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 |