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155 Cards in this Set
- Front
- Back
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Disease of large and medium sized vessels characterized by formation of atheromas - lesions that have lipid rich core surrounded by fibrous tissue, deposited in the intima of arteries
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Atherosclerosis
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Leading cause of mortality in US
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Atherosclerosis
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Major risk factors of atherosclerosis
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- HYPERLIPIDEMIA (high blood cholesterol, high triglycerides)
- DIABETES MELLITUS - CIGARETTE SMOKING - HYPERTENSION - OBESITY |
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Minor risk factors for atherosclerosis
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- Lack of physical activity
- Male sex - Increased age - Family history - Oral contraceptives, decreased estrogen or premature menopause - Type A personality - Elevated homocysteine levels |
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Two most common types of dyslipidemias
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IIb and IV
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Describe formation of atheromas
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- Monocytes adhere to vessel walls, enter tissue and become macrophages --> macrophages are transformed into FOAM CELLS after engulfing LDL --> foam cells accumulate in intima --> foam cells release factors causing aggregation of platelts , release of fibroblast growth factors and accumulation of smooth muscle --> after formation of plaque calcification occurs --> central core of plaque consists mainly of cholesterol
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Name complications of atherosclerosis
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- PLAQUE RUPTURE
- Development of fatty streaks - Ischemic heart disease or MI - Stroke - Renal artery ischemia - Death |
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Inhibits oxidation of LDL and its subsequent absorption by macrophages
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Vitamin E
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Works to remove cholesterol from tissues and plaques, therefore exerting a protective effect, increased by exercise
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HDL
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Etiology of dyslipidemia type IIa - how would patient present
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DECREASED LDL RECEPTORS
Greatly increased vascular and heart disease, XANTHOMAS |
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What type of dyslipidemia causes increased vascular and heart disease, occurs in DIABETIC, PREGNANT and ALCOHOLIC patients
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Type IV
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Hypertrophy of left ventricle can be caused by left-sided valvular disease such as _
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Aortic stenosis and mitral regurgitation
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Most common type of hypertension
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Essential
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Risk factors for essential hypertension
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- Family history
- Race (blacks) - Obesity - Cigarette smoking - Physical inactivity |
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What are the criteria for diagnosis of essential hypertension
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Blood pressure greater than 140/90 on THREE SEPARATE OCCASIONS or greater than 170/110 on single visit
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Chronic complications of essential hypertension
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- Hypertrophy of L ventricle
- Onion-skinning of vessel walls - Retinal hemorrhages |
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Elevated systemic arterial pressure associated with condition known to cause hypertension is called _
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Secondary hypertension
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Most common cause of secondary hypertension
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Renal disease
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Essential hypertension predisposes to _
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ISCHEMIC HEART DISEASE
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Name two causes for unilateral renal stenosis leading to secondary hypertension
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ATHEROSCLEROSIS - more common in black males and older individuals
FIBROMUSCULAR DYSPLASIA - more common in white females and young people |
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Name endocrine causes for secondary hypertension
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- Primary aldesteronism
- Pheochromocytoma - Hyperthyroidism - Acromegaly - Cushing syndrome |
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Congenital heart defect leading to secondary hypertension
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Coarctation of aorta
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_ causes a "beads on the string" sign on radiograph, leads to secondary hypertension
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Fibromuscular dysplasia of renal artery
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Type of hypertension where accelearted course results in end-organ damage in days
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Malignant (emergent)hypertension
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Name end organ damages caused by malignant hypertension
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- Cardiovascular- vascular damage, aortic dissection
- Pulmonary - pulmonary edema - Renal - "flea beaten kidneys", azotemia - Ocular - fundal hemorrhages, pappiledema - CNS - encephalopathy, seizures, coma |
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Early death in people with malignant hypertension occurs from _
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CVA
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Criteria for diagnosis of malignant hypertension
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Systolic greater than 220 or diastolic greater than 120
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Treatmen of malignant hypertension
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IV sodium nitroprusside or IV beta-blockers
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_ are the usual victims of malignant hypertension
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YOUNG BLACK MALES
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Inadequate supply of oxygen relative to demand
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Ischemic heart disease
