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101 Cards in this Set
- Front
- Back
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Can small vessels get atherosclerosis?
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No, they get arteriolosclerosis
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What term do we use when we see a lot of pink stuff on a slide?
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hyaline because it is pink
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How do you measure long term blood glucose levels for people with DM?
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The degree of nonenzymatic glycosylation on hemoglobin A. HA1C
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For how long does glycosylated hemogllobin A keep track of blood sugar spikes?
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6-8 weeks
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What is a good HA1C level for DM?
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below 6%
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What are the main dangers of DM that precipitate pathologies?
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blood sugar and osmotic pressure
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If you regulate blood sugar, what is the danger of DM?
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None!
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How do you get osmotic pressure complications from DM?
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Dehydration from osmotic diuresis AND cells with aldose reductase turning glucose into sorbitol which will attract water in and burst it
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Which tissues have aldose reductase and what pathology does high glucose result in there?
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pericytes in retina - microhemorrhages in retina
schwann cells in the long neurons - peripheral neuropathy |
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What does glycation do to BM's?
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it renders them permeable to protein
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What pathology results from glycation of glomerular BM vs arteriole BM?
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microalbuminemia and hyaline arteriolosclerosis
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how common is hyperplastic arterioloscerosis?
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not very common at all
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What races is hyperplastic arterioloscerosis more common in? Why?
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blacks and whites because they have more HTN and so are more likely to have malignant HTN
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What is the basic mechanism behind aneurysms?
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Weakening of the wall and outpouching
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What is the analogous disease in the lungs to an aneurysm?
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bronchiectasis
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WHat is the usual cause of bronchiectasis?
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repeated infections in cystic fibrosis patients
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What is the analogous disease in the gut to an aneurysm?
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diverticular disease
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Why is the abdominal aorta and not the proximal aorta more prone to atherosclerosis? Why don't dogs get abdominal aortic aneurysms?
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There is no vaso vasorum below the renal arteries to provide alternate path of nutrient delivery
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What is the triad of rupture abdominal aortic aneurysm that will be given besides the explicit name?
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1. hypotension
2. pulsatile mass 3. left flank pain |
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Why is it left flank pain?
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Because blood from the aorta on the left will leak out into the retroperitoneal space.
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WHat microbe is in syphillus?
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Treponema pallidum
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What does it like to infect and what results in that area?
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it likes to infect small vessels and this attracts a bunch of lymphocytes there which may occlude it.
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What is it called when the infection ends up occluding the vessel? Why?
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Endarteritus obliterans because it is obliterating the artery
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Why don't you usually have pain in syphillus?
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because the infection will also affect the nerves that are next to the vaso vasorum and knock them out.
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How common is syphillus now vs in the past?
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It used to be pretty common, then it died down, and now it is coming back again
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What murmur will you get with syphillitic aortic aneurysm?
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aortic regurgitation
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WHat are the two ways in which you get aortic regurgitation then?
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either the valve ring gets stretched out or the valve itself gets damaged
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WHat volume changes will happen in the heart with aortic regurgitation?
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You will have an increased end diastolic volume
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Id you have greater EDV without ventricular muscle damage, what kind of pulse will you get and why?
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Warhammer pulse because the frank starling mechanism
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What will this high cardiac output do to your head?
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Give you really high BP and maybe a headache there.
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What is a neurological complication of syphillitic aortic aneurysm?
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compression of the left recurrent laryngeal nerve that wraps in front and below- HOARSENESS
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What is the worst complication of syphillitic aortic aneurysm?
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rupture/dissection
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What is the symptom of dissection proximal aortic aneurysm?
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tearing pain going from the chest going into the back
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What kind of sign can you find for an aortic dissection in radial pulses?
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A difference in pulse strength from one side (usually left) being compressed (still not entirely sure how)
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What sign would you see in a CXR for a proximal aortic dissection? How sensitive is this?
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widening of the aortic knob which is 85% sensitive
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What is the classic disease that predisposes you to aortic dissections?
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marfan's syndrome
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What body measurements a person tell if they have marfan's?
