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341 Cards in this Set
- Front
- Back
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what 3 structures are in the carotid sheath?
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VAN: 1. internal jugular Van, 2. common carotid Artery, 3. vagus Nerve
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what branches off of the left main coronary artery?
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1. circumflex artery and 2. left anterior descending artery 3. 20% of the time the posterior descending artery
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what does the circumflex coronary artery supply?
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posterior left ventricle
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what does the left anterior descending artery supply?
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apex and anterior interventricular septum
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what branches off of the right coronary artery?
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posterior descending artery (80% of the time), acute marginal artery
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what does the acute marginal coronary artery supply?
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right ventricle
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what does the posterior descending coronary artery supply?
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posterior septum
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what supplies blood to the SA node?
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RCA
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where does coronary artery occlusion most commonly occur?
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left anterior descending artery (LAD) - supplies anterior interventricular septum
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when do coronary arteries fill?
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during diastole
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what symptoms can an enlarged left atrium cause?
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dysphagia due to compression of the esophageal nerve or hoarseness due to compressino of the recurrent laryngeal nerve (branch of the vagus)
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what 3 murmurs can be heard in the aortic area?
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1 aortic stenosis, 2. flow murmur, 3. aortic valve sclerosis
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what 2 murmurs can be heard in the pulmonic area?
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1. pulmonic stenosis, 2. flow murmur (i.e. ASD)
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what 2 diastolic murmurs can be heard in the tricuspid area?
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1. tricuspid stenosis, 2. ASD
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what 2 pansystolic murmurs can be heard in the tricuspid area?
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tricuspid regurg, 2. VSD
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what 2 murmurs can be heard in the mitral area?
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1. mitral regurg - systolic, 2. mitral stenosis - diastolic
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what 3 murmurs can be heard in the left sternal border area?
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1. arotic regurg and 2. pulmonic regurg - both diastolic, 3. hyperrophic cardiomyopathy - systolic
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what are the 6 systolic heart murmurs?
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1. arotic stenosis, 2. arotic valve sclerosis, 3. pulmonic stenosis, 4. tricuspid regurg, 5. VSD, 6. mitral regurg
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what are the 5 diastolic heart murmurs?
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1. aortic regurg, 2. pulmonic regurg, 3. tricuspid stenosis, 4. ASD, 5. mitral stenosis
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what is the Fick principle?
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CO = rate of oxygen consumption/ (arterial oxygen content - venous oxygen content)
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what is the mean arterial pressure equation?
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MAP = CO x TPR
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what is the CO equation?
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CO = SV x HR
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what is the equation to calculate MAP from diastolic and systolic pressures?
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MAP = 2/3 diastolic pressure + 1/3 systolic pressure
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what is the equation for pulse pressure?
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systolic pressure - diastolic pressure
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what is the pulse pressure proportional to?
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stroke volume
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what is the equation for stroke volume?
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EDV - ESV
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during exercise what increases CO?
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initially increased SV, after prolonged exercise, increased HR
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what 3 things affects SV?
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1. contractility, 2. afterload, 3. preload; ↑SV when ↑contractility, ↓afterload and ↑preload
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what 4 things increased contractility?
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1. catecholamines (increased Ca pump in the SR), 2. increased intracellular Ca, 3. decreased extracellular Na, 4. digitalis (increased intracellular Na = increased Ca)
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what 5 things decrease contractility?
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1. B1 blockade, 2. heart failure, 3. acidosis, 4. hypoxia/hypercapnea, 5. non-dihydropyridine Ca channel blockers
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what does preload equal?
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ventricular EDV
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what does afterload equal?
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MAP (proportional to peripheral resistance)
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what do venodilators due to preload?
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decrease preload; i.e. nitroglycerin
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what do vasodilators due to afterload?
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decrease afterload; i.e. hydralazine
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what 3 situations increase preload?
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1. exercise (slightly), 2. increased blood volume (overtransfusion), 3. excitement (sympathetics)
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what is force of contraction proportional to?
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initial length of cardiac muscle fiber = preload
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what is the equation for ejection fraction?
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EF = SV/EDV or (EDV-ESV)/EDV
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what is EF an index of?
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ventricular contractility
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what is the normal value for EF?
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>55%
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What is the equatino for resistance, pressure and flow?
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Δ P = Q x R
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what is the main determinant of blood viscosity?
