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165 Cards in this Set
- Front
- Back
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Bacterial endocarditis of which valve is associated with IV drug abuse?
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Tricuspid
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Characterize EKG changes in an MI
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ST elevation (transmural ischemia); ST depression (endocardial infarct); and Q waves (transmural infarct)
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characterize the AST levels in an MI
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Elevated 1-3 days post MI. Nonspecific enzyme found in heart, liver, and skeletal muscle
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Characterize the cardiac troponin I levels in an MI.
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Elevated between 4 hrs. and 7-10 days post MI most specific protein marker for MI
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Characterize the CK-MB levels in an MI
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Elevated in the first 24 hrs. post MI
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Characterize the LDH1 levels in an MI
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Elevated from 2 to 7 days post MI
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Describe a mitral prolapse murmur?
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Systolic murmur: most frequent valvular lesion, esp. in young women; late systolic murmur ending with 2nd heart sound
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Describe a mitral regurgitation murmur?
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Systolic murmur: high pitched holosystolic (continuous sound throughout systole); loudest at apex
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Describe a mitral stenosis murmur
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Diastolic murmur: rumbling late diastolic murmur following opening snap; LA > LV during diastole
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Describe a VSD murmur.
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Systolic murmur: Holosystolic murmur (continuous throughout systole)
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Describe an aortic regurgitation murmur
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Diastolic murmur: high-pitched 'blowing' murmur, beginning immediately in diastole; wide pulse pressure
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Describe an aortic stenosis murmur
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Systolic murmur: crescendo-decrescendo following ejection click; LV > aortic pressure during systole.
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Describe an Patent ductus arteriosus (PDA) murmur.
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Continuous murmur (systolic/diastolic): machine-like murmur; loudest at the time of 2nd heart sound
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Describe the bacterial growths in subacute bact. Endocarditis.
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Small vegetations on congentially abnormal valves
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Describe the onset of Staph. Aureus endocarditis.
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Rapid, acute onset
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Describe the onset of Streptoccus viridans endocarditis.
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Insidious, subacute onset
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Describe the S.aureus bacterial growths of acute bact. endocarditis?
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Large vegetations on previously normal valves
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During what weeks of pregnancy does preeclampsia present?
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20 weeks gestation to 6 weeks postpartum
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early/late posttransplant endocarditis
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S. epidermis/S. aureus
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How can pericarditis progress?
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It can resolve without scarring or it can lead to chronic adhesive or chronic constrictive pericarditis
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How does atherosclerosis progress?
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Fatty streaks in arteries-> Proliferative plaques-> Complex atheromas
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How does Prinzmental's variant angina present?
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Chest pain at rest
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How does stable angina present?
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Chest pain with exertion
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How does syphilis change the aorta?
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Causes dilation of the aorta and valve ring; can result in aortic aneurysm or aortic valve incompetence
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How does unstable/crescendo angina present?
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Worsening chest pain
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In what condition do you find Libman-Sacks endocarditis?
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Lupus (SLE causes LSE)
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Osler-Weber-Rendu syn. (hereditary hemorrhagic telangiectasia)
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AR, telangiectasia in skin, mucous membranes, respiratory tract, GI tract, urinary tract
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signs to differeniate ascites from cardiomegaly or cirrosis
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JVP
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To what does HTN predispose one?(5)
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Coronary heart dz, atherosclerosis, CHF, stroke, renal failure, retinopathy, and aortic dissection
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What are associations of preeclampsia?(3)
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1.Hemolysis 2.Elevated LFT (liver fxn test) 3.Low platelets
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What are clinical features of preeclampsia?(6)
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1.Headache 2.Blurred vision 3.Abdominal pain 4.Edema of face and extremities 5.Altered mentation 6.Hyperreflexia
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What are complications from an MI?(7)
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1.Card. Arrhythmia 2.LV failure/pul. edema 3.Thromboembolism: mural thrombus 4.Cardiogenic shock 5.Rupture of ventricular wall, interventricular septum, papillary muscle or cardiac tamponade 6.Fibrinous pericarditis (friction rub) 7.Dressler's syndrome
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What are complications of bacterial endocarditis?(4)
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1.Chordae rupture 2.Glomerulonephritis 3.Suppurative pericarditis 4.Emboli
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What are examples traumatic MI complications?(4)
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1.Vent wall rupture 2.Interventricular/Septum rupture 3.Papillary muscle rupture (4-10 days post-MI) 4.Cardiac tamponade (heart compression)
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What are fat emboli associated with?(2)
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Long bone fractures and liposuction
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What are Janeway lesions?
