Cardiac Pathology

Front 1

Clinical features of stable angina

Back 1

Chest pain induced by exercise or emotions. ST segment depression (subendocardial ischemia) Relieved by rest or nitroglycerin

Front 2

Clinical features of Prinzmetal angina

Back 2

Chest pain caused by coronary artery vasospasm. ST segment elevation. Relieved by nitroglycerin

Front 3

Clinical features of unstable angina

Back 3

Non-occlusive thrombus triggers release of TXA2 (vasoconstrictor). Occurs at rest. Risk of MI

Front 4

Coronary irrigation of the heart

Back 4

Left anterior descending artery supplies anterior portion of left ventricle and anterior 2/3 of interventricular septum (produces heart blocks) (45% of MI). Circumflex artery, branch of left coronary artery (15% of MI). Right coronary artery supplies posterior and inferior left ventricle, right ventricle, SA node (sinus bradycardia), papillary muscle (mitral insuficiency) (35% of MI)

Front 5

Risk factors for coronary artery disease

Back 5

Age, family history, cigarette smoke, hipertension, low HDL, high LDL, diabetes

Front 6

Clinical presentation of AMI

Back 6

Sudden onset of acute substernal chest pain radiated to left arm, jaw and neck. Shortness of breath, diapgoresis, nausea, vomiting and anxiety

Front 7

Serum markers of miocardial infarction

Back 7

CK-MB elevated by 8h, peaks 18h, normal in 3 days. Troponin elevated by 6h, peaks 16h, normal in 10 days. LDH elevted by 24h, peaks 6 days, normal in 14 days.

Front 8

Gross changes in miocardial infarction

Back 8

18h, no change. 24h vague pallor. 1-7d yellow pallor. 7-28d central pallor with red border. Months - white firm scar

Front 9

Microscopic changes in miocardial infarction

Back 9

4-24h coagulative necrosis. 1-3d neutrophilic infiltrate. 3-7d macrophages. 7-28d granulation tissue. Months - fibrotic scar

Front 10

Complications of MI

Back 10

Arrhythmias (MC COD), CHF, pericarditis, rupture (4-7 days post-infarct). Ventricular free wall (LAD) --> cardiac tamponade. Interventricular septum (LAD) --> left to right shunt. Papillary muscle (RCA) mitral insufficiency

Front 11

Features of sudden cardiac death

Back 11

Death within 1 hour of onset of symptoms by fatal arrhythmia. CAD (80%), hypertrophic cardiomyopathy, mitral valve prolapse, aortic stenosis

Front 12

Pathophysiology of heart failure

Back 12

Left ventricle fails --> decreased cardiac output --> RAA system and retention of Na and H20 --> increased venous return causes edema and partial compensation of CO. There's backward pulmonary congestion that causes dyspnea and pulmonary edema with decreased RV output that adds up to ystemic edema. Increased sympathetic tone and volume retention are compensation mechanisms

Front 13

Signs and symptoms of left heart failure

Back 13

Dyspnea (due to increased pulmonary hydrostatic pressure), pillow orthopnea (no gravity increases venous return with pulmonary congestion), rales, S3 gallop (volume overloaded ventricle)

Front 14

Complications of left heart failure

Back 14

Pulmonary edema, excessive RAA leads to secondary hyperaldosteronism, cardiogenic shock

Front 15

Features and treatment of systolic left heart failure

Back 15

Due to decreased contractility after infarction. EF<0.4. Rx. Inotropics (digitalis), decrease afterload with vasodilators (ACE inhibitor)

Front 16

Features and treatment of diastolic left heart failure

Back 16

Due to decreased compliance of left ventricle (increases left atrial pressure and pulmonary congestion). EF>0.4. Due to left ventricular hypertrophy, restrictive cardiomyopathy. Rx.: increase preload by decreasing heart rate (calcium channel blockers and B-blockers)

Front 17

Causes of right heart failure

Back 17

Left heart failure (MCC), cor pulmonale (primary pulmonary hypertension)

Front 18

Clinical features of right heart failure

Back 18

Jugular venous distension, nutmeg liver hepatomegaly, dependant pitting edema, ascites, pleural effusions, tricuspid insuficiency

Front 19

Causes and features of mitral stenosis

Back 19

Chronic rheumatic fever is MCC. Mid-diastolic murmur. Dyspnea and hemoptisis (pulmonary congestion), atrial fibrillation (left atrial dilation), dysphagia for solids (enlarged left atrium compresses esophagus), hoarseness (irritation of recurrent laryngeal nerve)

Front 20

Causes and features of mitral prolapse

Back 20

Valve leaflets undergo mysomatous degeneration. Associated with lethal ventricular arrhythmias in Marfan. Mid-systolic click. Infectious endocarditis and rupture of chordae tendinae are complications Rx.: CCA, b-blockers and negative inotropic agents

Front 21

Causes and features of mitral insuficiency

Back 21

Caused by mitral prolapse, left heart failure, infective endocarditis, RCA thrombosis (papillary muscle). Systolic murmur, S3 heart sound.

