Cardiovascular Diseases

Front 1

Inherited disorder of myocardial repolarization due to ion channels defect

Back 1

Congenital Long QT syndrome

Front 2

What is the risk of long QT syndrome?

Back 2

↑risk of Sudden Cardiac Death due to Torsade de pointes

Front 3

What are the syndrome associates with congenital long QT syndrome?

Back 3

Romano-Ward Syndrome

Jervell And Lange-Nielsen Syndrome

Front 4

Autosomal dominant, pure cardiac phenotype (no deafness)

Back 4

Romano-Ward Syndrome

(Congenital long QT syndrome)

Front 5

Autosomal recessive, sensorineural deafness and long QT interval

Back 5

Jervell and Lange-Nielsen syndrome

(Congenital long QT syndrome)

Front 6

What is torsade de pointes? What can cause it?How can be treated?

Back 6

Polymorphic ventricular tachycardia.

Characterized by shifting sinosoidal waveforms on ECG.

Caused by: Drugs, ↓Mg2+, ↓K+

Tx: Mg2+

Front 7

What drugs can cause torsade de points?

Back 7

Antiarrhythmics: Class III, Class IA

Antibiotics/virals: Macrolides, Cloroquine, HIV protease inhibitors

Antipsychotics: Haloperidol, respiredone

Antidepressants: TCAs

Antiemetics: Odansentron

Others: Methadone

Front 8

Torsade de pointes can lead to...?

What we can do about it?

Back 8

Ventricular Fibrillation.

CPR → Defibrillation

Front 9

Autosomal dominant disorder + ECG pattern of pseudo-right bundle branch block + ST elevation in V1-V3?

Back 9

Brugada Syndrome

Front 10

In what population is Brugada syndrome most common?

Back 10

Asian males population

Front 11

Brugada Syndrome can lead to...?

What we can do about it?

Back 11

Ventriculat tachyarrhythmias and sudden cardiac death.

Tx: Implantable cardioverter-defibrillator

Front 12

Most common type of ventricular pre-excitation syndrome

Back 12

Wolf-Parkinson-White Syndrome

Front 13

Abnormal fast accesory conduction pathway from atria to ventricle

Back 13

WPW syndrome

Front 14

What is the bundle of Kent?

What it does?

In what disease we can find it?

Back 14

--Fast accesory conduction pathway from atria to ventricle.

--Bypasses the AV node → ventricle depolarizes earlier

--WPW syndrome

Front 15

What findings we can find on ECG in WPW syndrome? What this finding can lead to?

Back 15

Delta wave with widened QRS complex and shortened PR interval → SVT

Front 16

How can we treat WPW syndrome?

Back 16

Antiarrhythmics:

Procanamide, Amiodarone

Front 17

Back 17

Atrial Fibrillation

Front 18

Back 18

Atrial Flutter

Front 19

Back 19

AV block 1st degree

Front 20

Back 20

AV block 2nd degree type 1

Front 21

Back 21

AV block 2nd degree type 2

Front 22

Back 22

AV block 3rd degree

Front 23

What characteristic rhythm has Atrial fib?

Describe relationship of waves on ECG.

Back 23

--Irregularly Irregular rhythm

--No P wave in between irregularly QRS complexes

Front 24

Most common cause of Atrial fib?

Back 24

--HTN and coronary artery disease

--Also HF.

Front 25

Atrial fib treatment.

Back 25

--Anticoagulation: heparin/warfarin

--Rate control: ß-blockers, CCB

--Rhythm control: Antiarrhythmics (Class IA, IC, III)

--Cardioversion: if > 48hrs

Front 26

Rapid succesion of identical, back-to-back atrail depolarization waves on ECG

Back 26

Atrial Flutter

Front 27

"Sawtooth" appearance on ECG

Back 27

Atrial Flutter

Front 28

Completely erratic rhythm with no identifiable waves on ECG

Back 28

Ventricle Fibrillation

Front 29

How to proceed when a ventricular fibrillation is on ECG for more than 30 seconds?

Back 29

CPR → Defribrillation

Front 30

What arrhythmia does have PR interval prolonged (>200msec) on ECG?

Back 30

AV block 1st degree

Front 31

What arrhythmia does have a progressive lengthening of PR interval until beat is "dropped" on ECG?

Back 31

AV block 2nd degree type 1

Front 32

On ECG: A P wave not followed by QRS complex; usually asymptomatic

Back 32

AV block 2nd degree type 2

Front 33

What is regularly irregular rhythm?

Mention an arrthythmia where can be found.

Back 33

Variable RR interval with a pattern.

AV block 2nd degree type 1

Front 34

Dropped beats that are not preceded by a change in the length of the PR interval on ECG

Back 34

AV block 2nd degree type 2

Front 35

On ECG Atria and ventricle beat interdependently of each other w/ Atrial rate > ventricular rate.

Back 35

AV Block 3rd degree

Front 36

What bacteria can cause an AV block?

Back 36

Borrelia burgdorferi

(Lyme Disease)

Front 37

What are the 5Ts of congenital heart diseases?

Back 37

Truncus Arteriosus

Transposition of the Great Vessels

Tricuspid Atresia

Tetralogy of Fallot

Total Anomalus Pulmonary Venous Return

Front 38

Are the 5 Ts of congenital heart diseases belongs to right-to-left or left-to-right shunts?

Back 38

Right-to-left Shunts

Front 39

Which shunt gives early cyanosis? Late cyanosis?

Back 39

Early cyanosis:

--Right-to-left shunt

Late cyanosis

--Left-to-right shunt

Front 40

What is the problem in persistence truncus arteriosus?

Back 40

Truncus arteriosus fails to divide into pulmonary trunk and aorta due to lack of aorticopulmonary septum

Front 41

Most patient are accompanied by what septal defect in truncus arteriosus.

Back 41

VSD

Front 42

What is the problem in transposition of the great vessels?

