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Flashcards in CARDIOLOGY- Pathology Deck (413):
1

Characteristics "Blue babies"

Right to left shunt, Early cyanosis

2

When is often diagnose right to left shunt?

Prenatally or become evident immediatly after birth

3

What is the treatment for right to left shunt?

Ussually require urgent surgical correction and/or maintenance of a Patent Ductus arterious

4

Right to left shunt diseases

The 5Ts:
1. Truncus arteriosus (1 vessel)
2. Tansposition (2 swithced vessels)
3. Tricuspid atresia (3= Tri)
4. Tetralogy of Fallot (4=Tetra)
5. TAPVR (5 letters)- Total Anomalous Pulmonary Venous Return

5

What happens in Persistent truncus arteriosus?

Failure of truncus arteriosus to divide into pulmonary trunk and aorta

6

What do most patients with persistent truncus arteriosus have?

Ventricular Septal Defect

7

What is wrong in D transposition of great vessels

Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)

8

What is the result of D transposition of great vessels?

Separation of systemic and pulmonary circulations

9

This is the prognosis of D transposition of great vessels?

Not compatible with life unless a shunt is present to allow mixing of blood (eg VSD, PDA, or patent foramen ovale)

10

Which is the reason of D transposition of great vessels?

Due to failure of the aorticopulmonary septum to spiral

11

Without treatment how is the life expectancy for D transposition of great vessels?

Without surgical intervention, most infants die within the first few months of life

12

Which problems are found in Tricuspid atresia?

Absence of tricuspid valve and hypoplastic RV

13

What is required in Tricuspid atresia for viability?

Both Ventricular Septal Defect and Atrial Septal Defect

14

What causes Tetalogy of Fallot?

By anterosuperior displacement of the infundibular septum

15

Most common cause of early childhood cyanosis

Tetralogy of Fallot

16

Characteristics of Tetralogy of Fallot

Pulmonary infundibular stenosis
Right Ventricular Hypertrophy
Overriding aorta
Ventricular Septal Defect

17

What is most important determinant for prognosis in Tetralogy of Fallot?

Pulmonary infundibular stenosis

18

In Tetrallogy of Fallot what causes right to left flow across Ventricular Septal defect?

Pulmonary stenosis

19

Clinical manifestation of Pulmonary stenosis causing right to left flow across Ventricular Septal defect

Early cyanotic "tet spells," Right Ventricular Hypertrophy

20

What does Squatting manuever causes in patients with Tetrallogy of Fallot?

↑ systemic vascular resistance, ↓right to left shunt, improves cyanosis

21

Treatment for Tetrallogy of Fallot

Early surgical correction

22

What happens in Total Anomalous Pulmonary Venous Return?

Pulmonary veins drain into right heart circulation (SVC, coronary sinus)

23

Which cardiac anomallies are associated to Total Anomalous Pulmonary Venous Return? which is the benefit?

Atrial Septal Defect, and sometimes Patent Ductus arteriosus
Allow for right to left shunting to maintain cardiac output

24

Characteristics "blue kids"

Left to right shunt- Late cyanosis

25

Name all Left to right shunt diseases

Ventricular Septal Defect
Atrial Septal Defect
Patent Ductus arteriosus

26

In order, which are the most frequent causes of Left to right shunt diseases

Ventricular Septal Defect >Atrial Septal Defect >Patent Ductus arteriosus

27

Most common congenital cardiac defect

Ventricular Septal Defect

28

Which are the clinical manifestations of Ventricular Septal Defect?

Asymptomatic at birth, may manifest weeks later or remain asymptomatic thoughout life

29

Which is the prognosis of Ventricular Septal Defect?

Most self resolve

30

Which is the risk of Larger lessions of Ventricular Septal Defect?

May lead to LV overload and heart failure

31

During ausculation what is heard in Atrial Septal defect?

Loud S1: wide , fixed split S2

32

Where does Atrial Septal defect ussualy occurs?

In septum secundum

33

Which could be the symptoms of Atrial Septal defect?

Range from none to Heart Failure

34

This is the difference between Atrial Septal defect and Patent foramen ovale

Distinct form patent foramen ovale in that septa are missing tissue rather than unfused

35

In Fetal period which shunt is consider normal?

Right to left

36

What happens in neonatal period if there is a patent ductus arteriosus?

↓ Lung resistance → shunt becomes left to right → progressive Right Ventricular hyperthrophy and /or Left Ventricle Hypertrophy and heart failure

37

Which murmur is associated to Patent ductus arteriosus?

Machine like murmur

38

What maintains patency in patent ductus arteriosus?

PGE synthesis and low O2 tension

39

What could be the result of uncorrected Patent ductus arteriosus?

Can result in late cyanosis in the lower extremities (differential cyanosis)

40

Which drug helps in Patent ductus arteriosus?

Indomethacin

41

When is recommended to administer PGE to keep open a Patent ductus arteriosus?

May be necessary to sustain life in conditions such as transposition of great vessels

42

When is Patent Ductus consider normal? When does it close?

PDA is normal in utero and normally closes only after birth

43

What is Eisenmenger syndrome?

Uncorrected left to right shunt (VSD, ASD, PDA)

44

Which is the pathophysiology of Eisenmenger syndrome?

↑ Pulmonary blood flow → pathologic remodeling of vasculature → pulmonary arteriolar hypertension → Right ventricle Hypertrophy occurs to compensate → Shunt becomes rigth to left

45

What does Eisenmenger syndrome clinicaly causes?

Late cyanosis, clubbing and polycythemia

46

At what age does Eisenmenger syndrome onsets?

Varies

47

Which types of coarctation of the aorta exist?

