• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/144

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

144 Cards in this Set

  • Front
  • Back
What is S3?
What does it Indicated?
early in diastole, during rapid ventricular filling.
Assoc with inc. filling pressures/dilated ventricles.
Indicates heart failure.
Slosh-ing --in.
Rapid ventricular filling is assoc. with 3 things.
1. Mitral Valve Regurgitation
2. inc. left atrial/ventricular filling pressures (stiff/dilated LV)
3. VSD
Causes of Poor Left Ventricle Function in S3.
1. Post MI
2. dilated cardiomyopathy
Wide Splitting is caused by?
Conditions that increase RV emptying.
1. Pulmonic Stenosis
2. Right Bundle Branch Block
(delay esp on inspiration)
Fixed Splitting is caused by?
ASD
Left to right shunt leads to delayed pulmonic valve closure regardless of breath
Paradoxical Spltting is caused by?
Delay of LV emptying.
1. Aortic Stenosis
2. Left Bundle Branch Block
Risk factors for Ischemic Heart Disease?
1. Central obesity
2. arthrogenic lipid pattern
3. hypertension
4. insulin resistance
5. evidence of a pro inflammatory state.
What marker indicates a pro-inflammatory state?
C-reactive Protein
Gross/Histological Changes in MI 12-24 hours
Slight Swelling colour change
Acidophillic dyes, striations, nuclei gone, neutrophils
Gross/Histological Changes in MI at 24H
Pale/reddish brown, surrounded by hyperemia
coagulative necrosis
Gross/Histological Changes in MI at 3 days
Yellow colour
replacement of Neutrophils by macs and phagocytosis of debris
Gross/Histological Changes in MI at 7 days
Yellow surrounded by red
Fibroblasts/new vessels
Gross/Histological Changes in MI at 5th week
Pallor due to fibrosis
Progressive fibrosis
Gross/Histological Changes in MI at 3-6 months
Gray/white scar
Mature Fibrosis Tissue
Major Cause of Death in MI first 6 hours
Severe arrhythmia
Major cause of death in MI in first 4-7 days.
Myocardial Rupture
Major Cause of death in post MI 3-6 months
Ventricular Aneurysm
6 complications of MI
1. Arrhythmia
2. Myocardial failure
3. Myocardial rupture (death via cardiac Tamponade)
4. Ruptured Papillary muscle
5. Mural thrombosis
6. Ventricular Aneurysm.
Cause of Rheumatic Fever
Group A Beta-haemolytic Streptococci

S. Pyogens
8 Sings of Rheumatic Fever
Fever
Erythema Marginitum
Verrecue (sterile, non-friable vegetations)
Valvular Damage
Migratory Poly-arthritis
Subcutaneous Nodules
Sydnham Chorea
Elevated ESR
Aschoff body
Rheumatic Fever
fragmented collagen, fibrinoid material, and multinucleated giant cells.
What is the major cause of early deaths in Rheumatic Fever?
Myocarditis
Valves Most likely affected in Rheumatic Fever in order.
Mitral Valve > Aortic > Tricuspid
Major cause of Acute Endocarditis.
Secondary infection due toStaph. Aureus (50%)
Major Cause of Sub-Acute Endocarditis
Strep. Viridans (S. Sanguis)
Often with pre-existing valvular damage
Clinical Features of Bacterial Endocarditis.
FROM JANE.
Fever
Roths Spots (eyes)
Oslers Nodes (tender les on pads)
Murmur
Janeway's leasions (small erythamatous lesions on palm/soles)
Anemia
Nail bed haemorrahges (splinter)
Emboli (septic)
Two major complications of Bacterial Endocarditis
1. Distal Emboli
2. Focal glomerulonephritis
Non-Bacterial Thrombotic (marantic) Emboli
Debilitating disorders (e.g. metastatic cancer)
Small sterile, friable fibrin deposits alone line of closure
Libman Sacks Endocarditis is associated with what?
What is the pathological finding?
SLE
Small vegetations on both sides of valves
Endocarditis of the Carcinoid Syndrome
cause is secretory products of carcinoid tumours.
