Cardiovascular: Pathoma, BRS, First Aid Flashcards Preview

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Flashcards in Cardiovascular: Pathoma, BRS, First Aid Deck (318):
1

Ischemic heart disease is caused by what?

Partial or complete interruption of arterial blood flow to the myocardium

2

What is the main cause for interruption of arterial blood flow to myocardium?

Atherosclerosis of coronary arteries

3

Incidence of IHD increases with what?

Age

4

How will ischemia present? (6)

1. Silent
2. Angina pectoris
3. Coronary steal syndrome
4. Myocardial infarction
5. Sudden cardiac death
6. Chronic ischemic heart disease

5

Frequency of IHD increases in patients who manifest what?

Metabolic syndrome

6

What does metabolic syndrome include?

1. Central obesity
2. Artherogenic lipid patterns
3. Hypertension
4. Insulin resistance
5. Proinflammatory state

7

What predisposes someone to metabolic syndrome?

Obesity
Physical activity
Genetic factors

8

What is angina pectoris?

Episodic chest pain that is caused by inadequate oxygenation of myocardium

9

How much stenosis or obstruction of a vessel is needed to cause angina?

>70-75%

10

Is there myocyte necrosis in angina?
Why?

No
Reversible

11

What is the most common type of angina?

Stable angina

12

What precipitates stable angina?
Why?

Exertion or stress
Can't get enough blood (oxygen) to heart

13

What causes stable angina?

CAD of coronary arteries greater than 70%

14

How does stable angina present? 3

1. Chest pain less than 20 minutes that radiates to left arm or jaw
2. Diaphoresis
3. Shortness of breath

15

Why is the 20 minute interval important?

After that you get irreversible injury and cell death

16

What does an EKG show in stable angina?
Why?

ST segment depression
Subendocardial ischemia

17

What relieves stable angina? (2)

1. Rest
2. Vasodilators like nitroglycerin

18

Function of nitroglycerin?

Vasodilation of veins mainly that decreases preload and decreases stress on myocardia

19

Unstable angina is chest pain that occurs when?

At rest

20

What causes unstable angina?

Rupture of atherosclerotic plaque with thrombosis and incomplete occlusion of coronary artery

21

What type of damage is occurring in unstable angina?

Reversible injury to myocytes

22

What does an EKG show on unstable angina?

ST segment depression

23

What relieves unstable angina?

Nitroglycerin: Vasodilation to decrease preload which decreases stress

24

What are unstable angina patients at risk for?

Progressing to full occlusion: Myocardial infarction)

25

Prinzmetal angina is due to what?

Coronary artery vasospasm

26

What is the timing of pain in prinzmetal angina?

Episodic/intermittent chest pain at rest

27

What type of damage occurs in prinzmetal angina?

Reversible injury to myocytes

28

What does prinzmetal EKG show?
Why

ST segment elevation
Transmural ischemia

29

What relieves prinzmetal angina? 2

1. Nitroglycerin: Decrease preload
2. Calcium channel blockers: Decrease spasm

30

What is the most important cause of morbidity from IHD?

Myocardial infarction

31

What is myocardial infarction?

Necrosis of cardiac myocytes (so after 20 minutes)

32

What mainly causes a myocardial infarction?

Rupture of a atherosclerotic plaque with thrombosis and complete occlusion of coronary artery

33

Other causes of myocardial infarction? (3)

1. Coronary artery vasospasm (Complete prinzmetal)
2. Emboli
3. Vasculitis (kawasaki's disease)

34

Symptoms of myocardial infarction?

1. Severe chest pain greater than 20 minutes that radiates to left arm/jaw
2. Diaphoresis
3. Dyspnea: Heart can't pump --> Fluid in lungs

35

Will nitroglycerin relieve myocardial infarction pain?

No

36

What ventricle is usually involved in an MI?

Left

37

What is most common artery involved in MI?
Which causes an infarction where?

LAD

Infarciton of anterior wall of LV and anterior part of IV septum

38

What is 2nd most common artery involved in MI?
Which causes an infarction where?

Right coronary

Infarction of right ventricle, posterior wall of LV and anterior portion of IV septum

39

What is 3rd most common artery involved in MI?
Which causes an infarction where?

Left circumflex

Infarction of lateral wall of LV

40

What are the 2 types of infarction based on heart layers involved?
Which is more common

1. Transmural: Entire ventricular wall from endo to epi. More common
2. Subendocardial infarction: Just 1/3 of the wall

41

ECG shows what during myocardial infarction?

1. During the initial subendocardial infarction, ST depression
2. During later transmural infarction, ST elevation

42

Why are there biomarkers for MI?

Irreversible damage to myocytes causes membrane breakdown thus releasing markers

43

What is the most SENSITIVE and most SPECIFIC cardiac marker?

Troponin I

44

When does troponin I peak?