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pelvic brim to toes is longer than pelic brim to the head
or arm span is greater than the height |
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What is the chromosome number and protein affected in marfan's?
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chromosome 15 and fibrillin protein
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What protein is defective in elher's danlos?
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collagen
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Is aortic dissection the most common cause of death in both these CT disorders?
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Close, sudden cardiac death is more common for marfan's
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What hear defect does everyone with marfan's have? What heart defect is also pretty common?
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Mitral valve prolapse with the occasional tricuspid valve prolapse
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Why is the cut off point for anemia for pregnant women cut down to 11.5?
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Because they essentially double their plasma volume without increasing their RBC's much.
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Are pregnant women at risk for aortic aneurysm? Why?
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Yes because they are prone to HTN from all that volume increase
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What is the likely dx for a smoker with primary lung cancer, headache, and retinal vein engorgement?
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superior vena cava syndrome
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What is the usual tx for someone with cancer ad SVC syndrome and what is the prognosis?
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The prognosis is pretty bad (likely death), but they try to shrink down the tumor cutting off the SVC using radiation.
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Why gets spider angiomas?
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pregnant women and cirrhosis pts
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Why would people with cirrhosis get something pregnant women get?
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They don't have the liver function to metabolize estrogen which causes it.
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Name this disease, who gets it, and what you would to to treat it. Why?
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Capillary haemangioma for infants. You leave it alone because it will go away by the time they are 8.
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What are the three types vessels that vasculitises affect and why is this important?
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They all have different symptoms!
1. small vessels like arteriole, capillaries, and venules 2. elastic arteries 3. muscular arteries |
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What is the cause of 99% of all small vessel vasculitis?
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type III hypersensitivity
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What process happens in the type III hypersensitivity?
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immune complexes deposit in the vessel wall, activate complement, which releases c5a, neutrophils are attracted and start killing tissue
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What sign come about as a result of this type III reaction in small vessels?
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palpable purpura from fibrinoid necrosis of the vessel
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How can you tell iff the small hemorrhages under the skin are from a coagulation or a vasculitis problem?
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coagulation hemorrhages are not palpable
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WHat is the main problem that results from vasculitis of the medium sized vessels?
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infarction
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What is the most common cause of MI in kids
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Kawasaki disease, which is an autoimmiune disease causing medium vessel vasculitis.
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WHat is the main problem that results from vasculitis of the large elastic sized vessels?
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loss of pulse or stroke
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What is causing more work when you see concentric hypertrophy?
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increased afterload (HTN/aortic stenosis)
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What is causing more work when you see dilatation and hypertrophy?
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A preload problem (CHF causing more wall stress)
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What happens in valve splitting during insppiration?
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The Tricuspid and Pulmonary valve close later and splitting is increased
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What causes S3 heart sound? Mnemonic?
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A volume overloaded chamber causing turbulence when new blood rushes in.
Threefill! |
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What causes S4 heart sound?
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A lack of compliance in ventricles when the atria are squeezing in.
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What are the two causes of an S4 heart sound that lead to decreased compliance upon late diastole?
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1. Ventricle is very thick and hypertrophied and can't contain much
2. Ventricle is already stretched very tight because of volume overload |
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What would your heart look like if you have HTN?
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Thick walled and not dilated
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What abnormal heart sounds would you hear with HTN?
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S4
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What abnormal heart sounds would you hear with CHF?
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S3 and S4
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How can you tell if an extra heart sound is coming from the left or the right?
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Right if it increaes on inspiration
Left if it increases on expiration |
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Why would a right heart sound increase on inspiration?
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You are pulling more blood into the compliant right, which emphasizes the sounds.
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Why would a left heart sound increase on expiration?
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You are helping the left heart to push stuff out.
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What is the difference in stenosis and regurgitation?
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stenosis is problem in opening whereas regurgitation is a problem in closing
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What does a aortic stenosis sound like? Why?
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A cresendo/decresendo diamond shaped ejection murmur because blood is being forced through and then more trickles.