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Small erythematous lesions on palms or soles
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What are nonbacterial causes of endocarditis?(2)
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Secondary to metastasis or renal failure (marantic/thrombotic endocarditis)
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What are Olser's nodes?
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Tender raised lesions on finger or toe pads
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What are possible manifestations of ischemic heart disease?(4)
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1.Angina(CAD narrowing > 75%) 2.Myocardial infarction 3.Sudden cardiac death 4.Chronic ischemic heart disease
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What are risk factors for HTN?(6)
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Age, obesity, diabetes, smoking, genetics, race (black>white>asian)
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What are Roth's spots?
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Round white spots on retina surrounded by hemorrhage
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What are some atherosclerosis symptoms?
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Angina and claudication, but can be asymptomatic
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What are some risk factors for preecalmpsia?(4)
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1.Preexisting HTN 2.Diabetes 3.Chronic renal dz 4.Autoimmune dz
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What are the 2 major causes of HTN?
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1.Primary (essential) HTN, related to inc cardiac output or TPR 2.Secondary HTN, usually related to renal dz
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What are the 3 most common sites of an MI?
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LAD > RCA > Circumflex
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What are the 3 types of Angina in ischemic heart dz?
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Stable angina, Prinzmetal's variant, and Unstable/crescendo
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What are the 7 types of heart murmurs?
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1.Aortic stenosis 2.Aortic regurgitation 3.Mitral stenosis 4.Mitral regurgitation 5.Mitral prolapse 6.VSD 7.Patent ductus arteriosus (PDA)
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What are the causes/associations of cardiogenic shock?
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A large infarct with a high incidence of mortality
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What are the complications of atherosclerosis?(6)
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Aneurisms, ischemia, infarcts, peripheral vasc dz, thrombus, and emboli
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What are the etiologies of dilated cardiomyopthy?(6)
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1.Chronic alcohol abuse 2.Beriberi (wet) 3.Coxacke virus B postviral myocarditis 4.Cocaine use 5.Chagas dz. 6.Doxirubicin toxicity 7.Peripartum caridiomyopathy 8.Hemochromatosis
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What are the finding in temporal arteritis?
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1.Unilateral headache 2.Jaw claudication 3.Impaired vision (opthalmic a. occlusion) 4.Systemic involvement and polymyalgia rheumatica (proximal muscle pain, periarticular pain)
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What are the findings in Buerger's dz?
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Intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynauld's phenom.), severe pain in affected part; may lead to gangrene.
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What are the findings in pericarditis?(5)
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1.Pericardial pain 2.Friction rub 3.ECG changes (diffuse ST elevations) 4.Pulsus paradoxicus 5.Distant heart sounds
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What are the findings of polyarteritis nodosa?(3)
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Hepatitis B infection (30% of patients), multiple aneurysms and constrictions on arteriogram, NO assoc w/ ANCA
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What are the findings of Wegener's granulomatosis?(3)
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1.C-ANCA positive 2.Chest x-ray reveals large nodular densities 3.Hematuria and red cell casts
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What are the major causes of Restrictive/obliterative cardiomyopathy?(4)
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1.Sarcoidosis 2.Amyloidosis 3.Post-radiation fibrosis 4.Endocardial fibroelastosis 5.Endomyocardial fibrosis (Loffler's)
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What are the possible lab findings in preeclampsia?(2)
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Thrombocytopenia and hyperuricemia
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What are the risk factors of atherosclerosis?(4)
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Smoking, HTN, diabetes mellitus hyperlipidemia, and family history
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What are the signs and symp of rheumatic fever or rheumatic heart dz?(7)
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FEVERSS: 1.Fever 2.Erythema marginatum 3.Valvular damage 4.ESR increase 5.Red hot joints (Polyarthritis) 6.Subcutaneous nodules 7.St Vitus' dance (Chorea)
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What are the signs and symp. of bacterial endocarditis?(8)
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1.Janeway lesions 2.Roth's spots 3.Nail bed hemorrhages 4.Osler's nodes 5.Fever 6.Anemia 7.Murmur 8.Emobli
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What are the symptoms of a pulmonary embolus (PE)?(3)
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Chest pain, tachypnea, and dyspnea
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What are the symptoms of an MI?(5)
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Severe retrosternal pain, pain in left arm and/or jaw, shortness of breath, fatigue, and adrenergic symptoms
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What are the symptoms of polyarteritis nodosa?
