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122 Cards in this Set
- Front
- Back
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Aschoff bodies
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fibrinoid deposition
Inflammatory cells, lymphocytes, plasma cells, macrophages Seen in RHD |
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Cases where chordae can rupture
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1. Mitral valve prolapse
2. Infective endocarditis |
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Setting where papillary mm. can rupture
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Myocardial infarct
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Mitral valve prolapse
Ausclultation |
Mid-systolic click
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When would you hear a mid-systolic click?
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Mitral Valve prolapse
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Best estimate of afterload
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Systolic blood pressure
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Normal max PCWP
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12 mmHg
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CHF
Physical exam |
Inc pulse
Dec BP JVD Peripheral edema Ascites Left ventricular heave Hepatomegaly Pallor, jaundice, cyanosis Cheyne-stokes breathing |
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CHF
Ausc |
S3 and/or S4 (S4 more common in diastolic dysfxn)
Inc P2 intensity Inspiratory rales Holosystolic murmur of MR and/or TR |
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CHF
Symptoms |
Dyspnea
Orthopnea Oliguria Nocturia6 Weakness Fatigue Edema (weight gain) Epigastric fullness & discomfort |
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Best predictor of mortality in CHF
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Low EF
High levels NE |
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Deleterious effects of sypathetic stimulation in CHF
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Instigate arrythmias
Vasoconstrict - increases afterload Venoconstrict - increases preload Direct myocardial toxicity Stimulate renin production Increase myocardial hypertrophy |
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Role of Aldosterone in CHF
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Stimulate Na retention
Stimulate fibrosis in myocardium Arrhythmias (major cause of mortality) Diminished endothelial funciton Diminished arterial compliance Diminished baroreceptor fxn Decreased uptake of NE |
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Characteristic of atherosclerotic plaques
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Smooth muscle cells
Foam cells macrophages, lymphocytes lipids: cholesterol, cholesterol esters, oxidized LDL Fibrosis ECM: collagen, proteoglycans, elastic fibers Eccentric and segmental |
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Cytokines interaction with fibrous cap
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IL-1 and TNF lower TIMP-2
TIMP-2 promotes cap |
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Markers of inflammatory lesion
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CRP
Myeloperoxidase SAA Lipoprotein-associated phospholipase A2 |
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Role of Angiotension II in atherosclerotic plaque
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Acts through NFKB on smooth muscle and endothelial cell
Inc CRP, fibrinogen Inc enothelial dysfxn |
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Fxn of Lp(a)
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Inhibits plasminogen
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Fxn of ROS in atherosclerosis
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Destroys NO
Interfer with smooth muscle cells Release inflammatory mediators |
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Most common sites for atherosclerosis
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1. Abdominal aorta
2. Proximal coronary arteries 3. Popliteal arteris 4. Desenceing thoracic aorta 5. ICA |
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Complications of Infarction
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Arrythmia
Shock Heart Failure Extension rupture Aneurysm Thrombosis & embolism Pericarditis Papillary muscle dysfunction |
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Most common cause of death associated with aortic dissection
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Cardiac tamponade
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Atherosclerosis timeline
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Foam cells
Fatty streak Intermediate lesion Atheroma Fibrous plaque Complicated lesion/rupture |
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Determinants of Coronary blood flow
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1. Perfusion pressure (diastolic BP)
2. Coronary resistance (due to external compression and intrinsic vascular resistance) |
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How do you increase Oxygen delivery in times of increased demand
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Must increase blood flow (oxygen extraction is already maximal)
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Fxn of:
NO endothelin prostacyclin EDHF |
NO, prostacyclin, and EDHF --> vasodilate
endothelin --> vasoconstrict |
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How will subendocardial ischemia look on EKG
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ST depression, ST downsloping, T wave inversion
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How will transmural ischemia look on EKG?
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ST elevation
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RCA supplies
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RV
Post 1/3 of IV septum AV & SA note Post inferior LV |
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LAD supplies
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Apical, anteroseptal, and anterior LV
Anterior 2/3 of IV spetum |
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LCCA supplies
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Lateral wall of LV
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Nitrates work by...
