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165 Cards in this Set
- Front
- Back
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most common cause of early cyanosis
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tetralogy of fallot
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right to left shunts (5)
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tetralogy of fallot
transposition of great vessels truncus arteriosus tricuspid atresia TAPVR (total anomalous pulmonary venous return) |
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tricuspid atresia characteristics (4)
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absence of tricuspid valve
hypoplastic right ventricle requires both ASD and VSD for viability |
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L-->R shunts
frequency? |
VSD > ASD > PDA
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cause of
early cyanosis vs. late cyanosis |
early: right-to-left
late: left-to-right (reversal of shunt later on, causes cyanosis) |
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ASD description of heart sounds
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loud S1
wide, fixed, split S2 |
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most common congenital cardiac anomaly
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VSD
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Eisenmenger's syndrome
3 sxs |
late cyanosis
clubbing polycythemia |
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tetralogy of fallot (4)
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PROVe
pulmonary stenosis RVH overriding aorta (overrides the VSD) VSD |
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tetralogy of fallot imaging
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x-ray shows boot-shaped heart because of RVH
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tetralogy of fallot is caused by _
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anterosuperior displacement of the infundibular septum
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a patient with tetralogy of fallot squats because...
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compression of femoral arteries -->
^ TPR --> v R-->L shunt directing more blood from the R ventricle to the lungs |
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transposition of great vessels is due to
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failure of aorticopulmonary septum to spiral
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coarctation of the aorta is associated with _
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turner's syndrome
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adult coarctation of the aorta sxs (2)
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notching of the ribs (due to collateral circulation)
hypertension in upper extremities, weak pulses in lower extremities |
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coarctation of the aorta is most commonly associated with _
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bicuspid aortic valve
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adult coarctation of the aorta can result in
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aortic regurgitation
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adult coarctation of the aorta is most commonly associated with
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bicuspid aortic valve
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patency of ductus arteriosus is maintained by (2)
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PGE synthesis
low O2 tension |
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uncorrected PDA can eventually result in
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late cyanosis in the lower extremities
[2^ reversal of shunt] [note that ductus empties distal to the subclavian, so the upper extremities would not receive the shunted blood] |
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22q11 syndromes --> congenital heart defects
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truncus arteriosus
tetralogy of fallot |
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down syndrome -->
congenital heart defects |
ASD
VSD AV septal defect (endocardial cushion defect) [laying "down" on the cushions] |
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congenital rubella -->
congenital heart defects |
septal defects
PDA pulmonary artery stenosis |
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turner syndrome -->
congenital heart defects |
preductal coarctation of the aorta
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marfan's syndrome -->
congenital heart defects |
aortic insufficiency (late complication)
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congenital heart defect in infant of diabetic mother
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transposition of great vessels
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___ --> transposition of great vessels
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diabetic mother
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____ congenital defect --> aortic insufficiency
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marfan's
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___ congenital defect --> coarctation of the aorta
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turner's
(preductal coarctation, specifically) |
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___ congenital defect -->
septal defects, PDA, pulmonary artery stenosis |
rubella
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___ congenital defect --> truncus arteriosus, tetralogy of fallot
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22q11 syndromes
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hypertension risk factors
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aged DOGS
age diabetes obesity genetics smoking black > white > asian |
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90% of hypertension is _
10% is mostly... |
primary, and related to ^ CO and ^ TPR
secondary to renal disease |
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hyperlipidemia signs
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atheromas
xanthomas tendinous xanthoma corneal arcus |
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atheromas are
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plaques in vessel walls
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xanthomas are
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plaques or nodules composed of
lipid-laden histiocytes in the skin esp at the eyelids (xanthelasma) |
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corneal arcus is
aka |
lipid deposit in cornea
(arcus senilis) |
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arteriosclerosis types
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monckeberg
arteriolosclerosis atherosclerosis |
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monckeberg arteriosclerosis characteristics
3 that it is, 3 that it isn't |
calcification of the media
esp: radial or ulnar "pipestem" arteries usu. benign does not obstruct blood flow intima not involved |
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arteriolosclerosis
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hyaline thickening of small arteries in
essential htn diabetes mellitus |
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_ is a histopathology seen in malignant htn
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hyperplastic onion skinning
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atherosclerosis is a disease of _ arteries
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elastic arteries
large and medium muscular arteries |
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risk factors for atherosclerosis
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smoking
hypertension diabetes hyperlipidemia family history |
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progression of atherosclerosis
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endothelial cell dysfunction -->
macrophage and LDL accumulation --> foam cell formation --> fatty streaks --> smooth muscle cell migration [to the intima] (involves PDGF and TGF-beta) --> fibrous plaque --> complex atheromas |
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complications of atherosclerosis
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aneurysms
ischemia infarcts peripheral vascular disease thrombus emboli |
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which arteries does atherosclerosis affect the most frequently?