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hematocrit
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when do you see an increase in blood viscosity?
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1. polycythemia, 2. hyperproteinemic states (multiple myeloma), 3. hereditary spherocytosis
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what is resistance proportional and inversely proportional to?
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resistance is directly proportional to viscosity and inversely proportional to the radius to the 4th power
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what accounts for most of the TPR?
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arterioles - they regulate capillary flow
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what are the 5 phases of the cardiac cycle?
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1. isovolumetric contraction, 2. systolic ejection, 3. isovolumetric relaxation, 4. rapid filling, 5. reduced filling
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what occurs during the isovolumetric contraction phase of the cardiac cycle?
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it is the period between mitral valve consure and aortic valve opening - period of highest oxygen consumption
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what occurs during the systolic ejection phase of the cardiac cycle?
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it is the period between aortic valve opening and closing
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what occurs during the isovolumetric relaxation phase of the cardiac cycle?
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it is the period between aortic valve closing and mitral valve opening
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what occurs during the rapid filling phase of the cardiac cycle?
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it is the period just after mitral valve opening
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what occurs during the reduced filled phase of the cardiac cycle?
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it is the period just before mitral valve colsure
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what causes S1?
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mitral and tricuspid valve closure
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where is S1 loudest?
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mitral area
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what causes S2?
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aortic and pulmonic valve closure
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where is S2 loudest?
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left sternal border
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what causes S3?
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increased filling pressures and more common in dilated ventricles
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when does S3 occur?
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in early diastole during rapid ventricular filling phase
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when is S3 normal?
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in children
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What causes S4?
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high artrial pressure - associated with ventricular hypertrophy - left atrium must push against stiff LV wall
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when does S4 occur?
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late diastole
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what does the a wave of jugular venous pulse represent?
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atrial contraction
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what does the c wave of jugular venous pulse represent?
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RV contraction (triscupid valve bulging into the atrium
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what does the v wave of jugular venous pulse represent?
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increased atrial pressure due to filling against closed tricupsid valve
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What causes S2 splitting?
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aortic valve closes before the pulmonic valve - inspiration increases the split due to drop in intrathoracic pressure
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what is wide S2 splitting associated with?
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pulmonic stenosis or right bundle branch block (anything that delays RV emptying)
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what is fixed S2 splitting associated with?
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ASD - leads to left ot right shunt and thus increased flow through the pulmonic valve regardless of breath
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what is paradoxical splitting associated with?
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aortic stenosis or left bundle branch block (anything that delays LV emptying)
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holosystolic, high pitched "blowing" murmur - loudest at apex, radiates to axilla
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mitral regurgitation
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holosystolic, high pitched "blowing" murmur - loudest at tricuspid area and radiates to right sternal border
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tricuspid regurgitation
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What causes mitral regurgitation?
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ischemic heart disease, mitral valve prolapse or LV dilation
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what causes tricuspid regurgitation?
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RV dilation or endocarditis
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what type of regurg can rheumatic fever cause?
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mitral > tricuspid
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crescendo-decrescendo systolic ejection murmur that radiates to the carotids, following an ejection click
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aortic stenosis
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what is associated with pulsus parvus et tardus?
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aortic stenosis - pulse is weak compared to heart sounds
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what often causes aortic stenosis?
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age-related calcification of the aortic valve
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holosystolic, hardsh murmur that is loudest at the tricuspid area?
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VSD
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late systolic murmur with midsystolic click
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mitral prolapse
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what is the most frequent vavular lesion?
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mitral prolapse
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where is mitral prolapse loudest?
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S2
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what can mitral prolase predispose to?
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infective endocarditis
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high-pictched 'blowing' diastolic murmur
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aortic regurgitation
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what causes aortic regurgitation?
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aortic root dilation, bicuspid aortic valve or rheumatic fever
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delayed late diastolic rumbling murmur that follows an opening snap
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mitral stenosis
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what causes mitral stenosis?
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most often secondary to rheumatic fever
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continuous machine-like murmur, loudest at time of S2
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PDA
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When would a valvular defection on the right side of the heart increase intensity? during inspiration or expiration
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inspiration because more blood flows into the RA
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When would a valvular defect on the left side of the heart increase intensity? during inspiration or expiration
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expiration because more blood flows into the LA
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what are the 5 phases of ventricular APs?