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Where would you hear an aortic stenosis and when would it be loudest? What extra heart sounds would there be?
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Right 2nd intercostal space loudest on expiration with a S4 heart sound due to LV hypertrophy w/o dilatation.
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Where would you hear the mitral valve?
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at the apex (5 intercostal, midclavicular)
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What would a mitral stenosis sound like (2 parts)? Why?
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You would hear a click as it opened in mid diastole, followed by a rumbling as blood rushes left over from last time comes gushing in.
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What happens anatomically to the left atrium in mitral stenosis?
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It gets both dilated and hypertrophied
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What does the dilation and hypertrophy predispose the left atria to?
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conduction distorders like a fib
stasis of blood and thrombus |
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How is the blood volume in the left ventricle in mitral stenosis?
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it is being underfilled so no hypertrophy
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What happens to the volume in chambers in mitral reguritation?
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more blood in left atria, which becomes more blood in the ventricle, and a lower CO.
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What is this: pansystolic murmur heard at the apex?
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mitral regurgitation because the AV valves leak during systole
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What extra heart sounds would you hear in mitral regurgitation? Why?
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S3 and S4 because the LV is overloaded from extra blood in atria (s3 and s4) and this causes it to hypertrophy (s4)
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Is there is an IV drug user with fever and a heart murmur, what is the most likely dx? Why?
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tricuspid valve infective endocarditis. This is the first valve that receives blood from the veins
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What kind of heart sounds would you hear on this person and where? When does it become louder?
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You would hear a pansystolic murmur at the right parasternal border at the 55ht intercostal space. Louder on inspiration.
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What two valves are the most likely targets for infective endocarditis coming from the lungs? Why?
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the mitral and the aortic because they are right after the lungs.
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What creates the austin flint murmur?
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In aortic regurgitation, blood is rushing back from the aorta and hits the anterior leaflet of the mitral valve as it is opening.
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When would you hear the austin fint murmur?
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Right as the mitral valve is opening so later on in the sound of the decresendo aortic regurgitation sound.
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What should you do when you hear an austin flint murmur? Why?
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call a cardiothoracic surgeon because that means that regirgiation is really bad.
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What are heart failure cells?
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They are macrophages in the lungs filled with hemosiderin because they have been eating all the blood backed into them by the failing LV.
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They say that left heart failure is a dx of ____ and Right heart failure is a dx of ____.
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left- symptoms
right- signs |
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give some examples of left heart failure symptoms
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SOB, weakness
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give some examples of right heart failure signs
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JVD, nutmeg liver, hepatomegaly, pitting edema
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Why is it pitting edema?
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because your lymph is still working to remove fluid AND proteins so there are no hypertonic forces pulling it back.
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What is the most common cause of congested liver?
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right heart failure.
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What happens in nocturnal paroxysmal dyspnea?
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You get short of breath while lying down at night.
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Is the left heart or right heart failing in nocturnal paroxysmal dyspnea? Why?
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the left because it will back up blood to the lungs producing the dyspnea
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Why does putting pillows under our head help with nocturnal paroxysmal dyspnea?
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you are decreasing the venous return that usually increases hen lying down. The left heart isn't as overwhelmed and won't back up.
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What;s the best nonpharmalogical tx for heart failure?
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restrict wter and salt
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What is the best drug for treating heart failure? Why?
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ACE inhibitors because they will decrease blood volume and TPR.
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What is a good drug to give in combination with ACE inhibitors? Why?
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spironolactone because eventually these pts will start producing aldosterone without ang II. They also saw it work great in trials to increase longevity.
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What determines whether a compartment will dilate or hypertrophy?
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if there is increased preload or afterload
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Why is there dilation in the atria in mitral stenosis, but not in the ventricle in aortic stenosis?
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atria are less powerful than ventricles and end up with more end systolic volume, leading to increased preload and dilation.
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What is hypertrophied in aortic stenosis?
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the left ventricle AND the left atrium
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Why is the left atrium hypertrophied?
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Because there is much less space in the ventricles, they have a harder time pushing blood through.
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