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CV > Pathology_Nichols_HighYield > Flashcards

Pathology_Nichols_HighYield Flashcards

mainly associations/buzz words some questions

1
Q

what disease favors the base of the heart and commonly involves the conduction system?

A

cardiac sarcoidosis

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1
Q

acutely, how much fluid can the pericardium accommodate without clinically significant increase in pressure

A

up to 200 ml >200 will rapidly increase pressure

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2
Q

head bobbing with each pulse (de Musset sign)

A

aortic regurgitation

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2
Q

in the early subacute phase of an un-reperfused MI, put the infiltrating cells in temporal order

A

lymphocytes (day 2) macrophages (day 3) fibroblasts (day 4)

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3
Q

acute childhood disease of medium arteries (commonly coronary)

A

Kawasaki disease

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4
Q

hyperdynamic bounding, but rapidly collapsing pulse (Corrigan pulse)

A

aortic regurgitation

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4
Q

palpable purpura

A

vasculitis

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4
Q

prototype restrictive cardiomyopathy

A

amyloidosis

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5
Q

is infective endocarditis destructive?

A

yes can cause perforation of a valve, abscesses, fibrotic scarring or calcification

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5
Q

blindness seen in?

A

temporal (giant cell) arteritis

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5
Q

where are cardiac myxoma typically located?

A

90% in the atria (72% in LA)

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6
Q

concentric LVH

A

hypertensive heart disease

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6
Q

connective tissue disorders (Marfans, Ehrlos Danlos) associated with?

A

MVP

aneurysms

aortic dissection (Marfan)

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7
Q

Acute HF Profile A: warm and dry, associated with?

A

transient myocardial ischemia or HF from lung disease

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7
Q

systemic lupus erythematosus

A

Libman-Sacks endocarditis

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7
Q

Roth spots

A

IE

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7
Q

mutation in ryanodine receptor (RyR)

A

familial catecholeminergic polymorphic ventricular tachycardia

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7
Q

most common cause of sudden death in young athletes (< 35)

A

hypertrophic cardiomyopathy

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8
Q

hibernating myocytes

A

chronic myocardial ischemia

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9
Q

constrictive pericarditis seen with? what type of pericarditis?

A

bacterial infections (typically staph aureus, strep pneumonia)

fibrinous (fibrinous and fibrous adhesions and organization with fibroblasts)

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10
Q

what is the major determinant of aortic aneurysm rupture?

A

diameter of aorta

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10
Q

this disease is 100% associated with smoking

A

Buerger disease (thromboangiitis obliterans)

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11
Q

normal LA pressure?

A

8 mmHg

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12
Q

vegetations on both sides of valve seen in?

A

Libman-Sacks endocarditis

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14
Q

LV end diastolic volume

A

150 ml

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14
Q

cystic medial (tunica media) degeneration

A

aortic aneurysm

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15
Q

clinical manifestations of HF seen when reduction of SV > ___%

A

>25% reduction (e.g. from 100ml to 75ml)

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15
Q

isolated right HF due to?

A

pulmonary disease (called cor pulmonale)

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16
Q

mucocutaneous lymph node syndrome is AKA?

A

Kawasaki disease

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17
Q

associated with malignant tumors (especially mucinous adenocarcinomas)

A

marantic endocarditis

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17
Q

janeway lesions

A

IE

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18
Q

2 main complications of marantic endocarditis

A

systemic emboli

infection (converts it to infective endocarditis)

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18
Q

intermittent claudication

A

peripheral artery disease

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19
Q

Jones criteria used to dx?

A

Rheumatic heart disease

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19
Q

features of a vulnerable plaque

A

large atheroma and thin fibrous cap

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19
Q

when reversal of obstruction fails to restore blood flow into myocardium injured by that obstruction, called?

A

no-reflow phenomenon

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19
Q

acute pericarditis is most commonly due to what?

A

viruses

most commonly Coxsackie virus (group B) or echovirus

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21
Q

heart failure cells

A

hemosiderin-laden macrophages

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22
Q

JVD increased with inspiration (Kussmaul’s sign)

A

cardiac amyloidosis

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23
Q

LV end diastolic pressure

A

10 mmHg

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24
Q

how to dx all peripheral vascular diseases?

A

H&P

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25
Q

myxomatous mitral valve

A

MVP

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25
Q

frequent causative agent in subacute bacterial endocarditis

A

strep viridans

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25
Q

in pericardial effusion, what do you see on ECG?

A

decreased voltage of QRS

electrical alternans

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26
Q

thin wavy myocytes

A

seen in the acute phase (1-3 days) of an un-reperfused MI

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28
Q

most common cardiac hemodynamic disorder

A

heart failure

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29
Q

How does CRP level relate to atherosclerosis?

