Week 1 (Exam 1) Flashcards
(191 cards)
1
Q
Strawberry Tongue
Conjuctivitis
Palm / Sole Erythema
A
Kawasaki Disease (Large / Med Vessel Arteritis)
2
Q
Carcinoid Tumor secretions
A
Serotonin: Induces plaque-like endocardial and valvular thickening
3
Q
Mid-Systolic Click (+/- murmur)
A
Mitral Valve Prolapse
4
Q
Crescendo Pattern chest pain occurring at rest
A
Unstable Angina
Usually a rupture of an atherosclerotic plaque with partial thrombus (crescendo can be caused by progressive mechanical obstruction)
5
Q
Pre-Existing conditions leading to infective endocarditis
A
Valvular Disease
Prosthetic Heart Valve
Structural Heart Disease
6
Q
Most common cause of sudden death due to Ischemia-Induced-Arrhythmia
A
Coronary Artery Disease
7
Q
Causes of Myocardial Vascular Contraction (vasospasm)
A
Lots of Vasoactive Mediators (coke, catecholamines)
Lots of Thyroid Hormones (catecholamine sensitive)
AutoAbs and T cells in Scleroderma
8
Q
Cause of Rheumatic Fever
A
Abs and CD4+ T Cell reactions against M Strep Ag
9
Q
CATCH-22
A
Cardiac Abnormalities, Abnormal Facies, Thymic Aplasia, Cleft Palate, Hypocalcemia, 22q11 Deletioin
10
Q
Fever, Pleuritic Pain, Pericardial Effusion
A
Dressler / Post-MI syndrome
Auto-immune fibrous pericarditis
11
Q
Maintaining oxygenation with Tricuspid Atresia
A
ASD/PFO and a VSD
12
Q
Ball Valve Obstruction and Mechanical Valve Damage from “wrecking ball embolism”.
A
Cardiac Myxoma
Elaborates IL-6, causing Fever and Malaise
Tumor “plop” on auscultation
13
Q
Major Giant Cell Arteritis Sx
A
Vision Loss Can Occur
Headache, facial pain, fever, ocular sx
14
Q
MacCallum Plaques
A
Acute Rheumatic Fever
15
Q
Risk factors for Myocardial Rupture
A
First MI, Age, No LV Hypertrophy
16
Q
Down syndrome Cardiac Defects
A
AV or Ventricular Septal Defects
17
Q
Thoracic Aortic Dissection Sx
A
Triad: Thoracic Pain + Pulse Abnormalities + Mediastinal Widening on CXR
18
Q
Conequence of AVM
A
High Output Cardiac Failure
19
Q
SA node damage
A
Sick Sinus Syndrome: Bradycardia
20
Q
How do the heart chambers change with age?
A
Left ventricle cavity reduces in size (esp w/ HTN) Atria Dilate (from fibrous mitral valve)
21
Q
Tibial and Radial Artery Vasculitis
A
Most Likely Thromboangiitis Obliterans (Buerger)
22
Q
Aschoff bodies with Anitschkow Cells
A
Histology of Acute Rheumatic Fever
23
Q
Turner syndrome (45X) CV defect
A
Coarctation of the aorta
24
Q
Causes of Systolic Dysfunction
A
Ischemic Injury, Dilated Cardiomyopathy, Valve Regurg
this decreases the ejection fraction
25
Serious but rare complications of mitral valve prolapse
Infective Endocarditis
Mitral Insufficiency (+/- cord rupture)
Arrhythmias
Thromboembolism
26
ACE
Converts Angiotensin I to II
27
Turner syndrome common lymphanioma
Cavernous (aka cystic hygroma)
28
IV drug use and the heart
Right Sided Endocarditis
29
T cell Mediated dz with 2/3 showing endothelial and anti-SM ABs
Giant Cell Arteritis
30
Undercooked pork
Trichenosis: infective myocarditis
31
Raynaud's, Then Claudication, then severe pain at rest, then ulceration, than gangrene of the digits. Whats up
Thromboangiitis Obliterans / Buerger Dz
32
Test for Pheochromocytoma
