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Hailey CRRAB I > First Aid Cardiovascular > Flashcards

First Aid Cardiovascular Flashcards

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1
Q

congenital rubella –>

A 
VSD
PDA
pulmonary artery stenosis
deafness
congenital cataracts
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2
Q

down syndrome –>

A

ASD

VSD

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3
Q

FAS –>

A

VSD
PDA
ASD
TF

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4
Q

Maternal DM I –>

A

TGA

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5
Q

Marfan syndrome –>

A

MVP
thoracic aortic aneurysm and dissection
aortic regurg

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6
Q

prenatal lithium exposure –>

A

Ebstein anomaly (tricuspid valve displaced)

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7
Q

Turner syndrome –>

A

bicuspid aortic valve

coarctation of aorta

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8
Q

Williams syndrome –>

A

supravalvular aortic stenosis

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9
Q

22q11 syndromes –>

A

PTA
TF
(neural crest cells)

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10
Q

Eisenmenger syndrome

A

uncorrected L –> R shunt (VSD, ASD, PDA) –> increased pulmonary blood flow –> pathologic remodeling of vasculature–> pulmonary arterial HTN –> RVH –> becomes R –> L shunt –> late cyanosis, clubbing, polycythemia

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11
Q

Kartagener syndrome

A

primary ciliary dyskinesia
triad: infertility, chronic sinusitis, s_____
defect in left-right dynein (involved in L/R asymmetry) can lead to DEXTROCARDIA

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12
Q

bulbar and truncal ridges derive from

A

neural crest cells

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13
Q

xanthoma

A

plaques or nodules composed of LIPID-LADEN HISTIOCYTES in skin and eyelids

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14
Q

xanthelasma

A

xanthoma in eyelid

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15
Q

tendinous xanthoma

A

lipid deposit in tendon (often Achilles)

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16
Q

corneal arcus

A

lipid deposit in cornea
common in elderly –> arcus senilis
earlier in life in hypercholesterolemia

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17
Q

definition of arteriosclerosis

A

hardening of arteries

arterial wall thickening and loss of elasticity

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18
Q

arteriolosclerosis

A

arteriosclerosis of small arteries and arterioles

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19
Q

two types of arteriolosclerosis

A
  1. HYALINE thickening of vessel walls in essential HTN or DM (pink highlighter around arteriole on histology)
  2. HYPERPLASTIC “onion skinning” in severe HTN with proliferation of SM cells
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20
Q

Monckeberg arteriosclerosis

A 
Medial calcific sclerosis
uncommon
affects medium-sized arteries
calcification of elastic lamina of arteries --> vascular stiffening w/o obstruction
intima NOT involved
does NOT obstruct blood flow
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21
Q

highlighter pink around arteriole lumen on histology slide

A

hyaline arteriolosclerosis

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22
Q

onion skinning appearance on histology slide

A

hyperplastic arteriolosclerosis

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23
Q

definition of atherosclerosis

A

disease of elastic arteries and large-medium0sized muscular arteries
form of arteriosclerosis (hardening/arterial wall thickening) caused by BUILD UP OF CHOLESTEROL PLAQUES

