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True of false: 50% is classified as secondary HTN (usually resulting from renal disease)
false. (90% essential/primary, 10% secondary)
"read the questioner's mind": HTN predisposes individuals to this disease (the one John Ritter died of)
aortic dissection
Pathology changes associated with HTN
hyaline thickening & atherosclerosis
This awful term refers to a stiffening of the arteries that invovles the media. Particularly likely to occur at the radial & ulnar arteries.
Monckeberg arteriosclerosis
True or false: atherosclerosis is a disease of small sized arteries
false. affects elastic, large & medium muscular arteries.
Earliest sign of atherosclerotic disease
fatty streak
most likely location
abdominal aorta. (then coronary artery, popliteal artery, and carotid artery)
Type of angina resulting from coronary artery spasm
Prinzmetal's variant
This coronary artery branch is most commonly implicated in myocardial infarction
LAD (left anterior descending)
most common cause of sudden cardiac death
(lethal) arrhythmia
Solid tissues like the heart, brain, kidney and spleen have only a single blood supply (not so good collaterals). Therefore infarcts are more likely to be --?
2 instances where red infarct is likely
(1) reperfusion (2) loose tissues with good collaterals - like the lungs or intestine
Rank the following vessels from most to least commonly occluded: RCA, LAD, circumflex
Histologic changes on day 1 of an MI?
pallor of infarcted area; coagulative necrosis
days 2-4?
dilated vessels (hyperemia); neutrophil invasion; extensive coagulative necrosis
days 5-10?
yellow-brown softening of infarcted region; macrophages present; granulation tissue begins to grow in
after 7 weeks?
infarct is gray-white; scar complete
True or false: ECG is not diagnostic during the first 6 hours following an MI
False; it is the gold standard within this time period
What is the test of choice within the first 24 hours?
This enzyme is elevated from 4 hours up to 10 days after an MI and is the most specific protein marker
cardiac troponin I
on ecg, transmural infarction causes ______
ST elevation, Q wave changes
Most common MI complication (90% of patients)
arryhthmias, esp. 2 days after infarct
automimmune phenomen several weeks post-MI that results in fibrinous pericarditis
Dressler's syndrome
high risk of mortality
cardiogenic shock (large infarcts)
seen about a week after the infarction
rupture of ventricular wall, septum, or papillary muscle
Most common Cardiomyopathies
dilated (congestive) cardiomyopathy; heart looks like a ballon on X-ray
True or False: substance abuse is a common cause of dilated cardiomyopathy
True; cocaine and alcohol especially
These two infectious diseases are associated with dilated myopathy
coxsackievirus B and Chagas' disease
True or false: hypertrophic cardiomyopathy causes systolic dysfunction
False; dilated myopathy causes systolic dysfunction, hypertrophic causes diastolic
Half of hypertrophic myopathies are inherited as an _________ trait (x-linked, dominant, etc.)
autosomal dominant; major cause of sudden death in young athletes
On echo in hypertrophic disease, the LV thickens and the chamber looks how?
like a banana
These "-osis" diseases are major causes of restrictive/obliterative cardiomyopathy
sarcoidosis, amyloidosis, hemochromatosis, endocardial fibroelastosis, endomyocardial (Loffler's) fibrosis⬦.also, scleroderma but it's not an -osis
Name two causes of holosystolic murmurs
1) VSD, 2) mitral regurg, and 3) tricuspid regurg
Widened pulse pressure seen with this diastolic murmur
aortic regurg
Describe the murmur associated with the most common valvular lesion
Mitral prolapse; late systolic murmur following mid-systolic click
True or false: aortic stenosis causes a decrescendo-crescendo murmur following an ejection click
False; ejection click is followed by a crescendo-decrescendo systolic murmur
cause of a continuous murmur loudest at time of S2?
patent ductus artieriosis
opening snap followed by late diastolic rumbling?
mitral stenosis
most common heart tumor?
primary cardiac tumor in 1) adults and 2) children
adults=myxoma (almost always in left atrium); children=rhabdomyoma
fun gross pathologic term for changes in liver with CHF?
what are "heart failure cells"?
hemosiderin-laden macrophages in lung
dyspnea on exertion, pulmonary edema, and paroxysmal nocturnal dyspnea are symptoms of?
left heart failure
patient says "I have to sleep upright." the clinical term for this is?
most pulmonary emboli arise from?
