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203 Cards in this Set
- Front
- Back
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What are the three layers that make up a normal blood vessel?
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tunica intimia, tunica media, adventitia
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Are medium or large sized arteries defined by the internal and external elastic lamina
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medium
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Are arteries or veins predisposed to dilatation, compression, penetration by tumors and inflammatory processes because of thin walls?
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veins
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Smooth muscle cell migrate from media to ____ with dedifferentiation from contractile to proliferative (synthetic capability).
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intima
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What are two cardiovascular conditions that commonly lead to a young person suddenly dropping dead?
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Berry Aneurysm and hypertrophic cardiomyopathy
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Berry Aneurysm is due to poorly developed musculature in tunica ____ with eventual degeneration of elastic lamina.
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media
Death may be caused by rupture leading to subarachoid or intracerebral hemorrhage. |
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Arteriovenous Fistula can lead to more strain on what side of heart?
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right side due to short circuit of blood arterial to venous circulation
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Atheromatous plaque – raised focal plaque within _____, weakening the _____, having a core of lipid (mainly cholesterol) covering fibrous cap (smooth muscle cells, macrophages, new vessels) and underlying smooth muscle proliferation
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intima
media |
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Abdominal aorta, coronary, popliteal, descending thoracic aorta, cerebral are all common locations for atherosclerosis. True or False?
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True
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A fatty streak is a precursor for _______
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atherosclerosis
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How do you calculate LDL cholesterol?
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Total cholesterol = HDL chol + LDL chol + VLDL chol
VLDL chol = triglycerides/5 LDL chol = (Total chol)-(HDL chol)-(tryglycerides/5) |
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What is the level at which you are considered to have low HDL cholesterol?
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less than 35 mg/dL
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Are African Americans more or less likely to suffer from hypertension compared to whites?
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more
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– systolic >140, diastolic >90 is considered hypertension. True or False?
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True
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Angiotensin II stimulates _______ from adrenal gland, increased sympathetic output from central nervous system and directly causes vasoconstriction
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aldosterone
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Atrial natriuretic factor is a hormone secreted by cells in cardiac ____ and increases urinary excretion of _____
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atria
sodium |
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Conn syndrome leads to an increase in ______
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aldosterone
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Malignant arteriosclerosis and arteriolosclerosis can lead to _____ necrosis if acute and Smooth muscle proliferation (“onion skin”) if chronic
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fibrinoid
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Monckeberg Medial Sclerosis --> atherschlerosis related, tunica ____ involved, see calcification and sclerosis
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media, degenerative calcification of media of large and medium sized muscular arteries, usually seen in elderly
-can be incidental finding on X-ray or mammography |
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Hyaline arteriolosclerosis is usually a consequence of longstanding ______ or _____
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benign hypertension
diabetes |
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Intermittent bilateral attacks of ischemia of fingers or toes characterized by pallor and pain precipitated by cold is known as _____
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Raynaud Phenomenon
Result of arterial vasospasm in skin |
|
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Rare noninflammatory thickening of large and medium sized muscular arteries (distinct from atherosclerosis and arteriosclerosis). Typically disease of women in reproductive years leading to the replacement of smooth muscle by fibrous tissue
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Fibromuscular dysplasia
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Is renal hypertension a complication of fibromuscular dysplasia?
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Yes
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Inflammation and necrosis of blood vessels is known as _____
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vasculitis
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Acute necrotizing vasculitis affecting medium and small muscular arteries (occasionally large arteries) in multiple organs, except lungs. No association with ANCA. Lesions consist of fibrinoid necrosis.
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Polyarteritis Nodosa
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This type of vasculitis is associated with Hepatitis B
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Polyartheritis Nodosa
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Involves smallest arteries and arterioles + venules in multiple organs. (size of vessel distinguishes it from polyarteritis nodosa. Broad category of inflammatory vascular lesions representing response to exogenous substances (bacterial products, drugs).
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Hypersensitivity Angiitis (microscopic polyarteritis)
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Hypersensitivity Angiitis (microscopic polyarteritis) is associated with what ANCA?
