U World (Cardiac-Path)
Terms in this set (157)
Right-sided heart endocarditis commonly occurs in what type of people?
IV drug users
Gram - endocarditis is caused by which bacteria?
Haemophilus, actinobacillus, cardiobacterium, Eikenella and Kingella (HACEK)
Stable angina is a fixed atheromatous obstruction of one or more coronary arteries occluding at least what % of the luminal cross section?
Prinzmetals angina shows up as what on an ECG machine?
The murmur of mitral valve prolapse will diminish by what mechanism, why?
squatting because of increased venous return and a rise in peripheral resistance
What 2 syndromes can cause mitral valve prolapse when inherited?
Ehlers-Danlos and Marfans
Congenital bicuspid valve leads to premature?
calcific aortic stenosis (60's)
What is the most common physical finding of pericarditis?
High pitched, leathery and scratchy sound
What is Kussmaul's sign?
Increase in the jugular venous pressure with inspiration
Kussmaul's sign is usually seen in what cardiac pathology?
Acute-onset, mid-chest pleuritic pain that decreases on sitting up and leaning forward is characteristic of what?
What are Aschoff bodies?
plump macorphages with abundant cytoplasm and central, round-to-ovoid nuclei
When are Aschoff bodies found?
In acute rheumatic carditis
What are Lichtenberg figures?
erythematous cutaneous marks in a fern-leaf pattern suggestive of second degree burn
What are the most common causes of death following being struck by lightning?
fatal arrhythmias and respiratory failure
Name a familial syndrome associated with bronchiectasis?
Jervell and Lange-Nielsen syndrome is one of the most common congenital causes of what heart abnormality?
The autosomal recessive disorder jervell and Lange-Nielsen syndrome is characterized by a long-QT syndrome and is accompanied by what other abnormality?
What is the most common cardiac abnormality predisposing to native valve bacterial endocarditis?
mitral valve prolapse
What other heart abnormality, besides mitral valve prolapse, can predispose someone the bacterial endocarditis, but is not the top anymore thanks to Antibiotics?
rhemuatic valvular disease
what heart abnormality can impact the laryngeal nerve?
left atrial dilation
Post-MI if someone complains of sharp and pleurtic pain what are you thinking?
Acute pericarditis, post-MI, can be exacerbated by?
swallowing or leaning forward
Dressler's syndrome occurs when post-MI?
one week to a few months
A MI type of pain is described as?
Unprovoked syncope in a previously asymptomatic young person may result from a congenital?
QT prolongation syndrome
Romano-Ward syndrome and Jervell and Lange-Nielsen syndrome may result from mutations in?
K+ channel protein (QT prolongation syndrome)
What worsens murmurs that are heard in hypertrophic cardiomyopathy?
Things that decrease the LV end diastolic volume (sudden standing, Valsalva)
Which 2 drugs help close a PDA?
indomethacin and ibuprofen
The ductus arteriosus connects which 2 vessels?
aorta and left pulmonary artery
PDA is most commonly caused by which 2 things?
prematurity and rubella
Severe aortic stenosis presents clinically with?
syncope, angina and dyspnea (SAD)
The most common cause of aortic stenosis in pts above the age of 70 is?
degenerative calcification of the aortic valve
Which organ, distal to the left ventricle, is least likely to develop infarction, why?
liver because it has dual blood supply (hepatic artery and portal vein).
What is the sole neurologic manifestation of acute rheumatic fever?
Rheumatic fever can be characterized by which 4 criteria?
Why does squatting improve cyanotic spells in tetralogy of fallot?
Increases total systemic vascular resistance thereby raising mean arterial pressure
What are the 4 non cyanotic congenital heart diseases?
ASD, VSD, patent ductus arteriosus and coarctation of the aorta
What is the most likely cause of fatigue and new-onset cardiac murmur in a young adult is?
what often accompanies bacterial endocarditis, in regards to the kidney?
acute, diffuse proliferative glomerulonephritis secondary to circulating immune complexes
small, erythematous or hemorrhagic, macular, nontender lesions on the palms and soles accompanied by bacteria endocarditis is called what?