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1. phase 0 = sodium; 2. phase 1 = K channels begin to open; 3. phase 2 - plateau due to calcium, 4. phase 3 - rapid repolarization due to K; 5. phase 4 - resting potential - high K permeability
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what are the 3 phases of pacemaker APs?
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1. phase 0 - upstroke = CA influx; 2. phase 3 - Ca inactivated, K efflux; 3. phase 4 - slow diastolic depolarization due to funny Na channels
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what does the slope of phase 4 of the pacemaker AP determine?
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HR
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What does the P wave of the ECG represent?
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atrial depolarization
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what does the PR interval of the ECG represent?
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conduction delay through the AV node (normall < 200msec)
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what does the QRS complex represent?
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ventricular depolarization (normally <120msec)
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what does the QT interval of the ECG represent?
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mechanical contraction of the ventricles
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what does the T wave of the ECG represent?
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ventricular repolarization
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What does the ST segment of the ECG represent?
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isoelectric - ventricles depolarized
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What causes a U wave on ECG?
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caused by hypokalemia, bradycardia
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what can prolonged QT interval predisope to?
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torsades de pointe
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what disease is caused by accessory conduction pathway from the atria to the ventricle (bundle of Kent), that bypasses the AV node?
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WPW syndrome
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what causes a delta wave on ECG?
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WPW syndrome - due to partial early ventricular depolarization
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what can WPW syndrome lead to?
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supraventricular tachycardia
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what ECG tracing is irregularly irregular?
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a fib
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ECG tracing: no discrete P waves in between irregularly spaced QRS complexes
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a fib
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how do you treat a-fib?
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with warfarin (coumadin)
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what can afib lead to?
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atrial stasis and thus stroke
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ECG tracing: a rapid succession of idetnical back to back atrial depolarization waves
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a flutter
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how do you treat a flutter?
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try to convert to sinus rhythm - use class IA, IC or III antiarrhythmics
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what ECG tracing has a sawtooth pattern?
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a flutter
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ECG tracing: prolonged PR interval, but maintains regular pattern
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1st degree heart block (AV block)
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ECG tracing: progressive lengthening of PR interval until beat is dropped
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2nd degree - Mobitz type 1 heart block
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ECG tracing: dropped beats not preceded by a change in the length of PR interval
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2nd degree - Mobitz type 2 heart block; pathological - can progress to 3rd degree block
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ECG tracing: atria and ventricle beat independently of each other
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3rd degree block
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ECG tracing: P waves bear no relation to QRS complexes
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3rd degree block
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what disease can result in 3rd degree heart block?
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Lyme disease
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ECG tracing: completely erratic rhythm with no identifiable waves
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V fib
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What is the action of ANP?
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a diuretic that causes generalized vascular relaxation - constricts efferent renal arterioles and dilates afferent arterioles
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how do the aortic arch baroreceptors and chemoreceptors transmit information regarding blood state?
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via the vegaus nerve to the medulla
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what type of stimuli does the aortic arch chemo and baroreceptors respond to?
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only to increased BP
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what type of stimuli do the chemo and baroreceptors in the carotid sinus respond to?
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increased and decreased BP
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how do the baroreceptors in the carotid sinus transmit information?
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via the glossopharyngeal nerve to the medulla
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what stimuli do the central chemoreceptors in the brain respond to?
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pH and Pco2 - not directly to Po2
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which organ gets the largest share of systemic cardiac output?
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liver
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which organ gets the higest blood flow per gram of tissue?
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kidney
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which organ has the highest arteriovenous O2 difference?
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heart
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how is increased oxygen demand of the heart compensated?
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increased coronary blood flow - not increased extraction of oxgyen
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what is the normal pressure of the left atrium?
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<12 mmHg
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what is the normal pressure of the left ventricle?
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<130/10 mmHg
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what is the normal pressure of the right ventricle?
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<25/<5 mmHg
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what is the normal pressure of the right atrium?
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<5 mmHg
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what is the normal pressure of the pulmonary artery?
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<25/10 mmHg
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what is the normal pressure of the aorta?
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<130/90 mmHg
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how can you measure left atrial pressure?
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pulmonary capillary wedge pressure
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what happens to the PCWP and LV diastolic pressure in mitral stenosis?
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PCWP > LV diastolic pressure
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what determines blood flow autoregulation of the heart?
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local metabolites - O2, adenosine, NO
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What determines blood flow autoregulation of the brain?