Elevated Urinary or Plasma Metanephrines
| it causes HTN
33
Eisenmenger Syndrome
Shunt Reversal
| Identified by Thickened pulmonary A walls, occlusion
34
Most Common Cardiac tumor in adults vs tumors
Adults: Myxoma
Children: Rhabdomyoma
35
Heart Attack with No Angina
Silent MI: results from denervated transplant
36
Causes or R to L cardiac shunts (symptomatic)
Tetrology of Fallot
Transposition of Great Arteries
Tricuspid Atresia
Patent Foramen Ovale (with increased pressure)
37
Diseases associated with berry aneurisms
AD Polycystic Kidney Disease
Marfan Syndrome
Ehlers Danlos
38
Arteriolosclerosis
Hyaline and Hyperplastic Arteriolosclerosis
Small Arteries and Arterioles
Downstream Ischemic Injury
39
Renal A Stenosis
Causes HTN
From Atherosclerosis or Fibromuscular Dysplasia
Abdominal Bruit
40
NSTEMI
plaque rupture and thrombus formation with partial occlusion causing injury and infarct to subendocardial myocardium
41
Rapidly Accelerating HTN
| Abdominal pain and bloody stool, myalgia, peripheral neuritis
Polyarteritis Nodosa (ass'd w/ Hep B), usually renal vessels and GI teact vasculitis
42
Ruptured vs Non-ruptured symptomatic AAA
Non: Pain in abdomen / back
Rupture: Severe acute pain, pulsatile mass, hypotension
43
Endocardial Fibroelastosis
Thickening of Left Ventricular Endocardium during first two years of life
Associated with congenital heart defects
44
Causes of L to R cardiac shunts (asymptomatic)
ASD / VSD
| PDA
45
Rhabdomyoma mutations
TSC1 (Hamartin) and TSC2 (Tuberin)
46
What causes Cor Pulmonale?
Any cause of Pulmonary HTN:
1. Parenchymal Lung Disease
Others: Lung Thromboemboli, Primary Pulmonary HTN
47
Lethal Effects of Churg-Strauss
Cardiomyopathy/Myocarditis and Infarction
| Almost half the deaths
48
Prolonged PR interval
First Degree Heart Block
49
Hyaline Arteriolosclerosis
Found in Chronic Hypertension
Increased SM Matrix and Plasma Protein leakage
Narrows lumen, happens in kidneys too
50
VSD Murmur
Holosystolic
51
Causes of Fibrinous and Serofibrinous Pericarditis
Acute MI, Dressler's, Uremia (CKD with BUN increase)
52
Where would you likely find a cardiac myxoma?
Left Atrium, beginning in septal region of Fossa Ovalis
53
Factors lowering LDL
Fiber
| Statins
54
Polyostic Fibrous Dysplasia, Cafe au Last Spots, Endocrine abnormalities, and myxomas. Whats the mutation?
GNAS1 (McCune-Albright Syndrome)
55
Flushing, Diarrhea, dermatitis, bronchoconstriction
Carcinoid Heart Disease
| similar to taking fenfluramine or ergot alkaloids for appetite suppression or migraine, respectively
56
Effects of HTN on the Brain and Eye
Multi-Infarct Dementia and Cerebrovascular Hemorrhage
Increased intracranial pressure/papilledema
Retinopathy
57
Most common cause of sudden death after exertion
Long QT syndrome
| K channel LOF, Caveolin/Na Current GOF
58
Causes of restrictive cardiomyopathy
Senile Amyloidosis
Fibrosis (radiation)
Myeloma, Inflammation, Mut Transthyretin
59
Metabolic Syndrome Criteria:
3 of 5:
| Abdominal Obesity, TAG increase, HDL decrease, High Blood Pressure, Insulin Resistance
60
What kind of pericarditis do you get from a malignant neoplasm?