Anti-glomerular basement membrane autoantibodies along with autoantibodies that attack the pulmonary alveolar basement membrane is characteristic of?
4-12 hours post MI and 12-24 hours post MI, what are the microscopic findings?
4-12 hrs: edema, hemorrhage and wavy fibers
12-24 hrs: contraction bands
1-5 days post MI what are the characteristic findings, 5-10 days and 10 to 14 days?
1-5 days: neutrophilic infiltrate
5-10 days: macrophage phagocytosis
10-14 days: granulation tissue and vascularization
Symptoms of stable angina do not become prominent until at least what % of the cross-sectional area of the coronary artery lumen is occluded?
Do Prinzmetal's angina generally response to vasodilators, like nitroglycerin?
Q waves (hours to days post) are a sign of?
What is pulses paradoxes?
fall in systolic blood pressure more than 10 mm Hg on inspiration (it is normal to have a drop in less than 10 mm Hg)
What is the triad for cardiac tamponade?
Muffled heart sounds, jugular venous dissension and hypotension
Tension pneumothorax would cause absent breath sounds and hyper or hypo resonance to percussion on the affected side?
What is the most common cause of ventricular fibrillation in individuals younger than 30 years of age?
In pts with HCM what often causes syncope?
dynamic ventricular outflow tract obstruction because of abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied inter ventricular septum
What are 2 common causes of systolic heart failure?
ischemic heart disease and dilated cardiomyopathy
What are 3 major causes of dilated cardiomyopathy?
viral, alcohol and genetic reasons
The Prussian blue stain detects?
After blood leaks from congested capillaries these iron-containing macromolecules are phagocytksed by macrophages and converted to?
hemosiderin or heart failure cells
Thick fibrous tissue in the pericardial space is indicative of?
Pts with constrictive pericarditis often have which symptoms?
Increased JVP, Kussmaul sign and pulses paradoxes
What is the etiology of constrictive pericarditis?
Normal pericardial space is replaced by a thick, fibrous shell that restricts ventricular volumes and eventually causes heart failure
In MI's changes on light microscopy are usually not apparent until how many hours after the onset of severe ischemia?
How long after an MI do macrophages migrate?
5 days post MI
What is the product of lipid peroxidation?
How does lipofuscin occur?
naturally aging cells
When does a S3 heart sound occur?
Sudden deceleration of incoming blood as the ventricle reaches its elastic limit
What is a major cause of a S3 sound?
What is the difference between constrictive and restrictive cardiomyopathy?
Constrictive pericarditis reduces ventricular compliance via an external force
In restrictive cardiomyopathy we hear a S3 sound while in constrictive pericarditis we hear a?
Janeway lesions are the result of?
embolization from infected cardiac valve vegetations.
Janeway lesions tend to localize where?
palms and soles of feet
In contrast to Janeway lesions, Osler nodes are?
painful, pustules found in the pulps of fingers and toes
What is the most common complication of a pt 3-7 days post transmural MI?
What acts for the most common cause of death in hospitalized pts after MI?
Why are previous MI's protective against ventricular free wall rupture?
because fibrosis tends to decrease the probability of myocardial tearing
Left ventricular free wall rupture occurs how many days post MI?
pts with interatrial septum defects might also have what congenital abnormality?
Kartagener's syndrome is most often associated with?
DiGeorge syndrome results from failure of dev of which pouches?
3rd and 4th pharyngeal pouches
Down Syndrome is most associated with what cardiac abnormality?
endocardial cushion defects (ASD and regurgitant AV valves)
DiGeore syndrome is most associated with what cardiac defect?
tetralogy of Fallot
Friedreich's ataxia is most associated with what cardiac abnormality?
