Cardio Path Flashcards
1
Q
Right to left shunts
A
Tetrology of Falot Transposition of great vessels Persistent Truncus arteriosus Tricuspid atresia Total Anomalous pulmonary venous return (TAPVR)
2
Q
Left to right shunts
A
VSD > ASD > PDA
3
Q
Close PDA
A
Indomethacin
4
Q
Eisenmenger’s Syndrome
A
uncorrected ASD, VSD, PDA causes shunt reversal due to PHTN
L to R –> R to L
Causes clubbing, cyanosis, polycythemia
5
Q
Tetrology of Falot
A
PROVe
Pulmonary stenosis
RVH
Over-riding Aorta
VSD
6
Q
why do tetrology of falot pts. squat?
A
Increase TPR –> decreases shunt so that blood goes to lungs and is oxygenated
combats cyanosis
7
Q
D-Transposition of the great vessels
A
Failure of aorticopulmonary septum to spiral
Aorta attached to RV
Pulmonary a attached to LV
Must have shunt to be compatible with life
8
Q
Coarctation of aorta associated with
A
Turner Syndrome–infantile
Bicuspid Aortic Valve–Adult
9
Q
Infantile coarctation of aorta
A
stenosis proximal to insertion of ductus arteriosus
10
Q
Adult coarctation of aorta
A
Stenosis distal to insertion of ductus arteriosus
Rib notching–collateral circulation of vertebral aa.
HTN in UE
Weak pulses in LE
11
Q
Why is PDA kept open?
A
Low O2 tension
PGE synthesis
12
Q
PDA Heart sound
A
machine like murmur
13
Q
Rx’s for open/close PDA
A
Open–PGE
Close–Indomethacin
14
Q
22q11 mutation associated with
A
Truncus arteriosus
Tet of fallot
15
Q
Down syndrome associated with
A
ASD
VSD
AV septal defect (endocardil cushion)
16
Q
Turner Syndrome associated with
A
Coarctation–preductal
17
Q
Marfan Syndrome associated with
A
Aortic insufficiency and dissection
18
Q
Infant of diabetic Mom
A
Transposition of great vessels
19
Q
HTN
A
> 140/90
20
Q
Malignant HTN
A
> 180/120
∆ in pressure is what mediates the damage
21
Q
Xanthelasma
A
Lipid laden macrophages deposited in skin of eylids
sign of hyperlipidemia
22
Q
Arcus Senilis
A
Lipid deposition in cornea
23
Q
Tendinous Xanthoma
A
Lipid deposition in tendons–achilles #1
24
Q
Monckeberg arteriosclerosis
A
Calcifications in the media of aa.
radial and ulnar especially
DOE NOT obstruct flow
25
Thickening of small arteries due to essential HTN or DM
Hyaline Arteriolosclerosis
26
Onion skinning of arteries due to malignant HTN
Hyperplastic arteriolosclerosis
27
Fibrous plaques and atheromas in INTIMA of large/medium arteries
Atherosclerosis
narrows lumen
28
Mediators of Smooth mm. migration in atherosclerosis
PDGF
| FGF
29
Atherosclerosis most common locations
bifurcations
1. Abdominal Aorta
2. coronary aa.
3. popliteal aa.
4. carotid aa.
30
Hypertensive Marfan with a history of sexual promiscuity and multiple syphilis infections COD
Thoracic Aortic Aneurysm
31
Longitudinal intramural tear forming a false lumen of aorta
Aortic Dissection
32
Aortic Dissection presentation
Tearing feeling radiating to back
mediastinal widening on CT
Pericardial tamponade, aortic rupture, death
33
Atherosclerosis
ST depression on EKG
retrosternal pain with exertion
Stable angina
34
```
CP at rest
ST elevation (Not MI)
```
Prynzmetal angina
coronary vasospasm
35
Thrombosis with incomplete coronary artery stenosis
ST depression
Worsening CP with minimal exertion
Unstable/crescendo angina
Basically an MI that hasn't infarcted
36
Coronary Steal Syndrome
vasodilator aggrevates ischemia by taking blood flow from stenosis to an area of higher profusion
Pressure gradient
37
Sudden Cardiac Death
Death from Cardiac causes w/in 1 hour of onset
lethal arrhythmia--most common
38
Chronic Ischemic Heart disease
progressive onset of CHF due to chronic ischemic myocardial damage
39
MI ∆'s 4-12 hrs
Early Coag necrosis
edema
hemorrhage
wavy fibers
Risk of Arrhythmia
40
MI ∆ 12-24 hrs.
