OPT Cardiac
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| vascular abnormalities cause disease by: | 1. narrowing or obstructing the lumen 2. weakening of the walls
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| hypertension | sustained systolic pressure of 140 or diastolic of 90
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| primary/essential hypertension | idiopathic hypertension, 95% of cases
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| malignant hypertension | rapidly rising BP, >200/120; leads to death in 1-2 years
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| hyaline arteriolosclerosis | plasma components leak across endothelium and trigger excess CT production; walls thicken and lumen narrows
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| hyperplastic arteriolosclerosis | vessels demonstrate 'onion-skin' laminations of replacement basement membrane material that encircles the vessel and narrows the lumen
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| arteriosclerosis | "hardening of the arteries" but really thickening and inelasticity of arteries from pathologic process
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| atherosclerosis | the most important pattern of arterial disease; thickening of arterial walls due to plaques involving large vessels
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| Mönckeberg medial calcific sclerosis | calcific deposits in muscular arteries but do not encroach on the lumen so are benign
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| arteriolosclerosis | thickening of vessel walls with resultant narrowing of the lumen
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| atheroma (atheromatous or atherosclerotic plaque) | raised mass protruding to vessel lumen with soft core and dense cap; fundamental lesion of atherosclerosis and cause of lumen narrowing
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| rate of atherosclerosis has improved because: | 1. altered lifestyle i.e. no smoking and better diets 2. improved therapies 3. prevention of recurrences
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| major risk factors for developing atherosclerosis: | 1. hyperlipidemia 2. hypertension 3. cigarette smoking 4. diabetes mellitus
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| response-to-injury hypothesis for formation of atherosclerosis | 1. focal areas of chronic endothelial injury or dysfunction
2. increased uptake and oxidation of LDL in areas of injury
3. intimal accumulation of macrophages and smooth muscle cells
4. proliferation of the smooth muscle cell in the fatty streak
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| 2 main physical changes of ahterosclerosis | 1. fatty streak 2. atheromas
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| fatty streak | aggregate of lipid-containing and smooth muscle cells; can be converted to an {atheroma} by ECM production of smooth muscle cells
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| aneurysm | congenital or acquired local dilation of blood vessels or heart in areas of weakness, more common in areas of higher pressure
-can be spherical or fusiform
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| true aneurysm | aneurysm that involve all 3 layers of the arterial wall
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| false aneurysm | aneurysm that is a breach in the wall and leads to extravascular hematoma
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| arterial dissection | blood spreading between layers of arterial wall
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| berry aneurysm | congenital defect of intracranial arteries
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| abdominal aortic aneurysms | aka atherosclerotic aneurysms; most common type of aneurysm in areas of severe atherosclerosis with damage to tunica media below the renal arteries
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| thoracic aortic aneurysms | aka syphilitic aneurysms; associated with hypertension and Marfan syndrome, up in chest so have swallowing/breathing issues
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| aortic dissection | intimal tears allow blood to enter wall and spread along the tunica media, usually within 10 cm of aortic valve
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| double-barreled aorta | blood reenters aortic lumen through another tear distal to the first
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| cystic medial degeneration/necrosis | elastin fragmentation with formation of cysts containing ECM; in people with CT disorders like Marfan's
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| vasculitis | inflammation of vessels, usually immune-mediated or from an infection
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| systemic necrotizing vasculitides | immunologic forms of vasculitis; includes Giant Cell arteritis, Kawasaki, Wegeners, and Buerger's
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| Giant Cell Arteritis | most common arteritides; autoimmune reaction agains vessel wall antigen, especially in temporal arteries
-centered around elastic membrane with multinucleated giant cells
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| Kawasaki disease | aka mucocutaneous lymph node syndrome; in children with immunoregulatory defeat that triggers vasculitis after exposure to common infection
-lymphadenopathy, erythema of palms and soles and {strawberry tongue}
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| Wegener granulomatosis | cause unknown but possibly hypersensitivity to inhaled antigens; respiratory symptoms and bloody gingiva
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| ANCA; antineutrophil cytoplasmic autoantibodies | lab test to detect the autoantibodies in systemic vasculitides
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| MPO-ANCA; anti-myeloperoxidase antineutrophil cytoplasmic autoantibodies | seen in some autoimmune renal disorders
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| PR3-ANCA; antiproteinase-3 antineutrophil cytoplasmic autoantibodies | detected in Wegener granulomatosis
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| thromboangiitis obliterans aka Buerger disease | leads to clots of radial and tibial arteries, related to tobacco use; preceded by Raynaud's and pain in foot instep