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abdominal aorta >
coronary artery > popliteal artery > carotid artery |
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symptoms of atherosclerosis
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angina
claudication can be asymptomatic |
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aortic dissection is associated with (2) notable causes
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hypertension
cystic medial necrosis (a component of Marfan's) |
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aortic dissection diagnosis (2)
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tearing chest pain radiating to the back
CXR shows mediastinal widening |
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EKG findings:
stable angina prinzmetal's angina unstable/crescendo angina |
ST depression
ST elevation ST depression |
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unstable/crescendo angina is caused by _
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thrombosis but no necrosis
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frequency of coronary artery occlusion
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LAD > RCA > circumflex
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evolution of MI
gross appearance of heart |
1st day
--dark mottling --pale with tetrazolium stain 2-4 days hyperemia 5-10 days --hyperemic border --central yellow-brown softening 7 weeks gray-white |
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evolution of MI: microscopic pathology
first day |
no visible change by light microscopy till 2-4 hours
12-24 hrs --contraction bands 4 hours --coagulative necrosis --neutrophil emigration |
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evolution of MI: microscopic pathology
2-4 days |
surrounding tissue: acute inflammation
hyperemia neutrophil emigration coagulative necrosis |
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evolution of MI: microscopic patholgy
5-10 days |
macrophages have degraded structural components
ingrowth of granulation tissue |
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risks for bad outcomes during the evolution of MI across the days and weeks
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1st day: arrhythmia
2-4 days: arrhythmia 5-10 days: --free wall rupture --tamponade --papillary muscle rupture --interventricular septal rupture 7 weeks --ventricular aneurysm |
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diagnosis of MI:
ECG |
gold standard in the first 6 hours
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diagnosis of MI:
cardiac troponin I |
rises after 4 hours
elevated 7-10 days more specific than other protein markers |
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diagnosis of MI:
CK-MB |
found in myocardium and skeletal muscle
useful for diagnosing reinfarction |
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in diagnosis of MI, AST is nonspecific and is found in...