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local metabolites - CO2 (pH)
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What determines blood flow autoregulation of the kidneys?
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myogenic and tubuloglomerular feedback
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What determines blood flow autoregulation of the lungs?
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hypoxia causes vasoconstriction (ONLY one that causes constriction - all others hypoxia causes dilation)
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What determines blood flow autoregulation of the skeletal muscle?
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local metabolites - lactate, adenosine, K
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What determines blood flow autoregulation of the skin?
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sympathetic stimulation most important - temperature control
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Starlings forces: what does Pc equal?
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capillary pressure - pushes fluid out of capillary
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Starlings forces: what does Pi equal?
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interstitial fluid pressure - pushes fluid into capillary
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Starlings forces: what does πc equal?
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plasma colloid osmotic pressure - pulls fluid into capillary
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Starlings forces: what does πi equal?
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interstitial fluid colloid osmotic pressure - pulls fluid out of capillary
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what is the starling equation?
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net filtration pressure = [(Pc-Pi) - (πc - πi)]
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what type of edema is caused by increased capillary pressure (Pc)?
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general edema, i.e. heart failure
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what type of edema is caused by increased capillary permeability (Kf)?
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local edema, i.e. toxins, infections, burns
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what type of edema is caused by increased interstitial fluid colloid osmotic pressure (πi)?
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local edema, i.e. lymphatic blockage
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what type of edema is caused by decreased plasma proteins (πc)?
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general edema, i.e. nephrotic syndrome or liver failure
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what are the 5 causes of right to left shunts?
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1. tetralogy of Fallot (most common cause of early cyanosis), 2. Transposition of the great vessels, 3. Truncus arteriosus, 4. Tricuspid atresia, 5. Total anomalous pulmonary venous return
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which causes blue babies, right to left or left to right shunts?
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right to left shunts
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what are the 3 causes of left to right shunts?
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1. VSD (most common congenital cardiac anomaly), 2. ASD, 3. PDA
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what is the most common congenital cardiac anomaly?
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VSD
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how do you close a PDA?
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with indomethacin
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what is a Eisenmenger's shunt?
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reversal of a left to right shunt to a right to left shunt due to progressive pulmonary HTN
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what are the 4 features of tetralogy of Fallot?
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1. pulmonary stenosis, 2. RVH, 3. overriding aorta, 4. VSD
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what causes Tetralogy of Fallot?
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anterosuperior displacement of the infundibular septum
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what causes transposition of the great vessels?
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failure of the aorticopulmonary septum to spiral
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what congenital anomaly causes the aortic to leave the heart anterior and the pulmonary trunk to leave the heart posteriorly?
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transposition of the great vessels
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define preductal coaractation of the aorta
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aortic stenosis proximal to insertion of the ductus arteriosus = infantile type
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define postductal coarctation of the aorta
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stenosis is distal to ductus arteriosus = adult type
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what is coarctation commonly associated with?
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Turner's syndrome and a biscupid aortic valve
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what can coarctation of the aorta result in?
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aortic regurgitation
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notching of the ribs, HTN in the upper extremities and weak pulses in the lower extremities
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coarctation of the aorta - post ductal (adult type)
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what does PDA lead to?
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RVH and failure
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what maintains the patency of PDA?
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PGE synthesis and low oxygen tension
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when would you want to maintain the patency of a PDA?
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With coarctation of the aorta
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What congenital cardiac defect is associated with 22q11 syndromes?
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truncus arteriosus, tetralogy of Fallot
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What congenital cardiac defect is associated with Down syndrome?
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ASD, VSD, AV septal defect (endocardial cushion defect)
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What congenital cardiac defect is associated with congenital rubella?
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septal defects, PDA, pulmonary artery stenosis
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What congenital cardiac defect is associated with Turner's syndrome?
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coarctation of the aorta
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What congenital cardiac defect is associated with Marfan syndrome?
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aortic insufficiency (late complication)
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What congenital cardiac defect is associated with offspring of a diabetic mother?
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transposition of the great vessels
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define HTN
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BP >140/90
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what are the risk factors for HTN?
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increasing age, obesity, diabetes, smoking, genetics, black >white>asian
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What does HTN predispose to?
