity is rheumatic fever?
II, antibodies to M protein cross react with self antigens
164
how does acute pericarditis present?
sharp pain aggravated ith inspiration and relieved with sitting up and leaning forward
friction rub
ECG: widespread ST segment elevation and/or PR depression
165
fibrinous acute pericarditis
causes: dressler syndrome, uremia, radiation
| presents with loud friction rub
166
serous acute pericarditis
viral pericarditis, noninfectious inflammatory diseases (rheumatoid arthritis, SLE)
167
suppurative/purulent
caused by bacterial infections (pneumococcus, streptococcus)
168
cardiac tamponade
compression of heart by fluid in the pericardium that leads to decreased CO
equilibration of diastolic pressures in all 4 chambers
169
hat are findings associated with cardiac tamponade
beck triad
increased heart rate
pulsus paradoxus
kussmaul sign
170
what is the beck triad
hypoTN
distended neck veins
distant heart sounds
171
what is seen on ECG with cardiac tamponade?
low-voltage QRS and electrical alternans (due to "swinging" movement of heart in large effusion)
172
pulsus paradoxus
decreased amplitude of systolic blood pressure by > 10 mmHg during inspiration
seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis and croup
173
syphillitic heart disease
tertiary syphillis disrupts vaso vasorum of aorta --> atrophy of the vessel wall and dilation of the aorta and valve ring
calcification of the aortic root and ascending aortic arch
tree bark aorta
174
what is the most common heart tumor?
metastasis (from melanoma, lymphoma)
175
myxsomas
most common primary cardiac tumor in adults
mostly in the atria (left)
ball valve obstruction
associated with multiple syncopal episodes
176
rhabdomyomas
most frequent primary cardiac tumor in children
| associated ith tuborous sclerosis
177
kussmaul sign
increasee in jvp on inspiration instead of the normal decrease
the negative intrathoracic pressure from inspiration ins not transmitted to the heart so there is impaired filling of the right ventricle. Blood backs up into the vena cava and causes JVD
178
when do you see kussmaul sign
constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors
179
what is raynaud's phenomenon?
decreased blood flow to the skin (fingers and toes usuually) due to arteriolar vasospasm in response to cold temperature or emotional stress
disease if primary idiopathic
syndrome if caused by disease process
180
what are causes of raynaud's syndrome?
mixed connective tissue disease
SLE
CREST
181
strawberry hemangioma
benign capillary hemangioma of infancy
first few weeks
grows rapidly and regresses spontaneously at 5-8
182
cherry hemangioma
benign capillary hemangioma of the elderly
| does not regress
183
pyogenic granuloma
polypoid capillary hemacioma that an ulcerate and bleed
| associated with trauma and pregnancy
184
cyctic hygroma
cavernous lymphangioma of the neck
| associated with turner syndrome
185
glomus tumor
benign painful red-blue tumor under fingernails
| arises from modified smooth muscle cells of the glomus body
186
bacillary angiomatosis
benign capillary skin papules found in AIDS patients
caused by bartonella henselae
mistake for kaposi
187
angiosarcoma
rare blood vessel malignancy occurring in head neck and breast areas
usually in elderly on sun-exposed areas
associated with radiation therapy and arsenic exposure
very aggressive and difficult to resect due to delay in diagnosis
188
lymphangiosarcoma
lymphatic malignancy associated with persistent lymphedema (post-radical mastectomy
189
kaposi sarcoma
endothelial malignancy
commonly effects skin, mouth, GI tract, respiratory tract
associated with HHV8 and HIV
mistake for bacillary angiomatosis
190
what are the large vessel vasculitis
temporal (giant cell) arteritis
| takayasu arteritis
191
what are the medium vessel vasculitis
```
polyarteritis nodosa
kawasaki disease
buerger disease (thromboangiitis obliterans)
```
192
what are the small vessel vasculitis?
