Cardiology and Blood Vessels Part 1 UWorld Qbank 2015
Terms in this set (126)
A 60-year-old patient has a persistent headache and difficulty chewing; arterial biopsy shows multinuclear giants cells and internal elastic membrane fragmentation. What condition does he likely have?
Temporal/ Giant cell arteritis; most common forms of systemic vasculitis in adults
Immediate prednisone therapy is given to a patient with temporal arteritis to prevent:
A 30-year-old Asian male with exertional calf pain and painful foot ulcers demonstrates hypersensitivity to intradermally injected tobacco extract. What condition does he likely have?
Buerger's disease/ thromboangiitis obliterans; presumably he is a heavy smoker who has developed immune hypersensitivy to a component of tobacco smoke
What is the pathologic process in Buerger's disease?
Segmental vasculitis extending into contiguous veins and nerves (a feature rarely seen in other types of vasculitis); segmental thrombosing vasculitis
A 34-year-old male dies in the cardiac intensive care unit. A cross-section of his right coronary artery shows significant narrowing due to advanced atheroclerosis. His father died from a heart attack at 40. What condition did the patient likely have?
Familial hypercholesterolemia results from:
An autosomal dominant mutation of the LDL receptor gene; can be heterozygous, 2- to 3-fold elevation of plasma cholesterol from birth, or homozygous 5- to 6- fold elevation; one of the most common inherited disorders
Age related isolated systolic hypertension is predominately caused from:
Decrease in compliance (increased stiffness) of the aorta and its proximal major branches
A 42-year-old male is brought to the ER complaining of severe headaches and oliguria. His BP is 240/150 mm Hg and his HR is 90/min. On ophthalmologic exam, there is papilledema bilaterally. What is the patient likely experiencing?
A hypertensive crisis: persistent diastolic pressure exceeding 130mmHg this is often associated with acute vascular damage
What vascular damage can result from a hypertensive crisis?
Hyperplastic arteriolosclerosis; onion-like concentric thickening of the walls of arterioles due to laminated smooth muscle cells and reduplicated basement membranes; renal involvement decreases GFR, activating the renin-angiotensin-aldosterone-system and further increasing BP in a vicious cycle
What provides major proliferative stimuli for the cellular components of atherosclerotic plaques?
Platlets; the pathogenesis of atherosclerotic plaques (atheromas) is thought to begin with endothelial cell injury, which results in increased endothelial permeability, enhanced leudocyte adhesion, and altered gene expression; endothelial dysfunction also promotes platelet adhesion, aggregation and release of growth factors and cytokines. Platelet-derived growth factor (PDGF) released by locally adherent platelets, dysfunctional endothelial cells, and infiltrating macrophages promotes migration of smooth muscle cells from the media into the intima and increases SMC proliferation; platlets also release TGF-beta, which is chemotactic from SMCs and induces interstitial collagen production
A 23-year old male with recurrent severe nosebleeds has pink spider-like lesions on his oral and nasal mucosa, face and arms. He most likely suffers from:
Osler-Weber-Rendu syndrome/ hereditary hemorrhagic telangiectasia; autosomal dominant condition marked by telangiectasisas in the skin and mucous membranes of the lips, oronasopharynx, respiratory, GI and urinary tract; rupture can cause epistaxis, GI bleeding or hematuria
A 22-year-old male presents to the ER with severe headaches and vomiting. He soon slips into a coma and dies. Autopsy shows a ruptured cerebral aneurysm with extensive intracranial hemorrhage. Name the cause of the patient's death.
Spontaneous intracranial hemorrhage (SICH); (no history of head trauma)
The three most common causes of spontaneous intracranial hemorrhage in young adults are:
1. Arteriovenous malformations; 2. Ruptured cerebral aneurysms; 3. Abuse of sympathomimetic drugs such as cocaine
What congenital cardiac anomaly is associated with cerebral aneurysms?