Hemorrhagic Pericarditis
61
Deep tissue hemangioma with indistinct borders that's more likely to bleed
Cavernous Hemangioma
62
Chronic mitral valve prolapse sx
Dyspnea
63
Common cause of acute lymphangitis
Group A b-hemolytic Strep
64
CRP
Increases with IL-6, CV Risk
65
Anomalous Pulmonary Venous Return
Sinus Venosa Defect (ASD): Near SVC entrance
66
VSD cardiac shunting effects
R Ventricular Hypertrophy
Pulmonary HTN
Eventually shunt reversal, causing cyanosis and death
67
CKMB time to normalization
48 - 72 hours
68
Osler Weber Rendu mutation
AD mut of TGF-b signaling pathway, leading to hemorrhagic telangiectasia and AV malformations
69
Plakoglobin mutation
Naxos Syndrome: ARVC + Plantar/Palmar Hyperkeratosis + Wooly Hair
70
Indomethacin
Closes PDA
71
Effects of HTN on Kidney
Renal Dysfuntion and Failure
72
Signs and Symptoms of Hypertrophic Cardiomyopathy
Sudden Death in young athletes
Systolic Ejection Murmur from Mitral Valve
Exertional Dyspnea and Angina
Palpitations: A Fib and Mural Thrombus
73
Right sided heart lesions
Probably carcinoid tumor: the left side is protected by the liver against mediators
74
Main mutation of hypertrophic cardiomyopathy
Sarcomeric proteins, b-Myocin Heavy Chain
| b-MHC
75
Major risk factor of Atherosclerosis
AAA
76
Causes of Aortic Dissection
HTN
| CT disorders
77
Purulent or suppurative pericarditis
Active infection from microbe
78
Signs and Sx of Acute Rheumatic Fever (6)
```
101+ fever
Migratory Polyarthritis
Pancarditis
Subcutaneous Nodules
Erythema Marginatum
Sydenham Chorea
```
79
PR3-ANCA (c-ANCA)
Associated with Granulomatosis with Polyangiitis
80
Deadly unless a shunt allows for life. Trouble breathing almost always present after birth
Transposition of Great Vessels
81
Major risk factor of Ehler Danlos
Mitral Valve Prolapse
| Abnormal Wound Healing
82
Takotsubo cardiomyopathy
Broken heart syndrome: catecholamine release causing ischemic coronary artery constriction
83
Systolic Murmur, Angina, Syncope, CHF
Calcific Aortic Stenosis (leads to left ventricular hypertrophy)
84
HFE
hemochromatosis can cause dilated cardiomyopathy
85
Most common cause of right heart failure
Left heart failure
86
Angiotensin II
Stimulates Adrenal Cortex to release Aldosterone
87
Possible compression sx associated with Thoracic Aortic Aneurysm
Respiratory tree: Breathing difficulty
Esophagus: Dysphagia
Recurrent Laryngeal Nerve: Couch
88
Most common cause of Arrhythmias
Ischemic Heart Disease
89
Rib Notching
Long Standing Coarctation of the Aorta
90
Prostaglandin E
Keeps PDA open
91
Lentigines, Endocrine dysfunctions, myxomas. Mutation?