Back 42

Failure of AP septum to spiral

Aorta leaves RV (anterior) and pulmonary trunk leaves LV (posterior) → separation of systemic and pulmonary circulation

Front 43

What we can see in transposition of the great vessels for them to survive?

Back 43

Septal defects

--VSD, PDA, patent foramen ovale

Front 44

What is tricuspid atresia? What the patients requieres to survive?

Back 44

Absence of tricuspid valve and hypoplastic RV.

Requieres Septal Defects

--ASD and VSD

Front 45

Mention the anomalies of Tetralogy of Fallot

Back 45

Pulmonary Stenosis

Right Ventricular Hypertrophy

Overriding of Aorta

VSD

Front 46

What characteristic shape we can see on X-ray of a patient with Tetralogy of Fallot

Back 46

Boot-shaped heart

Front 47

Outline the physiologic events that leads to the symptoms of Tetralogy of Fallot.

Back 47

Pulmonary Stenosis forces right-to-left shunt flow across VSD → RVH

"Tet spells" often caused by crying, fever, exercise due to exarcerbation of RV outflow obstruction.

Front 48

What maneuver can help the symptoms of Tetralogy of Fallot? What parameters affects?

Back 48

Squatting

↑Systemic vascular resistance: ↑Afterload

↑Preload (venous return)

↓Right-to-left shunt: improves cyanosis

Front 49

What is the problem on Total Anomalus Pulmonary Veins Return?

Back 49

Pulmonary veins drain into the right heart circulation

Front 50

What septal defects are associated with TAPVR?

For what purpose they exist?

Back 50

ASD, PDA: allow right-to-left shunt to maintain CO

Front 51

What is Ebstein anomaly?

Back 51

--Displacement of tricuspid valve leaflet downward into RV

--"Atrializing" the ventricle

Front 52

What heart conditions are associated with Ebstein Anomaly?

Back 52

Tricuspid regurgitation and right HF

Front 53

Most common cause of Ebstein Anomaly

Back 53

Lithium exposure in utero

Front 54

What is the most common congenital heart defect?

Back 54

VSD

Front 55

Mention left-to-right shunts anomalies in order of frecuency.

Back 55

VSD>ASD>PDA

Front 56

What findings we can expect in VSD?

Back 56

--O2 sat ↑ in RA,RV and pulmonary artery

--Holosystolic harsh-sounding murmur; loudest @ tricuspid area

Front 57

Are VSD self resolve or they must be surgically fixed?

Back 57

Most of them self resolve

Larger lesions may lead to LV overload and HF → must be surgically corrected

Front 58

What findings we can expect in ASD?

Back 58

O2 sat ↑ RA, RV, PA

Loud S1

Wide fixed split S2

Diastolic murmur @ tricuspid area

Front 59

What are the most common defects in ASD?

Back 59

1. Ostium Secundum defect

2. Patent Foramen Ovale

3. Ostium Primum defect

Front 60

What are the symptoms of ASD?

Back 60

Ranges from asymtomatic to HF

Classically: easy fatigability

Front 61

Outline the events in patent ductus arteriosus

Back 61

Normally in fetal period: Right-to-left shunt

Neonate period: ↓ pulmonary vascular resistance → shunt becomes left-to-right → progressive RVH and/or LVH and HF.

Front 62

In what congenital disease we can find a PDA?

Back 62

TGV

TAPVR

Front 63

How a PDA can be closed? How to maintain it open?

Back 63

Close: Indomethacin (NSAID)

Open: Prostagladins (E1,E2)

Front 64

How do you describe the murmur heard in PDA?

Back 64

Continuos machine-like murmur

Front 65

What happens if we keep a PDA untreated?

Back 65

Can eventually result in late cyanosis in the lower extremities (differential cyanosis)

Can evolve into Eisenmenger syndrome.

Front 66

What is Eisenmenger syndrome?

Back 66

Uncorrected left-to-right shunt (VSD, ASD, PDA) → ↑pulmonary blood flow → pathologic remodeling of vasculature → pulmonary arterial hypertension → RVH → shunts becomes right-to-left

Front 67

Late Cyanosis + clubbing + polycythemia

Back 67

Eisenmenger Syndrome

Front 68

What is coarctation of the aorta?

Back 68

Aortic narrowing near insertion of ductus arteriosus

Front 69

Hypertension in upper extremities + weak delayed pulse in lower extremities

Back 69

Coarctation of Aorta

Front 70

What defects or conditions are associated w/ Coarctation of the Aorta?

Back 70

Turner Syndrome

Bicuspid valve

Front 71

In what disease we can see notching of ribs on CXR? What caused this?

Back 71

Coarctation of Aorta.

With age, intercoastal arteries enlarge due to collateral circulation; arteries erodes ribs

Front 72

What are the complications of Coarctation of the Aorta?

Back 72

HF

↑risk of cerebral hemorrhage (berry aneurysm)

Aortic rupture

Possible endocarditis

Aortic Regurgitation

Front 73

What congenital cardiac defect we can see in alcohol exposure in utero?

Back 73

VSD, PDA, ASD, Tetralogy of Faloot

Front 74

What congenital cardiac defect we can see in congenital rubella?

Back 74

PDA, Pulmonary stenosis, septal defects

Front 75

What congenital cardiac defect we can see in Down syndrome?

Back 75

AV septal defects (endocardial cushions defects), VSD, ASD

Front 76

What congenital cardiac defect we can see in an infant of a diabetic mother?

Back 76

Transposition of the great vessels

Front 77

What congenital cardiac defect we can see in Marfan syndrome?

Back 77

MVP, thoracic aortic aneurysm and dissection, aortic regurgitation

Front 78

What congenital cardiac defect we can see in prenatal lithium exposure?

Back 78

Ebstein Anomaly

Front 79

What congenital cardiac defect we can see in Turner syndrome?

Back 79

Bicuspid aortic valve, coarctation of the aorta

Front 80

What congenital cardiac defect we can see in Williams syndrome?

