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88 Cards in this Set
- Front
- Back
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Eisenmenger's syndrome
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Symptoms: pulmonary hypertension, late cyanosis, right to left shunt
Pathogenesis: uncorrected VSD, ASD, or PDA (L->R shunt) causes vascular hypertrophy and pulmonary HTN, which reverses the shunt |
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Tetralogy of Fallot
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Symptoms: right to left shunt, early cyanosis, boot-shaped heart, cyanotic spells, squatting to increase SVR and decrease shunt
Pathogenesis: pulmonary stenosis, RVH, overriding aorta, VSD |
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Transposition of the great vessels
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Symptoms: death unless VSD, PDA, or patent foramen ovale present
Pathogenesis: aorta leaves from RV and pulmonary artery leaves from LV, separating systemic and pulmonary circulation, offspring of diabetic mother |
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Coarctation of the aorta
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Symptoms: notching of ribs, HTN in upper extremities, weak pulses in lower extremities, aortic regurgitation
Pathogenesis: aortic stenosis proximal (infantile) or distal (adult) to ductus arteriosus |
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Patent ductus arteriosus
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Symptoms: RVH and RV failure, machine-like continuous murmur
Pathogenesis: left to right shunt Treatment: indomethacin closes it, PGE keeps it open |
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ASD
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Symptoms: wide and fixed splitting of S2, paradoxical thromboembolism, loud S1, increase in pulmonary resistance and pulmonary HTN
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VSD
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Symptoms: increased pulmonary resistance, holosystolic murmur, loudest at tricuspid area
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Hypertension
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Symptoms: BP > 140/90, atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy, aortic dissection
Pathogenesis: mostly primary, due to age, obesity, diabetes, smoking, genetics |
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Signs of hyperlipidemia
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Atheromas - plaques in blood vessel walls
Xanthomas - lipid-laden histiocytes in skin, especially eyelids Tendinous xanthoma - especially Achilles Corneal arcus - lipid deposit in cornea |
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Atherosclerosis
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Symptoms: asymptomatic, angina, claudication, abdominal aorta > coronary > popliteal > carotid
Pathogenesis: endothelial cell dysfunction causes macrophage nad LDL accumulation, foam cells form, smooth muscle migrates, forms fibrous plaque |
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Arteriosclerosis
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Monckeberg - calcification in media of arteries, benign
Arteriolosclerosis - hyaline thickening of small arteries in essential HTN, onion skinning in malignant HTN Atherosclerosis - fibrous plaques and atheromas in intima of arteries |
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Stable angina
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Symptoms: ST depression on ECG, retrosternal chest pain on exertion, relieved with rest
Pathogenesis: atherosclerosis, usually stable plaque that occludes over 80% of the artery |
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Aortic dissection
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Symptoms: tearing chest pain radiating to back, widened mediastinum, aortic rupture and death
Pathogenesis: longitudinal intraluminal tear forms false lumen, HTN, cystic medial necrosis (Marfan's) |
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Prinzmetal's angina
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Symptoms: ST elevation on ECG
Pathogenesis: coronary artery spasm, ergonovine |
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Unstable angina
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Symptoms: ST depression on ECG, worsening chest pain
Pathogenesis: thrombosis without necrosis |
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Myocardial infarction
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Symptoms: nausea, vomiting, severe retrosternal chest pain, pain in left arm and jaw, shortness of breath
Pathogenesis: thrombosis with necrosis (LAD > RCA > LCX) Pathology: contraction bands and coagulative necrosis by 4 hours, neutrophils by 2-4 days (risk of arrhythmia), degradation by macrophages by 5-10 days (risk of free wall rupture, tamponade), granulation tissue by 10-14 days, scar complete by 7 weeks Diagnosis: ECG in first 6 hours, troponin I afterwards |
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Dilated cardiomyopathy
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Symptoms: S3, dilated heart with balloon appearance, systolic dysfunction
Pathogenesis: alcohol abuse, beriberi, Coxsackie B virus, cocaine, Chagas disease, doxorubicin, peripartum |
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Hypertrophic cardiomyopathy
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Symptoms:S4, normal sized heart, systolic murmur, sudden death in athletes
Pathogenesis: asymmetric septal hypertrophy causes septum to be too close to mitral valve leaflet, leading to outflow tract obstruction, usually from HTN, mutations in cardiac sarcomeric protein genes Treatment: beta-blocker, calcium channel blocker |