A

CRP is secreted by cells within plaques and can activate endothelial cells leading to a prothrombic state

CRP independently predicts risk of MI, stroke, PAD, sudden cardiac death

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30
Q

what are typical symptoms and signs of aortic aneurysms?

A

usually none

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31
Q

Constitutional risk factors for atherosclerosis

A

genetics

Age

gender (premenopausal women protected by estrogen)

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31
Q

5 P’s ? associated with?

A

pain, pallor, paralysis, paresthesia, pulselessness

acute arterial occlusion

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32
Q

genetic defects in myocyte contractile apparatus

A

hypertrophic cardiomyopathy

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33
Q

4 profiles of acute HF

A

Profile A: warm and dry

Profile B: warm and wet

Profile C: cold and wet

Profile L: cold and dry

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34
Q

most common complication of MVP

A

regurgitation

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35
Q

midsystolic click

A

MVP

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36
Q

type B aortic dissection involves?

A

involves the descending aorta

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38
Q

amount of blood ejected from the ventricle

A

stroke volume

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39
Q

signs of right HF?

A

volume overload:

JVD

lower leg edema

liver congestion

RUQ discomfort

ascites

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39
Q

Virchow’s triad

A

endothelial injury

hypercoagulability

abnormal blood flow (stasis or turbulence)

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39
Q

most common cause of sudden death in athletes > 35

A

atherosclerotic cardiovascular disease

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40
Q

true aneurysm

A

outpouching of all 3 layers (intima, media, adventitia)

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41
Q

common symptoms of HF

A

dyspnea fatigue

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42
Q

most common cause of sudden cardiac death

A

coronary artery disease (80%)

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44
Q

systolic ejection click

A

aortic stenosis

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45
Q

polymyalgia rheumatica associated with?

A

temporal (giant cell) arteritis

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47
Q

Acute HF Profile L: cold and dry, associated with?

A

decompensated HF with low C.O. too sudden to have caused fluid retention in response

L is for Low C.O. ?

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49
Q

chronic rheumatic disease is associated with ____ whereas acute rheumatic disease with ___

A

stenosis

regurgitation

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50
Q

sudden cardiac death due to abnormal cardiac signaling often due to

A

ventricular tachyarrhythmia

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52
Q

elongated and thin chordae tendinae, prone to rupture

A

MVP

53
Q

normal stroke volume

A

100 ml

54
Q

double apical impulse

A

hypertrophic cardiomyopathy

55
Q

In cardiac tamponade, a Swan-Ganz right heart catheterization will show what?

A

increased and equalized RA and LA pressures

56
Q

segmental transmural chronic granulomatous inflammation seen in?

A

temporal (giant cell) arteritis

57
Q

summation gallop

A

when both S3 and S4 are present with tachycardia (S3 and S4 overlap) can be seen in hypertensive heart disease

59
Q

LV end systolic volume

A

50 ml

61
Q

5 major factors determining the heart’s function as a pump?

A

preload

afterload

contractility

ventricular compliance

heart rhythm

62
Q

benign gelatinous mesenchymal neoplasm of the endocardium

A

cardiac myxoma

63
Q

how to diagnose acute pericarditis?

A

2 of the following:

typical chest pain (sharp substernal pleuritic positional)

pericardial friction rub

ECG: diffuse ST elevation

pericardial effusion

64
Q

4 chamber dilatation

A

idiopathic dilated cardiomyopathy

65
Q

flash pulmonary edema

A

seen when a mitral valve papillary muscle ruptures leading to rapid mitral regurgitation, increased LA pressure, pulmonary congestion/edema

66
Q

MI first affects what region?

A

subendocardial

67
Q

cardiac tamponade is what kind of syndrome?

A

functional

68
Q

How much pericardial fluid is normally in the pericardium?

A

15-50 ml

69
Q

rank the incidence of infection, marantic endocarditis, and rheumatic heart disease for the valves

A

mitral (116mm Hg) > aortic (72) > tricuspid (24) > pulmonary (5)

incidence related to resting pressure on the closed valve

70
Q

edema and rash involving palms and soles of feet

A

Kawasaki disease

72
Q

RV systolic pressure

A

25 mmHg

73
Q

radiograph showing bilateral pulmonary hilar lymphadenopathy

A

cardiac sarcoidosis

74
Q

in cardiac tamponade, what is both therapeutic and diagnostic?

A

pericardiocentesis

76
Q

LV systolic pressure

A

130 mmHg

77
Q

thromboangiitis obliterans AKA?

