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155 Cards in this Set

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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
Atherosclerosis
Leading cause of mortality in US
Atherosclerosis
Major risk factors of atherosclerosis
- HYPERLIPIDEMIA (high blood cholesterol, high triglycerides)
- DIABETES MELLITUS
- CIGARETTE SMOKING
- HYPERTENSION
- OBESITY
Minor risk factors for atherosclerosis
- Lack of physical activity
- Male sex
- Increased age
- Family history
- Oral contraceptives, decreased estrogen or premature menopause
- Type A personality
- Elevated homocysteine levels
Two most common types of dyslipidemias
IIb and IV
Describe formation of atheromas
- 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
Name complications of atherosclerosis
- PLAQUE RUPTURE
- Development of fatty streaks
- Ischemic heart disease or MI
- Stroke
- Renal artery ischemia
- Death
Inhibits oxidation of LDL and its subsequent absorption by macrophages
Vitamin E
Works to remove cholesterol from tissues and plaques, therefore exerting a protective effect, increased by exercise
HDL
Etiology of dyslipidemia type IIa - how would patient present
DECREASED LDL RECEPTORS

Greatly increased vascular and heart disease, XANTHOMAS
What type of dyslipidemia causes increased vascular and heart disease, occurs in DIABETIC, PREGNANT and ALCOHOLIC patients
Type IV
Hypertrophy of left ventricle can be caused by left-sided valvular disease such as _
Aortic stenosis and mitral regurgitation
Most common type of hypertension
Essential
Risk factors for essential hypertension
- Family history
- Race (blacks)
- Obesity
- Cigarette smoking
- Physical inactivity
What are the criteria for diagnosis of essential hypertension
Blood pressure greater than 140/90 on THREE SEPARATE OCCASIONS or greater than 170/110 on single visit
Chronic complications of essential hypertension
- Hypertrophy of L ventricle

- Onion-skinning of vessel walls

- Retinal hemorrhages
Elevated systemic arterial pressure associated with condition known to cause hypertension is called _
Secondary hypertension
Most common cause of secondary hypertension
Renal disease
Essential hypertension predisposes to _
ISCHEMIC HEART DISEASE
Name two causes for unilateral renal stenosis leading to secondary hypertension
ATHEROSCLEROSIS - more common in black males and older individuals

FIBROMUSCULAR DYSPLASIA - more common in white females and young people
Name endocrine causes for secondary hypertension
- Primary aldesteronism