24 hours

45

How long does troponin I remain high after MI?

7 to 10 days

46

CK-MB is most useful for what?

Detecting re-infarction

47

When does CK-MB rise?

4-6 hours after infarction

48

When does CK-MB peak?

24 hours

49

When does CK-MB return to normal? 72 hours

72 hours

50

What is the gold standard for diagnosing MI in first 6 hours?

ECG

51

When does LDH peak?
How long does it last?

3 days
4-7 days

52

When does myoglobin peak?
How long does it last?

First 6 hours
24 hours

53

Treatment of MI includes what? 6
Describe each

1. ASA/Heparin: limit more thrombosis
2. Supplemental O2: minimize ischemia
3. Nitrates: Vasodilate --> Decrease preload
4. Beta-blocker: Slow heart rate --> Decrease O2 need + decrease arrhythmia
5. ACE inhibitor: Decrease dilatation
6. Fibrinolysis/Angioplasty: Destroy blockage/open up vessel

54

How does an ACE inhiabitor decrease LV dilatation? 2

1. Blocks ANG II production --> prohibit constriction of peripheral arterioles --> Decrease afterload
2. Block ANG II --> No aldosterone secreted --> No blood volume increase

55

Two injuries due to fibrinolysis and angioplasty?

1. Contraction band necrosis
2. Reperfusion

56

What is contraction band necrosis?

Calcium will enter cell after blood flow is restored and cause contraction --> visible contraction bands

57

What is reperfusion injury?

Returning O2 rapidly to cell causes ROS to form --> Further damage the cells

58

What is a lab test for reperfusion injury?

See cardiac enzymes continue to rise after reperfusion

59

Less than 4 hours from infarction, what risks does patient have?

1. Cardiogenic shock: Heart fails --> Hypofusion
2. CHF: Dead tissue --> Can't pump--> Backs up into heart --> Decreased ejection fracture
3. Arrhythmia

60

Between 4 and 24 hours after infarction, what changes do you see macroscopically?

What risk?

1. Dark discoloration
2. Coagulative necrosis: Karyolysis, pyknosis, karyorrhexis

Arrhythmia

61

Between 1 and 3 days what change do you see? 2

What is patient at risk for?

Yellow pallor
Neutrophils on scene

Fibrinous pericarditis

62

How does fibrinous pericarditis present in days 1-3?
Why does it occur?

Chest pain with friction rub

Transmural infarction --> Neutrophils enlame entire wall --> Debris into pericardium --> Pericarditis

63

How does MI present in days 4-7? 2

1. Yellow pallor
2. Macrophages on scene

64

What is important about days 4-7 after MI?

Cardiac wall is weakest due to macrophages eating all the dead material.

65

What are the 3 things a patient is at risk for 4-7 days after MI?

1. Rupture of ventricular free wall --> Blood leaks into pericardium --> Compresses heart --> Cardiac tamponade
2. Rupture of IV septum --> Shunt from LV to RV
3. Rupture of papillary muscle --> Mitral insufficiency

66

What causes rupture of papillary muscle?

Occlusion of right coronary artery

67

In weeks 1-3, what are the macroscopic changes? (2)

1. Red border as granulation tissue enters from edge
2. Granulation tissue with fibroblasts, collagen, and BV's

68

Months after, what changes does MI patient have?

1. White scar of Type 1 collagen
2. Fibrosis

69

What risks does a patient with an MI have after months? (3)

1. Weak scar: leads to balloon like dilatation --> Aneurysm
2. Scar along heart wall --> Stasis --> Mural thrombus
3. Dressler syndrome

70

What happens in Dressler's syndrome?

Transmural infarct --> Pericardium leaks --> Form imune response against pericardium antigens --> Pericarditis 6-8 weeks after infarction

71

What is most common cause of death in first several hours after infarction?

Arrhythmia

72

What is sudden cardiac death due to?

Cardiac disease

73

How does sudden cardiac death appear? 2

1. Asymptomatic before
2. Less than 1 hour after symptoms arise

74

What usually causes sudden cardiac death?

Fatal ventricular arrhythmia

75

Most common etiology of sudden cardiac death?

Acute ischemia

76

90% of SCD patients have what pre-existing condition?

Severe atherosclerosis

77

Less common etiologies of SCD? 3

1. Mitral valve prolapse
2. Cardiomyopathy
3. Cocaine abuse

78

Chronic ischemic heart disease is defined how?

Poor myocardial function

79

What is Chronic IHD due to?

Chronic ischemic damage (with or without MI)

80

What do chronic IHD patients progress to?

CHF

81

What is coronary steal syndrome?

Vasodilator may aggravate ischemia by shunting blood from area of critical stenosis to an area of higher perfusion.

82

Congestive heart failure may be failure of what ventricle?

