Cardiology

Front 1

1. Pulmonary Hypertension

Back 1

a. ^ pressure in the lungs dt COPD, scleroderma, fibrotic dz
b. Hypoxia -> pulm vasoconstriction
c. Course: severe resp distress → cyanosis & RVH → RHF → death from decompensated cor pulmonale

Front 2

2. Systemic hypertension

Back 2

a. BP > 140/90
b. Risk factors: ^ age, obesity, smoking, genetics,
c. 90% Primary causes (essential) ^ CO and ^ TPR
d. 10% Secondary causes – Renal disease
e. Predisposes to : atherosclerosis, LVH, stroke, CHF, RF, retinopathy, and aortic dissection

Front 3

3. Left sided Hypertension

Back 3

a. Causes: Ischemic heart disease (MI)
b. HTN and aortic and mitral valvular disease causes LVH
c. Myocardial diseases such as pulmonary congestion and myocarditis
d. Clinical Manifestations: Dyspnea and orthopnea caused by pulmonary congestion and edema
e. Reduction in renal perfusion (→ ^ RAAS system)

Front 4

4. Right Sided Heart Failure

Back 4

a. MCC is LHF or left sided lesions (mitral stenosis)
b. COPD → Pulmonary HTN → RHF
c. Clinical Manifestations: Renal hypoxia → fluid retention → pitting edema ankles
d. Enlarged and congested liver (nutmeg liver) and spleen
e. Distention of the neck veins (JVD)

Front 5

5. Angina Pectoris

Back 5

a. Occurs when CAD narrowing is > 75% and the O2 demand is > blood supply
b. Extremely large meal→ Then Shovel! (Low CFR predisposes)
c. Stable: dt atherosclerosis -> rest relieves pain
d. Prinzmetal’s variant: dt coronary artery spasms
e. Unstable: thrombosis but no necrosis (worsening chest pain at rest)

Front 6

6. Chronic Ischemic heart disease

Back 6

a. progressive onset of CHF over years dt chronic ischemic myocardial damage
b. Inc. Risks: Smokers, High Cholesterol, DM, HTN -usually males.
c. Can present itself as a long-standing Unstable Angina Pectoris.
d. Dx: ECG, Blood markers, cardiac stress testing.

Front 7

7. Myocardial Infarction

Back 7

a. Elephant on my chest pressure
b. Embolism -> Dec in blood flow -> ischemia -> necrosis
c. MC is LAD (anterior septum) > RCA (inferior /posterior) > circumflex
d. EKG: ST segment elevation & Q wave changes
e. Cardiac enzymes: 1st troponin 3-6 hrs, 2nd CK/MB 6-10 hrs post MI
f. Complications: 90% develop arrhythmias, 50% mortality, 2/3 Heart failure.

Front 8

8. Aortic Stenosis/ Insufficiency

Back 8

a. Causes: Congenital bicuspid (2 cusps) valve→ calcification by 40-50yo
b. Age related valve (3 cusps) degeneration and calcification mc > 70yo
c. Rheumatic heart disease: LVH→diastolic dysfunction → LHF →SOB, chest pain, syncope with exertion
d. TX: valve replacement or Often results in SUDDEN DEATH
e. Murmur: crescendo-decresendo systolic ejection murmur following ejection click.

Front 9

9. Mitral Stenosis (MS)/ Insufficiency can lead to MVP

Back 9

a. Calcification of mitral valve → Narrowing of valve ↓ blood to body
b. Causes: rheumatic fever, congenital, carcinoid heart dz, Chronic MS → can result in LA dilation
c. Murmur: follows opening snap (dt tensing of chordae tendinae) delayed rumbling late diastolic murmur

Front 10

10. Mitral Valve prolapse

Back 10

a. Assoc w/Marfan and Ehlers-Danlos syndromes
b. Can be caused by Myxomatous degeneration, rheumatic fever, or chordae rupture
c. Most frequent valvular lesion, usually benign
d. Predisposes to infective endocarditis
e. Murmur: Systolic click heard loudest @ S2 followed by blowing murmur

Front 11

11. Endocarditis

Back 11

a. Mitral valve is most frequently involved
b. Can be bacterial, viral, or unknown
c. S/Sx: Duke criteria: Fever, Roth spots, Osler’s nodes, Janeway lesions, splinter hemorrhages, new murmur
d. Complications: chordae rupture, glomerulonephritis, suppurative pericarditis, emboli
e. Acute: Staph. aureus OR Subacute: Strep

Front 12

12. Rheumatic heart Disease

Back 12

a. Occur after group A strep pharyngitis
b. Immune mediated type II hypersensitivity rxn
c. Migratory polyarthritis MC presentation; myocarditis MCC death.
d. MV involved first→AV. Mitral regurgitation in acute attack; mitral stenosis in chronic Dz.
e. Jones criteria DDx→major criteria: carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules.

