Flashcards in CARDIOLOGY- Pathology Deck (413):
Characteristics "Blue babies"
Right to left shunt, Early cyanosis
When is often diagnose right to left shunt?
Prenatally or become evident immediatly after birth
What is the treatment for right to left shunt?
Ussually require urgent surgical correction and/or maintenance of a Patent Ductus arterious
Right to left shunt diseases
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
What happens in Persistent truncus arteriosus?
Failure of truncus arteriosus to divide into pulmonary trunk and aorta
What do most patients with persistent truncus arteriosus have?
Ventricular Septal Defect
What is wrong in D transposition of great vessels
Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior)
What is the result of D transposition of great vessels?
Separation of systemic and pulmonary circulations
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)
Which is the reason of D transposition of great vessels?
Due to failure of the aorticopulmonary septum to spiral
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
Which problems are found in Tricuspid atresia?
Absence of tricuspid valve and hypoplastic RV
What is required in Tricuspid atresia for viability?
Both Ventricular Septal Defect and Atrial Septal Defect
What causes Tetalogy of Fallot?
By anterosuperior displacement of the infundibular septum
Most common cause of early childhood cyanosis
Tetralogy of Fallot
Characteristics of Tetralogy of Fallot
Pulmonary infundibular stenosis
Right Ventricular Hypertrophy
Ventricular Septal Defect
What is most important determinant for prognosis in Tetralogy of Fallot?
Pulmonary infundibular stenosis
In Tetrallogy of Fallot what causes right to left flow across Ventricular Septal defect?
Clinical manifestation of Pulmonary stenosis causing right to left flow across Ventricular Septal defect
Early cyanotic "tet spells," Right Ventricular Hypertrophy
What does Squatting manuever causes in patients with Tetrallogy of Fallot?
↑ systemic vascular resistance, ↓right to left shunt, improves cyanosis
Treatment for Tetrallogy of Fallot
Early surgical correction
What happens in Total Anomalous Pulmonary Venous Return?
Pulmonary veins drain into right heart circulation (SVC, coronary sinus)
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
Characteristics "blue kids"
Left to right shunt- Late cyanosis
Name all Left to right shunt diseases
Ventricular Septal Defect
Atrial Septal Defect
Patent Ductus arteriosus
In order, which are the most frequent causes of Left to right shunt diseases
Ventricular Septal Defect >Atrial Septal Defect >Patent Ductus arteriosus
Most common congenital cardiac defect
Ventricular Septal Defect
Which are the clinical manifestations of Ventricular Septal Defect?
Asymptomatic at birth, may manifest weeks later or remain asymptomatic thoughout life
Which is the prognosis of Ventricular Septal Defect?
Most self resolve
Which is the risk of Larger lessions of Ventricular Septal Defect?
May lead to LV overload and heart failure
During ausculation what is heard in Atrial Septal defect?
Loud S1: wide , fixed split S2
Where does Atrial Septal defect ussualy occurs?
In septum secundum
Which could be the symptoms of Atrial Septal defect?
Range from none to Heart Failure
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
In Fetal period which shunt is consider normal?
Right to left
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
Which murmur is associated to Patent ductus arteriosus?
Machine like murmur
What maintains patency in patent ductus arteriosus?
PGE synthesis and low O2 tension
What could be the result of uncorrected Patent ductus arteriosus?
Can result in late cyanosis in the lower extremities (differential cyanosis)
Which drug helps in Patent ductus arteriosus?
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
When is Patent Ductus consider normal? When does it close?
PDA is normal in utero and normally closes only after birth
What is Eisenmenger syndrome?
Uncorrected left to right shunt (VSD, ASD, PDA)
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
What does Eisenmenger syndrome clinicaly causes?
Late cyanosis, clubbing and polycythemia
At what age does Eisenmenger syndrome onsets?
Which types of coarctation of the aorta exist?
In which associated situations is coarctation of the aorta seen?
Associated with bicuspid aortic valve, other heart defects
What is wrong in Coarctation of the Aorta infantile type?
Aorta narrowing is proximal to insertion of the ductus arteriosus (preductal)
Which pathology is associated to Coarctation of the Aorta?
What happens in Coarctation of the aorta in adult type?
Aorta narrowing is distal to ligamentum arteriosum (postductal)
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)
Which genetic disorders and diseases have congenital cardiac defect associated?
Infant of Diabetic Mother
Which congenital cardiac defect might 22q11 syndrome have?