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Ischemic heart disease is most often caused by _
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ATHEROSCLEROSIS
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Paroxysmal attacks of retrosternal pain, heaviness or squezing chest pain occur and may radiate to the neck, jaw, left shoulder or arm, often associated with diaphoresis or nausea
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ANGINA PECTORIS
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Most common form of angina pectoris
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STABLE ANGINA
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This type of angina is induced by exercise, relieved by rest, results from chronic stenosis of coronary arteries
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STABLE ANGINA
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This type of angina characterized by EPISODIC pain which occurs at rest, attacks are UNRELATED TO ACTIVITY, BLOOD PRESSURE OR HEART RATE but are related to coronary artery VASOSPASM, significant artery stenosis is often present
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PRINZMETALS (VARIANT) ANGINA
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This type of angina occurs at rest or with INCREASING FREQUENCY, SEVERITY OR DURATION, preceded by less and less activity, produces pain of longer and longer duration
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UNSTABLE ANGINA
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Unstable angina is induced by _
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RUPTURED ATHEROSCLEROTIC PLAQUE with subsequent thrombosis and embolization, activated platelets help cause thrombosis and vasospasm, microinfarcts can be caused
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These drugs cause relaxation of vascular smooth muscle causeng widespread venous dilation, this lowers preload and therefore reduces the workload and oxygen demand of the heart, to a lesser extent relaxation of coronary arteries provides ischemic myocardium with increased oxygen
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NITRATES
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Treatment of choice for acute episodes of angina
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Sublingual nitroglycerine
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Side effects of nitrate therapy for angina
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HEADACHE and TACHYPHYLAXIS, postural hypotension, and facial flushing
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Long acting nitrate such as _ can be used for angina prophylaxis
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ISOSORBIDE DINITRATE
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Name 3 types of drugs used in treatment of stable angina
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Nitrates
Beta blockers Ca channel blockers |
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Most common artery involved in acute MI
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LEFT ANTERIOR DESCENDING
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Infarcts of LAD involve which parts of the heart?
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Left ventricle near apex or anterior portion of interventricular septum
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Pathognomonic for transmural (q wave) infarcts
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ST elevation
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Is ST depression pathognomonic for non-transmural (non-Q wave) infarcts
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No, can be produced by digitalis drugs
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Lack of adequate perfusion to cardiac tissue that leads to myocyte death in affected area is called _
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MI
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MI is most often caused by _
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ATHEROSCLEROSIS with plaque rupture and thrombus
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Which part of the heart is most vulnerable to ischemia (because of decreased blood flow during systole) and therefore more likely to infarct
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Sub-endocardium
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How long does it take to affect full thickness of ventricular wall in transmural infarct
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3-5 hours
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Diffuse coronary atherosclerosis is found, this causes overall reduction of coronary flow, rupture or thrombosis eventually results, followed quickly by clot lysis, loss of perfusion to inner 1/3 of muscular wall of ventricle - name type of infarct, and what do you see on ECG
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Nontransmural (non Q wave) infarct - ST SEGMENT DEPRESSION ON ECG
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Atherosclerotic plaque ruptures, platelet-mediated thrombosis occludes vessel, occluded vessel stops flow of blood to entire muscular wall - type of infarct and what do you see on ECG
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Transmural infarct - ST SEGMENT ELEVATION
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Complications of MI
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- Arrhythmia
- Heart block - Myocardial rupture occurs most commonly during first week post MI - Papillary muscle rupture - Mural thrombus with possible embolization - Aneurysm - Death |
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Mechanism of death in sudden cardiac death is most often _
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Arrhythmia
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Right sided heart failure secondary to lung disorders that lead to pulmonary arterial hypertension
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Cor pulmonale
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PULMONARY EDEMA - left sided or R sided CHF
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LEFT
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ORTHOPNEA - L or R sided CHF
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Left
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S3 - L or R sided CHF
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Left
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Name causes of Left sided CHF
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Ischemia CAD
Systemic Hypertension L sided valvular disease Myocarditis Cardiomyopathy Congenital heart disease Pericardial disease |
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Name causes of R sided CHF
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L sided CHF
Left sided lesion COR PULMONALE Myocarditis Cardiomyopathy R sided valvular disease |
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NUTMEG LIVER hepatomegaly/ascites - L or R sided CHF