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p-ANCA
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Systemic vasculitis with prominent eosinophilia in young people with asthma. Associated with p-ANCA
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Churg-Strauss Syndrome
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Focal chronic granulomatous inflammation of temporal arteries
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Temporal Giant Cell Arteritis
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Pathology – granulomatous inflammation of media and intima with fragmented internal elastic lamina and giant cells. Disruption of INTERNAL elastic lamina. Most common form of vasculitis.
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Temporal Giant Cell Arteritis
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_____ Granulomatosis --> gives rise to respiratory symptoms and renal failure
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Wegener
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Wegener Granulomatosis is associated with C-ANCA. True or False?
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True
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This disease is characterized by inflammation of large arteries, classically aortic arch and branches and is commonly seen in young women and causing weak pulses in the upper extremities (pulseless disease)
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Takayasu Arteritis
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Acute necrotizing vasculitis of infancy and early childhood characterized by high fever, rash, conjunctival and oral lesions and lymphadenitis
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Kawasaki Disease
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What artery is most affected with Kawasaki Disease?
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coronary artery. coronary artery aneurysms frequent. (70% of patients). Also MI in young child could be a sign of Kawasaki Disease
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Occlusive inflammatory disease of small and medium arteries in distal arms and legs that is highly associated with smoking
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Buerger Disease
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Is infectious vasculitis very common?
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No but can be caused by bacteria and fungi
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What is a localized dilatation of blood vessel caused by congenital or acquired weakness in media.
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aneurysm
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Cystic medial degeneration is one of the more common causes of _____ aneurysms
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dissecting
seen in patients with Marfan Syndrome or Ehler Danlos Syndrome |
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Atherosclerotic Aortic Aneurysms usually occur above or below the renal arteries?
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below
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How is an abdominal mass caused by an aneurysm differentiated from an abdominal mass caused by a tumor?
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The one caused by the aneurysm should be pulsating
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Aneurysms caused by Syphilis affect the ascending or descending aorta most frequently?
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ascending
|
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Gross – “tree bark” and dilatation. Inflammatory cells and plasma cells characterize aneurysms caused by what organism?
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syphilis
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In older adults the most common risk factor of Dissecting Aneurysms is ____
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hypertension
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Is embolization due to varicose veins common?
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No
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Phlebothrombosis is thrombosis within a _____
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vein
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Phlegmasia alba dolens is a Iliofemoral venous thrombosis occurring in pregnant women or following delivery. True or False
|
True
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The ____ is known for known for producing thrombotic factors and therefore a hypercoagulable state
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Pancreas
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Dilatation of veins of head and neck with dusky cyanosis of head, neck and arms can be caused obstruction by neoplasm which compresses or invades vein. This is called what syndrome?
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Superior vena caval syndrome
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In ____ vena caval syndrome there is marked edema of legs, distension of superficial veins or lower abdomen. Usually caused by propagation of clot from femoral and iliac veins or a neoplasm with obstruction
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inferior
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Lymphangitis is usually caused by ____ infection
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bacterial
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Can filariasis be a cause of Lymphedema?
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yes
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Uncommon condition in young females characterized by progressive edema in one or both feet.
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Lymphedema Praecox.
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What disease is characterized by Lymphedema present at birth with apparent familial inheritance. Due to faulty development of lymphatics with the lower extremities as the major site
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Milroy
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What disease is similar to Milroy's disease but has no familial inheritance?
|
Simple Congenital Lymphedema
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Group of abnormally prominent small vessels giving rise to a focal red lesion usually in skin or mucous membranes
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Telangiectasias
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A port-wine stain or ______ is a vascular anomaly consisting of superficial and deep dilated capillaries in the skin which produce a reddish to purplish discoloration of the skin
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nevus flammeus
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Uncommon congenital disorder characterized by vascular masses in leptomeninges, port wine nevi of face, mental retardation and radiopacities in skull
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Sturge-Weber Disease
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Spider Telangiectasia is most common in pregnancy and liver disease because the liver cannot metabolize ____
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estrogen
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Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu disease) is Mendelian dominant or recessive?
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dominant
Hemorrhages arise from rupture of superficial blood vessels leading to nosebleeds and bleeding into intestinal, respiratory and urinary tract. |
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Benign lesions of blood vessel or lymphatic origin that create well-formed vascular channels is an ____
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angioma
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Rare disease in which cavernous hemangiomas occur within cerebellum, brain stem, eye grounds and other visceral neoplasms occur.