Right, Left or both

83

Causes of Left sided heart failure?
Explain each

1. Ischemia: Decrease blood flow --> Damage myocardium --> Can't pump well
2. Hypertension: Get concentric LV hypertrophy to deal with stress --> Extra O2 demands --> Ischemic damage --> Can't pump well
3. Dilated cardiomyopathy: Stretch all four chambers --> Can't contract well
4. Myocardial infarction: Nonfunctional tissue --> Can't pump well
5. Restrictive cardiomyopathy: Can't fill heart well --> Can't pump enough out
6. Aortic and mitral valvular disease

84

Two main Clinical manifestations of LCHF?

1. Pulmonary congestion
2. Decreased forward perfusion

85

Pulmonary congestion from LCHF is due to what?

Heart can't pump blood forward --> Backs up -->blood accumulates in lung --> Pulmonary congestion

86

Why does pulmonary congestion result in dyspnea?

Increase in hydrostatic pressure --> Pulmonary edema --> Dyspnea

87

What is PND?

Dyspnea upon laying flat for several hours

88

What is othopnea?

Dyspnea if late flat for a few minutes?

89

What are crackles?

Fluid in lungs upon auscultation

90

Ruptured pulmonary capillaries in LCHF results in what?

Blood in alveoli --> Macrophages arrive to clean up --> Iron fills maccrophages --> Forms hemosiderin laden cells called heart failure cells.

91

What are the 5 clinical manifestations of pulmonary congestion?

1. Dyspnea
2. PND
3. Orthopnea
4. Crackles
5. Heart failure cells

92

Decreased forward perfusion results in activation of what?

RAS

93

RAS activation has what two effects?

Decreased blood flow to kidneys activates juxtaglomerular apparatus --> Release renin --> Release Ang II -->
1. Constrict arterioles --> Increase total peripheral resistance
2. Go to adrenal gland --> Release aldosterone --> Cause resorption of sodium --> Water follows --> Increase blood volume

OVERALL = Increase resistance --> Exacerbates problem

94

Main treatment for LCHF?

ACE inhibitor

95

Right sided failure has what causes? 6

1. Left sided heart failure
2. Left-sided lesions
3. Pulmonary hypertension: Chronic lung disease/cor pulmonale --> Vessel constriction
4. Cardiomyopathy/Diffuse myocarditis
5. Tricuspid or pulmonary valvular disease
6. Left to right shunts

96

Most common cause of RCHF?
Why?

LCHF
Backup into pulmonary circuit --> Backups into right heart

97

Isolated RCHF is usually due to what?

Cor pulmonale

98

Clinical manifestations of RCHF? 4

1. Jugular vein backup --> JVD
2. Hepato and spleno congestion --> Hepatosplenomegaly + cardiac cirrhosis + nutmeg liver
3. Pitting edema: Due to increased hydrostatic pressure in low extremities.
4. Renal hypoxia: Fluid retention

99

Congenital defects arise when?

During embryogenesis weeks 3-8

100

Congenital heart defects are seen in what percentage of live births?

1%

101

Most congenital defects are caused by what?

Undetermined = Sporadic

102

Congenital defects overall usually result in what?

Shunting between left and right circulations

103

What is most common congenital heart defect?

Ventricular septal defect

104

VSD is a defect associated with what syndrome?

Fetal Alcohol Syndrome

105

What happens with blood flow in VSD?

Blood enters right atrium and can enters normal low pressure RV over high pressure LV. However upon returning to LA, blood chooses low pressure RV instead of high pressure LV resulting in LEFT TO RIGHT SHUNT

106

How does size of defect affect symptoms in VSD?

Small VSD = asymptomatic
Large VSD = large amounts of blood entering RV --> increase of blood in pulmonary circuit --> Pulmonary hypertension

107

What does pulmonary hypertension from VSD result in over time?

P-HTN --> Right side to become high pressure --> Blood now shunts from high pressure right to low pressure left ventricle --> Deoxygenated blood in systemic circulation --> Cyanosis

108

The reversal of a shunt due to a change in pressure from pulmonary hypertension is known as what?

Eisenmenger syndrome

109

3 consequences of Eisenmenger's syndrome?

1. RV hypertrophy: Due to pumping against higher pressure
2. Polycythemia: Deox blood --> Hypoxemia --> Release EPO --> Increase RBC's
3. Clubbing: Change in fingernails from cyanosis

110

Treatment of VSD? (2)

1. Small VSD close on their own
2. Surgical closure

111

Atrial septal defect includes what five types?

1. Patent foramen ovale
2. Septum primum
3. Septum secundum
4. Sinus venosus
5. Lutembacher syndrome

112

Patent foramen ovale is clinically significant how?

It's not. 20-30% of people have it.

113

Septum primum/Ostium primum is associated with what consequence?
What genetic disease is associated with this?

