Cardiovascular Pathology Flashcards
(164 cards)
1
Q
Bounding pulse with a thrill best palpated over the upper left sternal edge; continuous murmur heard (“machinery like murmur”)
A
Patent ductus arteriousus
2
Q
What does a patent ductus areteriousus result in?
A
1) Left to Right shunt
3
Q
What is the ductus arteriosus derived from?
A
Derived from the sixth aortic arch
4
Q
What do the 1-4,6 aortic arch derivatives become?
A
1) 1= maxillary artery
2) 2= stapedial
3) 3= Common carotid
4) 4= Right subclavian and left part of aorta
5) 6= pulmonary arteries and the ductus arteriosus
5
Q
What heart chamber when enlarged can cause dysphagia?
A
Left atrium
6
Q
How long is the PR interval in a 1st degree block?
A
1) consistently Pr interval is >200 msec
7
Q
ECG shows a progressive increase in PR length until a beat is dropped
A
2nd degree block type 1
8
Q
ECG showing dropped beats that are not preceded by a change in length of PR interval; 2:1 P to QRS ratio
A
2nd degree block type 2
9
Q
ECG showing atria and ventriclular beats disconnected
A
3rd degree block
10
Q
Palpitations with irregularly irregular tachyarrhythmia
A
Atrial fibrilation
11
Q
What causes an isolated episode of atrial fibrillation?
A
1) Binge alcohol consumption (holiday heart syndrome)
2) Increased sympathetic tone
3) Pericarditis
12
Q
What predisposes a pt. to Torsades de pointes?
A
Prolonged QT
13
Q
High QRS voltage in the precordial leads is indicative of?
A
Ventricular hypertrophy
14
Q
What are ECG findings of a transmural myocardial infarction?
A
Elevated ST segment
15
Q
Cause of coronary sinus dilation
A
1) Elevated right sided heart pressure due to Pulmonary hypertension
16
Q
What are the results of a arteriovenous shunt?
A
1) Increased cardiac output
2) Decreased peripheral resistance
3) Increase venous return
17
Q
What are the causes of right to left shunts that lead to early cyanosis?
A
think: Five T’s
1) Tetralogy of Fallot
2) Transposition of the great vessels
3) patent Truncus arteriosus
4) Tricuspid atresia
5) Total anaomalous pulmonary venous return
18
Q
Causes of left to right shunts
A
1) Patent ductus arteriosus
2) Patent foramen ovale
3) VSD
4) ASD
19
Q
What are the structural problems that occur in a tetralogy of fallot?
A
think: PROVe
1) Pulmonary stenosis
2) Right ventricular hypertrophy
3) Overiding aorta
4) Ventricular septal defect
20
Q
Boot shaped hear
A
Tetralogy of Fallot
21
Q
What is transposition of great vessels associated with?
A
Maternal diabetes
22
Q
Stenosis distal to ligamentum arteriosum; assoicated with notching of the ribs, hypertension in upper extremities and weak pulses in the lower extremities
A
think: aDult is Distal to the Ductus arteriousum
Coarctation of the aorta: Adult type
23
Q
Aortic stenosis proximal to the insertion of the ductus arteriosous
A
think: INfantile is In close to the heart
Coarctation of the aorta: infantile
24
Q
What is infantile coarctation of the aorta associated with?
A
Turner syndrome
25
What defects are more likely to occur with a 22q11 syndrome?
1) Truncus arteriosus
| 2) Tetralogy of Fallot
26
What defects are more likely with Down syndrome?
1) AV septal defect
27
Machine like murmur
Patent ductus arteriosus
28
What defects are more likely with congenital rubella
1) Septal defects
2) PDA
3) Pulmonary artery stenosis
29
What type of arteriolosclerosis occurs in malignanthypertension? Essential hypertension/diabetes?
1) Hyperplastic (onion skinning)
| 2) Hyaline
30
What is the progression that occurs in atherosclerosis?
1) Endothelial injury/cell dysfunction
2) macrophage and LDL accumulation (foam cell formation)
3) Fatty streaks
4) Smooth muscle cell migration
5) Extracellular matrix deposition
6) Fibrous plaque formed
31
Where is the most common location for atherosclerosis?
