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114 Cards in this Set
- Front
- Back
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What leads to Pulseless disease?
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Takayasu Arteritis, due to granulomatous inflammation, aneurysm formation, and dissection of the coronary, carotid, and renal arteries.
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What multisystem counterpart of the IgA nephropathy occurs in children?
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Henoch-Schonlein purpura. Involves mainly small arterioles and capillaries of the skin.
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What conditions are usually associated with aortic dissection?
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Old age, hypertension, and Marfan's syndrome.
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What condition does Marfan's syndrome lead to?
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Cystic medial degeneration, which can lead to aortic dissection.
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Risk factors of diabetes melitis?
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Artheroclerosis and aortic aneurysm.
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What condition is associated with tree bark appearance?
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Syphilitic aorta, obliterative endartitis. would have antibodies to Treponema pallidum.
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Related to bedrest and pain and swelling in legs, which worsens with raising the leg or movement.
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Thrombophlebitis,
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Main cause of essential hypertension?
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Kidneys over retention of Na+.
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What condition increases blood pressure by excess release of catecholamines..
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Pheochromocytoma.
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What is the first cell to be involved in artherosclerosis?
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Endothelial cells.
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What will varicose veins most likely lead to?
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Statis Dermatitis. Due to venus stasis which leads to hemasiderin deposition.
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What virus is associated with Karposi Sarcoma?
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Human herpesvirus-8, HHV8
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What condition is positive for C-ANCA, causes necrotizing granulomatous vasculitis in the lungs of the small arterioles?
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Wegener granulomatosis.
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What is Poly arteritis nodosa?
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Vasculitis of the small muscular arteries causing necrosis and microaneurysm formation followed by scarring and vascular occlusion mainly in kidneys and GI tract.
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What are varices?
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They are veins that have dilated due to blocked venous drainage.
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What promotes smooth muscle proliferation?
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Platelet Derived Growth Factor (PDGF)
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What are fatty streaks made up of?
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Lipid filled foam cells and small number of T-lymphocytes. These form in everyone >10 Yr
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What form of artheroslerosis is found in older people and has no serious sequelae?
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Monckeberg medial calcific sclerosis. It is the calcification of arteries of the elderly.
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What does Lymphadema sometimes lead to?
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More often cellulitis, but can lead to angiocarcinoma more than 10 years.
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What is the first cell to enter in the arothoma equation after damage to the endothelial cell?
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T-cells. They enter the damaged area and recruit inflammatory cells to the site initiating the arothoma plaque production.
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What produces an audible bruit on ausculation?
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arteriovenous fistula
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What condition is characterized by occlusion of the small muscular arteries of the lower extremities of smokers?
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Buerger's disease, AKA Thromboangiitis obliterans
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What condition can lead to pulmonary artery hypertension?
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Emphysema
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What is the worst side effect of Giant cell Temporal arteritis?
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Blindness
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Hepatitis B can be associated with which vasculitis.
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Polyarteritis nodosa, the antibody tested for is HBsAg.
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What are the four major treatable risk factors of artherosclerosis?
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Hyperlipidemia, hypertension, cigarette smoking, and diabetes.
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What are the four major nontreatable risk factors of artherosclerosis?
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Age, Male gender, Family history, and genetic abnormalities.
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What is a associated condition of micronodular cirrhosis?
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Spider Telangiectasias caused by estrogen excess from the liver. All arising from chronic alcoholism.
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What is a risk factor of Kowasaki's disease.
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Vasculitis of the small, medium, and large arteries. Leading to cardiac problems such as MI.
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What vasculitis is associated with asthma?
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Churg-Strauss vasculitis.
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What promotes smooth muscle proliferation?
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Platelet Derived Growth Factor (PDGF)
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What are fatty streaks made up of?
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Lipid filled foam cells and small number of T-lymphocytes. These form in everyone >10 Yr
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What form of artheroslerosis is found in older people and has no serious sequelae?
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Monckeberg medial calcific sclerosis. It is the calcification of arteries of the elderly.
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What does Lymphadema sometimes lead to?
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More often cellulitis, but can lead to angiocarcinoma more than 10 years.
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What is the first cell to enter in the arothoma equation after damage to the endothelial cell?
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T-cells. They enter the damaged area and recruit inflammatory cells to the site initiating the arothoma plaque production.
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What laboratory assay is good to assess someone's artherosclerotic disease risk?