Coarctation of the aorta; may occur as a solitary defect or may be associated with other congenital cardiac anomalies or with berry aneurysms of the Circle of Willis; berry aneurysms are particularly prone to rupture when associated with coarctation, because of hypertension in branches or the aortic arch proximal to the coarct resulting in subarachnoid hemorrhage
A 58-year-old man comes to the ER with abrupt-onset, severe chest pain that radiates to his back. His BP is 220/130 mm Hg in the left arm and 180/100 mmHg in the right. HR = 100/min. Initial laboratory studies show normal serum troponin levels and ECG is negative for ST segment changes. What is this patient most likely experiencing?
Aortic dissection; characterized by severe retrosternal chest pain radiating to the mid-to-upper back that can move down ward as the dissection progresses
What initiates an aortic dissection?
Tear in the aortic intima; dissection can progress both proximally and distally
What is the primary risk factor for aortic dissection?
Hypertension; longstanding hypertension → medial hypertrophy of the aortic vasa vasorum → reduced blood flow to the aortic media → medial degeneration with a loss of smooth muscle cells → enlargement and increased wall stiffness → increased aortic wall stress → increased risk of intimal tearing and dissection
What is a xanthelasma?
A type of xanthoma, yellowish macules/paules, usually found on the medial eyelids; dermal accumulations of benign-appearing macrophages with abundant, finely vacuolated (foamy) cytoplasm containing cholesterol (free and esterified), phospholipids, and triglycerides
What can cause xanthelasmas?
Hyperlipidemia and/ or dyslipidemia
In a patient presenting with xanthelasmas and no other medical complaints what is the next best step in management?
Serum lipids and blood glucose level; diabetic may develop secondary hyperlipidemia and/or dyslipidemia due in part to insulin resistance promoting increased VLDL production
A 53-year-old man has progressive exertional dyspnea. He has smoked 2packs of cigarettes per day for the last 35 years, has increased anteroposterior diameter of his chest, decreased breath sounds and scattered wheezes throughout his lungs. What condition does he likely have?
COPD caused by chronic bronchitis/emphysema
A patient with COPD has moderate dilation of the right ventricle and increased central venous pressure. He is likely suffering from:
Cor pulmonale secondary to COPD
How does right heart failure affect central venous pressure, capillary hydrostatic pressure, net plasma filtration and interstitial fluid pressue?
Increases central venous pressure, which leads to a rise in capillary hydrostatic pressure, net plasma filtration and interstitial fluid pressure, which also leads to increased lymph drainage
The absence of peripheral edema in a patient with moderately elevated central venous pressure can be best explained by what compensatory mechanism?
Increased lymphatic drainage; large elevation can overwhelm the lymphatic reabsorptive capacity lead to the development of overt edema
Autopsy of a 12-year-old Causcasian male who died in a motor vehicle accident shows many flat yellow spots on the inner surface of the aorta. Name these lesions.
Describe the composition of a fatty streak.
Intimal lipid-filled foam cells, derived from macrophages and smooth muscle cells that have engulfed lipoprotein (predominately LDL), which has entered the intima through an injured, leaky endothelium
Name the earliest lesions in the progression to atherosclerosis.
Do all fatty streaks progress to atherosclerotic plaques?
No; their occurrence and location in a child do not predict the occurrence or location of atheromatous plaques later in life
Name two causes of frothy, foamy urine.
1. Proteinuria 2. Bile salts in the urine
Why can heavy proteinuria, as in nephritic syndrome, cause regional or generalized interstitial edema?
Decreased plasma oncontic pressure → increases net plasma filtration
Name two conditions of vasculitis that consist of granulomatous inflammation of the media.
1. Temporal arteritis (distal carotid artery) 2. Takayasu arteritis (aorta and proximal aortic arterial branch)
A 52-year-old immigrant with vague chest pain and cough is diagnosed with mediastinal widening. PE reveals a decrescendo-type diastolic murmur over the left sternal border. Serum FTA-ABS testing is positive. What condition does this patient likely have?
"leutic" aneurysm/ syphilic aneurysm; his murmur is characteristic of aortic regurgitation and combined with mediastinal widening suggests an aortic aneurysm that has dilated the aortic annulus; positive serology for syphilis (positive FTA-ABS)
What pathologic process in tertiary syphilis causes aortic aneurysms?