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Lindeau-von Hippel disease
|
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Cavernous Lymphangioma (Cystic Hygroma) – composed of a proliferation of large cavernous lymphatic spaces usually occurs where?
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in the neck and axilla
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What syndrome is associated with lymphangiomas?
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Turner syndrome
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Neuromyoarterial receptor sensitive to temperature which regulates arteriolar flow. Located in skin most commonly in distal portion fingers and toes is called ____
|
glomus
Glomus tumor is extremely painful |
|
|
Bacillary angiomatosis is seen in patients with ____ and can also result from infection from what organism?
|
AIDS
Bartonella henselae |
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Represents an intergrade between hemangiomas and hemangiosarcomas
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Hemangioendothelioma
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Malignant vascular neoplasm composed of masses of anaplastic endothelial cells
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Hemangiosarcoma
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Polyvinyl chloride, arsenic, and Thorotrast exposure can lead to ___ angiosarcoma
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liver
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Rare malignant tumor which develops after prolonged lymphatic obstruction (e.g. –mastectomy for breast cancer).
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Lymphangiosarcoma
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|
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cells present in the walls of capillaries and venules external to endothelial cells.
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pericytes
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Is a Hemangiopericytoma usually painful?
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No, but frequently invade and metastasize
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The left coronary artery splits off into what two branches?
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left anterior descending
left circumflex |
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atherosclerosis, hypertension, and aortic and mitral valve disease are common causes of ____ sided heart failure
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left
|
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Pulmonary congestion is ___ in the lung tissue
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blood
|
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Cerebral hypoxia leads to hypoxic encephalopathy. True or False?
|
True
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The major cause of right sided heart failure is ___
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left sided heart failure
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Pure right sided failure caused by right ventricular strain as a result of intrinsic disease of lungs resulting in dilatation of right ventricle and atrium.is known as ____
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cor pulmonale
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Chronic passive congestion of the liver is known as __ liver. There is necrosis of the hepatic cell where?
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nutmeg
central veins |
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The most common cause of ischemic heart disease is ____
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atherosclerosis
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_____- paroxysmal chest pain resulting from transient ischemia
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Angina pectoris
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sudden cardiac death is usually attributed to a conduction system problem. true or false?
|
true
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With stable and unstable angina do you see ST elevation or ST depression?
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ST depression
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Prinzmetal angina is the feeling of chest pain unrelated to exertion and is characterized by ST segment elevation or depression?
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elevation
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Whereas angina can be relieved by vasodilators such as nitroglycerine, can MI be relieved by nitroglycerine?
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No
|
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Virtually all transmural infarcts occur in the ___ ventricle.
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left
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What coronary artery is most likely to be infarcted?
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left anterior descending
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A Paradoxic infarction occurs on the basis of collateral circulation. obstruction in coronary artery but infarction somewhere where you might not expect it. True or False?
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true
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If under the microscope you see variable waviness of fibers and sarcolemmal disrption but no coagulative necrosis, how long has it been since an MI occured
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less than 4 hours
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Occlusion of the right coronary artery leads to infarction of the ____ wall and ___ septum and papillary muscles of the left ventricle
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posterior
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If you see coagulative necrosis but no neutrophil infiltrate, how long has it probably been since the MI occured?
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less than 24 hours
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With an MI that happened between 1-3 days, would you expected to see neutrophils histologically?
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Yes
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With an MI that has happened 3-7 days ago, what is the predominant cell you expect to see?
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macrophages
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With two week after MI, there is well established ____ tissue
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granulation
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2 months post MI there should be formation of a dense ____ scar
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collagenous
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ST elevation on EKG usually signals what?
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MI, though could be Prinzmetal angina
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What cardiac markers should be used to assess if an MI has occured?
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Creatinine kinase (MB)
troponin |
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Which of the cardiac markers is useful to assess for reinfarction?
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CK because it normalizes after 3 days, whereas Troponin takes 5-9 days to normalize
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Which cardiac enzyme, though not very specific, rises first after an MI
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myoglobin
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Can ventricular fibrillation lead to sudden cardiac death?