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C-reactive Protein (CRP)
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What condition has Aschoff bodies and Anitschkow cells?
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Rheumatic Fever
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What causes Rheumatic fever?
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Group A Strep infection
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What is Jones Criteria for Rheumatic fever?
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J= Joints for Migratory Polyarthritis
O= Carditis= Endocarditis, pericarditis, and myocarditis N= Nodule (subcutaneous nodules, extensor surfaces) E= Erythema marginatum S= Sydenham's Chorea (late) |
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What valvular problems are with Rheumatic fever?
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Mitral and aortic valve stenosis or regurgitation.
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What is the virus associated with pericarditis?
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Coxsackie
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What has a velcro or leather rubbing sound to it?
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Pericarditis
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What is associated with right sided endocarditis?
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IV drug use
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What bacteria destroys the valve of heart in few days?
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Staph Aureus
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What is an autoimmune endocarditis?
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Libman-Sacks, caused by SLE usually. Vegetations not as severe as IE, usually do not embolize.
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What is the typical CHF type with systolic failure?
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Dilated (congested) Cardiomyopathy
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What cardiomyopathy is responsible for athletes to drop dead?
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HOCM Hypertrophic obstructive cardiomyopathy. Systolic murmur that gets louder with vavalsalva maneuver.
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What are the causes of Restrictive Cardiomyopathy?
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Amyloidosis, myocardial fibrosis post surgery or radiation, infiltrative heart dz: hemochromatosis, Pompe's dz, and sarcoidosis.
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What condition is associated with too high an ejection faction?
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Restrictive Cardiomyopathy
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Who does Kowasaki syndrome affect?
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Kids only, and has no known cause.
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What heart defect is associated with Turner's syndrome?
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Coarctation of the aorta.
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What condition causes loss of pulses in the upper extremities?
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Takayaso's Arteritis, Characterized by granulomatous inflammation of the aorta and vessels coming off especially carotids.
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What is Cor Pulmonale?
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Pure right sided heart failure, no left side involvement.
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What is a paradoxical embolis?
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It is an embolis from the venous circulation that has made it's way to the left side of the heart via ASD, VSD, or PDA and infarcted systemic arteries.
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What is polycythemia and what causes it?
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Polycythemia is an increase in the red cell population brought on usually by sustained hypoxemia.
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What are roth spots?
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they are round white spots found on the retina early in the course of endocarditis.
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What is Barlow's syndrome?
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It is a synonym for floppy mitral valve.
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What is the parasite that causes Chaga's disease?
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Trypanosoma cruzi, found mostly in South America.
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What BP's values are considered hypertension?
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Systolic > 160 and Diastolic > 90.
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What is the difference between sensitivity and specificity?
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High sensitivity means patients with a injury always test positive. High specificity is when patients who don't have injury do not test positive.
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What test in an MI is very sensitive thus good at ruling out MI's?
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Myoglobin, which can present changed within 2 hours. Is very sensitive as biomarker.
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What test is high for specificity and sensitivity for MI?
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Tropinin I
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What Creatine Kinase is most often found in Cardiac cells?
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CK-MM, then CK-MB, but MB is higher than in outer muscle cells.
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What Creatine Kinase Isoenzyme is found in the Brain?
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CK-BB mostly, but also has some CK-MM.
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What is the most common cause of heart failure?
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An abnormality of the pump itself is the number one cause. However, there are others, loss of functional heart muscle, something that interferes with the filling of the cardiac chambers, excessive work demands placed on ventricles, and disordered electrical activity (arrhythmias).
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What is orthopnea?
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Shortness of breath (dyspnea) while lying down.
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What factors affect Stoke Volume the most?
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Preload, afterload, and contractility.
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What are the main determinants of afterload?
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Peripheral vascular resistance,blood pressure, and aortic compliance.
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What arteries are the principle point of hypertension control?
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Arterioles
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What are some promoters of vascular smooth muscle cells?
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Main one is PDGF (platelet derived growth factor), endothelin 1, thrombin, FGF, IFN(gamma), IL-1,
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What are some inhibitors of vascular smooth muscle cells?
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Heparan sulfates, Nitric Oxide, TGF-b
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What are the 3 types of arteriosclerosis?
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1. Arteriosclerosis: thickening and loss of elasticity of arterial walls. 2. Monckeberg medial calcific sclerosis: calcific deposits in muscular arteries in people >50. 3. Arteriolosclerosis: small arteries and arterioles with thickened vessel walls and luminal narrowing, which is associated with HTN and Diabetes Mellitis. With Hyaline (onion) and hyperplastic variants.
