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68 Cards in this Set
- Front
- Back
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5 T's of right-to-left shunts
(early cyanosis) |
-tetralogy of fallot
-transposition of great vessels -tricuspid atresia -truncus arteriosus -total anomalous pulmonary venous return (TAPVR) |
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left-to-right shunts
(late cyanosis) 3 causes |
VSD >> ASD >> PDA
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uncorrected VSD, ASD, or PDA >> compensatory vascular hypertrophy >> progressive pulmonary hypertension
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Eisenmenger's syndrome
as pulmonary resistance increases, the shunt reverse to R>> L, which causes late cyanosis (clubbing and polycythemia) |
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ToF
PROVe |
pulmonary stenosis
right ventricle hypertrophy overriding aorta VSD right-to-left shunt exists b/c of the increased pressure caused by stenotic pulmonic valve |
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boot-shaped heart on x-ray
cyanotic spells PT squat to improve symptoms |
TOF
caused by anterosuperior displacement of the infudibular septum |
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congenital defect due to failure of the aorticopulmonary septum to spiral
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D-transposition of the great vessels
w/o surgical correction, extremely fatal |
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infantile coarctation of aorta
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aortic stenosis proximal to insertion of ductus arteriosus (preductal)
Turner syndrome check femoral pulses |
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adult type of coarctation of aorta
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stenosis is distal to ligamentum arteriosum (postductal)
notching of ribs, hypertension in upper extremities >>aortic regurgitation; associated with bicuspid aortic valve |
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apical displacement of tricuspid valve leaflets
decreased volume of RV atrialization of RV |
Ebstein's anomaly
c/o lithium in utero |
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22q11 syndromes
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truncus arteriosus
ToF interrupted aortic arch (DiGeorge) |
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Down syndrome
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ASD, VSD,, AV septal defect
(endocardial cushion defect) |
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Congenital rubella
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septal defects
PDA pulmonary artery stenosis |
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Turner syndrome
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Coarctation of aorta (preductal)
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Marfan's syndrome
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Aortic insufficiency
(late complication) |
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Infant of diabetic mother
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transposition of great vessels
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calcification in the media of aa, especially radial or ulnar
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Monkeberg
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hyaline thickening of small aa in essential hypertension or DM
"onion skinning" in malignant hypertension |
Arteriolosclerosis
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fibrous plaques and atheromas form in intima of arteries
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Atherosclerosis
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Atherosclerosis progression:
1. endothelial cell dysfunction 2. _____ and _____ accumulation 3. foam cell formation 4. fatty streaks 5. ________ migration (involves ____ and ____) 6. fibrous plaque 7. complex atheromas |
2. macrophage and LDL
5. smooth muscle cells (TGF-b and PDGF) |
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location of atherosclerosis (in order of most common)
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abdominal aorta
coronary artery popliteal artery carotid artery |
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mediastinal widening on CXR
tearing chest pain radiating to the back |
aortic dissection
associated with hypertension and cystic medial necrosis |
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ST depression on ECG (retrosternal chest pain with exertion); secondarty to atherosclerosis
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stable angina
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occurs at rest secondary to coronary artery spasm; ST elevation on ECG
Ergonovine test |
Prinzmetal's variant
midnight-early morning hours (Sxs) |
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ST depression on ECG (worsening chest pain at rest or with minimal exertion)
thrombosis but no necrosis |
unstable/crescendo angina
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mediastinal mass (bronchogenic carcinoma or NHL) >> compression of circulation
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superior vena cava syndrome
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loss of contractile function within ____ seconds of ischemia, c/o decreased aerobic ____ >> anaerobic (ATP and creatinine production)
-15% of myocytes >> _____? |
glycolysis
irreversible injury |
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dark mottling' pale with tetrazolium stain
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1st day MI
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hyperemia; extensive coagulative necrosis
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2-4 days post MI
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hyperemic border;
central yellow-brown softening |
5-10 days MI
risk of rupture/tamponade d/t macrophages degrading important structural components |
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recanalized artery, gray-white
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7 weeks MI
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inflammatory macrophages in ______ decrease stability of plaque by secreting _______ (which _______ collagen)
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intima
metalloproteinases decrease |
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what is the gold standard for MI dx?
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ECG
ST elevation (transmural) ST depression (subendocardial infart) Q waves (transmural) |
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friction rub 3-5 days post MI
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postinfarction fibrinous pericarditis
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autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post-MI)
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Dressler's syndrome
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blood flow is redistributed from ischemic >> non-ischemic areas via vasodilated collateral microvessels
with adenosine, dipyridamole |
Coronary steal
can lead to hypoperfusion/worse ischemia in occluded artery |
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most comon cause of in-hospital death d/t MI...
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LA/failure/cardiogenic shock (10-15% of cases)
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S3, balloon appearance on CXR
etiologies of dilated (congested) cardiomyopathy |
defective dystrophin, mitochondrial enzymes
Alcohol abuse wet Berberi Coxsackie B virus myocarditis chronic Cocaine use, Chagas' disease Doxorubicin toxicity hemochromatosis peripartum cardiomyopathy (systolic dysfunction) |
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S4, normal-sized heart, systolic murmur
etiologies of hyptertrophic cardiomyopathy |
AD; defective b-myosin heavy chain in sarcomeres
Friedreich's ataxia; sudden death in young atheletes diastolic dysfunction >> IV septum too close to mitral valve leaflet >> outflow tract obstruction |
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hypertrophic cardiomyopathy tx?