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Yes
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Increased complication of rupture of the ventricular free wall occurs during what period post MI
|
3-7 days during the macrophage phase
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Valvular stenosis causes ___ overload, and concentric hypertrophy
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pressure
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Valvular regurgitation causes ____ overload and eccentric hypertrophy
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volume
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Acute Rheumatic fever occurs due to infection via what organism?
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Group A streptococcus
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Acute rheumatic fever usually leads to a pancarditis. True or False?
|
True
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Ashoff bodies are seen with after contracting what disease?
|
rheumatic fever
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Would you expect to see bacteria in vegetations due to rheumatic fever?
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No
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Antistreptolysin O (ASO), anti-DNAse, anti-hyaluronidase are antibodies that might be positive in people suffering from _____
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acute rheumatic fever
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treat strep phrayngitis with ____
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penicillin
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What is the most common valve to be affected by chronic rheumatic heart disease?
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mitral valve
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A fish mouth deformity can occur due to ___ rheumatic heart disease
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chronic
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Libman-Sachs endocarditis can occur with which disease?
|
SLE
|
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Nonbacterial verrucous vegetations on surface of valves close to origin of valve leaflets from valve ring in Libman-Sachs endocarditis. What valve is most commonly affected by Libman-Sachs endocarditis?
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mitral valve
peridcarditis or myocarditis can occur |
|
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What pathogens can destroy a normal cardiac valve?
|
S. aureus, strep pyogenes
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Subacute endocarditis can result from a previously damaged heart valve and can be caused by what organism?
|
strep. viridans
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What valve is most commonly destroyed in IV drug users?
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tricuspid valve
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Sterile vegetations contain what two major components?
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platelets, fibrin
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MARANTIC ENDOCARDITIS is endocarditis secondary to chronic disease such as cancer. True or False?
|
True
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Marantic endocarditis have sterile vegetations that can result from a hypercoagulable state. ___ cancer can commonly lead to such a state
|
pancreatic
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In what type of endocarditis are there vegetations on both sides of the valve leaflets?
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Libman-Sachs endocarditis
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Calcified aortic stenosis can occur secondary to what infection?
|
aortic stenosis
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Congenital bicuspid aortic valve can predispose one to ____ aortic stenosis
|
calcified
|
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Aortic stenosis causes ____ hypertrophy
|
left ventricular
|
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Does calcification of the mitral valve annulus usually have any functional significance?
|
No
|
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Redundant mitral valve leaflets do not close completely during systole, resulting in mitral regurgitation. Valves prolapse into left ____. Can lead to infectious endocarditis
|
atrium
|
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Barlow's Syndrome is another word for ____
|
mitral valve prolapse
|
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A mid to late systolic click can be heard with mitral valve prolapse. True or False?
|
True
|
|
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Is mitral valve regurgitation a systolic or diastolic murmur?
|
systolic
|
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Papillary muscle dysfunction can cause mitral ____
|
regurgitation
|
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CARCINOID HEART DISEASE produces high levels of ____ what is metabolized in the ___
|
serotonin
lungs |
|
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Changes in _____ side of heart in patients with carcinoid tumors metastatic to liver
|
right
|
|
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Thromboembolic complications can occur with mechanical valves because ____
|
bloodflow across prosthetic valves are a bit more turbulent compared to normal valves
|
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Generalized inflammation of myocardium associated with necrosis and degeneration of myocytes, resulting in acute heart failure in previously healthy adolescent or young adult is termed ____
|
myocarditis
|
|
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Chagas disease, which is prevelant only in SA, can cause ____
|
myocarditis
|
|
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coxsackievirus, ECHO, influenza, HIV, cytomegalovirus can all cause myocarditis. True or False?
|
True
|
|
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Sarcoidosis causes the formation of granulomas and can result in myocarditis. True or False?
|
True
|
|
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Chronic viral myocarditis will lead to ___ ventricular hypertrophy
|
left
|
|
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With chronic myocarditis, what type of inflammatory cells would you expect to see under the microscope?
|
lymphocytes
macrophages |
|
|
Hypersensitivity myocarditis usually results from drug therapy and inflammation includes what type of cells?
|
eosinophils
|
|
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Giant cell myocarditis is marked by granulomatous inflammation and is rapidly fatal without transplant. True or False?
|
True
|
|
|
____thyroidism – tachycardia, increased cardiac output, may lead to angina and cardiac failure
|
hyper
|
|
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_____thyroidism – decreased cardiac output, bradycardia, impaired myocardial contractility
|
hypo
|
|
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Catecholamines can cause myocyte necrosis due to vaso____
|
constriction
|
|
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What are the three forms of cardiomyopathy?
