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FA CVS Patho

QuestionAnswer
Dx : Congenital heart disease associated with fetal alcohol syndrome. Atrial septal defect
Treatment for Patent Ductus Arteriosus? Indomethacin
List the most frequent to least frequent congenital diseases with left to right shunts. VSD > ASD > PDA
What is Eisenmenger's syndrome? Shunt reverses from L -> R to R -> L, due to increased pulmonary resistance.
Why do children squat in congenital heart disease with right to left shunts? TO compress femoral arteries, hence increase systemic vascular resistance, and decrease the right to left shunts to direct more blood into lungs.
List the 4 features of Tetralogy of Fallot. Pulmonary stenosis, RVH, Overiding of aorta, VSD
Shape of the heart in Tetralogy of Fallot? Boot shaped heart, due to RVH.
Cause of Tetralogy of Fallot. Anterosuperior displacement of the infundibular septum.
Cause of Transposition of great vessels? Failure of aorticopulmonary septum to spiral.
Location of aortic stenosis in infantile type coarctation of aorta and adult type coarctation of aorta? Infantile = preductal Adult = Postductal
Dx : Systolic murmur, Notching of ribs, Hypertension in upper extremities and weak pulses in lower extremities. Coarctation of Aorta
Main complication in Coarctation of Aorta? Aortic regurgitation
Dx : Continuous machine-like murmur Patent Ductus Arteriosus
What mantains patency of Patent Ductus Arteriosus? PGE2
Congenital cardiac defect associated with 22q11 syndromes Truncus arteriosus, Tetralogy of Fallot
Congenital cardiac defect associated with Down syndrome ASD VSD AV septal defect
Congenital cardiac defect associated with congenital Rubella Septal defects, PDA, Pulmonary artery stenosis
Congenital cardiac defect associated with Turner's syndrome Coarctation of Aorta
Congenital cardiac defect associated with Marfan's syndrome Aortic regurgitation (late complication)
Congenital cardiac defect associated with offspring of diabetic mother Transposition of great vessels
How does sodium contribute to the cause of hypertension? Sodium increaases plasma volume, and increases vasoconstriction.
List the signs of Hyperlipidemia. Atheromas, Xanthomas, Tendinous xanthoma, Corneal arcus
Dx : Calcification in media of arteries, especially radial or ulnar. Does not obstruct blood flow. Monckeberg Arteriosclerosis
Histology of small arteries in malignant hypertension. Hyperplastic "onion skin"
Histology of small arteries in essential hypertension. Hyaline thickening
Dx : Tearing chest pain radiating to back. CXR shows mediastinal widening Aortic disection
Dx : Associated with cystic medial necrosis (component of Marfan's syndrome) Aortic dissection
Dx : Loss of upper extremity pulse. Tearing chest pain. Aortic dissection
What is the common cause of death of Aortic dissection? Cardiac tamponade, due to aortic rupture.
Name the chemokines involved in smooth muscle cell migration in Atherosclerosis. PDGF FGF-Beta
List 4 most common locations of atherosclerosis. 1) Abdominal aorta 2) Coronary artery 3) Popliteal artery 4) Carotid artery
Dx : Chest pain on exertion, ST depression Stable angina
Dx : Chest pain, ST elevation Prinzmetal's angina
Dx : Worsening chest pain, ST depression, thrombosis but no necrosis Unstable angina
Dx : Death from cardiac cause within 1 hour of onset of symptom. No thrombus in most cases. Sudden cardiac death.