Back 80

Supravalvular Aortic Stenosis

Front 81

What congenital cardiac defect we can see in 22q11 syndrome?

Back 81

Truncus Arteriosus, Tetralogy of Fallot

Front 82

How do you define HTN?

Back 82

Persistent systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg

Front 83

Risk Factors for HTN

Back 83

Modifiable:

--obesity, diabetes, physical inactivity, excess salt intake, excess alcohol intake

Non-modifialbe

--family history, African American > Caucasian > Asian

Front 84

What is an hypertensive urgency?

Back 84

Severe hypertension (≥180 / ≥120 mmHg) without acute end-organ damage

Front 85

What is an hypertensive emergency?

Back 85

Severe HTN (≥180 / ≥120 mmHg with evidence of acute end-organ damage

Front 86

What end-organ damage can be seen in a patient with severe HTN?

Back 86

Encephalopathy, Stroke, Retinal Hemorrhages and exudes, papilledema, M, HF, aortic dissection, kidney injury, microangiopathy hemolytic anemia, eclampsia.

Front 87

What might cause secondary hypertension?

Back 87

Renal/renovascular disease (e.g. fibromuscular dysplasia)

Primary Hyperaldosteronism

Front 88

"String of beads" appearance on Renal Artery

Back 88

Fibromuscular dysplasia seen in Renalvascular disease. Common cause of secondary HTN

Front 89

What HTN predisposes to?

Back 89

Coronary Arteries Disease

Left ventricular Hypertension

Heart Failure

Atrial Fibrillation

Aortic Dissection

Aortic Aneurysm

Stroke

Chronic Kidney Disease

Retinopathy

Front 90

Sg: Plaques or nodules composed of lipid-laden histiocytes in skin

Back 90

Xanthomas

Front 91

Sg: Lipid deposit in tendons (especially Achilles)

Back 91

Tendinous Xantoma

Front 92

Sg: Lipid deposit in cornea

Back 92

Corneal Arcus

Front 93

What are the hyperlipidemia signs?

Back 93

Xanthomas, Xanthalesmas

Tendinous Xanthomas

Corneal Arcus

Front 94

Sg: Hardening of arteries, with arterial wall thickning and loss of elasticity

Back 94

Arteriosclerosis

Front 95

What type of vessels do arteriosclerosis affects?

Back 95

Affects small arteries and arterioles

Front 96

Sg: Thickening of the vessels wall in essential hypertention or diabetes mellitus

Back 96

Arteriosclerosis Hyaline type

Front 97

Sg: "Onion Skinning" in severe HTN with proliferation of smooth muscle cells

Back 97

Arteriosclerosis Hyperplastic type

Front 98

Which is more common: Arteriosclerosis or Monckeberg sclerosis?

Back 98

Arteriosclerosis

Front 99

What are the types seen in arteriosclerosis?

Back 99

Hyaline and Hypoplastic

Front 100

What type of vessels Monckeberg Sclerosis affects?

Back 100

Affects medium-sized arteries

Front 101

Sg: Calcification of internal elastic lamina and media of arteries

Back 101

Monckeberg Slerosis

Front 102

"Pipestem" appearance on X-ray

Back 102

Mockenberg Sclerosis

Front 103

Do Monckeberg Sclosis obstruct blood flow in the vessel affected?

Back 103

No. Vascular stiffening without obstruction.

Front 104

Back 104

Arterosclerosis hyaline type

Front 105

What type of vessels do atherosclerosis affects?

Back 105

Elastic arteries and large- and medium-sized muscular arteries

Front 106

What vessels are the most affected by atherosclerosis?

Back 106

Abdominal Aorta > Coronary Artery > Popliteal > Carotid Artery

Front 107

What are the risk factor for Atherosclerosis?

Back 107

Modifiable:

--smoking, HTN, hyperlipidemia (↑LDL), diabetes

Non-modifiable:

--Age, sex, (↑men and postmenopausal woman), family history

Front 108

Patient present with angina and claudication. What is the most likely diagnosis?

Back 108

Atheroslcerosis

Front 109

Outline the events that leads to an atherosclerotic plaque

Back 109

Endothelial cell dysfunction → macrophage and LDL accumulation → foam cell formation → fatty streak → smooth muscle migration (PDGF and FGF) → fibrous plaque → complex atheromas

Front 110

What are the cell involve in atherosclerosis?

Back 110

Endothelial cells

Macrophages

Smooth muscle cells

Front 111

What growth factors are involved in smooth cell migration?

Back 111

Platelet-derived growth factor (PDGF)

Fibroblast growth factor (FGF)

Front 112

What are the complication of Atheroslcerosis?

Back 112

Aneurysm

Ischemia

Infarcts

Peripheral vascular disease

Thrombus → emboli

Front 113

Back 113

Aortic Dissection

May present with back/abdominal pain

Front 114

Male Patient with tobacco use history, atherosclerosis history with a palpable pulsatile abdominal mass. What is the most likely dx?

Back 114

Abdominal Aortic Aneurysm

Front 115

Obliterative endarteritis of vasa vasorum. May first lead to abdominal or thoracic aneurysm, dissection or coartation of the aorta? What organism may cause this?

Back 115

thoracic aortic aneurysm due to syphilis (t. pallidum)

Front 116

What aortic disease is associated with cystic medial degeneration?

Back 116

Thoracic Aortic Aneurysm

Front 117

What are the risk of factors of Thoracic Aortic Aneurysm?

Back 117

HTN

Bicuspid aortic valve

Connective tissue disease (e.g. Marfan syndrome)

Front 118

Patient involved in a motor vehicle accident most likely will injure which part of the aorta?

Back 118

C: Aortic isthmus (proximal descending aorta just distal to origin of the left subclavian artery)

Front 119

What are the types of this finding?

