Cardio 3

jdlevenson's version from 2015-06-21 02:58


Question Answer
SLE most common CVD presentationPericarditis.
Pericarditis presentation Severe and constant middle or left chest pain that may radiate to the neck and shoulders (particularly trapezius ridge). Increases on inspiration and is relieved by sitting up and leaning forward (postural) and auscultation reveals pericardial friction rub best heard with patient lying forward.
Distended neck veins, diminished/ muffled heart sounds, profound hypotension, and pulsus paradoxusCardiac tamponade.
Pulsus paradoxus is...Drop in systolic BP > 10 mm on inspiration. Cardiac tamponade***. Disappearing radial pulse during inspiration
Cardiac tamponade is associated with pulsus paradoxus andArterial hypotension
Cardiac tamponade happens when pericardial pressure >10 mmHg resulting inCollapse of the atria, increase systemic venous pressure, reduced preload and eventually decreased CO -> cardiogenic shock
Cardiac tamponade findingsBeck triad (hypotension, distended JV, distant heart sounds), increased heart rate, pulsus paradoxus, low voltage QRS and electrical alternans
Aortic dissection, narrow it toLongstanding HTN***, Marfan and EHD. Rarely syphilis.
How does syphilis cause thoracic aorta aneurysmsVasa vasorum obliteration—particularly those in the thoracic aorta
Concentric vs Eccentric hypertrophyConcentric from pressure overload/ increased afterload, adding sarcomeres in parallel vs. eccentric from volume overload, addition of sarcomeres in series, allowing venitruclar dilation while maintain normal sarcomere lengths. Concentric is capable of generating greater forces and higher pressures while increased while thickness maintains normal wall stress. Becomes stiff.
Concentric hypertrophy happens inAortic stenosis and longstanding systemic HTN
Question Answer
Single most important risk factor for aortic dissection/ intimal tearsHTN. Then cystic medial degeneration. Recall it can go towards or away from the heart.
Where does blood/ hematoma formBetween intimal flap and medial wall.
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Single most important risk factor for aortic aneurysm? Others? Atherosclerosis and based on that, then smoking, HTN, DM, and hypercholesterolemia.
Most common locations for atherosclerotic plaques (and thus aneurysms)Large elastic vessels and large or medium sized muscular arteries; Abdominal aorta > Coronary artery > Popliteal artery > Internal carotid artery > Circle of Willis. Upper limb arteries, mesenteric and renal arteries all tend to be spared.
Acute onset heart failure in setting of recent viral infection...Consider DCM from viral myocarditis. Direct viral injury and from autoimmune reaction to virally altered myocytes.
Viral myocarditis or bacterial (such as from diphtheria) usually result in what heart problemDCM/ systolic dysfunction
Fatty streak composed of intimal lipid filled foam cells derived fromMacrophages and smooth muscle cells that have engulfed lipoproteins such as LDL; insudate into intima.
Aortic aneurysms are mostly caused by atherosclerosis, then medial degeneration (marfans) then last rare causePerivascular fibrosis/ dense periaortic fibrosis with inflammatory reaction, an unusual variant of AAA; the inflammatory reaction is rich in lymphocytes, plasma cells, macrophages and giant cells
DCM is a dx of exclusion once other etiologies of heart failure have been ruled out such aspericarditis, rhythmic disturbances, valvular defects, CAD
High systolic pressure gradient between left ventricle and aorta?Left ventricular outflow obstruction. Such as from aortic stenosis.
Acute onset mid-chest pleuritic that decreases on sitting up and leaning forwardAcute pericarditis. Fibrinous or serofibrinous are most common forms.
Acute pericarditis most often caused byMI, rheumatic fever, uremia and sometimes viral infection leading to fibrinous exudate accumulating in pericardial space
Kussmaul’s signParadoxic increase in jugular venous pressure with inspiration; found most often in patients with chronic constrictive pericarditis, which takes months or years to develop. Because volume restricted right ventricule cannot accommodate inspiratory increase in venous return. Need to also consider restrictive cardiomyopathy, severe right HF, tricuspid stenosis, and rarely cardiac tamponade. NOT EXPECTED in a case of ACUTE pericarditis.
Constrictive pericarditis causesIdiopathic or viral pericarditis; cardiac surgery or radiation therapy
Constrictive pericarditis signsIncreased JVP, kussmaul sign, pulsus paradoxus, pericardial knock
Constricve pericarditisThick fibrous tissue in pericardial space; rigid itssue encases heart and restricts ventricular filling causing low CO and right sided HF
S3Diastolic dysfunction and or ventricular volume overload
Restrictive cardiomyopathy causesamyloidosis, sarcoidosis, metastatic cancer or inborn metabolic errors
Pulsus paradoxus, systolic BP drop of 10 mm or more during inspiration, can be caused byCor pulmonale, constrictive chronic pericardial disease or cardiac tamponade.
Pericardial knockconstrictive pericarditis; brief high frequency precordial sound heard in early diastole (shortly after S2) (earlier than a S3 sound would be and also more sharp and accentuated)
Nmumber one cause of V Fib in people < 30Hypertrophic cardiomyopathy
Systolic anterior motion of MV occurs in patients withHypertrophic cardiomyopathy and cau cause eccentric MR or worsen LV outflow tract obstruction


