Cardiovascular - First Aid Flashcards Preview

Step 1 Exam > Cardiovascular - First Aid > Flashcards

Flashcards in Cardiovascular - First Aid Deck (359):
1

The truncus arteriosus gives rise to...

the ascending aorta and pulmonary trunk.

2

The bulbus cordis gives rise to...

outflow track of left and right atria.

3

The primitive atria gives rise to...

the trabeculated part of left and right atria.

4

The primitive ventricle gives rise to...

the trabeculated part of the left and right ventricles.

5

The primitive pulmnoary vein gives rise to...

the smooth part of the left atrium.

6

The left horn of the sinus venous gives rise to the...

coronary sinus.

7

The right horn of the sinus venous gives rise to...

the smooth part of the right atrium.

8

The right common cardinal vein and right anterior cardinal vein give rise to...

the SVC.

9

In the vertebrate embryo, the heart is...

the first functional organ and it beats spontaneously by week 4.

10

In week 4 of gestation, the primitive heart tube will...

loop to establish left-right polarity.

11

A defect in left-right dynein can lead to..

dextrocardia (as seen in Kartagener).

12

The foramen ovale closes soon after....

birth due to increased LA pressure.

13

A patent foramen ovale is caused by...

failure of the septum primum and septum secundum to fuse after birth; most left untreated.

14

Patent foramen ovale can lead to...

paradoxical emboli (venous thromboemboli that enter the systemic arterial circulation).

15

Ventricular Septal Defect (VSD) most commonly occurs in..

the membranous septum.

16

Babies with VSD are...

acyanotic at birth due to left to right shunt.

17

Outflow tract is formed when truncus arteriosus rotates and neural crest and endocardial cell migrations lead to...

truncal and bulbar ridges that spiral and fuse to form the aorticopulmonary septum.

18

Conotruncal abnormalities include:

1. transposition of the great vessels 2. tetralogy of fallot 3. persistent truncus arteriosus

19

The aortic and pulmonary valves are derived from...

endocardial cushions of the outflow tract.

20

The mitral and tricuspid valves are derived from...

fused endocardial cushions of the AV canal.

21

Fetal erythropoesis occurs in:

1. Yolk Sac (3-8 wks) 2. Liver (6 wks - birth) 3. Spleen (10-28 wks) 4. Bone marrow (18 wks to adult)

22

Fetal Hb (HbF)

alpha2gamma2

23

Adult Hb (HbA)

alpha2beta2

24

HbF has higher affinity for oxygen due to...

less avid binding of 2,3-BPG. This allows HbF to extract oxygen from maternal Hb across the placenta.

25

Highest concentration of O2 in the fetal circulation is in...

the umbilical vein. PO2 = 30 mmHg 80% saturated w/ O2

26

Blood entering the fetus through the umbilical vein is conducted via the...

ductus venosus into the IVC to bypass the hepatic circulation.

27

Most highly oxygenated blood reaching the heart via the IVC is...

diverted through the foramen ovale and pumped out the aorta to teh head and body.

28

Deoxygenated blood entering the RA from the SVC goes:

RA --> RV --> main PA --> PDA --> descending aorta

29

PDA is kept open in the fetal period due to...

high fetal pulmonary artery resistance due partly to low O2 tension.

30

At birth, when the infant takes their first breath...

decreased resistance in the pulmonary circulation causes increased left atrial pressure vs. right atrial pressure clossing the foramen ovale.

31

The ductus arteriosus closes due to...

increase in O2 and decrease in prostaglandins (from placental separation).

32

PDA is kept open medically with...

PGE1 and PGE2.

33

The umbilical vein becomes the...

ligamentum teres hepatis contained in the falciform ligament.

34

Umbilical arteries become...

medial umbilical ligaments

35

ductus arteriosus becomes...

ligamentum arteriosum

36

ductus venosus becomes...

ligamentum venosum

37

foramen ovale becomes...

fossa ovalis

38

allantois becomes...

urachus-median umbilical ligament; urachal cyst or sinus is a remnant

39

Notochord becomes...

nucleus pulposus of intervertebral disc

40

SA and AV nodes are supplied by...

the RCA and infarct may cause bradycardia or heart block.

41

The acute marginal artery supplies...

the RV.

42

The posterior decending artery supplies...

the posterior third of the interventricular septum and posterior walls of ventricles.

43

The LAD supplies...

the anterior 2/3 of the interventricular septum, anterior papillary muslce and anterior surface of the left ventricle.

44

The left circumflex coronary artery supplies...

the lateral and posterior walls of the LV.

45

Right-dominant circulation

PDA arises from RCA

46

Left-dominant circulation

PDA arises from LCX

47

Coronary artery occlusion most commonly occurs in the....

LAD.

48

Coronary blood flow peaks in...

early diastole.