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Fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neurologic dysfunction, cutaneous eruptions
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What are the symptoms of Takaysu's arteritis?(6)
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Fever, Arthritis, Night sweats, Myalgia, Skin nodules, Ocular disturbances, Weak pulses in upper extremities
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What are the symptoms of Wegeners granulomatosis?(8)
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1.Perforation of nasal septum 2.Chronic sinusitis 3.Otitis media 4.Mastoiditis 5.Cough 6.Dyspnea 7.Hemoptysis 8.Hematuria
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What are the symptoms/signs of Kawasaki Disease?
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Fever, congested conjunctiva, changes in lips/oral mucosa, lymphadenitis, and may develop coronary aneurysms
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What are the types of emboli?(6)
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1.Fat 2.Air 3.Thrombus 4.Bacteria 5.Amniotic fluid 6.Tumor
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What can cause Fibrinous Pericarditis?(3)
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1.Uremia 2.MI 3.rheumatic fever
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What can cause Hemorrhagic Pericarditis?(2)
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1.TB 2.Malignancy (eg melanoma)
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What can cause Serous Pericarditis?(4)
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1.SLE 2.rheumatoid arthritis 3.infection 4.uremia £®SIRUous£©
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What causes acute bact. Endocarditis?
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Staphyloccus aureus
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What causes cardiac dilation in CHF?
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Greater ventricle end-diastolic volume
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What causes dyspnea on exertion in CHF?
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Failure of LV output to increase during exercise
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What causes hepatomegaly in CHF?
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Inc central venous press-> inc resistance to portal flow (rarely leads to 'cardiac cirrhosis')
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What causes othopenea (dyspnea when supine) in CHF?
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Pooling of blood in lungs when supine that adds volume to congested pul. vasculature system
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What causes Paroxysmal nocturnal dyspnea/pulmonary edema in CHF?
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Failure of left heart to keep up with rt. Heart output-> acute rise pul. venous and capillary pressure-> transudation of fluid
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What causes prinzmental's variant angina?
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Coronary artery spasm
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What causes pulmonary edema in CHF?
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LV failure-> inc pul. venous press-> pul. venous distention/transudation of fluid
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What causes pulmonary emboli?
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95% of pulmonary emboli arise from deep leg veins: DVTs
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What causes Rheumatic fever?
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Pharyngeal infection with group A, beta-hemolytic streptococci; leads to cross reactivity with self (not due to direct effects of bacteria)
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What causes stable angina?
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Atherosclerosis
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What causes sudden cardiac death?
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Most commonly from lethal arrhythmia
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What causes the edema seen in CHF?
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RV failure-> inc venous press-> fluid transudation
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What causes Unstable/crescendo angina?
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Thrombosis but no necrosis in a branch of the coronary artery
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What happens 2-4 days after an MI?(5)
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1.Infarct appears pale 2.Tissue surrounding infarct shows acute inflammation 3.Dilated vessels (hyperemia) in infarct 4.Neutrophil emigration 5.Extensive coagulative necrosis
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What happens 5-10 days after an MI?(4)
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1.A hyperemic boarder forms around the infarct 2.The infarct shows central softening with brown/yellow color 3.An outer zone (ingrowth of granulation tissue) forms around infarct 4.Neutrophils and macrophages infiltrate infarcted tissue
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What happens by 7 weeks post-MI?(3)
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1.The Occluded artery causing the MI is recanalized 2.The infarct area is gray/white 3.The infarcted tissue shows contracted, complete scarring
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What happens to contractility, cardiac output, and effective atrial blood volume in CHF?