Truncus arteriosus, Tetralogy of Fallot
Down syndrome patients they could have these congenital cardiac defect
ASD, VSD, AV septal defect (endocardial cushion defect)
Congenital Rubella might present with these congenital cardiac defect
Septal defects, PDA, pulmonary artery stenosis
Which congenital cardiac defect are associated to Turner Syndrome?
Bicuspid aortic valve, coarctation of aorta (preductal)
Name congenital cardiac defect associated to Marfan syndrome
Mitral valve prolapse, thoracic aortic aneurysm and dissection, aortic regurgitation
Which congenital cardiac defect is associated to Infant of Diabetic mother?
Transposition of great vessels
What is hypertension?
Defined as a systolic BP > 140 and or diastolic BP > 90 mmHg
Name risk factors for Hypertension
↑ Age, obesity, diabetes, smoking, genetic, black> white> asian
Most common cause of Hypertension
Is 1º (essential)
What is related to Essential Hypertension?
Related to ↑ Cardiac Output or ↑Total Peripheric Resistance
Which is the cause of the remaining 10% of hypertension?
Mostly 2º to renal disease, including fibromuscular dysplasia in young patients
What is Hypertensive emergency?
Severe hypertension (> 180/120 mmHg) with evidence of acute, ongoing target organ damage (eg papilledema, mental status changes)
What does Hypertension predisposes?
Left Ventricle Hypertrophy
Cardiac Heart Failure
Which is a cause of hypertension in younger patients?
"String of beads" apperance of the renal artery in fibromuscular dysplasia
What is seen in Hypertensive nephrophaty?
Renal Arterial Hyalinosis
What are Xanthomas?
Plaques or nodules composed of lipid laden histiocytes in the skin
What is Xanthelasma?
Xanthomas especially the eyelids
What are Tendinous xanthoma?
Lipid deposit in tendon
Which tendon is the most common to have Tendinous xanthoma?
What is the corneal arcus?
Lipid deposit in cornea
If Corneal arcus appears early in life, you must suspect...
Which patients is common to see Corneal Arcus?
In eldery (Arcus senilis)
Which are the types of Arteriosclerosis?
Which is the common type of Arteriosclerosis?
How else is Monkeberg Arteriosclerosis known?
Medial calcific sclerosis
What happens in Monkeberg Arteriosclerosis?
Calcification in the media of the arteries
Which arteries are more common affected in Monkeberg Arteriosclerosis?
How are Monkeberg Arteriosclerosis classified?
How are Monkeberg Arteriosclerosis visualized? What do you see?
Pipestem arteries on the x ray
Why is Monkeberg Arteriosclerosis benign?
Because intima is not involved
Which are the types of Arteriolosclerosis
What could be seen in microscope with Hyaline Arteriolosclerosis?
Thickening of small arteries
Which diseases are associated to Hyaline Arteriolosclerosis?
Essential hypertension or Diabetes
Hyperplastic Arteriolosclerosis presents this characteristic in microscope
When is Hyperplastic Arteriolosclerosis seen?
What ha[[ems om Atherosclerosis?
Disease of Elastic Arteries and large and medium sized muscular arteries
How are the risk of Atherosclerosis classified?
Which are modifiable Atherosclerosis risk factors?
Smoking, hypertension, hyperlipidemia, diabetes
Non modifiable Risk factors of Atherosclerosis
Age, sex (Increased in men and postmenopausal women) and family history
What is important in the progression of Atherosclerosis in its pathogenesis?
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
Complications of Atherosclerosis
Aneurysms, ischemia, infarctsm peripheral vascular disease, thrombus, emboli
Frequent locations of Atherosclerosis
Abdominal Aorta > coronary artery > popliteal artery > carotid artery
Symptoms of Atherosclerosis
Angina, Claudication, but can be asymptomatic
What is an Aortic Aneurysm?
Localized pathologic dilation of the Aorta
When does a Aortic Aneurysm causes pain?
Sign of leaking, dissection or imminent rupture
Which factor is associated to Abdominal aortic aneurysm?
With which patients is more frequently seen Abdominal Aortic aneurism?
Occurs more frequently in hypertensive male smokers > 50 years old
Which diseases are associated to Thoracic aortic aneurysm?
Asociated with cystic medial degeneration due to hypertension (older patients) and Marfan syndrome (younger patients)
Historically with which diseases is Thoracic aortic aneurysm associated?
