Cardiovascular Flashcards
(80 cards)
1
Q
Virchow’s Triad
A
3 categories likely to contribute to thrombosis
- Stasis of bloodflow
- Endothelial injury
- Hypercoagulability
2
Q
Arteriolosclerosis (affects what? assoc. w/ what?)
A
Affects arterioles
Associated w/ hypertension & diabetes
3
Q
Monckeberg’s arteriosclerosis
A
Medial calcific sclerosis - calcifications in the muscular wall (tunica media) of arteries
4
Q
Hyaline arteriosclerosis
A
Thickening of arteries via deposition of hyaline
Associated w/ hypertension & diabetes
5
Q
Hyperplastic arteriosclerosis
A
Narrowing of the lumen of arteries (thickened BM & mm)
Associated w/ malignant hypertension
6
Q
Atherosclerosis
A
Affects larger arteries
Formation of intimal lesions (atheromas)
7
Q
Death rate of atherosclerosis & common cause of the death
A
50% death rate
25% due to MI
8
Q
Risk factors to arteriosclerosis
A
Male 40-60 y.o. Genetics Hypercholesterolemia Diabetes (2x risk) Hypertension Smoking Inflammation (CRP levels) Hyperhomocysteinemia Lipoprotein (a) levels
9
Q
Hyperhomocysteinemia
A
High homocysteine levels due to deficiencies of vitamin B6, folic acid (vitamin B9), and vitamin B12
10
Q
Steps in arterial plaque formation
A
- Accumulation of excess lipoproteins (LDL+Chol.) in subendothelial vessel wall
- Monocyte adhesion occurs at site of accumulation and the monocytes ingest lipid to become foam cells
- FGF and PDGF secreted by the endothelium and other cytokines released by foam cells recruit s.m. cell proliferation
- Plaque is fully developed w/ collagen cap & lipid core
11
Q
Fatty streaks
A
Non-pathological
Appear in children
May progress to atheromas
Reversible
12
Q
Common place to detect atheromas
A
Bifurcation of carotid a.
13
Q
Are atheromas reversible?
A
No
14
Q
Normal BP
A
<140/90
15
Q
Mild Hypertension BP
A
<159/104
16
Q
Moderate/Severe Hypertension BP
A
> 160/106
17
Q
Hypertension affects what % of the US population?
A
20-30%
18
Q
Concentric L ventricle hypertrophy
A
Compensated (normal cardiac output)
Outside dimensions are the same (hypertrophy on inside)
19
Q
L ventricle hypertrophy with ventricular dilation
A
Decompensated
Dec. contractility, dilation, CHF
20
Q
Complications of hypertension
A
Concentric LVH LVH & ventricular dilation Retinal injury Nephrosclerosis Dissecting hematoma of aorta
21
Q
Malignant hypertension BP
A
> 200/140
22
Q
Malignant hypertension complications
A
Cerebral edema/hemorrhage/encephalopathy
Papilledema
Renal failure
23
Q
Malignant hypertension prognosis
A
5 year life expectancy
24
Q
CHF compensatory mechanisms
A
Activating neurohumoral systems (release NE)
Frank-Starling Mechanism
Myocardial hypertrophy
25
Frank-Starling mechanism
Inc. end-diastolic filling volume to contract more forcefully
26
Which side of the heart is more likely to fail?
Left
27
Causes of L side heart failure
```
IHD
Hypertension
Myocarditis
Cardiomyopathy
Valvular disease
```
28
Causes of R side heart failure
L side heart failure
Pulmonary hypertension
Septal defects w/ L-R shunts
Valvular disease
29
Symptoms of L side heart failure
Dyspnea
Chronic cough
Orthopnea
Cerebral hypoxia
30
Symptoms of R side heart failure
Congestion of liver & spleen (nutmeg liver)
Edema (pitting) of subcutaneous tissues
Cerebral hypoxia
31
How common is CHD?