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cardiac
liver skeletal muscle |
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transmural infarct
EKG changes |
ST elevation
pathologic Q waves |
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subendocardial infarct
EKG changes |
ST depression
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why is subendocardium esp. prone to MI
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--especially prone to ischemia
--fewer collaterals --higher pressure |
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ECG diagnosis of MI:
LAD-affected areas |
anterior wall: V1-V4
anteroseptal: V1-V2 |
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ECG diagnosis of MI
LCX-affected areas |
anterolateral: V4-V6
lateral wall: I, aVL |
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ECG diagnosis of MI:
RCA-affected areas |
inferior wall: II, III, aVF
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MI complications
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arrhythmia
LV failure, pulmonary edema cardiogenic shock free wall rupture --> tamponade papillary muscle rupture --> severe mitral regurgitation IV septal rupture --> VSD aneurysm -- v CO --arrhythmia --embolus from mural thrombus postinfarction fibrinous pericarditis (3-5 days post-MI) Dressler's syndrome --autoimmune fibrinous pericarditis (several weeks) |
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cardiomyopathies
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dilated (congestive)
hypertrophic restrictive/obliterative |
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the most common cardiomyopathy
how common is it? |
dilated (congestive)
90% of cases |
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etiologies of dilated cardiomyopathy
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chronic alcohol
wet Beriberi coxsackie B virus myocarditis chronic cocaine chagas' disease doxorubicin hemochromatosis peripartum cardiomyopathy |
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hemochromatosis -->
what kind of cardiomyopathy? |
dilated (congestive)
restrictive/obliterative |
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clinical / diagnostic findings of dilated (congestive) cardiomyopathy
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S3
dilated heart on ultrasound balloon appearance on x-ray |
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clinical / diagnostic findings of hypertrophic cardiomyopathy (5)
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normal-sized heart
S4 apical impulses systolic murmur at left sternal border syncopal episodes |
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which one of the cardiomyopathies is especially known for syncopal episodes
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hypertrophic cardiomyopathy
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which one of the cardiomyopathies is known for systolic dysfunction?
(the others are diastolic dysfunction) |
dilated (congestive)
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a cause of sudden death in young athletes
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hypertrophic cardiomyopathy
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hypertrophic cardiomyopathy pathophys behind its murmur
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hypertrophied IV septum is
too close to mitral valve leaflet --> outflow tract obstruction |
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hypertrophic cardiomyopathy genetic associations
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50% are familial dominant
associated with Friedrich's ataxia |
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treat hypertrophic cardiomyopathy with
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beta-blocker
or non-dihydropyridine Ca++ channel blocker e.g. verapamil |
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restrictive/obliterative cardiomyopathy major causes include
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"L-SHAPE"
Loffler's syndrome sarcoidosis hemochromatosis amyloidosis postradiation fibrosis endocardial fibroelastosis |
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endocardial fibroelastosis =
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thick fibroelastic tissue in
endocardium of young children |
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loffler's syndrome =
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endomyocardial fibrosis
eosinophilic infiltrate |
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pulmonary edema in CHF causes what sound?
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rales
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heart-failure cells are __
due to __ |
hemosiderin-laden macrophages in the lungs
microhemorrhages from ^ capillary pressure |
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bacterial endocarditis mnemonic
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FROM JANE
fever roth's spots osler's nodes murmur janeway lesions anemia nail-bed hemorrhage emboli |
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complications of bacterial endocarditis (4)
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chordae rupture
glomerulonephritis suppurative pericarditis emboli |
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tricuspid valve endocarditis is associated with IV drug use.
what microorganisms? |
staph aureus
pseudomonas candida |
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bacterial endocarditis: most common symptom
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fever
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roth's spots
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round white spots on retina
surrounded by hemorrhage |
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osler's nodes
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tender raised lesions on
finger or toe pads |
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janeway lesions
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small erythematous lesions
on palm or sole |
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____ is necessary for diagnosis of bacterial endocarditis
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multiple blood cultures
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___ usually allow subacute bacterial endocarditis to occur (3)
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congenitally abnormal or diseased valves
sequela of dental procedures |
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endocarditis may be nonbacterial 2^
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malignancy
hypercoagulability |
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s. aureus causes acute bacterial endocarditis
viridans strep cause subacute bacterial endocarditis other bugs?? |
strep bovis -- colon cancer