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R sided
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PERIPHERAL EDEMA - L or R sided CHF
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R sided
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DISTENTION OF NECK VEINS - L or R sided CHF
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Right
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Condition where heart is unable to pump an adequate amount of blood to meet metabolic needs of the body
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CHF
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Name final common pathway in CHF
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Hypoperfusion of kidneys and activation of RAA axis which leads to Na and water retention
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Treatment of CHF is aimed at _
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Blocking the RAA axis or increasing cardiac performance and therefore renal perfusion
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Name THERAPEUTIC AGENTS in CHF
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ACE inhibitors
Ang II receptor blockers Digitalis Diuretics Dobutamine |
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First line treatment of CHF
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ACE inhibitors
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Name class of drugs which are able to lower blood pressure (lower afterload)improve cardiac performance and prevent aldosterone mediated salt and water retention typical of CHF
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ACE INHIBITORS
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Name drug that decreases mortality in CHF
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Enalapril
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Name ACE inhibitors used in treatment of CHF
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Enalapril
Captopril Lisinopril |
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Adverse effects of ACE inhibitors
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- Reversible renal failure
- ANGIOEDEMA, DRY COUGH, hyperkalemia, orthostatic hypotension - Fetotoxic and contraindicated in pregnancy |
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These agents block RAA axis at Ang II receptor producing same benefits as ACE inhbitors - give examples
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Angiotensin receptor blockers - LOSARTAN and VALSARTAN
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ARB's have all the same effects as ACE inhibitors except _
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Do not increase levels of bradykinin as do ACE inhibitors
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This drug treats CHF by increasing cardiac performance, increases intracellular Ca in cardiac myocytes therefore increasing contractility, blocks Na-K pump (increases intracellular Na, activity of Na Ca antiporter is dereased, increases intracellular Ca), improves symptoms but DOES NOT reduce mortality
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DIGITALIS
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Which drug used in treatment of CHF has low therapeutic index which means that toxix dose is close to therapeutic dose
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Digitalis
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Common adverse reactions of digitalis
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NAUSEA and headache
ARRHYTHMIAS (more serious) |
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This disease is caused by INFLAMMATION OF CARDIAC MUSCLE
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Myocarditis
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Most common cause of myocarditis
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VIRAL ETIOLOGY - usually COXSACKIE B
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How does HIV cause myocarditis
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Via toxoplasmosis and metastasis of Kaposis sarcoma
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Bacterial causes of myocarditis
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Staph Aureus
Corynebacterium diphtheriae |
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This disease is transmitted by Trypanosoma cruzi and causes myocarditis
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Chagas disease
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This disease is cause by Borrelia Burdorferi and causes myocarditis
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Lyme disease
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Patient presents with MUFFLED S1, AUDIBLE S3, murmur of MITRAL REGURGITATION and cardiomegaly - diagnosis
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Myocarditis
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2 major causes of endocarditis
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Rheumatic heart disease
Infective |
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Name bugs causing culture -negative endocarditis
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HACEK - Haemophilus, Actinobaciluus, Cardiobacterium, Eikenella, Kingella
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Predisposing conditions of infective endocarditis
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Damage
Surgical repair Prosthetic heart valves Congenital abnormalities |
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Most common causes of infective endocarditis
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Bacteria, usually gram positive cocci or fungi (Aspergillus, Candida)
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Name main clinical findings of infective endocarditis
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Petechiae
JANEWAY LESIONS OSLERS LESIONS SPLINTER HEMORRHAGES (subungual linear streaks) Roth's spots Splenomegaly |
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Which valves are often involved in infective endocarditis
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Mitral and aortic
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Presence of RIGHT SIDED valvular lesions (usually tricuspid) + infective endocarditis suggest _
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IV drug abuse
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Peripheral hemorrhages with slight nodular character found in patients with infective endocarditis are called _
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JANEWAY LESIONS
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Small tender nodules on fingers and toe pads in patients with infective endocarditis are called _
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OSLERS NODES
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_ predispose individuals to endocarditis caused by Staphylococcus epidermidis
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Prosthetic valves
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Which tumors of the heart are more common?
