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140 Cards in this Set

  • Front
  • Back
Baby presents with cyanosis (blue)

5 common causes? what is the underlying pathology?
5 T's
1. Tetralogy of Fallot (most common)
2. Transposition of great vessels
3. Truncus arteriosus
4. Tricuspid atresia
5. Total anomalous pulmonary venous return

R-L shunt
What is persistent truncus arteriosus and what does it cause?
failure of truncus arteriosus to divide into pulmonary trunk and aorta

causes early cyanosis
What is tricuspid atresia and what does it cause?

what MUST be present for surviival
absence of tricuspid valve --> loss of connection between RA and RV --> hypoplastic RV --> early cyanosis

ASD and VSD
What is total anomalous pulmonary venous return (TAPVR) and what does it cause
pulmonary vein drains into right heart circulation

causes early cyanosis
What are 3 common causes of late cyanosis (blue kids) and what are their relative frequencies?
Left-->Right shunt

VSD > ASD > PDA
what is the most common congenital cardiac anomaly and what does it cause
VSD --> late cyanosis
A kid presents with cyanosis, loud S1, and a wide, fixed split S2

dx?
ASD
Patent ductus arteriosus

what can it cause?

how do you treat?
late cyanosis (blue kids)

close with indomethacin
What is Eisenmenger's syndrome


pathway?

what can this cause?
When a L-->R shunt switches to R --> L

Uncorrected VSD/ASD/PDA --> pulmonary vascular hypertrophy --> pulmonary HTN --> incraseases pulmonary resistance, causes reversal of shunt

late cyanosis (clubbing and polycythemia)
4 heart abnormalities in tetralogy of fallot?

How can patients improve the symptoms and why?
SQUAT to imPROVe the symptoms

Pulmonary stenosis
RV Hypertertrophy
Overriding aorta
VSD

Squat --> compress femoral arteries --> increase TPR --> reduces R to L shunt, more blood directed from RV to lungs
Patient is a child that experienced early cyanosis

on x-ray, see a boot shaped heart, indicating Right ventricular hypertrophy

patient suffers 'cyanotic spells', or acute hypoxic events in which syncope occurs; squatting helps with these symptoms

dx?
cause?
Tetralogy of fallot

caused by anterosuperior displacement of the infundibular septum
Transposition of great vessels

Defect?
Cause?
Course?
Aorta leaves RV, PA leaves LV (switched)

caused by failure of aorticopulmonary septum to spiral

Must use surgery to present VSD/PDA/patent foramen ovale or death occurs in first few months
How does infantile coarctation of the aorta differ from adult type
infantile = coarctation is preductal (ductus arteriosu)

adult = coarctation is psostductal (distal to ligamentum arteriosum)

INfantile: IN close to the heart
aDult = Distal to Ductus
Adult comes in with notched ribs, HTN in upper extremities, weak pulses in lower extremities

Heart sounds - diastolic murmur that makes a blowing sound

dx?
Adult type coarctation of the aorta

Aortic regurgitation sound caused by bicuspid aortic valve
What condition is associated with high incidence of infantile coarctation of the aorta
Turner's
How does a patent ductus arteriosus change in fetal period to a neonate
Fetal = R--> L shunt (normal

Neonate = L--> R shunt (abnormal, due to decreased lung resistance) --> RV hypertrophy, failure
Patient has a 'machine like murmur' that is constant

dx?

what can happen if this goes uncorrected?
PDA

can cause cyanosis in lower extremities (differential cyanosis)
PDA

what keeps it open? why would you want to do that?
what closes it?
pgEE (prostaglandins) kEEps it open

may be necessary to sustain life if you have a condition like transposition of great vessels

Indomethacin closes it (NSAID)
One drug that closes PDA
indoemethacin

ENDomethacin ENDS PDA
Congenital cardiac defects associated with...

2 defects associated with 22q11
Truncus arteriosus, Tetralogy of Fallot
Congenital cardiac defects associated with...

Down Syndrome (3)
ASD
VSD
AV septal defect (endocardial cushion defect)
Congenital cardiac defects associated with...