5-HT
valves on right side involved
endocardial plaques
Alpha 1 receptors effect on splachnic/skin/muscle arterioles.
constriction
Beta-2 receptor effect on muscle arterioles/lung bronchioles
Dilate
Effect of E series prostaglandins
Vasodilators
Effect of F seies prostaglandins.
Vasoconstrictors
Thromaxane A2 effect on arterioles.
vasoconstriction
Causes of S4
atria contracting forcefully in an effort to overcome a stiff hypertrophic ventricle.
1. long standing hypertension
2. aortic stenosis
3. overlading of ventrcile
4. fibrosis post MI
What does a new S4 indicate?
MI
Two Patterns of Infarction
1. transmural infarction
2. subendocardial infarction
Mitral Vavle Prolapse sound and prevalence
murmur post Midsystolic click
7 % female
Causes of Mitral valve Prolapse
1. myxoid degeneration of ground substance (component of Marfans)
2. stretching of posterior mitral valve (floppy cusp)
3. can result in insuff. assoc. with arrhythmias, predisposition to infective endocarditis
Alpha 1 receptors effect on splachnic/skin/muscle arterioles.
constriction
Beta-2 receptor effect on muscle/lung arterioles
Dilate
Effect of E series prostaglandins
Vasodilators
Effect of F seies prostaglandins.
Vasoconstrictors
Thromboxane A2 effect on arterioles.
vasoconstriction
Causes of S4
atria contracting forcefully in an effort to overcome a stiff hypertrophic ventricle.
1. long standing hypertension
2. aortic stenosis
3. overlading of ventrcile
4. fibrosis post MI
What does a new S4 indicate?
MI
Two Patterns of Infarction
1. transmural infarction
2. subendocardial infarction
Mitral Vavle Prolapse sound and prevalence
murmur post Midsystolic click
7 % female
Causes of Mitral valve Prolapse
1. myxoid degeneration of ground substance (component of Marfans)
What usually causes Mitral Valve Stenosis ?
Auscultation and complications?
Rheumatic fever

Opening snap, delayed diastolic murmur.
Can cause pulmonary hypertension, left atrial hypertrophy
Why is atrial fibrillation a problem in mitral valve stenosis?
If dependent on atrial kick for LV filling, atrial fibrillation could lead to sudden congestive HF.
Causes of Mitral Valve Insuff.
1. Rheumatic HD
2. mitral valve prolapse
3. infective endocarditis
4. damage to papillary muscle in MI
5. 2 to LV dilation and stretching of mitral ring
What are the Clinical findings of Mitral Valve Insuff
1. Holosystolic murmur
2. Left sided heart failure(dyspnea, orthopnea, nocturnal dyspnea)
Causes of Aortic Stensis
1. calcific aortic stenosis (age related)
2. congenital bicuspid aortic valve
3. reumatic fever
Clinical findings of Aortic Stenosis
cresendo-decrescendo murmur with ejection click in systole
1. syncope
2. congestive HF
3. Angina
Aortic Insuff. Causes
1. non-dissection aortic aneurysm resulting from cystic medial necrosis
2. Rheumatic HD
3. Syphillitic Aortitis (dilation of aortic ring) rare.
Clinical Findings of Aortic Insuff upon auscultation?
immediate hight pitched diastolic murmur
Symptoms of Pulmonary Valve Stenosis
1. JVD
2. Cyanosis
3. right vent. Hypertrophy
where is the a defect in the Septum Primum? If large, what is it associated with?
lower part of septum, if large, assoc with AV defects
Septum Secondum
defect in fossa ovalis
Sinus Venosus
upper part of septum near entrance of superior vena cava
Clinical manifestations of Atrial Septal Defects
delayed until adult life
late compensation causes pulmonary hypertension and reversal of flow
paradoxic embolism
Letembacher Syndrome
ASD with mitral valve stenosis (rheumatic)
Tetralogy of Fallot Characteristics
1. cyanosis from birth
2. squat
3. right to left shunt due to pulmonary stenosis
Treatment for patent ductus arteriosis
indomethacin
surgery
Signs of Coarctation of the Aorta
1. narrowing of aorta distal to sub clavian vessels
2. collateral circulation/dilation of intercostals
3. upper extremity hypertension
4. notching of ribs on xray
What is neccessary for life in transposition of the great vessels?