Marfan syndrome is most associated with what cardiac abnormality?
cystic medial necrosis of the aorta
Tuberous sclerosis is most associated with what cardiac abnormality?
valvular obstruction due to cardiac rhabdomyomas
Turner's syndrome is most associated with what cardiac abnormality?
coarctations of the aorta
What are some physical findings of Turner's syndrome?
short stature, short and thick neck, broad chest and shortened fourth metacarpals
What is the most common congenital malformation affecting the heart in Turner's syndrome?
bicuspid aortic valve (may occur with coarctations of the aorta)
Kawasaki disease affects which pt population
children less than 5 y/o
what is the most serious side effect of kawasaki disease?
coronary artery aneurysm
what are some symptoms of kawasaki disease?
bilateral conjuntivitis, fever, lymphadenopathy, strawberry tongue and generalized rash
Dissecting aneurysms of the aorta are caused by what 2 conditions?
hypertensions and marfan syndrome
A thin fibrous cap overlying a coronary atherosclerotic plaque predisposes an individual to?
ulceration, fissuring or rupture
What is the major determinant of whether or not a coronary artery plaque will cause ischemic MI?
the rate at which it occludes the involved artery (because if it occludes slowly there can be collateral flow)
What are 3 main attributes that contribute to a plaque rupturing?
thin fibrous cap, rich lipid core and active inflammation
In 90% of individuals the posteroinferior wall of the left ventricle is supplied by?
posterior descending branch of the right coronary artery
The sinus node normally receives arterial supply from?
right coronary artery
The left coronary artery gives rise to?
LAD and LCX
The LAD supplies?
IV septum and anterior wall of left ventricle
The LCX supplies?
lateral wall of the left ventricle
Occlusion to which artery most often produces bradycardia?
right coronary artery
Occlusion of the LAD would produce ST elevations in leads?
Occlusion of the LCX would produce ST elevations in?
V5 and V6
What is a common cardiac clinical manifestation in pts with lupus?
Dystrophic calcification is considered a hallmark of?
cell injury and death
In the rare cases of lethal rheumatic fever, what is the main cause of death
heart failure due to severe myocarditis
Almost all cases of HCM are thought to be due to mutations in?
cardiac sarcomere proteins (beta-myosin heavy chain)
Congenital QT-interval prolongation predisposes to what lethal symptom?
torsades de pointes (ventricular tacharrhythmia)
Almost all cases in HCM are due to what type of inheritance pattern?
autosomal dominant mutations
Approx 1/3 of cases of dilated cardiomyopathy are genetic, these are due to autosomal dominant mutations of?
cardiac myocyte cytoskeletal proteins (dystrophin) or mitochondrial enzymes
Marfan syndrome is an autosomal dominant defect in the CT glycoprotein?
The 2 cardiovascular defects associated with Marfan's syndrome are?
mitral valve prolapse and cystic medial degeneration of the aorta (aortic dilatation/dissection).
The pathogenesis of nonbacterial thrombotic endocarditis (NBTE) often involves what kind of state?
What is Trousseau's syndrome?
What is Raynaud's phenomenon?
episodic, ischemic attacks of the digits that produce pallor and numbness (induced by cold or emotional stimuli).
What is one of the most specific signs for left-sided heart failure?
Orthopnea (dyspnea that is relieved by sitting up)
Bilateral lower extremity edema and congestive hepatomegaly are more specific for which type of heart failure?
right-sided heart failure
Systemic lupus can cause Libman-Sacks endocarditis, but may also cause what other cardiac abnormality?
acute coronary syndrome
Churg-Strauss syndrome characteristics?
lung vasculitis, severe asthma and eosinophilia
What channel is responsible for QT prolongation?
decreased outward K+ current during the depolarization phase
What is the major cardiac pathophysiological consequence of QT prolongation?
ventricular tachycardia, torsades de pointes
What are some causes of dilated cardiomyopathy?
viral myocarditis (coxsackie B), alcohol abuse and thiamine deficiency
A pt that presents with both pulmonary edema and jugular venous distension most likely has?
dilated cardiomyopathy (left and right heart failure)
A high systolic pressure between the left ventricle and the aorta is characteristic of?
left ventricular outflow obstruction
Mitral stenosis can cause atrial enlargement which may lead to?
atrial mural thromboses
Almost all cases of mitral stenosis are caused by?
chronic rheumatic heart disease
The vascular endothelium secretes which of the following substances to inhibit platelet aggregation?