Affects lower part of septum so it can affect AV valves.

Down's syndrome

114

Most common type of ASD is what?

Ostium/Primum secundum

115

Ostium/Primum secundum is a defect in what?

Fossa ovalis

116

Sinus venosus affects what area?

Upper part of septum near SVC

117

Lutembacher syndrome has what two components?

1. ASD
2. Mitral stenosis

118

Atrial septal defect results in what type of shunt?

Left to right shunt

119

ASD presents how on auscultation? 2

1. Split S2
2. Loud S1

120

Why does split S2 occur in ASD?

Blood from high pressure LA crosses to low pressure RA --> Extra volume on right side --> Delayed closure of pulmonic valve --> Split S2

121

What is the S2 sound?

Pulmonary and aortic valves closing

122

What is an important complication of ASD?

Paradoxical emboli: DVT emboli enters RA normally but crosses over to LA and lodges in brian or extremities.

123

When are ASD symptoms seen?
What is the main one?

Late in life

Cyanosis due to Eisenmenger's syndrome from P-HTN

124

What is Patent ductus arteriosus?

Failure of ductus arteriosus to close.

125

PDA is associated with what situations? 2

1. Congenital Rubella
2. People living in high altitudes

126

What is the mechanism of PDA?

Blood enters RA --> RV --> Enters pulmonary artery --> Chooses to enter low pressure lungs over high pressure aorta --> LA --> Enters LV --> Enters aorta --> Chooses low pressure lungs over high pressure systemic circulation --> LEFT TO RIGHT SHUNT

127

What happens over time in PDA patients?

P-HTN develops --> Blood now chooses low pressure aorta over high pressure lungs --> Deox blood goes to LOWER extremities --> Cyanosis in lower extremities in late life.

128

How does PDA appear at birth?

Asymptomatic left to right shunt

129

What causes PDA to appear in adulthood?

Eisenmenger's syndrome

130

What keeps the PDA open? 2

Prostaglandin E
Low O2 tension

131

What are treatments for PDA? (2)

1. surgery
2. Indomethacin

132

Function of indomethacin

Decrease prostaglandin E --> Close PDA

133

What is the quality of murmur in PDA?

Machine-like murmur

134

Tetralogy of Fallot is caused by what?

Anteriosuperior displacement of infundibular septum

135

Tetralogy of Fallot has what four components?

PROVe
Pulmonary infundibular stenosis
Right Ventricular Hypertrophy
Overriding aorta (of VSD)
Ventricular Septal Defect

136

What is the flow of blood in tetralogy of Fallot?

RA --> RV --> Due to stenosis --> Shunt to aorta = Right to left shunt

137

In babies, ToF results in what?

Cyanosis due to deoxygenated right sided blood entering systemic circulation.

138

What is shape of heart in ToF?

Boot-shaped heart

139

In adults, what will cause cyanosis to occur in ToF?

Exercise

140

How do patients deal with ToF?

Squat --> Increase left sided pressure --> Decrease shunt --> Oxygenate more blood --> less cyanotic

141

The main point behind squatting with ToF?

Increased arterial resistance --> Decreases shunting

142

Treatment of ToF?

Early surgery

143

In transposition of great vessels, what happens?

Aorta comes off RV and Pulmonary artery comes off LV resulting in two independent circuits that do not connect.

144

Can a person with transposition of great vessels live?

Only if they somehow form a shunt.

145

How do you treat Transposition of great vessels?
Specifically? (2)

Cause open PDA so that blood can mix

1. Give patient prostaglandin E
2. Surgically repair problem

146

What maternal condition is associated with Transposition of Great vessels?

maternal diabetes

147

How do ToGV patients present?

Early cyanosis since deox blood from right side enters aorta --> Systemic circulation

148

What is truncus arteriosus?

Truncus fails to divide providing one single large vessel coming from both ventricles.

149

How does blood flow in truncus arteriosus?

One vessels drains both ventricles but divides later --> Deox and ox blood mix --> Deox blood enters systemic circulation --> Cyanosis

150

What is tricuspid atresia?

Tricuspid valve orifice fails to develop

151

What does atresia mean?

Fail to form lumen of tube

152

In tricuspid atresia, how is the RV described?

Hypoplastic

153

In tricuspid atresia, what is the situation associated with?
What is flow of blood?
How does it present?

ASD: Right to left shunt

Tricuspid fails to form --> No blood to RV --> ASD forms --> Deox blood enters left side

Cyanosis

154

Coarctation means what?

Narrowing of aorta

155

Coarctation of aorta is divided into what two forms?

Infantile and Adult

156

Infantile CoA is associated with what?

PDA

157

In infantile CoA, where is the coarctation?

Distal to aortic arch
Proximal to PDA

158

Describe the pressures in infantile CoA?