1) Abdominal aorta > coronary artery > popliteal artery > carotid artery
32
What causes a predisposition for an abdominal aortic aneurysm?
1) Atherosclerosis
33
What causes a predisposition for a thoracic aortic aneurysm?
1) Hypertension
2) Cystic medial necrosis (Marfan's syndrome)
3) Tertiary syphilis
34
Longitudinal tear forming a false lumen in the aorta; presents with tearing chest pain radiating to the back; mediastinal widening
Aortic dissection
35
Coronary artery narrowing >75%; no myocyte necrosis
Angina
36
What are ECG findings of a stable/unstable angina?
ST depression
37
What are ECG findings of MI?
ST elevation
38
Most common cause of sudden cardiac death?
Lethal arrhythmia
39
What coronary artery is most commonly occluded first?
1) Left anterior descending coronary artery > Right coronary artery > Circumflex
40
# Define what the gross findings are for an MI at the following times:
1) 0-4 hr
2) 4-12 hr
3) 12-24 hr
4) 1-3 days
5) 3-14 days
6) 2 weeks to several months
1) No changes
2) Beginning of dark mottling
3) Dark mottling
4) Hyperemia
5) Hyperemic border with central yellow-brown softening
6) Gray-white scar
41
# Define what the microscopic findings are for an MI at the following times:
1) 0-4 hr
2) 4-12 hr
3) 12-24 hr
4) 1-3 days
5) 3-14 days
6) 2 weeks to several months
1) No changes
2) Early coagulative necrosis and wavy fibers
3) Contraction bands from reperfusion injury
4) Extensive coagulative necrosis/neutrophil migration
5) Macrophage infiltration followed by granulation tissue
6) Contracted scar
42
What are complications of MI at the following times:
1) 0-4 hr
2) 4-12 hr
3) 12-24 hr
4) 1-3 days
5) 3-14 days
6) 2 wks to several months
1) Cardiogenic shock
2) Arrhythmia
3) Arrhythmia
4) Fibrinous pericarditis
5) Free wall rupture leading to tamponade; papillary muscle rupture
6) Dressler's syndrome
43
What is Dressler's syndrome?
1) Autoimmune phenomenon resulting in fibrinous pericarditis several weeks after post-MI
44
How do you diagnose an MI?
1) Troponin is gold standard (rises afte 4 hours and elevated for 7-10 days)
45
When do CK-MB findings return to normal? What is measuring CK-MB useful for?
1) 48 hours
| 2) Useful for determining a reinfarction after an acute MI
46
What are ECG changes for a transmural infarct? Subendocardial infarct?
1) ST elevation and Q waves
| 2) ST depression
47
What Leads will there be ECG changes for the following MI locations:
1) Anterior wall and anteroseptal (LAD)
2) Anterolateral (LCX)
3) Lateral wall (LCX)
4) Inferior wall (RCA)
1) Changes in V1-4 leads
2) Changes in V4-6
3) Changes in I and aVL
4) Changes in II, III, aVF
48
What cardiomyopathy causes systolic dysfunctions?
1) Dilated cardiomyopathy
| 2) Due to Increased compliance and decreased contractility
49
S3, dilated heart on ultrasound, ballon apperance on chest x ray; presence of eccentric hypertrophy ( sarcomeres added in series)
Dilated cardiomyopathy
50
What cardiomyopathy causes diastolic dysfunctions?
1) Hypertrophic cardiomyopathy
2) Restrictive/obliterative cardiomyopathy
3) Result in decreased stroke volume
51
What cardiomyopathy is due to defects in sacromeres
Hypertrophic cardiomyopathy
52
Normal sized heart, S4, assymetric concentric hypertrophy (sacromeres added in parallel); Hypertrophied interventricular septum blocking mitral leaflet results in systolic murmur; decreased compliance
Hypertrophic cardiomyopathy
53
Haphazard disarray of bundles of myocytes. You should think...