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| Raynaud phenomenon | exaggerated vasoconstriction of digits and cyanosis of acral parts; red>white>blue
-primary in otherwise healthy people, secondary if systemic disorder
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| varicose veins | dilated, tortuous veins from high pressure and loss of wall support
-hemorrhoids and esophageal varices
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| phlebothrombosis/ thrombophlebitis | thrombus formation in veins; associated with Trousseau sign/migratory thrombophlebitis
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| lymphangitis | acute inflammation of lymphatics, can spread to lymph nodes and then become bacteremia
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| lymphedema | accumulation of interstitial fluid from lymphatic occlusion
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| peau d'orange | persistent lymphedema can thicken skin and give orange peel appearance
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| chylous ascites | interstitial fluid in peritoneal cavity
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| chylothorax | interstitial fluid in chest cavity
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| chylopericardium | interstitial fluid in cardiac cavity
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| primary lymphedema | accumulation of interstitial fluid as a congenital defect {simple congenital lymphedema} or familial origin {Milroy disease}; most commonly seen in legs
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| secondary lymphedema | arises secondary to processes that disrupt lymphatic drainage i.e. scarring, neoplasms, surgery, filariasis
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| hemangioma | benign tumor or blood vessel endothelium; capillary or cavernous depending on size
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| lymphangioma | benign tumor of lymphatics
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| angiosarcoma | malignant tumors of blood vessels and lymphatic vessels (lymphagiosarcoma) most common after radical mastectomy
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| Kaposi sarcoma | low-grade malignancy of vascular endothelium in AIDS patients with HHV-8
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| congestive heart failure | heart can no longer eject the blood delivered by the venous system so blood backs up
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| left-sided heart failure | from ischemic heart disease, aortic and mitral valve issues, hypertension; creates lung, kidney and brain problems
-decrease in renal perfusion but increase in total blood volume
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| dyspnea | breathlessness
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| orthopnea | dyspnea when reclining
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| paroxysmal nocturnal dyspnea | extreme dyspnea that wakes up from sleep
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| prerenal azotemia | decrease in renal filtration leads to increase in nitrogenous products
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| hypoxic encephalopathy | hypoxia of brain from poor perfusion; irritability, restlessness, and coma
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| right-sided heart failure | usually secondary to left-sided heart failure; primary from right-to-left shunts, cor pulmonale and tricuspid valve disease
-liver issues and peripheral edema (ascites, anasarca)
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| cor pulmonale | right ventricular strain from intrinsic lung disease; causes systemic venous congestion
-affects liver, spleen and kidneys
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| nutmeg liver | congestion of sinusoids of venous system creates this pattern in the liver
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| central hemorrhagic necrosis | rupture of liver sinusoids from engorgement
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| centrilobular necrosis | hepatocytes around the central vein undergo necrosis due to hypoxia
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| left-to-right shunts | most common congenital heart problem; patients not cyanotic at birth but increase in pressure leads to reversal of flow
-blood goes through lungs again
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| Eisenmenger syndrome | the increase in pressure of the pulmonary circulation and the right side of the heart leads to the reversal of left-to-right shunts
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| tardive cyanosis | late cyanosis in left-to-right shunts from pulmonary hypertension
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| atrial septal defects | failure of closure of foramen ovale during intrauterine life
-left-to-right shunt
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| ventricular septal defects | usually close spontaneously but increased risk for endocarditis
-left-to-right shunt
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| patent ductus arteriosus | channel between pulmonary artery and aorta remains open after birth
-left-to-right shunt
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| right-to-left cyanotic shunts | cyanotic at birth with unoxygenated blood in systemic circulation
-blood skips the lungs
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| paradoxical embolism | emboli in veins bypass the filtration in the lungs and end up in peripheral circulation
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| hypertrophic osteoarthropathy | clubbing of fingertips from long-standing cyanosis
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| Tetralogy of Fallot | 1. ventricular septal defect
2. dextraposed aorta
3. right ventricular obstruction
4. right ventricular hypertrophy
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| transposition of the great arteries | when aorta comes off the right ventricle instead of the left; can only survive if have a left-to-right shunt
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| coarctation of the aorta | narrowing or constriction of the aorta proximal (symptomatic) or distal (asymptomatic) to the ligamentum arteriosum