49

The most posterior part of the heart is...

the LA; enlargment can cause dysphagia or hoarseness.

50

CO =

SV x HR

51

MAP (mean arterial pressure) =

CO x TPR Also, MAP = 2/3 diastolic pressure + 1/3 diastolic pressure

52

Pulse pressure =

systolic pressure - diastolic pressure

53

Pulse pressure is proportional to...

SV and inversely proportional to arterial compliance.

54

SV =

EDV - ESV.

55

During the early stages of exercise, CO is maintained by...

increased HR and increased SV.

56

During the late stages of exercise, CO is maintained by...

increased HR only, the SV plateaus.

57

Diastole is preferentially shortened with...

increased HR leading to less filling time which decreases CO.

58

Increased pulse pressure is seen in (5):

1. hyperthyroidism 2. aortic regurgitation 3. arteriosclerosis 4. obstructive sleep apnea 5. exercise

59

Decreased pulse pressure is seen in (4):

1. aortic stenosis 2. cardiogenic shock 3. cardiac tamponade 4. advanced heart failure

60

Stroke volume is increased by...

increased contractility, increased preload and decreaed afterload.

61

Contractility increases with:

1. catecholamines 2. increased intracellular calcium 3. decreased extracellular sodium 4. digitalis

62

Catecholamines increase contractility by...

increasing the activity of the Ca2+ pump in the SR

63

Digitalis increases contractility by...

blocking the Na/K pump leading to increased intracellular sodium leading to decreased Na/Ca exchange leading to increased intracellular Ca

64

Contractility decreases with (5):

1. beta1-blockade (decreased cAMP) 2. heart failure with systolic dysfunciton 3. acidosis 4. hypoxia/hypercapnea 5. non-dihydropyridine Calcium channel blockers

65

Preload is approximated by..

ventricular EDV; it depends on venous tone and circulating blood volume.

66

Preload can be decreased with...

VEnodilators. (nitroglycerin)

67

Afterload is approximated by...

MAP.

68

The LV compensates for increased afterload by...

thickening to decrease wall tension.

69

Afterload is decreased with...

Vasodilators (Hydralazine).

70

Both preload and afterload are decreased by...

ACE inhibitors and ARBs.

71

Left ventricular EF is an index of...

ventricular contractility. Normal EF is > 55%.

72

EF is decreased in...

systolic heart failure and normal in diastolic heart failure.

73

Total resistance of vessels in series

TR = R1 + R2 + R3

74

Total resistance of vessels in parallel

1/TR = 1/R1 + 1/R2 + 1/R3

75

Viscosity depends mostly on...

hematocrit.

76

Viscosity increases in...

-polycythemia -hyperproteinemic states -aHereditary spherocytosis

77

Viscosity decreases in...

anemia.

78

Resistance is directly proportional to...

viscosity and vessel length and inversely proportional to the radius to the 4th power.

79

Most of the TPR is accounted for by...

arterioles which regulate capillary flow.

80

Positive Inotropes

catecholamines, digoxin

81

Negative Inotropes

heart failure, narcotic overdose

82

Things that increase volume, venous tone

fluid infusion, sympathetic activity

83

Things that decrease volume, venous tone

acute hemorrhage, spinal anesthesia

84

Things that increase TPR

vasopressors

85

Things that decrease TPR

exercise, AV shunt

86

S1

mitral and tricuspid valve closure; loudest at mitral area

87

S2

aortic and pulmonary valve closure; loudest at left sternal border

88

S3

in early diastole during rapid ventricular filling phase; associated with incresed filling pressures (MR, HCR) and is more common in dilated ventricles

89

S4

in late diastole; high atrial pressure; associated with ventricular hypertrophy; left atrium must push against the stiff LV wall

90

Normal splitting

Inspiration leads to a drop in intrathoracic pressure leading to an increase in venous return to the RV. Increased RV stroke volume leads to increased RV ejection time leading to delayed closure of the pulmonary valve.

91

Normal splitting is also contributed to by...

decreased pulmonary impedance.

92

Wide splitting is seen in conditions that...

delay RV emptying (pulmonic stenosis, right bundle branch block)

93

Fixed splitting is seen in...

ASD which leads to a left to right shunt which leads to increased RA and RV volumes which leads to increased flow through the pulmonic valve such that regardless of breath, pulmonic closure is greatly delayed.

94

Paradoxical splitting is seen in conditions that...

delay LV (aortic stenosis, left bundle branch block).

95

In paradoxical splitting, the normal order of valve closure is...

reversed so that P2 sound occurs before delayed A2 sound. Therefore, on inspiration, P2 closes later and moves closer to A2 (paradoxical).