1. compensatory anomaly eg. patent ductus arteriosis
2. keep open via prostaglandins
Turner's Syndrome is associated with what CHM?
Coarctation of the Aorta
Downs syndrome is assoc. with what CHM?
endocardial cushion effects which result in ASD/VSD's and AV valve deformities
When is a rubella infection problematic in pregnancy?
1st trimester
Manifestations of Congential Rubella Syndrome
Cardiovascular defects
Microencephaly
retardation
deafness
cataracts
growth retardation
Characteristics of Congestive/dilated cardiomyopathy
1. 4 chamber hypertrophy/dilation
2. R/L intractable heart failure
Proteins associated with Dilated Cardiomyopathy?
mutant cytoskelatin proteins (desmain/dystrophin)
mutant sarcomeric proteins (cardiac myosin heavy chain/actin)
Restrictive cardiomyopathy is caused by?
infiltrative process in myocardium
Amyloidosis, sarcoidosis, hemachromatosis, endocardial fibroelastosis, postradiation fibrosis
What is the cause of hypertrophic cardiomyopathy?
Beta-myosin heavy chain mutation
Clinical manifestations of hypertrophic cardiomyopathy
1. left ventricular outflow obstruction
2. syncope and sudden death (main cause of sudden death in young athletes)
What is arrhthmogenic RV cardiomyopathy and where does it occur?
Gradual replacement of RV muscle by fat causes arrhythmias and sudden death in athletes.
Causes of myocarditis
1. Usually viral (cocksackie virus)
2. componant of Chaga's disease (trypnaosma cruzi)
What is hydropericardium and its causes?
serous transudate in pericardial space
(any condition causing systemic edema) or congestive heart failure

e.g. nephrotic syndrome/liver disease (hypoprotenaemia)
2 main causes of Haemopericardium?
1. myocardial rupture assoc with acute MI
2. traumatic perforation of the heart/aorta
Causes of serous pericarditis and type of exudate
1. SLE
2. RF
3. Viral infections
clear/straw coloured protein rich exudate (small numbers of infl cells)
Causes of Fibrinous Pericarditis and type of exudate
1. uremia
2. MI
3. Acute RF
fibrin rich exudate
Purulent/Supparitive Pericarditis causes and appearence
1. bacterial infection
2. grossly cloudy/purulent, inflammatory exudate
What are the two causes of Haemorragic Pericarditis?
1 usually tumor invansion of the pericardium
2. tuberculosis
bloody inflammatory exudate
Causes of Chronic Congestive pericarditis
1. tuberculosis
2. pyogenic staph infection
Characteristics of Chronic congestive pericarditis
1. thickening and scarring of the pericardium
2. loss of elasticity
3. mimicks signs of right sided heart failure
4. pericardial pain/friction rub, distal heart sounds, pulsus paradoxus
5. ST elevation
Cardiac Tamponade (Beck's Signs)
1. Low arterial pressure
2. inc. central venous pressure
3. distant heart sounds
Clinical Signs of Pericarditis
1. Becks triad
2. pericardial rub (1 systolic, 2 diastolic)
Most common primary tumour of the heart
Myxoma (tumour of primative connective tissue)
Most common primary tumor of heart in infants/children
what is it associated with?
Rhabdomyoma (benign)