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All decrease
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What happens to renal blood flow in CHF?
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Decreases
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What happens to renin, angiotensin II, and aldosterone in CHF
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All increase
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What happens to sympathetic nervous activity in CHF?
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Increases
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What happens to the heart 1 day after an MI?(5)
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1.Infarct area: Dark mottling; pale w/ tetrazolium stain (no visible change by light microscopy in first 2-4hrs) 2.Coagulative necrosis in the infarct 3.Release of necrotic cell contents into the blood 4.Beginning of neutrophil emigration 5.Contraction bands visible after 4 hrs 6.Artery supplying infarcted tissue is occluded
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What happens to urinary excretion of water and Na in CHF?
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Decreases: (Na+/H20 reabsorption)
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What happens to venous pressure in CHF?
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Increases
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What histologic part of the aorta is affected by syphilis?
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Vasa vasorum
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What is 'pulseless disease'?
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Takayasu's arteritis
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What is a Cardiac Tamponade?
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Compression of the heart by fluid in pericardium, leading to dec cardiac output
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What is a Red infarct?
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A hemorrhagic infarct occurring in loose tissue with collaterals, such as lungs, liver, intestines, or following REperfusion
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What is Arteriolosclerosis?
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Hyaline thickening of small arteries in essential HTN; Hyperplastic 'onion skin' in malignant HTN
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What is associated with Rheumatic fever?
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Aschoff bodies, migratory polyarthritis, erythema marginatum, elevated ASO titers
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What is Atherosclerosis?
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Fibrous plaques and atheromas form in intima of arteries
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What is Buerger's disease?
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Known as Thromboangitis obliterans; idiopathic, segmental, thrombosing vasculitis of intermediate and small peripheral arteries and veins.
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What is chronic ischemic heart dz?
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Progressive onset of CHF over several years due to chronic ischemic myocardial damage
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What is Churg-Strauss Syndrome?
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Granulomatous vasculitis with eosinophilia
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What is Dressler's syndrome?
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Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI
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What is eclampsia?
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The addition of seizures to the preeclampsia triad
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What is fibrinous pericarditis?
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A friction rub of the pericardium usually 3-5 days post-MI
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What is Hypertrophic Cardiomyopathy (formerly IHSS: idiopathic hypertrophic subaortic stenosis)?
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Familial hypertrophy, usually asymmetric, involving the interventricular septum
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What is Kawasaki Disease?
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Acute, self-limited necrotizing vasculitis of small/medium sized vessels in infants/kids
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What is Libman-Sacks endocarditis?
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Vegetations found on both sides of valve but do not embolize (->mitral valve stenosis)
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What is malignant HTN?
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Severe/rapidly progressing HTN
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What is Microscopic Polyangiitis?
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Like Wegener's, but lacks granulomas; P- or C-ANCA
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What is Monckeberg arteriosclerosis?
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Calcification of the arteries (especially radial/ulnar); usually benign
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What is necessary to make bacterial endocarditis diagnosis?
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Multiple blood cultures
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What is Polyarteritis Nodosa (PAN)?
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Necrotizing immune complex inflammation of small or medium-sized muscular arteries; typically involving renal/visceral vessels.
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What is preeclampsia?
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A triad of HTN, protenuria, and edema that occurs in pregnancy
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What is Primary Pauci-immune Crescentic Glomerulonephritis?
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Vasculitis limited to kidney
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What is sudden cardiac death?
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Death from cardiac causes within 1 hr. of onset of symptoms
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What is Takayasu's arteritis?
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Thickening of aortic arch and proximal great vessels causing weak pulses in extremities and ocular disturbances.
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What is temporal arteritis?
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Vasculitis that affects medium/small arteries, usually branches of the carotid artery.
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What is the appearance of a heart with Hypertrophic cardiomyopathy?
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Walls of LV are thickened, chamber becomes banana shaped on echocardiogram
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What is the appearance of an aorta affected by syphilis?
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Tree bark appearance
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What is the incidence of preeclampsia?
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7% of pregnant women
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What is the inheritance pattern of Hypertrophic cardiomyopathy?