Hypertrophic cardiomyopathy
54
Causes of restrictive/obliterative cardiomyopathy
1) Sarcoidosis
2) Amyloidosis
3) Postradiation fibrosis
4) Loffler's syndrome
5) Hemochromotosis
6) Scleroderma
7) Carcinoid syndrome
55
Endomyocardial fibrosis with a prominent eosinophilic infiltrate
Loffler's syndrome
57
Causes of dilated (congestive) cardiomyopathy?
think: ABCCCD
1) Alcohol use
2) wet Beriberi
3) Coxsackie B virus myocarditis
4) Cocaine use
5) Chaga's disease
6) Doxorubicin toxicity
58
Pulmonary edema, nocturnal dyspnea, orthopenia
Left heart failure
59
What in the lungs microscopically would indicate left heart failure?
Presence of hemosiderin laden macrophages
60
Hepatomegally (nutmeg liver), Peripheral edema, jugular venous distension
Right sided heart failure
61
How does right heart failure usually occur?
1) Caused by left heart failure
| 2) Increased back pressure from the left heart causes right heart to work harder
62
Round white spots on retina surrounded by hemorrhage. What causes this?
1) Roth spots
| 2) Bacterial endocarditis
63
Tender raised lesions on finger or toe pads. What causes this?
1) Osler's nodes
| 2) Bacterial endocarditis
64
Small, painless, erythematous lesions on palm or sole. What cause this?
1) Janeway lesions
| 2) Bacterial endocarditis
65
What is the presentation of bacterial endocarditis?
think: FROM JANE
1) Fever
2) Roth spots (white spots in retina surrounded by hemorrhage
3) Osler's nodes ( raised lesions on fingers/toes)
4) Murmur
5) Janeway lesions (small, painless, erythematous lesion on palm or sole)
6) Anemia
7) Nail-bed hemorrhage
8) Emboli
66
Cause of bacterial endocarditis after prosthetic valve placement
Staphylococcus epidermidis
67
Cause of acute bacterial endocarditis
Staphylococcus aureus
68
What does bacterial endocarditis by Staphylococcus bovis indicate?
Colon cancer
69
What valve is most commonly affected by bacterial endocarditis? What valve is asscoiated with IV drugs
1) Mitral valve
| 2) Tricuspid valve
70
What are causes of sterile vegetations of endocarditis?
1) Non-bacterial thrombotic (cancer and hypercoaguable state)
2) Libman-sacks endocarditis (assoc. with SLE)
71
Cause of rheumatic fever?
1) Results from pharyngeal infection by Streptococcus pyogenes
2) Type II hypersensitivity
3) Antibodies to M protein
72
What can also occur with rheumatic fever?
1) Post streptococcal glomerulonephritis (nephritic syndrome)
2) Self limiting
3) due to deposition of immune complexes for M protein in the subepithelium
73
What are major criteria for rheumatic fever?
1) Erythema marginatum
2) Subcutaneous nodules
3) Pancarditis
4) Sydenham chorea
5) Migratory polyarthritis
74
What are Aschoff bodies and Anitschkow's cells? What are they found with?
1) aschoff bodies- granuloma with giant cells
2) Anitschkow's cells- activated histiocytes
3) Rheumatic fever
75
Wide spread ST segment elevation or PR depression
Acute pericarditis
76
Causes of fibrinous pericarditis? Serous? Suppurative?
1) Dressler's syndrome, uremia, radiation
2) Viral pericarditits, Rheumatoid arthritis, SLE
3) Bacterial infection
77
Compression of heart by fluid in the pericardium leading to decreased cardiac output that occurs rapidly
Cardiac tamponade
78
What is Kussmaul sign? What does this present with?
1) Prominence of Jugular venous distention on inspiration due to impaired right ventricle filling
2) Constricitive pericarditis, restrcitive cardiomopathies, right atrial tumors, or cardiac tamponade
3) Note that constrictive pericarditis takes a long time to develop
79
Decrease in amplitude of systolic blood pressure by >10 mmHg during inspiration
Pulsus paradoxus
80
Hypotension, increased venous pressure, distant heart sounds, increased heart rate, pulsus paradoxus
Cardiac tamponade
81
What tumor causes a ball-valve obstruction in the left atrium that causes multiple syncopal episodes?