Congenital rubella (3)
Septal defect
PDA
PA stenosis
Congenital cardiac defects associated with...

Turner Syndrome
Coarctation of aorta (preductal)
Congenital cardiac defects associated with...

Marfan's
Aortic insufficiency (late complication)
Congenital cardiac defects associated with...

Infant of diabetic mother
Transposition of great vessels
HTN

definition?
risk factors?
BP > or = 140/90

age, obesity, diabetes, smoking, genetics, black>white>asian
HTN

1. most common cause
2. 2nd most common cause
1. primary/essential, related to high CO or TPR

2. Renal disease
HTN

what is malignant HTN
Severe and rapidly progressing HTN
Atherosclerosis
LV hypertrophy
Stroke
CHF
Renal failure
Retinopathy
Aortic dissection

These are all associated with what general condition
HTN
Hyperlipidemia signs

what are atheromas
plaques in blood vessel walls
Hyperlipidemia signs

what are xanthomas?

xanthelesma?
plaques/nodules of lipid-laden histiocytes in skin

xanthoma of eyelids
Hyperlipidemia signs

what is a tendinous xanthoma
lipid deposited in tendon, esp. achilles
Hyperlipidemia signs

what is a corneal arcus
lipid deposit in cornea, non specific (arcus senilis)
Monckeberg Arteriorsclerosis
a. what happens
b. where
c. what does it cause
a. calcification in media of arteries
b. often in radial or ulnar arteries
c. usually benign, does not block flow; causes 'pipestream arteries'
Arteriosclerosis

a. what is it
b. associated conditions
c. what can you see with malignant HTN?
a. hyaline thickening of small arteries

b. associated in essential HTN or diabetes

c. see hyperplastic onion skinning
What is atherosclerosis?

what types of arteries?
fibrous plaques on intima of arteries

elastic arteries, large and medium sized muscular arteries
Smoking, HTN, diabetes, hyperlipidemia, family hx

predispose to what
atherosclerosis
Progression of atherosclerosis, from endothelial cell dysfunction to complex atheromas
endothelial dysufnction --> inflammation, accumulation of macrophages and LDL --> foam cells (macrophages full of LDL) --> fatty streaks --> smooth muscle migration into intima (PDGF, TGF) --> fibrous plaque --> complex atheroma
Aneurysms
Ischemia
Infarcts
Peripheral vascular disease
Thrombus
Emboli

complications of what
atherosclerosis
4 common locations for atherosclerosis
abdominal aorta > coronary artery > popliteal artery > carotid artery
What are 2 possible symptoms of
atherosclerosis
angina
claudication
Patient with HTN presents with tearing chest pain that radiates to the back

CXR shows mediastinal widening

MRI shows false lumen occupying most of the descending aorta

dx?
what has happened?
2 associated conditions?
What is the course?
aortic dissection

longitudinal intraluminal tear --> false lumen

HTN or cystic medial necrosis (marfan's)

may result in aortic rupture, death
Ischemic heart disease

what is it called when the coronoary artery is narrowed by >75%
angina
Ischemic heart disease

Patient has retrosternal chest pain WITH EXERTION, goes away at rest, ST depression

dx?
Secondary to...?
stable angina, usually secondary to atherosclerosis
Patient has chest pain at rest that comes on in cycles, often at night

-exercise stable

-ST elevation on ECG

dx?
secondary to what?
Prinzmetal's angina

Secondary to coronary artery spasm
Ischemic heart disease

Patient complains of chest pain at rest, that seems to get worse and worse

ST depression

dx? cause?
Unstable/crescendo angina

thrombosis but no necrosis
MI

what is the most common cause?

