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Cardio Drugs > Pathology > Flashcards

Pathology Flashcards

0
Q

Aortic stenosis

A

Diamond shaped (crescendo decrescendo) systolic murmur, elderly due to calcinosis of aortic leaflets, PE shows diminished carotid pulse during systole called pulsus parvus et tardus

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1
Q

Kawasaki presentation

A

Persistent fever, bilateral conjunctivitis, lymphadenopathy, cutaneous involvement (rash from extremities to trunk), CORONARY artery aneurysm
give child aspirin

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2
Q

Drugs causing QT prolongation (torsades de pointes)

A

Quinidine, procainamide, disopyramide, ibutilide, dofetilide, sotalol, TCAs, phenothiazines

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3
Q

22q11 syndromes

A

TOF, aortic arch anomalies, truncus arteriosus

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4
Q

Down syndrome

A

ASD, VSD, AV septal defect (endocardium cushion defect), regurgant AV valves

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5
Q

Congenital Rubella

A

PDA, septal defects, pulmonary artery stenosis

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6
Q

Turner syndrome

A

Coarctation of the aorta

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7
Q

Marfans syndrome

A

Cystic medial necrosis of aorta, aortic insufficieny and dissection

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8
Q

Infant of diabetic mother

A

Transposition of the great vessels

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9
Q

Tuberous sclerosis

A

Valvular obstruction due to cardiac rhabdomyoma

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10
Q

Friedreichs ataxia

A

Hypertrophic cardiomyopathy

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11
Q

Uncorrected PDA

A

Late cyanosis in LOWER extremities only, UE is spared

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12
Q

Prognosis of TOF

A

Severity of pulmonary stenosis

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13
Q

Abnormal neural crest migration

A

TOF, transposition of great vessels, persistent truncus arteriosus

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14
Q

Anterosuperior displacement of infundibular septum

A

TOF

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15
Q

Failure of aorticopulmonary septum to spiral

A

Transposition of great vessels

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16
Q

Atheroma

A

Plaque in small blood vessel

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17
Q

Xanthoma

A

Plaques or nodules composed of lipid-laden histiocytes in skin especially eyelids (xanthelasma)

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18
Q

Tendinous xanthoma

A

Lipid deposit in tendon, especially Achilles

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19
Q

Corneal arcus

A

Lipid deposit in cornea

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20
Q

Arteriosclerosis

A

Hardening of arteries

Monckeberg, arteriolosclerosis, atherosclerosis

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21
Q

Monckeberg

A

Calcification in the media of the arteries, especially radial or ulnar. Benign (intima not involved); does not obstruct blood flow

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22
Q

Arteriolosclerosis

A

2 types:

1) hyaline- eosiniohilic thickening of small aa. in non malignant (essential) HTN or DM
2) hyperplastic- onion skinning due to malignant HTN (>180/120)

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23
Q

Atherosclerosis

A

Fibrous plaques and atheromas form in INTIMA of arteries

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24
Q

Atherosclerosis location

A

Abdominal aorta> coronary artery> popliteal artery> carotid artery

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25
Q

Atherosclerosis progression

A
  1. Endothelial cell dysfunction
  2. macrophage and LDL accumulation
  3. foam cell formation
  4. fatty streaks
  5. smooth m. Cell migration (PDGF, FGF), proliferation, ECM deposition
  6. fibrous plaques
  7. complex atheromas
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26
Q

Angina

A

No symptoms until more than 75% occluded

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27
Q

Abdominal aorta aneurysm

A

Atherosclerosis, HTN male smoker

28
Q

Thoracic aortic aneurysm

A

HTN, Marfan’s, tertiary syphillis

29
Q

Tearing chest pain radiating to the back

A

Aortic dissection

30
Q

Aortic dissection

A

HTN= greatest risk factor!
Caused by intimal tear creating a false lumen
CT shows double barrel aorta
CXR shows mediastinal widening
Can result in pericardial tamponade, aortic rupture, death

31
Q

Aortic dissection– type A (proximal brachiocephalic trunk)

A

Right arm BP 120/60

Left arm BP 220/130

32
Q

Stable angina

A

Secondary to atherosclerosis, ST depression, no thrombus, relieved by rest

33
Q

Prinzmetals variant

A

Secondary to coronary artery spasm (cocaine use), ST elevation

34
Q

Unstable/crescendo angina

A

THROMBOSIS with incomplete coronary artery occlusion; ST depression

35
Q

Coronary steal syndrome

A

Vasodilator may aggravate ischemia by shunting blood away from area of critical stenosis to an area of higher perfusion (nitroglycerin tab)

36
Q

MI

A

Most due to acute thrombosis due to coronary atherosclerosis with COMPLETE occlusion of coronary artery and myocyte necrosis (within 5 minutes), initially ST depression and can progress to ST elevation with transmural necrosis

37
Q

Sudden cardiac death

A

Most due to fatal arrhythmia (v fib) —associated with CAD

38
Q

Chronic ischemic heart disease

A

Progressive to CHF over many years due to chronic ischemic myocardial damage;

39
Q

MI 0-4 hrs

A

Gross- none

LM- none

Risk- arrhythmia, CHF, cardiogenic shock

40
Q

MI 4-12 hrs

A

Gross- dark mottling, pale with tetrazoleum stain

LM- early coagulation necrosis, edema, hemorrhage, WAVY fibers

Risk- arrhythmia

41
Q

MI 12-24 hrs

A

Gross- dark mottling, pale with tetrazoleum stain

LM- CONTRACTiON bands from reperfusion injury, release necrotic cell enzymes, NEUTROPHIL migration