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Metastatic (secondary) tumors
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Most frequently occuring primary tumor of the heart
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Atrial myxoma
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This condition causes hypercoagulable state leading to thrombotic disorders and multiple spontaneous abortions
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Antiphospholipid syndrome (common in SLE) results from antibodies to phospholipids
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Most common cause of acute endocarditis
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Staph Aureus
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Patient presents with fever, anemia, embolic events and heart murmur, rapid onset - diagnosis + treatment
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Acute endocarditis
Treatment - IV antibiotics |
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Most common cause of subacute endocarditis
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Strep viridans
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This type of endocarditis results from poor dentition or oral surgery in patients with preexisting heart disease, onset over period of 6 months
Treatment? |
Subacute endocarditis
Treatment - IV antibiotics |
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This type of endocarditis is associated with metastatic cancer, sterile fibrin deposits appear on heart valves, sterile emboli cause cerebral infarcts
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NONBACTERIAL (marantic) endocarditis
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This endocarditis is a manifestation of SLE, caused by auto-antibody damage to valves, vegetations form ON BOTH SIDES OF THE VALVE
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Libman - Sacks endocarditis
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This syndrome is characterized by increased serotonin and other secretory products from carcinoid tumor, plaques bind on RIGHT SIDED VALVES of the heart
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Carcinoid syndrome
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Systemic inflammatory disorder with cardiac manifestations, causes endocarditis
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Rheumatic heart disease
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What is the precipitating event for rheumatic heart disease
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Bout of tonsillitis caused by group A beta hemolytic strep 1-4 weeks before heart involvement
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_ occurs between streptococcal antigens and human antigens in heart
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ANTIGENIC MIMICRY (results in immunologic origin for rheumatic heart disease)
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Cardiac manifestations of rheumatic fever
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Pancarditis - inflammation of all structures of heart
Pericarditis with effusions Myocarditis Endocarditis |
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MOST COMMON CAUSE OF EARLY DEATH in rheumatic fever
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Myocarditis (leads to cardiac failure)
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Endocarditis in rheumatic fever usually affects which valves
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MITRAL and AORTIC
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Name manifestations of rheumatic fever (other then cardiac)
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MIGRATORY POLYARTHRITIS
Sydenhams chorea Subcutaneous nodules Erythema marginatum Recent infection by group A strep ASCHOFF BODIES |
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Granuloma with giant cells seen in rheumatic fever
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ASCHOFF BODIES
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MOST COMMON form of cardiomyopathy
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DILATED
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Premature ventricular contractions, DECREASED EF, JVP, cardiomegaly, hepatomegaly - type of cardiomyopathy
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DILATED
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Name causes of dilated cardiomyopathy
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IDIOPATHIC
COXSACKIEVIRUS B alcoholics thiamine defficiency peripartum Trypanosoma cruzi (Chagas disease) TCA lithium doxorubicin |
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Dilated ventricles - right and left, heart failure, pulmonary edema - type of cardiomyopathy
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Dilated
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STIFFENED HEART MUSCLE, may result in right and left heart failure, tricuspid regurgitation - type of cardiomyopathy
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Restrictive
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Causes of restrictive cardiomyopathy
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Senile or primary amyloidosis
Sarcoidosis Hemochromatosis |
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Peripheral EDEMA, ascites, JVD - type of cardiomyopathy
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Restrictive
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Type of cardiomyopathy that usually occurs in young ATHLETES, usually AUTOSOMAL DOMINANT
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Hypertrophic
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Ventricular and ventricular septal hypertrophy, mitral regurgitation - type of cardiomyopathy
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Hypertrophic
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Dyspnea, syncope, S4 (!), systolic murmur, cardiomegaly on chest radiograph - type of cardiomyopathy
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Hypertrophic
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This type of cardiomyopathy is relieved by SQUATTING, exacerbated by physical exertion, sudden death
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Hypertrophic
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Most frequently occuring valvular lesion, often found in young women or Marfans patients, related to tissue laxity
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Mitral valve prolapse
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Murmur in mitral valve prolapse is exaggerated by _ and reduced by _
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VALSALVA MANEUVER
SQUATTING |
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Patients with this valvular lesion require endocarditis prophylaxis before surgical or dental procedures