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dilated, hypertrophic, restrictive
|
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Idiopathic Dilated Cardiomyopathy can result in poor contractility of the heart due to ventricular dilatation and therefore myocytes do not contract as much. True or False
|
True
|
|
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Atrophic and hypertrophic myocardial fibers and interstitial fibrosis is seen with what type of myocardial disease?
|
dilated cardiomyopathy
|
|
|
Most common identifiable cause of cardiomyopathy is the use of this substance
|
ethanol
|
|
|
Cobalt, catecholamines, anthracyclines, cyclophosphamide, and cocaine are all substances that can cause toxic ____
|
cardiomyopathy
|
|
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Cocaine, in addition to causing cardiomyopathy can also lead to sudden death by causing ventricular ____
|
arrhythmia
|
|
|
Cardiomyopathy can occur in what trimester of pregnancy?
|
last or first 6 months post partum
|
|
|
What causes hypertrophic cardiomyopathy?
|
100% genetic cause
|
|
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With hypertrophic cardiomyopathy there commonly is asymmetric hypertrophy of the ____
|
interventricular septum
|
|
|
Idiopathic hypertrophic subaortic stenosis (IHSS) – obstruction of left ventricular outflow tract can be associated with _____
|
hypertrophic cardiomyopathy
|
|
|
How do you treat hypertophic cardiomyopathy?
|
with beta blocker and calcium channel blockers to reduce contractility and decrease outflow obstruction
|
|
|
What causes restrictive cardiomyopathy?
|
infiltration of myocardium with a substance that doesn't belong there
|
|
|
Amyloidosis causes ___ sided heart failure most commonly
|
right
|
|
|
______ Cardiac Amyloidosis – deposition of prealbumin (transthyretin) in heart of elderly
|
Senile
|
|
|
Endomocardial Fibrosis occurs on what continent?
|
Africa
|
|
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Restrictive cardiomyopathy leads to decreased compliance that restricts filling during ____
|
diastole
|
|
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Loeffler syndrome is endomyocardial fibrosis with an ___ inflitrate. Causes restrictive cardiomyopathy
|
eosinophilic
|
|
|
Amyloidosis, sarcoidosis, hemochromatosis can all cause ____ cardiomyopathy
|
restrictive
|
|
|
What is the most common primary tumor of the heart?
|
Cardiac Myxoma
|
|
|
Cardiac Myxoma are most common in what chamber?
|
left atrium
|
|
|
Most common primary tumor of heart in infants and children
|
Rhabdomyoma
|
|
|
In Rhadbomyoma there are nodular masses in the ___cardium
|
myocardium
|
|
|
Metastasis to the heart commonly involve to the ___cardium
|
pericardium
|
|
|
Is aortic stenosis an example of volume or pressure hypertophy?
|
pressure
|
|
|
When a chamber is enlarged, does that mean that it is failing?
|
No, Chamber can be enlarged, that does not necessarily imply that the chamber is failing, when the chamber fails we use the term dilatation
|
|
|
When chamber enlargement is attributable to heart failure the term _____ is used
|
dilatation
|
|
|
Pressure produces mostly thickening at the line of closure and edge, whereas flow produces generalized thickening of the valve. True or False?
|
True
|
|
|
In order to produce physiologic conditions, how narrow must an obstruction be?
|
65% narrowing
|
|
|
A total anomalous pulmonary venous drainage means that oxygenated blood for some reason does not go the the _____
|
left atrium
|
|
|
What is the most common defect in the atrial septum?
|
Fossa ovalis or secundum type - common
|
|
|
The Ostium primum type of ASD is a defect in the formation of the endocardial cushion and affects the formation of what two valves?