Front 13

13. Carcinoid heart disease

Back 13

a. Caused by tumors (usually in the liver) that secrete functional hormones.
b. VERY slow growing tumors up to 20 yrs presents 50-70's
c. secretes serotonin, histamine, tachykinins, and prostaglandins released by the malignant cells –>vasoactive substances (cause vasoconstriction) → ^ pressure in Right heart
d. The preferential right heart involvement is most likely related to inactivation of the vasoactive substances by the lungs
e. The fibrous tissue in the plaques results in distortion of the valves leading to either stenosis, regurgitation, or both.

Front 14

14. Dilated cardiomyopathy

Back 14

a. MC cardiomyopathy ( 90%)
b. Systolic dysfunction (Left Ventricle enlarged and floppy -> not working properly → Dec LV ejection fraction)
c. Eccentric hypertrophy
d. Causes: Alcohol, Coxsackie, cocaine use, & chaga’s dz
e. Findings: hear a S3, displaced PMI, and on xray see a balloon heart

Front 15

15. Hypertrophic cardiomyopathy

Back 15

a. Diastolic Dysfunction
b. Concentric hypertrophy
c. Causes: familial, AD
d. The septum hypertrophies and blocks mitral leaflets obstructing outflow → systolic murmur & syncope
e. Findings: normal sized heart, S4, systolic murmur
f. Think young athletes and sudden death

Front 16

16. Restrictive Cardiomyopathy

Back 16

a. Diastolic dysfunction
b. Heart becomes stiff because of infiltrates in the muscle
c. Major causes of infiltrates are sarcoidosis, any fibrosis, hemochromatosis

Front 17

17. Myocarditis

Back 17

a. inflammation of the myocardium w/ myocyte necrosis
b. Causes: Viral (coxsackie, influenza), Toxic or Autoimmune
c. Had an illness 2 wks prior → signs of ventricular dysfunction → LV dilation → can get murmurs
d. 1st: initial insult, 2nd early subacute viral clearing phase, 3rd late subacute viral clearing & lysis of myocytes, 4th Chronic phase – immune response of too much XS loss of myocytes
e. 1/3 resolve, 1/3 develop mild scarring, 1/3 progress to dilated cardiomyopathy

Front 18

18. Metastatic pericardial disease aka hemorrhagic pericarditis

Back 18

a. Malignant Tumors can metastasize and deposit in the pericardial space (ex: melanoma, carcinoma of the bronchus, breast cancer, Hodgkin’s lymphoma, leukemia)
b. Can be an accumulation of blood and suppurative effusion in the pericardial space
c. Findings: pericardial pain, friction rub, pulsus paradoxus, distant heart sounds, ECG changes, ST segment elevation in several leads
d. Can lead to chronic adhesive or chronic constrictive pericarditis

Front 19

19. Pericardial effusions

Back 19

a. The pericardial space normally has 30-50mL of thin, clear and straw colored pericardial fluid.
b. Under various circumstances the parietal pericardium may be distended by serous fluid = pericardial effusion. (blood = hemopericardium, or pus = purulent pericarditis)
c. With long standing pressure the pericardium will dilate to accomadate the volume overload in the space. Slowly accumulating pericardial effusion can stretch a lot w/o affecting cardiac fxn.
d. Rapidly developing fluid collections such as due to hemorrhage caused by a ruptured MI or aortic dissection may → compression of the thin walled atria or ventricles --? Potentially fatal cardiac tamponade

Front 20

20. Pericarditis

Back 20

a. Definiton - It is usually secondary to infections, cardiac diseases, immune-mediated diseases, or systemic disorders
i. 1. Serous pericarditis- a noninfectious inflammation, such as RF, SLE, scleroderma, tumors, uremia, etc
b. Morphology - inflammatory reaction in pericardium with scant number of inflammatory cells; fluid 50-200ml, that accumulates slowly
i. 2. Fibrinous and serofibrinous pericarditis ( MC) and causes: Acute MI is the MCC, uremia, chest radiation, SLE, RF, cardiac surgery, trauma
c. Morphology
(1) Fibrinous pericarditis - surface is dry, with a fine granular roughening
(2) Serofibrinous pericarditis - thicker fluid, yellow and claudy, leukocytes and erythrocytes are present, and fibrin
d. Clinical feature: Pain, fever, cardiac failure, loud pericardial friction rub
e. can develop constrictive pericarditis b/c of scarring