PRKAR1A Null Mutation (Carney Complex)
92
Etiology of Arrhythmogenic Right Ventricular Cardiomyopathy
Defective desmosomes that link myocytes
| Familial ones are AD
93
STEMI
Complete occlusion of bv lumen
| transmural injury and infarct to myocardium
94
Possible causes of non-infective endocarditis
Cytokines from Sepsis
Procoagulant release from Tumors
Antiphospholipid Syndrome
SLE (Libman-Sacks): vegetations on mitral valve
95
CKMB and cTnl peak
24 hours
96
Onion Skin Lumen
Hyperplastic Arteriolosclerosis from Severe HTN
97
Asthma, Hypereosinophilia, Lung Infiltrates
Palpable Purpura
GI tract Bleeding
Renal Disease
Churg-Strauss Syndrome (less than half are ANCA positive)
98
Marfan syndrome CV Defects
Aortic Aneurisms and Dissections
99
Spider telangiectasia caues
Can be from increased estrogen (pregnancy, liver dz)
100
Tetrology of Fallot
VSD
Right Ventricular Hypertrophy
Pulmonary Valve Stenosis
Overriding Aorta
101
CKMB, cTnT, cTnl time to elevation
3 - 12 hours
102
Findings in Chronic Rheumatic Heart Disease
```
Valvular Leaflet Thickening, Short Chordae Tendonae, Fusion, Regurgitation
Valvular Stenosis (MITRAL>aortic>tricuspid)
Mitral Stenosis (diastolic rumbling murmur)
```
103
Secundum ASD
90% of all ASDs, in the center of the atrial septum
104
Pedunculated, globular, hard mottled gelatinous mass
Cardiac Myxoma
105
Pseudo-Aneurysm
Defect through the wall of the vessel, communicating with an extravascular hematoma that freely communicates with the intravascular space
AKA Pulsating Hematoma
106
Hyperhomocysteinemia
Increases coronary Atherosclerosis, vascular disease, stroke
107
Lung cavities, bleeding, infiltrates
Nose stuffiness, bleeding, SADDLING
Crescentic Glomerulonephritis
Granulomatosis with Polyangiitis
108
Causes of Diastolic Dysfunction
HTN, Aortic Stenosis, Hypertrophic Cardiomyopathy, Fibrosis (previous ischemic injury)
(this has a normal ejection fraction)
109
Systolic vs Diastolic cardiomyopathies
Systolic: Dilated
Diastolic: Hypertrophic and Restrictive
110
Dilated Cardiomyopathy genetics
TTN gene, coding for Titin Protein
111
"worst headache of my life"
| Neck pain, vomiting, double vision, seizures, LOC
Ruptured Berry Aneurism
112
Most likely organism involved with prosthetic valve stuff
Staph Epidermitis
113
Etiology of pyogenic granulomas
Can be in the gingiva of pregnant women
25% develop following trauma
Its a capillary granuloma btw, neither pyogenic nor granulomatous
114
Exercise-Induced chest pain
Stable Angina
| Stenotic occlusion of Coronary A
115
Growth Factors causing Smooth Muscle Cell Proliferation
PDGF, Fibroblast Growth Factor, TGF-a
| Contributes to atherosclerosis
116
Factors lowering HDL
Obesity and Smoking
117
Principal causes of Left Heart Failure
Myocardial Ischemia, HTN, Left-sided valve disease
118
Chest pain worse when laying with leg up
Chest pain better when seated upright
Fever, Friction rub, EKG
Pericarditis
119
Kawasaki Disease Infectious Trigger
Activated T Cells
120
Hypercoaguability state risk factors for thrombophlebitis (DVT) from tumor
Thrombotic paraneoplastic syndrome
| Migratory thrombophlebitis / Trousseau sign
121
CV risk of Tertiary Syphillis
Obliterative Endarteritis of Vasa Vasorum causing Thoracic Aneurysm
Aortic Valve Regurgitation
122
Port wine stain along Trigeminal N
```
Sturge-Weber:
Mental retardation, seizures, hemiplegia
Leptomeningeal capillary-venous malformation
Skull Radio-opacities
Glaucoma
```
123
Head, neck, chest, arm veinous dilation
Face swelling, neurologic manifestations
Respiratory distress
Superior Vena Cava Syndrome
| From Lung CA, Lymphoma (also aneurism, AV fistula, fibrosis)
124
Most common site of berry aneurism
Anterior Cerebral Artery Branch Point
125
Major risk factor for a Thoracic Aortic Aneurysm
Hypertension (also syphilic aortitis, CT disease, vasculitis)
126
Glomus Tumor
Usually on the fingers, can be subungual
| Made from modified smooth muscle from the glomus body (responsible for thermoregulation)
127
Possible Cause of AVM
Penetrating wound, rupturing arterial aneurism into adjacent vein
Inflammatory Necrosis of Vessels
Surgical AV Fistula for chemo or dialysis
128
Cardiac Muscle CK
MB Heterodimer
129
Amyloid
Insoluble b-Pleated Sheet
| Apple Green Birefringence on Congo Red
130
Lower extremity edema
| dissension of superficial lower abdominal veins
Inferior vena cava syndrome
| From HCC, Renal Cell Carcinoma, Thrombosis
131
What happens if you get calcifications on your valves?