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Restrictive cardiomyopathy
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Symptoms: diastolic dysfunction, incomplete filling
Pathogenesis: amyloid, sarcoid, fibrosis, hemochromatosis |
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CHF
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Symptoms: dyspnea on exertion, cardiac dilation, pulmonary edema, hemosiderin-laden macrophages, orthopnea, paroxysmal nocturnal dyspnea, hepatomegaly, lower extremity edema, JVD
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Pulmonary embolus
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Symptoms: chest pain, tachypnea, dyspnea
Pathogenesis: mostly from DVT from deep leg veins |
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Bacterial endocarditis
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Symptoms: fever, Roth spots (retina), Janeway lesions (palm and sole), Osler nodes (raised lesions on fingers and toes), splinter hemorrhages, mitral valve prolapse
Pathogenesis: acute (staph aureus), subacute (strep viridans, dental procedures), prosthetic (coag-negative staph), marantic (malignancy), Trousseau's syndrome (migratory thrombophlebitis), affects mitral and tricuspid valves |
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Libman-Sacks endocarditis
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Symptoms: wartlike sterile vegitations on both sides of valve, mitral stenosis or regurgitation
Pathogenesis: SLE |
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Rheumatic heart disease
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Symptoms: fever, erythema marginatum, valvular damage, high ESR, red-hot joints, subcutaneous nodules (Aschoff bodies), Sydenham's chorea
Pathogenesis: group A strep, affects mitral and aortic valves, immune-mediated (type II hypersensitivity) |
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Cardiac tamponade
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Symptoms: hypotension, JVD, distant heart sounds, increasd HR, pulsus paradoxus (Kussmaul pulse, decreased amplitude of pulse during inspiration)
Pathogenesis: compression of heart by fluid |
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Pericarditis
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Symptoms: pericardial sharp pleuritic pain, friction rub, pulsus paradoxus, distant heart sounds, ST elevation
Pathogenesis: serous (SLE, RA, viral, uremia), fibrinous (uremia, MI, RF), hemorrhagic (TB, malignancy) |
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Syphilitic heart disease
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Symptoms: tree bark appearance of aorta, aneurysm of ascending aorta or aortic arch, imcompetent aortic valve
Pathogenesis: disruption of vasa vasorum of aorta and dilation of aorta and valve ring |
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Cardiac myxoma
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Symptoms: left atrial ball mass, syncopal episodes
Pathogenesis: most common primary cardiac tumor in adults |
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Rhabdomyoma
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Pathogenesis: most common primary heart tumor in children
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Osler-Weber-Rendu syndrome
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Symptoms: hereditary telangiectasia, AV malformations of small vessels, dilated vessels on skin and mucus membranes, nosebleeds, skin discolorations
Pathogenesis: autosomal dominant |
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Raynaud's disease
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Symptoms: decreased blood flow to skin on cold temperature or stress, mostly in fingers and toes
Pathogenesis: arteriolar vasospasm, associated with SLE or CREST syndrome |
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Wegener's granulomatosis
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Symptoms: focal necrotizing vasculitis, necrotizing granulomas in lungs and upper airways, necrotizing glomerulonephritis, sinusutus, otitis, mastoiditis, cough, dyspnea, hematuria, hemoptysis
Pathogenesis: c-ANCA Treatment: cyclophosphamide, corticosteroids |
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Churg-Strauss syndrome
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Symptoms: granulomatous vasculitis with eosinophilia
Pathogenesis: p-ANCA |
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Sturge-Weber disease
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Symptoms: port-wine stain on face, leptomeningeal angiomatosis (intracerebral AVM)
Pathogenesis: congenital |
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Henoch-Schonlein purpura
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Symptoms: skin rash on buttocks and legs, arthralgia, intestinal hemorrhage, melena
Pathogenesis: IgA immune complexes in kids, often follows URIs, associated with IgA nephropathy |
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Buerger's disease
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Symptoms: thrombosing vasculitis, intermittent claudication, nodular phlebitis, cold sensitivity, severe pain, gangrene, amputation
Pathogenesis: heavy smoking Treatment: stop smoking |
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Kawasaki's disease
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Symptoms: necrotizing vasculitis, coronary aneurysms, fever, conjunctival changes, strawberry tongue, lymphadenitis
Pathogenesis: acute, self-limited, kids, Asians |
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Polyarteritis nodosa
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Symptoms: fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neurologic dysfunction