96

Aortic area murmurs

Systolic 1. aortic stenosis 2. flow murmur 3. aortic valve sclerosis

97

Left sternal border murmurs

Systolic 1. Hypertrophic cardiomyopathy Diastolic 1. aortic regurgitation 2. pulmonic regurgitation

98

Pulmonic area murmurs

Systolic 1. pulmonic stenosis 2. flow murmur

99

Tricuspid area murmurs

Pansystolic 1. tricuspid regurgitation 2. VSD Diastolic 1. tricuspid stenosis 2. ASD

100

Mitral area murmurs

Systolic 1. mitral regurgitation Diastolic 1. mitral stenosis

101

ASD commonly presents with...

a pulmonary flow murmur (increased flow through the pulmonic valve) and a diastolic rumble (increased flow across the tricuspid).

102

Blood flow across the actual ASD does...

not cause a murmur bc there is no pressure gradient.

103

Inspiration maneuver will...

increase the intensity of the right heart sounds.

104

Hand grip (increases systemic vascular resistance) which will...

increase intensity of MR, AR, and VSD murmurs decrease the intensity of AS, hypertrophic cardiomyopathy murmurs

105

Valsalva (standing decreases venous return) will...

decrease intensity of most murmurs increase intensity of the hypertrophic cardiomyopathy murmur

106

Rapid squatting (increases venous return, increases preload, increases afterload)

decreases intensity of hypertrophic cardiomyopathy murmur increases intensity of AS murmur

107

Mitral Regurgitation murmur

-holosystolic, high-pitched "blowing murmur" -loudest at apex, radiates toward axilla

108

MR murmur is enhanced by...

maneuvers that increase TPR (squatting, hand grip).

109

MR is often due to...

ischemic heart disease, MVP or LV dilation.

110

Tricuspid regurgitation murmur

-holosystolic, high-pitched "blowing murmur" -loudest at tricuspid and radiates to the right sternal border

111

TR murmur is enhanced by...

maneuvers that increase RA return (inspiration).

112

TR is commonly caused by...

RV dilation.

113

Rheumatic fever and endocarditis can cause either...

MR or TR.

114

Aortic Stenosis murmur

-crescendo-decrescendo systolic ejection murmur -loudest at base; radiates to carotids -pulsus parvus et tardus

115

Aortic stenosis can lead to...

Syncope, Angina and Dyspnea on exertion

116

Aortic stenosis is often due to...

age-related calcific aortic stenosis or bicuspid aortic valve.

117

VSD murmur

-holosystolic, harsh sounding murmur -loudest at tricuspid area -accentuated with hand grip maneuver due to increased afterload

118

Mitral valve prolapse murmur

-late systolic crescendo murmur with midsystolic click -best heard over apex and just before S2

119

MVP can predispose to...

infective endocarditis.

120

MVP can be caused by...

myxomatous degeneration, rheumatic fever or chordae.

121

MVP occurs earlier with...

maneuvers that decrease venous return (standing or valsalva).

122

Aortic regurgitation murmur

-high pitched "blowing" early diastolic decrescendo murmur -wide pulse pressure

123

Aortic regurgitation can present with...

boudning pulses and head bobbing.

124

AR is often due to...

aortic root dilation, bicuspid aortic valve, endocarditis or rheumatic fever.

125

Aortic regurgitation murmur is increased during...

hand grip. Vasodilators decrease the intensity of the murmur.

126

Mitral stenosis murmur

-follows opening snap due to abrupt halt in leaflet motion in diastole after rapid opening due to fusion of the leaflets -delayed rumbling late diastolic murmur

127

With mitral stenosis, a decreased interval between S2 and the opening snap correlates with...

increased severity.

128

MS often occurs secondary to...

rheumatic fever. Can lead to LA dilatation.

129

MS murmur is enhanced by...

maneuvers that increase LA return (expiration).

130

PDA murmur

-continuous machine-like murmur -loudest at S2 -best heart at left infraclavicular area

131

PDA is often due to...

congenital rubella or prematurity.

132

T wave inversion may indicate...

recent MI.

133

U wave is caused by...

hypokalemia and bradycardia.

134

Speed of conduction

Purkinje > atria > ventricles > AV node

135

Pacemaker potential

SA > AV > bundle of His/purkinje/ventricles

136

Torsades de pointes is...

polymorphic ventricular tachycardia characterized by shifting sinusoidal waveforms on ECG.

137

Torsades de pointes can progress to...

ventricular fib.

138

A predisposing factor for Torsades is...

long QT interval.

139

Torsades is caused by...

drugs, decreased K, decreased Mg.

140

Treatment of Torsades is with...

magnesium sulfate.

141

Congenital long QT is an...

inherited disorder of myocardial repolarization typically due to ion channel defects.