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Mitral valve prolapse
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Treatment for idiopathic dilated cardiomyopathy
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Digitalis
ACE inhibitors heart transplant chronic anticoagulation |
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Midsystolic click is often indicative of _
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Mitral prolapse
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Most common cause of mitral stenosis
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RHEUMATIC HEART DISEASE
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Patient presents with dyspnea, orthopnea, left atrial enlargement, mid-to-late diastolic murmur
PE findings - cyanosis, OPENING SNAP, diastolic rumbling murmur Type of valvular heart disease |
Mitral stenosis
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Causes of mitral regurgitation
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RHEUMATIC HEART DISEASE (50%)
Mitral valve prolapse Hypertrophic cardiomyopathy Papillary muscle dysfunction (secondary to MI) |
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Patient presents with arrhythmia, infective endocarditis, dilated left atrium and holosystolic murmur
PE findings - splitting of S2, S3 (!), systolic murmur Type of valvular heart diseae |
Mitral regurgitation
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Which drugs should NOT be administered in patient with aortic stenosis
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Beta blockers
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Patient presents with syncope and angina (dies shortly)
PE - delayed pulses, carotid thrill, CRESCENDO-DECRESCENDO SYSTOLIC EJECTION MURMUR Type of valvular heart disease |
Aortic stenosis
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Cause of aortic stenosis
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Thickening and CALCIFICATION of valve
Bicuspid aortic valves |
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Causes of aortic regurgitation
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Rheumatic heart disease
Syphilitic aortitis Nondissecting aortic aneurysm Marfans syndrome |
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Patient presents with left ventricular enlargement, dyspnea and early diastolic murmur
PE findings - wide pulse pressure, water-hammer pulse, S3, BLOWING, DECRESCENDO DIASTOLIC MURMUR |
Aortic regurgitation
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Name 3 causes of systolic ejection murmurs
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Aortic valve stenosis
Hypertrophic cardiomyopathy Pulmonic valve stenosis |
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Name 3 causes of holosystolic systolic murmur
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Mitral regurgitation
Tricuspid regurgitation Ventricular septal defect |
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Name cause of late-systolic murmur
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Mitral valve prolapse
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Name 2 causes of earlyy diastolic murmurs
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Aortic valve regurgitation
Pulmonic valve regurgitation |
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Name cause for mid-late diastolic murmur
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Mitral stenosis
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Name cause for continuous diastolic murmur
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PDA
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Most common vasculitis in US
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Temporal arteritis
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Patient presents with ASTHMA, ELEVATED PLASMA EOSINOPHILS, heart disease, type of vasculitis associated with p-ANCA
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Churg-Strauss disease
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This disease is often associated with an UPPER RESPIRATORY INFECTIONS IN CHILDREN
Patient presents with hemorrhagic urticaria, palpable purpura, RBC casts in urine, ATOPIC patient Name disease + cause |
Henoch-Schonlein purpura
IgA immune complex mediated acute vasculitis, renal deposits in mesangium |
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Malignant vascular tumor, especially in HOMOSEXUAL males, viral origin, common malignancy in AIDS patients
Name probable cause |
Kaposi sarcoma
Reactivation of latent HHV 8 infection |
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This disease affects YOUNG CHILDREN, causes fever, conjunctival lesions, lymphadenitis, coronary artery aneurysms
Name disease and type of pathology |
Kawasakis disease
Acute necrotizing inflammation |
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MORMON patient presents with epistaxis and GI bleeding
Diagnosis, type of inheritance |
Rendu-Osler-Weber syndrome
AUTOSOMAL DOMINANT |
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Patient presents with fever, weight loss, abdominal pain and hypertension (renal). Medical history significant for HEPATITIS B INFECTION
Diagnosis + pathology |
Polyarteritis nodosa
P- ANCA antibodies lead to necrotizing degeneration of media, aneurysms |
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This disease is prevalent in young ASIAN FEMALES, patient presents with LOSS OF CAROTID, RADIAL and ULNAR PULSES, fever, night sweats, deficits arthritis and visual problems
Diagnosis + which vessel affected |
Takayasus arteritis
AORTIC ARCH |
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ELDERLY MALE presents with HEADACHE, absence of pulse, VISUAL DEFICITS and polymyalgia rheumatica
Blood work - SIGNIFICANT INCREASE IN ESR Diagnosis |
TEMPORAL (GIANT CELL) ARTERITIS
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23 year old JEWISH MALE who SMOKES HEAVILY. He presents with cold, pale limbs, pain, RAYNAUDS PHENOMENON and gangrene of two fingers
Diagnosis |
Thromboangiitis obliterans (Buergers disease)
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This disease is associated with increased incidence of RENAL CELL CARCINOMAS, patient presents with HEMANGIOBLASTOMAS of the cerebellum, brainstem and retina, hepatic, renal and pancreatic cysts, AUTOSOMAL DOMINANT (chromosome 3)
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Von Hippel Lindau disease
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48 year old male presents with cough, ulcers of sinuses and NASAL SEPTUM, RBC casts in urine
Diagnosis + cause |
Wegeners granulomatosis - CANCA causes necrotizing GRANULOMATOUS LESIONS in KIDNEY, LUNG and upper respiratory tract
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