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22 Cards in this Set
- Front
- Back
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Evolution of MI
- general - first day - 2-4 days - 5-10 days - 7 weeks |
- coronary artery occlusion LAD>RCA>circumflex
- sx's: diaphoresis, nausea, vomiting, severe retrosternal pain, pain in L arm and/or jaw, shortness of breath, fatigue, adrenergic sx's 2-4 hrs - no visible change by light microscopy First day - coag necrosis - contraction bands visible after 4 hrs - release of contents of necrotic cells into bloodstream - PMN emigration - dark mottling; pale with tetrazolium stain grossly on heart 2-4 days - tissue surroudning infarct shows acute inflammation - dilated vessels (hyeremia) - PMN emigration - extensive coag necrosis in muscle - risk of ARRHYTHMIA 5-10 days - risk of FREE WALL RUPTURE - rupture of interventricular septum - rupture of papillary muscle - granulation tissue - macrophages - neutrophils remove necrotic debris - hyperemic border; central yellow-brown softening - maximally yellow and soft by 10 days grossly 7 weeks - risk for VENTRICULAR ANEURYSM - contracted scar complete - recanalized artery - gray-white tissue grossly |
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Diagnosis of MI
1. method for Dx in first 6 hrs? 2/ Cardiac troponin 1? 3. CK-MB? 4. AST? 5. ECG changes? 6. LDH? |
Increased enzymes distinguishes MI from angina!
1. ECG is gold std for dx in 1st 6 hrs - ST elevation, ST depression, pathological Q waves 2. CARDIAC TROPONIN 1 rises after 4 hrs - elevated for 7-10 days - MORE SPECIFIC than other protein markers 3. AST - nonspecific - can be found in cardiac, liver, and sk musc tissue 4. ECG - changes include: - ST elevation (transmural infarct) - ST depression (subendocardial infarct) - pathologic O waves (transmural infarct) 6. LDH is test of choice 2-7 days after suspected MI |
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MI complications
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1. cardiac arrhythmia
- important cause of death - common in 1st few days 2. LV failure and pulmonary edema 3. cardiogenic shock (large infarct - high risk of mortality) 4. ventricular free wall rupture --> cardiac tamponade; papillary muscle --> MITRAL REGURG and interventricular septal rupture --> VSD --> L-R shunt --> RHF 5. aneurysm formation - decreased CO, risk of arrhythmia, embolus from mural thrombus 6. fibrinous pericarditis - friction rub - 3-5 days post-MI - due to increased vessel permeability in pericardium 7. Dressler's syndrome - autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post-MI) 8. mural thrombus - assoc. w/LAD coronary artery thrombosis |
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Dilated (congestive cardiomyopathy)
- epi - causes - XRAY? |
- most common cardiomyopathy
Etiologies: ABCCCD - alcohol abuse - coxsackie B virus myocardiits - chronic cogain use - chagas disease - Doxorubicin toxicity and peripartum cardiomyopathy - heart dilates and looks like balloon on CXR - idiopathic is most common type. SYSTOLIC DYSFUNCTION ENSUES!!! |
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hypertrophic CM
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- often asymmetric involving the interventricular septum
- normal heart size - 50% of cases familial, AD - cuase of sudden death in young athletes - loud S4 - apical impulses - systolic murmur - Tx: B-blocker or non-dihydropyridine Ca channel blocker (verapamil) - Familial AD type -mut in heavy chain of B-myosin and the troponins!!! DIASTOLIC DYSFUNCITON ENSUES!!! |
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restrictive CM
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major causes:
- sarcoidosis - amyloidosis - postradiation fibrosis - endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children) - Loffler's syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate) - hemochormatosis (dilated CM also with hemochrom.) DIASTOLIC DYSFUNCTION ENSUES!!! |
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CHF - explain cause of each abnormality:
1. dyspnea on exertion 2. cardiac dilation 3. pulmonary edema, PND 4. orthopnea 5. hepatomegaly 6. ankle, sacral edema 7. JVD |
1. failure of LV output to increase during exercise
2. greater ventricular EDV 3. LV faiulre --> increased pulmonary venous pressure --> pulmonary venous distention and transudation of fluid - presence of hemosiderin-laden macrophages ("heart failure" cells) in the lungs 4. orthopnea - b/c INCREASED VENOUS RETURN IN SUPINE POSITION exacerbates pulmonary vascular congestion 5. Hepatomegaly (nutmeg liver) - increased central venous pressure --> increased resistance to portal flow - rarely leads to cardiac cirrhosis 6. RV failure --> increased venous pressure --> fluid transudation 7. RHF --> increased venous pressure |
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main cause of RHF?