High pressure above coarctation
Low pressure below coarctation

159

What is mechanism of blood flow in infantile CoA?

RA--> RV --> PA --> Cross PDA to low pressure aorta below coarctation --> Deox blood in lower extremities --> Lower extremity cyanosis

160

What disease is associated with infantile CoA?

Turner's

161

Is adult form of CoA associated with PDA?

NO

162

Where is coarctation in adult CoA?

Distal to aortic arch?

163

Mechanism of blood flow in adult CoA?

Since narrowing is below arch --> High pressure above and low pressure below --> High pressure in UE + low pressure in LE

164

How does adult CoA present?

HTN in upper extremity
Hyptension with weak pulses in lower extremity

165

When is adult form of CoA found?

In adulthood

166

What defect is adult CoA associated with?

Bicuspid aortic valve

167

What X-ray feature is seen in adult CoA?
Why?

Notching of ribs

Collateral circulation develops across intercostal arteries --> Engorged arteries --> Notching of ribs

168

What is Turner's syndrome associated with in congenital heart defects?

Coarctation of Aorta (Infantile)

169

What are congenital defects are Down syndrome patients known for?
Such as? 3

Endocardial cushion defects

ASD, VSD, AV septal defect

170

Congenital rubella is associated with what congenital CV defects? 5

Septal defects: VSD,
PDA
Pulmonary artery stenosis
Valvular stenosis
Aortic stenosis

171

22q11 syndromes are associated with what CV defects? (2)

1. Truncus arteriosus
2. Tetralogy of Fallot

172

Marfan's syndrome is associated with what CV defects?

Aortic insufficiency and dissection

173

Infant of diabetic mother has what associated CV defects?

Transposition of great vessels

174

Noncyanotic congenital CV defects include what two types?

No shunt
Left-to-right shunt

175

What are the diseases of noncyanotic congenital CV defects?

No shunts = 1. Aortic stenosis 2. CoA

L-2-R shunts = 1. PDA, ASD, VSD

176

Rank frequency of left to right shunt defects?

VSD > ASD > PDA

177

Right to left shunts are known as what? 3

Blue babies
Early cyanosis
Cyanotic diseases

178

What are the 5 T's of right to left shunts?

Tetralogy of Fallot
Transposition of great arteries
Truncus arteriosus
Tricuspid Atresia
Total anomalous pulmonary venous return

179

What do most patients with truncus arteriosus also have?

VSD

180

What is total anomalous pulmonary venous return?

Pulmonary veins return to RA

181

Two types of valvular disease?

Stenosis and regurgitation

182

Acute rheumatic fever is what?

Systemic complication of pharyngitis due to Group A beta-hemolytic strep

183

How old are children usually with ARF?
How many weeks after strep throat is ARF seen?

5-15 years old
2-3 weeks

184

What is the etiology of ARF?

The Bacterial M protein of Group A strep resembles human tissues and causes type II hypersensitivity against own heart tissues.

185

What evidence prior to ARF must be had?
How is this accomplished? 2

Evidence of group A strep infection
ASO or anti-DNase B titer

186

Minor criteria for ARF? 2

Fever
Elevated ESR

187

Major criteria for ARF?

JONES
J = Joint problems = Migratory polyarthritis
O = Heart problems (pan-carditis)
N = Nodules in Skin
E = Erythema marginatum
S = Sydenham's chorea

188

What is first layer of heart to be affected in ARF?
Which results in what?

Endocardium
Tiny vegetations on mitral valve (possibly aortic as well) --> Regurgitation

189

Myocardium is second layer to be affected in ARF, what forms here?

Aschoff bodies of: Giant cells + Fibrinoid material (degenerated collagen) + Anitschkow Cells

190

How do anitschkow cells appear?

Slender wavy nuclei (Caterpillar nuclei)

191

Pericarditis in ARF presents how?

Friction rub

192

Which of the 3 layers of carditis is most likely to kill ARF patient?

Myocarditis

193

What is erythema marginatum?

Rash that is more red on edges

194

Sydenham's chorea is what?

Rapid involuntary muscle movement

195

What is the First Aid acronym for Rheumatic fever facts?

FEVERSS

F=Fever
E=Erythema Marginatum
V=Valvular damage (vegetation and fibrosis)
E=Elevated ESR
R = Red-hot joints (migratory polyarthritis)
S=Subcutaneous nodules
S=St. Vitus' dance (Sydenham's chorea)

196

Rheumatic endocarditis has what happen in early stage?

Valve leaflets are red and swollen with tiny vegetations resulting in mitral valve regurgitation

197

As a consequence of healing, what changes do valves have in ARF?

Valves become thickened, fibrotic and deformed.

198

Chronic rheumatic valvular disease is result of what?

Valve scarring that results from rheumatic fever?

199

Chronic rheumatic valvular disease results in what?

