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67 Cards in this Set

  • Front
  • Back
Congenital Right-to-Left Shunts
Congenital Right-to-Left Shunts
(early cyanosis - blue babies)

5 T's
1.) Tetralogy of Fallot (MCC early cyanosis)
2.) Transposition of great vessels
3.) Truncus arteriosus - failure to divide into pulm trunk & aorta
4.) Tricuspid atresia - absence tricuspid valve, hypoplastic RV, requires ASD & VSD to survive
5.) Total anomalous pulmonary venous return - pulm veins drain into rt heart circ
Eisenmenger's Syndrome
R --> L shunting
Uncorrected VSD, ASD, or PDA
-compensatory pulmonary vascular hypertrophy
-progressive pulmonary hypertension
-shunt reversal from L-->R to R-->L (late cyanosis, clubbing, polycythemia)
Tetralogy of Fallot
Tetralogy of Fallot
**anterosuperior displacement of infundibular septum

1.) Pulmonary stenosis (most important prognostic factor)
2.) RV hypertrophy
3.) Overriding aorta (overrides VSD)
4.) VSD

**early cyanosis w/R-->L shunting
**R-->L b/c RV pressure is increased from pulm valve stenosis
"boot shaped heart on X-ray"
Tetralogy of Fallot
Patient squats to relieve SOB
Tetralogy of Fallot
-increased TPR to decrease R-->L shunting
-more blood flows from RV to lungs
D-transposition of the great vessels
D-transposition of the great vessels

failure of aorticopulmonary septum to spiral
separation of systemic & pulmonary circulations
**aorta leaves RV (anterior)
**pulm trunk leaves LV (posterior)
not compatible w/life unless a shunt (PDA, VSD, patent foramen ovale)

without surgical correction most infants die w/in 1st few months

"aorta anterior & to the rt"
Coarcation of the Aorta

-infantile type
-adult type
Coarcation of the Aorta
**can result in aortic regurgitation

-infantile type
**preductal (INfant IN close to the heart; proximal to insertion of ductus arteriosus)
**associated w/Turner's syndrome

-adult type
**postductal (aDult Distal to Ductus)
**distal to ligamentum arteriosum
**associated w/
---notching of ribs (collateral circulation)
---hypertension in UE
-weak pulses in LE

**Adult type most commonly associated w/bicuspid valve
**check femoral pulses on exam
Patent ductus arteriosus

-fetal period
-neonatal period
Patent ductus arteriosus

-fetal period
**normal, shunting is rt-->left

-neonatal period
**lung resistance decreases
**shunting becomes L-->R
**subsequent RVH & failure

**continuous, machine-like murmur

**maintains --> PGE, low O2 tension (keep open in conditions like transposition)
**closes --> indomethacin

**uncorrected will lead to late cyanosis
hemosiderin-laden macrophages
heart failure cells, in the lungs
MCC Rt heart failure?
Left heart failure
Tx of CHF:
Tx of CHF:

1.) reduce mortality
-ACE inhibitors

2.) symptomatic relief
-thiazide diuretics
-loop diuretics
Tricuspid endocarditis?
IV drug abuse

s. aureus
Bacterial Endocarditis

Bacterial endocarditis

Bacteria FROM JANE
Roth's spots
Osler's nodes
Janeway lesions
Nail-bed hemorrhage

Acute endocarditis - s. aureus
Subacute - viridans strep (dental procedures; happens to abnl valves - congenital, damaged, etc)

-may be 2ndary to:
hypercoaguable state
s. epidermidis on prosthetic valves
s. bovis in colon cancer
round white spots on retina surrounded by hemorrhage
Roth's spots
bacterial endocarditis
tender raised lesion on finger or toe pads
Osler's nodes
bacterial endocarditis
small erythematous lesions on palm/sole
Janeway lesions
bacterial endocarditis
granuloma w/giant cells
Aschoff bodies
Rheumatic fever/heart dz
Anitschkow's cells
activated histiocytes
rheumatic fever
elevated ASO titers
rheumatic fever
Rheumatic Fever