Infantile type
Adult type

48

In which associated situations is coarctation of the aorta seen?

Associated with bicuspid aortic valve, other heart defects

49

What is wrong in Coarctation of the Aorta infantile type?

Aorta narrowing is proximal to insertion of the ductus arteriosus (preductal)

50

Which pathology is associated to Coarctation of the Aorta?

Turner Syndrome

51

What happens in Coarctation of the aorta in adult type?

Aorta narrowing is distal to ligamentum arteriosum (postductal)

52

Coarctation of the aorta can be associated to these findings

Notching of the ribs (collateral circulation), hypertension in upper extremities, and weak, delayed pulses in lower extremities (radiofemoral delay)

53

Which genetic disorders and diseases have congenital cardiac defect associated?

22q11 syndrome
Down syndrome
Congenital Rubella
Turner Syndrome
Marfan Syndrome
Infant of Diabetic Mother

54

Which congenital cardiac defect might 22q11 syndrome have?

Truncus arteriosus, Tetralogy of Fallot

55

Down syndrome patients they could have these congenital cardiac defect

ASD, VSD, AV septal defect (endocardial cushion defect)

56

Congenital Rubella might present with these congenital cardiac defect

Septal defects, PDA, pulmonary artery stenosis

57

Which congenital cardiac defect are associated to Turner Syndrome?

Bicuspid aortic valve, coarctation of aorta (preductal)

58

Name congenital cardiac defect associated to Marfan syndrome

Mitral valve prolapse, thoracic aortic aneurysm and dissection, aortic regurgitation

59

Which congenital cardiac defect is associated to Infant of Diabetic mother?

Transposition of great vessels

60

What is hypertension?

Defined as a systolic BP > 140 and or diastolic BP > 90 mmHg

61

Name risk factors for Hypertension

↑ Age, obesity, diabetes, smoking, genetic, black> white> asian

62

Most common cause of Hypertension

Is 1º (essential)

63

What is related to Essential Hypertension?

Related to ↑ Cardiac Output or ↑Total Peripheric Resistance

64

Which is the cause of the remaining 10% of hypertension?

Mostly 2º to renal disease, including fibromuscular dysplasia in young patients

65

What is Hypertensive emergency?

Severe hypertension (> 180/120 mmHg) with evidence of acute, ongoing target organ damage (eg papilledema, mental status changes)

66

What does Hypertension predisposes?

Atherosclerosis
Left Ventricle Hypertrophy
Stroke
Cardiac Heart Failure
Renal Failure
Retinopathy
Aortic dissection

67

Which is a cause of hypertension in younger patients?

"String of beads" apperance of the renal artery in fibromuscular dysplasia

68

What is seen in Hypertensive nephrophaty?

Renal Arterial Hyalinosis

69

Hyperlipidemia Signs

Xanthomas
Tendinous Xanthoma
Corneal Arcus

70

What are Xanthomas?

Plaques or nodules composed of lipid laden histiocytes in the skin

71

What is Xanthelasma?

Xanthomas especially the eyelids

72

What are Tendinous xanthoma?

Lipid deposit in tendon

73

Which tendon is the most common to have Tendinous xanthoma?

Achilles

74

What is the corneal arcus?

Lipid deposit in cornea

75

If Corneal arcus appears early in life, you must suspect...

Hypercholesterolemia

76

Which patients is common to see Corneal Arcus?

In eldery (Arcus senilis)

77

Which are the types of Arteriosclerosis?

Monkeberg
Arteriolosclerosis

78

Which is the common type of Arteriosclerosis?

Arteriolosclerosis

79

How else is Monkeberg Arteriosclerosis known?

Medial calcific sclerosis

80

What happens in Monkeberg Arteriosclerosis?

Calcification in the media of the arteries

81

Which arteries are more common affected in Monkeberg Arteriosclerosis?

Radial
Ulnar

82

How are Monkeberg Arteriosclerosis classified?

Ussually benign

83

How are Monkeberg Arteriosclerosis visualized? What do you see?

Pipestem arteries on the x ray

84

Why is Monkeberg Arteriosclerosis benign?

Because intima is not involved

85

Which are the types of Arteriolosclerosis

Hyaline
Hyperplastic

86

What could be seen in microscope with Hyaline Arteriolosclerosis?

Thickening of small arteries

87

Which diseases are associated to Hyaline Arteriolosclerosis?

Essential hypertension or Diabetes

88

Hyperplastic Arteriolosclerosis presents this characteristic in microscope

Onion Skinning

89

When is Hyperplastic Arteriolosclerosis seen?

Severe hypertension

90

What ha[[ems om Atherosclerosis?

Disease of Elastic Arteries and large and medium sized muscular arteries

91

How are the risk of Atherosclerosis classified?

Modifiable
Non modifiable

92

Which are modifiable Atherosclerosis risk factors?

Smoking, hypertension, hyperlipidemia, diabetes

93

Non modifiable Risk factors of Atherosclerosis

Age, sex (Increased in men and postmenopausal women) and family history

94

What is important in the progression of Atherosclerosis in its pathogenesis?

Inflammation

95

Which is the progression of Atherosclerosis?

Endothelial cell dysfunction → macrophage and LDL accumulation → foam cell formation → fatty streaks → smooth muscle cell migration (involves PDGF ans FGF), proliferation , and extracellular matrix deposition → fibrous plaque → complex atheromas

96

Complications of Atherosclerosis

Aneurysms, ischemia, infarctsm peripheral vascular disease, thrombus, emboli

97

Frequent locations of Atherosclerosis

Abdominal Aorta > coronary artery > popliteal artery > carotid artery

98

Symptoms of Atherosclerosis

Angina, Claudication, but can be asymptomatic

99

What is an Aortic Aneurysm?