Stenosis

200

Mitral valve stenosis leads to what?

Thickening of chordae tendinae and cusps

201

Aortic valve in CRV results in what?

Fusion of comissures

202

Fusion of comisures in aortic valve CRV results in what? (2)

1. Small orifice --> FIshmouth appearance
2. Stenosis --> Can't completely open valve

203

Mitral stenosis causes what pressure difference to develop?

Diastolic pressure higher in left atrium than in left ventricle

204

What is aortic stenosis

Narrowing of aortic valve orifice

205

What is aortic stenosis due to mainly? (2)

1. Fibrosis
2. Calcification

206

When does aortic stenosis present?

Late adulthood (>60 years old)

207

Two others causes of aortic stenosis?

Bicuspid aortic valve
Chronic rheumatic valve disease

208

Aortic valve is usually what organization?

Tricuspid

209

What's the problem with bicuspid aortic valves?

Two cusps do the work of 3 --> increases risk for aortic stenosis

210

How does CRVD cause aortic stenosis?

It has mitral valve stenosis and fusion of aortic valve comissures

211

What is difference between "wear-and-tear" aortic stenosis and CRVD caused aortic stenosis

Wear and tear aortic stenosis has only the aortic valve affected, CRVD = mitral + aortic valve

212

Compensation in aortic stenosis leads to what? 2

1. longer asymptomatic stage
2. Systolic ejection click followed by crescendo-decrescendo murmur

213

Complications resulting from aortic stenosis? (3)

1. LV Hypertrophy: Due to pumping against stenotic valve
2. Angina and syncope with exercise: Stenosis reduces systemic blood flow --> Don't get enough during exercise
3. Microangiopathic hemolytic anemia: Blood cells rupture moving across bad valve

214

Treatment of aortic stenosis?

Replace valve after symptoms appear

215

Aortic regurgitation is what?

backflow of blood from aorta into LV during diastole

216

AR arises due to what? 4
Which is most common

1. Isolated aortic root dilation (Most common)
2. Syphilitic aneurysm
3. Valve damage (such as CRVD)
4. Non-dissecting aortic aneurysm

217

Why does aortic root dilatation cause AR?

Dilation of root --> Pulls valves apart --> Regurg occurs

218

Clinical features of AR? 7

BE-PHILE
1. Bounding pulses
2. Early blowing diastolic murmur
3. Pulsating nail bed
4. Head bobbing
5. Increasing pulse pressure
6. LV dilation
7. Eccentric hypertrophy of one part of ventricle

219

Treatment of AR?

Valve replacement

220

What is the most common valvular lesion?

Mitral valve prolapse

221

What is mitral valve prolapse?

Ballooning of mitral valve into left atrium during systole

222

Mitral valve prolapse is due to what?

Myxoid degeneration of valve making it floppy

223

What diseases commonly have mitral valve prolapse? 2

Marfan and Ehlers Danlos

224

Clinical features of MVP? 3

1. Mid-systolic click with systolic regurgitation murmur
2. Arrhythmia
3. Can turn into infective endocarditis

225

Treatment of MVP?

Valve replacement

226

Mitral regurg involves what?

Reflux of blood from LV into LA during systole

227

Mitral regurg is a complication of what prior problem usually?

Mitral valve prolapse

228

Other causes of mitral regurg? 4

1. LV dilation
2. Infective endocarditis (Bad leaflets)
3. ARF (Mitral valve)
4. Papillary muscle rupture after MI

229

Clinical features of mitral regurgitation? 3

1. Holosystolic blowing murmur
2. Louder with squatting and expiration
3. volume overload and left-sided heart failure

230

Why does squatting make mitral regurg louder?

Increase systemic resistance --> less blood forward --> more blood backwards --> Louder murmur

231

Why does expiration make mitral regurg louder?

Increase in amount of blood entering LA --> Increase blood in LV --> increase in regurgitated blood

232

What is mitral stenosis?

Narrowing of mitral valve orifice

233

Cause of mitral stenosis?

CRVD

234

Clinical symptoms of mitral valve stenosis?

1. Opening snap with diastolic rumble
2. Volume overload leads to dilation of LA

235

Consequences of dilated LA in mitral valve stenosis?

1. Pulmonary congestion: Overloading LA --> Blood backs up into pulmonary circuit --> Pulmonary congestion --> Edema + Alveolar hemorrhage --> Heart failure cells

2. Pulmonary HTN: Excess blood in circuit --> Rt heart pumps against --> Right heart fails

3. Atrial fibrillation: Dilation --> Abnormal wall movement --> Stasis --> Mural thrombi

236

What syndrome is tricuspid valve involved in?

Carcinoid syndrome

237

The pulmonary valve is normally affected by what

Congenital malformations

238

Endocarditis is what?