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atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy and aortic dissection
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define atheromas
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plaques in blood vessel walls - sign of hyperlipidemia
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define xanthomas
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plaques or nodules composed of lipid-laden histiocytes in the skin, especially they eye lids - sign of hyperlipidemia
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define tendinous xanthoma
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lipid deposit in tendon, especially Achilles - sign of hyperlipidemia
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define corneal arcus
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lipid deposit in cornea (or non-specific = arcus senilis) - sign of hyperlipidemia
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What is Monckeberg arteriosclerosis?
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calcification in the media of the arteries, espeically radial or ulnar. Intima NOT involved
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does Moknckeberg arteriosclerosis obstruct blood flow?
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no, it is usually benign
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What is associated with "pipestem" arteries?
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Monckeberg arteriosclerosis
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calcification of the media of arteries
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Monckeberg arteriosclerosis
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hyaline thickening of small arteries
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arteriolosclerosis
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what causes hyperplastic "union skinning" of small arteries?
|
arteriolosclerosis - due to malignant HTN
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fibrous plaques and atheromas formation in the intima of arteries
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atherosclerosis
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where does atherosclerosis occur?
|
in the INTIMA (unlike Monckeberg which occurs in the Media)
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Define aortic dissection
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longitudinal intraluminal tear forming a false lumen
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what is aortic dissection associated with?
|
HTN or cystic medial necrosis (in Marfan syndrome)
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what presents with tearing chest pain radiating to the back?
|
aortic dissection
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what type of arteries are affected by atherosclerosis?
|
elastic arteries and large and medium sized musclar arteries
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what are the risk factors for atherosclerosis?
|
smoking, HTN, DM, hyperlipidemia, family history
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what is the progression of atherosclerosis?
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1. endothelial cell dysfunction, 2. marcophage and LDL accumulation, 3. foam cell formation, 4. fatty streaks, 5. smooth muscle cell migration, 6. fibrous plaque, 7. complex atheromas
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what are the 6 complications of atherosclerosis?
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1. aneurysms, 2. ischemia, 3. infarcts, 4. peripheral vascular disease, 5. thrombus, 6. emboli
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what are the 4 most common locations of atherosclerosis?
|
abdominal aorta > coronary artery > popliteal artery > carotid artery
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what are the symptoms of atherosclerosis?
|
angina, claudication (can be asymptomatic)
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what type of angina causes ST depression?
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stable and unstable
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what kind of angina causes ST elevation?
|
variant
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what causes stable angina?
|
atherosclerosis
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what causes variant angina?
|
coronary artery spasm
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what causes unstable angina?
|
thrombosis but no necrosis
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define MI
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acute thrombosis due to coronary artery atherosclerosis, results in myocyte necrosis
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what is the most common cause of sudden cardiac death?
|
a lethal arrhythmia
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define chronic ischemic heart disease
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progressive onset of CHF over many years due to chronic ischemic myocardial damage
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what 3 organs are red infarcts common?
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1. liver, 2. lungs, 3. intestine
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what 3 organs are pale infarcts common?
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brain, kidney, heart
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what causes reperfusion injury?
|
free radicals cause damage
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which coronary arteries are more likely to become occluded?
|
LAD > RCA > circumflex
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what are the symptoms of an MI?
|
diaphoresis, nausea, vomiting, severe retrosternal pain, pain in left arm and or jaw, SOB, fatigue, adrenergic symptoms
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Following an MI, when is the greatest risk for arrhythmias?
|
2-4 days
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Following an MI, when is the greatest risk for free wall rupture, tamponade, papillary muscle rupture or ventricular septal rupture?
|
5-10 days
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Following an MI, when is the greatest risk for ventricular aneurysm?
|
7 weeks
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Diagnosing an MI: what is the gold standard in the first 6 hours?
|
ECG
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Diagnosing an MI: when does troponin I rise?
|
after 4 hours and is elevated for 7-10 days - more specific than other protein markers
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Diagnosing an MI: when does CK-MB rise?
|
after 1 day
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Diagnosing an MI: When does AST rise?
|
about 2 days after
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Diagnosing an MI: what does ST elevation tell us?
|
transmural infarct
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Diagnosing an MI: what does ST depression tell us?
|
subendocardial infarct
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Diagnosing an MI: what do pathological Q waves tell us?
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transmural infarct
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what are the 3 characteristics of transmural infarcts?
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1. increased necrosis, 2. affects entire wall, 3. ST elevation on ECG
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What are the 4 characteristics of subendocardial infarcts?