142

2 types of Congenital long QT syndrome

1. Romano-Ward Syndrome 2. Jervell and Lange-Nielsen Syndrome

143

Romano-Ward Syndrome features

-congenital long QT -autosomal dominant -pure cardiac phenotype

144

Jervell and Lange-Nielsen syndrome features

-congenital long QT -autosomal recessive -sensorioneural deafness

145

Wolff-Parkinson-White (WPW) Syndrome is the most common type of...

ventricular pre-excitation syndrome. There is an abnormal fast accessory conduction pathway from the atria to ventricle that bypasses the rate-slowing AV node.

146

As a result of the accessory pathway in WPW, ventricles begin to...

partially depolarize earlier, giving rise to the characteristic delta wave with shortened PR interval on ECG.

147

WPW may result in...

a reentry circuit leading tosupraventricular tachycardia.

148

A. fib ECG

no discrete P waves erratic baseline (irregularly irregular)

149

A. fib can result in...

atrial stasis and lead to thromboembolic stroke.

150

Treatment for A. fib includes...

rate control, anticoagulation, and possible pharmacolgical or electrical cardioversion.

151

Atrial flutter is....

a rapid succession of identical back-to-back atrial depolarization waves. "sawtooth appearance"

152

Pharmacologic conversion to sinus rhythm for atrial flutter

-class IA, IC or III antiarrhythmics

153

Rate control for atrial flutter

beta-blocker or calcium channel blocker

154

Definitive treatment for atrial flutter is...

catheter ablation

155

V. fib ECG

completely erratic with no identifiable waves.

156

V. fib will cause...

fatal arrhythmia w/o immediate CPR and defibrillation

157

1st degree AV block

-PR interval prolonged (> 200 ms) -benign/asymptomatic -No treatment

158

2nd degree AV block - Mobitz type I

-progressive lengthening of the PR interval until a beat is dropped -usually asymptomatic

159

2nd degree AV block - Mobitz type II

-dropped beats that are not preceded by a change in the length of the PR interval -usually 2:1 per block -may progress to 3rd degree -treated with pacemaker

160

3rd degree AV block

-atria and ventricles beat independently of each other -both P waves and QRS complexes are present (no relation to each other) -atrial rate faster than ventricular -treated with pacemaker -can be due to lyme disease

161

Atrial natriuretic peptide (ANP) is released from...

atrial myocytes in response to increased blood pressure and atrial pressure.

162

ANP causes...

vasodilation and decreased sodium reabsorption at the renal collecting tubule. It constricts the efferent renal arterioles and dilates the afferent arterioles via cGMP, promoting diuresis and "aldosterone escape".

163

B-type natriuretic peptide is released from..

ventricular myocytes in response to increased tension. It has similar physiologic action to ANP with a longer half-life.

164

BNP blood test is used for diagnosing...

heart failure (good negative predictive value)

165

Nesiritide is...

a recombinant form of BNP used to treat HF.

166

Aortic arch receptors transmits signals via...

the vagus nerve to the solitary nucleus of the medulla and responds to increased bp only.

167

Carotid sinus recptors transmit singals via...

the glossopharyngeal nerve to teh solitary nucleus of medulla. It responds to both increased and decreased blood pressure.

168

Cushing Reaction

increased intracranial pressure constricts arterioles leading to cerebral ischemia and reflex sympathetic increase in pefusion pressure leading to increased stretch and baroreceptor mediated bradycardia.

169

Peripheral chemoreceptors are stimulated by...

decreased PO2 (less than 60), increased PCO2 and decreased pH of blood.

170

Central chemoreceptors are stimulated by...

changes in pH and PCO2 of brain interstiatial fluid.

171

Organ with largest share of systemic CO

liver

172

Organ with highest blood flow per gram of tissue

kidney

173

Pulmonary capillary wedge pressure is a good approximation of...

left atrial pressure.

174

In mitral stenosis, PCWP is...

greater than LV diastolic pressure.

175

Factors determining autoregulation in the heart

-local metabolites - CO2, adenosine, NO

176

Factors determining autoregulation in the brain

local metabolites - CO2

177

Factors determing autoregulation in the kidneys

myogenic and tubuloglomerular feedback

178

factors determining autoregulation in the lungs

hypoxia causes vasoconstriction

179

Factors determining autoregulation in the skeletal muscle

lactate, adenosine, K+, H+, CO2

180

factors determining autoregulation in the skin

sympathetic stimulation

181

Kf =

filtration constant (capillary permeability)

182

Jv (net fluid flow) =

(Kf)(Pnet)

183

Pnet (net filtration pressure) =

(Pc - Pi) - (pic - pii)

184

Increased capillary pressure can be caused by...

heart failure.

185

Decreased plasma proteins can be due to...

nephrotic syndrome or liver failure.

186

Increased capillary permeability can be caused by...

toxins, infxns, burns.

187

Increased interstitial fluid colloid osmotic pressure can be caused by...

lymphatic blockage. q

188

22q11 Syndrome (Digeorge) is associated with...

truncus arteriosus and tetralogy of fallot

189

Down Syndrome is associated with...