Rheumatic Fever

Erythema marginatum
Valvular damage (vegetation & fibrosis)
ESR elevated
Red-hot joints (migratory polyarthritis)
Subcutaneous nodules
St. Vitus dance (chorea)

type II hypersensitivity
antibodies to M protein (not direct effect of bacteria)

Early death --> myocarditis
Late sequelae - rheumatic heart dz, valvular lesions
**lesions affect valves closing against high pressure
( mitral > aortic >> tricuspid )

Aschoff bodies (granuloma w/giant cells)
Anitschkow's cells (activated histiocytes)
elevated ASO
sharp pain
worse w/inspiration
better sitting up & leaning forward
Acute pericarditis

1.) Fibrinous - most common; Dressler's syndrome, uremia, radiation; friction rub
2.) Serous - noninfectious inflammatory dz (rheumatic arthritis, SLE)
3.) Suppurative/Purulent - infectious agents
increased JVD
distant heart sounds
increased HR
Cardiac Tamponade
(pulsus paradoxus)

compression of heart by fluid in pericardium (blood, effusions) --> decreased CO
equilibration of diastolic pressure in all 4 chambers
Pulsus paradoxus
systolic BP decreases by > 10 mmHg with inspiration

severe cardiac tamponade
obstructive sleep apnea
"tree bark" appearance of aorta
syphilitic heart dz
calcification of aortic root & ascending aortic arch
syphilitic heart dz
Syphilitic Heart Dz
Syphilitic Heart Dz

tertiary syphilus
disrupts vasa vasorum of aorta
--> dilation of aorta & valve ring

can result in aneurysm of ascending aorta or aortic arch
aortic valve incompetence

calcification of aortic root & ascending aortic arch
"tree bark" appearance of aorta
"ball-valve" obstruction in LA
multiple syncopal episodes

primary cardiac tumor in adults
90% in atria, mostly left

-tumor in heart
-primary cardiac tumor of adults
-primary cardiac tumor of children

-tumor in heart --> metastasis
-metastases --> melanoma, lymphoma
-primary cardiac tumor of adults --> myxoma
-primary cardiac tumor of children --> rhabdomyoma (assoc w/tuberous sclerosis)
increase in JVP on inspiration
Kussmaul's sign

(assoc w/cardiac tumors?)
Varicose veins

caused by -->
predispose to -->
Varicose veins

caused by --> chronically elevated venous pressure
predispose to --> poor wound healing, varicose ulcers
Raynaud's Dz vs Raynaud's phenomenon
Raynaud's Dz vs Raynaud's phenomenon

phenomenon when 2ndary to
-mixed CT dz
MC form childhood systemic vasculitis
Henoch-Schonlein purpura
port-wine stain on face
intracerebral AVM
early onset glaucoma
Sturge-Weber Dz

congenital vascular disorder
affects capillary sized vessels

nevus flammeus - port-wine stain on face
ipsilateral leptomeningeal angiomatosis - intracerebral AVM
early onset glaucoma
Vinyl chloride
ThO2 (thorotrast)
exposure liniked to Angiosarcoma

highly lethal malignancy of the liver
(vascular tumor)
HIV associated vascular tumors
Bacillary angiomatosis
--benign capillary skin papules
--caused by Bartonella henselae

Kaposi's sarcoma
--endothelial malignancy of the skin
--associated w/HHV8 & HIV
S3 murmur
dilated heart on ultrasound
balloon appearance on CXR
Dilated (congestive) cardiomyopathy

most common (90%) of cardiomyopathies

systolic dysfunction ensues
eccentric hypertrophy (sarcomeres added in serries)

Etiologies: ABCCCD
Alcohol abuse
wet Beriberi
Coxsackie B virus myocarditis
chronic Cocaine abuse
Chaga's Dz
Doxorubicin toxicity
peripartum cardiomyopathy
eccentric hypertrophy (sarcomeres added in series)
Dilated (congestive) cardiomyopathy
Type of Dysfxn with:

Dilated (congestive) cardiomyopathy -->
Hypertrophic cardiomyopathy -->
Restrictive/obliterative cardiomyopathy -->
Type of Dysfxn with:

Dilated (congestive) cardiomyopathy --> systolic dysfxn
Hypertrophic cardiomyopathy --> diastolic dysfxn
Restrictive/obliterative cardiomyopathy --> diastolic dysfxn
sudden death in young athletes
hypertrophic cardiomyopathy
S4 sound
apical impulse
systolic murmur
nl-sized heart
Hypertrophic cardiomyopathy

-causes diastolic dysfxn

-hypertrophied interventricular septum "too close" to mitral valve --> outflow obstruction
-syncopal episodes
-50% cases familial
-associated w/friedreich's ataxia

disoriented, tangled, hypertrophied myocardial fibers

sudden death in young athletes

concentric hypertrophy (sarcomeres added in parallel)

Tx: beta blocker, or non-dihydropyridine calcium channel blocker (verapamil)
concentric hypertrophy (sarcomeres added in parallel)
hypertrophic cardiomyopathy
Restrictive/obliterative cardiomyopathy
Restrictive/obliterative cardiomyopathy

diastolic dysfxn

post-radiation fibrosis
endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children)
Loffler's syndrome (endomyocardial fibrosis w/prominent eosinophilic infiltrate)
Hemochromatosis (dilated cardiomyopathy can also occur)
calcification in the media of the arteries
radial & ulnar artery
usually benign "pipestem" arteries
does not obstruct blood flow
intima not involved
"onion skinning"
arteriosclerosis --> malignant hypertension
hyaline thickening of small arteries
essential HTN
diabetes mellitus
-elastic arteries & large / medium sized muscular arteries

Abominal aorta > coronary artery > popliteal artery > carotid artery
what cytokines are involved in atherosclerosis?
PDGF & TGF-beta
what is thoracic aneurysm associated with?
cystic medial necrosis (Marfan's syndrome)
chest pain radiating to back
aortic dissection

-longitudinal intraluminal tear
-false lumen formed in aorta

-assoc w/HTN or cystic medial necrosis (Marfan's syndrome)

CXR - mediastinal widening
how much mus coronary arteries narrow before angina?
> 75%
ST segment depression
stable angina
(mostly 2ndary to atherosclerosis)
Prinzmetal's variant
occurs at rest
2ndary to coronary artery spasm
ST elevation
unstable angina / crescendo
thrombosis but no necrosis
ST depression
Coronary steal syndrome
vasodilator aggravates ischemia by shunting blood from area of stenosis to area of higher perfusion

(ischemic area arteries are already maximally dilated; nitroglycerin works by venodilating, reducing preload & thus work on the heart)
Sudden cardiac death
death from cardiac cause within 1 HOUR of sx onset
-most commonly lethal arrythmias
Frequency of arteries involved in MI?
LAD > RCA > circumflex
When does granulation tissue appear following MI?
~5-10 days
When does mm rupture occur following MI?
~5-10 days

macrophages have degraded important structural components`
When do neutrophils begin to emigrate following MI?
~12-24 hours
Window of acute inflammation following MI?
~2-4 days

extensive coagulative necrosis
neutrophil emigration
7 weeks post-MI biggest risk?
Ventricular aneurysm
contracted scar has completed
Enzyme isoforms used for detecting MI?
**elevates w/in 4 hours
**remains elevated for 7-10 days

**predominantly in myocardium, but also in skeletal mm
**useful for dx reinfarction on top of acute MI (peaks 1 day; drops w/in 2-3 days)
What kind of infarct is indicated by?

-ST depression
-ST elevation
-pathologic Q waves
What kind of infarct is indicated by?

-ST depression --> subendocardial infarct
-ST elevation --> transmural infarct
-pathologic Q waves --> transmural infarct
Transmural infarct
increased necrosis
affects entire wall
ST elevation; Qwaves
Subendocardial infarcts
ischemic necrosis of < 50% ventrical wall
subendocardium especiall vulnerable to ischemia
ST depression
Dressler's syndrome
autoimmune phenomenon
results in fibrinous pericarditis
several weeks post-MI
thiamine deficiency

seen in:

dry BeriBeri - polyneuritis, symmetrical mm wasting
wet Beriberi - high output cardiac failure (dilated cardiomyopathy); edema