Aortic Stenosis
132
Arteriovenous Malformation (AVM)
Tangle of worm-like vascular channels with A to V shunts
133
Antiphospholipid Syndrome
Can cause Fetal Loss during pregnancy
Primary or associated with Lupus
Auto-Abs against the endothelial membrane
134
What kind of pericarditis do you get from Tb?
Caseous Pericarditis
135
Cyanosis, Holosystolic Murmur, Systolic Ejection Murmur, Syncope / Cyanosis episodes
Tetrology of Fallot
136
Diseases associated with asymmetric / secondary Raynaud's
SLE, Scleroderma, Thromboangiitis Obliterans
137
Premenopausal estrogenized women protective effect
MI
138
cTnl, cTnT time to normalization
more than 5 days
139
Peau d'orange
Draining lymphatics of skin overlying breast cancer filled with tumor cells
140
How does the epicardium and myocardium change with age?
Increase in lipofuscin, fat, and amyloid (transthyretin)
| Myocyte loss and basophilic degeneration
141
Most likely organism involved with poor dentition / invasive dental procedures
HACEK
| homophiles, actinobacillus, cardiobacterium, eikenella, kingella
142
Possible Side Effects of Chronic Rheumatic Fever
Infective Endocarditis
| Left Atrial Enlargement causing A Fib, Thrombi (from mitral stenosis and regurgitation)
143
String of Beads Angiography
Fibromuscular Dysplasia, commonly renal A
| 50% have epigastric abdominal bruit
144
Major physical exam findings of infective endocarditis
```
Subungual splinter hemorrhages
Janeway lesions (red dots on hands and feet)
Osler nodes (dark lumps on hands, fingers)
Roth Spots (dark spots on retina)
```
145
Sx of Right Sided CHF
(all due to veinous congestion): Hepatosplenomegaly
Distended Jugular Veins
Effusions involving peritoneal, pleural, pericardial spaces
Edema (esp ankles)
146
Results of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
RV myocardium replaced by adipose, fibrosis, dilation
| V Tach or V Fib leading to Sudden Death
147
Atherosclerosis
"gruel" and "hardening"
Atheromatous plaque formation
Stenosis / occlusion, plaque rupture, aneurysm
148
HTN in UE, Hypotension in LE
| Possible eventual concentric LV Hypertrophy
Coarctation Without PDA
Often Asx
(remember: Coarctation is associated with Turners)
149
Giant Cell Myocarditis with non-necrotizing granulomas
Myocardial Sarcoidosis
150
Coarctation of the Aorta
Causes HTN
| Hyperextension in UEs with Hypoextenion in LEs
151
Harsh Systolic Murmur, Crescendo-Decrescendo
Calcific Aortic Stenosis
152
Sea Anemone-Like lesions on the valves, resembling Lambl Excrescences
Papillary Fibroelastoma
153
Cushing Syndrome
Anterior Pituitary Tumor secreting ACTH (primary)
| Tumor on Adrenal secreting Cortisol Directly
154
Floppy valve
Mitral valve prolapses back into L Atrium during Systole
Associated with Marfan
Leaflets are thick and rubbery, with ballooning / hooding
155
BB homodimer
Creatine Kinase Expressed in brain and lung.
