Step1: Cardio Path

Front 1

R >> L shunt

Back 1

blue babies
early cyanosis
ID'd early and require surgery/PDA to correct

Front 2

The 5 T's of blue babies

Back 2

Truncus Arteriosus (1 vessel)
Transposition (2 switched vessels)
Tricuspid Atresia (3 - Tri)
Tetratology of Fallot
TAPVR (5 letters)
**Tet, Transposition Truncus due to neural crest migration problems

Front 3

Persistent Truncus Arteriosus

Back 3

failure of truncus arteriosus to divide into pulm trunk and aorta >> most pts also have VSD.

Front 4

Transposition of Great Vessels

Back 4

Aorta leaves RV and pulmonary trunk leaves LV due to failure of aorticopulonary septum to spiral >> separation of systemic/pulmonary circuits.

**Must create shunt to allow survival until surgery. Give PGE to maintain PDA
**associated w/ maternal DM

Front 5

Tricuspid Atresia

Back 5

absence of tricuspid valve and hypoplastic RV; requires ASD and VSD for survival

Front 6

Tetralogy of Fallot

Back 6

Due to anterosuperior displacement of the infundibular septum. **most common cause of early childhood cyanosis

PROVe
Pulmonary stenosis
RVH (boot-shaped heart)
Overriding aorta
VSD

Front 7

Tet sx

Back 7

PS forces R >> L flow across VSD >> cyanotic spells. Squatting increases SVR and lessens shunt, improving cyanosis.
**amount of shunt depends on amount of stenosis

Front 8

Total anomalous pulmonary venous return

Back 8

Pulmonary veins drain into RH circulation; associated w/ ASD and PDA to allow R >> L shunt to maintain CO.

Front 9

L >> R shunting

Back 9

blue kids
late cyanosis
VSD > ASD > PDA

Front 10

VSD

Back 10

Most common congenital cardiac defect
Assoc w/ FAS
Asx at birth, may resolve or cause problems later on

Large lesion can lead to pulm HTN >> Eisenmenger

Front 11

Eisenmenger Syndrome

Back 11

Uncorrected L>>R shunt increases pulmonary blood flow >> pulm HTN >> RVH and shunt becomes R >> L. See late cyanosis, clubbing, polycythemia.

Front 12

ASD

Back 12

Loud S1, wide/fixed split S2.
Usually occurs in septum secundum
In Downs problem is in septum primum

Can cause paradoxical embolism

Front 13

PDA

Back 13

continuous machinelike murmur
maintained by PGE synthesis and low O2 tension
associated w/ congenital rubella

R >> L shunt in fetus becomes L >> R in newborn >> pulm HTN >> Eisenmenger >> cyanosis of lower extremities

Front 14

Coarctation of the aorta

Back 14

narrowing of the aorta assoc w/ bicuspid aortic valve

Front 15

infantile coarctation of aorta

Back 15

after the aortic arch, before the PDA
Associated w/ Turner's. Assoc w/ PDA. Can present as LE cyanosis.

Front 16

adult coarctation of aorta

Back 16

distal to the ductus; associated w/ notching of ribs due to collateral circulation, HTN in upper extremities and weak, delayed pulses in lower.

Front 17

22q11

Down's

Back 17

DiGeorge; characterized by truncus arteriosus, tet of fallot

Down's: ASD, VSD, AV septal defect

Front 18

Marfan

Back 18

characterized by MVP, thoracic aortic aneurysm, AR

Front 19

Infant of diabetic mother

Back 19

characterized by transposition of great vessels

Front 20

HTN etiology

Back 20

90% primary in adults; related to increased CO or TPR. Rest is secondary due to renal dz like fibromuscular dysplasia.

Front 21

Signs of hyperlipidemia

Back 21

Xanthomas: skin plaques composed of lipid-laden histiocytes
Tendinous Xanthomas: lipid deposits in achilles or other tendons.
Corneal arcus: pale lipid ring in cornea seen early w/ hypercholesterolemia, common in elderly.

Front 22

Monckeberg

Back 22

rare calcification of the media of radial or ulnar arteries. Does not obstruct blood flow. Usually benign. No involvement of the intima. Pipestem arteries on xray.

Front 23

Arteriolosclerosis.

Back 23

hyaline thickening of small arteries in essential HTN or DM or hyperplastic onionskinning in severe HTN.

Front 24

progression of atherosclerosis

Back 24

Endothelial cell dysfunction >> macrophage and LDL accumulation >> foam cell formation >> fatty streaks >> SM cell migration, prolif and ECM deposition >> fibrous plaque > complex atheroma
**SM cells play a key role in hyperplasia/fibrosis
**metalloproteases from macrophages degrade collagen and predispose to rupture.