With 3º syphilis (obliterative endarteritis of the vasa vasorum)
What is Aortic dissection?
Longitudinal intraluminal tear forming a false lumen
What is associated to Aortic dissection?
Hypertension, bicuspid aortic valve, and inherited connective tissue disorders (eg. Marfan, syndrome)
Which clinical manifestations does Aortic dissection has?
Tearing chest pain, of sudden onset, radiating to the back +/- markedly unequal BP in arms
Which study helps to see Aortic Dissection? What does it shows?
CXR shows mediastinal widening
Where is the false lumen found in Aortic dissection?
Can be limited to the ascending aorta, or propagate from the descending aorta
Which could be the complications of Aortic dissection?
Pericardial tamponade, aortic rupture and death
Possible Ischemic heart disease manifestations
Coronary steal syndrome
Sudden cardiac death
Chronic ischemic heart disease
What is Angina?
Chest pain due to ischemic myocardium secondary to coronary artery narrowing or spasm; no myocyte necrosis
How is Angina classified?
Which is the usual cause of Stable angina?
Usually secondary to atherosclerosis
How is stable angina manifested? How does it get better?
Exertional chest pain in classic distribution, resolving with rest
What is ussually seen in ECG in Stable angina?
Ussually with ST depression on ECG
How else is Varina angina known?
When does variant angina starts? why?
Occurs at rest secondary to coronary artery spasm
What is seen on the ECG in variant angina (Prinzmetal)?
Transient ST elevation on ECG
Which are the possible triggers of Prinzmetal angina?
Tobacco, cocainem triptans, but trigger is often unknown
Which is the treatment for Variant angina (Prinzmetal)?
With calcium channel blockers, nitrates and smoking cessation
Which is the cause of Unstable/ crescendo angina?
Thrombosis with incomplete coronary artery occlusion
What is seen in ECG in Unstable/ crescendo angina?
Clinical presentation of Unstable/ crescendo angina
Increased in frequency or intensity of chest pain; any chest pain at rest
What happens in Coronary steal syndrome?
Distal to coronary stenosis, vessels are maximally dilated at baseline
What is the treatment for Coronary steal syndrome?
Administration of vasodilators
Name vasodilators use for Coronary steal syndrome
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
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)
What happens during a myocardial infarction?
Most often acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary arteryand myocyte necrosis
Which are the possible findings in ECG in myocardial infarction?
If transmural, ECG will show ST elevations; if subendocardial, ECG may show ST depressions
What makes the diagnosis of myocardial infarction?
When do we consider Sudden cardiac death?
Death from cardiac causes within 1 hour of onset of symptoms
Most common reason of Sudden cardiac death
Lethal arrhytmia (eg vantricular fibrilation)
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)
What could be the result of Chronic ischemic heart disease?
Progressive onset of CHF over many years due to chronic ischemic myocardial damage
Which is the order of frequency of occluded coronary arteries?
LAD (left anterior descending) > RCA > circumflex
Symptoms of Myocardial infarction
Diaphoresis, nausea, vomiting,severe retrosternal pain, pain in the left arm and/ or jaw, shortness of breath, fatigue
Which are the gross and light microscopic changes in MI during the first 4 hours?
Compliations of MI during the first 4 hours
Arrythmia, HF, cardiogenic schock, death
During the first 24 hours these are gross changes in MI
Dark mottling; pale with tetrazolium stain
Light microscope changes in MI during the 4- 12 hrs
Early Coagulative necrosis, release of necrotic cell contents into blood: edema, hemorrhage, wavy fibers
Which are the risk of MI during the first 24 hours?
Arrythmia, HF, cardiogenic schock, death
When do MI changes start?
From the 4th hour
What happens in MI during the 12-24 hours in light microscope?
Neutrophil migration starts
Which risk does reperfusion has during MI?
Reperfusion injury may cause contraction bands (due to free radical damage)
At this point of MI happens extensive coagulative necrosis
What else is found in ligth microscope during MI in day 1-3?
Tissue surrounding infarct shows acute inflamation with neutrophils
Possible complications of MI found in 1-3 days
Hyperemia is the gross finding seen during which day of MI?
What is seen in gross in days 3-14 in MI?
Hyperemic border; central yellow brown softening
When is commonly seen Maximal yellow and soft in MI?
By 10 days
Macrophages, then granulation tissue at margins are present during these days of MI
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
Which MI complication found in days 3-14 is consider "time bomb"?