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What is the most common arteries to have artherosclerosis?
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Abdominal aorta > coronary arteries > popliteal arteries > descending thoracic aorta > internal carotid arteries > circle of willis
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Describe the basic structure of an artherosclerotic plaque.
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Intimal thickening and lipid accumulation, Raised white yellow intimal-based lesion with prominence around ostia of major branching points. Plaque composed of 1. superficial fibrous cap: smooth muscle cells, leukocytes, dense connective tissue (ECM). 2. Necrotic lipid laden core of foam cells, cholesterol clefts, and dead cells. 3. Periphery has neovascularization.
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What are the four treatable risk factors for artherosclerosis?
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Hyperlipidemia, hypertension, cigarette smoking, and diabetes.
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What are the non-modifiable risk factors for Artherosclerosis?
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Age, male gender, family history, and genetic abnormalities.
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What is important in the initiation and growth of an artherosclerotic plaque?
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Initiated by injury to the endothelium, then chronic inflammatory process procedes with interaction of modified lipoproteins, macrophages, T lymphocytes, smooth muscle cell proliferation and migration, lipoproteins gain entry into injuried vessel become oxidized and eaten by macrophages which then die. Causes of injury can be hyperlipidemia, smoking, hypertension, immune attack, disturbed flow, and toxins.
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What oxidizes LDL's in plaques?
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Monocytes enter plaque and engulf LDLs that have entered injured area, and oxidize the LDL becoming Foam cells themselves. Oxidized LDL's in foam cells paralyze the macrophages. Smooth muscle cells can also become foam cells by taking up the LDL and oxidizing it.
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What is hyaline arteriolosclerosis and who does it occur in?
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Occurs in older people, more generalized in hypertension, Diabetics, major part of benign nephrosclerosis.
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What is hyperplastic Arteriolosclerosis (onion skin) and who does it occur in?
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It is onion skin concentric laminated thickening of vessel walls. Occurs in Maliginant hypertension (acute elevations), and vasculitides.
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What is a True Aneurysm?
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It is bound by all 3 arterial wall layers. Caused by artherosclerosis and cystic medial degeneration.
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What is a false aneurysm?
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This is a breach in a vessel wall leading to hematoma that communicates with intravascular space. Caused by artherosclerosis and cystic medial degeneration.
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What is important about aortic aneuryms?
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Typically occur in men > 50 yr. Risk of rupture correlates with size, minimal risk < 5cm, 5-10% annual risk if greater than 5cm, 25% annual risk if >6cm. Has a high operative mortality, 5% for unruptured, and 50% for ruptured. Most commonly inbetween Renal arteries and biforcation.
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What can C-reactive protein do?
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It is an important assessor of potential cardiovascular risk in normal healthy individuals. It is an acute phase reactant that increases in response to inflammation. It causes endothelial cell activation, promotes thrombosis, and increases leukocyte adherence in atheromas.
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What aortic condition does syphilus cause?
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Tertiary syphilis is called Treponema pallidum. It usually affects the ascending aorta and arch, leading to valvular insufficiency which can cause left side overload and hypertrophy (cor bovinum). It is characterized by inflammation of the vasa vasorum with eventual obliterative endarteritis often with plasma cells around. The intimal surface often described as looking like tree bark. Leads to heart failure but rarely ruptures.
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Aortic dissection is often seen in who?
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Dissection of blood along laminar planes of aortic media forming a blood filled intramural channel. Rupture= massive hemorrhage and sudden death usually. 1. Men 40-60 YR. who are hypertensive. 2. People with connective tissue diseases affecting the aorta like Marfan syndrome, defect in fibrillin gene. Causes cystic medial degeneration.
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What is the most serious Aortic dissection location?
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At the root of the aorta. Because it can close off the coronary arteries. The more proximal the worse. Symptoms of aortic dissection is severe anterior chest pain radiating to the back and moves down as dissection moves down.
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Must know this for exams, what is the most common vasculitis of adults?
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Adults: Temporal Arteritis
Children: Henoch-Schonlein purpura |
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What vasculitis is characterized by direct antibody attack?
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Good pasture's disease
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What vasculitis is characterized by immune complexs that deposit and cause problems?
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SLE
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What are the vessels involved with vasculitis in the diseases?