s. epidermidis -- prosthetic valves HACEK organisms -- culture-negative endocarditis |
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HACEK organisms
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haemophilus
actinobacillus cardiobacterium eikenella corrodens kingella |
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libman-sacks endocarditis (3)
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wart-like
sterile vegetations both sides of valve |
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frequency of complications re: libman-sacks endocarditis
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benign > mitral regurg > mitral stenosis
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rheumatic heart disease can cause early deaths by __
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myocarditis
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rheumatic heart disease mnemonic
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FEVERS S
fever erythema marginatum valvular damage ESR red-hot joints (migratory polyarthritis) subcutaneous nodules st. vitus' dance (chorea) |
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most common early vs. late lesion of rheumatic heart disease
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mitral prolapse
mitral stenosis |
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3 lab / histopath findings re: rheumatic heart disease
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aschoff bodies (granuloma with giant cells)
anitschkow's cells (histocytes) ^ ASO titers |
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rheumatic heart disease is mediated by
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type II hypersensitivity
antibodies to M protein |
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cardiac tamponade:
(7) |
v CO
^ HR equilibration of diastolic pressures in all 4 chambers hypotension JVD distant heart sounds pulsus paradoxus |
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pulsus paradoxus
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exaggerated v in amplitude of pulse during inspiration
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pulsus paradoxus is seen in (5)
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tamponade
asthma obstructive sleep apnea pericarditis croup |
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syphilitic heart disease (5)
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disrupts vasa vasorum
aneurysm/dilation valve incompetence calcification "tree bark" appearance |
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cardiac tumors
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myxomas (most common 1^ tumor in adults)
rhabdomyomas (most common 1^ tumor in children) metastases are the most common heart tumor (melanoma, lymphoma) |
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varicose veins -->
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poor wound healing
varicose ulcers |
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raynaud's disease -->
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cold, emotional stress
--> arteriolar vasospasm --> v bloodflow to skin usu @ fingers and toes |
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raynaud's phenomenon is 2^ what?
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mixed connective tissue disease
SLE CREST syndrome |
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vasculitides that affect small vessels
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small:
raynaud's wegener's granulomatosis --microscopic polyangiitis --1^ pauci-immune crescentic glomerulonephritis --Churg-Strauss Sturge-Weber Henoch-Schonlein-Purpura |
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vasculitides that affect small and medium vessels
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small and medium vessels:
--buerger's disease --kawasaki disease small and medium arteries: --polyarteritis nodosa |
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medium vessel diseases cause _
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thrombosis / infarction of arteries
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vasculitides that affect medium and large arteries
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takayasu's arteritis
temporal arteritis |
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temporal arteritis is aka
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giant cell arteritis
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vascular tumors (9)
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strawberry hemangioma
cherry hemangioma pyogenic granuloma cystic hygroma glomus tumor bacillary angiomatosis angiosarcoma lymphangiosarcoma Kaposi's sarcoma |
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wegener's granulomatosis triad
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focal necrotizing vasculitis
necrotizing granulomas in lung and upper airway necrotizing glomerulonephritis |
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wegener's granulomatosis sxs
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hemoptysis
hematuria perforation of nasal septum chronic sinusitis otitis media mastoiditis cough dyspnea |
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wegener's granulomatosis diagnostic findings (4)
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c-ANCA
cxr: large nodular densities hematuria red cell casts |
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wegener's granulomatosis rx
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cyclophosphamide and corticosteroids
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ANCA-positive vasculitides
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Wegener's granulomatosis
-- c-ANCA microscopic polyangiitis -- p-ANCA 1^ pauci-immune crescentic glomerulonephritis churg-strauss -- p-ANCA |
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microscopic polyangiitis (2)
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like wegener's but lacks granulomas
p-ANCA |
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churg-strauss (9)
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granulomatous vasculitis
eosinophilia asthma sinusitis --skin lesions --peripheral neuropathy (e.g. wrist/foot drop) can involve: --heart --GI --kidneys |
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sturge-weber (4)
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congenital:
port-wine stain (nevus flammeus) on face ipsilateral leptomeningeal angiomatosis seizures early-onset glaucoma |
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henoch-schonlein purpura sxs (5)
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rash @ buttocks and legs
arthralgia intestinal hemorrhage abdominal pain melena |
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the most common childhood systemic vasculitis
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henoch-schonlein purpura