Vasa vasorum obliteration; tertiary syphilis begins with vasa vasorum endarteritis and obliteration resulting in inflammation, ischemia, and weakening of the adventitia; aneurismal dilation of the thoracic aorta results, and can extend to dilate the aortic valve ring; currently rare in the US
What is the single most significant risk factor for intimal tears leading to aortic dissections?
Hypertension; cystic medial degeneration, which may be seen in connective tissue diseases such as Marfan syndrome, also predisposes patients (especially younger ones) to aortic dissection
Myxomatous changes in the media of large arteries is referred to as:
Cystic medial degeneration
Medial degeneration is characterized by:
Fragmentation of elastic tissue (basket weave pattern of separated elastic fibers) & separation of the elastic and fibromuscular components of the tunica media by small, cleft-like spaces that become filled with amorphous extracellular matrix
Name a frequent cause of cystic medial degeneration in younger patient.
Marfan syndrome; autosomal dominant defect in fibrillin-1, a glycoprotein that is a major component of extracellular matrix microfibrils, which form the scaffolding for elastic fibers
What enzyme cross-links elastin fibers and collagen fibers and is responsible for maintaining the elastic lamina and ensuring the integrity of the aorta?
What arteries are spared in polyarteritis nodosa?
Pulmonary arteries; kidneys, heart, liver and GI tract are commonly involved
Small, bright-red, popular lesions that are not itchy or painful under the nipple of a 35-year-old male patient who is otherwise healthy are likely:
Cherry hemangiomas; most common benign vascular tumors in adults and typically appear during the third or forth decade of life; always superficial on the skin and are not found on the mucosa or deep tissues; proliferation of capillaries and post-capillary venules in the papillary dermis is seen on light microscopy
High intraplaque activity of what enzyme in an atherosclerotic lesion would predispose to MI?
Metalloproteinases; balance of collagen synthesis and degradation determines the mechanical strength of the fibrous cap; plaque rupture can lead to thrombosis and/ or thromboembolism
A 67-year-old Caucasian male with a past medical history significant for severe, ongoing drug-resistant hypertension, dies of an intracranial hemorrhage. At autopsy the right kidney is significantly shrunken, though the left kidney appears grossly normal. What mechanism most likely explains the renal morphology found?
Oxygen and nutrient deprivation due to unilateral renal artery stenosis; the ischemic kidney secretes high levels of renin, causing the hypertension
What is the most common cause of renal artery stenosis?
Obstruction by an atheromatous plaque at the origin of the renal artery; occurs more frequently in males and patients with diabetes mellitus
Autopsy of a 65-year-old Caucasian male demonstrates widespread narrowing of the renal arterioles. The arteriolar walls are homogenously thickened and stain pink with hematoxylin-eosin. Name two diseases and/or conditions that may have lead to these changes.
Diabetes mellitus and/or nonmalignant hypertension; description is characteristic of hyaline arteriolosclerosis; hyaline material is thought to result from leakage of plasma constituents across the vascular endothelium + excessive ECM production by smooth muscle cells stimulated by chronic/repeated endothelial energy from hemodynamic stress and/or metabolic derangements (e.g. high blood glucose)
An asthmatic develops wrist drop, has eosinophilia and serum antibodies against neutrophil myeloperoxidase. He most likely suffer from:
Churg-Strauss syndrome; combination of adult-onset asthma, eosinophilia, and p-ANCA; other criteria include history of allergy, mono- or polyneuropathy, migratory/transient pulmonary infiltrate and paranasal sinus abnormalities
A patient presents with acute-onset chest pain and dyspnea. A V/Q scan shows a perfusion defect that is not anatomically matched by a ventilation defect, suggesting that this patient is most likely suffering from a:
What is the most common cause of PE?
A 34-year-old female presents with a small bluish lesion under the nail of her right index finger. The lesion is extremely tender to touch. If the lesion is a tumor, name two tumors that it might be.
1. Glomus tumor (glomangioma) 2. Subungual melanoma
A benign glomus tumor (glomangioma) originates from what type of cells? Include function.
Modified smooth muscle cells that control the thermoregulatory functions of dermal glomus bodies
A 64-year-old male has difficulty walking. He experiences muscle cramps in his right thigh after walking about one block on level ground. The cramps subside quickly with rest. Name the symptom and cause.