Front 25

atherosclerosis locations

Back 25

abd aorta > coronary artery > popliteal > carotid

Front 26

aortic aneurysm

Back 26

localized pathologic dilation of the aorta. Pain a sign of leak, dissection or imminent rupture

Front 27

Abd aortic aneurysm

Back 27

associated w/ atherosclerosis; more frequent in male hypertensive smokers 50+

Front 28

thoracic aortic aneurysm

Back 28

Associated w/ cystic medial degeneration due to HTN (older) or Marfan (younger) and tertiary syph.

Front 29

aortic dissection

Back 29

Longitudinal intraluminal tear forms a false lumen. Associated w/ HTN, bicuspid valve, Marfan.
-presents w/ tearing chest pain that radiates to back, +/- unequal BP in arms.
-Mediastinal widening on CXR

Front 30

Angina

Back 30

Chest pain due to inadequate O2 supply to heart. No necrosis. Reversible injury; subendocardium is most at risk.

Front 31

stable angina

Back 31

Pattern of predictable transient chest discomfort during exertion secondary to fixed plaque and inappropriate vasoconstriction due to endothelial cell dysfunction.
-ST depression on EKG
-treated by decreasing O2 demand w/ rest or nitroglycerin
-reversible damage to myocytes
-70% stenosis

Front 32

unstable angina

Back 32

Sudden increase in tempo/severity of angina, occurring w/ less exertion or at rest.
-due to plaque rupture and incomplete obstruction.
-reversible injury to myocytes
-ST depression on EKG
-need to restore supply w/ drugs or stent

Front 33

variant angina

Back 33

Prizmetal
-seen at rest due to CA spasm
-transient ST elevation on EKG
-triggers are tobacco, cocaine, triptans
-tx is Ca blocker, nitrate, smoking cessation

Front 34

MI

Back 34

Severe crushing chest pain that radiates to jaw, arm
Acute thrombosis >> complete obstruction >> necrosis.
-ST elevation if transmural
-ST dep if subendocardial
-biomarkers are dx
LAD > RCA > LCX

Front 35

Sudden cardiac death

Back 35

Death w/in 1 hour of cardiac sx
-lethal arrhythmia is top cause
-assoc w/ CAD, cardiomyopathy, long QT

Front 36

Chronic ischemic HD

Back 36

progressive onset CHF over many years due to chronic ischemic myocardial damage

Front 37

MI on ECG

Back 37

ECG is gold standard in first 6 hours
-STEMI (transmural)
-ST depression (subendocardial)
-pathologic Q waves (evolving or old infarct)

Front 38

troponin

Back 38

rises after 4 hours, peaks at 24 stays high for 7-10 days. Most specific protein marker

Front 39

CK-MB

Back 39

in myocardium and also Skeletal muscle; rises 4-6 hours, peaks at 24, returns in 48
**helpful for diagnosing reinfarction following acute MI.

Front 40

transmural infarct

Back 40

necrosis affecting entire wall
See STEMI, Q waves

Front 41

subendocardial infarct

Back 41

ischemic necrosis of <50% of ventricular wall
See ST depression

Front 42

MI first 4 hrs

Back 42

No gross or microscopic changes;
cardiogenic shock, CHF and arrhythmia

Front 43

MI 4-24hrs

Back 43

dark mottling; nuclei disappear
coagulative necrosis
arrhythmia

Front 44

MI 1-3 days

Back 44

yellow pallor
PMN's
fibrinous pericarditis presents w/ chest pain and friction rub

Front 45

MI 4-7 days

Back 45

yellow pallor
macrophages
Rupture of ventricular free wall >> cardiac tamponade risk is highest day 6-14

Front 46

MI 1-3wks

Back 46

red border of dead tissue
granulation tissue w/ fibroblasts

Front 47

MI months

Back 47

white scar, type I collagen
fibrosis
aneurysm, Dressler syndrome

Front 48

Dressler syndrome

Back 48

AI phenomenon resulting in fibrinous pericarditis 6-8wks after MI; make autoAB for pericardium

Front 49

diagnosing MI location: anterior wall

Back 49

LAD, V1-V4

Front 50

diagnosing MI location: anteroseptal

Back 50

LAD; V1-V2

Front 51

diagnosing MI location: anterolateral

Back 51

LAD or LCX; V4-V6

Front 52

diagnosing MI location: lateral wall

Back 52

LCX; I, AVL

Front 53

diagnosing MI location: inferior wall

Back 53

RCA, II, III, AVF

Front 54

MI complication

Back 54

**arrhythmia (early complication, esp before reaching hospital)
cardiogenic shock
ventricular free wall rupture
friction rub day 1-3
dressler syndrome (after weeks/months)