Myxoma
83
Necrotizing vasculitis affecting small vessels involving lungs, kidneys and skin; palpable purpura; lesions are all in same stage; +p-ANCA
Microscopic polyangiitis
84
Small vessel vascultits; associated with asthma, granulomatous vasculitis with eosinophilia, +p-ANCA
Churg-Strauss syndrome
85
Branches of the External Carotid Artery (from proximal to distal)
1) Superior thyroid
2) Ascending pharyngeal
3) Lingual
4) Facial
5) Occipital
6) Posterior auricular
7) Terminal branches: Maxillary and Superficial temporal
86
Results due to an infection of HHV8; presents as patches of purple/red macules or raised plaques
Kaposi sarcoma
87
Kaposi Sarcoma that occurs in older men of Eastern European/Mediterranean descent; not associated with HIV; localized
Chronic Kaposi sarcoma (classic)
88
Kaposi Sarcoma that is prevalent among South African Bantu children; not associated with HIV; tumor involves the viscera and is extremely aggressive
Lymphadenopathic Kaposi Sarcoma (African)
89
Name the different forms of Kaposi Sarcoma
1) Chronic (classic)
2) Lymphadenopathic (African)
3) Transplant assoc.
4) AIDS assoc.
90
Kaposi Sarcoma that is associated with transplant or immunosuprresion; aggressive and sometimes fatal
Transplant associated Kaposi Sarcoma
91
Autosomal dominant disorder characterized by cortical tubers, subependymal hamartomas in the brain, mental retardation, cardiac rhabdomyomas, facial angiomas, and leaf shaped skin pigments
Tuberous sclerosis
92
Rare congenital vascular disorder with characterized with port-wine stain and leptomeningeal capillary-venous malformation
Sturge Weber syndrome
93
Cerebellar hemangioblastomas, retinal hemangiomas, and liver cysts
1) Von Hippel-Lindau disease
| 2) Autosomal dominant
94
Vasculitits that has focal nectrotizing vasculitis, necrotizing granulomas in the lung, and necrotizing glomerulonephritis; +c-ANCA
Wegener's granulomatosis
95
Most common childhood systemic vasculitis; often follows an upper respiratory infection; presents with palpable purpura on extensors of the LE, arthalgia, and GI symptoms; vasculitis secondary to IgA deposition
Henoch-Schonlein purpura
96
Vasculitis that occurs in Asian children; presents with fever, strawberry tongue, cervical lymphadenitis, and hand-foot erythema; may also have bilateral conjunctivitis and rash
Kawasaki disease
97
Also known as the "Pulseless" disease due to the formation of granulomas in the aortic arch causing decreased blood flow to the upper extremities; common in Asian females <40
Takayasu's arteritis
98
Vasculitis common in the elderly that causes headaches and vision complications that could lead to irreversible blindness; affects the temporal artery segmentally
Temporal (giant cell) arteritis
100
Pt. presents with "puffy face" and a recent onset of headaches with dyspnea. Symmetrical facial swelling and conjunctival edema. PERRLA. Dilated vessels are seen over neck and upper trunk. Heart sounds are clear. What should you suspect?
Superior vena cava syndrome
101
Positive C-ANCA
Wegener's Granulomatosis
102
What are the findings of Wegener's granulomatosis?
1) Granulomas in the lungs
2) Hemoptysis
3) Rapid progressive cresentric glomerulonephritis (type III)
4) Recurrent epitaxis
103
Positive P-ANCA
1) Churg-Strauss syndrome
2) Microscopic polyangiitis
3) Ulcerative colits/Primary biliary sclerosis
104
Granulomatous, necrotizing vasculitis with eosinophilia; + P-ANCA
1) Churg-Strauss syndrome
105
Benign, painful, red-blue tumor under fingernails; arises from modified smooth muscles cells
Glomus tumor
106
What is the cause of decrease in left ventricular chamber size and a sigmoid shpaed ventricular septum, progressive accumulation of cytoplasmic granules containing brownish lipofuscin pigment?
Aging
107
Sharp chest pain that increases with deep inspirations and decreases when sitting up
Acute pericarditis
108
What is the most common acute pericarditis?