Which 2 substances work together to maintain capillary patency?
Prostacyclin and thromboxane A2
What enzyme produces prostacyclin?
Serotonin produced by platelets outside of the CNS function to?
vasodilate and increase vascular permeability
What is the function of Hageman factor (factor XII)?
activated by collagen exposed when the vascular basement membrane is damaged and participates in the activation of the clotting pathway
In adult (post ductal) type of congenital aortic coarctation where does collateral circulation occur?
dilated intercostal arteries
Ingestion of appetite suppressants such as fenfluramine, dexfenfluramine and phentermine has been associated with what finding?
secondary pulmonary hypertension
Chronic pulmonary hypertension leads to right ventricular hypertrophy that can lead to?
Cerebral berry aneurysms are associated with genetic disorder such as?
autosomal dominant polycystic kidney disease and Ehlers-Danlos syndrome
Which cardiac connection abnormality is considered a variant of normal in adult pts?
patent foramen ovale
Endocardial cushion defects are commonly associated with?
What is truncus arterioles?
A single great vessel (aorta, pulmonary artery and coronary vessels) leaving the heart
What is differential cyanosis?
cyanosis of the lower extremities but not of the upper body
What cardiac defect is responsible for differential cyanosis? Why does this occur?
patent ductus arteriosus. occurs because blood flows through the ductus arteriosus and connects to the distal aorta which feeds blood into the lower extremities
Differential cyanosis restricted to the lower body in a child is most suggestive of?
patent ductus arteriosus
Localized amyloidosis confined to the cardiac atria is due to polypeptide fragments of?
Amyloidosis of these organs are associated with what peptides? Thyroid, pancreatic islets, cerebrum and pituitary gland?
Pancreatic Islet: islet amyloid protein (amylin)
Pit gland: prolactin
The systolic diamond-shaped (crescendo-decrescendo) murmur is characteristic of?
Clinically significant cardiac tamponade is associated with hemodynamic findings such as?
pulsus paradoxus and arterial hypotension
What is pulsus paradoxus?
abnormally large decrease (more than 10) in systolic blood pressure and pulse wave amplitude during inspiration
What type of necrosis develops after irreversible ischemic injury?
What type of necrosis is associated with bacteria?
Lethal tissue ischemia causes coagulative necrosis in most tissues, however, the exception is what organ system? What type of necrosis?
CNS; liquefactive necrosis
What are the most common primary cardiac neoplasms of the heart?
Histologically, how would you describe myxomas?
scattered cells within a mucopolysaccharide stroma
Fibrous intimal thickening with endocardial plaques limited to the right heart are characteristic of?
carcinoid heart disease
What metabolite is often associated with carcinoid sysnrome?
5-hydroxyindoleacetic acid (metabolite of serotonin)
What is a normal catabolite of epi and norepi?
The severity of carcinoid heart disease correlates with plasma levels of ________ and urinary excretion of ________
serotonin; 5-hydroxyindoleacetic acid
Episodic and transient anginal chest pain, occuring during the nighttime hours and accompanied by temporary ST-segment elevations are characteristic of?
Which test can be used to test for Prinzmetal's angina?
What does ergonovine do in pts with Prinzmetal's angina?
stimulates both alpha and serotonergic receptors results in hypercontractile coronary segments at low doses
Phenotolamine as an antagonist for?
alpha 1 and 2
What is the common treatment for Prinzmetal's angina?
nitrates and CCB's