6-8 : 1,000
32
Causes of CHD
Environmental factors
| Chromosomal abnormalities
33
Types of non-cyanotic CHD
ASD
VSD
PDA
34
ASD
Atrial septal defect - 2nd most common type of non-cyanotic CHD
35
VSD
Ventricular septal defect - Most common form of non-cyanotic CHD
Occurs in 4 : 1,000
36
PDA
Patent ductus arteriosus - Connects aorta & pulmonary a., should normally close within a few days of birth
37
Types of cyanotic CHD
Tertalogy of Fallot
| Transposition of great arteries
38
Anomalies of Tetralogy of Fallot
1. VSD
2. Overriding of VSD by aorta
3. Narrowed RV outflow
4. RV hypertrophy
39
Primary cause of IHD
atherosclerosis
40
Causes of IHD
Atherosclerosis (>75% narrowing)
Hypertension (Inc. myocardial O2 demand)
Hypotension/shock (Dec. BV)
Pneumonia (Dec. oxygenation)
Anemia (Dec. O2 carrying capacity)
41
Clinical types of IHD
Angina pectoris
MI
Chronic IHD w/ CHF
Sudden cardiac death
42
Angina pectoris (cause & types)
Caused by transient, reversible myocardial ischemia
1. Stable - predictable pain relieved via rest or sublingual NG
2. Unstable - Inc. freq./duration, happens w/ no/minimal exertion
43
Cases of IHD annually and death rate
1. 5 mil cases annually
| 0. 5 mil die
44
How long must ischemia last to cause irreversible myocyte injury & cell death
20-40 min
45
How long after a death via MI can an autopsy reveal the cause?
12-24 hours after death
46
Symptoms of MI
```
Chest pain
SOB
Nausea/vomiting
Diaphoresis (sweat)
Low-grade fever
```
47
Diaphoresis
Sweating profusely
48
Tests for MI
ECG/EKG
| Test for inc. in serum proteins (troponin, CPK-MB) from damaged cardiac myocytes
49
Tx for MI
Coronary stents
CABG
Streptokinase
50
Most common cause of sudden cardiac death
IHD (80-90%)
51
Causes of sudden cardiac death in young px
Congenital coronary artery abnormalities
Aortic valve stensosis
Myocardial hypertrophy
52
Types of cardiac myopathies
Primary - Disease solely confined to heart mm.
| Secondary - Myocardium is involved as part of a systemic disorder
53
3 patterns of cardiomyopathies
1. Dilated
2. Hypertrophic
3. Restrictive
54
Characteristics of dilated cardiomyopathy
Primary/Secondary/Genetic(20-50%)/Acquired
Poor ventricle contractility
Nonspecific histology (fibrosis & hypertrophy)
55
Characteristics of hypertrophic cardiomyopathy
Genetic (AD)/Missense point mutation
Stiff ventricles cause inadequate filling (diastolic dysfxn)
Histology = myocyte disarray w/ fibrosis
56
Characteristics of restrictive cardiomyopathy
Idiopathic/Secondary to radiation fibrosis, amyloidosis, sarcoidosis, hemochromatosis
Stiff ventricles cause inadequate filling (diastolic dysfxn)
57
Myocarditis causes
Pyogenic bacteria
Viruses - Coxsackie A&B
Parasites - Chagas disease
Hypersensitivity - Perivascular infl. w/ eosinophils
58
Mitral valve stenosis (cause, occurance, features)
Result of ARF(acute rheumatic fever) - Secondary to Group A beta-hemolytic streptococcal pharyngitis
Occurance - 80% children/20% adults
Features - Arthritis, carditis, rash, subcutaneous nodules
59
Rheumatic carditis features
Pericarditis - Fibrinous
Endocarditis - Sterile vegetations
Myocardtiis - Aschoff bodies
Recurrent ARF -> fibrosis & mitral valve stenosis
60
Aschoff bodies
Granulomatous inflammation seen in rheumatic fever - consists of mononuclear cells & fibroblasts
61
Causes of mitral valve regurgitation
IHD
IE
Floppy mitral valve (MV prolapse)
62
MV prolapse features
```
Isolated or part of Marfan syndrome
Myxomatous degeneration (weakening of CT)
Complications in 3% px - endocarditis, thromboemboli, atrial fibrillation, sudden death
```
63
Aortic valve stenosis (causes)
Chronic rheumatic valvular disease
Advanced age (70-80 y.o.)