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1. due to ischemic necrosis of < 50% of ventricle wall, 2. subendothelium is especially vulnerable to ischemia, 3. due to fewer collaterals there is higher pressure, 4. ST depression on ECG
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what are the 7 complications of Mis?
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1. arrhythmias, 2. LV failure and pulmonary edema, 3. cardiogenic shock, 4. ventricular free wall rupture, 5. aneurysm fomraiton, 6. fibrinous pericarditis (friction rub, 3-5 days post MI), 7. Dressler's syndrome - autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)
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what is the most common cardiomyopathy?
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dilated (congestive) cardiomyopathy
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what type of dysfunction, systolic or diastolic, occurs with dilated (congested) cardiomyopathy?
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systolic dysfunction
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what are the 7 etiologies of dilated cardiomyopathy?
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1. alcohol abuse, 2. beriberi, 3. coxsackie B virus myocarditis, 4. doxorubicin toxicity, 5. chornic cocaine use, 6. Chagas' disease, 7. peripartum cardiomyopathy
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Findings: S3, dilated heart on ultrasound, balloon appearance on chest x-ray
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dilated (congestive) cardiomyopathy
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Define hypertrophic cardiomyopathy
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hypertrophied IV septum is too close to mitral valve leaflet leading to outflow obstruction
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How is hypertrophic cardiomyopathy inherited?
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50% of hypertrophic cardiomyopathy is transmitted by AD pattern
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what is a common cause of death in young athletes?
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hypertrophic cardiomyopathy
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disoriented, tangled, hypertrophied myocardial fibers
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hypertrophic cardiomyopathy
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Findings: S4, apical impulses, systolic murmur
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hypertrophic cardiomyopathy
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what type of dysfunction, systolic or diastolic, occurs with hypertrophic cardiomyopathy?
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diastolic dysfunction
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how do you treat hypertrophic cardiomyopathy?
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beta blocker or heart specific calcium channel blocker - verapamil
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what type of dysfunction, systolic or diastolic, occurs with restrictive/obliterative cardiomyopathy?
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diastolic dysfunction
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what are the major causes of restrictive/obliterative cardiomyopathy?
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sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis (young children), and hemochromatosis
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define CHF
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a clinical syndrome that occurs in patients with abnormality of cardiac structure or function, who develop a constellation of clinical symtpoms and signs
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CHF: what causes dyspnea on exertion?
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failure of LV output to increase during exercise
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CHF: what causes cardiac dilation?
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greater ventricular end-diastolic volume
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CHF: what causes pulmonary edema and paroxymal nocturnal dyspnea?
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LV failure - increased pulmonary venous pressure leads to distention and transudation of fluid. Presence of hemosiderin-laden macrophages (heart failure cells) in the lungs
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CHF: what causes orthopnea?
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increased venous return in supine position exacerbates pulmonary vascular congestion
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CHF: what causes hepatomegaly (nutmeg liver)?
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increased venous pressure leads to increased resistance to portal flow (rarely leads to cardiac cirrhosis)
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CHF: what causes ankle and sacral edema?
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RV failure which increases venous pressure and leads to fluid transudation
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CHF: what causes jugular venous distention?
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R heart failure which increases venous pressure
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what causes right heart failure?
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almost always secondary to LHF, if isolated usually due to cor pulmonale
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what are the 6 types of embolus?
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1. Fat, 2. air, 3. thrombus, 4. bacteria, 5. amniotic fluid, 6. tumor
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what are the symptoms of pulmonary embolus?
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chest pain, tachypnea, dyspnea
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where do most pulmonary embolie arise from?
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95% arise from DVTs
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what predisposes to DVTs?
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Virchow's Triad: staiss, hypercoagulability and endothelial damage
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Fever, Roth's spots, Osler's node, new murmur, Janeway lesions, anemia, splinter hemorrhges on nail beds
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bacterial endocarditis
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what are Roth's spots?
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round white spots on retina surrounded by hemorrhage - indicates bacterial endocarditis
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what are Osler's nodes?
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tender raised lesions on figer or toe pads - indicates bacterial endocarditis
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what are Janeway lesions?
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small erythematous lesions on palm or sole - indicates bacterial endocarditis
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which valve is most commonly involved with bacterial endocarditis?
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mitral valve
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what is associated with tricuspid valve endocarditis?
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IV drug abuse
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What are the 4 complications of bacterial endocarditis?