LV pseudoaneurys (mural thrombus "plugs" hole in myocardium)
Gross findigs in MI after 2 weeks to several months
Gray white myocardial zone
When do we expect to see Contracted scar completed in MI?
2 weeks to several months
Complication of MI during 2 weeks to several months
True ventricular aneurysm (outward bulge during contraction, dyskinesia)
What is Dressler syndrome?
Is a type of pericarditis, inflammation of the sac surrounding the heart (pericardium)
Autoimmune phenomenom resulting in fibrinous pericarditis
Which is the gold standard of MI during the first 6 hours?
When does Cardiac Troponin I rises?
After 4 hours
How much time does Troponin I stays elevated durin MI?
7- 10 days
Which is the most specific protein marker during MI?
Cardiac Troponin I
Biomarker predominantly found un myocardium but can also be released fro skeletal muscle
Which is the use for CK-MB?
Diagnosing reinfarction following acute MI
Why is CK-MB usefull in Diagnosing reinfarction following acute MI?
Because levels return to normal after 48 hours
Which ECG changes could be seen in MI?
Pathologic Q waves
MI that present ST elevation
ST segment elevation myocardial infarction
Acute Transmural infarct
Which MI is presented with ST depression?
When do we find Pathologic Q waves?
Evolving or old transmural infarct
Types of infarcts
Characteristics of Transmural infarcts
Affects entire wall
How is Transmural infarct found in ECG?
When is consider a Subendocardial infarct?
Due to ischemic necrosis of < 50% of ventricle wall
Which structure of heart is especially vulnerable to ischemia?
Which ECG is found in Subendocardium Infarct
Which artery is related to Anterior wall infarction?
Left Anterior Descending Artery
Lead that show Q waves in Anterior wall infarction
Artery that irrigates Anteroseptal structure
Left Anterior Descending Artery
Leads hat show Anteroseptal infarction
Who irrigates Anterolateral wall of the heart?
Left Anterior Descending Artery
If there is a Anterolateral infarction which leads indicate the infarction?
Which artery irrigates Lateral wall of the heart?
These leads indicate a Lateral wall infarction
Which wall does Right Coronary artery irrigates?
Which leads indicate a right coronary territory infarction?
II, III, aVF
LV failure and pulmonary edema
Ventricular free wall rupture
Ventricular pseudoaneurysm formation
Postinfarction fibrinous pericarditis
Important cause of death before reaching hospital as MI complication
When is common to see Cardiac Arrhythmia as MI complication?
In first few days
When can cardiogenic shock happen as MI complication?
Large infarct- high risk of mortality
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
When is the greatest risk of Ventricular free wall rupture as MI complication?
6-14 days postinfarct
Which are the complications of Ventricular pseudoaneurysm formation?
↓ Cardiac output, risk of arrhytmia, embolus form mural thrombus
When is the greatest risk of Ventricular pseudoaneurysm formation after MI?
1 week post MI
When can Postinfarction fibrinous pericarditis happens?
1-3 days post MI
What is Dressler syndrome?
Autoimmune phenomenom resulting in fibrinous pericarditis
When is expected to possible see Dressler syndrome?
Several weeks post MI
Which is the most common cardiomyopathy
From all cardiomyopathies which percentage represents Dilated cardiomyopathy?
90% of cases
Which are the often causes of Dilated cardiomyopathy?
Idiopathic or congenital
Other etiologies of Dilated cardiomyopathy are...
Cosackie B virus myocarditis
chronic Cocaine use
Which are the findings of Dilated cardiomyopathy?
Dilated heart on echocardiogram
Ballon apperance of heart on CXR
Which is the treatment for Dilated cardiomyopathy?
Na+ restriction, ACE inhibitors, β blockers, diuretics, digoxin, implatable cardioverter defibrilator (ICD), heart transplant
Which are possible consequences of Dilated cardiomyopathy?
Systolic dysfunction ensues
Eccentric hypertrophy (sarcomers added in series)
Which is the most common cause of Hypertrophic cardiomyopathy?
60-70 % of cases are familial
The familial cases of Hypertrophic cardiomyopathy which inheritance mode do they follow?
Which is the possible cause of Autsomal dominant Hypertrophic cardiomyopathy?
commonly a β- myosin heavy chain mutation
Rarely with which other disease is Hypertrophic cardiomyopathy associated?