Congenital bicuspid valve (40-50 y.o.)
64
AV regurgitation (causes)
Valve cusp destruction (IE, rheumatic carditis)
Weakened valve cusps (Marfans)
Dilation of aortic root
65
Infective endocarditis (predisposing factors)
```
Valvular disease
IV drug abuse
Intracardiac shunts
Prosthetic valves
Immune suppression
Diabetes
```
66
Infective endocarditis (features)
```
Fever
Fatigue
Anemia
Myalgia/arthralgia
Heart murmur
Roth spots (retinal)
Splinter hemorrhages (nail bed)
```
67
Acute endocarditis (features)
```
SHORT duration
VIRULENT organism
LARGE vegetations
PROMINENT tissue destruction
Previously NORMAL valve
```
68
Subacute endocarditis (features)
```
LONG duration
LOW VIRULENCE organism
SMALL vegetations
LESS tissue destruction
Previously ABNORMAL valve
```
69
Infective endocarditis (complications)
```
Rupture of chordae tendinae
Valvular regurgitation
Contiguous spread of infection
Thromboembolism
Septic emboli w/ abscesses
```
70
Vasculitis (causes)
```
Infection
Immunologic mechanisms
Radiation
Trauma
Caustic substances
```
71
Vasculitis classifications
1. Large vessel - Giant cell ... Takayasu arteritis
2. Med. vessel - Polyarteritis nodosa ... Kawasaki disease
3. Small vessel - Microscopic polyangiitis ... Wegener granulomatosis
72
Giant cell (temporal) arteritis (cause, features, tx)
```
LARGE VESSEL VASCULITIS
Unknown cause
Rare <50 y.o.
Tenderness @ temples, Stiff shoulders/neck, Visual disturbances
Granulomatous infl., Intimal fibrosis
Tx - corticosteroids
```
73
Takayasu arteritis (cause, features)
```
LARGE VESSEL VASCULITIS
Unknown cause
), visual disturbances
Involves aortic arch & branches
Granulomatous infl., Intimal fibrosis
```
74
Polyarteritis nodosa (cause, features)
MEDIUM VESSEL VASCULITIS
Unknown cause (once thought to be assoc. w/ Hep B)
Acute relapsing chronic fever, melena, hematuria, abdominal pain, hypertension
KIDNEY>HEART>LIVER>GI
75
Kawasaki disease (Mucocutaneous lymph node syndrome) (cause, features)
MEDIUM VESSEL VASCULITIS
Antiendothelial Ab triggered by viral infxn
Infants & children < 4 y.o.
Mucous membrane erythema, fever, skin rash, lymphadenopathy (usually self-limited)
76
Microscopic polyangiitis (cause, features, triggers)
SMALL VESSEL VASCULITIS
MPO-ANCA
Skin rash, other organs affected, fibrinoid necrosis, karyorrhexis of pmn's
Triggers - drugs, bacteria, foreign/tumor proteins
77
Melena
tarry stool appearance
78
Wegener granulomatosis (cause, features)
SMALL VESSEL VASCULITIS
PR3-ANCA
Strawberry gingivitis
Sinusitis, pneumonitis, renal failure, glomerulonephritis
Affects kidneys & LR tract
Fibrinoid necrosis, necrotizing granulomas
79
Beurger disease (Thromboangiitis obliterans) (cause, features)
Endothelial injury from smoking
<35 y.o.
Pain of extremities, ischemic ulcers, gangrene
Vasculitis w/ thrombosis
80
Dissecting aortic hematoma (predisposing conditions, complications, pathology)
Hypertension, Marfan's
Rupture (hemorrhage), branch obstruction, sudden death
Intimal tear btwn. mid & outer 1/3 of media
Affecting ascending aorta is HIGH RISK of death (Type A)