Back 119

Left: Stanford type A (proximal)→ involves ascending aorta

--Tx: Surgery

Right: Stanford type B (distal) → involves descending aorta and/or aortic arch

--Tx: ß-blockers then vasodilators

Front 120

A pt with tearing chest pain (sudden onset) radiating to the back +/- markedly unequal BP in arms

Back 120

Aortic Dissection

Front 121

What aortic disease may have longitudinal intimal tearing forming a false lumen, On CXR: mediastinal widening?

Back 121

Aortic Dissection

Front 122

Angina usually 2° to ischemic myocardium 2° to coronary artery narrowing or spasm

Back 122

Stable Angina

Front 123

Angina usually with ST depression on ECG and resolve with nitroglycerin

Back 123

Stable Angina

Front 124

Angina that occurs at rest 2ry to coronary artery spasm

Back 124

Variable (Prinzmental)

Front 125

Angina with transient SR elevation on ECG

Back 125

Variable (Prinzmental)

Front 126

Angina triggered by tobacco, cocaine, and triptans

Back 126

Variable (Prinzmental)

Front 127

How to treat a variable angina?

Back 127

Tx: Ca2+ channel blockers, nitrates ans smoking cessation

Front 128

Angina due to thrombosis with imcomplete coronary occlusion

Back 128

Unstable

Front 129

Angina +/- ST depression and/or T-wave inversion on ECG but no cardiac biomarkers elevation

Back 129

Unstable

Front 130

Vessels are maximally dilated at baseline; distal to coronary stenosis. What may you suspect?

Back 130

Coronary Steal Syndrome

Front 131

Why vasodilators makes worse the conditions seen in coronary steal syndrome?

Back 131

In CSS, vessels are already dilated because of an obstruction of a vessel if vasodilators are administrated it will dilates more the coronary arteries making more blood flow away from the obstructed area.

Front 132

What heart condition may cause death from cardiac cause within 1 hour of Synmptoms?

Back 132

Sudden Cardiac Death

Front 133

What is the most common cause of death in SCD?

Back 133

Ventricular Fibrillation

Front 134

What are the causes of Sudden Cardiac Death?

Back 134

--Coronary arteries disease (70%)

--Cardiomiopathy (hypertrophic dilated)

--Hereditary ion channelopathies (long QT, brugada)

Front 135

Heart condition with progressive onset of HF over many years due to chronic ischemic myocardial damage.

Back 135

Chronic Ischemic heart disease

Front 136

STEMI or Non-STEMI:

Trasmural Infarcts

Full thickness of myocardial wall involved

Back 136

ST-segment Elevation MI

(ST elevation + Q wave on ECG)

Front 137

STEMI or Non-STEMI:

Subendocardial infarts

Subendocardium (inner 1/3) especially vulverable to ischemia

Back 137

Non-ST-segment elevation MI

(ST depression on ECG)

Front 138

Myocardial Infarction are more often due to...?

Back 138

Rupture of coronary artery atherosclerotic plaque.

Front 139

Light microscopy: Early coagulative necrosis, release of necrotic cell contents into blood; edma, hemorrhage, wavy fibers. Neutrophils appear.

What time do this correspond?

Back 139

Myocardial Infarction

0 -24 hrs

Front 140

What complication does a MI have in the first 24 hrs?

Back 140

Ventricular arrhthmias, HF, cardiogenic shock

Front 141

What is reperfusion injury and how many hours/days can occurs after an MI?

Back 141

--Reperfusion injury: associated with the generation of free radicals → hypercontraction of myofibrils through ↑ free calcium influx

--Occurs in the first 24 hrs after injury

Front 142

Light microscopy: Extensive coaugulative necrosis. Tissue surrounding infarct shows acute inflammation w/ neutrophils

What time this coincides after an MI?

Back 142

1 - 3 days after MI

Front 143

What complication can occurs in day 1 - 3 after a MI?

Back 143

Postinfarction fibrinous pericarditis

Front 144

Light microscopy: Macrophages, then granulation tissue at margins

What time this coincide after an MI?

Back 144

3 - 14 days after a MI

Front 145

Free wall rupture → tamponade

Papillary muscle rupture → Mitral regurgitation

Interventricular septal rupture (due to macrophages-mediated structural degradation)

LV pseudoaneurysm (risk of rupture)

What time this coincides after an MI?

Back 145

Complication after in the first two weeks (3 - 14 days) after an MI

Front 146

Contracted scar complete

What time this coincide after an MI?

Back 146

More than 2 week after an MI

Front 147

Autoimmune phenomenon resulting in fibrinous pericarditis

What time this coincide after an MI?

Back 147

Dressler Syndrome

Complication after 2 week of a MI

Front 148

HF, arrhythmias, true ventricular aneurysm (risk of mural thrombosis)

What time this coincide after an MI?

Back 148

More than 2 weeks after a MI

Front 149

In the first 6 hrs after a MI, what diagnostic method is the best?

Back 149

ECG

Front 150

Which cardiac biomarker is more specific to diagnose a MI?

Back 150

Cardiac Troponin I (rises after 4hrs; peaks at 24hrs; ↑ for 7 -10 days)

CK-MB is not specific becuase it can be released from skeletal muscle (rises after 6 -12 hrs)

Front 151

Which cardiac biomarker is useful in diagnosing reinfarction following acute MI?

Back 151

CK-MB becuase levels return to normal after 48hrs

Front 152

What changes we can see on ECG after a MI?

Back 152

ST elevation (STEMI, trnasmural infarction)

ST depression (NSTEMI, subendocardial infarct)

Hyperacute (peaked) T wave

T-wave inversion

New left bundle branch block

Pathologic Q wave

Poor R wave progression (evolving or old trnasmural infarct)

Front 153

On ECG you see leads with ST elevation or Q waves on: V1 - V2

What region of the heart you might suspect to be injured? What artery supplies this region?

Back 153

Anteroseptal (LAD)

Front 154

On ECG you see leads with ST elevation or Q waves on: V3 - V4

What region of the heart you might suspect to be injured? What artery supplies this region?

Back 154

Anteroapical (distal LAD)

Front 155

On ECG you see leads with ST elevation or Q waves on: V5 - V6

What region of the heart you might suspect to be injured? What artery supplies this region?