What is the cause of death in sudden cardiac death? Ventricular fibrilation (lethal arrhythmia)
Dx : Progressive onset of CHF. Myocardial tissue replaced with non-contractile scar tissue. Chronic ischemic heart disease
Give examples of tissues with Red (hemorrhagic) tissues. Liver Lung Intestine and also following reperfusion
Give examples of tissues with Pale infarcts. Heart, Kidney, Spleen
List the common coronary artery to get occluded. 1) LAD 2) RCA 3) Circumflex
Time since MI : Contraction bands. 1-2 hours
Time since MI : Early coagulative necrosis, beginning of neutrophil emigration 4 hours
Time since MI : Tissue surrounding infarct shows acute inflammation. 2-4 days
Time since MI : Hyperemia. 2-4 days
Time since MI : Hyperemic border with central yellow brown softening. 5-10 days
Time since MI : Dark mottling. Pale with tetrazolium stain. First day
Time since MI : Gray white 7 weeks
Patient is at risk for what cardiac problems 2-4 days after MI? Arrthymia
Patient is at risk for what cardiac problems 5-10 days after MI? Free wall rupture, Tamponade, Papillary muscle rupture, Ventricular septal rupture. (macrophages have degraded important structural components)
Time since MI : Ingrowth of granulation tissue from outer zone. 5-10 days
Patient is at risk for what cardiac problems 7 weeks after MI? Ventricular aneurysm
Gold standard of diagnosis of MI in the 1st 6 hours. ECG
MI diagnosis: Rises after 4 hours and is elevated for 7-10 days Cardiac troponin I
ECG reading of transmural infarct. ST elevation
ECG reading of sub-endocardial infarct ST depression
List the complications of MI ACTS RAPID Arrhythmia, CHF, Thrombus (mural), Shock, Rupture, Aneurysm, Pericarditis, Infarct, Dressler's syndrome
List the causes of Dilated Cardiomyopathy ABCCCD P Alcohol, Beriberi, Coxsackie B, Cocaine, Chagas, Doxorubicin, Peripartum
What is the abnormal heart sound heard in dilated cardiomyopathy? S3
What are the abnormal heart sounds heard in hypertrophic cardiomyopathy? S4, Apical impulses, Systolic murmur
How does the systolic murmur in hypertrophic cardiomyopathy vary with preload? The murmur increases in intensity when preload decreases
How does the systolic murmur in aortic stenosis vary with preload? The murmur increases in intensity when preload increases (more volume to eject)
What is the CXR findings of dilated cardiomyopathy? Balloon appearance
What is the CXR findings of restrictive cardiomyopathy? Normal sized heart
What is the treatment for hypertrophic cardiomyopathy? Beta-blocker, or Heart specific calcium channel blocker
State the type of genetic inheritance of the familial cases of hypertrophic cardiomyopathy. Autosomal DOMINANT
State the major causes of restrictive cardiomyopathy. Endocardial fibroelastosis (child), and other inflitrative diseases : sarcoidosis, amyloidosis, post-radiation fibrosis, hemochromatosis.
Is dilated cardiomyopathy a systolic or diastolic dysfunction? Systolic dysfunction
Explain the cause of orthopnea (shortness of breath in supine position) in a patient with heart failure. Increase venous return in supine position will exacerbate pulmonary vascular congestion.
State 2 causes of fat emboli. Bone fractures, and Liposuction
Dx : Postpartum DIC Amniotic fluid embolism
State the Virchow's triad. 1) Stasis 2) Hypercoagulability 3) Endothelial damage
What are the clinical findings of bacterial endocarditis? Bacteria FROM JANE Fever, Roth spots, Osler's nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhage, Emboli
What is the pathogen that cause Acute bacterial endocarditis? Staph Aureus (high virulence)
What is the pathogen that cause Subacute bacterial endocarditis? Viridans streptococcus (low virulence)
Dx and pathogen : Small vegetations on congenitally abnormal or diseased valves. History of dental procedures. Subacute bacterial endocarditis, by viridans streptococcus.
Dx and pathogen : Large vegetations on previously normal valves. Acute bacterial endocarditis, by Staph aureus.
What is the pathogen that cause bacterial endocarditis associated with colon cancer and ulcerative colitis? Strep. bovis
What is the pathogen that cause bacterial endocarditis associated with prosthetic valves? Staph. epidermidis
Dx : Endocarditis non-bacterial secondary to malignancy or hypercoagulable state. Marantic endocarditis (non bacterial thrombotic endocarditis)
Dx : Verrucous (wartlike) sterile vegetation on both sides of mitral valve. Associated with lupus. Libman-Sacks endocarditis
List the heart problems associated with SLE. 1) Pericarditis 2) LSE 3) Fibrinoid necrosis
What is the pathogen associated with rheumatic heart disease? Group A Beta-hemolytic streptococci
State the histological findings in rheumatic heart disease. Aschoff bodies surrounded by anitschkow's cells
What type of hypersensitivity is Rheumatic heart disease? Type II hypersensitivity
What are the clinical/laboratory findings of rheumatic heart fever? FEVERSS Fever, Erythema marginatum, Valvular damage (vegetation and fibrosis), ESR increase, Red-hot joints (migratory polyarthritis), Subcutaneous nodules (Aschoff bodies), St. Vitus dance (chorea) + elevated ASO titers and anti-DNAase B
Dx : Hypotension, jugular venous distension, distant heart sounds, increased HR, pulsus paradoxus Cardiac tamponade
What is Pulsus paradoxus (Kussmaul's pulse)? Decrease in amplitude of pulse during inspiration.
