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Pathology - cardiac Flashcards

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1
Q

Right-to-left shunts in early cyanotic babies

A 
5 T's
Truncus arteriosus (1 vessel)
Transposition (2 switched vessels)
Tricuspid atresia (3 = tri)
Tetralogy of Fallot (4 = tetra)
TAPVR (anomalous pulmonary venous return) (5 letters)

Generally caused by defects in aorticopulmonary septum (derived from neural crest)

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2
Q

Tetralogy of Fallot pathology

A

Caused by anterosuperior displacement of the infundibular septum

Four defects: pulmonary stenosis, RVH, overriding aorta, VSD

Pulm stenosis causes right-to-left shunting across VSD and RVH

Squatting increases systemic resistance, decr. R-to-L shunt, improves cyanosis

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3
Q

Late cyanosis in babies

A

VSD > ASD > PDA

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4
Q

ASD pathology

A

usually ostium secundum defects

distinct from PDA: pathology is missing tissue rather than unfused septa

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5
Q

End-stage effects of Eisenmenger syndrome

A

Late cyanosis, clubbing**, polycythemia

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6
Q

Associations with coarctation of the aorta

A

Bicuspid aortic valve, Turner syndrome (45 X)

aortic narrowing near insertion of ductus arteriosis (juxtaductal)

Look for delayed pulses in the lower extremities

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7
Q

Hypertension pathology

A

Primary (essential) - 90%, related to incr. CO or TPR

Secondary - 10%, related to renal/renovascular dz, primary hyper-aldosterone

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8
Q

Cause of hypertension in young woman

A

Fibromuscular dysplasia - string of beads in renal artery

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9
Q

Hypertensive nephropathy

A

Renal arterial hyalinosis

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10
Q

Evidence of end-organ damage in hypertensive emergency

A

Encephalopathy, stroke, retinal hemorrhages/exudates, papilledema, MI, HF, aortic dissection, kidney injury, MAHA, eclampsia

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11
Q

Hyperlipidemia signs

A

Xanthoma/xanthelesma - lipid-laden histiocytes in the skin

Tendinous xanthoma - seen particularly in Achilles

Corneal arcus - common in elderly

All appear in familial hypercholesterolemia

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12
Q

Arteriosclerosis

A

Arterial wall thickening and loss of elasticity

Includes arteriolosclerosis and medial calcific sclerosis

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13
Q

Arteriolosclerosis (two types)

A

Hyaline - thickening of vessel walls, seen in essential HTN/DM

Hyperplastic - proliferation of smooth muscle cells (onion skinning), seen in severe HTN

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14
Q

Medial calcific sclerosis

A

calcification of elastic lamina or arteries

Leads to vascular stiffening without obstruction

Intima not involved!

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15
Q

Atherosclerosis pathology progression

A

endothelial cell dysfunction –> macrophage/LDL accumulation –> foam cell formation –> fatty streaks –> smooth muscle migration (PDGF/FGF), ECM deposition –> fibrous plaque –> complex atheroma –> arterial occlusion or plaque rupture

Look for cholesterol crystals

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16
Q

Aortic aneurysm (abdominal vs. thoracic)

A

Localized pathologic dilatation of aorta

Abdominal: assoc. with atherosclerosis, older men

Thoracic: cystic medial degeneration, assoc. with bicuspid aortic valve, Marfan, tertiary syphillis (obliterative endarteritis)

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17
Q

Aortic dissection

A

intimal tear forming a false lumen

end results: rupture, pericardial tamponade, death

Type A: Ascending aorta, proximal, treat with surgery

Type B: involves descending aorta, treat with b-blockers then vasodilators

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18
Q

Coronary steal syndrome

A

phenomenon where administration of vasodilators (CCBs) dilates normal vessels and shunts blood to well-perfused areas, leading to decreased flow and ischemia in post-stenotic region

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19
Q

Pathologic evolution of MI

4-24 hrs

A

early coagulative necrosis, neuts appear, contraction bands with reperfusion

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20
Q

Pathologic evolution of MI

1-3 days

A

Extensive coagulative necrosis

Tissue surrounding infarct shows acute inflammation with neutrophils

Watch for pericarditis

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21
Q

Pathologic evolution of MI

3-14 days

A

Macrophages, then granulation tissue (thus, mac-mediated structural degradation)

Watch for free wall rupture (tampondade), pap muscle rupture (MR), septal rupture

LV pseudoaneurysm also appears

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22
Q

Pathologic evolution of MI

2 weeks - months

Study These Flashcards
A

Contracted scar

Dressler syndrome: post-MI pericarditis (pleuritic chest pain, pericardial rub/effusion), autoimmune reaction to myocardial neo-antigens

True ventricular aneurysm (risk of mural thrombus)

23
Q

MI diagnosis (ECG, markers)

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A

ECG: gold standard in first 6 hours

troponin-I: rises after 4 hours, high for 7-10 days, more specific

CK-MB: rises after 6-12 hours (returns to normal in 48 hrs), found in myocardium, can be released from skeletal muscle, useful for reinfarction

24
Q

Transmural vs. subendocardial infarcts

Study These Flashcards
A

Transmural: incr. necrosis, affects entire wall, ST elevation

Subendocardial: less than 50% of wall affected, especially vulnerable to ischemia, ST depression