Inflammation of endocardium (inner surface)

239

Endocarditis is usually the result of what?

Infection

240

General features of bacterial endocarditis? 3

1. Large soft vegetations on valvular surfaces
2. Ulceration and perforation of valves cusps
3. Rupture of chordae tendineae

241

Two classifications of bacterial endocarditis?

Acute endocarditis
Subacute endocarditis

242

What is acute endocarditis caused by?

Highly virulent pathogens like staph aureus

243

Staph aureus is most common cause of endocarditis in what demographic?

IV drug abusers

244

Acute endocarditis like staph aureus is secondary to what?

Infection elsewhere

245

What is state of valves that highly virulent bacteria like staph aureus inhabit?

Normal healthy

246

What does acute endocarditis result in?

Large vegetations with rapid onset of symptoms due to destruction of valve

247

Subacute endocarditis is caused by what?

Less virulent bacteria like strep viridans

248

What is the most common cause of bacterial endocarditis?

Strep Viridans

249

Subacute endocarditis occurs on what state of valves?

Previously damaged valves such as congenital heart disease or valvular heart disease

250

What is result of subacute endocarditis?

subendocardium is exposed allowing for formation of thrombotic vegetations that do not destroy the valve.

251

What allows for bacteria in subacute endocarditis to inhabit a valve?

Bacteremia such as during a dental procedure

252

Staph epidermidis is most common in what?

Endocarditis of prosthetic valves

253

Strep bovis is seen in what patients?

Endocarditis of patients with underlying colorectal carcinoma

254

Endocarditis with negative blood cultures is due to what?

HACEK organisms
Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

255

Clinical features of bacterial endocarditis? 8

FROM JANE

1. Fever
2. Roth's spots
3. Osler nodes: Painful lesions on fingers/toes
4. Murmur: Vegetations disrupt flow

5. Janeway Lesions: nonpainful on palms/soles
6. Anemia
7. Nailbed hemorrhage
8. Emboli (septic): Vegetations come off and lodge

256

What valve is most frequently involved in bacterial endocarditis?

Mitral valve

257

Tricuspid valve bacterial endocarditis is associated with what?

IV drug abuse (Don't Tri Drugs)

258

Lab features of bacterial endocarditis? 5

1. Positive blood cultures
2. Microcytic anemia: Low hemoglobin, low MCV
3. Hepcidin traps iron
4. Ferritin will be hidden (Low TIVC)
5. TEE = best for detecting lesions on valves

259

Nonbacterial thrombotic endocarditis is what?
Where do vegetations arise?
What do they cause?

Sterile vegetations that arise with hypercoagulable state or underlying adenocarcinoma

Mitral valve along lines of closure

Regurgitation

260

Libman-Sacks endocarditis is what?

Sterile vegetations associated with SLE (lupus)

261

What makes the vegetations in Libman-Sacks endocarditis special?
What does it result in?

Vegetations present on surface AND undersurface of mitral valve

Results in mitral regurgitation

262

The cause of endocarditis of carcinoid syndrome is what?

Secretory products of carcinoid tumors (vasoactive peptides and amines)

263

What does endocarditis of carcinoid syndrome result in?

Thickened endocardial plaques

264

What is cardiomyopathy?

Disease of heart muscle that results in cardiac dysfunction

265

What is most common form of cardiomyopathy?

Dilated cardiomyopathy (90%)

266

Dilated cardiomyopathy involves dilation/stretching of what?

All four chambers of heart

267

What are causes of dilated cardiomyopathy? (6)

MIDCAP BC

1. Idiopathic (Most common)
2. mutation (AD)
3. Coxsackievirus
4. Alcohol abuse
5. Drugs: Doxorubicin, Cocaine
6. Pregnancy: late or right after birth

7. wet Beriberi
8. Chagas disease

268

Treatment of dilated cardiomyopathy?

Transplant

269

Hypertrophic cardiomyopathy is what?

Massive hypertrophy of left ventricle

270

What causes hypertrophic cardiomyopathy?

Genetic mutations in sarcomere proteins (autosomal dominant)

271

Clinical features of hypertrophic cardiomyopathy? 3

1. Decreased cardiac output: Too much muscle --> Lose compliance --> Diastolic dysfunction
2. Sudden death due to ventricular arrhythmias
3. Syncope with exercise: IV septum creates block in LV --> Blood can't get out well

272

What genetic disease is associated with hypertrophic cardiomyopathy?

Friedreich's ataxia

273

Microscopic features of hypertrophic cardiomyopathy?

Disoriented, tangled, hypertrophied myocardial fibers

274

Treatment of hypertrophic cardiomyopathy?

1. Beta blocker
2. Calcium channel blocker

275

Restrictive cardiomyopathy is what?

Diastolic problem of not being able to fill due to decreased compliance of ventricular myocardium.

276

Causes of restrictive cardiomyopathy?