Localized pathologic dilation of the Aorta

100

When does a Aortic Aneurysm causes pain?

Sign of leaking, dissection or imminent rupture

101

Which factor is associated to Abdominal aortic aneurysm?

Atherosclerosis

102

With which patients is more frequently seen Abdominal Aortic aneurism?

Occurs more frequently in hypertensive male smokers > 50 years old

103

Which diseases are associated to Thoracic aortic aneurysm?

Asociated with cystic medial degeneration due to hypertension (older patients) and Marfan syndrome (younger patients)

104

Historically with which diseases is Thoracic aortic aneurysm associated?

With 3º syphilis (obliterative endarteritis of the vasa vasorum)

105

What is Aortic dissection?

Longitudinal intraluminal tear forming a false lumen

106

What is associated to Aortic dissection?

Hypertension, bicuspid aortic valve, and inherited connective tissue disorders (eg. Marfan, syndrome)

107

Which clinical manifestations does Aortic dissection has?

Tearing chest pain, of sudden onset, radiating to the back +/- markedly unequal BP in arms

108

Which study helps to see Aortic Dissection? What does it shows?

CXR shows mediastinal widening

109

Where is the false lumen found in Aortic dissection?

Can be limited to the ascending aorta, or propagate from the descending aorta

110

Which could be the complications of Aortic dissection?

Pericardial tamponade, aortic rupture and death

111

Possible Ischemic heart disease manifestations

Angina
Coronary steal syndrome
Myocardial infarction
Sudden cardiac death
Chronic ischemic heart disease

112

What is Angina?

Chest pain due to ischemic myocardium secondary to coronary artery narrowing or spasm; no myocyte necrosis

113

How is Angina classified?

Stable
Variant Angina
Unstable/crescendo

114

Which is the usual cause of Stable angina?

Usually secondary to atherosclerosis

115

How is stable angina manifested? How does it get better?

Exertional chest pain in classic distribution, resolving with rest

116

What is ussually seen in ECG in Stable angina?

Ussually with ST depression on ECG

117

How else is Varina angina known?

Prinzmetal

118

When does variant angina starts? why?

Occurs at rest secondary to coronary artery spasm

119

What is seen on the ECG in variant angina (Prinzmetal)?

Transient ST elevation on ECG

120

Which are the possible triggers of Prinzmetal angina?

Tobacco, cocainem triptans, but trigger is often unknown

121

Which is the treatment for Variant angina (Prinzmetal)?

With calcium channel blockers, nitrates and smoking cessation

122

Which is the cause of Unstable/ crescendo angina?

Thrombosis with incomplete coronary artery occlusion

123

What is seen in ECG in Unstable/ crescendo angina?

ST depression

124

Clinical presentation of Unstable/ crescendo angina

Increased in frequency or intensity of chest pain; any chest pain at rest

125

What happens in Coronary steal syndrome?

Distal to coronary stenosis, vessels are maximally dilated at baseline

126

What is the treatment for Coronary steal syndrome?

Administration of vasodilators

127

Name vasodilators use for Coronary steal syndrome

Dypiridamole
Regadenoson

128

Which is the purpose to give Vasodilators in Coronary steal syndrome?

Dilates normal vessels and shunts blood toward well perfused areas → ↓ flow and ischemia in the poststenotic region

129

What helps to study Coronary steal syndrome?

Pharmacologic stress test because (Dilates normal vessels and shunts blood toward well perfused areas → ↓ flow and ischemia in the poststenotic region)

130

What happens during a myocardial infarction?

Most often acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary arteryand myocyte necrosis

131

Which are the possible findings in ECG in myocardial infarction?

If transmural, ECG will show ST elevations; if subendocardial, ECG may show ST depressions

132

What makes the diagnosis of myocardial infarction?

Cardiac biomarkers

133

When do we consider Sudden cardiac death?

Death from cardiac causes within 1 hour of onset of symptoms

134

Most common reason of Sudden cardiac death

Lethal arrhytmia (eg vantricular fibrilation)

135

Causes associated to Sudden cardiac death

CAD- coronary artery disease (up to 70% of cases)
Cariomyopathy (hypertrophic, dilated)
Heredtary ion channelopathies (eg Long QT syndrome)

136

What could be the result of Chronic ischemic heart disease?

Progressive onset of CHF over many years due to chronic ischemic myocardial damage

137

Which is the order of frequency of occluded coronary arteries?

LAD (left anterior descending) > RCA > circumflex

138

Symptoms of Myocardial infarction

Diaphoresis, nausea, vomiting,severe retrosternal pain, pain in the left arm and/ or jaw, shortness of breath, fatigue

139

Which are the gross and light microscopic changes in MI during the first 4 hours?

None

140

Compliations of MI during the first 4 hours

Arrythmia, HF, cardiogenic schock, death

141

During the first 24 hours these are gross changes in MI

Ocluded artery
Infarct
Dark mottling; pale with tetrazolium stain

142

Light microscope changes in MI during the 4- 12 hrs

Early Coagulative necrosis, release of necrotic cell contents into blood: edema, hemorrhage, wavy fibers

143

Which are the risk of MI during the first 24 hours?

Arrythmia, HF, cardiogenic schock, death

144

When do MI changes start?

From the 4th hour

145

What happens in MI during the 12-24 hours in light microscope?

Neutrophil migration starts

146

Which risk does reperfusion has during MI?