granulomatosis with polyangiitis (wegener's)
microscopic polyangitis
churg-strauss syndrome
henoch-schonlein purpura
193
epidemiology of large vessel vasculitis
temporal - elderly females
| takayasu - asian females <40
194
temporal (giant cell) arteritis symptoms and associations
elderly females
unilateral headache, jaw claudication
irreversible blindness due to ophthalmic artery occlusion
associated with polymyalgia rheumatica
195
what is the pathology of temporal arteritis
focal granulomatous inflammation with increased ESR
196
what arteries are most commonly affected in temporal arteritis
branches of the carotid
197
how do you treat temporal arteritis
high dose corticosteroids prior to temporal artery biopsy to prevent vision loss
198
takayasu's arteritis symptoms
```
pulseless disease (weak upper extremity pulses)
fever
night sweats
arthritis
myalgias
skin nodules
ocular disturbances
```
199
pathology of takayasu's
granulomatous thickening and narrowing of the aortic arch and great vessels
increased ESR
200
treatment of takayasu's
corticosteroids
201
epidemiology of medium vessel vasculitis
polyarteritis nodosa: young adults
| kawasaki disease: asian children <40
202
polyarteritis nodosa symptoms
fever, weightloss, malaise, headache
ab pain, melena
HTN, neuro dysfxn, cutaneous eruptions, renal damage
hep B seropositivity in 30%
203
arteries effected in polyarteritis nodosa
renal and visceral vessels, not pulmonary arteries
204
pathology of polyarteritis nodosa
immune complex mediated
transmural inflammation of the arterial wall w/ fibrinoid necrosis
innumerable microaneurysms and spasm on arteriogram
205
treatment of polyarteritis nodosa
corticosteroids, cyclophosphamide
206
symptoms of kawasaki disease
```
fever
cervical lymphadenitis
conjunctival injection
strawberry tongue
hand-foot erythema
desquamating rash
possible coronary artery aneurysm thrombosis leading to MI and rupture
```
207
treatment of kawasaki's
IVIg, aspirin
208
buerger disease symptoms
intermittent claudication may lead to gangrene, autoamputation of digitis, superficial nodular phlebitis
raynaud's
(segmental thrombosing vasculitis)
209
treatment of buerger's
smoking cessation
210
symptoms of granulomatosis with polyangiitis
upper respiratory tract: perforation of nasal septum, chronic sinusits, otitis media, mastoiditis
lower respiratory tract: hemoptysis, cough, dyspnea
renal: hematuria, red cell casts
211
what is the triad that is associated with granulomatosis with polyangiitis
focal necrotizing vasculitis
necrotizing granulomas in the lung and upper airway
necrotizing glomerulonephritis
212
what are the ANCA associated vasculitis?
PR3-ANCA/c-ANCA (anti-proteinase 3): wegner's
| MPO-ANCA/ p-ANCA (anti-myeloperoxidase): microscopic polyangiitis and churg strauss
213
what do you see on CXR in wegners
large nodular deposits
214
how do you treat wegner's
cyclophosphamide and corticosteroids
215
microscopic polyangiitis symptoms
necrotizing vasculitis ommonly involving lung, kidneys and skin ith pauci-immune glomerulonephritis and palpable purpura
like wegners without nasopharyngeal involvement and no granulomas
216
treatment of microscopy polyangiitis?
cyclophosphamide and corticosteroids
217
symptoms of churg-strauss?
asthma, sinusitis, palpable purpura, peripheral neuropathy (wrist and foot drop)
can involve heart, GI, kidneys
218
pathology of churg-strauss
granulomatous, necrotizing vasculitis with eosinophilia, increased IgE
219
henoch-schonlein purpura presentation
follows URI
classic triad: skin (palpable purpura on buttocks and leg), arthralgias, and GI (abdominal pain, melena, multiple lesions of same age)
220
cause of henoch-schonlein purpura?
vasculitis secondary to IgA complex deposition, associated with IgA nephropathy
