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67 Cards in this Set
- Front
- Back
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Congenital Right-to-Left Shunts
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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 |
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Eisenmenger's Syndrome
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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) |
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Tetralogy of Fallot
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Tetralogy of Fallot
**PROVe **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 |
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"boot shaped heart on X-ray"
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Tetralogy of Fallot
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Patient squats to relieve SOB
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Tetralogy of Fallot
-increased TPR to decrease R-->L shunting -more blood flows from RV to lungs |
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D-transposition of the great vessels
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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" |
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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 |
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Patent ductus arteriosus
-fetal period -neonatal period -findings -drugs |
Patent ductus arteriosus
-fetal period **normal, shunting is rt-->left -neonatal period **lung resistance decreases **shunting becomes L-->R **subsequent RVH & failure -findings **continuous, machine-like murmur -drugs **maintains --> PGE, low O2 tension (keep open in conditions like transposition) **closes --> indomethacin **uncorrected will lead to late cyanosis |
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hemosiderin-laden macrophages
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heart failure cells, in the lungs
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MCC Rt heart failure?
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Left heart failure
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Tx of CHF:
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Tx of CHF:
1.) reduce mortality -ACE inhibitors -beta-blockers -ARBs -spironolactone 2.) symptomatic relief -thiazide diuretics -loop diuretics |
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Tricuspid endocarditis?
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IV drug abuse
s. aureus pseudomonas candida |
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Bacterial Endocarditis
-findings -organisms -nonbacterial |
Bacterial endocarditis
Bacteria FROM JANE Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail-bed hemorrhage Emboli Acute endocarditis - s. aureus Subacute - viridans strep (dental procedures; happens to abnl valves - congenital, damaged, etc) -may be 2ndary to: malignancy hypercoaguable state lupus s. epidermidis on prosthetic valves s. bovis in colon cancer |
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round white spots on retina surrounded by hemorrhage
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Roth's spots
bacterial endocarditis |
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tender raised lesion on finger or toe pads
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Osler's nodes
bacterial endocarditis |
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small erythematous lesions on palm/sole
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Janeway lesions
bacterial endocarditis |
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granuloma w/giant cells
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Aschoff bodies
Rheumatic fever/heart dz |
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Anitschkow's cells
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activated histiocytes
rheumatic fever |
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elevated ASO titers
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rheumatic fever
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Rheumatic Fever
-findings -pathophys -sequelae -labs |
Rheumatic Fever
FEVERSS 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 |
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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 |
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hypotension
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 |
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Pulsus paradoxus
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systolic BP decreases by > 10 mmHg with inspiration
severe cardiac tamponade asthma obstructive sleep apnea pericarditis croup |
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"tree bark" appearance of aorta
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syphilitic heart dz
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calcification of aortic root & ascending aortic arch
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syphilitic heart dz
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Syphilitic Heart Dz
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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 |
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"ball-valve" obstruction in LA
multiple syncopal episodes |
myxoma
primary cardiac tumor in adults 90% in atria, mostly left |
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MCC:
-tumor in heart -metastases -primary cardiac tumor of adults -primary cardiac tumor of children |
MCC:
-tumor in heart --> metastasis -metastases --> melanoma, lymphoma -primary cardiac tumor of adults --> myxoma -primary cardiac tumor of children --> rhabdomyoma (assoc w/tuberous sclerosis) |
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increase in JVP on inspiration
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Kussmaul's sign
(assoc w/cardiac tumors?) |
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Varicose veins
caused by --> predispose to --> |
Varicose veins
caused by --> chronically elevated venous pressure predispose to --> poor wound healing, varicose ulcers |
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Raynaud's Dz vs Raynaud's phenomenon
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Raynaud's Dz vs Raynaud's phenomenon
phenomenon when 2ndary to -mixed CT dz -SLE -CREST |
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MC form childhood systemic vasculitis
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Henoch-Schonlein purpura
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port-wine stain on face
intracerebral AVM seizures 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 seizures early onset glaucoma |
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Vinyl chloride
Arsenic ThO2 (thorotrast) |
exposure liniked to Angiosarcoma
highly lethal malignancy of the liver (vascular tumor) |
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HIV associated vascular tumors
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Bacillary angiomatosis
--benign capillary skin papules --caused by Bartonella henselae Kaposi's sarcoma --endothelial malignancy of the skin --associated w/HHV8 & HIV |
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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 hemochromatosis peripartum cardiomyopathy |
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eccentric hypertrophy (sarcomeres added in series)
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Dilated (congestive) cardiomyopathy
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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 |
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sudden death in young athletes
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hypertrophic cardiomyopathy
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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) |
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concentric hypertrophy (sarcomeres added in parallel)
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hypertrophic cardiomyopathy
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Restrictive/obliterative cardiomyopathy
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Restrictive/obliterative cardiomyopathy
diastolic dysfxn sarcoidosis amyloidosis 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) |
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Monckeberg
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calcification in the media of the arteries
radial & ulnar artery usually benign "pipestem" arteries does not obstruct blood flow intima not involved |
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"onion skinning"
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hyperplastic
arteriosclerosis --> malignant hypertension |
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arteriosclerosis
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hyaline thickening of small arteries
essential HTN diabetes mellitus |
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atherosclerosis
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-elastic arteries & large / medium sized muscular arteries
Abominal aorta > coronary artery > popliteal artery > carotid artery |
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what cytokines are involved in atherosclerosis?
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PDGF & TGF-beta
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what is thoracic aneurysm associated with?
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hypertension
cystic medial necrosis (Marfan's syndrome) |
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chest pain radiating to back
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aortic dissection
-longitudinal intraluminal tear -false lumen formed in aorta -assoc w/HTN or cystic medial necrosis (Marfan's syndrome) CXR - mediastinal widening |
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how much mus coronary arteries narrow before angina?
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> 75%
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ST segment depression
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stable angina
(mostly 2ndary to atherosclerosis) |
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Prinzmetal's variant
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Angina
occurs at rest 2ndary to coronary artery spasm ST elevation |
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unstable angina / crescendo
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thrombosis but no necrosis
ST depression |
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Coronary steal syndrome
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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) |
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Sudden cardiac death
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death from cardiac cause within 1 HOUR of sx onset
-most commonly lethal arrythmias |
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Frequency of arteries involved in MI?
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LAD > RCA > circumflex
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When does granulation tissue appear following MI?
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~5-10 days
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When does mm rupture occur following MI?
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~5-10 days
macrophages have degraded important structural components` |
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When do neutrophils begin to emigrate following MI?
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~12-24 hours
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Window of acute inflammation following MI?
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~2-4 days
extensive coagulative necrosis neutrophil emigration |
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7 weeks post-MI biggest risk?
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Ventricular aneurysm
contracted scar has completed |
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Enzyme isoforms used for detecting MI?
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Troponin-I
**elevates w/in 4 hours **remains elevated for 7-10 days CK-MB **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) |
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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 |
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Transmural infarct
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increased necrosis
affects entire wall ST elevation; Qwaves |
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Subendocardial infarcts
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ischemic necrosis of < 50% ventrical wall
subendocardium especiall vulnerable to ischemia ST depression |
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Dressler's syndrome
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autoimmune phenomenon
results in fibrinous pericarditis several weeks post-MI |
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Beriberi
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thiamine deficiency
seen in: -malnutrition -alcoholism dry BeriBeri - polyneuritis, symmetrical mm wasting wet Beriberi - high output cardiac failure (dilated cardiomyopathy); edema |