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

190

Congenital rubella is associated with...

septal defects, PDA and pulmonary artery stenosis.

191

Turner syndrome is associated with...

bicuspid aortic valve and coarctation.

192

Marfan is associated with...

MVP, thoracic aortic aneurysm and dissection, and aortic regurgitation.

193

The infant of a diabetic mother is at increased risk for...

transposition of the great vessels.

194

Hypertensive emergency

-severe hypertension (>180/120) -acute ongoing target organ damage (papilledema, mental status changes)

195

HTN predisposes to..

atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy and aortic dissection.

196

Primary HTN is related to...

increased CO and TPR.

197

Secondary HTN is due to...

renal disease, including fibromuscular dysplasia (in younger pts).

198

On angiogram, fibromuscular dysplasia is shown as...

"string of beads" of the renal artery.

199

Xanthomas are...

plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids.

200

Tendinous xanthoma is seen in...

the achilles (lipid deposit).

201

Corneal arcus is...

lipid depsoit in the cornea that appears early in life with hypercholesterolemia. Common in elderly.

202

Monckeberg Arteriosclerosis is...

calcification in the media of the arteries (esp radial or ulnar).

203

Monckeberg arteriosclerosis shows...

"pipestem" arteries on x-ray.

204

Monckeberg arteriosclerosis does not...

obstruc blood flow and intima is not involved.

205

Arteriolosclerosis is either...

hyaline or hyperplastic.

206

Hyaline arteriolosclerosis is...

thickening of small arteries in essential HTN or DM.

207

Hyperplastic arteriolosclerosis is...

"onion skinning" seen in severe HTN.

208

Modifiable risk factors for atherosclerosis

-smoking -HTN -hyperlipidemia -diabetes

209

Nonmodifiable risk factors for atherosclerosis

-age -sex (increased in men and postmenopausal women) -FHx

210

Progression of Atherosclerosis

endothelial cell dysfunction --> macrophage and LDL accumulation --> foam cell formation --> fatty streaks --> smooth muscle migration, proliferation and ECM deposition --> fibrous plaques --> complex atheromas

211

Compolications of atherosclerosis (6)

1. aneurysms 2. ischemia 3. infarcts 4. peripheral vascular disease 5. thrombus 6. emboli

212

Symptoms of atherosclerosis

-angina -claudication

213

Abdominal aortic aneurysm occurs more frequently in...

hypertensive male smokers older than 50.

214

Abdominal aortic aneurysm is associated with..

atherosclerosis.

215

Thoracic aortic aneurysm is associated with...

cystic medial degeneratio ndue to HTN or Marfan and tertiary syphilis.

216

Aortic dissection is a...

longitudinal intraluminal tear forming a false lumen.

217

Aortic disseciton is associated with...

HTN, bicuspid aortic valve, and inherited CT disorders.

218

Aortic dissection can present with...

tearing chest pain, with sudden onset, radiation to the back and +/- unequal BP in arms.

219

CXR of aortic dissection shows...

mediastinal widening.

220

Aortic dissection results in...

pericardial tamponade, aortic rupture and death.

221

Angina is usually due to...

ischemic myocardium secondary to coronary artery stenosis or spasm.

222

Stable Angina is usually secondary to...

atherosclerosis.

223

Stable angina presents with...

exertional chest pain (ST depression) that resolves with rest.

224

Variant angina (Prinzmetal) occurs at rest secondary to...

coronary artery spasm. Tranisent ST elevation.

225

Triggers of variant angina are...

tobacco, cocaine, triptans.

226

Treat variant angina with...

calcium channel blockers, nitrates and smoking cessation.

227

Unstable/crescendo angina is due to...

thrombosis with incomplete coronary artery occlusion; ST depression on ECG.

228

Unstable angina presents with...

increased frequency/intensity of chest pain and at rest

229

Coronary steal syndrome occurs...

distal to coronary stenosis and the vessels are maximally dilated at baseline.

230

In coronary steal syndrome, administration of vasodilators (dipyridamole, regadenoson) dilates...

normal vessels and shunts blood toward well-perfused areas leading to decreased flow and ischemia in the poststenotic region.

231

MI is most often due to...

acute thrombosis due to coronary artery atherosclerosis with complete occlusion of coronary artery and myocte necrosis.

232

If MI is transmural, ECG will show...

ST elevation.

233

If MI is subendocardial, ECG may show...

ST depressions.

234

Sudden Cardiac Death is...

death from cardiac causes within 1 hr of onset of symptoms, most commonly due to a lethal arrhythmia.

235

Sudden cardiac death is associated with...

CAD, cardiomyopathy and hereditary ion channelopathies.