Cause of sudden death in young athletes
Which is the cause of sudden death in young athletes due to Hypertrophic cardiomyopathy?
Possible findings in Hypertrophic cardiomyopathy
S4, systolic murmur
Treatment for Hypertrophic cardiomyopathy
Cessation of high intensity athletics, use of β blocker or non dihdropyridine calcium channel blockers
If a patient is at high risk for Hypertrophic cardiomyopathy what is the alternative treatment?
Implantable cardioverter defibrillators
What occurs afterwards Hypertrophic cardiomyopathy?
Diastolic dysfunction ensues
Which are possible consequences of Hypertrophic cardiomyopathy?
Marked ventricular hypertrophy, often septal predominance. Myofibrillar disarray and fibrosis
Pathogenesis of Obstructive Hypertrophic cardiomyopathy (subset)
Hypertrophied septum too close to anterior mitral leaflet → outflow obstruction → dyspnea, possible syncope
Which kind of hypertrophy is seen in Hypertrophic cardiomyopathy?
How else is Restrictive cardiomyopathy known?
Name the major causes of Restrictive/Infiltrative cardiomyopathy
Which patient are at higher risk to develope Endocardial fibroelastosis?
What is the Loffler syndrome?
Endomyocardial fibrosis with a prominent eosinophilic infiltrate
Hemochromatosis is associated to these cardiomyopathies
Restrictive/ infiltrative cardiomiopathy
What occurs afterwards Restrictive/ infiltrative cardiomyopathy?
Which ECG problem is seen in Restrictive/ infiltrative cardiomiopathy?
Low voltage ECG despite thick myocardium (especially amyloid)
Clinical syndrome of cardiac pump dysfunction
Congestive Heart failure
Symptoms of Congestive Heart failure
Dyspnea, orthopnea and fatigue
Signs of Congestive Heart failure
Rales, JVD, and pitting edema
Which manifestations can Congestive Heart failure has?
What is found in Systolic dysfunction of Congestive heart failure?
Low EF, poor contractility
Which is the often cause of Systolic dysfunction in Congestive Heart failure?
Secondary to ischemic heart disease or Dilated cardiomyopathy
Which are the findings in diastolic dysfunction of Congestive heart failure?
Normal EF and contractility
Impaired relaxation, Decrease compliance
Which is the common cause of Right heart failure?
Most often results from left heart failure
Which is the caused of isolated Right heart failure?
Ussually to cor pulmonale
Which drugs decreased the risk of mortality in Congestive Heart failure?
ACE inhibitors, β blockers, angiotensin II receptor blockers, and spironolactone
Which drugs don't help during decompensated Congestive Heart Failure?
ACE inhibitors and β blockers
Whic is the cause of Cardiac dilation in Congestive Heart Failure?
Greater ventricular end diastolic volume
Cause of dyspnea on exertion in Congestive Heart Failure
Failure of Cardiac Output to ↑ during excercise
Characteristics of Left heart failure
Paroxysmal nocturnal dyspnea
Which is the pathogenesis in Pulmonary edema caused by left heart failure?
↑ pulmonary venous pressure → pulmonary venous distention and transudation of fluid
Which microscopic characteristic does Pulmonary edema caused by left heart failure has?
Presence of hemosiderin laden macrophages ("heart failure cells") in the lungs
Clinical manifestation of Orthopnea
Shortness of breath when supine
Pathogenesis in Orthopnea caused by left heart failure
↑ Venous return from redistribution of blood (immediate gravity effect) exacerbates pulmonary vascular congestion
Clinical manifestation of Paroxysmal nocturnal dyspnea
Breathless awakening from sleep
Pathogenesis in Paroxysmal nocturnal dyspnea caused by left heart failure
↑ Venous return from redistribution of blood, reabsorption of edema, etc
Manifestations of right heart failure
Hepatomegaly (nutmeg liver)
Pathogenesis of Hepatomegaly caused by right heart failure
↑ Central venous pressure → ↑ resistance to portal flow. Rarely leads to "cardiac cirhosis"
Which is the explantion of Peripheral edema caused by right heart failur?
↑ Venous pressure→ Fluid transudation
Why does Yugular venous distention occurs in right heart failure?
↑ Venous pressure
Which drugs just give symptomatic relief in CHF?
Thiazide or loop diuretics
Which is the most common symptom of Bacterial endocarditis
Symptoms of Bacterial endocarditis
Splinter hemorrgages on nail bed
What are the Roth spots?
