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Hailey CRRAB I > First Aid Cardiovascular > Flashcards

First Aid Cardiovascular Flashcards

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
Q

non-modifiable risk factors for atherosclerosis

A

age
sex (increased in men and postemenopausal women)
family hx

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26
Q

complications of atherosclerosis

A 
aneurysms
ischemia
infarcts
peripheral vascular disease (PAD)
thrombus
emboli
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27
Q

location of atherosclerosis

A

abdominal aorta > coronary artery > popliteal artery > carotid artery

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28
Q

symptoms of atherosclerosis

A

angina
claudication
*may be asymptomatic

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29
Q

atherosclerosis progression (pathophysiology)

A

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

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30
Q

define aortic aneurysm

A

localized pathologic dilatation of the aorta

thoracic or abdominal

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31
Q

AAA risk factors

A 
associated with ATHEROSCLEROSIS
hx of tobacco use
increased age
male sex
family hx
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32
Q

Thoracic aortic aneurysm risk factors

A

associated with CYSTIC MEDIAL DEGENERATION
HTN
bicuspid aortic valve
connective tissue disease (Marfan syndrome)
tertiary syphilis (obliterative endarteritis of the vasa vasorum)

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33
Q

relate tertiary syphilis and vasculature

A

obliterative endarteritis of the vasa vasorum

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34
Q

aortic dissection associations

A

(longitudinal intimal tear forming false lumen)
HTN
bicuspid aortic valve
inherited connective tissue disorders (eg Marfan)

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35
Q

types of aortic dissection

A

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
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36
Q

aortic dissection complications

A

rupture
pericardial tamponade
death

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37
Q

ischemic heart disease manifestations

A 
angina
coronary steal syndrome
myocardial infarction
sudden cardiac death
chronic ischemic heart disease
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38
Q

symptoms of MI

A 
diaphoresis
nausea
vomiting
severe retrosternal pain
pain in L arm and /or jaw
SOB
fatigue
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39
Q

commonly occluded coronary arteries

A

LAD > RCA > circumflex

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40
Q

gross, microscopic, and complications of MI @ 0-4 hrs

A

none

none

arrhythmia
HF
cardiogenic shock

41
Q

gross, microscopic, and complications of MI @ 4-24 hrs

A

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
Q

gross, microscopic, and complications of MI @ 1-3 days

A

hyperemia, pale

extensive coagulative necrosis
tissue surrounding infarct shows acute inflammation with neutrophils

postinfarction fibrinous pericarditis

43
Q

gross, microscopic, and complications of MI @ 3-14 days

A

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
Q

free wall rupture –>

A
  • tamponade
  • papillary muscle rupture –> mitral regurg
  • interventricular septal rupture due to marcophage-mediated strux degradation
45
Q

gross, microscopic, and complications of MI @ 2 weeks to several months

A

recanalized artery
grey-white

contracted scar complete

Dressler syndrome
HF
arrhythmias
true ventricular aneurysm (risk of mural thrombus)

46
Q

gold standard of MI diagnosis within first 6 hours

A

EKG

47
Q

diagnosis of MI

A
  • EKG changes
  • cardiac troponin
  • CK-MB
48
Q

EKG changes in MI

A

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
Q

types of infarcts and characteristics

A

transmural

  • increased necrosis
  • affects entire wall
  • ST elevation, Q waves

subendocardial
- ischemic necrosis of

50
Q

troponin I

A

rises after 4 hours
up for 7-10 days
more SPecific (rule IN) than other protein markers

51
Q

CK-MB

A

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
Q

ST elevations or Q waves in V1-V2 indicates…

A

anteroseptal (LAD) infarct

53
Q

ST elevations or Q waves in V3-V4 indicates…

A

anteroapical (distal LAD) infarct

54
Q

ST elevations or Q waves in V5-V6 indicates…

A

anterolateral (LAD or LCX) infarct

55
Q

ST elevations or Q waves in I, aVL indicates…

A

lateral (LCX) infarct

56
Q

ST elevations or Q waves in II, III, aVF indicates…

A

inFerior (RCA) infarct

57
Q

MI complications

A 
cardiac arrhythmia 
LV failure --> pulmonary edema
cardiogenic shock 
ventricular free wall rupture
ventricular pseudoaneurysm formation
true ventricular aneurysm
postinfarction fibrinous pericarditis
Dressler syndrome
58
Q

unstable angina/NSTEMI tx

A 
anti-coagulation (heparin)
anti-platelet (aspirin + clopidogrel)
beta-blocker 
ACE inhibitor
statins

symptom control with:
nitroglycerin
morphine

59
Q

STEMI tx

A 
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
Q

dilated cardiomyopathy mnemonic

A 
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
Q

dilated cardiomyopathy tx

A 
Na+ restriction
ACE inhibitor
beta-blocker
diuretics
digoxin
ICD
heart transplant
62
Q

hypertrophic cardiomyopathy tx

A

cessation of high-intensity athletics
beta-blocer or non-dihydropyridien Ca2+ channel blocker
ICD if patient is high risk