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24
Q

modifiable risk factors for atherosclerosis

A

smoking
HTN
hyperlipidemia
DM

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25
non-modifiable risk factors for atherosclerosis
age sex (increased in men and postemenopausal women) family hx
26
complications of atherosclerosis
``` aneurysms ischemia infarcts peripheral vascular disease (PAD) thrombus emboli ```
27
location of atherosclerosis
abdominal aorta > coronary artery > popliteal artery > carotid artery
28
symptoms of atherosclerosis
angina claudication *may be asymptomatic
29
atherosclerosis progression (pathophysiology)
inflammation important in pathogenesis** endothelial cell dysfxn --> macrophage and LDL accumulation --> foam cell formation --> fatty streaks --> SM cell migration (involves PDGF and FGF), proliferation, extracellular matrix deposition --> fibrous plaque --> complex atheromas
30
define aortic aneurysm
localized pathologic dilatation of the aorta | thoracic or abdominal
31
AAA risk factors
``` associated with ATHEROSCLEROSIS hx of tobacco use increased age male sex family hx ```
32
Thoracic aortic aneurysm risk factors
associated with CYSTIC MEDIAL DEGENERATION HTN bicuspid aortic valve connective tissue disease (Marfan syndrome) tertiary syphilis (obliterative endarteritis of the vasa vasorum)
33
relate tertiary syphilis and vasculature
obliterative endarteritis of the vasa vasorum
34
aortic dissection associations
(longitudinal intimal tear forming false lumen) HTN bicuspid aortic valve inherited connective tissue disorders (eg Marfan)
35
types of aortic dissection
Stanford type A (proximal): - involves Ascending aorta - may extend to arotic arch or descending aorta - tx is surgery Standford type B (distal): - involves descending aorta and/or aortic arch - no ascending aorta involvement - tx with beta-blockers then vasodilators
36
aortic dissection complications
rupture pericardial tamponade death
37
ischemic heart disease manifestations
``` angina coronary steal syndrome myocardial infarction sudden cardiac death chronic ischemic heart disease ```
38
symptoms of MI
``` diaphoresis nausea vomiting severe retrosternal pain pain in L arm and /or jaw SOB fatigue ```
39
commonly occluded coronary arteries
LAD > RCA > circumflex
40
gross, microscopic, and complications of MI @ 0-4 hrs
none none arrhythmia HF cardiogenic shock
41
gross, microscopic, and complications of MI @ 4-24 hrs
dark mottling; pale with tetrazolium stain early coagulative necrosis, release of necrotic cell contents into blood edema hemorrhage wavy fibers neutrophils appear *reperfusion injury may cause contraction bands (due to free radical damage) arrhythmia HF cardiogenic shock
42
gross, microscopic, and complications of MI @ 1-3 days
hyperemia, pale extensive coagulative necrosis tissue surrounding infarct shows acute inflammation with neutrophils postinfarction fibrinous pericarditis
43
gross, microscopic, and complications of MI @ 3-14 days
hyperemic border; central yellow-brown softening maximally yellow and soft by 10 days macrophages then granulation tissue at margins ``` free wall rupture LV pseudoaneurysm (risk of rupture) ```
44
free wall rupture -->
- tamponade - papillary muscle rupture --> mitral regurg - interventricular septal rupture due to marcophage-mediated strux degradation
45
gross, microscopic, and complications of MI @ 2 weeks to several months
recanalized artery grey-white contracted scar complete Dressler syndrome HF arrhythmias true ventricular aneurysm (risk of mural thrombus)
46
gold standard of MI diagnosis within first 6 hours
EKG
47
diagnosis of MI
- EKG changes - cardiac troponin - CK-MB
48
EKG changes in MI
can include: - ST elevation (STEMI, transmural infarct) - ST depression (NSTEMI, subendocardial infarct) - hyperacute (peaked) T wave - T-wave inversion - new LBBB - pathologic Q waves/poor R wave progression
49
types of infarcts and characteristics
transmural - increased necrosis - affects entire wall - ST elevation, Q waves subendocardial - ischemic necrosis of
50
troponin I
rises after 4 hours up for 7-10 days more SPecific (rule IN) than other protein markers
51
CK-MB
rises after 6-12 hours found in myocardium predominantly but also released from skeletal muscle useful: diagnosing reinfarction following acute MI levels return to normal after 48 hours
52
ST elevations or Q waves in V1-V2 indicates...
anteroseptal (LAD) infarct
53
ST elevations or Q waves in V3-V4 indicates...
anteroapical (distal LAD) infarct
54
ST elevations or Q waves in V5-V6 indicates...
anterolateral (LAD or LCX) infarct
55
ST elevations or Q waves in I, aVL indicates...
lateral (LCX) infarct
56
ST elevations or Q waves in II, III, aVF indicates...
inFerior (RCA) infarct
57
MI complications
``` cardiac arrhythmia LV failure --> pulmonary edema cardiogenic shock ventricular free wall rupture ventricular pseudoaneurysm formation true ventricular aneurysm postinfarction fibrinous pericarditis Dressler syndrome ```
58
unstable angina/NSTEMI tx
``` anti-coagulation (heparin) anti-platelet (aspirin + clopidogrel) beta-blocker ACE inhibitor statins ``` symptom control with: nitroglycerin morphine
59
STEMI tx