A

Buerger disease

79
Q

proportion of end dyastolic volume ejected

A

ejection fraction

81
Q

Pancarditis

A

Rheumatic heart disease (inflammation of endo, myo, and epicardium)

82
Q

boxcar nuclei

A

hypertensive heart disease

82
Q

molecular mimicry

A

rheumatic heart disease

83
Q

Modifiable risk factors for atherosclerosis

A

“SHODDY”

Smoking

HTN

Obesity

Diabetes

Dyslipidemias

84
Q

frequent causative agent in acute bacterial endocarditis

A

staph aureus

85
Q

pulsus paradoxus seen in? what is it?

A

cardiac tamponade

an exaggeration of the normal decrease in blood pressure with inspiration (>10 mmHg systolic decrease in BP)

86
Q

tx of cardiac myxoma? effective?

A

surgical excision yes, it’s curative

88
Q

thickening and fusion of chord tendinae

A

mitral stenosis

89
Q

most common cause of mitral regurgitation?

A

MVP

90
Q

hypercoagulable states are precursors to this…

A

marantic endocarditis

91
Q

most common disease of the pericardium?

A

acute pericarditis

92
Q

tx for Buerger’s disease

A

smoking cessation

93
Q

strawberry tongue

A

Kawasaki disease

94
Q

what are the signs of cardiac tamponade?

A

Becks Triad:

JVD

hypotension

muffled heart sounds

95
Q

what can be used to estimate the amount of pericardial effusion and also distinguish cardiomegaly from pericardial effusion?

A

Echo

97
Q

false aneurysm

A

contained (by the adventitia or thrombus) ruptures of the intima and media (sometimes adventitia)

99
Q

crescendo-decrescendo systolic murmur

A

aortic stenosis

hypertrophic cardiomyopathy (also described as being rough and at the left sternal border)

100
Q

what is the worst complication of atherosclerosis?

A

superimposed thrombosis

101
Q

chronically, how much fluid can the pericardium accommodate without clinically significant increase in pressure

A

2000ml (2L)

103
Q

Aschoff bodies and anitschkow cells

A

Rheumatic heart disease

104
Q

diastolic decrescendo murmur

A

aortic regurgitation

105
Q

type A aortic dissection involves?

A

involves ascending aorta and or arch more common and serious

106
Q

stunned myocytes

A

acute myocardial ischemia

107
Q

signs of acute pericarditis?

A

pericardial friction rub (classically triphasic: atrial and ventricular systole and rapid filling phase of early systole)

widespread ST elevation

leukocytosis

elevated troponin

108
Q

myocyte disarray

A

hypertrophic cardiomyopathy

110
Q

normal ejection fraction

A

67%

112
Q

Acute HF Profile B: warm and wet, associated with?

A

volume overload with maintenance of perfusion to extremities

114
Q

contraction band necrosis

A

seen in the acute phase of an un-reperfused MI

115
Q

tx for Kawasaki disease?

A

aspirin and IVIG

117
Q

S3 gallop seen in?

A

HF

idiopathic dilated cardiomyopathy

118
Q

how can you differentiate hypovolemic shock due to hemorrhage from acute HF due to myocardial ischemia? Why is this important?

A

central venous pressure:

CVP is elevated in HF and low in hypovolemic shock

opposite tx:

tx for HF is diuresis tx for hypovolemia is fluids

119
Q

Acute HF Profile C: cold and wet, associated with?

A

volume overload w/o perfusion to extremities

120
Q

Raynauds phenomenon seen in?

A

Buerger disease (thromboangiitis obliterans)

121
Q

markers for MI

A

troponin I

CK-MB

122
Q

enlarged firm tan waxy heart

A

cardiac amyloidosis

123
Q

what is elevated in aneurysms and mediates continuous remodeling in arteries?

A

matrix metalloproteinases (MMPs)

124
Q

> ____ minutes of ischemia leads to infarction

A

>20 minutes

126
Q

Group A, beta-hemolytic strep pharyngitis associated with?

A

Rheumatic heart disease

127
Q

myocytolysis

A

chronic myocardial ischemia

128
Q

osler nodes

A

IE

129
Q

slitlike fishmouth

A

mitral stenosis

130
Q

____ is primarily a disease of young african americans who present with arrhythmias

A

cardiac sarcoidosis

131
Q

non-bacterial thrombotic endocarditis AKA

A

marantic endocarditis

132
Q

most common cause of MI

A

coronary atherosclerosis (90%)

133
Q

specific symptoms of HF

A

paroxysmal nocturnal dyspnea orthopnea

135
Q

apical holosystolic murmur

A

mitral regurgitation

136
Q

what disease presents with nonspecific symptoms and signs of HF?

A

idiopathic dilated cardiomyopathy

138
Q

2 main complications of infectious endocarditis (IE)

A

HF

septic emboli

139
Q

what disease is a diagnosis of exclusion?