236

Chronic ischemic heart disease is...

progressive onset of CHF over many yrs due to chronic ischemic myocardial damage.

237

Most commonly occluded arteries in MI

LAD > RCA > circumflex

238

Cardiac troponin I rises after...

4 hrs and is increaesd for 7-10 days after MI. More specific than other protein markers.

239

CK-MB is predominantly found in...

the myocardium but can also be released from skeletal muscle.

240

CK-MB is useful in diagnosing...

reinfaction following acute MI bc levels return to normal after 48 hours.

241

ECG changes of MI

-ST elevation (transumral) -ST depresion (subendocardial) -pathologic Q waves (old transmural)

242

Anterior wall infarct (LAD) is seen in leads...

V1-V4.

243

Anteroseptal infarct (LAD) is seen in leads...

V1-V2.

244

Anterolateral infarct (LAD or LCX) is seen in leads...

V4-V6.

245

Lateral wall infarct (LCX) is seen in leads...

I, aVL.

246

Inferior wall infarct (RCA) is seen in leads...

II, III, aVF.

247

Cardiac arrhythmia is...

an important cause of death before reaching the hospital; common in first few days after MI.

248

Ventricular free wall rupture leads to...

cardiac tamponade.

249

Papillary muscle rupture leads to....

mitral regurgitation.

250

Interventricular septum ruptur leads to...

VSD.

251

Greatest risk of wall/septum rupture and papillary muslce rupture after MI is...

6-14 days postinfarct.

252

Greatest risk of ventricular pseudoaneurysm formation is...

1 wk post-infarct. It leads to decreased CO, risk of arrhtyhmia, and embolus from mural thrombus.

253

Risk of postinfarction fibrinous pericarditis is greatest...

1-3 days post-MI.

254

Dressler syndrome is...

an autoimmune phenomenon resulting in fibrinous pericarditis (seen several weeks post-MI).

255

Dilated cardiomyopathy is often idiopathic or congenital but other causes include...

-Alcohol abuse -Beriberi -Coxsackie B virus myocarditis -Cocaine use -Chagas disease -Doxorubicin toxicity -hemochromatosis -peripartum cardiomyopathy

256

Findings of Dilated cardiomyopathy

-HF -S3 -dilated heart on echocardiogram -balloon appearance of heart on CXR -systolic dysfunction (decreased EF) -eccentric hypertrophy

257

Treatment of dilated cardiomyopathy

-Na restriction -ACE inhibitors -Beta-blockers -diuretics -digoxin -implantable carioverter defibrillator -heart transplant

258

Hypertrophic cardiomyopathy is usually...

familial, AD and due to a beta-myosin heavy-chain mutation.

259

Hypertrophic cardiomyopathy can be assocaited with...

Friedreich ataxia

260

Hypertrophic cardiomyopathy is a cause of...

sudden death in young athletes due to ventricular arrhythmia.

261

Findings of Hypertrophic cardiomyopathy

-S4 -systolic murumur -diastolic dysfunction -often septal predominance of hypertrophy -myofibrillar disarray and fibrosis

262

Obstructive HCM is when...

the hypertrophied septum is too close to teh anterior mitral leaflet leading to outlet obstruction leadin gto dyspnea and possible syncope.

263

Treatment of HCM

-cessation of high-intensity athletics -beta-blocker or calcium channel blocker -ICD

264

Major causes of restrictive/infiltrative cardiomyopathy include...

sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, Loffler syndrome and hemochromatosis.

265

Loffler syndrome is...

endomyocardial fibrosis with a prominent eosiniophilic infiltrate.

266

Restrictive cardiomyopathy leads to...

diastolic dysfunction. There can be low-voltage ECG despite a thick myocardium.

267

CHF is a clinical syndrome of...

cardiac pump dysfunction. Symptoms include dyspnea, orthopnea, and fatigue. Signs include rales, JVD and pitting edema.

268

Systolic dysfunction features

-low EF -poor contractility -often secondary to ischemic heart disease or DCM

269

Diastolic dysfunction features

-normal EF and contractility -impaired relaxation -decreased compliance

270

Right heart failure most often results from...

left heart failure.

271

Isolated right heart failure is due to...

cor pulmonale.

272

Drugs that decrease the mortality of CHF

-ACE inhibitors -beta-blockers -AngII receptor blockers -spironolactone

273

In CHF, thiazides and loop diuretics are mainly used for...

symptomatic relief.

274

Hydralazine with nitrate therapy improves...

both symptoms and mortality in some CHF pts.

275

In pulmonary edema, an increased pulmonary venous pressure leads to...

pulmonary venous distention and transudation of fluid.

276

Pulmonary edema has the presence of...

hemosiderin-laden macrophages (heart failure cells) in the lungs.

277

Orthopnea is...

shortness of breath when supine due to increased venous return exacerbating the pulmonary congestion.