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Large vessels: Giant Cell (Temporal) arteritis, Takayasu's.
Medium vessels: Polyarteritis Nodosa, Kawasaki Disease Small vessels: Wegener's, Churg Strauss, Microscopic Polyangiitis, Henoch-Schonlein Purpura |
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What vasculitis is called the pulseless disease?
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Takayasu's because of decreased pulses in Upper extremities.
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What vasculitis's are associated with granulomatous inflammation?
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Giant Cell (temporal arteritis), Takayasu's, Wegener's, Churg Strauss
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What vasculitis is associated with Hepatitis B? Must remember for exam.
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Polyarteritis Nodosa. Usually affects the kidneys but spares the lungs. Characterizes by fibrinoid necrosis.
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What vasculitis is known for being C-ANCA?
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Wegener's Vasculitis. Which usually affects the Lungs, and has granulomatous inflammation.
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What vasculitis is known to be associated with eosinophils?
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Churg-Strauss (allergic angiitis), also associated with asthma. And is P-ANCA
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What Vasculitis is associated with immunoglobulin IgA?
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Henoch-Schonlein purpura
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What vasculitis is associated with smoking?
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Buerger's disease (thromboangiitis obliterans). Often in men less than 35 YO, and leads to LE gangrene and amputation.
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Do Varicose veins usually lead to pulmonary emboli?
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No, they usually don't. Stasis dermatis and ulcers can develop.
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In thrombophlebitis (deep vein thrombosis), is there a risk of pulmonary emboli?
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Yes, very high. Adenocarcinoma can cause multiple varicose veins to develop and this is called trousseau syndrome.
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What is a hemangioma?
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Is a vascular Neoplasia, and are approximately 7% of all benign tumors in children. Occur in capillary beds. A juvenile capillary is associated with lots of small vascular spaces, whereas a cavernous hemangioma has large dilated spaces (common in liver). Capillary (strawberry) hemangioma, grow fast then involute are gone by age 7.
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What is Kaposi's Sarcoma?
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Intermediate grade malignancy of blood vessels. 1. Chronic Classic European. 2. AIDS patients 3. African/Lymphadenopathic (aggressive) 4. Transplant associated All are associated with HHV8 (human herpes virus 8) and have a Patch-Plaque-Nodular histology. All also have spindle cells forming split like spaces.
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What is important about angiosarcoma?
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Commonly starts in skin, low survival, can come from radiation which ~ 2 years or lymphadema takes ~ 10 years.
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What is the preferred energy substrate of the heart?
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Long chain fatty acids, but can use glucose and lactate.
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What node is the pacesetter for the heart?
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SA node
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What is Laplace's law?
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Wall tension= PxR/ 2T
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What is Ejection Fraction?
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EF = Stroke volume / End diastolic volume
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What is heart failure and congestive heart failure?
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Heart Failure: Pathophysiologic state, heart cannot deliever enough blood to meet the needs of the body.
Congestive Heart Failure: Clinical syndrome that reflects inadequate pump function. |
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What is systolic dysfunction?
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Progressive deterioration of contractile function, most common, IHD, HTN.
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What is diastolic dysfunction?
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Heart chamber can't relax and filling is compromised, restrictive heart diseases.
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What is the difference between forward failure and backward failure?
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Forward failure is diminished CO (cardiac output). Backward failure is accumulation of blood in the venous system.
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What are the most common causes of left heart failure?
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Ischemic heart disease, Hypertension, Aortic/Mitral valve disease, and non ischemic myocardial disease. These all lead to damming of blood in pulmonary circulation and diminished peripheral blood pressure/ flow.
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What are some consequences of left heart failure?
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LV hypertrophy and dilation with left atrial enlargement secondary. Lungs congested and edema, siderophages (heart failure cells in lungs), Dyspnea, orthopnea, PN Dyspnea, and Kerley's B lines on Xray. Reduced renal perfusion activating angio-ald system, salt retention and water - edema (peripheral/pulm). The brain (advanced stages), hypoxic encephalopathy.
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What are the consequences of Right heart failure?
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Most often secondary to left heart failure. If it is purely Right heart failure then usually associated with severe pulmonary hypertension (cor pulmonale). Leads to engorged systemic and portal venous systems and minimal pulmonary congestion. The liver can develope nutmeg liver, spenomegaly, and ascites. Peripheral edema, renal congestion (more than left) and brain hypoxia.
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