Front 21

21. Bicuspid aortic valve

Back 21

a. 2 flaps instead of 3 may not cause symptoms
b. MC associated w/ coarctation of the aorta and aortic stenosis
c. Coarctation of the aorta
a. Narrowing just distal to origin of left subclavian artery. BP in arms will be > than in the legs
b. Symptoms of severe coarctation à Pulm HTN
c. Symptoms of mild coarctation (asym as kids as get older HTN, leg cramps w/exercise)
d. Systemic Complications: ^ risk aortic dissection and systemic HTN → Extensive development of collateral circulation w/ dilation of intercostal arteries → Rib notching 3-8 on inferior border

Front 22

22. Patent Ductus Arteriosis

Back 22

a. Causes a R→L shunting of blood in utero
b. After birth lung pressures are low and shunt becomes L → R
c. PDA or Failure of DA to close after birth can lead to RVH and failure.
d. Continuous machine like murmur. Uncorrected PDA may eventually result in late cyanosis in lower extremities (blue kids)

Front 23

23. Ventricular Septal Defect

Back 23

a. Common congenital anomaly causing L → R shunt
b. Will cause R sided CHF and/or pulmonary HTN if very large.
c. If small, the infant may be asymptomatic at first and as they get older around 15-18 months begin to see Sx. (blue kids)

Front 24

24. Atrial septal defect

Back 24

a. The R ventricle will fill during diastole ^ R ventricular volume. → ^ blood on the R → causes a wide fixed split S2
b. L → R shunt, → pulm HTN → late cyanosis → blue kids

Front 25

25. Tetralogy of Fallot

Back 25

a. Most common cyanotic heart defect (right to left shunt) early cyanosis = Blue babies
b. * Must have all four of these * (PROVe)
1. Pulmonary Valve stenosis (narrowed)
2. RVH (Right Ventricular Hypertrophy)
3. Overriding Aorta
4. VSD (Ventricular Septal Defect)
c. early cyanosis is caused by the R → L shunt across the VSD.
d. R → L shunt exists b/c ^ pressure from stenotic pulm valve.
e. Findings: “boot shaped heart” on x-ray. Tet Spells (infant) - blue crying baby
Squatting to alleviate DOE (toddler)
Metabolic & Resp Acidosis w/ hypoxemia
Harsh Systolic Heart Murmur

Front 26

Hemodynamic Conditions
26. Embolism

Back 26

a. Passage and trapping of blood clot
b. Most frequent place of origin is the lungs.

Front 27

Hemodynamic Conditions
27. Hemorrhage

Back 27

a. Escape of blood from the vasculature to the surrounding tissues.
b. Cz: Trauma.
c. Results; Hematoma, Hemothroax, hemopericardium, hemoperitoneum, hemarthrosis.

Front 28

Hemodynamic Conditions
28. Edema

Back 28

a. Abnormal Accumulation of fluid in interstitial tissue spaces or body cavities
b. Cz: Inc Hydrostatis pressure
i. Eg CHF, RSHF Eg. Periferal Edema, LSHF Eg. Pulmonary edema.
c. Dec. oncotic pressure
i. Eg. Nephrotic syndrome, Cirrhosis of Liver
d. Inc. sodium retention
i. Eg. Primary: Renal disorders
ii. Secondary: CHF

Front 29

Hemodynamic Conditions
29. Shock

Back 29

a. Circulatory collapse results in hypoperfusion and dec. oxygenation of tissues.
b. Cz: Dec. CO, Wide spread peripheral vasodilation.
c. Types: Hypovolemic shock, Cardiogenic shock, Septic Shock. Neurogenic shock.
d. Stages: Nonprogressive stage, progressive stage, irreversible stage.

Front 30

Hemodynamic Conditions
30. Thrombosis

Back 30

a. Intravascular coagulation of blood.
b. Cz: Significant interruption of blood flow.
c. Et: Venous stasis, CHF, polycythemia, sickle cell disease, OCB, cigarette smoking.

Front 31

Vascular conditions
31. Aneurysms

Back 31

a. Abnormal Dilations arteries or veins.
b. Cz:
i. Atherosclerotic: Descending, abdominal aorta.
ii. Berry: Circle of Willis, not atherosclerosis.
iii. Syhilitic: Tertiary syphilis: Obliterative endarteritis of the vasa vasorum ‘tree-bark’ aorta. Ascending aorta.
iv. Dissecting aneurysms: Lonitudinal intraluminal tear. Ass w/HTN, cystic medial necrosis (Marfan syndrome) not athrosclerosis.