Front 55

DCM

Back 55

-Most common type
-Causes ABCCCD: alcohol, wet beriberi, coxsackie B, cocaine, chagas, doxorubicin
also pregnancy

Front 56

Dilated cardiomyopathy dx and tx

Back 56

Findings: HF, S3, dilated heart w/ balloon appearance on EKG, eccentric hypertrophy and systolic dysfunction

Tx: Na restriction, ACE inhib, beta blocker, diuretic, digoxin, ICD, transplant

Front 57

HCM

Back 57

most are familial, AD defect of beta myosin heavy chain (sarcomere problem)
-Can be assoc w/ Friedrich ataxia (rarely)
-Sudden cardiac death in athletes

Front 58

HCM dx and tx

Back 58

findings: S4, systolic murmur, myofibrillar disarray and fibrosis on path, concentric hypertrophy, diastolic dysfunction
Tx: Stop high-intensity athletics, use beta blocker or Ca blocker, ICD if high risk.

Front 59

obstructive HCM

Back 59

subset w/ hypertrophied septum too close to anterior mitral leaflet >> outflow obstruction >> dyspnea, syncope
-functional AS

Front 60

RCM

Back 60

Major causes are sarcoid, amyloid, post-RT fibrosis, hemochromatosis, Loffler syndrome (endomyocardial fibrosis w/ Eos)

Front 61

RCM presentation

Back 61

diastolic dysfunction, low-voltage EKG despite thick myocardium

Front 62

HF

Back 62

cardiac pump dysfunction

Front 63

LHF

Back 63

can be due to ischemia, HTN, DCM, MI, RCM

Sx include dyspnea, orthopnea, fatigue, rales, JVD, pitting edema, RAS activation

Front 64

Systolic dysfunction

Back 64

low EF, poor CTY, often secondary to ischemic HD or DCM

Front 65

diastolic dysfunction

Back 65

normal EF and CTY, impaired relaxation, decreased CPL.

Front 66

RHF

Back 66

most often results from LHF. Isolated RHF usually due to cor pulmonale

Sx include JVD, HSM, nutmeg liver, pitting edema

Front 67

decreasing mortality w/ HF

Back 67

ACE inhib, beta blockers, ARB, spironolactone decrease mortality
-thiazides/loop diuretics relieve sx
-hydralazine + nitrates can improve sx and mortality in some

Front 68

cardiac dilation

Back 68

due to greater EDV

Front 69

dyspnea on exertion

Back 69

due to failure of CO to increase w/ exercise

Front 70

presentation of bacterial endocarditis

Back 70

bacteria FROM JANE
fever, roth spots, osler nodes, murmur, janeway lesions, anemia, nail-bed hemorrhage, emboli

Front 71

bacterial endocarditis location

Back 71

Mitral valve is most common; tricuspid in drug user. can cause chordae rupture, glomerulonephritis, pericarditis, emboli

Front 72

acute bacterial endocarditis

Back 72

staph aureus; see vegetations on previously normal valves. Rapid onset, large vegetations that destroy valves.

Front 73

subacute bacterial endocarditis

Back 73

strep viridans; see smaller vegetations on already abnormal valve. Thrombotic vegetations trap transient bacteria after dental procedure.

low virulence org can only infect abnormal valves

Front 74

other causes

Back 74

-staph epidermis on prosthetic valve
-strep bovis in colon cancer pts
-coxiella burnettii or bartonella if neg culture

Front 75

rheumatic fever

Back 75

consequent to pharyngeal infection w/ GAS
Death due to myocarditis or late-developing valve lesion mitral > aortic >> tricuspid. MR then MS

Front 76

rheumatic fever mechanism

Back 76

Type II hypersensitivity rxn, not a direct effect of bacteria. AB for M protein cross react w/ self.
**molecular mimicry

Front 77

rheumatic fever signs and sx

Back 77

Evidence of prior GAS infection: ASO or anti-DNase B titer, fever, high ESR, major criteria

Aschoff bodies (granuloma w/ giant cells)

Front 78

rheumatic fever major criteria

Back 78

JONES
joint polyarthritis, endocarditis, subq nodules, erythema marginatum, sydenham chorea

Front 79

acute pericarditis

Back 79

sharp pain worse w/ inspiration, relieved by sitting up/forward. Friction rub.
ECG: widespread STE, PR depression