156
Marfan syndrome Risk
Aortic Aneurysm and Aortic Dissection
157
Most common thoracic Aorta Dissection
Proximal to Left Common Carotid A
| DeBakey 1
158
Coxsackievirus B
Most common cause of infectious myocarditis
159
Factors Increasing HDL
Exercise
| Moderate Alcohol
160
What happens if you get a fibrous mitral valve?
Buckling prolapse during systole, causing Atrial Dilation and Arrhythmia
161
Effects of HTN on the heart and aorta
Cardiac Hypertrophy and CHF
Ischemic Heart Disease
Aortic Dysfunction
162
Nephritis, Hemoptysis, Cutaneous Purpura, muscle weakness, bowel pain and bleeding
Microscopic Polyangiitis
163
Confirmatory Tests for Acute Rheumatic Fever
Abs to Streptolysin O and DNase B
164
Causes of Mycotic Aneurism
Septic Emboli (infective endocarditis)
Extension of adjacent infectious process
Circulating organisms directly infecting arterial wall
165
Causes of Calcific Aortic Stenosis
Chronic HTN
Hyperlipidemia
Inflammation
Accelerated by bicuspid aortic valve
166
Diastolic Dysfunction
Left Atrial Enlargement -> A Fib
167
Risk factors of angiosarcoma
Liver (arsenic, thorotrast, PVC production)
Lymphedema s/p axillary LN dissection
Radiation
168
Takayasu Arteritis
Thickening of Aorta and Major Branch Vessels
| Weakening of Pulses with Ocular Disturbances
169
Serous Pericarditis
Viral or Noninfectious
170
Enlarged Atria, Normal Ventricles
Restrictive Cardiomyopathy
171
Inflamed Eyes
Mouth Ulcers
Genital Ulcers
Behcet's Disease: HLA-B51, Neutrophilic vasculitis
172
Bacillary Angiomatosis is a vascular proliferation due to what?
Bartonella, seen on silver stain (warthog starry stain)
| Treat with Abx
173
Rheumatic Fever effects on the heart
Pericarditis, Myocarditis, +/- Endocarditis
Verrucae formation at mitral valve
MacCallum Plaques
174
Boot Shaped Heart
Tetrology of Fallot
175
Eosinophilic Infiltrative Fibrosis associated with Myoproliferation (leukemia/lymphoma)
Loeffler Endocarditis
176
Hypertensive Crisis
Systolic over 180-200
| Diastolic over 120
177
MPO-ANCA
Associated with Microscopic Polyangiitis
178
Kerley B Lines, Hemosiderin-laden Macrophages, Pulmonary Edema
Left Sided CHF
179
Hypertensive Emergency
HTN Crisis + end organ damage
180
Doxorubicin
Can cause dilated cardiomyopathy
181
Hypoxia, Increased Pulmonary Vascular Pressure
| Harsh, Machinery-like Murmur
PDA
182
Cor Pulmonale Etiology
Pulmonary HTN
| Large Pulmonary Embolus
183
Most likely organism in native, structurally abnormal valves
Step Viridans
184
Marfan Gene mutation
FBN1 Fibrillin Gene
| Increased TGF-B: elastic tissue weakening
185
MM Homodimer
Creatine Kinase Expressed in cardiac and skeletal muscle
186
Mönckenberg Medial Sclerosis
Age related degenerative process
Calcification of muscular arteries, internal elastic membranes
No Narrowing of lumen, usually not clinically significant
187
Episodic Coronary Artery spasm, relieved with vasodilators
Prinzmetal Variant Angina
| Unrelated to Physical Activity
188
Most common malignant heart tumor
Angiosarcoma
189
Factors Increasing LDL
Animal Products
| Trans Fat
190
Lower half of body cyanotic, absent femoral pulses
| Heart failure / shock
Infantile (+PDA) Coarctation of Aorta
191
Mitral Valve Annular Calcification
Nidus for Thrombus and infective endocarditis
| Usually normal, progresses to regurgitation, stenosis, arrhythmias (heart block, sudden death)