Back 155

Anterolateral (LAD or LCX)

Front 156

On ECG you see leads with ST elevation or Q waves on: I, aVL

What region of the heart you might suspect to be injured? What artery supplies this region?

Back 156

Lateral (LCX)

Front 157

On ECG you see leads with ST elevation or Q waves on: II, III, aVF

What region of the heart you might suspect to be injured? What artery supplies this region?

Back 157

Inferior (RCA)

Front 158

On ECG you see leads with ST elevation or Q waves on: V7 - V9 and ST depression + tall R wave on: V1 - V3

What region of the heart you might suspect to be injured? What artery supplies this region?

Back 158

Posterior (PDA)

Front 159

What is an Important cause of death before reaching the hospital after MI?

Back 159

cardiac arrthymia

Front 160

Sharp pain + aggravated by inspiration + friction rub after MI

What time this coincide after an MI?

Back 160

Postinfarction fibrinous pericarditis

(1 - 3 days after MI)

Front 161

Posteromedial papillary muscle rupture can result in ...? How long after an MI this can occur?

Which blood vessel supply this structure?

Back 161

Mitral regurgitation (After 2 - 7 after MI)

Posterior Descending artery

Front 162

Contained free wall rupture can decrease _____ and have a risk of ____, and_____.

Back 162

Ventricular Pseudoaneurysm formation (3 -14 days after MI)

↓Cardiac Output

Risk of arrhythmia, embolus from mural thrombosis

Front 163

Free wall rupture leads to _____.

Back 163

5 -14 days after MI

Cardiac tamponade

Front 164

Outward bulge with contraction ("dyskinesia") associated with fibrosis

Back 164

True ventricular aneurysm ( > 2 weeks after MI)

Front 165

Treatment for Unstable angina/NSTEMI (7)

Back 165

Anticouagulation (heparin)

Antiplatelet therapy (aspirin + ADP receptor inhibitor [clopidrogrel])

ß-blocker

ACE inhibitors

Statins

Sx control w/ nitroglycerin and morphine

Front 166

Treatment for STEMI (7+1)

Back 166

Tx for Unstable angina/NSTMI + repefusion therapy (percutaneous coronary intervention preferred over fibrinolysis)

Front 167

What is the most common cardiomyopathy?

Back 167

Dilated cardiomyopathy (90%)

Front 168

Mention etiologies that may cause dilated cardiomyopathy.

Back 168

Most often: Idiopathic or Familial

Others: Chronic alcohol abuse, Wet beriberi, Coxsackie B viral myocarditis, Chagas Disease, Cocaine use, Doxorubicin toxicity, hemochromatosis, sarcoidosis, peripartum cardiomyopathy

Front 169

What are the ABCCCD of dilated cardiomyopathy

Back 169

Etiologies:

Alcohol abuse (chronic)

Beriberi (wet)

Coxsackie B virus (myocarditis)

Chagas Disease

Doxorubicin (toxicity)

Front 170

HF + S3 + systolic regurgitant murmur + balloon appearance of heart on CXR

Back 170

Dilated cardiomyopathy

Front 171

What abnormal heart sound can be heard in dilated cardiomyopathy?

Back 171

S3

Front 172

Balloon appearance of heart on CXR

Back 172

Dilated cardiomyopathy

Front 173

Treatment for dilated cardiomyopathy (7)

Back 173

Na+ restriction, ACE inhibitors, ß-blockers, diuretics, digoxin, ICD, heart transplant.

Front 174

What is eccentric hypertrophy? With what cardiomyopathy is associated?

Back 174

Sarcomere added in series

Associated w/ Dilated cardiomyopathy

Front 175

What is marked ventricular hypertrophy? With what cardiomyopathy is associated?

Back 175

Myofibrillar disarray and fibrosis

Associated w/ Hypertrophic cardiomyopathy

Front 176

What type of dysfunction is seen in dilated cardiomyopathy?

Back 176

Systolic dysfunction

Front 177

What type is dysfunction is seen in hypertrophic cardiomyopathy?

Back 177

Diastolic Dysfunction

Front 178

What is the most common cause of hypertrophic cardiomyopathy?

Back 178

Familial (Autosomal dominant) → commonly a ß-myosin heavy-chain mutation)

Front 179

Which cardiac disease is associated with Friedreich Ataxia?

Back 179

Hypertrophic cardiomyopathy

Front 180

What hear condition causes syncope during exercise and may lead to SCD due to ventricular arrhythmia?

Back 180

Hypertrophic cardiomyopathy.

Especially in young athletes

Front 181

What abnormal heart sound can be heard in hypertrophic cardiomyopathy?

Back 181

S4

Front 182

S4 + systolic murmur + may see mitral regurgitation due to impaired mitral valve closure

Back 182

Hypertrophic cardiomyopathy

Front 183

Is the size of the heart is normal, bigger or smaller in hypertrophic cardiomyopathy? In dilated cardiomyopathy?

Back 183

HC: Normal

DC: Bigger

Front 184

Treatment for hypertrophic cardiomyopathy (4)

Back 184

Cessation of high-intensity athletics, ß-blocker, Non-dihydropyridine Ca2+ channel blockers, ICD (if pt is high risk)

Front 185

Asymmetric septal hypertrophy and systolic anterior motion of mitral valve leads to what?

Back 185

Outflow obstruction → dyspnea, possible syncope in Obstructive hypertrophic cardiomyopathy

Front 186

The major causes of this cardiomyopathy is sarcoidosis, amyloidosis post radiation fibrosis, endocardial fibroelastosis and hemochromatosis

Back 186

Restrictive/infiltrative cardiomyopathy

Front 187

What cardiac disease is associated with Loffler syndrome?

Back 187

Restrictive/infiltrative cardiomyopaty

Front 188

What dysfunction can be seen in restrictive/infiltrative cardiomyopathy?