63
Q

hypertrophic cardiomyopathy characteristics

A

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
Q

restrictive/infiltrative cardiomyopathy characteristics

A

DIASTOLIC DYSFUNCTION

major causes:
sarcoidosis
amyloidosis
postradiation fibrosis
endocardial fibroelastosis
Loffler syndrome
hemochromatosis (also dilated cm)
65
Q

classic LHF

A

pulmonary edema
orthopnea
paroxysmal nocturnal dyspnea

66
Q

classic RHF

A

peripheral edema
hepatomegaly (nutmeg liver)
jugular venous distention

67
Q

systolic dysfunction pathophysiology

A

reduced EF
increased EDV
decreased contractility (often secondary to ischemia/MI or dilated cardiomyopathy)

68
Q

diastolic dysfunction pathophysiology

A

preserved EF
normal EDV
decreased compliance (often secondary to myocardial hypertrophy)

69
Q

most common cause of RHF is…

A

LHF

70
Q

isolated RHF is usually due to…

A

cor pulmonale

71
Q

HF tx

A

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
Q

sudden cardiac death most commonly due to…

associated with…

A

lethal arrhythmia (ventricular fibrillation)

CAD (70% of cases)
cardiomyopathy (hypertrophic, dilated)
hereditary ion channelopathies (eg long QT syndrome, Brugada syndrome)

73
Q

define chronic ischemic heart disease

A

progressive onset of HF over many years due to chronic ischemic myocardial damage

74
Q

types of shock

A

hypovolemic
cardiogenic
obstructive
distributive

75
Q

hypovolemic shock

A

by hemorrhage, dehydration, burns

skin: clammy, cold

DECREASED CVP/PRELOAD**
decrased CO
increased SVR/afterload

76
Q

hypovolemic shock tx

A

IV fluids

77
Q

cardiogenic shock

A

acute MI
HF
valvular dysfunction
arrhytmia

skin: cold, clammy

increased CVP/preload
DECREASED CO**
increased SVR/afterload

78
Q

cardiogenic shock tx

A

inotropes

diuresis

79
Q

obstructive shock

A

cardiac tamponade
PE

skin: cold, clammy

increased CVP/preload
DECREASED CO**
increased SVR/afterload

80
Q

obstructive shock

A

relieve obstruction

81
Q

distributive shock

A

sepsis
CNS injury
anaphylaxis

skin: warm, dry

decreased CVP/preload
increased CO
DECREASED SVR/AFTERLOAD**

82
Q

distributive shock tx

A

pressors, IV fluids

83
Q

systemic inflammatory response syndrome

A 
>2:
fever/hypothermia
tachycardia
tachypnea
leukocytosis/leukopenia
84
Q

first sign of shock

A

tachycardia

85
Q

end result of shock

A

multiple organ dysfunction syndrome (MODS)

86
Q

cardiac tumors

A

myxomas
rhabdomyomas
most common heart tumor is a metastasis

87
Q

myxoma

A

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
Q

rhabdomyomas

A

most freq primary cardiac tumor in children

associated with tuberous sclerosis

89
Q

Kussmaul sign pathophys

A

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
Q

Kussmaul sign seen in…

A

constrictive pericarditis
restrictive cariomyopathies
RA/RV tumors

91
Q

Large-vessel vasculitis

A

Temporal (giant cell) arteritis

Takayasu arteritis

92
Q

Medium-vessel vasculitis

A 
Polyarteritis nodosa
Kawaskai disease
Buerger disease (thromboangiitis obliterans)
93
Q

Small-vessel vasculitis

A

Granulomatosis with polyangiitis (Wegener)
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Henoch-Schonlein purpura (HSP)

94
Q

Temporal (giant cell) arteritis

A

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
Q

Temporal (giant cell) arteritis tx

A

high-dose corticosteroids (prior to temporal artery biopsy to prevent blindness)

96
Q

Takayasu arteritis

A

usually asian female

97
Q

Takayasu arteritis tx

A

corticosteroids

98
Q

polyarteritis nodosa

A

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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