A

idiopathic dilated cardiomyopathy

140
Q

what tx can save patients from blindness in temporal (giant cell) arteritis?

A

steroids

141
Q

most common cause of right HF

A

left HF

142
Q

steps in the response to injury hypothesis in atherosclerosis

A

1: injury to endothelial cells
2: accumulation of lipid (LDL) in the tunica intima
3: Leukocyte and smooth muscle recruitment into the tunica intima
4: Foam cell formation
5: ECM deposition

143
Q

S4 gallop seen in?

A

Hypertensive heart disease

aortic stenosis

hypertrophic cardiomyopathy

144
Q

increased ESR seen in?

A

IE

temporal (giant cell) arteritis

145
Q

RA pressure

A

3 mmHg

146
Q

____ is primarily a disease of older adults who present with HF

A

cardiac amyloidosis

147
Q

what are some features of the late subacute phase of an un-reperfused MI?

A

angiogenesis

proliferation of fibroblasts

formation of granulation tissue

replacement of granulation tissue with fibrous collagen scar

148
Q

normal PR interval time?

A

120-200 ms

149
Q

define a 1st degree AV block

A

PR interval >200ms with all impulses reaching the ventricles (all fascicles intact)

150
Q

normal QRS time

A

< 100 ms

151
Q

normal QTc?

what signals dangerous heart disease?

A

< 440 ms

>440 ms

152
Q

most common cause of prolonged QT interval?

A

myocardial ischemia

153
Q

the ____ artery supplies the anterior LV and blockage can cause abnormalities in electrical leads ____

A

LAD

V1-V4

154
Q

the ____ artery supplies the lateral LV and blockage can cause abnormalities in electrical leads ____

A

L circumflex

V5-V6

155
Q

the ____ artery supplies the inferior LV and blockage can cause abnormalities in electrical leads _____

A

R coronary a.

II, III, aVF

156
Q

acute blockage of a major epicardial coronary a can lead to what EKG changes?

later, a transmural MI can lead to what EKG changes?

A

elevation of ST segment and an inverted T wave

pathologic Q wave (large, long, deep negative deflection of QRS)

157
Q

sinus tachycardia is physiological and starts in the _____ and never exceeds ____

A

SA node

220 impulses/min minus persons age

158
Q

atrial fibrillation rate? EKG findings?

A

60-220

no P waves

159
Q

atrial flutter rate? EKG findings? Results from?

A

~150/min

2 P waves for each QRS

reentry around tricuspid valve

160
Q

supraventricular tachycardia usually due to? responds to?

A

reentry in RA near AV node

valsalva maneuver, carotid sinus massage, facial of ice water

161
Q

2 types of ventricular tachyarrythmias?

A

v tachycardia

v fibrillation

162
Q

ventricular tachycardia on EKG? types? can degenerate to?

A

wide QRS (>120 ms), rate <200/min

monomorphic or polymorphic

v fib (occurs more in polymorphic)

163
Q

tx for v fib?

A

electrical defibrillation

164
Q

Congenital long QT syndrome characteristically shows…

A

torsades de pointe

165
Q

Type 1 Congenital long QT syndrome due to mutations in? result?

A

gene for a Ik subunit (K+ channel)

decreased outward K+ current –> impaired repolarization –> prolonged QT interval –> EAD from multiple foci

166
Q

Brugada syndrome:

common in?

defect in?

result?

EKG?

A

young asian males

Na+ channels

decreased Na+ inflow –> decreased duration of AP

persistently elevated ST segments and inverted T wave in leads V1-V3, with V Fib

167
Q

Familial catecholeminergic polymorphic V tach

mutation in? result?

presents with?

1st manifestation?

EKG?

Tx?

A

RyR –> triggered activity from DAD

life threatening v tach or v fib during emotional or physical stress

syncope

normal QT interval

B-Blockade or implanted defibrillator

168
Q

Myocarditis

usually from?

2 phases?

gross pathology?

90% recover, 10% progress to ___

A

viral: Parvovirus B19, HHV6
early: direct viral infection of myocyes; late: autoimmune attack of myocytes

pale mottled flabby dilated heart w/ multifocal interstitial inflammation

chronic dilated cardiomyopathy

169
Q

RV cardiomyopathy

mutations in?

mechanism?

disease begins where?

characterized by?

results in?

EKG?

Dx?

Tx?

A

desmosomal proteins

2 hit mechanism

RV apex

fatty replacement of myocytes –> lymphocyte infiltration –> fibrous scarring

reentrant v tach from RV

inverted T wave in leads V1-V3 and epsilon wave

Echo

implanted defibrillator

CV (4 decks)

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