Reperfusion injury may cause contraction bands (due to free radical damage)

147

At this point of MI happens extensive coagulative necrosis

1-3 days

148

What else is found in ligth microscope during MI in day 1-3?

Tissue surrounding infarct shows acute inflamation with neutrophils

149

Possible complications of MI found in 1-3 days

Fibrinous pericarditis

150

Hyperemia is the gross finding seen during which day of MI?

1-3 days

151

What is seen in gross in days 3-14 in MI?

Hyperemic border; central yellow brown softening

152

When is commonly seen Maximal yellow and soft in MI?

By 10 days

153

Macrophages, then granulation tissue at margins are present during these days of MI

3-14 days

154

Possible Complications of MI during day 3-14

Free wall rupture → tamponade papillary muscle rupture → mitral regurgitation ; interventricular seotal rupture due to macrophage- mediated structural degradation

155

Which MI complication found in days 3-14 is consider "time bomb"?

LV pseudoaneurys (mural thrombus "plugs" hole in myocardium)

156

Gross findigs in MI after 2 weeks to several months

Recanalized artery
Gray white myocardial zone

157

When do we expect to see Contracted scar completed in MI?

2 weeks to several months

158

Complication of MI during 2 weeks to several months

Dressler syndrome
HF
Arrythmias
True ventricular aneurysm (outward bulge during contraction, dyskinesia)

159

What is Dressler syndrome?

Is a type of pericarditis, inflammation of the sac surrounding the heart (pericardium)
Autoimmune phenomenom resulting in fibrinous pericarditis

160

Which is the gold standard of MI during the first 6 hours?

ECG

161

When does Cardiac Troponin I rises?

After 4 hours

162

How much time does Troponin I stays elevated durin MI?

7- 10 days

163

Which is the most specific protein marker during MI?

Cardiac Troponin I

164

Biomarker predominantly found un myocardium but can also be released fro skeletal muscle

CK-MB

165

Which is the use for CK-MB?

Diagnosing reinfarction following acute MI

166

Why is CK-MB usefull in Diagnosing reinfarction following acute MI?

Because levels return to normal after 48 hours

167

Which ECG changes could be seen in MI?

ST elevation
ST depression
Pathologic Q waves

168

MI that present ST elevation

ST segment elevation myocardial infarction
Acute Transmural infarct

169

Which MI is presented with ST depression?

Subendocardial infarct

170

When do we find Pathologic Q waves?

Evolving or old transmural infarct

171

Types of infarcts

Transmural infarcts
Subendocardial infarcts

172

Characteristics of Transmural infarcts

↑ necrosis
Affects entire wall

173

How is Transmural infarct found in ECG?

ST elevation
Q waves

174

When is consider a Subendocardial infarct?

Due to ischemic necrosis of < 50% of ventricle wall

175

Which structure of heart is especially vulnerable to ischemia?

Subendocardium

176

Which ECG is found in Subendocardium Infarct

ST depression

177

Which artery is related to Anterior wall infarction?

Left Anterior Descending Artery

178

Lead that show Q waves in Anterior wall infarction

V1-V4

179

Artery that irrigates Anteroseptal structure

Left Anterior Descending Artery

180

Leads hat show Anteroseptal infarction

V1-V2

181

Who irrigates Anterolateral wall of the heart?

Left Anterior Descending Artery
Left Circumflex

182

If there is a Anterolateral infarction which leads indicate the infarction?

V4-V6

183

Which artery irrigates Lateral wall of the heart?

Left circumflex

184

These leads indicate a Lateral wall infarction

I, aVL

185

Which wall does Right Coronary artery irrigates?

Inferior wall

186

Which leads indicate a right coronary territory infarction?

II, III, aVF

187

MI complications

Cardiac Arrythmia
LV failure and pulmonary edema
Cardiogenic shock
Ventricular free wall rupture
Ventricular pseudoaneurysm formation
Postinfarction fibrinous pericarditis
Dressler syndrome

188

Important cause of death before reaching hospital as MI complication

Cardiac Arrhythmia

189

When is common to see Cardiac Arrhythmia as MI complication?

In first few days

190

When can cardiogenic shock happen as MI complication?

Large infarct- high risk of mortality

191

Which is the pathogenic of Ventricular free wall rupture as MI complication?

Ventricular free wall rupture→ Cardiac tamponade; papilary muscle rupture→ several mitral regurgitation; and interventricular septum rupture → VSD

192

When is the greatest risk of Ventricular free wall rupture as MI complication?

6-14 days postinfarct

193

Which are the complications of Ventricular pseudoaneurysm formation?

↓ Cardiac output, risk of arrhytmia, embolus form mural thrombus

194

When is the greatest risk of Ventricular pseudoaneurysm formation after MI?

1 week post MI

195

When can Postinfarction fibrinous pericarditis happens?

1-3 days post MI

196

What is Dressler syndrome?

Autoimmune phenomenom resulting in fibrinous pericarditis

197

When is expected to possible see Dressler syndrome?

Several weeks post MI

198

Which is the most common cardiomyopathy

Dilated cardiomyopathy

199

From all cardiomyopathies which percentage represents Dilated cardiomyopathy?

90% of cases

200

Which are the often causes of Dilated cardiomyopathy?

Idiopathic or congenital

201

Other etiologies of Dilated cardiomyopathy are...

Alcohol abuse
Wet Beriberi
Cosackie B virus myocarditis
chronic Cocaine use
Chagas disease
Doxurubicin toxicity
hemochromatosis
peripartum cardiomyopathy

202

Which are the findings of Dilated cardiomyopathy?

Heart failure
S3
Dilated heart on echocardiogram
Ballon apperance of heart on CXR

203

Which is the treatment for Dilated cardiomyopathy?