What does it lead to?
acute thrombosis due to coronary artery atherosclerosis

leads to myocyte necrosis
Patient experiences acute chest pain, and 1 hour later is dead

what is this called?
most common cause?
sudden cardiac death

deadly arrhythmia
What is chronic ischemic heart disease
Progressive onset of CHF over many years due to chronic ischemic myocardial damage
What coronary arteries are most often occluded?
LAD > RCA > circumflex
Patient presents to the ER with
-diaphoresis
-nausea
-vomiting
-severe retrosternal pain
-pain in left arm/jaw
-shortness of breath
-fatigue
-adrenergic symptoms

what's going on
MI
When after an MI is there risk of an arrhythmia
Within first 4 days
When after an MI is there risk for free wall rupture, tamponade, papillary muscle rupture, or interventricular septal rupture

why is this risk heightened at this time
5-10 days after

macrophages have degraded important structural components
When after an MI is there increased risk for a ventricular aneurysm
7 weeks
Evolution of an MI

a. what can you see in the first 2-4 hours

b. what can you start to see after 4 hours

c. what shows up after 12-24 hours
a. No change by light microscopy

b. early coagulative necrosis, release of necrotic cells into bloodstream, start of neutrophil emigration

c. contraction bands visible
On the first day of an MI, what would you see from the infarcted area if you stained it with tetrazolium stain
Tissue would be pale
Evolution of an MI

-Tissue surrounding infarct shows acute inflammation
-hyperemia (dilation)
-PMN emigration
-muscle shows coagulative necrosis

how long after the MI
2-4 days
Evolution of an MI

Tissue has a hyperemic border with a central yellow-brown softening

outer zone of granulation tissue

how long has it been since the MI?
5-10 days
Evolution of an MI

Tissue is gray/white, artery is recanalized, contracted scar is complete

how long since MI
7 weeks
After an MI, when is the tissue maximally yellow and soft
10 days
Diagnosis of MI

Gold standard of diagnosis within first 6 hours
ECG
Diagnosis of MI

What can you look for after 4 hours that is more specific than other protein markers

how long does it last
troponin I rises after 4 hours, elevated for 7-10 days
Diagnosis of MI

how do you diagnose reinfarction on top of acute MI

where is it found
Ck-MB


myocardium and skeletal muscle
Diagnosis of MI

A nonspecific protein that can be fond in cardiac, liver, and skeletal muscle cels
AST
Diagnosis of MI - where was the infarct if on ECG you see
a. ST elevation
b. ST depression
c. Pathologic Q waves
a. transmural
b. subendocardial
c. transmural
Transmural infarct vs. Subendocardial infarct

amount of necrosis
T = full wall thickness

SE = ischemic necrosis of <50% of wall, subendocardium vulnerable due to fewer collaterals and higher pressure
Transmural infarct vs. Subendocardial infarct

ECG findings
T = ST elevation, Q waves

SE = ST depression
ECG diagnosis of MI

If V1-V4 have Q waves, where is the infarct
Anterior wall (LAD)
ECG diagnosis of MI

If V1-V2 have Q waves, where is the infarct
Anteroseptal (LAD)
ECG diagnosis of MI

If V4-V6 have Q waves, where is the infarct
Anterolateral (LCX)
ECG diagnosis of MI

If ledes I and aVL have Q waves, where is the infarct
lateral wall (LCX)
ECG diagnosis of MI

If ledes II, III, and aVF have Q waves, where is the infarct
Inferior wall (RCA)
MI complications

One important complication often seen in first few days, common cause of death before reaching hospital
arrhythmia
MI complications

What is cardiogenic shock
Ventricles fail to pump enough blood to body after MI
MI complications - what is the result of
a. ventricular free wall rupture
b. papillary muscle rupture
c. interventricular septal rupture
a. Cardiac tamponade
b. Mitral regurg
c. VSD
MI complications

3 risks of a post-MI aneurysm
1. decrease CO
2. risk of arrhythmia
3. embolus from mural thrombus
MI complications

3-5 days after an MI, you hear a friction rub

What could be going wrong
Postinfarction fibrinous pericarditis
MI complications

Several weeks post-MI, you get fibrinous pericarditis

dx?
Dressler's syndrome = autoimmune phenomenon resulting in fibrinous pericarditis
Cardiomyopathies

what is the most common cardiomyopathy?
Dilated (congestive)
Alcohol abuse
wet Beriberi
Coxsackie B virus myocarditis
Chronic cocaine use
Chagas'
Doxorubicin toxicity
Hemochromatosis
Peripartum cardiomyopathy

Common etiologies of what condition
dilated cardiomyopathy
On chest exam, you hear an S3

-see dilated heart on ultrasound
-CXR reveals balloon appearance of heart

dx?