278

Bacterial endocarditis presents with...

fever, new murmur, Roth spots, Osler nodes, Janeway lesions, anemia, and splinter hemorrhages.

279

Acute bacterial endocarditis is due to...

S. aureus; large vegetations on previouisly normal valves.

280

Subacute bacterial endocarditis is due to...

viridans streptococci; smaller vegetations on congenitally abnormal valves; sequela of dental procedures

281

Culture negative bacterial endocarditis is most likely due to...

Coxiella burnetii and Bartonella.

282

Endocarditis may also be nonbacterial secondary to...

malignancy, hypercoagulable state or lupus. *S. bovis present in colon cancer. **S. epidermidis present on prosthetic vavles.

283

The most commonly involved valve in endocarditis is...

the mitral valve.

284

Involvement of the tricuspid valve with endocarditis is associated with...

IV drug abuse; S. aureus, Pseudomonas and Candida.

285

Complications of bacterial endocarditis

-chordae rupture -glomerulonephritis -suppurative pericarditis -emboli

286

Rheumatic fever is a consequence of...

pharyngeal infection with group A beta-hemolytic streptococci.

287

Rheumatic fever casues early death due to...

myocarditis.

288

Late sequelae of rheumatic fever includes rheumatic heart disease which affects the valves in this order....

mitral > aortic > tricuspid. (high pressure valves are affected most)

289

Early lesion of rheumatic fever is...

mitral valve regurgitation. Late lesion is mitral stenosis.

290

Rheumatic fever is assocaited with...

Aschoff bodies (granuloma with giant cells) Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus) increased ASO titers

291

Rheumatic fever is not a direct effect of the bacteria. It is...

immune mediated (type II HSR). There are antibodies to M protein that cross react with self-antigens.

292

Acute pericarditis commonly presents with...

sharp pain, aggravated by inspiration adn relieved by sitting up or leaning forward. Friction rub.

293

ECG changes of acute pericarditis include...

ST segment elevation and/or PR depression.

294

Fibrinous acute pericarditis is caused by...

Dressler syndrome, uremia, radiation. Presents with a loud friction rub.

295

Serous pericarditis is...

viral pericarditis; noninfectious inflammatory diseases

296

Suppurative/purulent pericarditis

usually caused by bacterial infections (pneumococcus, strep)

297

Cardiac tamponade is...

compression of the heart by fluid in the pericardium leading to decreased CO.

298

Cardiac tamponade displays equibrilation of...

diastolic pressure in all 4 quadrants.

299

Findings of cardiac tamponade

-Beck triad (hypotension, distended neck veins, distant heart sounds) -increased HR -pulsus paradoxus -Kussmaul sign

300

ECG of cardiac tamponade shows...

low voltage QRS and electrical alternans

301

Pulsus paradoxus is..

decrease in amplitude of systolic blood pressure by more than 10 mmHg during inspiration.

302

Pulsus paradoxus is seen in...

cardiac tamponade, asthma, OSA, pericarditis and croup.

303

Tertiary syphilis disrupts the vasa vasorum of the aorta with consequent...

atrophy of the vessel wall and dilation of the aorta and valve ring.

304

Syphilitic heart disease may display...

calcification of the aortic root an dascending aortic arch. This leads to "tree bark" appearnce of the aorta.

305

Syphilitic heart disease may result in...

aneurysm of the ascending aorta or aortic insufficiency.

306

The most common primary cardiac tumor in adults is...

myxoma. 90% occur in the atria.

307

Myxomas are usually described as....

a "ball valve" obstruction in the LA associated with multiple syncopal episodes.

308

The most frequent primary cardiac tumor in children is...

a rhabdomyoma associated with tuberous sclerosis.

309

The Kussmaul sign is...

increase in JVP on inspiration instead of a normal decrease.

310

Increased JVP upon inspiration can occur when the negative intrathoracic pressure is not...

transmitted to the heart and there is impaired filling of the RV leading to backup of blood in the vena cava leading to JVD.

311

Kussmaul sign may be seen with...

constrictive pericarditis, restrictive cardiomyopathies, and right atrial or ventricular tumors.

312

The raynaud phenomenon is called Raynaud syndrome when....

secondary to a disease process sucha as mixed CT disorder, SLE or CREST syndrome.

313

Strawberry hemangioma is a...

benign capillary hemangioma of infancy.

314

Strawberry hemangioma appears in...

the first few wks of life, grows rapidly and regresses spontaneously at 5-8 yrs.

315

Cherry hemangioma is...

a benign capillary hemangioma of the elderly. They do not regress.

316

Pyogenic granulmona is...

a polypoid capillary hemangioma that can ulcerate and bleed.

317

Pyogenic granuloma is associated with...

trauma and pregnancy.

318

A cystic hygroma is...

a cavernous lymphangioma of the neck.