Na+ restriction, ACE inhibitors, β blockers, diuretics, digoxin, implatable cardioverter defibrilator (ICD), heart transplant

204

Which are possible consequences of Dilated cardiomyopathy?

Systolic dysfunction ensues
Eccentric hypertrophy (sarcomers added in series)

205

Which is the most common cause of Hypertrophic cardiomyopathy?

60-70 % of cases are familial

206

The familial cases of Hypertrophic cardiomyopathy which inheritance mode do they follow?

Autosomal dominant

207

Which is the possible cause of Autsomal dominant Hypertrophic cardiomyopathy?

commonly a β- myosin heavy chain mutation

208

Rarely with which other disease is Hypertrophic cardiomyopathy associated?

Friedreich ataxia

209

Cause of sudden death in young athletes

Hypertrophic cardiomyopathy

210

Which is the cause of sudden death in young athletes due to Hypertrophic cardiomyopathy?

Ventricular arrhytmia

211

Possible findings in Hypertrophic cardiomyopathy

S4, systolic murmur

212

Treatment for Hypertrophic cardiomyopathy

Cessation of high intensity athletics, use of β blocker or non dihdropyridine calcium channel blockers

213

If a patient is at high risk for Hypertrophic cardiomyopathy what is the alternative treatment?

Implantable cardioverter defibrillators

214

What occurs afterwards Hypertrophic cardiomyopathy?

Diastolic dysfunction ensues

215

Which are possible consequences of Hypertrophic cardiomyopathy?

Marked ventricular hypertrophy, often septal predominance. Myofibrillar disarray and fibrosis

216

Pathogenesis of Obstructive Hypertrophic cardiomyopathy (subset)

Hypertrophied septum too close to anterior mitral leaflet → outflow obstruction → dyspnea, possible syncope

217

Which kind of hypertrophy is seen in Hypertrophic cardiomyopathy?

Concentric Hypertrophy

218

How else is Restrictive cardiomyopathy known?

Infiltrative

219

Name the major causes of Restrictive/Infiltrative cardiomyopathy

Sarcoidosis
Amyloidosis
Postradiation Fibrosis
Endocardial fibroelastosis
Loffler syndrome
Hemochromatosis

220

Which patient are at higher risk to develope Endocardial fibroelastosis?

Young children

221

What is the Loffler syndrome?

Endomyocardial fibrosis with a prominent eosinophilic infiltrate

222

Hemochromatosis is associated to these cardiomyopathies

Restrictive/ infiltrative cardiomiopathy
Dilated cardiomiopathy

223

What occurs afterwards Restrictive/ infiltrative cardiomyopathy?

Diastolic dysfunction

224

Which ECG problem is seen in Restrictive/ infiltrative cardiomiopathy?

Low voltage ECG despite thick myocardium (especially amyloid)

225

Clinical syndrome of cardiac pump dysfunction

Congestive Heart failure

226

Symptoms of Congestive Heart failure

Dyspnea, orthopnea and fatigue

227

Signs of Congestive Heart failure

Rales, JVD, and pitting edema

228

Which manifestations can Congestive Heart failure has?

Systolic dysfunction
Diastolic dysfunction

229

What is found in Systolic dysfunction of Congestive heart failure?

Low EF, poor contractility

230

Which is the often cause of Systolic dysfunction in Congestive Heart failure?

Secondary to ischemic heart disease or Dilated cardiomyopathy

231

Which are the findings in diastolic dysfunction of Congestive heart failure?

Normal EF and contractility
Impaired relaxation, Decrease compliance

232

Which is the common cause of Right heart failure?

Most often results from left heart failure

233

Which is the caused of isolated Right heart failure?

Ussually to cor pulmonale

234

Which drugs decreased the risk of mortality in Congestive Heart failure?

ACE inhibitors, β blockers, angiotensin II receptor blockers, and spironolactone

235

Which drugs don't help during decompensated Congestive Heart Failure?

ACE inhibitors and β blockers

236

Whic is the cause of Cardiac dilation in Congestive Heart Failure?

Greater ventricular end diastolic volume

237

Cause of dyspnea on exertion in Congestive Heart Failure

Failure of Cardiac Output to ↑ during excercise

238

Characteristics of Left heart failure

Pulmonary edema
Orthopnea
Paroxysmal nocturnal dyspnea

239

Which is the pathogenesis in Pulmonary edema caused by left heart failure?

↑ pulmonary venous pressure → pulmonary venous distention and transudation of fluid

240

Which microscopic characteristic does Pulmonary edema caused by left heart failure has?

Presence of hemosiderin laden macrophages ("heart failure cells") in the lungs

241

Clinical manifestation of Orthopnea

Shortness of breath when supine

242

Pathogenesis in Orthopnea caused by left heart failure

↑ Venous return from redistribution of blood (immediate gravity effect) exacerbates pulmonary vascular congestion

243

Clinical manifestation of Paroxysmal nocturnal dyspnea

Breathless awakening from sleep

244

Pathogenesis in Paroxysmal nocturnal dyspnea caused by left heart failure

↑ Venous return from redistribution of blood, reabsorption of edema, etc

245

Manifestations of right heart failure

Hepatomegaly (nutmeg liver)
Peripheral edema
Jugular distention

246

Pathogenesis of Hepatomegaly caused by right heart failure

↑ Central venous pressure → ↑ resistance to portal flow. Rarely leads to "cardiac cirhosis"

247

Which is the explantion of Peripheral edema caused by right heart failur?

↑ Venous pressure→ Fluid transudation

248

Why does Yugular venous distention occurs in right heart failure?