Risk- arrhythmia

42
Q

MI 1-3 days

A

Gross- hyperemia

LM- coagulative necrosis, acute inflammation, neutrophil migration

Risk- fibrinous pericarditis

43
Q

MI 3-14 days

A

Gross- hyperemic border, yellow brown softening

LM- macrophage followed by granulation tissue

Risk- free wall rupture leading to tamponade, papillary m. Rupture, ventricular aneurysm, inter ventricular septal rupture due to macrophages that have degraded important structural components

44
Q

MI 2 weeks to several months

A

Gross- gray white

LM- scar

Risk- dressler syndrome

45
Q

Transmural infarct

A

Increased necrosis, affects entire wall, ST elevation, Q waves

46
Q

Subendocardial infarcts

A

Ischemic necrosis of less than 50% of ventricle wall

ST depression

47
Q

DX MI

A 
Gold standard= EKG in first 6 hrs
Order of enzymes= TCA 
Troponins--stay high for 7-10 days, specific for MI
CK-MB-- non specific, show reinfarction
AST-- last to rise

Pathological Q waves= transmural infarct

48
Q

Anterior wall infarct

A

LAD

V1-V4

49
Q

Anteroseptal wall infarct

A

LAD

V1-V2

50
Q

Anterolateral wall infarct

A

LCX

V4-V6

51
Q

Lateral wall infarct

A

LCX

I, aVL

52
Q

Inferior wall infarct

A

RCA

II, III, aVF

53
Q

Dilated Cardiomyopathy

A

Most common due to ECCENTRIC hypertrophy, Systolic dysfunction
- if familial due to mutation in dystrophin gene
-ABCCCD
Alcohol abuse, wet Beriberi, Coxsackie B myocarditis, chronic Cocaine use, Chagas disease, Doxorubicin toxicity, hemochromatosis, peripartum cardiomyopathy
- S3 dilated heart
RX: Na restriction, diuretics, ACE inhibitors, digoxin, heart transplant

54
Q

Hypertrophic cardiomyopathy

A

Diastolic dysfunction
concentric hypertrophy (added in parallel)
**proximity of hypertrophied interventricular septum to mitral leaflet obstructs outflow tract, resulting in systolic murmur and syncopal episode
Most are familial ( B-myosin light chain mutation) , Friedreichs ataxia
Sudden death in athletes
Normal sized heart, S4, apical impulse, systolic murmur
RX: B blocker or verapamil to decrease work of heart

55
Q

Restrictive cardiomyopathy

A

Diastolic dysfunction, less compliant, problem with filling
- causes include sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis, Lofflers syndrome (endomyocardial fibrosis with eosinophils), hemochromatosis (dilated CM too)

56
Q

Diastolic heart failure

A

Increased LVEDP

Normal LVEDV, normal EF

57
Q

Systolic heart failure

A

Increased LVEDP, LVEDV

Decreased EF

58
Q

Pulmonary edema

A

Decreases lung compliance
Acutely- transudation of fluid, non-inflammatory
Chronic- hemosiderin laden macrophages “heart failure cells”

59
Q

Bacterial Endocarditis

A

FROM JANE

Fever
Roth spots
Osler's nodes
Murmur
Janeway lesion
Anemia
Nail bed hemorrhage 
Emboli
-mitral valve most frequent
- triscupid valve=IV  Drug abusers (s aureus, pseudomonas, candida)
Acute- s aureus on normal valves
Subacute- strep viridans from dental procedure on diseased valves
-due to malignancy, hypercoagulable state, SLE, S bovis (colon cancer),
60
Q

Rheumatic fever

A

After strep pyogenes

  • immune mediated damage–type II hypersensitivity, AB to M protein, not a direct effect of bacteria
  • early deaths due to myocarditis
  • late sequelae include heart disease mitral>aortic>tricuspid, early is regurgitation late is stenosis
  • Aschoff bodies (Granulomatous with giant cells), Anitschkows cells (histiocytes), elevated ASO
61
Q

Rheumatic fever symptoms

A 
FEVERSS
Fever
Erythema marginatum
Valvular damage
ESR increase 
Red hot joints
Subcutaneous nodules
St virus dance (chorea)
62
Q

Fibrinous pericarditis

A

Dressers, uremia, radiation

-immunologic

63
Q

Serous pericarditis

A

Viral pericarditis, non infectious inflammatory (RA, SLE)

-immunological

64
Q

Suppurative/purulent pericarditis

A

Bacterial infections (pneumococcus, streptococcus)

65
Q

Cardiac tamponade

A

Findings= hypotension, increased JVD, muffled heart sounds (TRIAD) and increased HR

Pulsus paradoxus

66
Q

Pulsus paradoxus

A

Decrease in amplitude of systolic BP by >10 during inspiration

Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup

67
Q

Syphilitic heart disease

A

3’ syphillis
Disrupts vasa vasorum, atrophy of vessel, dilation of aorta, calcification of aortic root,more bark, aneurysm thoracic aorta

68
Q

Kussmauls sign

A

Increase in JVP on inspiration instead of normal decrease

Seen with constrictive pericarditis, restrictive cardiomyopathy, right sided heart tumors, cardiac tamponade

Cardio Drugs (7 decks)

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