Front 32

Vascular conditions
32. Aortic dissection

Back 32

a. 60-70y/o, complication of High BP. Constant Chronic Pain.
b. Def: Lonitudinal Intraluminal tear. Not atherosclerosis, ass. w/Marfan Syndrome.
c. S/SE: Severe, tearing ripping, chest pain radiates to back.
d. Ddx: MI: Negative ECG and heart enzymes, Ultrasound positive.
e. Results: Cystic Medial Degenration, Aortic Rupture/Cardiac Tamponade.

Front 33

Vascular conditions


33. Arteriosclerosis

Back 33

a. General term for three types of vascular disease w.rigidity, thickening, of blood vesseles.
i. Monckeberg arteriosclerosis: 50y/o, medial calcific sclerosis: Radial and ulnar arteries.
ii. Arteriolosclerosis: hyaline thickening of small arteries esp. kidneys.
1. Ass. HTN and DM
2. Two variants: Hyaline arteriolosclerosis: Hyaline thickening.
3. Hyperplastic arteriolosclerosis: concentric, laminated, onionskin.

Front 34

Vascular conditions
34. Atherosclerosis

Back 34

a. MC cause of death bc. of vascular dz. In developed countries.
b. Cz: Fibrous atheromas in intima of arteries with central core of cholesterol and lipid-laden macrophages ‘foam cells’, covered by a fibrous cap.
c. Plaques may:
i. Ulcerate, hemorrhage or calcify.
ii. Thrombus formation
iii. Embolization.
d. Atheromas develop from fatty streaks→ Appear very early in life→ Ischemic heart disease, MI or aneurysm.

Front 35

Vascular conditions
35. Familial hypercholesterolemia

Back 35

a. Et: Autosomal dominant genetic disorder heterozygous. (LDLR gene of chromosome 19)
b. Result: Absence of LDL cholesterol receptors-→ Absent hepatic clearance→ premature atherosclerosis.
c. Clinical: xanthomatois, arcus senilis corneae.

Front 36

Vascular conditions
36. Giant cell arteritis (temporal arteritis)

Back 36

a. Medium to large arteries, granuloma formation
b. Giant Cells w/mononuclear cells, neutrophils, and eosinophils
c. Location: Branches of carotid artery
d. Visual impairment- ophthalmic artery, Inc. ESR.

Front 37

Vascular conditions
37. Peripheral arterial disease (PAD)

Back 37

a. Arterialsclerosis of leg arteries.
b. Inc. smoking, , high intake of processed foods and animal products.
c. High risk of thromboembolism and death.
d. Intermittent claudication w/peripheral pulses obscured.

Front 38

Vascular conditions
38. Pulmonary embolism (PE)

Back 38

a. Et: Based on Virchow’s triad: Hypercoagulability, Hemodynamic changes (stasis, turbulence), Endothelial injury/dysfunction.
b. Originates: lower extremities or pelvis.
c. Predisposing Factors: Venous stasis, CHF, Cancer, fractures, OBC.
d. Results: hemorrhagic, or red infarcts (bc. lungs have dual blood supply). ASYM to Death.

Front 39

Vascular conditions
39. Raynaud’s phenomenon (primary and secondary)

Back 39

a. Primary: Raynaud disease
i. Young Women
ii. Recurrent vasospasm small arteries.
iii. Cyanosis Fingers and Toes
iv. S/SE: Chilling
b. Seondary: Raynaud Phenomenon
i. Secondary bc. of an underlying disorder
ii. MC Cz: Systemic Lupis Erythmatosis
iii. Second MC Cz: Scleroderma
c. Results (Primary and Secondary): Ulceration and gangrene.

Front 40

Vascular conditions
40. Thromboangiitis obliterans (Bueger’s Disease)

Back 40

a. Young Jewish Men
b. Acute Inflammatory Dz: Affects- small to medium arteries/veins of extremities.
c. Results: Painful ischemic disease, gangrene, distal claudication/necrosis of digits.
d. Major Risk Factor: Heavy Smoking, even smokeless tobacco.

Front 41

Vascular conditions
41. Thrombosis –deep vein (DVT)

Back 41

a. Lead to Embolism, deep veins of Legs.
b. Et: Based on Virchow’s triad: Hypercoagulability, Hemodynamic changes (stasis, turbulence), Endothelial injury/dysfunction.

