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FA CVS Patho
| Question | Answer |
|---|---|
| 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
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