Front 22

Causes and features of aortic stenosis

Back 22

MCC is calcified congenital bicuspid valve, rheumatic fever, old age. Decreased stroke volume and cardiac output, increased afterload. Left ventricular hypertrophy. Systolic murmur. Associated with angina (less coronary filling), syncope (reduced cardiac output) and microangiopathic hemolytic anemia with schistocytes

Front 23

Causes and features of aortic insuficiency

Back 23

MCC is essential hypertension, infective endocarditis, syphilitic and aortic aneurysms. Left ventricular hypertrophy, increased preload. Diastolic murmur, bounding pulse.

Front 24

Pathophysiology of rheumatic fever

Back 24

Antibodies against streptococal M protein cross react with heart valves producing fibrosis/stenosis, as well as systemic features

Front 25

Jones major criteria of rheumatic fever

Back 25

Migratory polyarthritis, pancarditis, subcutaneous nodules, erythema marginatum, sydenhan chrorea

Front 26

Pathognomonic lesion of rheumatic heart fever

Back 26

Aschoff body. Fibrinoid necrosis surrounded by macrophages (Anitschkow cells), lymphocytes and plasma cells

Front 27

Clinical features of subacute endocarditis

Back 27

Strep viridans colonizes damaged valves. "FROM JANE". Fever, Roth spots on retina, Osler nodes (painful subcutaneous nodules on fingers and toes), murmur, Janeway lesions (painless red lesions on palms and soles), anemia, nailbed hemorrhage, septic emboli

Front 28

Preductal coarctation of the aorta

Back 28

Associated with Turner syndrome. Narrowing of aorta proximal to ductus arteriosus. Ususally associated with PDA that supplies oxygenated blood to distal aorta. Presents in newborn with CHF, weak pulses and cyanosis of lower extremities.

Front 29

Postductal coarctation of the aorta

Back 29

Narrowing of aorta distal to ductus arteriosus. Hypertension in upper extremities and hypotension in lower extremities. Can produce aortic insuficiency, berry aneurysms and secondat hypertension due to increased RAA (low renal flow)

Front 30

Right to left shunts

Back 30

Early cyanosis due to blood shunt past the lungs. Tetralogy of Fallot, transposition of great vessels, truncus arteriosus, tricuspid atresia.

Front 31

Left to right shunts

Back 31

Late cyanosis due to Eisenmenger syndrome. VSD, ASD, PDA

Front 32

Eisenmenger syndrome

Back 32

Right side of the heart hypertrophies due to a septal defect or PDA and shunt reverses from left-right to right-left producing cyanosis

Front 33

Tetralogy of Fallot

Back 33

Overriding aorta, pulmonic stenosis, right ventricular hypertrophy, VSD. Cyanosis depends on degree of pulmonic stenosis. PDA or ASD are cardioprotective.

Front 34

Transposition of the great vessels

Back 34

Inversion of aorta and pulmonary arteries. Infants of diabetic mothers. Must have ASD, VSD or PDA to survive.

Front 35

Truncus arteriosus

Back 35

Common pulmonary artery and aortic trunk. Massive blood flow to the lungs causes pulmonary hypertension. Early cyanosis and CHF.

Front 36

VSD

Back 36

Communication between ventricles. Large defect leads to pulmonary hypertension and Eisenmenger syndrome. Systolic murmur.

Front 37

ASD

Back 37

Communication between atriums. Associated with fetal alcohol syndrome.

Front 38

PDA

Back 38

Communication between aorta and pulmonary artery. Associated with congenital rubella. During pregnancy PDA is kept by PGE2. Close with indomethacin. Machinery murmur. Eisenmenger syndrome.

Front 39

Dilated cardiomyopathy

Back 39

Idiopathic, postpartum, alcohol, Coxackie B infections, doxorubicin and cocaine. Presents as CHF with decreased ejection fraction

Front 40

Hypertrophic cardiomyopathy

Back 40

Cause of death in young athletes. Autosomal dominant. Asymetrical hypertrophy in ventricular septum. Decreased compliance and stroke volume. Rx.: increase preload with beta blockers (decrease HR)

Front 41

Carcinoid heart disease

Back 41

Right sided endocardial and valvular fibrosis secondary to serotonin in patients with carcinoid metastasis to liver. Skin flushing, diarrhea, crmaping, bronchospasm, wheezing, telangiectasia