tuberous sclerosis
Kausmalls sign is
inc. jugular venous pressure on inspiration
Presenting features of Congestive Heart Failure
1. dyspnea
2. edema
3. norturnal dyspnea
4. S3??
Peptide associated with congestive heart failure
B-type natriuretic peptide
Causes of left sided heart failure
1. ischaemic HD
2. hypertension
3. aortic/mitral valve disease
4. myocardial diseases (carditis/cardiamyopathy)
Clinical Features of Left Sided Heart Failure
1. dyspnea
2. orthopnea
3. edema
4. pleural effusion w/ hydrothorax
5. reduction in renal perfusion causing activation of RAA and NA/water retention
6. cerebral anoxia
Clinical Features of Right sided heart Failure
1. Rengal hypoxia leading to greater fluid retention and peripheral edema
2. edema occurs first in dependent areas (pitting edema in ankles)
3. pleural effusion/ascities
4. enlarged congested liver/spleen (fatty regions in liver, nutmeg pattern)
Causes of LV hypertrophy
1. hypertension
2. aortic/mitral valve disease
Causes of RV failure and hypertrophy
1 LVF
2. Chornic lung disease
3. mitral valve disease
4. congential HD (left to right shunt, pulmonic stenosis)
What is Eisenmingers Syndrome?
1. uncorrected ASD, VSD or PDA causes compensatory hypertrophy which results in progressive pulmonary hypertension
2 late cyanosis (clubbing, absolute polycythemia)
Diabetic mother heart disease
Transposition of the great vessels
what type of heart defects does the 22q11 syndromes cause?
Conotruncal malformations; interupted aorta, VSD, truncus arteriosus, tetralogy of fallot
Marfans is associated with which valvular problem
aortic insuff.
Coarctation of the aorta infantile and adult type?
In the adult, what valvular malformation is it associated with?
1. infantile type is proximal to ductus arteriosus
2. adult type is distal to the heart and assoc with bicuspid valve and can result in aortic regurgitation
Monckeberg Arteriosclerosis
-calcification of the tunica media
-radial/ulnar arteries
-benign does not affect blood flow
What is Arteriosclerosis caused by?
What is a sign of malignant hypertension?
Hyaline thickening of small arteries in essential hypertension
Hyperplastic onion skins in malignant hypertension
What is Cystic medial necrosis?
1. break down of collagen , elastin and smooth muscle
2. assoc with marfan's disease
3. aortic dissection
Presentation of Aortic dissection
tearing chest pain to back
mediastinal widening
Common location of atherosclerosis
abdo aorta > coronary arteries > popliteal artery > carotid artery
Where do red haemorrhages occur?
1. loose tissue with collaterals in liver, lung, intestine
2. following reperfusion infarct
Where do pale haemorrhages occur?
Solid tissue with single blood supply
Kidney, Heart
What are the two ECG findings on transmural infarct?
ST elevation
Pathologic Q wave
ECG findings on subendocardial infarct
ST depression
Types of Emboli
Fat (long bone fractures and liposuction)
Air
Thrombis (PE)
Bacteria
Amniotic fluid (can lead to DIC)
Tumor
Telangiectasia
arteriovenous malformation in small vessels
dilated vessels on skin and mucous membranes
What is Heriditary Telangiectasia also known as?
What is its genetic origin?
What are the symptoms?
1. Also known as Osler-weber-rendu syndrome
2. autosomal dominant
3. Nosebleeds/skin discolourations (ateriovenous malformations in small vessels)
Raynaud's Disease
dec. in blood flow to skin due to arterioloar vasospasm in response to cold/stress
Raynaud's Phenomenon
secondary to mixed connective tissue disease, SLE
What is the characteristic triad seen Wegener's Granulomatosis?
Triad
1. focal necrotizing vasculitis

2.necrotising granulomas in lung/upper airway

3. necrotising glomerulonephritis
Symptoms of Wegener's Granulomatosis
1. perforation of nasal septum
2. chronic sinusitis
3. otis media
4. mastoiditis
5. cough/dyspnea
6. hemoptysis
7. hematuria
Findings in Wegener's Granulomatosis
c-ANCA (anti-neutrophil cytoplasmic antibodies)
xray = large nodular densities
hematuria/red cell casts
Treatment for Wegner's Granulomatosis
cyclophosphamide and corticosteroids
Microscopic Polyangiitis
Like Wegener's but lacks granulomas
p-ANCA
Primary pauci immun crescentic glomerulo-nephritis
limited to kidney, scarcity of anti-bodies
Wjhat is Churg-Strauss Syndrome?
What does it mimic?