1) Fibrinous
| 2) Friction rub present
109
Causes of pulus paridoxus
1) Cardiac tamponade
2) Acute Asthma
3) Obstructive sleep apnea
4) Pericarditis
5) Croup
110
Transmural inflammation of the arterial wall with fibrinoid necrosis
Polyarteritis nodosa
111
Cause of acute plaque change
Chnage in plaque stability
112
What maintains plaque stability?
1) Mechanical strength of the fibrous cap
| 2) Inflammatory macrophages may reduce plaque stability by secreting metalloproteinases which degrade collagen
113
What occurs when a pt. has a diastolic pressure >130?
Malignant hyper tension
| 1) Onion skin like concentric thickening of the walls of arterioles
114
Absence of C1 esterase inhibitor
Hereditary angioedema
115
What is the function of C1 esterase inhibitor?
1) Inhibit Classic complement pathway
| 2) Inhibit kallikrein (catalyzes kininogen to bradykinin)
116
Holosystolic, harsh sounding murmur; loudest at tricuspid area; accentuated with hand grip
VSD
117
Ejection click with crescendo-decrescendo systolic murmur; radiates to the carotids
Aortic stenosis
118
Diastolic murmur following an open snap; late dystolic rumbling
Mitral stenosis
119
Holosystolic, high pitched, blowing murmur; radiates toward axillae
Mitral regurgitation
120
Late systolic crescendo murmur with midsystolic click; loudest at S2; increased with decreased venous return
Mitral valve prolapse
121
What causes claudifcation
Atherosclerosis
| 1) composed of fixed stenotic lesions consisting of lipid filled intimal plaques
122
what are fatty streaks?
Intimal lipid filled foam cells derived from macrophages and smooth muscles that have engulfed LDL which entered the intima through injured endothelium
123
Pt. presents with skin and mucosal telangiectasias (spider like lesions) as well as recurrent severe nosebleeds
Osler Weber Rendu
124
Syndromes that cause prolonged QT and congenital neurosensory deafness
Jervell and Lange-Nielsen syndrome
125
Blowing diastolic decrescendo murmur; wide pulse pressure; may present with bounding pulses and head bobbing
Aortic regurgitation
126
What can invoke Prinzmetal angina?
Ergonovine
127
Calcified deposits in muscular arteries, affects individuals >50 ; often palpable, clinically asymptomatic; do not narrow vessel
Medial calcinosis (Monckeberg's)
128
Intermittent muscle pain reproducible caused by exercise and relieved by rest
Claudification
129
Angina characterized by episodic, transient attacks that occur at rest and during the middle of the night; present with transmural ischemia and ST elevation
Prinzmetal angina
130
What coronary artery if blocked has a bad prognosis?
1) Left main coronary artery (covers 2/3 of the heart)
131
What is the approach to treat a pt. with stable angina?
1) Reduce risk factors (DM, exercise, improve diet, stop smoking, improve lipid panel, improve bp)
2) Aspirin
3) Beta blocker
4) Nitrates
5) Ca channel blocker
6) PCI (Percutaneous Coronary Intervention
132
How long do Tropinin levels remain abnormal after heart damage?
5 to 14 days
133
What is the difference between stable angina and unstable angina?
1) Stable angina occurs due to increased oxygen demand that cannot be met
2) Unstable angina is due to reduced resting coronary flow
134
What is the treatment for Prinzmetal's angina?
1) Ca Channel blocker
| 2) Nitrate
135
How long does Troponin take to increase after heart damage?
3 to 5 hours
136
What is standard procedure for troponin measurements?
1) One on admission and one every 8 hours after, for 24 hours
137
How long does it take for troponin to raise? CK-MB?
1) 3 to 5 hours
| 2) 4 to 8 hours
138
What non-cardiovascular problem can raise troponin levels?
Chronic kidney failure
139
How do you determine of an anterior infarct? posterior? Lateral? inferior?
1) V1-4 ST segment elevation
2) ST segment depression and prominent T waves at V1-2
3) Q waves in lead I and aVL
4) Q waves in Leads II and III, and aVF
140
What is the initial treatment that must be given for MI?