Contraction bands
release of necrotic contents into blood
Neutrophils start to invade
Arrhythmia risk
41
MI ∆ 1-3 days
Neutrophils
extensive coag necrosis
acute inflammation
risk of fibrinous pericarditis
42
MI ∆ 3-14 Days
Macrophages
granulation tissue at margins (red border)
Risk of free wall rupture
43
2+ weeks post MI ∆'s
gray/white gross appearance
Contracted scar complete
risk of Dressler's Syndrome
44
Dx reinfaction
CK-MB
returns to normal in 48 hrs. where trops stay up for 7-10 days
45
MI with lots of necrosis
entire wall effected
ST elevation
Transmural
46
MI with < 50% ischemic necrosis of ventricle wall
| ST depression of EKG
Subendocardial infarct
47
Dressler's Syndrome
Autoimmune phenomenon --> fibrinous pericarditis
several weeks post MI
48
S3
Dilated heart on US
Balloon appearance of heart on Chest xray
ECCENTRIC hypertrophy
Dilated cardiomyopathy
sarcomeres added in series
49
Dilated Cardiomyopathy causes
```
Alcohol abuse
wet beriberi
Coxsackie B
Cocaine
Chagas Disease
Doxorubicin
hemochromatosis
peripartum cardiomyopathy
```
50
Dilated Cardiomyopathy Tx
```
Na restriction
ACE-I
diuretics
digoxin
heart transplant
```
51
Sudden death in athlete
outflow tract obstruction
asymmetric CONCENTRIC hypertrophy
Syncope
Hypertrophic Cardiomyopathy
Sarcomeres added in //
52
Hypertrophic Cardiomyopathy Tx
ß Blockers
| CCB's (non-dihydro)
53
Hypertrophic Cardiomyoathy asssociated with
ß myosin heavy chain mutation
Friedrich's Ataxia
54
Mechanism of outflow tract obstruction with Hypertrophic cardiomyopathy
IV septum is hypertrophied and too close to mitral valve leaflets --> leaflets then obstruct outflow --> Syncope
55
Loeffler's Syndrome
endomyocardial fibrosis with prominant eosinophilic infiltrates
seen in restrictive obliterative cardiomyopathy
56
restrictive/obliterative cardiomyopathy causes
```
sarcoidosis
amyloidosis
postradiation fibrosis
enoscardial fibroelstosis
Loeffler Syndrome
hemochromatosis
```
57
Rx that reduce mortality of CHF
ACE-I
ß-Blocker
ARBs
Spironolactone
Hydralazine with Nitrate in some pts.
58
Rx for Sx relief in CHF
Thiazides or loops
59
Hemosiderin Laden Macrophages in lung
Left Heart Failure buzz
60
Orthopnea
SOB when supine
61
RHF Signs
Nutmeg liver
JVD
Peripheral edema
62
LHF signs
pulmonary edema
paroxysmal nocturnal dyspnea
orhopnea
63
Sx of endocarditis
```
Fever
Roth spots (retina)
Osler Nodes (digits)
new murmur
Janeway Lesions (palms and soles)
anemia
splinter hemorrhage on nail bed
```
64
Endocarditis bugs
Acute--S. aureus
| Subacute--S. Viridans
65
Post dental procedure endocarditis
S. viridans (mutans)
66
Endocarditis
| Colon Cancer
S. bovis
67
Prosthetic Valve endocarditis
S. epidermidis
68
Who gets endocarditis on right side (tricuspid)?