|
tricuspid, mitral
can eventually lead to mitral regurgitation |
|
|
In a left to right shunt at the atrial level, there will be ____ hypertrophy of the right atrium and right ventricle with increased pulmonary flow and hemodynamic changes in the tricuspid and pulmonic valves
|
volume
|
|
|
Where is the most common location of a ventricular septal defect?
|
defect to occur beneath the aortic valve, confluent in part with the membranous septum
|
|
|
The most common ventricular septal defect is called subaortic. True or False?
|
True
|
|
|
With ventricular septal defects, there is ____ hypertrophy of the right ventricle, left atrium, left ventricle
|
volume
|
|
|
There is a tendency for ______ to occur in small or closing ventricular septal defects
|
infective endocarditis
|
|
|
When the VSD defect is large, there is not only volume hypertrophy of the right ventricle, left atrium and left ventricle, the' ____ of the left ventricle may be transmitted to the right ventricle resulting in ______ hypertrophy of the right ventricle.
|
pressure
|
|
|
With a patent ductus arteriosis there is volume hypertrophy of what two chambers?
|
left atrium, left ventricle
|
|
|
Is there increased pulmonary flow in atrial septal defects, ventricular septal defects, and patent ductus arteriosis?
|
Yes
|
|
|
Is pulmonary hypertension most common in large ventricular defect, patent ductus arteriosus, or in atrial septal defect?
|
large ventricular septal defect
|
|
|
With pulmonary hypertension there is pressure hypertrophy on the right side with decrease in volume hypertrophy of the left side. This can cause a reversal of the shunt from left-to-right to right-to-left. What is the phenomenon called?
|
physiology of Eisenmenger's complex
|
|
|
An obstruction occurs when the anatomical size of the orifice is less than ____
|
65%
|
|
|
With pulmonary stenosis there is ____ hypertrophy of the right ventricle
|
pressure
|
|
|
supravalvular aortic stenosis is associated with abnormal ____ and peripheral pulmonary stenosis
|
calcium
|
|
|
Subaortic stenosis may present as distinct fibromuscular stenosis, or as hypertrophic obstructive cardiomyopathy. True or False?
|
True
|
|
|
With coarctation of the aorta there is hypertension _____ and hypotension ____ to the area of narrowing. Use proximal and distal
|
proximal
distal |
|
|
In hypoplasia of the transverse arch there is narrowing of the transverse arch and the asending aorta is bigger or smaller? This defect is usually accompanied with an atrial septal defect and a widely patent ductus arteriosus
|
smaller
|
|
|
With the complex of a small ascending aorta the right side of the heart is being or small compared to the left side of heart?
|
hypertrophy of right ventricle but smallness of the left side
|
|
|
What congenital heart defect is associated with a U shaped defect?
|
Tetralogy of Fallot
|
|
|
An overriding aorta that is connected to both the right and left ventricle is associated with what congenital defect?
|
Tetralogy of Fallot
|
|
|
Where is the defect in Tetralogy of Fallot?
|
in the infundibulum of the outflow tract of the right ventricle
|
|
|
In Cyanotic Tetralogy of Fallot, the right ventricle is contracting against systemic and infundibular resistance, leading to decreased pulmonary flow and the reason for cyanosis. True or False?
|
True
|
|
|
With cyanotic tetralogy of fallot we are dealing with a right to left shunt, whereas with acyanotic tetralogy of fallot we are dealing with a left to right shunt. True or False?
|
True
|
|
|
Do ASD/VSDs usually lead to cyanosis?
|
no
|
|
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Children can squat in order to increase systemic resistance and thus decrease right to left shunting and cynaosis. True or False?
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True
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What is the treatment of Tetralogy of Fallot?
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patching shut the VSD and widening the pulmonary outflow tract
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With transposition of the Great vessels, at birth, one must administer _____ to maintain a patent ductus arteriosus
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prostaglandins
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How do you tell an ASD from a VSD based on oxygenation?
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in ASD both the right atrium and the right ventricle will have increased oxygenation, whereas in VSD only the right ventricle will have increased oxygenation
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In utero, when the coarctation of the aorta is proximal or distal to the ductus arteriosus is circulation all well?
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proximal
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