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Flashcards in CV path Deck (129):
1

R -> L shunt

early cyanosis, blue baby
urgent surgical correction and/or maintenance of PDA

2

R -> L shunt causes

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)

3

D-transposition of great vessels

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

4

tricuspid atresia

absence of tricuspid valve and hypoplastic RV
requires both ASD and VSD for viability

5

tetralogy of fallot

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

6

TAPVR

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

7

L->R shunt

late cyanosis -> blue kids
VSD>ASD>PDA

8

VSD

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

9

ASD

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

10

PDA

assocaited with continuous machine like murmur

11

eisenmenger syndrome

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

12

coarctation of aorta

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

13

alcohol exposure in utero

VSD
PDA
ASD
tetralogy of fallot

14

congenital rubella

septal defects
PDA
pulmonary a stenosis

15

downs

AV septal defect (endocardial cushion defect)
ASD
VSD

16

DM

transposition of great vessels

17

marfans

MVP
thoracic aortic aneurysm and dissection
aortic regurg

18

prenatal lithium exposure

ebstein anomaly
septal and post leaflets of tricuspid displaced toward apex

19

turners

bicuspid aortic valve
coarctation of aorta

20

williams syndrome

supravalvular aortic stenosis

21

22q11

truncus arteriosis
tetraology of fallot

22

mockenberg

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

23

obliterative endarteritis of vasa basorum

thoracic aortic aneurysm d/t tertiary syphilis

24

aortic dissection

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

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