Cardiology Flashcards

Question

Mitral Valve Prolapse

Answer 1

Ballooning of mitral valve into LA during systole Due to myxoid degeneration of the valve making it floppy Pw/ incidental mid-systolic click followed by a regurgitation murmur (usually asymptomatic) **Click/murmur become SOFTER w/ squatting (↑ systemic resistance = ↓ LV emptying) Complications rare = infectious endocarditis, arrhythmia & severe mitral regurge Tx = valve replacement

Answer 2

Reflux of blood from the LV into the LA during systole Usually arises as a complication of MVP; other causes include LV dilation, Infective endocarditis, Acute rheumatic heart disease, papillary muscle rupture after MI = Holosystolic 'blowing' murmur; louder w/ squatting & expiration = results in volume overload and left-sided HF

Answer 3

Narrowing of the mitral valve orifice usually due to chronic rheumatic valve disease = Opening snap followed by diastolic rumble Volume overload leads to dilatation of the LA = - Pulmonary congestion w/ edema & alveolar hemorrhage - Pulmonary HTN & right-sided HF, - A Fib w/ associated risk for mural thrombi

Answer 4

Inflammation of the endocardium that lines the surface of cardiac valves; usually due to bacterial infection = Fever (due to bacteremia), Murmer (due to vegetations), Janeway lesions (erythematous nontender lesions on palms & soles), splinter hemorrhages in nail bed & Roth spots (seen fundoscopically) (both due to embolization of septic vegetations) Labs - + Blood Cultures; Anemia of chronic disease - transesophageal endocardiogram is useful for detecting lesions on valves

Answer 5

= most common, infects previously damaged valves, resulting in small vegetations that do not destroy the valve

Answer 6

most common in IV drug abusers = affects normal valves (tricuspid most commonly), results in large vegetations that destroy the valve

Answer 7

associated w/ endocarditis of prosthetic valves

Answer 8

associated w/ endocarditis in Pt w/ underlying colorectal carcinoma

Answer 9

(Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella) Associated w/ endocarditis w/ negative blood cultures

Answer 10

due to sterile vegetations that arise in association w/ a hypercoagulable state or underlying adenocarinoma Vegetations arise on the mitral valve along lines of closure & result in mitral regurgitation

Answer 11

due to sterile vegetations that arise in association w/ SLE Vegetations are present on the surface & undersurface of the mitral valve & result in mitral regurgitation **vegetation present on both sides of the valve**

Answer 12

Dilation of all 4 chambers; most common cardiomyopathy Most commonly idiopathic; Genetic mutation (AD), myocarditis (coxsackie A/B), Alcohol abuse, Drugs, Pregnancy (late), or Hemochromatosis are also possible causes = systolic dysfunction leading to biventricular CHF -complications = mitral & tricuspid valve regurgitation & arrhythmia Tx = heart transplant

Answer 13

Massive hypertorphy of the Left Ventricle Usually due to genetic mutations in sarcomere proteins (most common form is AD) = diastolic dysfunction & ↓ CO; Sudden death due to ventricular arrhythmias; syncope w/ exercise (subaortic hypertrophy of septum = functional aortic stenosis) **common cause of sudden death in young athletes** *Biopsy shows myofiber hypertrophy w/ disarray

Answer 14

↓ compliance of the ventricular endomycardium that restricts filling during diastole Causes = amyloidosis, sarcoidosis, endocardial fibroelastosis & Loeffler syndrome (=endocardial fibroelastosis w/ eosinophilic infiltate & eosinophilia) Pw/ CHF; classic finding = low-voltage EKG w/ diminished QRS amplitude

Answer 15

Benign mesenchymal tumor w/ gelatinous appearance & abundant ground substance on histology Most common primary cardiac tumor of adults Usually forms as a pedunculated mass in the LA that causes syncope due to obstruction of the mitral valve

Answer 16

Benign hamartoma of cardiac muscle Most common primary cardiac tumor in children (associated w/ tuberous sclerosis) Usually arises in the ventricle

Answer 17

Metastatic tumors are more common in the heart than primary tumors Most commonly involve the pericardium, resulting in pericardial effusion Common metastases to the heart include breast & lung carcinoma, melanoma, & lymphoma

Answer 18

Inflammation of the blood vessel wall Etiology usually unknown, most causes are not infectious =Nonspecific Sx of inflammation (fever, fatigue, weight loss, myalgias) =Sx of organ ischemia (due to luminal narrowing or thrombosis of the inflamed vessel) Large vessel = aorta & its major branches Medium vessel = Muscular arteries that supply organs Small vessel = arterioles, capillaries & venuoles