319

Cystic hygroma is associated with..

Turner syndrome.

320

Glomus tumor is...

a benign, painful, red-blue tumor under the fingernails.

321

Glomus tumor arises from...

modified smooth muscle cells of the glomus body.

322

Bacillary angiomatosis is...

a benign capillary skin papules found in AIDS pts.

323

Bacillary angiomatosis is caused by...

Bartonella henselae.

324

Angiosarcoma is a...

blood vessel malignancy typically occuring int he head, neck and breast. Usually in elderly on sun-exposed areas.

325

Angiosarcoma is associated with...

radiation and arsenic.

326

Angiosarcoma is difficult to resect due to...

delay in diagnosis.

327

Lymphangiosarcoma is...

a lymphatic malignancy associated with peristent lymphedema (post-radical mastectomy).

328

Kaposi sarcoma is...

an endothelial malignancy of the skin, but also the mouth, GI tract and respiratory tract.

329

Kaposi sarcoma is associated with...

HHV-8 and HIV.

330

Bacillary angiomatosis is often mistaken for...

Kaposi sarcoma and vice versa.

331

Temporal (Giant Cell) Arteritis Features

-elderly females -unilateral headache, jaw claudication -branches of carotid a -focal granulomatous inflammation

332

Temporal arteritis may lead to...

irreversible blindness due to ophthalmic artery occlusion.

333

Temporal arteritis is asscoaited with...

polymyalgia rheumatica.

334

Temporal arteritis is treated with...

high-dose corticosteroids prior to temporal artery biopsy to prevent vision loss.

335

Takayasu arteritis features

-asian females less than 40 -pulseless disease -fever -night sweats -arthritis -myalgias -skin nodules -ocular disturbances -granulomatous thickening and narrowing of aortic arch

336

Polyarteritis nodosa features

-young adults -Hep B -fever, weight loss, malaise, HA -abdomainal pain, melena -HTN, neurologic dysfunction, cutaneous eruptions, renal damage

337

Polarteritis nodosa typically involves...

renal and visceral arteries (not pulmonary).

338

Polarteritis nodosa is mediate by...

immune complex. There is transmural inflammation of the arterial wall with fibrinoid necrosa.

339

On arteriogram, polyarteritis nodosa displays...

innumerable microaneurysms and spasm.

340

Polyarteritis nodosa is treated with...

corticosteroids and cyclophosphamide.

341

Kawasaki disease features

-asian children < 4 -fever, cervical lymphadenitis, conjunctival injection, strawberry tongue, hand-foot erythema, desquamating rash

342

Kawasaki diseaes may develop...

coronary artery aneurysms with thrombosis leading to MI or rupture.

343

Kawasaki should be treated with...

IV immunoglobulin and aspirin.

344

Buerger disease features

-heavy smokers, males < 40 -intermittent claudication leading to gangrene, autoamputation of digits -nodular phlebitis -segmental thrombosin vasculitis

345

Buerger disease often also presents with..

raynaud phenomenon.

346

Treat Buerger disease with...

smoking cessation.

347

Wegener's granulomatosis with polyangiitis features

-upper respirator tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis -lower respirator tract: hemoptysis, cough, dyspnea -renal: hematuria, red cell casts *PR3-ANCA/c-ANCA

348

Triad of Wegener's granulomatosis

-focal necrotizing vasculitis -necrotizing granulomas in the lung and upper airways -necrotizing glomerulonephritis

349

CXR of Wegener's shows...

large nodular densities.

350

Treat Wegener's with...

cyclophosphamide and corticosteroids.

351

Microscopic polyangiitis is...

necrotizing vasculitis involving the lungs, kidneys, and skin with pauci-immune glomerulonephritis and palpable purpura.

352

Microscopic polyangiitis presents similarly to...

granulomatosis with polyangiitis (Wegener's) but without the nasopharyngeal involvement. No granulomas. **MPO-ANCA/p-ANCA

353

Treat Microscopic polyangiitis with...

cyclophosphamide and corticosteroids.

354

Churg-Strauss syndrome presents with...

asthma, sinusitis, palpable purpura and peripheral neuropathy. Can also involve the heart, GI and kidneys.

355

Pathology of Churg-Strauss

granulomaotus, necrotizing vasculitis with eosinophilia

356

Labs of Churg Strauss

-MPO-ANCA/p-ANCA -increased IgE

357

The most common childhood systemic vasculitis is...

Henoch-Schonlein purpura and it often follows a URI. Associated with IgA nephropathy.

358

Classic triad of Henoch-Schonlein purpura is...

1. Skin (palpable purpura on buttocks/legs) 2. Arthralgias 3. GI (abdominal pain, melena, multiple lesions of the same age)

359

The vasculitis of Henoch-Schonleinpurpura is secondary to...

IgA deposition.