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1. chordae rupture, 2. glomerulonephritis, 3. suppurative pericarditis, 4. emboli
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what is the most common cause of acute bacterial endocarditis?
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S. aureus
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bacterial endocarditis: large vegetationso n previously normal valves. What is the etiology?
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S. aureus
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What is the most common cause of subacute bacterial endocarditis?
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viridans streptococcus
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bacterial endocarditis: smaller vegetations on congenitally abnormal or diseased valves
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viridans streptococcus
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what bacteria is associated with prosthetic heart valves?
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s. epidermidis
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what bacteria is associated with endocarditis secondary to colon cancer?
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S. bovis
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What diseases can cause nonbacterial endocarditis?
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malignancy or hypercoagulable state (marantic/thrombotic endocariditis)
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Verrucous, sterile vegetations on both sides of the heart valve
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Libman-Sacks endocarditis
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what can Libman-Sacks endocarditis result in?
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mitral regurg, less commonly mitral stenosis
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when is Libman-Sacks endocarditis seen?
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SLE
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what causes rheumatic heart disease?
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pharyngeal infection with GAS (beta hemolytic)
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which valves are affected in rheumatic heart disease?
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mitral > aortic >> tricuspid
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What is associated with Aschoff bodies?
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rheumatic heart disease
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what is associated with Anitschkow's cells?
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rheumatic heart disease
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What is the pathology of rheumatic heart disease?
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immune mediated, type II HS; NOT a direct effect of bacteria
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what are the 7 symptoms of rheumatic fever?
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1. fever, 2. erythema marginatum, 3. valvular damage, 4. increased ESR, 5. red-hot joints (migratory polyarthritis, 6. subcutaneous nodules (Aschoff body), 7. St. Vitus' dance (chorea)
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define cardiac tamponade
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compression of the heart by fluid in the pericardium, leading to decreased CO
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what causes equilibration of diastolic pressure in all 4 chambers?
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cardiac tamponade
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findings: hypotension, increased venous pressure (JVD), distant heart sounds, 4. increased HR, 5. pulsus paradoxus
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cardiac tamponade
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what is pulsus paradoxus?
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"Kussmaul's pulse": decreased in amplitude of pulse during inspiration; seen in severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis and croup
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What are the causes of serous pericarditis?
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SLE, rheumatiod arthritis, viral infection, uremia
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what are the 3 causes of fibrinous pericarditis?
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1. uremia, 2. MI (Dressler's syndrome), 3. rheumatic fever
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What are the 2 causes of hemorrhagic pericarditis?
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1. TB, 2. malignancy (melanoma)
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what are the complications of pericarditis?
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can lead to chronic adhesive or chronic constrictive pericarditis; (can resolve wihtout scarring)
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findings: pericardial pain, friction rub, pulsus paradoxus, distant heart sounds
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pericarditis
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What is the effect of syphilitic heart disease?
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disruption of the vasa vasorum or the aorta with consequent dilation of the aorta and valve ring; can lead to calcification of the oartic root and ascending aortic arch
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finding: tree bark apperance of the aorta
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syphilitic heart disease
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what are the complications of syphilitic heart disease?
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can result in aneurysm of the ascending arta or aortic arch and aortic valve incompetence
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what is the most common primary cardiac tumor in adults?
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myxomas
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where do most myxomas occur?
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in the atria - mostly left; can cause ball valve obstruction
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what is the most common primary cardiac tumor in children?
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rhabdomyomas (associated with tuberous sclerosis)
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what is the most common heart tumor overall?
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metastases - melanoma or lymphoma
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what is the Kussmaul's sign?
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increase in jugular venous pressure on inspiration
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define telangiectasia
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arteriovenous malformation in SMALL vessels, dilated vessels on skin and mucous membranes
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how does hereditary hemorrhagic telangiectasia present?
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nosebleeds and skin discolorations - inherited AD
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define Raynaud's disease
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decreased blood flow to the skin due to arteriolar vasospams - effects SMALL vessels, in response to cold or stress; called Raynaud's phenomenon when secondary to an autoimmune disease
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Triad: focal necrotizing vasculitis, necrotizing granulomas in lungs and upper airways and necrotizing glomerulonephritis
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Wegener's granulomatosis
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what sized blood vessels does Wegener's granulomatosis affect?
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SMALL vessels
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Findings: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis and hematuria
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Wegener's granulomatosis
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what antibody is associated with Wegener's granulmatosis?