↑ Venous pressure

249

Which drugs just give symptomatic relief in CHF?

Thiazide or loop diuretics

250

Which is the most common symptom of Bacterial endocarditis

Fever

251

Symptoms of Bacterial endocarditis

Fever
New murmur
Roth spots
Osler nodes
Janeway lesions
Anemia
Splinter hemorrgages on nail bed

252

What are the Roth spots?

Round white spots on retina surrounded by hemorrhage

253

What are the Osler nodes?

Tender raised lesions on finger or toe pads

254

What are the Janeway lesions?

Small, painless , erythematous lesions on palm or sole

255

What is needed to diagnos Bacterial endocarditis?

Multiple blood cultures necessary

256

How is Bacterial endocarditits classified?

Acute
Subacute
Culture negative

257

Which bacteria causes acute Bacterial endocarditis?

S. Aureus (high virulence)

258

How is Acute Bacterial endocarditis caused by S. Aureus seen?

Large vegetations on previously normal valves

259

How is the onset of Acute Bacterial endocarditis caused by S. Aureus?

Rapid onset

260

Who causes Subacute Bacterial endocarditis ?

Viridians Streptococi (low virulence)

261

Which are the damage caused by Subacute Bacterial endocarditis ?

Smaller vegetations on congenital abnormal or diseased valves

262

In which cases do we see Subacute Bacterial endocarditis?

Sequela of dental procedures

263

Which complication can be seen as sequela of dental procedures?

Subacute Bacterial endocarditis

264

How is the onset in subacute Bacterial endocarditis ?

Gradual onset

265

Who causes culture negative Bacterial endocarditis?

Most likely Coxiella burnetii and Bartonella spp

266

Name other non bacterial causes of Endocarditis

Malignancy
Hypercoagulable state
Lupus (marantic/ thrombotic endocarditis)

267

Which bacteria is present in cancer colon?

S. bovis

268

Which bacteria could be found in prosthetic valves?

S. epidermidis

269

Which valve is most frequently involved in Bacterial endocarditis?

Mitral valve

270

If tricuspid valve endocarditis is seen, what is associated?

IV drug abuse

271

Which valve suffering endocarditis is associated to IV drug abuse?

Tricuspid

272

Bacterias Associated to Tricuspid valve endocarditis?

S. aureus
Pseudomonas
Candida

273

Complications of Bacterial endocarditis

Chordae rupture
Glomerulonephritis
Suppurative pericarditis
Emboli

274

How is Rheumatic fever adquired?

A consequence of pharyngeal infection with group A β hemolytic streptococci

275

Which is the risk of Rheumatic Fever?

Early deaths due to myocarditis

276

Late sequale of Rheumatic Fever

Rheumatic heart disease

277

In Rheumatic heart disease, in order who are the most affected valves?

Affects heart valves- mitral > aortic>> tricuspid
(high pressure affected most

278

Early lesion seen in Rheumatic Fever

Mitral Regurgitation

279

Late lesion in Rheumatic Fever

Mitral Stenosis

280

Which findings are associated to Rheumatic Fever?

Aschoff bodies
Anistschkow cells
↑ ASO titers

281

What are Aschoff bodies?

Granuloma with giant cells

282

What are the Anistschkow cells?

Enlarged macrophages with ovoid, wavy, rod like nucleus

283

Which are the causes of Rheumatic fever?

A consequence of pharyngeal infection
Immune madiated not a direct effect of Bacteria

284

Who is responsable of immune mediated Rheumatic fever?

Type II hypersensitivity

285

Which is the pathogenesis in Immune mediated who Rheumatic fever?

Antibodies to M protein cross react with self antigens

286

Findings in Rheumatic fever

FEVERSS
Fever
Erythema marginatum
Valvular damage (vegetation and fibrosis)
ESR ↑
Red hot joints (migratory polyarthritis)
Subcutaneous nodules
St. Vitus' dance (Sydenham chorea)

287

In which disease do we see St. Vitus' dance?

Sydenham chorea

288

Clinical presentation of acute pericarditis

Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward

289

How is Acute pericarditis presented?

Friction Rub

290

ECG changes in Acute pericarditis

Widespread segment elevation and/or PR depression

291

Types of Acute pericarditis

Fibrinous
Serous
Supurative/ purulent

292

Who are the cause of Fibrinous Acute pericarditis

Dressler syndrome, uremia, radiation

293

How is Fibrinous Acute pericarditis presented?

Loud friction rub

294

Causes of Serous Acute pericarditis

Viral pericarditis
Noninfectious inflammatory diseases

295

How is viral pericarditis treated?

Often resolves spontaneously

296

Causes of Noninfectious inflammatory diseases of Serous pericarditis

Rheumathoid arthritis
SLE

297

Who causes Supurative/ purulent Acute pericarditis?

Ussually caused by bacterial infections (eg. Pneumococcus, Streptococcus)

298

Why is Supurative/ purulent Acute pericarditis nowdays rare?

Rare now with antibiotics

299

What is cardiac tamponade?

Compression of heart by fluid in pericardium

300

Which fluids can cause cardiac tamponade?

Blood, effussions

301

Which is the result of Cardiac tamponade?

Leading to ↓ Cardiac Output

302

What happens during cardiac tamponade?

Equilibration of diastolic in all 4 chambers

303

Findings in Cardiac tamponade

Beck triad
↑ Heart Rate
Pulsus paradoxus
Kussmaul sign

304

What does Beck triad has?

Hypotension
Distended neck veins
Distant heart sounds

305

What does ECG in Acute pericarditis?

Shows low voltage QRS and electrical alternans (due to "swinging" movement of the heart in large effusion)

306

What is the Pulsus paradoxus?