What is the pathogenesis?
dilated cardiomyopathy

Ventricluar dysfunction --> hypertrophy of ventricular wall myocardium (sarcomeres added in series, eccentric) --> systolic dysfunction
Common cause of sudden death in young athletes
hypertrophic cardiomyopathy
dilated vs. hypertrophic cardiomyopathy

type of hypertrophy?
dilated = eccentric hypertrophy, sarcomeres added in series

hypertrphic = concentric hypertrophy, sarcomeres added in parallel
Patient with a syncopal episode comes in to clinic. You see...
-has a normal sized heart
-S4
-Apical impulses
-Systolic murmur

dx?

treat?
Hypertrophic cardiomyopathy

B-blocker or non-dihydropyridine Ca channel blocker
Dilated vs. hypertrophic cardiomyopathy

what type of dysfunction ensues
dilated --> systolic dysfunction

hypertrophic --> diastolic dysfunction
Hypertrophic cardiomyopathy

what is the actual defect in the heart that syncope and systolic murmur'

what would you see histologically?
Hypertrophied interventricular septum and mitral valve leaflet are so close that they obstruct the outflow tract

Also see disoriented, hypertorphied myocardial fibers
Hypertrophic cardiomyopathy

a. % of cases due to genetic causes, and what is the cause

b. associated with what neurological condition
a. 50% familial, autosomal dominant

b. Friedreich's ataxia
-Sarcoidosis
-amyloidosis
-post-radiation fibrosis
-endocardial fibroelastosis (fibroelastic tissue in endocardium of young kids)
-Loffler's syndrome (endomyocardial fibrosis wih a prominent eosinophilic infiltrate)
-hemochromatosis (dilated cardiomyopathy can also occur)

all major causes of what?

what type of dysfunction ensues?
restrictive/obliterative cardiomyopathy

diastolic dysfunction ensues
CHF
Abnormality = dyspnea on exertion
What is the cause
Failure of LV to pump output to increase during exercise
CHF
Abnormality = y dilation
What is the cause
Greater ventricular end-diastolic volume
CHF
Abnormality = Pulmonary edema, paroxysmal nocturnal dyspnea, heart failure cells

What is the cause
what key thing would you see histologically and what caused them?
LV failure --> increased pulmonary venous pressure ---> pulmonary venous distention, transudate

heart failure cells = hemosiderin-laden macrophages in lungs due to microhemorrhages from increased pulmonary capillary pressure
CHF
Abnormality = orthopnea (SOB when supine)
What is the cause
increased venous return when supine exacerbates pulmonary vascular congestion
CHF
Abnormality = Hepatomegaly (nutmeg liver)
What is the cause
increased central venous pressure --> increased resistance to portal blood flow

rarely leads to cardiac cirrhosis
CHF
Abnormality = Ankle, sacral edema
What is the cause
RV failure --> increased venous pressure --> transudation
CHF
Abnormality = JVD
What is the cause
RH failure --> increased venous pressure
CHF
Abnormality = RHF
What is the cause
most often caused by LHF

isolated --> result of cor pulmonale
-fever
-Roth's spots
-Osler's nodes
-new Murmur
-Janeway lesions
-anemia
-Nail bed splinter hemorrhage
-Embolus

consider what diagnosis
bacterial endocarditis

FROM JANE
bacterial endocarditis - what are these called

Round white spots on retina surrounded by hemorrhage
Roth's spots
bacterial endocarditis - what are these called

Tender raised lesions on finger or toe pads
Osler's nodes
bacterial endocarditis - what are these called