25
Dilated cardiomyopathy
Eccentric hypertrophy (cells added in series) Alcohol, wet Beriberi, Coxsackie b, Cocaine use, Chagas, Doxorubicin tox Look for S3, balloon appearance on CXR Tx: Na restriction, ACEis, BBs, diuretics
26
Hypertrophic cardiomyopathy
Mostly familial (B-myosin heavy chain mutation) Assoc. with Friedrich ataxia Look for S4, mitral regurg (impaired valve closure) Tx: BBs, CCBs (verapimil), ICD if high-risk Path: myofibrillar disarray and fibrosis can be obstructive
27
Restrictive/infiltrative cardiomyopathy
Sarcoid/amyloid, postradiation fibrosis, hemochromatosis Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate) Leads to diastolic dysfunction
28
Systolic vs. diastolic dysfunction
systolic: reduced EF, incr. EDV, decr. contractility diastolic: preserved EF, normal EDV, decr. compliance
29
Decreased mortality in HF
ACEis/ARBs BBs Spironolactone
30
Hemosiderin-laden macrophages in the lungs
Sign of pulmonary edema
31
Four types of shock
Hypovolemic (decr. preload) Cardiogenic (decr. CO) Obstructive (decr. CO) Distributive (decr. SVR)
32
Bacterial endocarditis findings
Fever Roth spots (white spots on retina) Osler nodes (finger/toe pads), Mitral valve/murmur Janeway lesions (red lesions on palms/soles) Anemia Nail splinter hemorrhages Emboli
33
acute endocarditis etiology
S. aureus (high virulence) Rapid onset, large vegetations on normal valves
34
chronic endocarditis etiology
viridans streptococci Smaller vegetations on damaged valves Dental procedure sequela
35
tricuspid valve endocarditis
S. aureus, Pseudomonas, Candida
36
culture negative endocarditis
Coxiella, Bartonella, HACEK (h. flu, actinobacillus, cardiobacterium, eikenella, kingella)
37
Rheumatic fever
Consequence of pharyngeal infection with GABHS, type II hypersensitivity (Abs to M protein cross-react) Early: MVR, progresses to MS ``` Joints (migratory polyarthritis) Heart sign Nodules Erythema marginatum Sydenham chorea ``` Tx: penicillin
38
Acute pericarditis
Sharp pain, aggravated by inspiration Causes: coxsackie, idiopathic, autoimmune (Dressler, SLE, RA), radiation therapy
39
Tamponade findings
Equilibration of diastolic pressure in all four chambers Beck triad: hypotension, distended neck veins, distant heart sounds low-voltage QRS and electrical alternans
40
Cardiac tumors
Myxomas - ball valve obstruction in left atrium, early diastolic tumor plop sound Rhabdomyomas - Most frequent primary tumor in children (assoc. with tuberous sclerosis)
41
Kussmaul sign
- increase in JVP with inspiration (normally there's a decrease) Impaired filling of RV with inspiration due to constrictive pericarditis, restrictive cardiomyopathies, right atrial/ventricular tumors
42
Vascular tumors assoc. with elderly
Angiosarcoma - rare, malignancy, if hepatic then assoc. with vinyl chloride/arsenic, very aggressive Cherry hemangioma - benign, capillary, does not regress
43
Vascular tumors assoc. with AIDS
Bacillary angiomatosis - capillary skin papules, caused by Bartonella henselae, neutrophilic infiltrate Kaposi sarcoma - endothelial malignancy, assoc. with HHV-8, HIV, lymphocytic infiltrate
44
Vascular tumors assoc. with pregnancy or childhood
Pyogenic granuloma - pregnancy, can ulcerate and bleed Strawberry hemangioma - grows rapidly, regresses spontaneously by 5-8 yo
45
Raynaud phenomenon
decr. blood flow to skin due to arteriolar vasospasm in response to cold/stress syndrome occurs when 2ry to SLE, CREST, mixed connective tissue dz Tx: CCBs
46
Large-vessel vasculitis
Temporal arteritis - elderly females, can lead to blindness due to ophthalmic artery occlusion, assoc. w/ polymyalgia rheumatica Takayasu arteritis - aortic arch syndrome, weak UE pulses, granulomatous thickening of aortic arch
47
Medium-vessel vasculitis
Polyarteritis nodosa - young adults, Hep B, const. sx, renal/visceral vessels (microaneurysms), immune complex mediated, tx: cyclophosphamide Kawasaki dz - CRASH and burn (conjunctiva, rash, adenopathy, strawberry tongue, hand-foot changes, fever, can develop coronary artery aneurysms Beurger dz - heavy smokers under 40, male, intermittent claudication, loss of digits, often seen w/ Raynaud, tx = quit smoking!
48
ANCA assoc vasculitidies
GPA (c-ANCA, anti PR3) - nasal septum perforation, chronic sinusitis, hemoptysis, hematuria, red cell casts, large pulmonary nodules on CXR Microscopic polyangiitis (p-ANCA, anti MPO) - necrotizing vasculitis involving lungs, kidneys, skin. No nasal involvement. EGPA (p-ANCA, anti MPO) - asthma, sinusitis, peripheral neuropathy, look for eosinophilia
49
Henoch-Schonlein Purpura
Follows URI, triad: skin (palpable purpura), arthralgias, GI (ab pain) secondary to IgA complex deposition, assoc with IgA nephropathy
50
Familial chylomicronemia syndrome
Type 1 defect in lipoprotein lipase and ApoC-II risk of pancreatitis
51
Familial hypercholesterolemia
Type 2a defect in LDL receptor, ApoB-100 (lack of uptake by liver --> incr. LDL serum) premature coronary artery disease
52
Familial dysbetalipoproteinemia
Type 3 ApoE defect premature coronary artery disease
53
Familial hypertriglyceridemia
Type 4 | ApoA-V defect

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