↓ amplitude of systolic blood pressure by > 10 mmHg during inspiration

307

Which cases present pulsus paradoxus?

Cardiac Tamponade
Asthma
Obstructive sleep apnea
Pericarditis
Croup

308

Which syphilis causes syphilitic heart disease?

3º syphilis

309

Which is the pathogenesis of 3º syphilis in syphilitic heart disease?

Disrupts the vasa vasorum of the aorta with consequent atophy of the vessel wall and dilation of the aorta and valve ring

310

What can be seen in syphilitic heart disease?

Calcification of the aortic root and ascending aortic arch

311

What does syphilitic heart disease leads to?

"Tree bark" appearance of the aorta

312

Which could be the results of syphilitic heart disease?

In aneurysm of the ascending aorta or aortic arch and aortic insufficiency

313

Which are the most common heart tumors?

Is a metastastis (eg. from melanoma, lymphoma)

314

Most common primary cardiac tumor in adults

Myxomas

315

Where is the most common site of heart myxomas

90% occur in the atria (mostly left atrium)

316

How are cardiac myxomas described?

As a "ball valve" obstruction in the left atrium

317

Clinical findings caused by cardiac myxomas

Associated with multiple syncopal episodes

318

Most frequent primary tumor in children

Rhabdomyomas

319

Which disease is associated to Rhabdomyomas heart tumor?

Tuberous sclerosis

320

What is identified in Kussmaul sign?

↑ in Jugular venous pressure on inspiration instead of a normal ↓

321

How is Jugular Vein distenssion produced with inspiration?

Inspiration → negative intrathoracic pressure not transmitted to heart → impaired filling of right ventricle → blood backs up into venae cavae→ Jugular Vein Distenssion

322

When is Kussmaul sign seen?

Constrictive pericarditis
Restrictive cardiomyopathies
Right atrial or ventricular tumors

323

What is Raynaud phenomenon

↓ blood flow to skin due to arteriolar vasospasm in response to cold temperature or emotional stress

324

Where are the most often sites of Raynaud phenomenon presentation?

Most often in the fingers and toes

325

When do we call Raynaud disease?

When Primary (Idiopathic)

326

When is called Raynaud syndrome?

When secondary to a disease process

327

Which diseases are related to Raynaud syndrome?

Such as mixed connective tissue disease, SLE or CREST (limited form of systemic sclerosis) syndrome

328

Which vessels are affected in Raynaud phenomenon?

Affects small vessels

329

Vascular tumors

Strawberry hemangioma
Cherry hemangioma
Pyogenic granuloma
Cystic hygroma
Glomus tumor
Bacillary angiomatosis
Angiosarcoma
Lymphangiosarcoma
Kaposi sarcoma

330

Characteristics of Strawberry hemangioma

Benign capillary hemangioma of infancy

331

Which is the incidence of Strawberry hemangioma?

1/200 birhts

332

When is the age of apperance of Strawberry hemangioma?

Appears in first few weeks of life

333

Which is the normal evolution of Strawberry hemangioma?

Grows rapidly and regresses spontaneously at 5-8 years old

334

Benign capillary hemangioma of the elderly

Cherry hemangioma

335

Expected evolution of Cherry hemangioma

Does not regress. Frequency increases with age

336

Characteristics of Pyogenic granuloma

Polypoid capillary hemangiomathat can ulcerate and bleed

337

What is associated to Pyogenic granuloma?

With trauma and preganancy

338

Cavernous lymphangioma of the neck

Cystic Hygroma

339

Which disease is associated to Cystic Hygroma?

Turner syndrome

340

What is Glumous tumor?

Benign, painful, red blue tumor under fingernails

341

From where does Glomus tumor arises?

Arises from modified smooth muscle cells of glomus body

342

Benign capillary skin papules found un AIDS patients

Bacillary angiomatosis

343

Who causes Bacillary angiomatosis?

Bartonella henselae infections

344

With wich other Vascular tumor is Bacillary angiomatosis mistaken?

Kaposi sarcoma

345

What is Angiosarcoma?

Rare blood vessel malignancy

346

Typical Sites of Angiosarcoma apperance

In the head, neck, and breast areas

347

Who are at higher risk for Angiosarcoma?

Usually in eldery, on sun exposed areas

348

What is associated to Angiosarcoma?

Associated with radiation therapy and arsenic exposure

349

Why does Angiosarcoma has very bad prognosis?

Verry agresive and dificult to resect due to delay in diagnosis

350

What is Lymphangiosarcoma?

Lymphatic malignancy associated with persistent lymphedema

351

Example of Lymphangiosarcoma patients who are at higher risk

Post radical mastectomy

352

What is Kaposi sarcoma? where does it commonly appear?

Endothelial malignancy most commonly of the skin, but also mouth, GI tract and respiratoy tract

353

Viruses associated to Kaposi sarcoma

HHV-8 and HIV

354

Which vascular tumor is frequently mistaken with Kaposi sarcoma?

Bacillary angiomatosis

355

How are Vasculitis classified?

Large vessel vasculitis
Medium vessel vasculitis
Small vessel vasculitis

356

Large vessel vasculitis

Temporal (giant cell) arteritis
Takayasu arteritis

357

Who are mainly affected by Temporal (giant cell) arteritis?

Eldery females

358

Clinical manifestation of Temporal arteritis

Unilateral headache (temporal artery), jaw claudication

359

Which is the highest risk of Temporal arteritis?

May lead to irreversible blindness

360

Which is the reason of irrevesible blindness caused by Temporal arteritis?