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Autosomal Dominant
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What is the most common cardiomyopathy?
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Dilated (congested) cardiomyopathy (90%)
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What is the most common heart tumor
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Metastases
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What is the most common primary cardiac tumor in adults?
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Myxoma
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What is the most common primary cardiac tumor in children
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Rhabdomyoma (associated w/ tuberous sclerosis)
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What is the most common vasculitis?
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Temporal arteritis
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What is the physiologic consequence of a cardiac tamponade?
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Equilibration of pressures in all 4 chambers
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What is the treatment for Buerger's dz?
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Stop smoking
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What is the treatment for temporal arteritis?
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Responds well to steroids
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What is the treatment of eclampsia?
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IV Magnesium sulfate/diazepam; this is a medical emergency
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What is the treatment of polyarteritis nodosa?
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Corticosteroids, Cyclophosphamide
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What is the treatment of preeclampsia?
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Deliver the fetus ASAP; otherwise rest, salt restriction, treatment of HTN
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What is the treatment of Wegener's granulomatosis?
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cyclophosphamide and Corticosteroids
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What is the x-ray appearance of a heart with dilated myopathy?
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Dilated: looks like a balloon on x-ray
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What is Wegner's granulomatosis?
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Focal necrotizing vasculitis and necrotizing granulomas in the lung and upper airway and by necrotizing glomerulonephritis
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What lab finding is present w/ Temporal arteritis?
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Elevated ESR
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What lab finding is seen in Takayasu's arteritis or temporal arteritis?
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Elevated ESR
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What organs does Churg-Strauss Syndrome affect?
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Lung, heart, skin, kidneys, nerves
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What part of the heart/vasculature can be damaged by syphilis?
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Aortic root and ascending aorta
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What pathology do you find w/ pulmonary edema in CHF?
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Presence of hemosiderin-laden macrophages (heart failure cells).
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What percentage of HTN is primary?
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90%
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What percentage of HTN is secondary?
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10%
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What population is associated with sudden death from Hypertrophic cardiomyopathy?
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Young athletes
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What population is Churg-Strauss syndrome found in?
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Often found in atopic pts
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What population typically has Buerger's disease?
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Heavy smokers
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What predisposes one to deep vein thromosis (DVT)?(3)
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Virchow's triad: 1.Stasis 2.Hypercoagulability 3.Endothelial damage
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What stage of Syphilis can affect the heart?
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Tertiary
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What symptoms are associated with CHF?(8)
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1.Ankle and sacral edema 2.Hepatomegaly (nutmeg liver) 3.Pulmonary edema 4.Paroxysmal nocturnal dyspnea 5.Dyspnea on exertion 6.Orthopnea (dyspnea when supine) 7.Cardiac dilation
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What tests are used to diagnose an MI?(5)
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1.EKG (the gold standard) 2.Cardiac troponin I 3.CK-MB 4.LDH1 5.AST
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What type of bacterial endocarditis/organism is associated with dental procedures?
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Subacute endocarditis from Strep. Viridans infection
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What type of embolus is associated with DIC?
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Amniotic fluid, especially postpartum
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What visual complication can temporal arteritis cause?
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Occlusion of ophthalmic artery leading to blindness
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Where do myxomas occur?
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90% occur in the atria, mostly LA; myxomas are described as a 'ball valve' obstruction.
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Where do Pale infarcts occur?
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Solid tissues with single blood supply: brain, heart, kidneys, and spleen
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Where do Red infarcts occur?
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Loose tissue with collaterals: lungs, liver, intestines
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Where does a MI usually occur?
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In the left anterior descending coronary artery (LAD)
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Where histologically does atherosclerosis occur?
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The elastic arteries and medium to large muscular arteries
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Where, anatomically, does atherosclerosis most occur?(4)
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Abdominal aorta > coronary a. > popliteal a. > carotid a.
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Which valve is most frequently involved in bacterial endocarditis?
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Mitral
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Which valves are most affected by rheumatic heart dz?
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Mitral > aortic >> tricuspid (high pressure valves most affected)
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Who gets Takayasu's arteritis?
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Primarily affects young Asian females
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Who gets temporal arteritis?
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Affects elderly females
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