Answer 19

LVV = Granulomatous vasculitis that classically involves branches of the carotic artery Most common form in older adults (>50), usually females Pw/ headache (temporal a.), visual distrubances (ophthalmic a.), & jaw claudification. Flu-like Sx w/ joint & muscle pain often present ESR is elevated (>100) Biopsy = inflamed vessel wall w/ giant cells & intimal fibrosis (lesions are segmental = negative biopsy doesn't exclude disease) Ts = corticosteroids; *high risk for blindness w/out Tx

Answer 20

LVV = Granulomatous vasculitis that classically involves the aortic arch at branch points In adults ) ESR is elevated Tx = corticosteroids

Answer 21

MVV = necrotizing vasculitis involving multiple organs (lungs are spared) Classically in young adults; Pw/ HTN (renal a.), ab pain w/ melena (mesenteric a.), neurologic disturbances & skin lesions. Associated w/ serum HBsAg Lesions of varying stages are present. Early lesion consists of transmural inflammation w/ fibrinoid necrosis; eventually heals w/ fibrosis, producing 'string-of-pearls' appearance Tx - corticosteroids & cylcophosphamide (fatal if not Tx)

Answer 22

MVV - classically affects Asian children < 4 yo Pw/ nonspecific signs including fever, conjunctivitis, erythematous rash of palms & soles, and enlarged cervical lymph nodes Coronary artery involvement is common and leads to risk for thrombosis w/ MI, & aneurysm w/ rupture Tx = aspirin** and IVIG; disease is self-limited **need to make sure it is not viral infection before giving aspirin (due to risk of Reye's syndrome)

Answer 23

MVV - Necrotizing vasculitis involving digits Pw/ ulceration, gangrene, autoamputation of fingers & toes; Raynaud phenomenon is often present Highly associated w/ heavy smoking; and classically seen in younger males Tx = smoking cessation

Answer 24

SVV = Necrotizing granulomatous vasculitis involving nasopharynx, lungs & kidneys Classic presentation is a middle-aged male e/ sinusitis/nasopharyngeal ulceration, hemoptysis w/ bilateral nodular lung infiltrates, & hematuria due to rapidly progressive glomerulonephritis Biopsy reveals reveals large necrotizing granulomas w/ adjacent necrotizing vasculitis Serum c-ANCA levels correlate w/ disease activity Tx = cyclophosphamide & steroids; relapses are common WeCener Granulomatosis - c-ANCA, Cyclophsphamide

Answer 25

SVV - necrotizing vasculitis involving multiple organs, especially lung & kidney Pw/ similar to Wegener (but nasopharyngeal involvement & granulomas are absent) Serup p-ANCA levels correlate w/ disease activity Tx - corticosteroids & cyclophosphamide; relapses are common

Answer 26

SVV - necrotizing granulomatous inflammation w/ eosinophils involving multiple organs, especially lungs & heart *Asthma & peripheral eosinophilia are often present Serum p-ANCA levels correlate w/ disease activity

Answer 27

SVV - due to IgA immune complex deposition; most common vasculitis in children Pw/ PALPABLE purpura on buttocks & legs, GI pain & bleeding, & hematuria (IgA nephropathy); usually occurs following an URTI Disease is self-limited, but may recur; Tx w/ steroids if severe

Answer 28

↑ blood pressure; may involve pulmonary or systemic circulation Systemic HTN is defined as pressure > 140/90 mm Hg (normal < 120/80) - can have isolated systolic or diastolic HTN Divided into primary and secondary types based on etiology

Answer 29

HTN of unknown etiology (95%) Risk factors include: - age, race (↑ AA, ↓ Asian), obesity, stress, lack of physical activity & high-salt diet

Answer 30

HTN due to an identifiable etiology (5%) Renal artery stenosis is a common cause (renovascular HTN) - ↓ blood flow to glomerulus = JGA secretes renin = ANGI -> ANGII (by ACE) -> ANGII ↑ BP by contracting arteriolar AM (↑ TPR) & promoting adrenal release of aldosterone (↑ Na reabsorption = expanding plasma volume) =↑ plasma renin & unilateral atrophy of affected kidney (neither seen in primary HTN) - Atherosclerosis (elderly males) & fibromuscular dysplasia (young females) = important causes

