Pathoma - 8 (Cardiac)

arold001's version from 2015-12-31 01:10

Section 1

Question Answer
What causes stable angina?atherosclerosis of coronary arteries with >70% stenosis --> decreased blood flow thats not able to meet demands of the myocardium
What causes UNSTABLE angina?rupture of atherosclerotic plaque with thombosis and INCOMPLETE occlusion of a coronary artery
what will the EKG of prinzmetal angina show?ST segment elevation due to TRANSMURAL ischemia
unlike unstable angina, what causes MI?due to rupture of atherosclerotic plaque with thrombosis and COMPLETE occlusion of coronary artery --> lack of flow to myocardium
occlusion of the LAD artery leads to infarction of where areas?anterior wall and anterior septum of LV
occlusion of the RCA leads to infarction to what 3 areas?posterior wall, posterior septum, papillary muscles of LV
occlusion of the left circumflex artery leads to infarction to which area?lateral wall of LV
whats the most sensitive and specific marker for MI?troponin I = rise 2-4 hours after infarction, peak at 24 hours and return to normal by 7-10 days
what marker is useful for detecting reinfarction?CK-MB = levels rise 4-6 hours after infarction, peak at 24 hours and return to normal by 72 hours
whats a complication of MI <4 hourscardiogenic shock, CHF, arrhthymia
what microscopic changes occur 4-24 hours after an MI?coagulative necrosis
whats the most common complication that occurs 4-24 hours after MI?arrhythmia
whats the most common complication that occurs 1-3 days after MI?fibrinous pericarditis = cp with friction rub
whats the most common complication that occurs 4-7 days after infarction?rupture of ventricular free wall, interventricular septum or papillary muscle
what artery feeds the papillary muscles of the heart?RCA
what gross change of the heart do you see from 1-7 days?yellow pallor
what gross changes do you see 1-3 weeks after MI?RED BORDER emerges as granulation tissue enters from free edge of infarct
whats the most common complication months after the MIaneurysm (since scar is weak), mural thrombus (stasis since scar isnt as flexible), Dressler syndrome

Section 2

Question Answer
what are 4 causes of sudden cardiac death?severe atherosclerosis, MVP, cardiomyopathy, cocaine abuse
whats the 1st line treatment for left-sided heart failure?ACE inhibitors
whats the most common reason for RIGHT sided heart failure?left sided heart failure
describe how lung disease causes right heart failurelung disease --> hypoxia --> constriction in lung --> right heart has to pump against constricted lung
what are some signs of LEFT sided heart failure?dyspnea, paraoxysmal nocturnal dyspnea, orthopnea, crackles
what are some signs of RIGHT sided heart failure?JVD, pitting edema, painful hepatosplenomegaly with nutmeg liver

Section 3

Question Answer
describe how you can go from L-->R to R--> L shuntL-->R shunt causes increased flow thru pulmonary circulation --> results in hypertrophy of pulmonary vessels and pulmonary HTN. Increased pulmonary resistance leads to reversal of shunt
what congential heart defect is associated with fetal alcohol syndrome?VSD
whats the most common type of ASD?ostium secundum
what type of ASD is a/w down syndrome?ostium primum
whats an important complication of ASD?paradoxical emboli = RT sided emboli that originates in the DVT goes to RA --> LA --> LV --> systemic circulation --> brain
what drug maintains patency of PDA?PGE2
whats the tx for closure of the PDA?INDOMETACIN
how does blood flow in PATENT ductus arteriosus?LA --> LV --> aorta --> pulmonary artery --> right heart
name the 4 characteristics of Teratology of Fallot1) pulmonic valve stenosis 2) RV hypertrophy 3) VSD 4) aorta overlying VSD
what congenital heart defect is associated with maternal diabetes?transposition of great vessels
congential heart defect that results in hypertrophy of RV and atrophy of LVtransposition of great vessels
congential heart defect that causes RV hypoplasiatricuspid atresia
what other congential heart defect will you find in a cyanotic child with tricuspid atresia?ASD
what other congential heart defect is associated with INFANTILE coaractation of the aorta?PDA (adult form is NOT associated with PDA)
wheres the coaraction of the aorta in INFANTILE form?btw aortic arch and PDA
what heart defect is associated with ADULT coarctation of the aorta?bicuspid aortic valve