Front 42

Vascular conditions
42. Varicose vein

Back 42

a. Abnormally dilated and tortuous veins
b. Superficial veins in lower extremities.
c. Predisposition: Inc. venous pressure Eg. Pregnancy, thrombophlebitis or prolonged standing.

Front 43

Vascular conditions
43. Vasculitis

Back 43

a. Inflammatory & Necrotizing
b. Often immune mediated (HepB, surface AG’s, Hep C RNA, DNA)
c. Classified: Polyarthritis nodosa, henoch-Schonlein purpura.

Front 44

Vascular neoplasms
44. Hemangiomas

Back 44

a. MC Tumor of Infancy. Inc. number of normal/abnormal BV’s
b. Cz: Port-wine Stains (Flat Lesions)
c. Types:
1) Capillary (Birthmark/Stawberry Type)- BV’s represent capillaries in subq tissues→ Resolve by 7y/o.
2) Vavernous- Larger dilated vascular channels in internal organs. Damage nerves. Require Tx ass w/VonHippel-Lindaw Disease: AD, hemangioblastomas of brain, retina, internal organs, Inc. Risk Renal Cell Carcinoma.

Front 45

Vascular neoplasms
45. Kaposi’s sarcoma

Back 45

a. HHV-8 Malignant vascular tumor that occurs in several forms.
b. Morph: Reddish-purple to dark-blue cutaneous macules, plaques, or nodules.
i. Classic: Ashkenazic Jewish or Mediterranean origin.
ii. Endemic (African): Young African men and children. Effects Jaw.
iii. Epidemic : Ass. With AIDS.

Front 46

Infectious vascular diseases
46. bacterial endocarditis

Back 46

a. Inflammation of the endocardium of the heart.
b. Acute: Staphylococcus auresus
c. Subacute: Streptococcus viridans (Rheumatic Related)
d. Cz: Rheumatic endocarditis (Group A Beta-hemolytic streptococci).
i. Occurs in valves, posterior left atrium creates MacCallum plaque.
ii. Valve Leaflets are red and swollen and tiny warty, bead-like rubbery vegetations.
iii. Healing of valves causes thickening→ Cz’s: Rheumatic Heart Disease (RHD) and valvular prolapse.

Front 47

Infectious vascular diseases
47. Chagas disease

Back 47

a. Protazoa Infection: Trypanomasoma cruzi.
b. Transmission: Kissing Bug, painless bite. Can enter placenta.
c. Attack macrophages and enter heart nervous, reticuloendothelial, and muscle tissue.
d. Tx: Nifurtimox

Front 48

Infectious vascular diseases
48. Lyme Disease

Back 48

a. Et: Borrelia burgdorferi from Tick.
b. Morph: Bull’s eye red rash with central clearing.
i. Stage 1: Erythema chronicum migrans, flulike symtooms.
ii. Stage 2: neurologic (Bell’s palsy) and cardiac (AV nodal block) manifestations.
iii. Stage 3: Chronic monoarthritis and migratory polyarthritis.
c. Dx: IgM or IgG antibody to spirochete. PCR of DNA.

Front 49

Infectious vascular diseases
49. Rocky Mountain Spotted Fever

Back 49

c. Et: Rickettsia rickettsia from Tick.
d. Ca; Vasculitis→ Coronary vessels.
e. Clinical: Flu-like, prupural rash, petechiae, GI pain arthralgia’s. Rashes start on limbs and move towards trunk.

Front 50

Infectious vascular diseases
50. Viral hemorrhagic fever (Yellow fever ~ Dengue fever, filoviruses)
b. Dengue

Back 50

a. Yellow fever Virus
i. Et: Flavivirus (arbovirus) from mosquitos
ii. Monkey or human reservoir
iii. S/SE: High fever, black vomitus, and jaundice.
Dengue:
i. Et: A. aegypti mosquite
ii. Clinical: Flu-like, severe pain in muscles and joints, maculopapular rash, and leukopenia.
iii. Hemorrhagic fever results in shock and hemorrhaging that progresses to death.

Front 51

Infectious vascular diseases
52. Viral myocarditis

Back 51

a. Presents Young persons, w/biventricular heart failure.
b. Et: Coxsakievirus
c. Morph: Diffuse myocardial degeneration and necrosis w inflammatory infiltrate.
d. Ass. With Chagas disease of South America.

Front 52

Myocardial infarction

Back 52

1. partial interruption of blood supply to heart, causing tissue damage
2. Elevated ST segment
3. s/s dyspnea, chest pain, sweating, pain in left arm
4. risk factors: stress, DM, HTN, smoking, diet
5. damage to myocardium