- Pheochromocytoma

- Hyperthyroidism

- Acromegaly

- Cushing syndrome
Congenital heart defect leading to secondary hypertension
Coarctation of aorta
_ causes a "beads on the string" sign on radiograph, leads to secondary hypertension
Fibromuscular dysplasia of renal artery
Type of hypertension where accelearted course results in end-organ damage in days
Malignant (emergent)hypertension
Name end organ damages caused by malignant hypertension
- Cardiovascular- vascular damage, aortic dissection
- Pulmonary - pulmonary edema
- Renal - "flea beaten kidneys", azotemia
- Ocular - fundal hemorrhages, pappiledema
- CNS - encephalopathy, seizures, coma
Early death in people with malignant hypertension occurs from _
CVA
Criteria for diagnosis of malignant hypertension
Systolic greater than 220 or diastolic greater than 120
Treatmen of malignant hypertension
IV sodium nitroprusside or IV beta-blockers
_ are the usual victims of malignant hypertension
YOUNG BLACK MALES
Inadequate supply of oxygen relative to demand
Ischemic heart disease
Ischemic heart disease is most often caused by _
ATHEROSCLEROSIS
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
ANGINA PECTORIS
Most common form of angina pectoris
STABLE ANGINA
This type of angina is induced by exercise, relieved by rest, results from chronic stenosis of coronary arteries
STABLE ANGINA
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
PRINZMETALS (VARIANT) ANGINA
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
UNSTABLE ANGINA
Unstable angina is induced by _
RUPTURED ATHEROSCLEROTIC PLAQUE with subsequent thrombosis and embolization, activated platelets help cause thrombosis and vasospasm, microinfarcts can be caused
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
NITRATES
Treatment of choice for acute episodes of angina
Sublingual nitroglycerine
Side effects of nitrate therapy for angina
HEADACHE and TACHYPHYLAXIS, postural hypotension, and facial flushing
Long acting nitrate such as _ can be used for angina prophylaxis
ISOSORBIDE DINITRATE
Name 3 types of drugs used in treatment of stable angina
Nitrates
Beta blockers
Ca channel blockers
Most common artery involved in acute MI
LEFT ANTERIOR DESCENDING
Infarcts of LAD involve which parts of the heart?
Left ventricle near apex or anterior portion of interventricular septum
Pathognomonic for transmural (q wave) infarcts
ST elevation
Is ST depression pathognomonic for non-transmural (non-Q wave) infarcts
No, can be produced by digitalis drugs
Lack of adequate perfusion to cardiac tissue that leads to myocyte death in affected area is called _
MI
MI is most often caused by _
ATHEROSCLEROSIS with plaque rupture and thrombus
Which part of the heart is most vulnerable to ischemia (because of decreased blood flow during systole) and therefore more likely to infarct
Sub-endocardium
How long does it take to affect full thickness of ventricular wall in transmural infarct
3-5 hours
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
Nontransmural (non Q wave) infarct - ST SEGMENT DEPRESSION ON ECG
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
Transmural infarct - ST SEGMENT ELEVATION
Complications of MI
- Arrhythmia
- Heart block
- Myocardial rupture occurs most commonly during first week post MI
- Papillary muscle rupture
- Mural thrombus with possible embolization
- Aneurysm
- Death
Mechanism of death in sudden cardiac death is most often _
Arrhythmia
Right sided heart failure secondary to lung disorders that lead to pulmonary arterial hypertension
Cor pulmonale
PULMONARY EDEMA - left sided or R sided CHF
LEFT
ORTHOPNEA - L or R sided CHF
Left
S3 - L or R sided CHF
Left
Name causes of Left sided CHF
Ischemia CAD
Systemic
Hypertension
L sided valvular disease
Myocarditis
Cardiomyopathy
Congenital heart disease
Pericardial disease
Name causes of R sided CHF
L sided CHF
Left sided lesion
COR PULMONALE
Myocarditis
Cardiomyopathy
R sided valvular disease
NUTMEG LIVER hepatomegaly/ascites - L or R sided CHF
R sided
PERIPHERAL EDEMA - L or R sided CHF
R sided
DISTENTION OF NECK VEINS - L or R sided CHF
Right
Condition where heart is unable to pump an adequate amount of blood to meet metabolic needs of the body
CHF
Name final common pathway in CHF
Hypoperfusion of kidneys and activation of RAA axis which leads to Na and water retention
Treatment of CHF is aimed at _
Blocking the RAA axis or increasing cardiac performance and therefore renal perfusion
Name THERAPEUTIC AGENTS in CHF
ACE inhibitors
Ang II receptor blockers
Digitalis
Diuretics
Dobutamine
First line treatment of CHF
ACE inhibitors
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
ACE INHIBITORS
Name drug that decreases mortality in CHF
Enalapril
Name ACE inhibitors used in treatment of CHF
Enalapril
Captopril
Lisinopril
Adverse effects of ACE inhibitors
- Reversible renal failure
- ANGIOEDEMA, DRY COUGH, hyperkalemia, orthostatic hypotension
- Fetotoxic and contraindicated in pregnancy
These agents block RAA axis at Ang II receptor producing same benefits as ACE inhbitors - give examples
Angiotensin receptor blockers - LOSARTAN and VALSARTAN
ARB's have all the same effects as ACE inhibitors except _
Do not increase levels of bradykinin as do ACE inhibitors
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
DIGITALIS
Which drug used in treatment of CHF has low therapeutic index which means that toxix dose is close to therapeutic dose
Digitalis
Common adverse reactions of digitalis
NAUSEA and headache