Pathogenesis: immune complex inflammation of medium-sized arteries, hep B Treatment: corticosteroids, cyclophosphamide |
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Takayasu's arteritis
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Symptoms: increased ESR, fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, weak pulses in upper extremities
Pathogenesis: granulomatous thickening of aortic arch, Asian females |
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Temporal arteritis
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Symptoms: unilateral headache, jaw claudication, impaired vision
Pathogenesis: focal granulomatous inflammation, elderly females Treatment: high-dose steroids |
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Torsaud's points
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Symptoms: syncope
Pathogenesis: QT prolongation, Romano-Ward syndrome, Jervell and Lange-Nielson syndrome (neurosensory hearing loss), mutations in K+ channels |
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Wolff-Parkinson-White
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Symptoms: delta wave on EKG, re-entrant supraventricular tachycardia, shortened PR interval
Pathogenesis: accessory pathway |
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Atrial fibrillation
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Symptoms: lack of P waves, irregular R-R intervals, narrow QRS complexes, palpitations
Pathogenesis: SA node hyperconduction, alcohol, pericarditis |
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Marfan's syndrome
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Symptoms: mitral valve prolapse, cystic medial aortic degeneration (predisposes to aortic dissection)
Pathogenesis: connective tissue disease |
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Mitral regurgitation
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Symptoms: high-pictched holosystolic murmur, can lead to dilated cardiomyopathy
Pathogenesis: ischemic heart disease, mitral valve prolapse, LV dilation, rheumatic fever |
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Aortic stenosis
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Symptoms: syncope
Pathogenesis: age-related, bicuspid aortic valve |
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Mitral valve prolapse
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Symptoms: late systolic murmur with midsystolic click
Pathogenesis: valvular lesion |
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Aortic regurgitation
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Symptoms: early diastolic decrescendo murmur decreased by amyl nitrate, best heard when leaning forward, widened pulse pressure, large SV, palpitations, head bobbing
Pathogenesis: aortic root dilation, bicuspid aortic valve, rheumatic fever |
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Down's syndrome
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Symptoms: ASD, VSD, AV septal defect (endocardial cushion defect)
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Turner's syndrome
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Symptoms: coarctation of the aorta
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DiGeorge syndrome
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Symptoms: thymic aplasia, parathyroid nonformation, tetralogy of Fallot, truncus arteriosus
Pathogenesis: 22q11.2 deletion |
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Turner's syndrome
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Symptoms: coarctation fo the aorta
Pathogenesis: XO chromosome |
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Carotid baroreceptor syncope
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Symptoms: syncope on pressing on baroreceptor
Pathogenesis: carotid (glossopharyngeal nerve), aortic arch (vagus nerve, responds to increasing BP only) |
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Tricuspid regurgitation
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Symptoms: holosystolic murmur over left sternal border that increases with inspiration
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Cor pulmonale
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Symptoms: RVH, exertional dyspnea
Pathogenesis: increased puulmonary vascular resistance |
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Cardiac output
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Stroke volume * heart rate
Rate of O2 consumption / (arterial O2 content - venous O2 content) |
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Mean arterial pressure
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2/3 diastolic pressure + 1/3 systolic pressure
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Stroke volume
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EDV - ESV
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Factors that increase contractility
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Catecholamines
Increased intracellular calcium Decreased extracellular sodium (decreased Na/Ca exchanger activity) Digitalis (increases intracellular Na by blocking Na/K ATPase) |
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Factors that decrease contractility
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Beta 1 blockade
Heart failure Acidosis Hypoxia/hypercapnea Non-dihydroxypyridine Ca channel blockers |
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Factors that increase myocardial O2 demand
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Increased afterload
Increased contracility Increased heart rate Increased heart size (more wall tension) |
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Ejection fraction