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| ischemic heart disease | imbalance between myocardial demand and supply of oxygen; leading cause of death in the US
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| acute plaque changes | fissuring, hemorrhage, rupture, embolization into distal coronary arteries
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| coronary artery thrombosis | arises from plaque rupture that exposes collagen to platelet aggregation and local coagulation
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| coronary artery vasospasm | reduction of cardiac blood flow from unknown cause but possibly stress on top of preexisting atherosclerosis
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| angina pectoris | intermittent chest pain from transient reversible myocardial ischemia without infarct
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| typical/stable angina | associated with atherosclerosis; brought on by stress or exertion and relieved with rest or nitroglycerin
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| prinzmetal angina | vasospasm but not with fixed stenosis; occurs at rest, even sleep, and relieved with nitroglycerin
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| unstable/crescendo angina | from atherosclerotic stenosis and platelet aggregation; most intense and prolonged pain from exertion
-warns of future MI aka {preinfarction angina}
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| myocardial infarction | area of myocardial necrosis from local ischemia
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| subendocardial infarction | inner 1/3 of ventricle wall where necrosis begins
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| transmural myocardial infarction | necrosis of full thickness of ventricular wall
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| cardiac troponin I | specific enzyme for contractile protein, remains elevated for days following an MI
-other enzymes to test: creatine kinase and MB isoenzyme
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| intracoronary thrombolytic medications | clot busters like tPA that can limit infarct
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| coronary artery bypass grafting (CABG) | bypass with leg vein or mammary artery
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| transluminal angioplasty | removes, destroys and compresses stenosing plaques
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| chronic ischemic heart disease (ischemic cardiomyopathy) | slow development of CHF from longterm ischemia; causes arrhythmias (tachycardia, bradycardia, ventricular fibrillation and asystole)
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| sudden cardiac death | unexpected death from cardiac disease, usually due to a lethal arrhythmia
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| systemic hypertensive heart disease | combination of hypertension and left ventricular hypertrophy
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| pulmonary hypertensive heart disease (cor pulmonale) | right ventricular enlargement secondary to pulmonary hypertension
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| acute cor pulmonale | right ventricular dilation from pulmonary embolism
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| chronic cor pulmonale | right ventricular hypertrophy from prolonged pressure overload
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| rheumatic fever | acute autoimmune condition following group A strep; antigen cross reacts in heart and joints
-get {arthritis} and {skin lesions}
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| acute rheumatic heart disease | get carditis of all three layers {pancarditis}
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| Aschoff bodies | collections of intramuscular inflammatory cells that form this pattern of myocarditis in rheumatic heart disease
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| Anitschkow cells | large macrophages surrounding necrotic centers seen in rheumatic heart disease
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| vurrucae | inflammatory vegetations on valve leaflets
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| chronic rheumatic heart disease | secondary to fibrocalcific thickening of valves so get improper closure
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| infective endocarditis | colonization of heart valves or wall by microorganisms; forms thrombotic masses {vegetations}
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| acute endocarditis | secondary to highly virulent organisms on otherwise healthy hearts; usually Staph aureus
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| subacute endocarditis | lower virulence microorganisms that colonize hearts that have had issues; usually Strep viridans in plaque
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| cardiomyopathy | primary non-inflammatory disorder of myocardium
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| dilated cardiomyopathy | dilated, hypocontracting hearts; requires transplant
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| hypertrophic cardiomyopathy | heavy, hypercontracting heart with hyperplasia of left ventricle; ejection is strong but low volume
-sudden, unexplained death in young athletes
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| restrictive cardiomyopathy | decrease in ventricular flexibility
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| myocarditis | inflammatory process that injures myocardium, usually from infection
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| pericarditis | inflammation of pericardium secondary to myocardial or endocardial disease
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| pericardial effusion | fluid accumulation in pericardial sac
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| constrictive pericarditis | complete encasement of heart in fibrous CT
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| hemopericardium | when pure blood fills pericardial sac
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| cardiac tamponade | compression of the heart by fluid accumulation in pericardial sac
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