ARRHYTHMIAS (more serious)
This disease is caused by INFLAMMATION OF CARDIAC MUSCLE
Myocarditis
Most common cause of myocarditis
VIRAL ETIOLOGY - usually COXSACKIE B
How does HIV cause myocarditis
Via toxoplasmosis and metastasis of Kaposis sarcoma
Bacterial causes of myocarditis
Staph Aureus

Corynebacterium diphtheriae
This disease is transmitted by Trypanosoma cruzi and causes myocarditis
Chagas disease
This disease is cause by Borrelia Burdorferi and causes myocarditis
Lyme disease
Patient presents with MUFFLED S1, AUDIBLE S3, murmur of MITRAL REGURGITATION and cardiomegaly - diagnosis
Myocarditis
2 major causes of endocarditis
Rheumatic heart disease

Infective
Name bugs causing culture -negative endocarditis
HACEK - Haemophilus, Actinobaciluus, Cardiobacterium, Eikenella, Kingella
Predisposing conditions of infective endocarditis
Damage
Surgical repair
Prosthetic heart valves
Congenital abnormalities
Most common causes of infective endocarditis
Bacteria, usually gram positive cocci or fungi (Aspergillus, Candida)
Name main clinical findings of infective endocarditis
Petechiae
JANEWAY LESIONS
OSLERS LESIONS
SPLINTER HEMORRHAGES (subungual linear streaks)
Roth's spots
Splenomegaly
Which valves are often involved in infective endocarditis
Mitral and aortic
Presence of RIGHT SIDED valvular lesions (usually tricuspid) + infective endocarditis suggest _
IV drug abuse
Peripheral hemorrhages with slight nodular character found in patients with infective endocarditis are called _
JANEWAY LESIONS
Small tender nodules on fingers and toe pads in patients with infective endocarditis are called _
OSLERS NODES
_ predispose individuals to endocarditis caused by Staphylococcus epidermidis
Prosthetic valves
Which tumors of the heart are more common?
Metastatic (secondary) tumors
Most frequently occuring primary tumor of the heart
Atrial myxoma
This condition causes hypercoagulable state leading to thrombotic disorders and multiple spontaneous abortions
Antiphospholipid syndrome (common in SLE) results from antibodies to phospholipids
Most common cause of acute endocarditis
Staph Aureus
Patient presents with fever, anemia, embolic events and heart murmur, rapid onset - diagnosis + treatment
Acute endocarditis

Treatment - IV antibiotics
Most common cause of subacute endocarditis
Strep viridans
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
This type of endocarditis is associated with metastatic cancer, sterile fibrin deposits appear on heart valves, sterile emboli cause cerebral infarcts
NONBACTERIAL (marantic) endocarditis
This endocarditis is a manifestation of SLE, caused by auto-antibody damage to valves, vegetations form ON BOTH SIDES OF THE VALVE
Libman - Sacks endocarditis
This syndrome is characterized by increased serotonin and other secretory products from carcinoid tumor, plaques bind on RIGHT SIDED VALVES of the heart
Carcinoid syndrome
Systemic inflammatory disorder with cardiac manifestations, causes endocarditis
Rheumatic heart disease
What is the precipitating event for rheumatic heart disease
Bout of tonsillitis caused by group A beta hemolytic strep 1-4 weeks before heart involvement
_ occurs between streptococcal antigens and human antigens in heart
ANTIGENIC MIMICRY (results in immunologic origin for rheumatic heart disease)
Cardiac manifestations of rheumatic fever
Pancarditis - inflammation of all structures of heart