Front 80

fibrinous type

Back 80

dressler syndrome, uremia, radiation. see loud friction rub

Front 81

serous

Back 81

viral; resolves spontaneously often

Front 82

suppurative

Back 82

bacterial like strep pneumo. rare w/ AB

Front 83

cardiac tamponade

Back 83

heart compressed by fluid in pericardium >> decreased CO.
-see equal diastolic pressure in all chambers
-Beck triad of hypotension, distended neck veins, distant heart sounds
-increased HR, pulsus paradoxus, Kussmaul sign
-low-voltage EKG, electrical alternans

Front 84

pulsus paradoxus

Back 84

decrease in aplitude of SBP by 10+mm during inspiration. seen in cardiac tamponade, asthma, OSA, croup, pericarditis

Front 85

syphilitic heart dz

Back 85

tertiary syph disrupts the vasa vasorum of the aorta >> atrophy of vessel wall, aortic dilation.
-calcifications of aorti root and ascending arch >> tree bark appearance.
-aneurysm of ascending aorta/arch

Front 86

most common cardiac tumor

Back 86

met
come from breast, lung, melanoma, lymphoma

Front 87

myxoma

Back 87

most common primary cardiac tumor; pedunculated valve obstruction in LA associated w/ syncopal episodes

arises from mesenchyme

Front 88

rhabdomyoma

Back 88

most common primary cardiac tumor in kids; assoc w/ TSC

benign hamartoma that arises in vents

Front 89

Kussmaul sign

Back 89

paradoxical increase in JPV on inspiration seen w/ constrictive pericarditis, RCM, RH tumors

insp >> negative intrathoracic pressure not transmitted to heart >> impaired RV filling >> blood backs up into VC >> JVD.

Front 90

Raynaud phenomenon

Back 90

decreased blood flow in skin due to arteriolar vasospasm in response to cold temp or stress.
-Raynaud dz is idipathic
-syndrome when secondary to a CT dz, SLE

Front 91

strawberry hemangioma

Back 91

benign capillary tumor of infancy that grows rapidly and spontaneously regresses at 5-8yrs

Front 92

cherry hemangioma

Back 92

benign cap tumor of elderly that does not regress.

Front 93

cystic hygroma

Back 93

cavernous lymphangioma of neck. assoc w/ turner's

Front 94

bacillary angiomatosis

Back 94

benign capillary skin papules in AIDS pts due to bartonella. Mistaken often for kaposi's

Front 95

angiosarcoma

Back 95

rare blood vessel malignancy in head, neck, breast. Seen in elderly, sun-exposed areas. Assoc w/ RT, arsenic. aggressive and tough to resect.

Front 96

lymphangiosarcoma

Back 96

lymphatic malignancy assoc w/ persistent lymphedema, like post mastectomy. See persistent arm swelling 10 years after mastectomy

Front 97

Kaposi sarcoma

Back 97

endothelial malignancy of skin or mouth, assoc w/ HHV8 and HIV.
-older eastern european men, AIDS pt, transplant recipients

Front 98

temporal arteritis

Back 98

affects branches of carotid; see unilateral headache, jaw pain in elderly females.
-can cause blindness
-granulomatous inflammation and high ESR
-corticosteroids prior to temporal artery biopsy

Front 99

Takayasu arteritis

Back 99

granulomatous thickening/narrowing of aortic arch in Asian females under 40
-weak UE pulses, fever, arthralgia, night sweats
-corticosteroids

Front 100

Polyarteritis nodosa

Back 100

immune-complex mediated vasculitis of renal and visceral vessels in in yount adults, esp HB+
-fever, wt loss, abd pain, melena, HTN
-corticosteroids
-spares the lung

Front 101

Kawasaki Dz

Back 101

vasculitis in asian kids <4 yrs
-fever, cervical lymph, strawberry tongue
-may dev CA aneruysm >> MI
-Tx is IVIG and aspirin

Front 102

Buerger dz

Back 102

segmental thrombosing vasculitis in heavy smokers male 40+
-gangrene of digits, raynaud
-quit smoking

Front 103

Wegeners

Back 103

C disease: affects nasopharynx, lungs, kidney. C-ANCA positive; tx is cyclophosphamide, corticosteroids
-large nodules on CXR
-C-ANCA: cytplasmic anti-neutrophil cytoplasmic AB

Front 104

Microscopic polyangitis

Back 104

Similar to Wegeners but no nasopharyngeal involvement
same tx
-P-ANCA - perinuclear staining

Front 105

Churg-Strauss

Back 105

asthma, peripheral neuropathy, granulomatous necrotizing vasculitis w/ eos.
P-ANCA

Front 106

Henoch-Schonlein purpura

Back 106

most common childhood systemic vasculitis; often follows URI
-palpable purpura, arthralgia, abd pain
-Secondary to IgA complex deposition
-assoc w/ IgA nephropathy