Due to opthalmic artery occlusion

361

Which disease is associated to Temporal arteritis?

Polymyalgia rheumatica

362

Which are the most commonly affected arteries in Temporal arteritis?

Branches of carotid artery

363

In light microscope what is seen in Temporal arteritis?

Focal granulomatous inflammation

364

Which labs are affected in Temporal arteritis?

↑ ESR

365

Which is the treatment for Temporal arteritis?

Treat with high dose corticoesteroids prior to temporal artery biopsy to prevent vision loss

366

Main affected by Takayasu arteritis

Asian females < 40 years old

367

Clinical presentation of Takayasu arteritis

"Pulseless disease" (weak upper extremity pulses), fever, night sweats, arthtis, myalgias, skin nodules, ocular disturbances

368

Pathology findings in Takayasu arteritis

Glanulomatous thickening and narrowing of aortic arch and proximal great vessels

369

Treatment for Takayasu arteritis

Corticoesteroids

370

Lab studies altered in Takayasu arteritis

↑ ESR

371

Medium vessel vasculitis

Polyarteritis nodosa
Kawasaki disease
Buerger disease

372

Group of age who present Polyarteritis nodosa?

Young adults
Hepatitis B seropositivity in 30% of patients

373

Clinical presentation of Polyarteritis nodosa

Fever, weight loss, malaise, headache
GI: abdominal pain, melena
Hypertension, neurologic dysfunction
Cutaneous eruptions, renal damage

374

Which are the commonly vessels affected by Polyarteritis nodosa?

Typically involves renal and visceral vessels, no pulmonary arteries

375

How is Polyarteritis nodosa consider?

Immune complex mediated

376

Pathology of Polyarteritis nodosa

Transmural inflammation of the arterial wall with fibrionid necrosis

377

In Polyarteritis nodosa what is found on arteriogram?

Innumerable microaneurysms and spasm

378

What is the treatment for Polyarteritis nodosa?

Corticoesteroids, cyclosphosphamide

379

Kawasaki disease principally affects...

Asian children <4 years old

380

Which are clinical manifestations of Kawasaki disease?

Fever, cervical lymphadenitis, conjunctival injection, changes in lips/oral mucosa ("stawberry tongue"), hand foot erythema, desquamating rash

381

Which are the risk of Kawasaki disease?

May develop coronary artery aneurysms, thrombosis → MI, rupture

382

How is Kawasaki disease treated?

Treat with IV immunoglobulin and aspirin

383

Alternative name for Buerger disease

Thromboangiitis obliterans

384

Patients how have increased rik for Buerger disease

Heavy smokers, males <40 years old

385

Clinical presentation of Thromboangiitis obliterans

Intermittent claudication may lead to gangrene, autoamputation of digits, superficial nodular phlebitis

386

What else is often present in Buerger disease?

Raynaud phenomenom

387

Pathology of Thromboangiitis obliterans

Segmental thrombosing vasculitis

388

How is Buerger disease treated?

Smoking cessation

389

Small cell vasculitis

Granulomatosis with polyangiitis
Microscopic polyangiitis
Churg Strauss syndrome
Henoch Schonlein purpura

390

Alternative name for Granulomatosis with polyangiitis

Wegner

391

Lower respiratory tract manifestations of Wegner disease

Hemoptysis, cough, dyspnea

392

Upper respiratory tract of Granulomatosis with polyangiitis

Upper respiratory tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis

393

Renal manifestations of Wegner disease

Hematuria, red cell casts

394

Triad in Granulomatosis with polyangiitis

Focal necrotizing vasculitis
Necrotizing granulomas in the lung and upper airway
Necrotizing glomerulonephritis

395

Which labs help in the diagnosis of Wegner disease?

PR3- ANCA/ cANCA (anti-proteinase 3)

396

Which other study helps to study Wegner disease?

CXR

397

What could be found in CXR in Granulomatosis with polyangiitis?

Large nodular densities

398

How is Wegner disease treatred?

Cyclophosphamide, corticoesteroids

399

What is Microscopic polyangiitis?

Necrotizing vasculitis

400

Which orgnas are commonly involved in Microscopic polyangiitis?

Lung, kidneys, and skin

401

What could be found in Microscopic polyangiitis?

Pauci immune glomerulonephritis and palpablepurpura

402

Which is the presentation of Microscopic polyangiitis?

Similar to granulomatosis with polyangiitis but without nasopharyngeal involvement

403

Labs for Microscopic polyangiitis

MPO-ANCA/p-ANCA (antimyeloperoxidase)

404

Treatment for Microscopic polyangiitis

Cyclophosphamide and corticosteroids

405

Clinical presentation of Churg Strauss syndrome

Asthma,sinusitis, palpable purpura, peripheral neuropathy (eg. wrist/foot drop)

406

What else can Churg Strauss syndrome present?

Involve heart, GI, kidneys (pauci immune glomerulophritis)

407

Pathologic findings in Churg Strauss syndrome

Granulomatous, necrotizing vasculitis with eosinophilia

408

Labs in Churg Strauss syndrome

MPO- ANCA/ p-ANCA, ↑ IgE level

409

Most common childhood systemic vasculitis

Henoch Schonlein purpura

410

Commonly what precedes Henoch Schonlein purpura

Upper Respiratory tract Infection

411

Classic triad of Henoch Schonlein purpura

Skin: palpable purpura on buttocks/ legs
Arthralgias
GI: abdominal pain, melena, multiple lesions of same age

412

What is the cause of Henoch Schonlein purpura?

Vasculitis secondary to IgA complex deposition

413

Which disease is associated to Henoch Schonlein purpura?

With IgA nephropathy