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CV path Flashcards

1
Q

R -> L shunt

A

early cyanosis, blue baby

urgent surgical correction and/or maintenance of PDA

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2
Q

R -> L shunt causes

A 
5 T's
Truncus arteriosus (1 vessel)
Transposition (2 switched vessels)
Tricuspid atresia (3=Tri)
Tetrology of Fallot (4=tetra)
TAPCR (5 letters in name)
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3
Q

D-transposition of great vessels

A

not compatible w/life w/o shunt (VSD, PDA, PFO)

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4
Q

tricuspid atresia

A

absence of tricuspid valve and hypoplastic RV

requires both ASD and VSD for viability

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5
Q

tetralogy of fallot

A

d/t anterosuperior displacement of infundibular septum
MCC of early childhood cyanosis
PROVe
Pulmonary infundibular stenosis (prognostic)
Right ventricular hypertrophy (boot shape on CXR)
Overriding aorta
VSD

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6
Q

TAPVR

A

total anomalous pulmonary venous return
pulmonary vv drain into right heart circulation
associated with ASD and PSD to allow for R->L shunting to maintain CO

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7
Q

L->R shunt

A

late cyanosis -> blue kids

VSD>ASD>PDA

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8
Q

VSD

A

MC congenital cardiac defect
most self resolve
if large enough may lead to LV overload and HF

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9
Q

ASD

A

loud S1
wide fixed split of S2
ostium secundum defects most common (isolated)
ostium primum defects (other cardiac anomalies)
distinct from foramen ovale in that septa are missing rather then unfused

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10
Q

PDA

A

assocaited with continuous machine like murmur

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11
Q

eisenmenger syndrome

A

uncorrected L->R shunt -> increased pulmonary flow -> pulmonary HTN -> RVH occurs to compensate -> shunt becomes R -> L -> cyanosis, clubbing, polycythemia

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12
Q

coarctation of aorta

A

bicuspid aortic valve
turners
HTN in upper extremities and weak pulse in lower
erosion of ribs by collateral aa

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13
Q

alcohol exposure in utero

A

VSD
PDA
ASD
tetralogy of fallot

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14
Q

congenital rubella

A

septal defects
PDA
pulmonary a stenosis

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15
Q

downs

A

AV septal defect (endocardial cushion defect)
ASD
VSD

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16
Q

DM

A

transposition of great vessels

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17
Q

marfans

A

MVP
thoracic aortic aneurysm and dissection
aortic regurg

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18
Q

prenatal lithium exposure

A

ebstein anomaly

septal and post leaflets of tricuspid displaced toward apex

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19
Q

turners

A

bicuspid aortic valve

coarctation of aorta

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20
Q

williams syndrome

A

supravalvular aortic stenosis

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21
Q

22q11

A

truncus arteriosis

tetraology of fallot

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22
Q

mockenberg

A 
medial calcific sclerosis 
uncommon
affects medium sized aa
calcification of elastic lamina of aa -> vascular stiffening w/o obstruction 
pipestem appearance on XRAY 
does  NOT obstruct blood flow 
intima NOT involved
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23
Q