Back 188

Diastolic dysfunction

Front 189

Cardiomyopathy that has low-voltage ECG despite thick myocardium.

Back 189

Restrictive/infiltrative cardiomyopathy

Front 190

Shortness of breath when lying down + Breathless awakening from sleep + rales

Back 190

Left heart failure

Front 191

Nutmeg liver + venous distension + pitting edema

Back 191

Right heart failure

Front 192

Presence of hemosiderin-laden macrophages in lungs

What heart condition you might suspect?

Back 192

Left heart failure

Front 193

What are the most common cause of Right heart failure and Cor pulmonale?

Back 193

RHF: due to LHF

CP: RFH due to pulmonary cause

Front 194

What is systolic dysfunction?

Back 194

Reduced EF, ↑EDV; ↓contractility often 2° to ischemia/MI or dilated cardiomyopathy

Front 195

What is diastolic dysfunction?

Back 195

Preserve EF, normal EDV; ↓compliance often 2° to myocardial hypertrophy

Front 196

What drug reduce mortality in HF?

Back 196

--ACE inhibitors (-pril)

--ARB (-artan)

--Aldosterone antagonist (spironolactone/eplerenone)

--ß-blockers (metoprolol, carvedilol)

Front 197

What drugs are used to relief the Sx in HF?

Back 197

---Loop Diuretics in severe cases (Furosemide, bumetanide, torsemide) or Thiazide Diuretes in mild cases (Hydrochlorothiazide, chlorthalidone, metolazone)

---Digoxin

---Vasodilators (nitrates, hydralazine*)

*certain pts

Front 198

How to treat a pt w/ chronic HF?

Back 198

ACE inhibitors + Aldosterone Antagonist + ß-blockers

Relief of Sx: Loop or thiazide diuretics, Digoxin

Front 199

How to manage an acute HF?

Back 199

NO LIP

Nitrates

Oxygen

Loop Diuretics

Inotropic Drug (Dobutamine)

Positioning (Sit up pt)

Front 200

What is the pulmonary capillary wegde pressure (PCWP)?

Back 200

PCWP = Measure left atrium pressure (via a Swan-Ganz catheter) = Left Diastolic Pressure

PCWP ~ 12 mmHg; LDP ~ 10 mmHg

Front 201

What is BNP? what differs from ANP?

Back 201

Brain Natriuretic Peptide = released from the ventricle in response to ↑ tension

Atrial natriuretic peptide = released from atria in response to ↑blodd volume/pressure

Front 202

How does ANP works?

Back 202

Acts via cGMP → vasodilation + ↓Na+ reabsorption at the renal collecting tubules.

Dilates afferent renal arterioles + constrict efferent arterioles → promotes diuresis ans constribute to "aldosterone escape" mechanism.

Front 203

What blood test can be done to diagnose HF?

Back 203

BNP (very good negative predictive value)

Front 204

What recombinant form of drug can be use to treat HF?

Back 204

BNP → nesiritide

Front 205

Which has longer half-life, ANP or BNP?

Back 205

BNP

Front 206

What type of shock correspond the following PWCP and SVR values?

Back 206

1) Hypovolemic Shock

2)Cardiogenic/Obstructive

3)Distributive

Front 207

Mention causes of hypovelemic, cardiogenic/obstructive and distributive shocks.

Back 207

--Hypovelemic: Hemorrhage, dehydration, burns

--Cardiogenic: Acute MI, HF, valvular dysfunction, arrhythmia

--Obstructive: Cardiac tamponade, pulmonary embolism

--Distributive: Sepsis, anaphylaxis, CNS injury

Front 208

Skin condition in shock:

Cold, clammy skin?

Warm, dry skin?

Back 208

Cold, clammy skin: hypovolemic, cardiogenic/obstructive

Warm, dry skin: Distributive

Front 209

Treatment used in shock:

IV fluid only?

IV fluis + pressor?

Inotropes, diuresis?

Relieve obstruction?

Back 209

IV fluids only: hypovolemic

IV fluids + pressor: Distributive

Inotropes, diuresis: Cardiogenic

Relieve ibstruction: Obstructive

Front 210

Round white spots on retina surrounded by hemorrhage. What is the most likely dx?

Back 210

Roth spots (Bacterial endocarditis)

Front 211

Tender raised lesions on finger or toe pads

Back 211

Osler nodes (Bacterial endocarditis)

Front 212

Small, painless, erythematous on palm or sole

Back 212

Janeway lesions (Bacterial endocarditis)

Front 213

Glomerulonephritis + septic arterial or pulmonary embolis + splinter hemorrhages on nail bed

Back 213

Bacterial Endocarditis

Front 214

What valve is most common affects in bacterial endocarditis?

Back 214

Mitral valve

tricuspid valve in IV drug abuse

Front 215

What organism is most common in acute bacterial endocarditis?

Back 215

S. aureus (high virulence)

Front 216

What organism is most common in subacute bacterial endocarditis?

Back 216

Viridans streptococci (low virulence)

Front 217

How do you describe the vegetation found in acute and subacute bacterial endocarditis?

Back 217

ABE: Larger vegetations on previously normal valve

SABE: Smaller vegetations on congenital abnormal or diseased valves

Front 218

What procedure can be a sequela of bacterial endocarditis?

Back 218

Dental Procedure

Front 219

What organism may cause bacterial endocarditis in colon cancer patients? In patients with prostatic valves?

Back 219

S. bovis = colon cancer patients

S. epidermis = prostatic valves

Front 220

What may cause nonbacterial endocarditis?

Back 220

Marantic/thromobic 2ry to malignancy, hypercoagulable state, or lupus

Front 221

If culture comes negative in bacterial endocarditis (BE), what organism may cause BE?

Back 221

--Coxiella burnetti (Q fever; cattle/sheep amniotic fluid)

--Bartonella (Cat scratch fever, bacillary angiomatosis)

--HACEK (Haemophilis, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)

Front 222

Tricuspid valve endocarditis is associated with ____? What organism can cause it?