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cANCA
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how do you treat Wegener's granulomatosis?
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cyclophophsamide and corticosteroids
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what sized blood vessels are affected by microscopic polyangiitis?
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SMALL vessels
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does microscopic polyangiits cause granulomas?
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No - distinguishes it from Wegenger's granulomatosis
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what anitbody is associated with microscopic polyangiits?
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p-ANCA
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define primary pauci-immune crescentric glomerulonephritis
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vasculitis affecting SMALL vessels limited to the kidney. Few antibodies (paucy)
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finding: granulomatous vasculitis with eosinophilia
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Churg-Strauss syndrome
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what organs are affected by Churg-Strauss syndrome?
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lung, heart, skin, kidney and nerves
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what type of patient is Churg-Strauss common in?
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atopic patient
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what antibody is associated with Churg-Strauss syndrome?
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p-ANCA
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finding: port-wine stain on face and leptomeningeal angiomatosis (intracerebral AVM)
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Sturge-Weber disease
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define sturge-weber disease
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congenital vascular disorder that affects capillary sized blood vessels
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what is the most common form of childhood systemic vasculitis?
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Henoch-Schonlein purpura
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findings: skin rash on buttock and legs, arthralgia, intestinal hemorrage, abdominal pain and melena
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Henoch-Schonlein purpura
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when does Henoch-Schonlein pupura present?
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It follwos URIs
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What type of immune complex is involved in Henoch-Schonlein purpura?
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IgAs
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what size vessels are affected by Henoch-Schonlein purpura?
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SMALL vessels
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In Henoch-Schonlein purpura are the lesions the same age or different ages?
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multiple lesions of the same age (Differs from PAN)
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what are the 3 common sites that are affected by henoch-schonlein purpura
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1. skin, 2. joints, 3. GI
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what disease is associated with Henoch-Schonlein purpura?
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IgA nephropathy
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Finding: idiopathic, segmental, thrombosing vasculitis of small and medium peripherial arteries and veins
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Buerger's disease
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In what type of patient is Buerger's disease most often seen?
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heavy smokers
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Findings: intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynaud's phenomenon), severe pain in affected part
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Buerger's disease
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what are the complications of Buerger's disease
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may lead to gangrene and autoamputation of digits
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what is the treatment for Buerger's disease?
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smoking cessation
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necrotizing vasculitis of small/medium vessels that occurs in children and is self-limiting
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Kawasaki disease
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what is the complication of Kawasaki disease?
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may develop coronary aneurysm
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findings: fever, congested conjunctiva, changes in lips/oral mucosa - strawberry tongue, lymphadenitis
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Kawasaki disease
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necrotizing immune complex inflammatio of medicum sized muscular arteries
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PAN
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what sites are most affected by PAN?
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renal and visceral vessles
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Are the lesions associated with PAN the same age or differing ages?
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lesions are of different ages (as opposed to Henoch-schonlein purpura)
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findings: fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neurolgoic dysfunction, cutaneous eruptions
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PAN
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what is associated with PAN?
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hepatitis B
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findings: multiple aneurysms and constrictions on arteriogram
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PAN
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is PAN assocaited with ANCA?
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not typically
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how do you treat PAN?
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corticosteroids, cyclophosphamide
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granulomatous thickening of aortic arch and/or proximal great vessels
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Takayasu's arteritis
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what sized vessels are affected by Takayasu's arteritis?
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medium and large
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what population is associated with Takayasu's arteritis?
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asian women over 40 yoa
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Findings: fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, weak pulses in upper extremities
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Takayasu's arteritis
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what lab finding is associated with Takayasu's arteritis?
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increased ESR
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what is the most common vasculitis that affects medium and large arteries?
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Temporal arteritis
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what are the findings in temporal arteritis?
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focal, granulomatous inflammation usually in the branches of the carotid artery
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findings: unilateral headache, jaw claudication, impaired vision
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Temporal arteritis
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what sized arteries arteries are affected by Temporal arteritis?
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medium and large
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what is the major complication of Temporal arteritis?
|
occlusion of the ophthalmic artery that can lead to irreversible blindness
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what lab findings are associated with temporal arteritis?
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increased ESR, 50% of patients have systemic involvement and polymylagia rheumatica
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how do you treat temporal arteritis?
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high-dose steroids
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