Round white spots on retina surrounded by hemorrhage
What are the Osler nodes?
Tender raised lesions on finger or toe pads
What are the Janeway lesions?
Small, painless , erythematous lesions on palm or sole
What is needed to diagnos Bacterial endocarditis?
Multiple blood cultures necessary
How is Bacterial endocarditits classified?
Which bacteria causes acute Bacterial endocarditis?
S. Aureus (high virulence)
How is Acute Bacterial endocarditis caused by S. Aureus seen?
Large vegetations on previously normal valves
How is the onset of Acute Bacterial endocarditis caused by S. Aureus?
Who causes Subacute Bacterial endocarditis ?
Viridians Streptococi (low virulence)
Which are the damage caused by Subacute Bacterial endocarditis ?
Smaller vegetations on congenital abnormal or diseased valves
In which cases do we see Subacute Bacterial endocarditis?
Sequela of dental procedures
Which complication can be seen as sequela of dental procedures?
Subacute Bacterial endocarditis
How is the onset in subacute Bacterial endocarditis ?
Who causes culture negative Bacterial endocarditis?
Most likely Coxiella burnetii and Bartonella spp
Name other non bacterial causes of Endocarditis
Lupus (marantic/ thrombotic endocarditis)
Which bacteria is present in cancer colon?
Which bacteria could be found in prosthetic valves?
Which valve is most frequently involved in Bacterial endocarditis?
If tricuspid valve endocarditis is seen, what is associated?
IV drug abuse
Which valve suffering endocarditis is associated to IV drug abuse?
Bacterias Associated to Tricuspid valve endocarditis?
Complications of Bacterial endocarditis
How is Rheumatic fever adquired?
A consequence of pharyngeal infection with group A β hemolytic streptococci
Which is the risk of Rheumatic Fever?
Early deaths due to myocarditis
Late sequale of Rheumatic Fever
Rheumatic heart disease
In Rheumatic heart disease, in order who are the most affected valves?
Affects heart valves- mitral > aortic>> tricuspid
(high pressure affected most
Early lesion seen in Rheumatic Fever
Late lesion in Rheumatic Fever
Which findings are associated to Rheumatic Fever?
↑ ASO titers
What are Aschoff bodies?
Granuloma with giant cells
What are the Anistschkow cells?
Enlarged macrophages with ovoid, wavy, rod like nucleus
Which are the causes of Rheumatic fever?
A consequence of pharyngeal infection
Immune madiated not a direct effect of Bacteria
Who is responsable of immune mediated Rheumatic fever?
Type II hypersensitivity
Which is the pathogenesis in Immune mediated who Rheumatic fever?
Antibodies to M protein cross react with self antigens
Findings in Rheumatic fever
Valvular damage (vegetation and fibrosis)
Red hot joints (migratory polyarthritis)
St. Vitus' dance (Sydenham chorea)
In which disease do we see St. Vitus' dance?
Clinical presentation of acute pericarditis
Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward
How is Acute pericarditis presented?
ECG changes in Acute pericarditis
Widespread segment elevation and/or PR depression
Types of Acute pericarditis
Who are the cause of Fibrinous Acute pericarditis
Dressler syndrome, uremia, radiation
How is Fibrinous Acute pericarditis presented?
Loud friction rub
Causes of Serous Acute pericarditis
Noninfectious inflammatory diseases
How is viral pericarditis treated?
Often resolves spontaneously
Causes of Noninfectious inflammatory diseases of Serous pericarditis
Who causes Supurative/ purulent Acute pericarditis?
Ussually caused by bacterial infections (eg. Pneumococcus, Streptococcus)
Why is Supurative/ purulent Acute pericarditis nowdays rare?
Rare now with antibiotics
What is cardiac tamponade?
Compression of heart by fluid in pericardium
Which fluids can cause cardiac tamponade?
Which is the result of Cardiac tamponade?
Leading to ↓ Cardiac Output
What happens during cardiac tamponade?
Equilibration of diastolic in all 4 chambers
Findings in Cardiac tamponade
↑ Heart Rate
What does Beck triad has?
Distended neck veins
Distant heart sounds
What does ECG in Acute pericarditis?
Shows low voltage QRS and electrical alternans (due to "swinging" movement of the heart in large effusion)
What is the Pulsus paradoxus?
↓ amplitude of systolic blood pressure by > 10 mmHg during inspiration
Which cases present pulsus paradoxus?