True or false: Amniotic fluid can lead to DIC
what are the component of virchow's triad?
stasis, hypercoagulability, endothelial damage
what is pulsus paradoxus?
greater than 10 mmHg drop in systolic on inspiration
what is electrical alternans?
characteristic of tamponade on ECG in which QRS complex height varies beat-to-beat
What valve is usually involved in endocarditis?
What valve indicated drug use if it is involved?
Can endocarditis be non-bacterial?
Yes. It can be secondary to metastasis, renal failure (maranctic or thrombotic), fungal
What type of endocarditis does s. Aureus cause?
rapid onset, high virulence, tends to occur secondary to infection elsewhere
What do the vegetations look like
What type of endocarditis does s. viridians cause?
subacute. Tends to have smaller vegetations.
What predisposes you to s.viridins endocarditis?
tends to occur on previously damaged valves, so rheumatic fever. It is commonly seen after dental work.
What are the 8 sings of endocarditis?
JR=NO FAME Janeway lesions, Roth's spots, Nail-bed hemorrhages, Osler's nodes, Fever, Anemia, Murmur (new), Emboli
What do Janeway Lesions look like?
multiple small flat erythematous lesions on palms and soles
What are roth spots?
round white spots on the retina surrounded by hemorrhage.
What are osler's nodes?
Tender raised lesions on the fingers and toes.
What is the etiology of these lesions?
Bacterial vegetations flipping off the heart valve and lodging in the periphery.
What type of bacteria causes rheumatic fever?
Group A beta-hemolytic strep
(strep pyogenes)
when does it occur?
Children 5-15 years, four weeks after a bacterial infection
Is the bacteria responsible for the symptoms?
No. RF is an autoimmune reaction of a cross-reactive protein that is found in the initial bacterial infection.
What are the non cardiac clinical signs of rheumatic fever?
FEVERSS - Fever, Erythema marginatum, valve damage, Elevated ESR, Red-hot joints (migratory polyarthritis), Subcutaneous nodules, and St. Vitus dance (chorea)
What hear valves are effected?
Mitral (most frequent), Aortic, Tricuspid (5%) - high pressure valves mainly.
What is an Aschoff body?
classic histological sign of RF, found in the myocardium, contained fibrinoid material, fragmented collages, surrounded by giant cells.
What are the cardiac signs of RF?
Verrucious vegetations on the valve, pancarditis, possible pericardial effusions and myocarditis (most common cause of death)
Name four causes of serous pericarditis.
RAIL - Rheumatic Arthritis, Infection, Lupus, and Uremia
What is serous pericarditis?
straw colored, protein rich exudates - non-purulent, and acute
What are three causes of fibirnous exudates?
MI, Rheumatic fever, and Uremia
Cloudy pericardial exudates indicated what?
Bacterial infection
What are two causes of Hemorrhagic pericarditis?
malignancy and TB
What is hemorrhagic pericarditis?
Bloody and inflammatory exudates
What are the clinical signs of pericardial exudates?
pericardial pain, friction rub, decreased heart sounds, ST elevation throughout, and pulses paradoxes (like cardiac tamponade)
What are the long term sequela of pericarditis?
chronic adhesive or constrictive pericarditis
What is constiricit pericadritis
Fibrous scarring in the pericardium obliterates the space and constrict the right side of the heart (because it is less able to withstand the pressure)
What types of pericaditis lead to this?
TB and pyrogenic staph infections
What part of the heart does syphilis damage?
The vaso vasorum of the aorta
What does this lead to?
Dilation of the aorta and valve ring
What clinical results does this have?
it can cause an aortic aneurysm or valvular incompetence
What parts of the aorta are effected
ascending and arch
What is the appearance or the aorta?
Called a "tree-bark" appearance.

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