obliterative endarteritis of vasa basorum

A

thoracic aortic aneurysm d/t tertiary syphilis

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24
Q

aortic dissection

A

intimal tear

associated w/HTN, bicuspid aortic valve, inherited CT dis

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25
Stanford type A aortic dissection
proximal involves ascending aorta surgery
26
stanford type B aortic dissection
distal involves descending aorta and/or arch ascending aorta NOT involved Tx medically w/beta blockers, then vasodilators
27
prinzmental angina
``` aka variant secondary to coronary a spasm transient ST elevation triggers: tabacco, cocaine, triptans Tx: CCBs, nitrates, smoking cessation ```
28
coronary steal
distal to coronary stenosis vessels maximally dilated at baseline administration of vasodilators dialtes normal vessels and shunts blood toward well-perfused ares -> decreased flow to heart used in pharm stress test
29
MI
LAD>RCA>circumflex
30
MI gross 0-4 hrs
none
31
MI light 0-4 hrs
none
32
MI complications 0-4 hrs
arrhythmia HF cardiogenic shock
33
MI 4-24 hr gross
dark mottling | pale w/tetrazolium stain
34
MI 4-24 hr light
early coagulative necrosis release of necrotic cell contnets into blood edema hemorrhage wavy fivers neutros reperfusion injury may cause contraction bands
35
MI 4-24 hrs complications
arrhythmia HF cardiogenic shock
36
MI 1-3 days gross
hyperemia
37
MI 1-3 days light
extensive coagulative necorsis | acute inflammation w/neutros
38
MI 1-3 days complications
post MI fibrinous pericarditis
39
MI 3-14 days gross
hyperemic border around central yellow-brown softening | maximally yellow and soft by 10 days
40
MI 3-14 days light
macros | granulation tissue at margins
41
MI 3-14 days complications
free wall rupture -> tamponade; papillary mm rupture -> mitral regurg -> interventricular septal rupture d/t macro mediated degradation LV pseudoaneurysm
42
MI 2 wks- 2mo gross
recanalized aa | gray-white scar
43
MI 2wks-2mo light
contracted scar complete
44
MI 2wk-2mo complications
``` dressler syndrome HF arrhythmias true ventricular aneurysm risk of mural thrombus ```
45
Dx of MI first 6 hrs
EKG gold standard ST elevation (transmural) or depression (subendo) hyperacute/peaked T waves T wave inversion new LBBB pathologic Q waves poor R wave progression (evolving or old transmural infarct
46
cardiac troponin I
rises after 4hrs and is high for 7-10 days | most specific
47
CK-MB
rises after 6-12 hrs | return to normal in 48hrs
48
transmural infarcts
ST elevation increased necrosis affects entire wall
49
subendocardial infarcts
d/t ischemic necrosis
50
anteroseptal MI
LAD | V1-2
51
anteroapical MI
distal LAD | V3-4
52
anterolateral MI
LAD or LCX | V5-6
53
lateral MI
LCX | I, aVL
54
inferior MI
RCA | II, III, aVF
55
dresseler syndrome
autoimmune phenomenon resulting in fibrinous pericarditis fever pain
56
Tx of unstable angina and/or NSTEMI
``` anticoagulate antiplatelet beta blockers ACEIs statins nitro and morphine ```
57
STEMI
same as NSTEMI plus reperfusion therapy
58
dilated cardiomyopathy
MC cardiomyopathy | often idiopathic or familiar
59
causes of dilated cardiomyopathy
``` ABCCD alcohol wet Beriberi Coxsackie B virus myocarditis Chagas disease Doxorubicin toxcicity hemochromatosis sarcoidosis peripartum cardiomyopathy ```
60
findings of dilated cardiomyopathy
``` HF S3 systolic regurgitant murmur systolic dysfnx dialated heart of ECG ballon appearance on CXR ```
61
Tx of dilated cardiomyopathy
``` Na restriction ACEI BB diuretics digoxin ICD heart transplant ```
62
hypertrophic cardiomyopathy
60-70% familial AD (beta-myosin mutation) associated w/Friedreich ataxia syncope during exercise and SCD
63
findings of hypertrophic cardiomyopathy
S4 systolic murmur mitral regurg diastolic dysfunction
64
Tx of hypertrophic cardiomyopathy