IV druggies
S. aureus, Pseudomonas, Candida
69
Most common valve for endocarditis
Mitral
70
Rheumatic Fever cause
Strep Pyogenes
Abs to M protein attack heart (type II)
71
Rhematic Fever Dx
Aschoff bodies--granuloma with giant cells
Anitschkow's cells--activated hitiocytes
elevated ASO titers
72
Early and late manifestations of Rheumatic fever
Early--MVP
Late--Mitral stenosis
73
Rhematic Fever Sx
JONES
Joints, heart, Nodules, erythema marginatum, syndenham's chorea
74
Fibrinous pericarditis causes
Dressler's Syndrome
Uremia
Radiation
loud friction rub
75
Seous Pericarditis
Viral
SLE
RA
76
Suppurative/Purulent pericarditis
bacterial infxns
pneumococcus, strep
77
Pulsus Paradoxus
decrease in systolic blood pressure by > 10 mmHg during inspiration
Seen with cardiac tamponade, croup, sleep apnea, pericarditis
78
```
JVD
Increased venous pressure
hypotension
Tachycardia
pulsus paradoxus
```
Cardiac Tamponade
79
Tree Bark appearance of aorta
calcification of aortic root and ascending arch
disrupted vasa vasorum with atrophy of vessel wall
3º syphilis
80
most common 1º cardiac tumor
Myxoma
81
Myxoma most common site
left atrium
ball valve obstruction of LA --> syncope
82
most common 1º cardiac tumor in kids
Rhabdomyoma
83
Rhabdomyoma is associated with
Tuberous Sclerosis
84
Most common heart tumor overall
Mets from melanoma and lymphoma
85
Kussmaul's sign
icreased JVD on inspiration instead of decrease
constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors
86
Raynaud's Syndrome
Secondary to disease process
SLE, CREST, Mixed CT disease
87
old woman
jaw claudication
unilateral headache
elevated ESR
Temporal (Giant Cell) Arteritis
effects carotid artery vessels
88
Temporal (Giant Cell) Arteritis associated with
polymyalgia rheumatica
89
Temporal (Giant Cell) Arteritis Tx
High Dose corticosteroids
Prevent blindness--ophthalmic Artery occlusion
90
```
Asian female < 40
Weak UE pulse
fever
night sweats
arthritis
myalgias
skin nodules
occular disturbances
high ESR
```
Takayasu's Arteritis
91
Takayasu Arteritis description
Granulomatous thickening of aortic arch and proximal great vessels
92
Takayasu Arteritis Tx
Corticosteroids
93
```
Young adult
HBV+
Melena and GI pain
HTN
Renal Damage
neurologic dysfunction
cutaneous erruptions--different age lesions
```
Polyarteritis nodosa
94
Polyarteritis nodosa vessels effected
visceral and renal vessels
not pulmonary artery
95
Polyarteritis nodosa Tx
Corticosteroids
| Cyclophosphamides
96
```
Asian Child (< 4)
Strawberry tongue
cervical lymphadenitis
hand/foot erythema
desquamating rash
```
Kawasaki Disease
97
Kawasaki Disease COD
Coronary Arty aneurysm --> MI
98
Kawasaki Disease Tx
Aspirin (only time to give to kid)
| IV Ig
99
```
Heavy Smoker male > 40
Intermitent claudication
autoamputation of digits
superficial nodular phlebitis
Raynaud's phenomenon
```
Buerger's Disease
100
Buerger's Disease Tx
Quit Smoking
101
p-ANCA+
Necortizing vasculitis of lung, kidney, skin
Pauci-immune GN
palpable purpura
No granulomas
micorscopic polyangiitis
102
micorscopic polyangiitis Tx
Cyclophosphamide
| corticosteroids
103
```
Hemoptysis
hematuria
RBC casts in urine
c-ANCA+
Chronic sinusitis and otitis media
```
Wegener's Granulomatosis
104
```
IgE
Eosinophils
Asthma
peripheral neuropathy
p-ANCA+
Granulomas
Palpable purpura
```
Churg Strauss Syndrome
105
Most common childhood systemic vasculitis
Henoch-Schoenlein Purpura
106
Henoch-Schoenlein Purpura Sx
Palpable purpura on buttocks and legs
arthralgia
abd. pain, melena, multiple lesion same age
107
Strawberry hemangioma
benign capillary hemangioma of infancy
regresses by 5-8 yrs
108
Cherry hemangioma
benign capillary hemangioma of elderly
does not regress
109
Pyogenic granuloma
polypoid capillary hemangioma
ulcerates and bleeds
due to trauma & pregnancy
110
Cystic Hygroma
Cavernous hemangioma of neck
Associated with Turner Syndrome
111
Glomus Tumor
benign painful tumor under fingernail
modified smooth mm. cells of glomus
112
Bacillary angiomatosis
AIDs pt. with Bartonella henselae
mistaken for Kaposi's
113
Angioarcoma
malignant blood vessel of breast, head, neck
associated with radiation Tx of breast cancer, Hodgkin's,
aggressive
114
Lymphangiosarcoma
Lymphatic malignancy
post radical mastectomy pts. from persistent lymphedema
115
Kaposi's Sarcoma
HHV-8
AIDs pt.
endothelial malignancy of mouth, GI, respiratory tract
116
Port wine stain (naveus flemus) on face
ipsilateral leptomeningeal angiomatosis
Seizures
early onset glaucoma
Sturge-Weber Disease
117
Sturge-Weber Disease vessel size effected
capillary size