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describe henoch-schonlein purpura rash
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palpable purpura @ buttocks and legs
multiple lesions of the same age |
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buerger's disease is aka
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thromboangiitis obliterans
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thromboangiitis obliterans is aka
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buerger's disease
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what type of vasculitis is buerger's disease? (4)
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idiopathic
segmental thrombosing @ small and medium vessels |
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buerger's disease sxs
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intermittent claudication
superficial nodular phlebitis cold sensitivity (Raynaud's) severe pain |
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buerger's disease sequelae
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gangrene
autoamputation of digits |
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kawasaki disease: what kind of vasculitis? (4)
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acute
self-limiting necrotizing small and medium vessels |
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kawasaki disease sxs (5)
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fever
conjunctivitis changes in lips/oral mucosa ("strawberry tongue") lymphadenitis desquamative skin rash |
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kawasaki disease rx
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IV Ig
aspirin |
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polyarteritis nodosa what type of vasculitis? (3)
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immune complexes
transmural fibrinoid necrosis |
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polyarteritis nodosa sxs (8)
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fever/malaise
headache abdominal pain melena weight loss hypertension neurologic dysfunction cutaneous eruptions |
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polyarteritis nodosa typically involves what vessels?
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renal
visceral not pulmonary |
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a vasculitis that is associated with hepatitis B in 30% of patients
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polyarteritis nodosa
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polyarteritis nodosa diagnostic findings
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hepatitis B seropositivity in 30% of pts
aneurysms and constrictions on arteriogram |
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polyarteritis nodosa rx
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corticosteroids
cyclophosphamide |
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pulseless disease is aka
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takayasu's arteritis
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takayasu's arteritis pathology details
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granulomatous thickening of
aortic arch and/or proximal great vessels medium and large arteries |
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takayasu's arteritis
lab & epi |
^ ESR
asian females < 40 |
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takayasu's arteritis sxs
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Fever
Night sweats Arthritis Myalgia SKIN Nodules Ocular disturbances Weak pulses in upper extremities |
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the most common vasculitis affecting medium and large arteries
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temporal arteritis
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temporal arteritis epi
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elderly females
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temporal arteritis pathology
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focal
granulomatous medium and large arteries |
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temporal arteritis sxs and findings (6)
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unilateral headache
jaw claudication impaired vision (ophthalmic artery occlusion, may --> blindness) ^ ESR half of patients --systemic involvement and --polymyalgia rheumatica |
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temporal arteritis rx
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high-dose steroids
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steroids are specifically listed for which vasculitides in first aid?
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wegener's granulomatosis
polyarteritis nodosa temporal arteritis |
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henoch-schonlein purpura:
pathology, pathophys (3) |
follows URIs
IgA immune complexes associated with IgA nephropathy |
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strawberry hemangioma (3)
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benign
infancy initally grows, then spontaneously regresses |
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cherry hemangioma
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benign
elderly -- frequency ^ with age does not regress |
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pyogenic granuloma
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polypoid capillary hemangioma
can ulcerate and bleed associated with trauma and pregnancy |
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something in neck of turner's syndrome patients is called __
it is __ |
cystic hygroma
cavernous lymphangioma |
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glomus tumor is
|
benign
painful red-blue tumor under fingernails |
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glomus tumor comes from
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modified smooth muscle cells of glomus body
|
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bacillary angiomatosis (4)
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benign
capillary skin papules AIDS patients Bartonella henselae |
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angiosarcoma (5)
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highly lethal malignancy
liver vinyl chloride arsenic ThO2 (thorotrast) |
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lymphangiosarcoma
|
lymphatic malignancy
associated with persistent lymphedema (e.g. post-radical mastectomy) |
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post-radical mastectomy, pt may be at risk of _ tumor
why? |
lymphangiosarcoma
associated with persistent lymphedema |
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kaposi's sarcoma is a _ _ of the skin
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endothelial malignancy
|