no high- intensity activity BB nondihydropyridine CABs ICD if pt at high risk
65
obstructive hypertrophic cardiomyopathy
asymmetric septal hypertrophy and systolic ant motion of mitral valve -> outflow obstruction -> dyspnea and syncope
66
restrictive/infiltrative cardiomyopathy causes
``` sarcoidosis amyloidosis postradiation fibrosis endocardial fibroelastosis (young kids) loffler syndrome hemochromatosis ```
67
restrictive/infiltrative cardiomyopathy
diastolic dysfunction | low ECG despite thick myocardium
68
loffler syndrome
endomyocardial fibrosis w/prominent eosinophilic infiltrate
69
systolic dysfnx
reduced EF increased EDV decreased contractility often secondary to ischemia/MI or dilated cardiomyopathy
70
diastolic dysfnx
preserved EF normal EDV decreased compliacne often secondary to myocardial hypertrophy
71
what improves mortality in HF pt
hydralazine eith nitrate therapy
72
signs of L HF
orthopnea paroxysmal nocturnal dyspnea pulmonary edema
73
signs of R HF
hepatomegaly (nutmeg liver) JVD peripheral edema
74
hypovolemic shock
``` d/t hemorrhage, dehydration, burns skin cold and clammy CVP/preload very decreased CO decreased SVR/afterload increased Tx fluids ```
75
cardiogenic shock
``` d/t acute MI, HF, valvular dysfnx, arrhythmia skin cold and clammy CVP/preload increased CO very decreased SVR/afterload increased Tx inotropes, diuresis ```
76
obstructive cardiogenic shock
``` d/t tamponade, PE skin cold and clammy CVP/preload increased CO very decreased SVR/afterload increased Tx inotropes, diuresis ```
77
distributive shock
``` d/t sepsis, CNS injury, anaphylaxis skin warm and dry CVP/preload decreased CO increased SVR/afterload very decreased Tx pressors, fluid ```
78
bacterial endocarditis
``` FROM JANE fever Roth spots Osler nodes Murmur (new) Janeway lesions Anemia Nail-bed hemorrhage Emboli ```
79
roth spots
round white spots on retina surrounded by hemorrhage
80
osler nodes
tender raised lesions on finger or toe pads
81
janeway lesions
small painless erythematous lesions on palm or sole
82
acute bacterial endocarditis
S. aureus
83
subacute bacterial endocarditis
viridans
84
prosthetic valve endocarditis
S. epidermis
85
nonbacterial endocarditis
aka marantic/thrombotic secondary to malignancy hypercoaguable state lupus
86
IV drug abuse endocarditis
tricuspid S. aureus pseudo candida
87
culture neg endocarditis
coxiella burnetti bartonella HACEK
88
HACEK
Haemophilus actinobacillus cardiobacterium eikenella kingella
89
RF murmurs
early MR late MS
90
jones criteria
``` Joint carditis Nodules in skin (subQ) Erythema marginatum Sydenham chorea ```
91
cardiac tamponade
Beck's triad increased HR pulsus paradoxus low voltage QRS and electrical alterans
92
becks triad
hypotension distended neck vv distant heart sounds
93
pulsus peridoxus
``` decrease in amplitude of systolic BP by >10mmHg during inspiration cardiac tamponade asthma obstructive sleep apnea pericarditis croup ```
94
syphilitic heart disease
tertiary disrupts vasa vasorum of aorta -> atrophy of vessel wall and dilation of aorta and valve ring -> thoracic aneurysm calcification in aortic root -> tree bark appearance
95
myxomas
MC primary cardiac tumor in adults 90% in atria ball valve obstruction -> multiple sycopal episodes diastolic tumor 'plop' sound
96
rhabdomyomas
MC cardiac tumor in kids | tuberous sclerosis
97
kussmaul sign
increased JVP on inspiration instead of normal decrease | seen with constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumorjs
98
angiosarcomas
``` rare blood vessel malignancy head, neck, breast areas usually in elderly on sunexposed areas associated w/radiation, postmastectomy lymphedema, poor prognosis ```
99
hepatic angiosarcomas
vinyl chloride and arsenic exposure | poor prognosis
100
bacillary angiomatosis