Question Answer
Fibrous intimtal thickening with endocardial plaques limited to the right heartCarcinoid syndrome/ carc. Heart disease. May progress to pulmonic stenosis and or restrictive cardiomyopathy.
Severity of carcinoid syndrome determined bySerotonin levels and urinary excretion of its metabolite 5-hydroxyindoleacetic acid. Also will see niacin deficiency.
Carcinoid syndrome symptomsSkin flushing, abdominal cramping, n/v, diarrhea
Carcinoid tumors produce serotonin and...Bradykinin, kallilkrein, histamine, prostaglandins and or tachykinins
Why does carcinoid syndrome only affect right heartSerotonin, along with bradykinin, is generally inactivated by pulmonary vascular endothelial monoamine oxidase
Recall, carcinoid syndrome is most common malignancy in what systemSmall intestine
Most plentiful catecholamine in urineVMA; indicator of catecholamine level in blood
Cancer mets to heart usually go toPericardium or myocardium
Ankylosing spondylitis is associated withUveitis, apical pulmonary fibrosis, peripheral enthesopathies and aortic insufficiency
Aging associated with increased or decreased left ventricle sizeDecreased.
Localized amyloidosis confined to cardiac atria/ isolated atrial amyloidosis is due toDeposition of abnormally folded B-pleated hsheet confirmation atrial NATRIURETIC PEPTIDE-derived proteins. Incidence increases with age reaching >90% in the ninth decade. Senile cardiac amyloidosis** increases risk of AFib.


Question Answer
Persistent lymphedema, such as after radical mastectomy and or radiation, predisposes toLymphangiosarcoma, malignant neoplasm of endothelial lining of lymphatic channels. Occurs approximately 10 years following radical mastectomy.
Bacillary angiomatosis vs Kaposi Sarcoma, benign? B, not K
Bacillary angiomatosis vs Kaposi Sarcoma, AIDS?Both
Bacillary angiomatosis vs Kaposi Sarcoma, infiltrate made ofB- neutrophils and K-lymphocytes
Bacillary angiomatosis vs Kaposi Sarcoma, causeB- bartonella henselae vs K- HHV8/ HIV
Hemangiomas, Strawberry vs Cherry vs Pyogenic, whoStrawberry – infants/ children; Cherry – elderly, Pyogenic – pregnancy or trauma
Hemangiomas, Strawberry vs Cherry vs Pyogenic, prognosisStrawberry – grows with child but then usually regresses by 5-8 years; Cherry – does not regress; Pyogenic – can ulcerate and bleed
Liver hemangiosarcoma a/wArsenic (pesticides), thorotrast (radioactive), and PVC
Pyogenic hemangiomas consist ofHypertrophic granulation tissue; polypoid form of capillary hemangioma; grow rapidly
Port-wine stains/ nevus flammeus consists of whatMalformed dilated blood vessels in superficial dermis; dark red or purple typically involving face or limbs
Kaposi sarcoma consists ofSpindle shaped cells from smooth muscle and vascular endothelial lineage
Cardiac atrial myxomamost common primary cardiac neoplasm; 80% time in LA
Cardiac atrial myxoma composition Scattered cells within mucopolysac stroma, abnormal blood vessels and hemorrhaging; produce a large amount of VEGF (which constributes to angiogenesis, hemorrhaging and friability seen in these tumors) and IL-6 (leading to constitutional symptoms). Often pedunculated and may become very large.
Cardiac atrial myxoma pathologyValvular obstruction (position dependent), hemorrhage, embolus and constitutional symptoms from IL-6


Question Answer
Granulomatous inflammation of media?GCA (older men >50; tends to be temporal arteries) and Takayasu arteritis (aortic arch; women <40)
Leukocytoclastic vasculitis/ MPA/ hypersensitivity vasculitis, histologySegmental fibrinoid necrosis of small vessels; similar to PAN
PAN, histologySegmental transmural necrotizing inflammation of medium to small sized arteries; necrotic tissue and deposits of immune complexes and plasma proteins with smudy eosinophilic deposit + fibrinoid necrosis
Buerger’s diseaseThrombosing vasc of medium and small arteries principly tibial and radial** arteries; usually seen in chronic smokers and people <35
Rheumatoid arteritis , hypersensitivity vascultiis that affects...Arterioles and arteries of any size; produces visceral infarctions after longstanding RArthritis; similar to PAN and MPA
Monckeberg’s medial calcific sclerosis do or do not narrow vessel lumendo NOT; asymptomatic; seen in adults > 50
Hyaline arteriosclerosis a/w high or low levels of HTNLOW levels
Transmural inflammation of arterial wall with fibrinoid necrosisPAN** (young adults, Hep B, typically renal and visceral; immune complex mediated; string of pearls; fever, weight loss, malaise, headache, neurological dysfunction...)
Hyperplatic arteriolosclerosis results fromDiastolic pressures >120-130/ severe HTN; presents as onion-like concentric thickening of walls of arterioles as result of laminated smooth muscle cells and reduplicated basement membranes;