Back 222

IV drug abuse.

S. aureus, Pseudomonas and Candida

Front 223

What heart related disease is a consequence of pharyngeal infection with group A ß-hemolytic streptococci?

Back 223

Rheumatic fever

Front 224

Which valves does rheumatic heart disease affects?

Back 224

Mitral > aortic >> tricuspid

(high-pressure valves affected most)

Front 225

Granulomas with giant cells. What disease you might suspect?

Back 225

Aschoff bodies (Rheumatic heart disease)

Front 226

Enlarged macrophage with ovoid, wavy, rod-like nucleus. What disease you might suspect?

Back 226

Anitschkow cells (rheumatic heart disease

Front 227

What valve lesion can be seen as an early lesion in rheumatic heart disease? As a late lesion?

Back 227

EL: Mitral regurgitation

LL: Mitral Stenosis

Front 228

What blood test can be done to diagnose rheumatic fever?

Back 228

Anti-streptolysin O (ASO)

Front 229

What type of hypersensitivity occurs in rheumatic heart disease? How does it do it?

Back 229

HS II; Antibodies to M protein cross-react with self antigens (molecular mimicry)

Front 230

What drug can be used for prophylaxis or to treat Rheumatic fever?

Back 230

Penicillamin

Front 231

What are the major criteria for rheumatic fever?

Back 231

J♥NES

Joint (migratory polyartheritis)

♥ (carditis)

Nodules in skin (subcutaneous)

Erythema marginatum

Sydenham chorea

Front 232

Sharp pain aggravated by inspiration and relieve by sitting up and leaning forward + friction rub

Back 232

Acute pericarditis

Front 233

What heart disease have an ECG change include widespread ST-segment elevation and/or PR depression?

Back 233

Acute pericarditis

Front 234

What are the Causes of acute pericarditis?

Back 234

Most common: idiopathic (viral)

Confirm infection (coxsackie virus)

Neoplasia

Autoimmune (SLE, RA)

Uremia

CV (acute STEMI/Dressler syndrome)

Radiation therapy

Front 235

WHat are the Types of pericarditis?

Back 235

--Fibrinous = Load friction rub = dressler syndrome, uremia, radiation

--Serous = viral pericarditis, non infectious inflammatory disease

--Suppurative = bacterial infection

Front 236

What is the most likely dx?

Back 236

Cardiac tamponade

Front 237

What is the most likely dx?

Back 237

Pericarditis

Front 238

Hypotension + distended neck veins + distant heart sounds

Back 238

Beck traid (Cardiac Tamponade)

Front 239

What heart disease may have an ECG that shows low-voltage QRS and electrical alternans (due to "swinging" movement of heart in large effusion)?

Back 239

Cardiac tamponade

Front 240

What is Pulsus paradoxus? With what conditions is associated?

Back 240

↓in amplitude of systolic BP by > 10mm Hg during inspiration.

---Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup

Front 241

What is Pulsus parvus et tardus? With what condition is associated?

Back 241

Pulses are weak with delayed peak.

---Seen in aortic stenosis

Front 242

What layers has to be pierced in order to do a periocardiocentesis?

Back 242

Skin → superficial/deep fascia → pectoralis major muscle → external/internal costal membrane → thoracic muscle → fibers of pericardium → parietal layer of serum pericardium

Front 243

"tree bark" appearance of aorta

Back 243

3° syphilis

Front 244

What disease may disrupt vasa vasorum of the aorta with consequence atrophy of vessel wall?

Back 244

3° syphilis

Front 245

Dilatation of the aorta and valve ring + calcification of aortic root and ascending aortic arch

Back 245

3° syphilis

Front 246

What are the cardiovascular consequence of 3° syphilis?

Back 246

Aneurysm of ascending aorta or aortic arch, aortic insifficiency

Front 247

What is the most common cause of cardiac tumors?

Back 247

Metatasis

--Melanoma, Lymphoma

Front 248

Most common 1° tumor in adult

Back 248

Myxoma (90% occur in atria; mostly left atrium)

Front 249

"Ball valve" obstruction in left atrium

Back 249

Myxoma

Front 250

Most frequent 1° cardiac tumor in children

Back 250

Rhabdomyosarcoma

Front 251

What disease is associated with rhabdomyosarcoma?

Back 251

Tuberous sclerosis

Front 252

What heart condition may cause an early diastolic "tumor plop" sound?

Back 252

Myxoma

Front 253

What is Kussmaul sign? In what diseases can be seen?

Back 253

↑ in JVP on inspiration instead of a normal ↓

Seen in constrictive pericarditis, restrictive cardiomyopathy, right atrial or ventricular tumors

Front 254

Outline the events seen in Kussmaul sign

Back 254

Inspiration → negative intrathoracic pressure not transmitted to heart → impaired filling of right ventricle → blood back up into venae cavae → JVD

Front 255

Which vasculitides affects large-sized vessels?

Back 255

Temporal (giant cell) arteritis

Takayasu arteritis

Front 256

Which vasculitides affects medium-sized vessels?

Back 256

--Polyarteritis nodosa

--Kawasaki disease (mucocutaneous lymph node syndrome

--Buerger disease (thromboangiitis obliterans)

Front 257

Which vasculitides affects small-sized vessels?

Back 257

--Granulomatosis with polyangititis (Wegener)

--Microscopic polyangiitis

--Eosinophilic granulomatosis with polyangiitis (Chrug-Strauss)

--Henoch-Schonlein purpura

Front 258

Usually elderly females + unilateral headache + pain after chewing + pain in shoulder and hips

Back 258

Giant cell (Temporal) Arteritis

*Pain after chewing (jaw claudication)

**Pain in shoulder and hips (polymyalgia rheumatica)

Front 259

Vasculitis with ↑ ESR + focal granulomatous inflammation

Back 259

Giant cell (temporal) arteritis

Front 260

What vasculitis most commonly affects branches of carotids artery?