A SHELF

Amyloidosis

Sarcoidosis: Granulomas in wall of heart
Hemochromatosis: Iron in wall of heart
Endocardial fibroelastosis: FIbrosis in endocardium
Loeffler Syndrome: Eosinophil infiltrate of heart
Fibrosis Postradiation

277

Which cause of restrictive cardiomyopathy is seen in children?

Endocardial fibroelastosis

278

How does restrictive cardiomyopathy present? (3)

1. CHF: Can't fill heart --> Backs up
2. Low-voltage EKG
3. Diminished QRS amplitudes

279

Two cardiac tumor types?

1. Myxoma
2. Rhabdomyoma

280

Myxoma is what?

Mesenchymal proliferation with gelatinous appearance to tumor

281

Myxoma has abundant what?

Ground substance

282

Myxoma is most primary cardiac tumor in what demogrpahic?

Adults

283

Can myocytes form tumors?

No

284

How does myxoma present?

Pedunculated mass in left atrium obstructing the mitral valve --> Syncope

285

What is rhabdomyoma?

Hamartoma of cardiac muscle

286

Rhabdomyoma is most common primary cardiac tumor in what demographic?

Children

287

Rhabdomyoma is associated with what disease?

Tuberous sclerosis

288

Where does rhabdomyoma grow?

Ventricle

289

Are myxoma and rhabdomyoma benign or malignant?

Benign

290

What is the most common heart tumor?

A metastasis

291

Common metastases primary locations?

1. Breast carcinoma
2. Lung carcinoma
3. Melanoma
4. Lymphoma

292

Metastases usually invade what layer of heart?
Resulting in what?

Pericardium
Pericardial effusion

293

Myocarditis most often presents as what?

Biventricular heart failure in young people with no other major heart diseases

294

Myocarditis morphological characteristics? 2

1. Diffuse myocardial degeneration
2. Necrosis with inflammatory infiltrate

295

Myocarditis has what etiology?
Specifically?

Viral
Coxsackievirus

296

What causes myocarditis in south america?

Chagas disease

297

What is hydropericardium?

Accumulation of serous transudate in pericardial space

298

What causes hydropericardium?
Most often?

Anything that can cause systemic edema.

Hypoproteinemia like in nephrotic syndrome or chronic liver disease

299

What is hemopericardium?

Accumulation of blood in pericardial sac

300

What causes hemopericardium?

Traumatic perforation of heart or aorta by myocardial rupture associated with MI

301

Five types of acute pericarditis?

1. Serous
2. Fibrinous/Serofibrinous
3. Purulent/Suppurative
4. Hemorrhagic
5. Caseous

302

Serous pericarditis is associated with what causes? (3)

1. SLE
2. Rheumatic fever
3. Viral infections

303

What is the liquid in acute pericarditis?

Protein-rich exudate with inflammatory cells

304

What is fibrinous/serofibrinous pericarditis characterized by?

Fibrin-rich exudate

305

What causes fibrinous/serofibrinous pericarditis? 5

1. uremia
2. Myocardial infarction
3. ARF
4. Dressler's syndrome
5. Radiation

306

What is clinical finding in fibrinous/serofibrinous pericarditis?

Loud friction rub

307

Purulent/suppurative pericarditis is characterized by what?

Inflammatory exudate

308

What causes purulent/suppurative pericarditis?

Bacterial infection

309

Hemorrhagic pericarditis is characterized by what?

Bloody inflammatory exudate

310

What causes hemorrhagic pericarditis? 2

1. Tumor invasion
2. TB or other bacterial infection

311

Overall, acute pericarditis presents how? 5

1. Sharp pain
2. Aggravated by inspiration
3. Relieved by sitting up and leaning forward
4. Friction rub
5. ST segment elevation or depression

312

Chronic pericarditis has what etiology? 2

1. TB
2. Pyogenic staph

313

Characteristics of chronic pericarditis? 4

1. Thickening and scarring of pericardium
2. Loss of elasticity
3. Mimics Right sided heart failure
4. Proliferation of fibrous tissue

314

Hypertrophy of left ventricle is caused by what? 2

HTN
Aortic or mitral valvular disease

315

Hypertrophy of right ventricle causes? 4

1. LV failure
2. Chronic lung disease
3. Mitral valve disease
4. Congenital heart disease with L-2-R shunt

316

Define cor pulmonale

Right ventircular hypertrophy secondary to prmary disease of pulmonary vasculature (P-HTN)

317

What is cardiac tamponade?

Compression of heart by fluid in pericardium --> leading to decreased cardiac output.

318

Findings in cardiac tamponade? 6

1. Equilibration of diastolic pressure in all 4 chambers
2. Hypotension
3. Increased JVD
4. Distant heart sounds
5. Increase HR
6. Pulsus paradoxus