Section 4

Question Answer
whats a systemic complication of group A strep pharyngitis?acute rheumatic fever
whats causes acute rheumatic fever?MOLECULAR MIMICRY!! bacterial M protein resembles proteins in human tissue
increased anti-DNase B titer are used to diagnose what?rheumatic fever due to GAS
what is the most common cause of death in pts with rheumatic fever due to GAS?MYOCARDITIS!!
whats the hallmark sign of myocarditis in rheumatic fever?Aschoff body with histiocyte
name the major criteria of rheumatic fever1) migratory polyarthritis 2) pancarditis (endocarditis with MV regurg, myocarditis with ashoff body, pericarditis with friction rub), 4) subcutaneous nodules 5) erythema marginatum 6) sydenham chorea
whats the hallmark of myocarditis?aschoff body with anitschkow cells
cell with "catepillar" nucleusanitschow cell of MYOCARDITIS
heart condition that leads to classic fish mouth appearancechronic rhuematic heart disease
how is GAS related to rheumatic fever related to endocarditis?complication of group A pharyngitis = rheumatic fever due to molecular mimcry. Now complication of chronic rheumatic fever = infectious endocarditis
what disease do you see fusion of commisures of aortic valve?chronic rheumatic heart disease
systolic ejection click f/b crescendo-decrescendo murmuraortic stenosis
how can you tell the difference btw aortic stenosis due to wear and tear vs. chronic rheumatic feverrheumatic disease = mitral valve stenosis AND fusion of aortic valve commisures. wear and tear will just show aortic stenosis
whats the most common cause of aortic regurg?isolated aortic root dilation
early blowing diastolic murmuraortic regurg
what decreases diastolic pressure?regurg
what increases systolic pressureincreased SV
pt presents with bounding pulse, pulsating nail bed and head bobbing. diagnosis?increased pulse pressure due to aortic regurg

Section 5

Question Answer
what causes mitral valve prolapse?myxoid degeneration (accumulation of ground substance) of valve, making it floppy
why does MVP click and mumur become SOFTER with squatting?increased systemic resistence decreases LV emptying
holosystolic blowing murmurmitral regurg
explain why mitral valve regurg murmur gets louder with expirationexpiration --> increased return to the LA --> increase blood to LV --> increase regurg back
whats the most common cause of mitral regurg?MVP, LV dilation due to left sided heart failure, infective endocarditis, acute rheumatic heart disease, papillary muscle rupture after mI
whats the most common cause of mitral stenosis?chronic rheumatic heart disease
opening snap followed by diastolic rumblemitral stenosis
acute rheumatic fever vs. chronic rheumatic fever on mitral valveacute rheumatic fever: mitral regurg
chronic rheumatic disease: mitral stenosis
whats the most common cause of endocarditis in IV drug users?staph aureus
what bacteria causes endocarditis in prosthetic valvesstaph epidermidis
what does HACEK orgs stand for?Hemophilis, Actinobacillus, Cardiobacterium, Eikenella, Kingella
whats the difference btw Janeway lesions and Oslers nodes in endocarditis?Janeway lesions = erythematous NONTENDER lesions of PALMS and SOLES. Oslers nodes: PAINFUL lesions on FINGER PADS and toes
janeway lesions, osler nodes and splinter hemorrhages are associated with what heart disease?endocarditis
what anemia is associated with endocarditis?anemia of chronic disease = due to chronic inflammation

Section 6

Question Answer
Which virus causes dilated cardiomyopathy?coxsackievirus A or B = lymphocytic infiltrate in myocardium
What is hypertropic cardiomyopathy due to?mutation in sarcomere proteins
young athlete has syncope with exercise. diagnosis>HCM = hypertrophy of ventricular septum results in functional aortic stenosis
biopsy shows endomyocardial fibrosis with eosinophilic infiltrate and eosinophiliaLoefflers syndrome --> restrictive cardiomyopathy
whats a rare cause of RESTRICTIVE cardiomyopathy in children?endocardial fibroelastosis = endocardium becomes really fibrosed and thick
whcih cardiomyopathy is characterized by low-voltage EKG with diminished QRS amplituderestrictive cardiomyopathy
whats the most common PRIMARY cardiac tumor in adults?myxoma = benign mesenchymal tumor with gelatinous appearance and ground substance
pt presents with pedunculated mass in LA that causes syncopemyxoma = benign mesenchymal tumor with gelatinous appearance and ground substance
benign hamartoma of cardiac musclerhabdomyoma
whats the most common primary cardiac tumor in children?rhabdomyoma
whats the most common primary cardiac tumor in adults? kids?adults: myoxoma (located in LA)
kids: rhabdomyoma (located in ventricles)
metastasis to the heart involves what part of the heart?pericardium --> pericardial effusion. so if pt presents with pericardial effusion, think of breast or lung carcinoma, melanoma or lymphoma

Section 7

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