Obstructive sleep apnea
Which syphilis causes syphilitic heart disease?
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
What can be seen in syphilitic heart disease?
Calcification of the aortic root and ascending aortic arch
What does syphilitic heart disease leads to?
"Tree bark" appearance of the aorta
Which could be the results of syphilitic heart disease?
In aneurysm of the ascending aorta or aortic arch and aortic insufficiency
Which are the most common heart tumors?
Is a metastastis (eg. from melanoma, lymphoma)
Most common primary cardiac tumor in adults
Where is the most common site of heart myxomas
90% occur in the atria (mostly left atrium)
How are cardiac myxomas described?
As a "ball valve" obstruction in the left atrium
Clinical findings caused by cardiac myxomas
Associated with multiple syncopal episodes
Most frequent primary tumor in children
Which disease is associated to Rhabdomyomas heart tumor?
What is identified in Kussmaul sign?
↑ in Jugular venous pressure on inspiration instead of a normal ↓
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
When is Kussmaul sign seen?
Right atrial or ventricular tumors
What is Raynaud phenomenon
↓ blood flow to skin due to arteriolar vasospasm in response to cold temperature or emotional stress
Where are the most often sites of Raynaud phenomenon presentation?
Most often in the fingers and toes
When do we call Raynaud disease?
When Primary (Idiopathic)
When is called Raynaud syndrome?
When secondary to a disease process
Which diseases are related to Raynaud syndrome?
Such as mixed connective tissue disease, SLE or CREST (limited form of systemic sclerosis) syndrome
Which vessels are affected in Raynaud phenomenon?
Affects small vessels
Characteristics of Strawberry hemangioma
Benign capillary hemangioma of infancy
Which is the incidence of Strawberry hemangioma?
When is the age of apperance of Strawberry hemangioma?
Appears in first few weeks of life
Which is the normal evolution of Strawberry hemangioma?
Grows rapidly and regresses spontaneously at 5-8 years old
Benign capillary hemangioma of the elderly
Expected evolution of Cherry hemangioma
Does not regress. Frequency increases with age
Characteristics of Pyogenic granuloma
Polypoid capillary hemangiomathat can ulcerate and bleed
What is associated to Pyogenic granuloma?
With trauma and preganancy
Cavernous lymphangioma of the neck
Which disease is associated to Cystic Hygroma?
What is Glumous tumor?
Benign, painful, red blue tumor under fingernails
From where does Glomus tumor arises?
Arises from modified smooth muscle cells of glomus body
Benign capillary skin papules found un AIDS patients
Who causes Bacillary angiomatosis?
Bartonella henselae infections
With wich other Vascular tumor is Bacillary angiomatosis mistaken?
What is Angiosarcoma?
Rare blood vessel malignancy
Typical Sites of Angiosarcoma apperance
In the head, neck, and breast areas
Who are at higher risk for Angiosarcoma?
Usually in eldery, on sun exposed areas
What is associated to Angiosarcoma?
Associated with radiation therapy and arsenic exposure
Why does Angiosarcoma has very bad prognosis?
Verry agresive and dificult to resect due to delay in diagnosis
What is Lymphangiosarcoma?
Lymphatic malignancy associated with persistent lymphedema
Example of Lymphangiosarcoma patients who are at higher risk
Post radical mastectomy
What is Kaposi sarcoma? where does it commonly appear?
Endothelial malignancy most commonly of the skin, but also mouth, GI tract and respiratoy tract
Viruses associated to Kaposi sarcoma
HHV-8 and HIV
Which vascular tumor is frequently mistaken with Kaposi sarcoma?
How are Vasculitis classified?
Large vessel vasculitis
Medium vessel vasculitis
Small vessel vasculitis
Large vessel vasculitis
Temporal (giant cell) arteritis
Who are mainly affected by Temporal (giant cell) arteritis?
Clinical manifestation of Temporal arteritis
Unilateral headache (temporal artery), jaw claudication
Which is the highest risk of Temporal arteritis?
May lead to irreversible blindness
Which is the reason of irrevesible blindness caused by Temporal arteritis?
Due to opthalmic artery occlusion
Which disease is associated to Temporal arteritis?
Which are the most commonly affected arteries in Temporal arteritis?
Branches of carotid artery
In light microscope what is seen in Temporal arteritis?
Focal granulomatous inflammation
Which labs are affected in Temporal arteritis?
Which is the treatment for Temporal arteritis?