main cause of RHF in isolation? |
- LHF
- cor pulmonale |
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embolus types
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Fat - long bone fracture, liposuction
Air Thrombus Bacteria Amniotic fluid - lead to DIC especially postpartum Tumor Pulmonary embolus --> chest pain, tachypnea, dyspnea 95% of pulmonary emboli arise from deep leg veins!!! |
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DVT - predisposed to Virchow's triad
1. 2. 3. |
1. stasis
2. hypercoagulability 3. endothelial damage |
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A fib --> thrombus formation
- decribe difference between pre- and post-mortem thromus |
Pre-mortem thrombi
- thin, white lamnatuions (lines of Zahn) - composed of platelets Post-mortem thrombi - no lines of Zahn - resemble chicken fat |
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Bacterial endocardiits
- signs and sx's (mnemonic) - acute vs. subacute - which valves - complications |
sign's and sx's - FROM JANE
- Fever - Roth spots (round white spots on retina surrounded by hemorrhage) - Ostler's nodes (tender, raised lesions on finger or toe pads) - Murmur - Janeway lesions (small erythematous lesions on palm or sole - Anemia - Nail-bed hemorrhage (splinter hemorrhages) - Embili Acute - S.aureus (high virulence) - large vegitations on previously normal valves - rapid onset Subacute - S.viridans (low virulence) - smaller vegitations on congenitally abnl or diseased valves - sequelae of dental procedures!!! - more insidious onset Mitral valve is most freq involved - Tricuspid assoc with IVDU Complications: - chordae rupture - glomerulonephritis - suppurative pericarditis - emboli endocarditis may also be nonbacterial secondary to malignancy or hypercoagulable state (marantic/thrombotic endocarditis) |
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Non-bacterial endocarditis
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- paraneoplastic syndrome, sterile vegitations on mitral valve
- pro-coag effect from mucin production by tumors of colon and pancreas |
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Libman-Sacks endocarditis
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- verrucous vegitations occur on both sides of the valve (can be associated with mitral regurgitation and less commonly, mitral stenosis)
- SEEN IN LUPUS - so, SLE causes LSE |
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Rheumatic heart disease
- due to? - cause of early death? - late sequelae? - pathology/pathophysiology - labs - pathophysiologic basis |
- consequence of pharyngeal infection with Group A strep
- early death due to MYOCARDITIS - late sequelae - rhematic heart diseae - mitral valve > aortic >> tricuspid (high pressure valves affected most) - Aschoff bodies (granuloma w/giant cells) - Anischkow's cells (activated histiocytes) - migratory polyarthritis - erythema marginatum - elevated ASO titers TYPE II HSTY rxn - not direct effect of bacteria FEVERSS: Fever, Erythema marginatum, Valvular damage (vegitation and fibrosis), ESR increase, Red-hot joints (polyarthritis), Subcutaneous nodules (Aschoff bodies), St. Vitus' dance (chorea) |
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cardiac tamponade
- define - findings |
compression of heart by fluid (eg - blood, effusions) in pericardium
--> decreased CO - equilibration of diastolic pressures in all 4 chambers - findings: hypotension, increased JVD, distant heart sounds - increased HR - pulsus paradoxicus (Kussmaul's pulse - decrease in amplitude of pulse during inspiration - seen in severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup) |
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pericarditis
- serous - fibrinous - hemorrhagic |
serous pericarditis
- caused by SLE, RA, viral infection, uremia fibrinous pericarditis - caused by uremia, MI (Dressler's syndrome), rheumatic fever Hemorrhagic pericardiits - TB, malignancy (eg - melanoma) Findings in pericarditis: - pericardial pain - friction rub - pulsus peradoxus - distant heart sounds - ECG chagnes with DIFFUSE ST-SEGMENT ELEVATION - can resolve w/o scarring or elad to chronic adhesive or chronic constrictive pericarditis - sharp, stabbing pain that varies with breathing - relieved by leaning forward |
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Syphilitic heart disease
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tertiary syphilis disrupts vasa vasorum of aorta w/consequent dilation of aorta and valve ring
- can see CALCIFICATION OF AORTIC ROOT and ascending aortic arch - leads to "tree bark" appearance of aorta - can result in aneurysm of ascending aorta or aortic arch and aortic valve incompetence |
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Cardiac tumors
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myxomas - most common primary cardiac tumor
- 90% in atria - predominantly LA - associated with multiple syncopal episodes Rhabdomyomas - most frequent primary cardiac tumor in children (assoc. with tuberous sclerosis) metastases are most common heart tumor overall (from melanoma, lymphoma) see Kussmaul's sign- increased JVP on inspiration |
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Telangiectasia
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Arteriovenous malformation in small vessels - looks like dilated capillary
- hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) - AD inheritance - presents with nosebleeds and skin discolorations - affects SMALL VESSELS |
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Raynaud's disease
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decreased bf to skin due to arteriolar VASOSPASM
- response to cold temperature or emotional stress most often in fingers and toes - called Raynaud's phenomenon when secondary to mixed connective tissue disease, SLE, or CREST syndrome - affects SMALL VESSELS |
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Wegener's granulomatosis
- define - sx's - tests - tx |
characterized by triad of focal necrotizing vasculitis
- necrotizing granulomas in lung and upper airway - necrotizing glomerulonephritis - large breaks in GBM with fibrinoid necrosis Sx's: - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough - dyspnea - hemoptysis - hematuria tests: - cANCA strong marker - CXR may reveal large nodular densities - hematuria and rbc casts Tx: cyclophosphamide and corticosteroids affects SMALL VESSELS RESPIRATORY AND RENAL involvement |