``` benign capillary skin papules AIDS Bartonella henselae infections frequently mistaken for kaposi sarcoma neutros ```
101
cherry hemangioma
benign capillary hemangioma of elderly | does not regress
102
cystic hygroma
cavernous lymphangioma of neck | turners
103
glomus tumor
bengin painful, red/blue tumor under fingernails | arises from modified smooth mm cells of thermoregulatory glomus body
104
kaposi sarcoma
``` endothelial malignancy skin (MC), mouth, GI, respiratory tract HHV-8 HIV frequently mistaken for bacillary angiomatosis, but lymphocytic infiltrate ```
105
pyogenic granuloma
polypoid capillary hemangioma ulcerates and bleeds associated w/trauma and prego
106
strawberry hemangioma
benign capillary hemagioma of infancy appears in first few wks of life grows rapidly and regresses spontaneously by 5-8
107
secondary causes of Raynauds
SLE CREST CT disease
108
Tx of raynauds
CABs
109
large vessel vasculitis
temporal | takayasu
110
temporal/giant cell arteriits
``` usually elderly females u/l HA and jaw claudication may lead to irreversible blindness d/t opthalmic a occlusion associated w/polyarthritis rheumatica focal granulomatous inflammation Tx w/high dose corticosteroids ```
111
takayasu arteritis presentation
usually asian females
112
takaysu path and Tx
granulomatous thickening and narrowing of arotic arch and proximal great vessels Tx corticosteroids
113
medium vessel vasculitis
polyarteritis nodosa kawasaki disease buerger disease
114
polyarteritis nodosa presenation
``` young adults hepB seropositive (30%) fever weight loss malaise HA GI: pain, melena HTN neuro dysfnx cutaneous eruptions renal damage ```
115
polyarteritis nodosa path
renal and visceral vessels, not pulmonary aa IC mediated trasmural inflammation -> fibrinoid necrosis innumerable renal microaneurysms and spasms Tx corticosteroids, cyclophosphamide
116
kawasaki disease
asian kids
117
kawasaki complications and Tx
coronary a aneurysms, thrombosis, or rupture -> death | Tx IV IG and aspirin
118
buerger disease
aka throboangiitis obliterans heavy smokers males gangrene, autoamputation, superficial nodular phlebitis raynauds
119
small vessel vasculitis
granulomatosis w/polyangitis (wegener) microscopic polyangiitis eosinophilic granulomatosis w/polyangiitis (churg-strauss) henoch-schonelein purpura
120
granulomatosis w/polyangitis presentation
wegners URT: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis LRT: hemoptysis, cough, dyspnea renal: hematuria, red cell casts
121
granulomatosis w/polyangitis path
triad: focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, necrotizing glomerulonephritis PR3-ANCA/c-ANCA/anti-proteinase3 CXR large nodular densities
122
granulomatosis w/polyangitis Tx
cyclophosphamide | corticosteroids
123
microscopic polyangitis presentation
necrotizing vasculitis commonly involving lung, kidneys, and skin pauci-immune glomerulonephritis and palpable purpura presents like granulomatosis w/polyangitis, but not nasopharyngeal involvement
124
microscopic polyangitis path
NO granulomas | MPO-ANCA/p-ANCA/anti-myeloperoxidase
125
microscopic polyangitis Tx
cyclophosphamide | corticosteroids
126
eosinophilic granulomatosis w/polyangiitis presentation
``` aka churg strauss asthma sinusitis skin nodules or purpura peripheral neuropathy (wrist/foot drop) heart, GI, kidneys (pauci-immune glomerulonephritis) ```
127
eosinophilic granulomatosis w/polyangiitis path
granulomatous, necrotizing vasculitis w/eos MPO-ANCA/p-ANCA/anti-myeloperoxidase increased IgE
128
henoch-schonlein purpura presentation
MC childhood systemic vasculitis often follows URI triad: palpable purpura on buttocks and legs, arthralgias, GI pain
129
henoch-schonlein purpura path
casculitis secondary to IgA ICs | associated w/IgA nephropathy/Bergers disease

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