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69 Cards in this Set

  • Front
  • Back
What is the definition of pulmonary hypertension?
A pulmonary blood pressure > 30/15 mm Hg
What is the pathogenic mechanism of passive (venous) pulmonary hypertension?
Anything that raises left atrial pressure:

Mitral stenosis, left ventricular failure (systemic HTN, MI, valvulopathy, CM)
What is the pathogenic mechanism of hyperkinetic pulmonary hypertension?
Increased pulmonary blood flow secondary to a congenital shunt (cyanotic or acyanotic)
What are the two mechanisms that produce pulmonary hypertension in patients with emphysema?
capillary destruciton and hypoxia-induced vasoconstriction
What are the two forms of pulmonary hypertension that give rise to cor pulmonale?
Obstructive/obliterative and vasoconstrictive
Clinical idiopathic pulmonary hypertension is most likely to occur in which patient population?
Females aged 20-40 years
What are the pathologic characteristics of grade 3 pulmonary hypertension?
intimal fibrosis
Medial hypertrophy is associated with which grade of PH?
Grade 1
What is heart failure?
Heart failure occurs when compensation mechanisms in the ventricles are unable to maintain normal flow.
What is the significance of b-type natriuretic peptide (BNP)?
It is produced by the left ventricle in response to volume/pressure overload and indicates the extent of cardiac failure.
What is the most common cause of right heart failure?
Left Heart Failure
What are some of the effects of right heart failure?
increased venous pressure, peripheral edema, ascites, congestive hepatomegaly
What is the relationship between hypertension and atherosclerosis?
Hypertension accelerates atherosclerosis
What syndrome is associated with an adrenal cortical adenoma that secretes excessive amounts of aldosterone leading to secondary hypertension?
Conn syndrome
What form of arteriosclerosis is associated with circumferential calcification of arterial media, but does not cause luminal narrowing?
Monckebergy medial calcific sclerosis
What is the most common valvular abnormality?
Calcific aortic stenosis
Where are the calcified areas located in calcific aortic stenosis?
In the cusps at the base
What abnormality is most likely if a 52 year old patient presents with aortic stenosis?
bicuspid aortic valve
What is the mechanism behind rheumatic heart disease?
M-proteins from Group A β-hemolytic streptococcal infection cross react with proteins on the endocardium
What is pathognomonic for acute rheumatic heart disease?
Achoff nodules
What is the most common cause of mitral stenosis in the world?
Chronic Rheumatic Heart Disease
What are the characteristic signs of chronic rheumatic heart disease?
Massive left atrial dilation, fusion of commissures & chordae tendineae, "fish-mout" appearance of mitral valve
What vavlular abnormality is commonly seen in young women and is associated with a mid-systolic click?
Mitral Valve Prolapse

(also associated with Marfan syndrome)
Histologically, what is the cause of mitral valve prolapse?
Expansion of the spongiosa, disrupting the fibrosa causing insufficiency
An individual with mitral valve prolapse has an increased risk of infectious endocarditis caused by which organism?
Streptococcus viridans
What are the clinical presentations of infective endocarditis?
Fever, malaise, flu-like symptoms, Roth spots, SPLINTER hemorrhages
What is marantic endocarditis associated with?
Non-infective (marantic) thrombotic endocarditis is associated with hypercoagulable states such as cancer of DIC
Patients with antibodies to double stranded DNA have an increased risk for which type of endocarditis?
Libman-Sacks Endocarditis
What is the most common valvular abnormality in elderly female patients?
Mitral annular calcification
What can cause damage to the tricuspid and pulmonary valves?
Carcinoid syndrome or IV drug abuse
What arterial changes can hypertension or diabetes mellitus cause in the kidney?
Hyaline arteriolosclerosis
What type of aneurysm is caused by atherosclerosis?
fusiform aneurysms

(most common type in the elderly)
What is the most common site for fusiform aneurysm formation?
abdominal aorta
Which type of aneurysm results from the weakening of a small portion of the circumference of an artery?
saccular aneurysms
What is the most common cause of large arterial saccular aneurysms?
cystic medionecrosis
What genetic defect underlies Marfan syndrome?
mutation in fibrillin-1
What are the cardiovascular effects of Marfan syndrome?
Cystic medionecrosis, aneurysms, mitral valve prolapse/insufficiency
What is the most common site for berry aneurysm formation?
Branch points of the circle of Willis, especially between the anterior cerebral and anterior communicating arteries
What causes berry aneurysms?
Defects in the media of the vessels at branch points
Berry aneurysms are associated with which conditions?
polycystic kidney disease and von Hippel-Lindau syndrome
Rupture of berry aneurysms are the most common cause of which type of hemorrhage?
subarachnoid hemorrhage
What is senile arteriosclerosis associated with?
intimal thickening, medial muscle decrease and collagen increase
What type of aneurysm is located in the proximal aorta and never leads to a dissecting aneurysm?
syphilitic aneurysms
What type of vasculitis is associated with positive titers of c-ANCA and p-ANCA and involvement of lungs and nasopharynx?
Wegener granulomatosis
What indirect immunofluorescent test is diagnostic (95%) for Wegener granulomatosis?
cytoplasmic lysosomal serine protease (c-ANCA)
Which vasculitis is associated with hepatitis infections?
polyarteritis nodosa
Which vasculitis is associated with coronary aneurysms in persons less than 4 years of age?
Kawasaki disease
Also known as "pulseless" disease, this condition can affect the aortic arch of young females.
Takayasu's disease
Where is the source of bleeding in a Charcot-Bouchard aneurysm rupture?
lenticulo-striate artery
What is the etiology of an aortic dissection?
hypertension or medionecrosis
What is the most common cause of death in an aortic dissection?
External aortic rupture into pericardial space
Which type of cardiac aneurysm consists of a wall of pericardium?
False aneurysm
How do true cardiac aneurysms form and what problems do they cause?
They form as a result of a healing transmural infarct; problems are due to heart failure or arrhythmia
what is the most common cause of systemic hypertension?
Unknown causes are the most common
Systemic hypertension in conjunction with elevated urinary VMA levels is suggestive of which underlying disease?
pheochromocytoma
What is the most common cardiomyopathy?
Dilated Cardiomyopathy
Which defective gene underlies familial dilated cardiomyopathy?
dystrophin
What is the most common cause of non-traumatic death in adolescents?
Hypertrophic Cardiomyopathy
What is the underlying genetic defect in 50% of individuals with hypertrophic cardiomyopathy?
mutation in β-myosin heavy chain
Amyloidosis, sarcoidosis, and hemochromatosis can all cause which form of cardiomyopathy?
Restrictive Cardiomyopathy
How do parasitic infections result in restrictive cardiomyopathy?
Eosinophilia leads to Endomyocardial fibrosis
Mutations in RyR2 cardiac ryanodine receptors can result in right heart failure do to infiltration of what substance?
Fat
Names the two most common reasons for heart transplants.
Ischemic Heart Disease and Dilated Cardiomyopathy
What histological feature of cardiomyocytes indicates hypertrophy?
"Boxcar" nuclei
Dilated Cardiomyopathy can be caused by?
Alcoholism, myocarditis (Coxsackie B virus, Chagas, HIV), adriamysin therapy, cobalt
What is the most common primary cardiac tumor in adults?
Left atrial myxoma
What is the most common primary cardiac tumor in children?
Rhabdomyoma
What additional condition is suspected when a primary cardiac tumor is found in a child?
Tuberous sclerosis
Secondary cardiac neoplasms are 20X more common than primary cardiac neoplasms.

True or False?
True