Pericarditis with effusions

Myocarditis

Endocarditis
MOST COMMON CAUSE OF EARLY DEATH in rheumatic fever
Myocarditis (leads to cardiac failure)
Endocarditis in rheumatic fever usually affects which valves
MITRAL and AORTIC
Name manifestations of rheumatic fever (other then cardiac)
MIGRATORY POLYARTHRITIS
Sydenhams chorea
Subcutaneous nodules
Erythema marginatum
Recent infection by group A strep
ASCHOFF BODIES
Granuloma with giant cells seen in rheumatic fever
ASCHOFF BODIES
MOST COMMON form of cardiomyopathy
DILATED
Premature ventricular contractions, DECREASED EF, JVP, cardiomegaly, hepatomegaly - type of cardiomyopathy
DILATED
Name causes of dilated cardiomyopathy
IDIOPATHIC
COXSACKIEVIRUS B
alcoholics
thiamine defficiency
peripartum
Trypanosoma cruzi (Chagas disease)
TCA
lithium
doxorubicin
Dilated ventricles - right and left, heart failure, pulmonary edema - type of cardiomyopathy
Dilated
STIFFENED HEART MUSCLE, may result in right and left heart failure, tricuspid regurgitation - type of cardiomyopathy
Restrictive
Causes of restrictive cardiomyopathy
Senile or primary amyloidosis
Sarcoidosis
Hemochromatosis
Peripheral EDEMA, ascites, JVD - type of cardiomyopathy
Restrictive
Type of cardiomyopathy that usually occurs in young ATHLETES, usually AUTOSOMAL DOMINANT
Hypertrophic
Ventricular and ventricular septal hypertrophy, mitral regurgitation - type of cardiomyopathy
Hypertrophic
Dyspnea, syncope, S4 (!), systolic murmur, cardiomegaly on chest radiograph - type of cardiomyopathy
Hypertrophic
This type of cardiomyopathy is relieved by SQUATTING, exacerbated by physical exertion, sudden death
Hypertrophic
Most frequently occuring valvular lesion, often found in young women or Marfans patients, related to tissue laxity
Mitral valve prolapse
Murmur in mitral valve prolapse is exaggerated by _ and reduced by _
VALSALVA MANEUVER

SQUATTING
Patients with this valvular lesion require endocarditis prophylaxis before surgical or dental procedures
Mitral valve prolapse
Treatment for idiopathic dilated cardiomyopathy
Digitalis
ACE inhibitors
heart transplant
chronic anticoagulation
Midsystolic click is often indicative of _
Mitral prolapse
Most common cause of mitral stenosis
RHEUMATIC HEART DISEASE
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
Causes of mitral regurgitation
RHEUMATIC HEART DISEASE (50%)
Mitral valve prolapse
Hypertrophic cardiomyopathy
Papillary muscle dysfunction (secondary to MI)
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
Which drugs should NOT be administered in patient with aortic stenosis
Beta blockers
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
Cause of aortic stenosis
Thickening and CALCIFICATION of valve
Bicuspid aortic valves
Causes of aortic regurgitation
Rheumatic heart disease
Syphilitic aortitis
Nondissecting aortic aneurysm
Marfans syndrome
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
Name 3 causes of systolic ejection murmurs
Aortic valve stenosis

Hypertrophic cardiomyopathy

Pulmonic valve stenosis
Name 3 causes of holosystolic systolic murmur
Mitral regurgitation

Tricuspid regurgitation

Ventricular septal defect
Name cause of late-systolic murmur
Mitral valve prolapse
Name 2 causes of earlyy diastolic murmurs
Aortic valve regurgitation

Pulmonic valve regurgitation
Name cause for mid-late diastolic murmur
Mitral stenosis
Name cause for continuous diastolic murmur
PDA
Most common vasculitis in US
Temporal arteritis
Patient presents with ASTHMA, ELEVATED PLASMA EOSINOPHILS, heart disease, type of vasculitis associated with p-ANCA
Churg-Strauss disease
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
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
This disease affects YOUNG CHILDREN, causes fever, conjunctival lesions, lymphadenitis, coronary artery aneurysms

Name disease and type of pathology
Kawasakis disease

Acute necrotizing inflammation
MORMON patient presents with epistaxis and GI bleeding

Diagnosis, type of inheritance
Rendu-Osler-Weber syndrome

AUTOSOMAL DOMINANT
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
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
ELDERLY MALE presents with HEADACHE, absence of pulse, VISUAL DEFICITS and polymyalgia rheumatica

Blood work - SIGNIFICANT INCREASE IN ESR

Diagnosis
TEMPORAL (GIANT CELL) ARTERITIS
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)
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)
Von Hippel Lindau disease
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