Intermittent claudication most likely from atherosclerosis causing stenosis of larger arteries (ipsilateral external iliac or common femoral arteries and/or both the superficial femoral and profunda femoris arteries)
Marked, one-sided kidney atrophy in a 60-year-old patient is suggestive of:
Renal artery stenosis (RAS); occurs in elderly individiuals due to atherosclerotic changes in the arterial intima or in women of child bearing age due to fibromuscular dysplasia
Name two finding common in renal artery stenosis.
Hypertension (due to renin secretion) and abdominal bruit present during systole and diastole (specific but not necessary)
A Caucasian male has fever weight loss and muscle pain. Several weeks ago he had dark stools and malaise. Muscle biopsy demonstrates transmural inflammation of the arteries with fibrinoid necrosis. Some arteries also show fibrous wall thickening. What is his likely diagnosis?
Polyarteritis nodosa (PAN); segmental, transmural, necrotizing inflammation of medium to small sized arteries that can occur in any organ but spares the lung
Polyarteritis nodosa is associated with what infection?
Hepatitis B infection (10-30%)
A 72-year old woman has persistent headaches, fatigue, and diffuse muscular pain. She has a history of hypertension and osteoarthritis. Her father had a subarachnoid hemorrhage from a ruptured berry aneurysm. She is treated with prednisone, leading to marked and rapid improvement in her symptoms. What condition does she likely have?
Temporal arteritis/ giant cell arteritis; associated with polymyalgia rheumatic and responds quickly to glucocorticoids
What type of inflammation occurs in temporal arteritis?
Granulomatous inflammation of the media
A 50-year-old Caucasian female with a history of breast cancer had a radical mastectomy and radiation several years ago. She now presents with persistent right arm swelling. What rare condition is she at increased risk of developing?
Lymphangiosarcoma; a rare malignant neoplasm of the endothelial lining of lymphatic channels; persistent lymphedema with chronic dilatation of lymphatic channels is a predisposing factor; typically could appear approximately 10 years following radical mastectomy
Over the past few months, a 54-year-old male has experienced several episodes of thrombophlebitis involving various sites in both his arms and legs. These symptoms may indicate the presence of:
Visceral cancer; a paraneoplastic syndrome of hypercoagulability may be seen in some patients with cancer, especially adenocarcinomas of the pancreas colon or lung; "Trousseau's syndrome" or migratory superficial thrombophlebitis in which superficial venous thromboses appear in one site, resolve and then appear in another
A 62-year-old woman has a vague feeling of heaviness in her legs, especially when standing still for long periods. She has osteoarthritis and reflux disease. She has worked as a cashier for 20 year and has dilated and tortuous superficial veins in her lower legs. Name this condition.
Varicose veins; results from impairment of the venous valves and reflux of venous blood
Name 5 common complications resulting from varicose veins.
Painful thromboses, stasis dermatitis, skin ulcerations, poor wound healing, superficial infections; result of poor blood flow; thromboembolism is a very infrequent complication while venous stasis ulcers are very common
A 6-year-old boy has a routine blood draw that shows milky plasma that forms a creamy-appearing supernatant upon standing. Further testing shows that his plasma lipoprotein lipase activity measured after intravenous heparin administration is substantially lower than normal. What condition does he likely have?
Familial chylomicronemia syndrome (type 1 hyperlipoproteinemia); an autosomal recessive condition most often caused by lipoprotein lipase (LPL) deficiency; LPL is normally bound to heparan sulfate moieties on the vascular endothelium, heparin administration releases them, allowing LPL activity to be measured in vitro; without sufficient LPL activity, the body is unable to clear dietary lipid loads due to defective hydrolysis of serum triglycerides (especially chylomicrons)
Patients with familial chylomicronemis syndrome present with what 4 symptoms/lab values in childhood?
1. Marked hypertriglyceridemia 2. Recurrent acute pancreatitis 3. Lipemia tetinalis (milky-appearing retinal vasculature) 4. Eruptive xanthomas (small yellowish papules surrounded by erythema found mainly on extensor surfaces)
Tendon xanthomas and xanthelasmas are primarily seen with:
Hypercholesterolemia; (Note: eruptive skin xanthomas may be present in hypertriglyceridemia)
A 52-year-old male has vague abdominal discomfort. Abdominal palpation reveals a centrally-located, pulsatile mass. What is the likely diagnosis?