Treat with high dose corticoesteroids prior to temporal artery biopsy to prevent vision loss
Main affected by Takayasu arteritis
Asian females < 40 years old
Clinical presentation of Takayasu arteritis
"Pulseless disease" (weak upper extremity pulses), fever, night sweats, arthtis, myalgias, skin nodules, ocular disturbances
Pathology findings in Takayasu arteritis
Glanulomatous thickening and narrowing of aortic arch and proximal great vessels
Treatment for Takayasu arteritis
Lab studies altered in Takayasu arteritis
Medium vessel vasculitis
Group of age who present Polyarteritis nodosa?
Hepatitis B seropositivity in 30% of patients
Clinical presentation of Polyarteritis nodosa
Fever, weight loss, malaise, headache
GI: abdominal pain, melena
Hypertension, neurologic dysfunction
Cutaneous eruptions, renal damage
Which are the commonly vessels affected by Polyarteritis nodosa?
Typically involves renal and visceral vessels, no pulmonary arteries
How is Polyarteritis nodosa consider?
Immune complex mediated
Pathology of Polyarteritis nodosa
Transmural inflammation of the arterial wall with fibrionid necrosis
In Polyarteritis nodosa what is found on arteriogram?
Innumerable microaneurysms and spasm
What is the treatment for Polyarteritis nodosa?
Kawasaki disease principally affects...
Asian children <4 years old
Which are clinical manifestations of Kawasaki disease?
Fever, cervical lymphadenitis, conjunctival injection, changes in lips/oral mucosa ("stawberry tongue"), hand foot erythema, desquamating rash
Which are the risk of Kawasaki disease?
May develop coronary artery aneurysms, thrombosis → MI, rupture
How is Kawasaki disease treated?
Treat with IV immunoglobulin and aspirin
Alternative name for Buerger disease
Patients how have increased rik for Buerger disease
Heavy smokers, males <40 years old
Clinical presentation of Thromboangiitis obliterans
Intermittent claudication may lead to gangrene, autoamputation of digits, superficial nodular phlebitis
What else is often present in Buerger disease?
Pathology of Thromboangiitis obliterans
Segmental thrombosing vasculitis
How is Buerger disease treated?
Small cell vasculitis
Granulomatosis with polyangiitis
Churg Strauss syndrome
Henoch Schonlein purpura
Alternative name for Granulomatosis with polyangiitis
Lower respiratory tract manifestations of Wegner disease
Hemoptysis, cough, dyspnea
Upper respiratory tract of Granulomatosis with polyangiitis
Upper respiratory tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
Renal manifestations of Wegner disease
Hematuria, red cell casts
Triad in Granulomatosis with polyangiitis
Focal necrotizing vasculitis
Necrotizing granulomas in the lung and upper airway
Which labs help in the diagnosis of Wegner disease?
PR3- ANCA/ cANCA (anti-proteinase 3)
Which other study helps to study Wegner disease?
What could be found in CXR in Granulomatosis with polyangiitis?
Large nodular densities
How is Wegner disease treatred?
What is Microscopic polyangiitis?
Which orgnas are commonly involved in Microscopic polyangiitis?
Lung, kidneys, and skin
What could be found in Microscopic polyangiitis?
Pauci immune glomerulonephritis and palpablepurpura
Which is the presentation of Microscopic polyangiitis?
Similar to granulomatosis with polyangiitis but without nasopharyngeal involvement
Labs for Microscopic polyangiitis
Treatment for Microscopic polyangiitis
Cyclophosphamide and corticosteroids
Clinical presentation of Churg Strauss syndrome
Asthma,sinusitis, palpable purpura, peripheral neuropathy (eg. wrist/foot drop)
What else can Churg Strauss syndrome present?
Involve heart, GI, kidneys (pauci immune glomerulophritis)
Pathologic findings in Churg Strauss syndrome
Granulomatous, necrotizing vasculitis with eosinophilia
Labs in Churg Strauss syndrome
MPO- ANCA/ p-ANCA, ↑ IgE level
Most common childhood systemic vasculitis
Henoch Schonlein purpura
Commonly what precedes Henoch Schonlein purpura
Upper Respiratory tract Infection
Classic triad of Henoch Schonlein purpura
Skin: palpable purpura on buttocks/ legs
GI: abdominal pain, melena, multiple lesions of same age
What is the cause of Henoch Schonlein purpura?
Vasculitis secondary to IgA complex deposition