Small erythematous lesions on palm or sole
Janeway lesion
In bacterial endocarditis, what may be causing the new heart murmur
damaged aortic valve
Common cause of acute bacterial endocarditis

where do you see vegetations

how is the onset
s. aureus

large vegatations on previously healthy valves

rapid onset
Common cause of subacute bacterial endocarditis

where do you see vegatations

where do you get it from

speed of onset
viridans strep

smaller vegetations on congenitally abnormal or diseased valves

from dental procedures

insidious
2 causes of nonbacterial endocarditis
Malignancy

Hypercoagulable state (marantic/thrombotic endocarditis)
bacterial endocarditis

Bacteria associated with this condition in a patient with colon cancer
S. bovis
bacterial endocarditis

type of bacteria seen on prosthetic valves
s. epidermidis
Type of bacteria that cause culture-negative bacterial endocarditis
HACEK
bacterial endocarditis

Most frequent valve involved
mitral
bacterial endocarditis

What valve is implicated in IVDU

3 associated bugs?
TRIcuspid valve (don't TRI drugs)

S. aureus, Pseudomonas, Candida
Chordae rupture
Glomerulonephritis
Suppurative pericarditis
Emboli

Complications of what condition?
bacterial endocarditis
Type of endocarditis caused by SLE

where are the vegetations and how big are they

associated with what conditions
Liban-Sacks endocarditis
(SLE causes LSE)

Small, sterile vegetations on both sides of the valve

Associated with mitral regurgitation, sometimes mitral stenosis
Patient presents with
-Fever
-Erythema marginatum
-Valvular damage (vegetation and fibrosis)
-ESR increased
-Red hot joints (migratory polyarthritis)
-Subcutaneous nodules
-St. Vitus' dance (chorea)

dx?
Rheumatic Fever secondary to GABHS infection

FEVERSS
On biopsy of heart tissue, you see
-aschoff bodies (granuloma with giant cells)
-Anitschkow's cells (activated histiocytes)
-elevated ASO titers

dx?
Rheumatic heart disease
What causes Rheumatic heart disease
type II hypersensitivity (immune mediated)

Igs made to M protein of GABHS, attack heart, kidney, etc.
Rheumatic fever
a. early sequelae involving heart
b. late sequelae - which valves most affected
a. death due to myocarditis

b. rheumatic heart disease
-high pressure valves: Mitral > aortic >> tricuspid
Rheumatic heart disease

a. early lesion
b. late lesion
a. mitral valve prolapse

b. mitral stenosis
What is the condition in which the heart is compressed by fluid (blood, effusions) in the pericardium, leading to decreased CO

what does this condition do to diastolic pressures
cardiac tamponade

equilibriates diastolic pressures in all 4 heart chambers
Patient has:
-hypotension
-JVD (venous pressure increased)
-distant heart sounds
-increased HR
-pulsus paradoxus (exaggerated decrease in amplitude of pulse in inspiration)

dx?
Cardiac tamponade
5 conditions in which you see pulsus paradoxus
1. cardiac tamponade
2. asthma
3. obstructive sleep apnea
4. pericarditis
5. croup
Patient comes in with
-hemoptysis
-hematuria
-perforation of nasal septum
-chronic sinusitis
-otitis media
-mastoiditis
-cough
-dyspnea

CXR reveals large nodular densities

dx?

What is the triad associated with this?

treat?
Wegner's granulomatosis (small vessels)

1. necrotizing vasculitis 2. necrotizing granulomas in lung and upper airway
3. necrotizing glomerulonephritis

Cyclophosphamide and corticosteroids
What is a small vessel vasculitides that has necrotizing vasculitis and glomerulnephritis, but lacks the granulomas of Wegner's

also is pANCA positive
Microscopic polyangiitis
What is one vasculitis limited to the kidney that lacks antibody response
primary pauci-immune crescentic glomerulonephritis