Abdominal aortic aneurysm
What is the major cause of abdominal aortic aneurysm?
Atherosclerosis; atherosclerotic atheromas can sufficiently progress enough to weaken the underlying media of the aortic wall
Abdominal aortic aneurysm start from:
An intimal streak leading to atherosclerosis
The pathogenesis of atherosclerosis is though to begin with:
Endothelial cell injury; choronic endothelial cell injury may result from hypertension (and related hemodynamic factors), hyperlipidemia, smoking, diabetes, homocysteine, toxin (including alchohol), viruses, and/or immune reaction; results in endothelial cell dysfunction and/or exposure of subendothelial collagen (endothelial cell denudation)
Atherosclerosis occurs in:
Large elastic arteries as well as large and medium-size muscular arteries
Skin biopsy from the thigh of a male child demonstrates vascular lesions with IgA and C3 deposition. What disease does he likely have?
Henoch-Schonlein purpura; a systemic hypersensitivity disease of uncertain etiology; produces leukocytoclastic angiitis in small vessels of the dermis and the GI tract
What is the most likely clinical presentation for a patient with Henoch-Schonlein purpura?
Skin rash and abdominal pain; purpuric rask (100%), colicky abdominal pain (85%), polyarthralgia (70%); the rash is palpable and usually occurs on the lower extremities at first; most common in male children 3-11
A woman undergoes a total hip arthroplasty. While recovering in the hospital two days after the operation, she experiences acute hemodynamic decompensation. A state chest CT scan with IV contrast shows a filling defect within the lumen of the pulmonary artery. This finding is consistent with:
Hypercoagulability, which can lead to PE, can be prevented by administering:
Low-dose heparin; an anticoagulant that acts by binding to antithrombin III
Name a rare tumor that is associated with exposure to carcinogens such as arsenic, thorotrast, and polyvinyl chloride and expresses CD 31, which is PECAM (platelet endothelial cell adhesion molecule), an endothelial cell marker.
A male is hospitalized with recent-onset oliguria and high serum creatinine level. He has been seen in clinic several times for an intranasal ulcer that has failed to heal. Name the likely diagnosis.
Wegner's/ granulomatosis with polyangiitis; nasal mucosal ulceration and glomerulonephritis are characteristic of Wegner's
Wegner's/granulomatosis with polyangiitis is associated with antibodies against:
Neutrophils; C-ANCA (cytoplasmic-staining antineutrophil cytoplasmic antibodies) are virtually pathognomonic with a better than 90% specificity and sensitivity
A 3-month-old has a slowly bright red growing skin lesion on his buttock. What is the most likely diagnosis?
Strawberry (capillary) hemangioma; most common childhood benign vascular tumor
What is a reperfusion injury?
Cells can paradoxically die at an accelerated pace after blood flow has been restored to an ischemic tissue in a timely manner through apoptosis or necrosis
Increased levels of creatine kinase indicates:
Cell membrane damage; the enzyme creatine kinase leaks across the damaged cell membranes of the heart, brain or skeletal muscle
A normal bleeding time indicates:
Adequate platelet function
Normal activated partial thromboplastin time (aPTT) indicates:
Intact intrinsic coagulation system: factor XII, XI, IX, VIII (specific to intrinsic pathway)
Normal prothrombin time (PT) indicates:
Intact extrinsic coagulation system: factor VII (specific to extrinsic pathway)
Coagulopathies (i.e. clotting factor deficiency) generally present with:
Deep-tissue bleeding into joints, muscles, and subcutaneous tissue
Platelet defects typically present with:
Mucocutaneous bleeding (e.g. epistaxis, petechiae)
What is the most common complication of bicuspid aortic valves?
Aortic stenosis; on average ~50 vs >65 for senile calcific stenosis
A newborn with a continuous murmur with systolic accentuation that is hear best at the left infraclavicular region, most likely has:
Patent ductus arteriosus
What can be given to close a patent ductus arteriosus?