Give examples of diseases where pulsus paradoxus is seen? Cardiac tamponade, Asthma, Obstructive sleep apnea, Pericarditis, and Croup
What causes serous pericarditis? SLE, Rheumatoid arthritis, Viral infection, Uremia
What causes fibrinous pericarditis? Uremia, MI (Dressler's syndrome), Rheumatic fever
What causes hemorrhagic pericarditis? TB, Malignancy (eg. melanoma)
Dx : Pericardial pain, friction rub, pulsus paradoxus, distant heart sounds. Pericarditis
What is the ECG changes seen in pericarditis? ST-segment elevation in multipe leads.
What does pericarditis lead to if it does not resolve? Chronic constrictive pericaridits (due to thickening of parietal pericardium)
How does tertiary syphilis lead to dilation of aorta and valve ring? It disrupts the vasa vasorum of aorta causing vessel ischaemia
What is the gross or microscopic findings of syphilitic heart disease? Calcification of aortic root and ascending aortic arch. Leads to "tree-bark" appearance of the aorta.
Dx : Aortic valve regurgitation Brassy cough and hoarse voice. Plasma cell infiltrate in aortic vessel wall. Syphilitic heart disease (syphilitic aneurysm)
What is the most common primary cardiac tumor in adults? Cardiac myxoma
Dx : Ball-valve obstruction in the left atrium. Associated with syncopal episodes. Cardiac myxoma
What is the most common primary cardiac tumor in children? Rhabdomyoma
Dx : Cardiac tumor in children, associated with tuberous sclerosis. Rhabdomyoma
What is Kussmaul's sign? Increase in jugular venous pressure on inspiration.
Dx : Dilated vessels on skin and mucous membranes. Nose bleeds and skin discolorations. Hereditary-hemorrhagic telangiectasia
Dx : Arteriolar vasospasm in fingers and toes in response to cold temperature or emotional stress. Raynaud's disease
Raynaud's phenomenon is when Raynaud's disease is secondary to what diseases? Mixed connective tissue disease, SLE, CREST syndrome
Dx : Focal necrotizing vasculitis, necrotizing granulomas in respiratory tract, and necrotizing glomerulonephritis. Wegener's granulomatosis
c-ANCA is found in what disease? Wegener's granulomatosis
p-ANCA is found in what disease? Microscopic polyangiitis, Chhurg-Strauss syndrome
Dx : Hematuria and red cell cast. CXR reveal large nodular densities. Wegener's granulomatosis
What is the treatment of Wegener's granulomatosis? Cyclophosphamide and corticosteroids.
Dx : Like Wegener's but lacks granulomas. Microscopic polyangiitis
Dx : Vasculitis limited to kidney. Lack of antibodies. Primary pauci-immune cresentic glomerulonephritis.
Dx : Granulomatous vasculitis with eosinophilia. Often seen in atopic patients. Churg-Strauss syndrome.
Dx : Port-wine stain on face. Leptomeningeal angiomatosis. Sturge-Weber disease
Dx : Skin rash on buttocks and legs (palpable purpura). Arthalgia, Intestinal hemorrhage Henoch-Schonlein purpura
What is the immune complexes seen in Henoch-Schonlein purpura? IgA
Dx : Claudication, Raynaud's phenomenon, gangrene and auto-amputation of digits. Buerger's disease
What is the risk factor for Buerger's disease? Smoking
Dx : Young kid, Fever, congested conjuctiva, strawberry tongue, lymphadenitis Kawasaki disease
What is the complication of Kawasaki disease? Coronary Aneurysms
Dx : Vasculitis. Lesions are of different ages. Polyarteritis nodosa
Dx : Fever, Melena, myalgia, abdominal pain, neurologic dysfunction, hypertension, cutaneous eruptions Polyarteritis nodosa
Dx : Vasculitis. Hepatitis B seropositivity in 30% of patients. Polyarteritis nodosa
Dx : Vasculitis. Multiple aneurysms and constrictions on arteriogram. Not associated with ANCA. Polyarteritis nodosa
What is the treatment for polyarteritis nodosa? Corticosteroids and cyclophosphamide
What are the symptoms of Takayasu's arteritis? FAN MY SKIN On Wednesday Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities.
Dx : Unilateral headache, jaw claudication, impaired vision Giant cell (temporal) arteritis
What artery do giant cell arteritis usually affects? Branches of carotid artery
What is the treatment for giant cell arteritis? High-does steroids
What are round white spots on retina surrounded by hemorrhage called? Roth spots
What are small erythematous lesions on palm and sole called? Janeway lesions, seen in bacterial endocarditis
What are tender raised lesions on finger and toe pads called? Osler's nodes, seen in bacterial endocarditis
Created by: lemontea88