cardio path
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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 --?
- pale
- 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
- LAD>RCA>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?
- CK-MB
- 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?
- metastasis
- 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?
- nutmeg
- 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?
- orthopnea
- most pulmonary emboli arise from?
- DVT
- True or false: Amniotic fluid can lead to DIC
- TRUE
- 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?
- Mitral
- What valve indicated drug use if it is involved?
- Tricuspid
- 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
- Large.
- 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.