Answer 31

mild or moderate elevation in BP = Clinically silent; vessels & organs are damaged slowly over time Most causes of HTN are benign

Answer 32

severe elevation in BP (>200/120) May arise from preexisting benign HTN or de novo Pw/ acute end-organ damage (acute renal failure, headache, & papilledema) **Is a medical emergency** comprises <5% of cases

Answer 33

Intimal plaque that obstructs blood flow (in medium & large sized vessels) Modifiable RF = HTN, hypercholesterolemia (LDL), smoking & diabetes Nonmodifiable RF = age, gender (estrogen is protective), & genetics Damage to endothelium allows lipids to leak into the intima, lipids are oxidized & then consumed by macrophages via scavenger receptors = foam cells =Results in fatty streaks that progress to atherosclerotic plaques

Answer 34

account for >50% of disease in Western countries Stenosis of medium-sized vessels results in impaired blood flow and ischemia, leading to = Peripheral vascular disease, Angina, Ischemic bowel disease Plaque rupture w/ thrombosis results in MI & stroke Plaque rupture w/ embolization results in atherosclerotic emboli, **characterized by cholesterol crystals w/in the embolus Weakening of vessel wall results in aneurysm

Answer 35

Narrowing of small arterioles diveded into hyaline & hyperplastic types

Answer 36

caused by proteins leaking into the vessel wall, producing vascular thickening; proteins are seen as pink hyaline on microscopy *Consequence of long-standing benign HTN or Diabetes = reduced vessel caliber w/ end-organ ischemia; classically produces glomerular scarring (arteriolonephrosclerosis) that slowly progresses to chronic renal failure =reason that Pt w/ HTN or Diabetes get renal failure

Answer 37

Thickening of vessel wall by hyperplasia of smooth muscle ('onion-skin' appearance) * Consequence of malignant HTN = reduced vessel caliber w/ end-organ ischemia May lead to fibrinoid necrosis of the vessel wall w/ hemorrhage; classically causes acute renal failure w/ a characteristic 'flea-bitten' appearance (pin-point hemorrhages from blowing out small vessels)

Answer 38

Calcification of the media of muscular (medium-sized) arteries **nonobstructive** Not clinically significant; seen as an incidental finding on x-ray or mammography

Answer 39

Intimal tear w/ dissection of blood through media of the aortic wall Most common cause is HTN; also associated w/ inherited defects of CT (Margan or Ehlers-Danlos Syndrome) Occurs in the proximal 10cm (high stress region) w/ preexisting weakness of the media Pw/ sharp, tearing chest pain that radiates to the back Complications = pericardial tamponade (most common cause of death), rupture w/ fatal hemorrhage, & obstruction of branching arteries w/ resultant end-organ ischemia

Answer 40

Balloon-like dilation of the thoracic aorta Due to weakness in the aortic wall *Classically seen in tertiary syphilis; endarteritis of the vasa vasorum results in luminal narrowing, ↓ flow & atrophy of the vessel wall = 'tree bark' appearance of the aorta Complications = dilation of the aortic valve root resulting in aortic valve insufficiency; compression of mediastinal structures; & thrombosis/embolism

Answer 41

Balloon-like dilation of the abdominal aorta; usually arises below the renal arteries, but above the aortic bifurcation Primarily due to atherosclerosis; classically seen in male smokers >60yo w/ HTN Pw/ a pulsatile abdominal mass that grows w/ time Complications = rupture (esp when >5cm) (pw/ triad of HTN, Pulsatile ab mass & flank pain); compression of local structures & thrombosis/embolism

Answer 42

Benign tumor comprised of blood vessels Commonly present at birth; often regresses during childhood Most often involves skin & liver **will blanch when pressed on (vs a bleed into the skin (ex a purpura))

Answer 43

Malignant proliferation of endothelial cells; highly aggressive Common sites include skin, breast & liver - Liver angiosarcoma is associated w/ exposure to polyvinyl chloride (PVC), arsenic, & Thorotrast

Answer 44

Low-grade malignant proliferation of endothelial cells; associated w/ HHV-8 Pw/ purple patches, plaques, & nodules on the skin; may also involve visceral organs Classically seen in: - Older Eastern European males - tumor remains localized to skin; Tx w/ surgical removal - AIDS - tumor spreads early; Tx - antiretroviral agents - Transplant recipients - tumor spreads early; Tx - ↓ immunosuppression

Cardiology Flashcards

(68 cards)