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b-blocker or
non-dihydropyridine calcium channel blocker (verapamil) |
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etiologies of restrictive/obliterative cadiomyopathy
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sarcoidosis
amyloidosis postradiation fibrosis endocardial fibroelastosis (young children) Loffler's syndrome (prominent eosinophilic infiltrate) hemochromatosis diastolic dysfunction |
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RVH/cor pulmonale c/o _______
typical patient? |
pulmonary hypertension
20-40s female defective lung parenchyma or pulmonary vasculature |
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increased ANP and BNP
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ventricular hypertrophy + volume overload
>> Dx: CHF |
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reperfusion injury d/t generation of __________
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O2-free radicals
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persistent/repetitive low flow state
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myocardial hibernation
-myocardial stunning - less severe; repetition >> hibernation -ischemic preconditioning - dev'd resistance to infarction by cardiac myocytes previously exposed to repetitive non-lethal ischemia -ventricular remodeling - compensate for increased load |
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concentric hypertrophy of LV
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hypertensive heart disease
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S-shaped ventricular septum
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normal aging heart
-decreased chamber apex-base length -cytoplasmic lipofuscin pigment -atrophy -fibrosis |
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nutmeg liver
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CHF
increased central venous pressure >> increased resistance to portal flow |
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decreased EF leads to increased _________ volume
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end-systolic ventricular
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S3 (ventricular gallop) >> lie in lat decubitus and exhale fully
=?? |
LV systolic failure (1/2 filled) or restrictive cardiomyopathy
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diastolic failure leads to increased ________, as the result of decreased compliance but normal ________
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LVEDP
contractility |
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systolic failure leads to increased _______ and ______ due to decreased _______ and ________
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LVEDP and LVEDV
contractility; EF |
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round white spots on retina surrounded by hemorrhage
tender raised lesions of finger or toe pads small erythematous lesions on palm/sole |
Roth's spots
Osler's nodes Janeway lesions |
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acute endocarditis due to which organism??
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S. aureus
rapid onset; fibrin deposition |
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subacute endocarditis due to which organism??
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Viridans streptococci; smaller vegetations on congenitally abnormal or diseased valves
sequela of dental procedures; more insidious onset than acute |
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verrucous, sterile vegetations occurs on both sides of valve
benign; can be associated with mitral regurgitation and mitral stenosis |
Libman-Sacks endocarditis
(SLE >> LSE) |
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granuloma w/ giant cells
activated histiocytes elevated ASO titers antibodies to M protein |
Rheumatic heart disease
Aschoff bodies Anitschkow's cells type II hypersensitivity |
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pericardial knock post-S2
due to TB caseous pericarditis |
chronic constrictive pericarditis
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erythema marginatum, valvular damage, increased ESR, Red-hot joints (migratory polyarthritis, subcutaneous nodules, chorea
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Rheumatic heart disease
mitral> aortic >> tricuspid (high pressure valves affected most) group A b-hemolytic streptococi |
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exaggerated decrease in amplitude of pulse during inspiration
JVD |
pulsus paradoxus (Kussmaul's pulse)
seen in severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup |
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disrupted vasa vasorum of the aorta with consequent dilation of the aorta and valve ring
calcification of the aortic root and ascending aortic arch; "tree bark" appearance |
tertiary Syphilitic heart disease
can result in aneurysm of the ascending aorta or aortic arch and aortic valve incompetence |
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pulsus alternana
dicrotic pulse pulsus parvus et tardus hyperkinetic pulse acute pericarditis |
damaged LV
severe systolic lesion (carotid aa) aortic stenosis rapid ejection of large SV v. decreased afterload (fever/exercise/PDA/AV fistula) acute-onset, mid-chest pleuritic pain that decreases on sitting up and leaning forward (fibrinous or serofibrinous types; friction rub) |
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what is the most common primary cardiac tumor in adults? where do they occur?
in children? most common heart tumor? |
myxomas; LA (multiple syncope episodes)
rhabomyomas; with tuberous sclerosis metastases (from melanoma, lymphoma) |
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triad of focal necrotizing vasculitis, necrotizing granulomas in the lung + upper airway, necrotizing glomerulonephritis
hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis |
Wegener's granulomatosis
c-ANCA |
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CXR has large nodular densities; hematuria and red cell casts
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Wegener's granulomatosis
tx: cychophosphamide and corticosteroids |
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like Wegener's but lacks granulomas
p-ANCA |
microscopic polyangiitis
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vasculitis limited to kidney
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primary pauci-immune crescentic glomerulonephritis
(paucity of antibodies) |
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granulomatous vasculitis with eosinophilia
presents with asthma, sinusitis, skin lesions, peripheral neuropathy (eg wrist/foot drop) p-ANCA |
Churg-Strauss syndrome
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port-wine stain (nevus flameus) on face
ipsilateral leptomeningeal angiomatosis (intracerebral AVM) seizures early-onset glaucoma |
Sturge-Weber disease
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