Back 260

Giant cell (temporal) arteritis

Front 261

What vasculitis may lead to irreversible blindness due to ophthalmic artery occclusion?

Back 261

Giant cell (temporal) arteritis

Front 262

What vasculitis is associated with polymyalgia rheumatica?

Back 262

Giant cell (temporal) arteritis

Front 263

Vasculitis usually in asian femoles > 40 years old

Back 263

Takayasu Arteritis

Front 264

Vasculitis: "Pulseless disease" (weak upper extremity pulses)

Back 264

Takayasu Arteritis

Front 265

Vasculitis: Fever, night sweat, arthritis, myalgia, skin nodules, ocular disturbance

Back 265

Takayasu arteritis

Front 266

With what vasculitis is this related?

Back 266

Takayasu arteritis

--Granulomatous thickening and narrowing of aortic arch and proximal great vessels

Front 267

Vasculitis: Young adult + Hepatitis B positive

Back 267

Polyarteritis nodosa

Front 268

Vasculitis: Typically involves renal and visceral vessels, not pulmonary arteries

Back 268

polyarteritis nodosa

Front 269

Vasculitis: Trasmural inflammation of the arterial wall with fibrinoid necrosis (Immune complex mediated)

Back 269

Polyarteritis nodosa

Front 270

Vasculitis: Different stages of inflammation may coexist in different vessels

Back 270

Polyarteritis nodosa

Front 271

"String of Pearls"

Vasculitis or fibromuscular dysplasia?

Back 271

Polyarteritis nodosa

--Innumerable renal microaneurysm and spams

Front 272

Vasculitis: Asian children < 4 years old + conjunctival injection + rash + adenopathy

Back 272

Kawasaki disease

Rash (polymorphous → desquamating)

Adenopathy (cervical)

Front 273

Vasculitis: Oral mucositis + edema and erythema on hand/foot

Back 273

Kawasaki disease

Strawberry tongue (oral mucositis)

Hand-foot changes

Front 274

Vasculitis: May develop coronary artery aneurysm

Back 274

Kawasaki disease

Front 275

Vasculitis: Treat with high-dose corticosteroid prior to biopsy

Back 275

Giant cell (temporal) arteritis

--prevents blindness

Front 276

Vasculitis: Treat with corticosteroids

Back 276

Takayasu arteritis

Front 277

Vasculitis: Tx: corticosteroids or cyclophosphamide

Back 277

Polyarteritis nodosa

Granulomatosis with polyangiitis (Wegener)

Microscopic polyangitis

Front 278

Vasculitis: Treat with IV immunoglobulin and aspirin

Back 278

Kawasaki

Front 279

Vasculitis: Treat with smoking cessation

Back 279

Buerger Disease (thromboangiitis obliterans)

Front 280

Vasculitis: Heavy smokers < 40 years

Back 280

Buerger Disease (thromboangiitis obliterans)

Front 281

Vasculitis: Intermittent claudication may lead to gangrene

Back 281

Buerger Disease (thromboangiitis obliterans)

Front 282

Raynaud phenomenon + autoamputation of digits + superficial nodular phlebitis

Back 282

Buerger Disease (thromboangiitis obliterans)

Front 283

Vasculitis: Segmental thrombosing vasculitis

Back 283

Buerger Disease (thromboangiitis obliterans)

Front 284

Vasculitis + Upper respiratory tract: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis

Back 284

Granulomatosis with polyangiitis (Wegener)

Front 285

Vasculitis + Lower respiratory tract: hemoptysis, cough, dyspnea

Back 285

Granulomatosis with polyangiitis (Wegener)

Microscopic Angiitis

Front 286

Vasculitis w/ Renal: hematuria, red cell cast

Back 286

Granulomatosis with polyangiitis (Wegener)

Front 287

Chronic sinusitis + hemoptysis + red cell cast in urine

Back 287

Granulomatosis with polyangiitis (Wegener)

Front 288

--Focal necrotizing vasculitis

--Necrotizing granulomas in the lung and upper airway

--Necrotizing glomerulonephritis

Back 288

Granulomatosis with polyangiitis (Wegener)

Front 289

PR3-ANCA/c-ANCA

Associated with what disease?

Back 289

Granulomatosis with polyangiitis (Wegener)

Front 290

Vaculitis w/ CXR: large nodular densities

Back 290

Granulomatosis with polyangiitis (Wegener)

Front 291

Necrotizing vasculitis involving lung, kidneys and skin without granulomas

Back 291

Microscopic polyangitis

Front 292

MPO-ANCA/p-ANCA

Associated with what disease?

Back 292

Microscopic polyangitis

Front 293

Vaculitis associated with Asthma, sinusitis, skin nodules or purpura, peripheral neuropathy (wrist drop/foot drop)

Back 293

Eosinophilic granulomatosis with polyangiitis

(churg-strauss)

Front 294

Vasculitis associated with Paucini-immune glomerulonephritis

Back 294

Eosinophilic granulomatosis with polyangiitis(churg-strauss)

Front 295

Vasculitis that can involve heart, GI, kidneys

Back 295

Eosinophilic granulomatosis with polyangiitis(churg-strauss)

Front 296

Granulomatous + necrotizing vasculitis with eosinophils

Back 296

Eosinophilic granulomatosis with polyangiitis(churg-strauss)

Front 297

MPO-ANCA/p-ANCA

↑IgE level

Associated with what disease?

Back 297

Eosinophilic granulomatosis with polyangiitis(churg-strauss)

Front 298

Chilhood vasculitis often follows upper respiratory infection

Back 298

Henoch-Schonlein purpura

Front 299

Palpable purpura on buttocks/legs + arthralgias + abdominal pain

Back 299

Henoch-Schonlein purpura

Front 300

Vasculitis 2° to IgA immune complex deposition

Back 300

Henoch-Schonlein purpura

Front 301

Back 301

Arteriosclerosis hyperplastic type

Front 302

Vasculitis Associated with IgA nephropathy (Berger disease)

Back 302

Henoch-Schonlein purpura