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(EDV - ESV)/EDV
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Resistance
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Proportional to viscosity
Inversely proportional to radius^4 |
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Viscosity
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Depends on Hct
Increases in polycythemia, hyperproteinemia (multiple myeloma), hereditary spherocytosis |
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S2 splitting
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Normal: increases with inspiration
Wide: pulmonic stenosis Fixed splitting: ASD Paradoxical splitting (P2 before A2): aortic stenosis |
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Mitral/tricuspid regurgitation
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Holosystolic blowing murmur
MR - ischemic heart disease, mitral valve prolapse, LV dilation, RF TR - RV dilation, endocarditis, RF |
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Aortic stenosis
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Crescendo-decrescendo systolic ejection murmur following ejection click
LV pressure > aortic pressure during systole Often due to age-related calcific aortic stenosis |
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VSD
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Holosystolic harsh murmur
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Mitral valve prolapse
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Late systolic murmur with midsystolic click
Most frequently due to valvular lesion |
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Aortic regurgitation
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High-pitched blowing diastolic murmur
Causes wide pulse pressure Due to aortic root dilation, bicuspid aortic valve, or rheumatic fever |
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Mitral stenosis
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Opening snap, then late diastolic murmur
LA pressure > LV pressure during diastole Often secondary to RF |
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PDA
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Continuous machine-like murmur
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Torsades de pointes
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Ventricular tachycardia
Can progress to V-fib Prolonged QT interval predisposes to this |
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Wolff-Parkinson-White syndrome
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Accessory conduction bypassing AV node
Characteristic delta wave Can cause re-entrant supraventricular tachycardia |
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Atrial fibrillation
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Erratic baseline
No P waves Treat with warfarin |
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Atrial flutter
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Sawtooth appearance of flutter waves
Use class IA, IC, or III antiarrhythmics |
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First degree AV block
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PR > 200
Asymptomatic |
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Second degree Mobitz type I (Wenckebach) block
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Progressive lengthening of PR interval until a beat is dropped
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Motitz type II
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2:1 block
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3rd degree block
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Atria and ventricles beat independently
Treat with pacemaker |
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Effects of low MAP
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Decreased baroreceptor firing -> increased synpathetics - b1 (heart rate, contractility), a1 (venoconstriction and venous return and arteriolar vasoconstriction)
JGA senses decreased circulating volume -> RAS - AII vasoconstriction, aldosterone increases blood volume Increase in CO and TPR |
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Aortic arch receptors
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Respond to increased BP
Transmits via vagus nerve |
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Carotid sinus receptors
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Responds to increase and decrease in BP
Transmits via glossopharyngeal nerve |
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Carotid massage
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Increases pressure on carotid artery
Stretches baroreceptors Increases afferent baroreceptor firing Decreases HR |
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Causes of edema
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Increased capillary pressure (heart failure)
Decreased plasma proteins (liver failure, nephrotic syndrome) Increased capillary permeability (toxins, infections, burns) Increased interstitial fluid colloid osmotic pressure (lymphatic blockage) |
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Anti-arrhythmics - class I
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Na channel blocker, slows phase 4 depolarization
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Anti-arrhythmics - class II
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Beta-blockers
Decrease cAMP, lower Ca currents, decrease slope of phase 4 depolarization AV node particularly sensitive Used for VTach, SVT, Afib, Aflutter |
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Anti-arrhythmics - class III
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Potassium channel blockers
Increase AP duration |