1) Aspirin
2) Low molecular weight heparin (enoxaparin)
3) Beta blocker
4) ACE inhibitor
5) Morphine
141
What drugs decrease mortality in pt. with MI?
1) Aspirin
2) Beta blocker
3) ACE inhibitor
142
What are absolute contraindications for tPA?
1) Trauma
2) Previous stroke
3) Recent invasive surgery
4) Dissecting aortic aneurysm
5) Active bleeding
143
What is the differential for chest pain?
1) CARDIO - angina, MI, pericarditis, dissecting aortic aneurysm
2) PULM - Pneumonia, Pleuritis, Pneumothorax, Pulmonary embolism
3) GASTR - esophageal rupture, GERD, esophageal spasm
4) MUSC - costochondritis, rib fracture, muscle strain, herpes zoster
144
What are causes of high output congestive heart failure?
1) Pregnancy
2) Hyperthyroidism
3) Chronic anemia
4) AV fistulas
5) Wet beriberi
6) Paget's disease
7) Aortic insufficency
145
What are the symptoms of Left sided heart failure?
1) Pulmonary dyspnea
2) Dyspnea on exertion
3) Paroxysmal nocturnal dyspnea
4) Orthopnea
146
What drugs are contraindicated in pt. with CHF?
1) Calcium channel blockers
2) Metformin (Act on AMP dependent protein kinase causing increased insulin sensitivity)
3) Thiazolidinediones (binds to PPAR gamma -> increase insulin sensitivity)
4) NSAIDs
147
Describe the NYHA classifcation system for congestive heart failure.
1) Class I - no change with most physical activity
148
What beta blocker is the drug of choice for treatment of congestive heart failure?
Carvedilol
149
What drugs are indicated for treatment of CHF?
1) ACE inhibitor
2) Beta-blocker
3) Diuretic
4) Digoxin (if EF <40% and non-responsive)
5) Hydralazine and isosorbide dinatrates
150
What is the first step in treatment for a pt. who has AFib and is hemodynamically unstable?
1) Cardioversion
151
What is the goal in treatment for a patient with hemodynamically stable AFib?
1) Control rate (Beta blocker or Ca Channel blocker)
2) Improve rhythm
3) Anticoagulate
152
What is the drug of choice used for stable SVT?
Adenosine 6 mg
153
What indicates Wolf-Parkinson- White syndrome?
1) Delta waves on ECG
154
Wide QRS complex, unstable pt. with cannon A waves
Ventricular tachycarida
155
What murmurs have a decrease in intensity with squatting?
1) MVP
| 2) HCM
156
What causes cannon A waves?
1) Contraction of both the atrium and ventricle at the same time
2) Observed in ventricular tachycardia
157
What are the causes for pulseless electrical activity (PEA)?
think: H's and T's
1) Hypoxia
2) Hypotension
3) Acidosis
4) Hyperkalemia
5) Hypovolemia
6) Tension pneumo
7) Pulmonary embolism
8) Tamponade
158
What murmurs have an increased in intensity with a Valsalva maneuver?
1) MVP
| 2) HCM
159
Diastolic decrescendo murmur
Aortic regurgitation
160
Opening snap followed by a low pitched diastolic rumble
Mitral valve stensosi
161
What is the first thing to diagnose a thoracic aortic dissection ACUTELY ("tearing in back with unequal bp in extremities")
CT angiography
162
Causes of aortic stenosis?
Calcification of aortic valves
163
Harsh crescendo-decrescendo systolic murmur
Aortic stenosis
164
Pti. presents with morning headaches, swelling of his face and arms which subsides after getting up. 60 pack year smoking. JVD. What should you think?
Superior vena cava syndrome
165
A 38-year-old female presents to the office with the complaint of painful vaginal ulcers that first appeared several weeks ago. History reveals she also has “watery eyes” that sometimes causes her vision to be blurred. Past medical history reveals oral ulcers several years ago that have recurred several times. Physical examination reveals erythema and clear discharge from the eyes, and 2 1cm ulcers on the vulva.
Behcet syndrome
166
Treatment for Behcet syndrome
steroids
167
Recurrent oral and genital ulcerations, eye involvement, and fever
Behcet syndrome