PAUCI-immune = PAUCIty of antibodies
Patient presents with
-Asthma
-Sinusitis
-Skin lesions
-Peripheral neuropathy (wrist/foot drop)
-may also see pathology on heart, GI, kidneys

see p-ANCA

dx?
What would you see on biopsy
Churg Strauss

See granulomatous vasculitis with eosinophilia
Patient presents with
-nevus flammeus (port-wine stain on face)
-ipsilateral leptomeningeal angiomatosis (intracerebral AVM)
-seizures
-early onset glaucoma

dx?
what does it affect?
How do you get it
Sturge-Weber Disease

Affects capilary-sized blood vessels

Congenital
What is the most common form of childhood systemic vasculitis
Henoch Schonlein purpura
Patient is a child who presents following a URI with
-palpable purpura on butt and legs (rash)
-Arthralgia
-Severe abdominal pain
-melena

dx?
What antibodies would you expect to find?
What is one disease association?
Henoch-Schonlein purpura

IgA immune complexes deposited on small vessels

Associated with IgA nephropathy
Patient is a heavy smoker, presents with
-intermittent claudication
-superficial nodular phlebitis
-cold sensitivity (raynaud's phenomenon)
-severe pain peripherally

dx?
path?
course?
Buerger's disease

Idiopathic, spontaneous thrombosing of small and medium peripheral arteries and veins

May lead to gangrene and autoamputation of digits if patient doesn't stop smoking
ASIAN child gets
-fever
-conjunctivitis
-lymphadenitis
-changes in lips and oral mucosa
-desquamative skin rash

dx?
path?
Treat?
Kawasaki disease

Necrotizing vasculitis in small or medium vessels, found in kids, esp. Asians

Treat with IV immunoglobulin and aspirin
Patient presents with
-fever, wt. loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neuro dysfunction, cutaneous eruptions (different ages)

-Arteriogram reveals multiple aneurysms and constrictions

-Hep B seropositive (30%)

dx?
What would you see on histo?
Where does this disease affect?
treat?
Polyarteritis nodosa

IC-mediated transmural vasculitis with fibrinoid necrosis

Affects small and medium renal and visceral vessels; not pulmonary arteries

treat with corticosteroids, cyclophosphamide
Patient is an Asian female <40, presents with
-Fever
-Arthritis
-Night sweats
-MYalgia
-SKIN nodules
-Ocular disturbances
-Weak pulse in upper extremities

-Tests reveal elevated ESR

dx?
what would you see on histo?
Takayasu's arteritis

granulomatous thickening of aortic arch and/or proximal great vessels

Symptom mnemonic: FAN MY SKIN On Wednesday
Elderly female presents with
-unilateral headache
-jaw claudication
-impaired vision (occlusion of ophthalmic artery can lead to irreversible blindiness)

-Find elevated ESR
-Half of patients have systemic involvement and polymyalgia rheumatica

dx?
What would you see on biopsy?
treat?
Temporal (giant cell) arteritis

Branches of carotid (medium and large arteries) show focal, granulomatous inflammation

High dose steroids

"TEMPoral arteritis affects the TEMPles"
Vascular tumors

A benign capillary hemangioma of infancy that initially grows with the child, but spontaneously regresses
Strawberry hemagioma
Vascular tumors

Benign capillary hemangioma of elderly that does not regress, increases with age
Cherry hemangioma
Vascular tumors

Polyoid capillary hemangioma in oral/nasal that can ulcerate and bleed, associated with trauma and pregnancy
pyogenic granuloma
Vascular tumors

Cavernous lymphagioma of neck, associated with Turners
Cystic hygroma
Vascular tumors

Benign, painful, red-blue tumor under fingernails that arises from modified smooth muscle cells of the glomus body
Glomus tumor
Vascular tumors

Benign capillary skin papules found in AIDS patiens, often mistaken for kaposi's

what is the bacteria
bacillary angiomatosis

bartonella henselae infection
Vascular tumors

Lethal malignancy of liver, associated with vinyl chloride, arsenic, and ThO2 (thorotrast) exposure
Angiosarcoma
Vascular tumors

Lymphatic malignancy associated with persistent lymphedema (eg. Post-radical mastectomy)
Lymphangiosarcoma
Vascular tumors

Endothelial malignancy of the skin associated with HHV-8 and HIV

Mistaken for bacillary angiomatosis often
kaposi's sarcoma