NSAIDs: indomethacin and ibuprofen → inhibit PGE1 synthesis
A 32-year-old has a several day history of high-grade fever, dyspnea and fatigue. He has a new holosystolic murmur with a blowing quality, heard best over the cardiac apex. What is the likely diagnosis and cardiac finding?
Bacterial endocarditis resulting in mitral regurgitation
Erythematous macules on the sole of the foot in a patient with bacterial endocarditis are most likely:
Janeway lesions; painless and possibly hemorrhagic
Janeway lesions result from:
Septic embolization from infected cardiac valve vegetations
A fibrous tissue in the pericardial space is diagnostic for:
Constrictive pericarditis; causes low CO and right-sided heart failure resistant to medications
Name 4 physical exam findings in constrictive pericarditis:
1. Increased jugular venous pressure 2. Kussmaul sign 3. Pulsus paradoxus 4. Pericardial knock (occurs earlier in diastole than the S3 heart sound)
What is Kussmaul sign?
A paradoxical rise in JVP during inspiration; the volume-restricted right ventricle is unable to accommodate the inspiratory increase in venous return
Normally during inspiration JVP:
A 58-year-old undergoes coronary artery bypass grafting which eliminates hypokinesia of the anterior wall of his left ventricle and improves his ejection fraction from 35-50%. This phenomenon is known as:
Hibernating myocardium; repetitive ischemia or persistent hypoperfusion of cardiac myocytes can result in a chronic but reversible loss of contractile function; myocardial stunning is a less severe form of ischemia-induced reversible loss of contractile function caused by brief ischemic episodes (<30min)
A presystolic sound that immediately precedes the first heart sound is descriptive of:
S4; heard immediately after atrial contraction phase as blood is forced into a stiff ventricle
S4 is normal in:
Healthy older adults
S4 is cause by:
Sudden rise in end-diastolic pressure following atrial contraction; can be heard in patients with reduced ventricular compliance (eg. hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy)
A holosystolic murmur best heard at the apex of the heart that radiates to the axilla is indictive of:
What auscultatory finding is the best indication of the severity of mitral regurgitation?
S3 gallop; reflect an increased rate of left ventricular filling due to a large volume of regurgitant flow re-entering the ventricle during mid diastole
Severe mitral regurgitation that relinquishes after treatment with a diuretic suggests a diagnosis of:
Functional mitral regurgitation; due to transient hemodynamic factors causing LV dilatation and/ or papillary muscle ischemia rather than a fixed mitral valve lesion (the regurgitation in this case would most likely be reduced but not eliminated by a diuretic)
Wide, fixed splitting of S2 that does not vary with respiration is characteristic of:
Atrial septal defect; creates a left-to-right shunt because of the high pressure in the left atrium
Patients with an atrial septal defect are at risk for irreversible changes in the:
Pulmonary vessels; increased blood flow through the muscular pulmonary arteries may cause laminated medial hypertophy that can increase the pulmonary vascular resistance above the total systemic vascular resistance cause the original left to right intra cardiac shut to reverse and cause late-onset cyanosis, with clubbing and polycythemia (Eisenmenger syndrome); pulmonary vascular sclerosis can become irreversible and closure of the cardiac septal defect can no longer be hemodynamically tolerated by the right ventricle
An accessory conduction pathway (Wolff-Parkinson-White syndrome) that bypasses the atrioventricular node (eg. bundle of Kent) would cause what changes on ECG?
Shortened PR-interval, a delta wave (small upslope) at the start of the QRS complex and a widened QRS interval
A drug that dilates arterioles and veins and promotes diuresis is most likely an analog of:
Brain natriuretic peptide; Nesiritide can be used in patients with decompensated left ventricular dysfunction leading to congestive heart failure
A low-pitched holosystolic murmur heard best at the left sternal border with accentuation during the handgrip exercise is characteristic of:
Ventricular septal defect
Name two causes of ventricular stiffening which can cause an S4 heart sound:
1. Restrictive cardiomyopathy 2. Left ventricular hypertrophy following prolonged hypertension
A patient has nocturnal episodes of chest pain found to be accompanied by transient ST-segment elevation in leads I, AVL, V1-V4 on 24-hour ECG monitoring. These finding are suggestive of:
Prinzmetal's angina; uncommon pattern of episodic angina that usually occurs at rest
What drug is used as a provocative diagnostic test for coronary vasospasm?