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Venodilate --> reduce preload and wall tension
Vasodilate coronary arteries Vasodilate periphearl arterioles --> reduce afterload |
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Sequence of AMI
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Rupture plaque --> platelet thrombus --> AMI
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Complications of AMI
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Arrythmias, CHF, MVR, Myocardial rupture, pericardidtis, thromboembolism, cardiac tamponade
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When not to use thrombolytics
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UA and NSTEMI
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Most common cause of death in acute MI
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Ventricular arrythmias
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Murmur of MR
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Holosystolic murmur at apex
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ECG of dilated cardiomypathy
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Atrial and ventricular arrythmias
Conduction defects Diffuse repolarization (ST sement and T wave) Atrial and ventrigular enlargement |
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Dilated Cardiomyopathy
Treatment |
Salt restriction and diuretics
Beta blockers AII receptor blockers ACE inhibitors Spironolactone Digoxin Amiodarone (antiarrythmatic drug) Implantable cardioverter defibrillator Anticoagulation |
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Histology of Hypertrophic Cardiomyopathy
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Myocardial fibers in disarray
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Symptoms of hypertrophic cardiomyopathy
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Angina, syncope, dyspnea
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Murmur of hypertrophic cardiomyopathy
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Crescendo-decrescendo at lower left sternal border
Inc w/ valsalva, dec w/ squatting Opposite in Aortic stenosis Holosystolic blowing murmur of mitral regurg at apex |
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ECG hypertrophic cardiomyopathy
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LVH
Left atrial enlargement Q waves in the inferior and lateral leads Atrial and ventricular arrhythmias |
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Why would you do a myometctomy?
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In hypertrophic cardiomyopathy
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Clinical Findings Restrictive cardiomyopathy
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Left and right heart failure
Dec CO Systemic venous congesion Arrythmias (amyloid infiltrates conduction system) |
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Appears like constructive pericarditis
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restrictive cardiomyopathy
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Cardiomyopahty where mural thromubs are prevelant
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Dilated
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What is endocardial fibroelastosis?
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Cause of HF in infants
Causes restrictive cardiomyopathy |
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Thrombophlebitis
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Painful swollen calf
Can embolize to lung |
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Thorotrast can cause
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Angiosarcoma
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Increased serum rheumatoid factor means:
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Infective Endocarditis
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most common organism on prosthetic heart valve IE
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S. epidermidis
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Most common scenerio with IE
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MVP
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Cystic medial necrosis & fragmentation
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Aortic dissection
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Risk factors for aortic dissection
Which is most impt? |
HTN most impt
Iatrogenic, genetics(marfans EDS), Pregnancy |
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Classic clinical symptoms of aortic dissection
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Retrosternal chest pain
Loss of upper extremity pulse AV regurg |
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Venous pressure readings in Mitral Regurg
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Increase in v wave
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Changes to heart in MR
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LA dilates and hypertrophies
LHF due to volume overload in LV and LA |
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Clinical finidngs MR
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Dyspnea, inspiratory crackles, S3, holosystolic murmur over apex, arrythmias
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When is PH seen in MR
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Acute MR, not chronic MR
this is b/c the LA is too small/rigid to accommodate the increased blood |
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Most common cause of MV stenosis
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RHD
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Clinical manifestations of Mitral Stenosis
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Dyspnea, fatigue, orthopnea, PND, weight loss, edema, ascities
hemoptysis Atrial fibrilation |
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Mitral stenosis murmur
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low pitched rumbling during diastole, with pre-systolic accentuation
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Common manifestation of MS
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Atrial fibrillation --> conduction fibers stretched out
Predispose for thromboemboli |
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Hallmark of MS on pressure readings
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LA and LV in diastole
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Clinical manifestations of AV Stenosis
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LVH
Chest pain Exertional dyspnea and syncope |
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AV stenosis murmur
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Crescendo-decrescendo systolic murmur at base of heart
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MVP murmur
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Mid-systolic click
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Histopath of MVP
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Myxoid degeneration...fibrous tissue is replaced by myxoid tissue
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What is an Antischokow cell
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altered cardiac muscle cell
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Describe Aschoff body
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Aschoff giant cells
Cardiac histiocytes Antischokw cells fibrinoid deposition |
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Kussmaul's sign
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increased JVD with inspiration because RV cannot handle extra VR
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Constrictive pericarditis appears very similar to...
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Restrictive cardiomyopathy
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Trisomies and their related anamolies
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Downs - AV canal, VSD, ASD, TOF
Turners - CoA, AS Edwards - VSD |
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Effect of Diabetes on fetus
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RDS
Acts as a growth factor...hypertrophied hearts |
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What is Cri du chat?
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Deletion of short arm on chromosome 5
cat like cry VSD Mental Retardation |
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Noonan syndrome
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Short stature
dysmorphic facial appearance chest deformites CHD --> Pulm stenosis and RH failure |
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Most common CHD in adults
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ASD
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congenital AS usually also seen with
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CoA
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Portion of EKG that increases w/ HR?