``` anti-coagulation (heparin) anti-platelet (aspirin + clopidogrel) beta-blocker ACE inhibitor statins *REPERFUSION THERAPY MOST IMPORTANT (PC intervention over fibrinolysis) ``` symptom control with: nitroglycerin morphine
60
dilated cardiomyopathy mnemonic
``` most common (90%) SYSTOLIC DYSFUNCTION ``` ``` ABCCCD alcohol abuse wet beriberi coxsackie b virus myocarditis chronic cocaine use chagas disease doxorubicin toxicity + hemochromatosis sarcoidosis peripartum cardiomyopathy ```
61
dilated cardiomyopathy tx
``` Na+ restriction ACE inhibitor beta-blocker diuretics digoxin ICD heart transplant ```
62
hypertrophic cardiomyopathy tx
cessation of high-intensity athletics beta-blocer or non-dihydropyridien Ca2+ channel blocker ICD if patient is high risk
63
hypertrophic cardiomyopathy characteristics
DIASTOLIC DYSFUNCTION 60-70% of cases are familial, AUTOSOMAL DOMINANT can be assoc with Friedreich ataxia --> syncope during exercise and may lead to death in young athletes due to ventricular arrhythmia - marked vetnricular hypertrophy, often septal predominancy
64
restrictive/infiltrative cardiomyopathy characteristics
DIASTOLIC DYSFUNCTION ``` major causes: sarcoidosis amyloidosis postradiation fibrosis endocardial fibroelastosis Loffler syndrome hemochromatosis (also dilated cm) ```
65
classic LHF
pulmonary edema orthopnea paroxysmal nocturnal dyspnea
66
classic RHF
peripheral edema hepatomegaly (nutmeg liver) jugular venous distention
67
systolic dysfunction pathophysiology
reduced EF increased EDV decreased contractility (often secondary to ischemia/MI or dilated cardiomyopathy)
68
diastolic dysfunction pathophysiology
preserved EF normal EDV decreased compliance (often secondary to myocardial hypertrophy)
69
most common cause of RHF is...
LHF
70
isolated RHF is usually due to...
cor pulmonale
71
HF tx
decrease mortality: ACE inhibitors or ARBs beta-blockers (except in acute decompensated HR) spironolactone symptom relief: thiazide or loop diuretics improved symptoms and mortility: hydralazine with nitrate therapy
72
sudden cardiac death most commonly due to... associated with...
lethal arrhythmia (ventricular fibrillation) CAD (70% of cases) cardiomyopathy (hypertrophic, dilated) hereditary ion channelopathies (eg long QT syndrome, Brugada syndrome)
73
define chronic ischemic heart disease
progressive onset of HF over many years due to chronic ischemic myocardial damage
74
types of shock
hypovolemic cardiogenic obstructive distributive
75
hypovolemic shock
by hemorrhage, dehydration, burns skin: clammy, cold DECREASED CVP/PRELOAD** decrased CO increased SVR/afterload
76
hypovolemic shock tx
IV fluids
77
cardiogenic shock
acute MI HF valvular dysfunction arrhytmia skin: cold, clammy increased CVP/preload DECREASED CO** increased SVR/afterload
78
cardiogenic shock tx
inotropes | diuresis
79
obstructive shock
cardiac tamponade PE skin: cold, clammy increased CVP/preload DECREASED CO** increased SVR/afterload
80
obstructive shock
relieve obstruction
81
distributive shock
sepsis CNS injury anaphylaxis skin: warm, dry decreased CVP/preload increased CO DECREASED SVR/AFTERLOAD**
82
distributive shock tx
pressors, IV fluids
83
systemic inflammatory response syndrome
``` >2: fever/hypothermia tachycardia tachypnea leukocytosis/leukopenia ```
84
first sign of shock
tachycardia
85
end result of shock
multiple organ dysfunction syndrome (MODS)
86
cardiac tumors
myxomas rhabdomyomas *most common heart tumor is a metastasis*
87
myxoma
most common primary cardiac tumor in adults 90% occur in LA "ball valve" obstruction in LA associated with multiple syncopal episodes early diastolic "tumor plop" sound
88
rhabdomyomas
most freq primary cardiac tumor in children associated with tuberous sclerosis
89
Kussmaul sign pathophys
increase in JVP on inspiration instead of a normal decrease *inspiration --> negative intrathoracic pressure not transmitted to heart --> impaired filling of RV --> blood backs up into venae cavae --> JVD
90
Kussmaul sign seen in...
constrictive pericarditis restrictive cariomyopathies RA/RV tumors
91
Large-vessel vasculitis
Temporal (giant cell) arteritis | Takayasu arteritis
92
Medium-vessel vasculitis
``` Polyarteritis nodosa Kawaskai disease Buerger disease (thromboangiitis obliterans) ```
93
Small-vessel vasculitis
Granulomatosis with polyangiitis (Wegener) Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) Henoch-Schonlein purpura (HSP)
94
Temporal (giant cell) arteritis
usually elderly females unilateral HA (temporal artery) jaw claudication most commonly affects branches of carotid artery may lead to --> blindness due to opthalmic arter occlusion associated with polymyalgia rheumatica (PMR) focal granulamtous inflammation increased ESR
95
Temporal (giant cell) arteritis tx
high-dose corticosteroids (prior to temporal artery biopsy to prevent blindness)
96
Takayasu arteritis
usually asian female
97
Takayasu arteritis tx
corticosteroids
98
polyarteritis nodosa
young adults hepatitis b seropositivity in 30% ``` fever weight loss malaise HA GI: abdominal pain, melena HTN neuralgic dysfxn cutaneous eruptions renal damage ```

Hailey CRRAB I (5 decks)

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