In the event of an interruption of blood flow secondary to arterial occlusion name an organ that is less susceptible to infarction.
Liver; dual blood supply from the hepatic artery and portal vein (+ retrograde arterial flow through accessory vessels); exception in transplanted liver
A congenitial defect in the lower part of the intratrial septum is most likely?
Ostium primum atrial septal defect; the result of failure of the endocardial cushions of the atriovenricular canal to fuse completely during embryonic development
An ostium primum atrial septal defect is associated with:
A crescendo-decrescendo systolic ejection murmur at the right sternal border is classic for:
Name three causes of aortic stenosis
1. Congenitally abnormal valve with calcification (e.g. bicuspid valve) 2. Calcified normal valve 3. Rheumatic heart disease (most common worldwide, 1&2 most common in US)
Myocardium with myocyte hypertophy, haphazardly arranged myocytes and myocyte bundles and prominent interstitial spaces is consistent with a diagnosis of:
Hypertrophic cardiomyopathy; prominent intersitial spaces suggest fibrosis
Hypertrophic cardiomyopathy is most often the result of:
Mutations in the genes coding for cardiac sacromere proteins, most commonly beta-myosin heavy chain; 50% of cases are familial; inheritance is autosomal dominant with variable expression
ECG with sinus bradycardia and ST segment elevation in leads II, III and aVF suggests occlusion of what coronary artery?
Right coronary artery; bradycardia suggests ischemic injury to the sinus node which receives its blood supply from the RCA; ECG findings are consistent with transmural ischemic injury to the inferior wall of the heart which is supplied by the posterior descending branch of the RCA in 90% of individuals.
Name two causes of increased thickness of the ventricular wall and decreased left ventricular cavity size:
1. Long-standing hypertension; 2. Aortic stenosis
A 32-year-old man has sharp mid-chest pain that increases with deep inspirations and decreases when he sits up. He had a mild respiratory illness one week ago. Name the likely diagnosis.
Acute pericardidits; sharp and pleuritic chest pain that decreases upon sitting up and leaning forward due to decreased pressure on the parietal pericardium
A 75-year-old male has worsening dyspnea and fatigue on exertion in addition to episodes of sever lightheadedness during physical activity. He has a harsh ejection-type systolic murmur at the base of the heart that radiates to the neck. What is his most likely diagnosis and cause.
Aortic stenosis from calcium deposition on the aortic leaflets/ senile aortic stenosis; aortic stenosis is best heard at the right second intercostal space and may radiate to the carotids
A 34-year-old present with a BP of 80/60, pulse becomes undetectable to palpation during each inspiration and jugular veins are distended. He had a mild respiratory illness one week ago. What is the most likely diagnosis?
Cardiac tamponade; due to a serous viral pericarditis and a significant acute pericardial effusion; Beck's triad: hypotension, muffled/distant hear sounds, distended neck veins
Name a condition other than cardiac tamponade in which you would expect the combination of acute-onset CVP elevation with hypotension and tachycardia.
Deep, poorly localized chest or arm discomfort (angina) which is reproducible associated with physical exertion or emotional stress and is relieved within 5 minutes by rest and/or sublingual nitroglycerin is diagnostic for:
The lesion most often underlying stable angina is a fixed atheromatous obstruction of one or more coronary arteries that occludes at least what percentage of the luminal cross sectional area?
75%; <75% are typically asymptomatic
What is the most common cardiac abnormality predisposing to native valve bacterial endocarditis in the 15- to 60-year-old age group in the US?
Mitral valve prolapse; predisposes to infected vegetation on mitral leaflets; rheumatic valvular disease is also a potential, although less common, precipitant of NVBE
A 4-year-old boy has a 102F fever that has persisted for the past 5 days. Both conjunctivae are injected with no exudates. His tongue is bright red and lips are cracked. Non-pitting edema is present on his hands and feet. He visited his grandparents in China last year. What is the likely diagnosis?
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