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QT interval
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Physiological changes in pregnant woman's heart?
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Inc SV, CO, HR, blood volume
Dec SVR |
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What is dobutamine?
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Positive inotrope
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U waves tend to represent what abnormalitiy?
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Hypokalemia
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How to visualize R atrial enlargement on ECG?
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p wave taller in lead II
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How to visualize L atrial enlargement on ECG?
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p wave wider and biphasic in V1
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How does bundle branch block look on ECG?
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wide QRS
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Which closes first, mitral or tricuspid
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mitral
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Describe the murmur of mitral stenosis.
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High pitched opening snap
Early Diastolic Best heard between the apex and left sternal border |
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Murmur of mitral valve prolapse
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Mid-systolic click
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What is hyperplastic arteriolosclerosis?
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BM duplication and smooth muscle hyperplasia
Usually in renal arterioles Can be caused by malignant HTN onion skin appearance |
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microscopic change
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o 30-60 min get mitochoncdrial swelling
o 6-12 hrs get wavy fibers and contraction bands o 24 hrs, myocytes are eosinophilic and exhibit features of coag necrosis o 24 hrs, PMNS o 2-3 days striations are gone and PNS are karyorrhetic o 5-8 days PMS gone and macrophages present 3-4 days is transition from PMNS to macrophages o 1-3 weeks collagen inc and granulation tissue less vascular o 1 month on, debris gone and CT less celular |
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How long Troponin I is there fore
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apperatne in 2-4 hr
peaks 18 hr lasts 7-10 days |
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Most common aneurysm in men >55 & symptoms associated
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AAA
Rupture gives left flank pain, hypotension, pulsatile mass |
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Why does Inc HR inc demand
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B/c more time in systole, and therefore less time able to extract oxygen
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How to treat Prinzmetal angina?
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Calcium channel blockers
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Risk factors for Stable Angina
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HTN
Smoking Hyperlipidemia Diabetes Male Old |
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EKG of subendocardial ischemia
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ST depression, downsloping, or T wave inversion
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What does ischemia preconditioning mean?
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Those with previous angina attacks are less likely to have die from MI
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Why give someone w/ MI morphine
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Dec anxiety, and therefore sympathetics and O2 demand
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How treat STEMI?
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Aspirin, heparin, Beta blockers, nitrates, tpa,
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Cannon a wave
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AV dissociation/VTach
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Low vs. high pitched and which part of stethescope to use
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The diaphragm is for HIGH-pitched sounds/ murmurs :
S1, S2, MR, AI The bell: low sounds S3/S4 or mitral stenosis |
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Loud S1
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Mitral stenosis, but necessarily in late stage of disease
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Why do we need chylomicrons?
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Cholesterol and TGs are too hydrophobic to be transported freely
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Mitral valve problems are more common in which sex
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Women
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Aortic valve problems are more common in which sex
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Males
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Austin Flynt murmur
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Happens during AR
Low frequency middiastolic rumbling sound at apex Turbulent flow across Mitral valve during diastole |
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Murmur of AR
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Blowing murmur in early diastole along left sternal border
& Austin Flint murmur |
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Prone to annuloaortic ectasia
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Marfan's disease
Ankylosing spondylitis Tertiary syphyllis |
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Most common reason to replace Mitral valve
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MVP
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Histo of RHD
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Aschoff bodies, which are found in the interstitum (not in muscle tissue)
Have Aschoff giant cells Antischokow cells (which are altered cardiac muscle cells) Cardiac histioccytes Fibrinoid deposition lymphoctyes, plasma cells, macropahges |
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Fish mouth valve seen in what pathology?
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RHD mitral stenosis
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Normal JVP
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<5
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Most common cause of Mitral stenosis
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RHD
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Mitral stenosis murmur
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opening snap and decrrescendo to mid diastole
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Subacute BE vs. ABE
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SBE: less virulent (S. viridans), underlying previous damage, Systemic sequalea are impt
ABE: |
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IV drug users generally have issues w/ which valve
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TV insufficiency
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Pathogen that commonly effects prosthetic heart vavles
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S. epidermidis
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Most common underlying pathologies for IE
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1. MVP
2. Normal 3. Degenerative |
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How can a VSD cause IE
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Jed lesion
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Where is cystic medial necrosis found?
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Aortic dissection
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Clinical findings of aortic dissection?
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Acute retrosternal chest pain radiating to the back
Aortic valve regurg Loss of upper extremity pulse |