What type of patients is it seen in?
granulomatous vasculitis with eosinophila in lungs, nerves often seen in atopic patients
Clinical manifestations of asthma
p-ANCA
Sturge-Weber disease
Congenital vascular disorder that affects capillary vessels
manifests with port wine stain and leptomeningeal angiomatosis
What are the symptoms of Henoch-Schonlein Purpura?
What can its origin be?
Most common form of childhood systemic vasculitis
Presents with
1. skin rash on buttocks and legs (haemorragic uticaria)
2. arthralgia
3. intestinal haemorrhage
4. abdo pain
5. melena (black feces)
Its origin may be post-streptococcal
Beurger's Disease (thromboangitis obliterans)
idiopathic, segmental, thrombosing vasculitis of small and medium peripheral arteries and veins in heavy smokers
Symptoms of Beurger's Disease
Intermittent claudication
superficial nodular phlebitis
cold sensitivity (Raynaud's Phenom)
severe pain
STOP SMOKING
Kawasaki Disease
Acute, self limiting disease of infants and kids (asians)
necrotizing vasculitis of small/med vessels
Symptoms of Kawasaki Disease
coronary aneurysms
fever
congested conjunctiva
changes in lips/oral mucosa (strawberry tongue)
lymphadentis
What is Polyarteritis nodosa?
necrotizing immune complex inflammation of medium sized muscular arteries
Symptoms of Polyarteritis Nodosa
fever
weight loss,
malaise
abdo pain
melena
headache
myalgia
hypertension
neurologic dysfunction
cutaneous eruptions
What are the findings on investigation of Polyarteritis Nodosa?
Hep B in 30 percent
multiple aneurysms and constrictions on arteriogram
Treat with cyclophosphamide and corticosteroids
What is Takayasu's Arteritis?
Pulseless disease
Granulomatous thickening of Aortic arch/Proximal great vessels
elevated ESR
Asian Females
Symptoms of Takayasu's Arteritis
Fever
Arthritis
Night Sweats
Myalgia
Skin Nodules
Ocular Disturbances
Weak Pulse in upper extremity
What is Temporal Arteritis?
Most Common that affects medium and large arteries (usually branches of carotid)
Focal granulomatous inflamation, elderly females
What are the Symptoms of Temporal Arteritis?
What is associated with Temporal Arteritis 50% of the time?
1. Unilateral headache
2. jaw claudication
3. impaired vision (can lead to irreversible blindness)
4. Elevated of ESR
50% have polymyalgia rheumatica
Treatment for Temporal Arteritis
High Dose steroids
What is hypersensitivity vasculitis?
What are characteristic of the lesions?
Immune complex mediated vasculities characterised by acute inflammation of smale blood vessels.
Lesions are of the same age (unlike polyarteritis nodosa)
may be precipitated by exogenous antigens (drugs, foods, infection) Like Henoch-Schonlein purpura (strep orgin?)
What are the two types of large vessel vasculitis?
1. Takayasu's (women 15-45)
2. Giant Cell Ateritis (tempral arteritis) (aged 50 +)
What are the three types of Medium Vessel Vasculitis?
1. Kawasaki's
2. Polyarteritis Nodosa
3. Isolated CNS Ateritis
What are the small vasculitides?
1. Wegener's Vasculitis
2. Churg-Strauss Vaculitis
3. Microscopic polyarteritis
4. Henoch-Schonlein Purpura
5. Essential cryoglobulinemic vasculitis
What is the difference between concentric and excentric hypertrophy?
chronic hypertension or aortic valve stenosis, the ventricular chamber radius may not change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres. This is termed concentric hypertrophy. This type of ventricle is capable of generating greater forces and higher pressures, while the increased wall thickness maintains normal wall stress. This type of ventricle becomes "stiff" (i.e., compliance is reduced), which can impair filling and lead to diastolic dysfunction. Sometimes the chamber radius is increased and the wall thickness is increased moderately - this is termed eccentric hypertrophy - and can occur when there is both volume and pressure overload. An example of this would be when systolic dysfunction and a volume overload state occur in a concentrically hypertrophied heart, thus stimulating chronic chamber dilation. Chamber dilation occurs as new sarcomeres are added in-series to existing sarcomeres.