Classic Presentations > CARDIO > Flashcards

CARDIO Flashcards

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1
Q

Congenital Heart Path

Comp?

A

COMP = Infective Endocarditis

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2
Q

Aortitis (Vasa Vasorum destruction)

Etiology?

A

ET:

- 3ry Syphilis

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3
Q

Transposition of the Great Arteries

Mech, Imaging (CLUE)?

A

MECH:
Failure of fetal AP Septum to SPIRAL (during septation of TA).

IMAGING (Echo) = “Aorta ant to Pulm art”

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4
Q

Preductal Coarctation of the Aorta

Seen In?

A

SEEN IN:

- Turner’s Sx

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5
Q

Bicuspid Aortic Valve

Seen In (2), Comp?

A

SEEN IN:

  • Turner Sx
  • Adult / Postductal Coarctation of Aorta

COMP:
- Aortic dissection

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6
Q

Aortic Aneurysm

Etiology, Causes by Location (3)?

A

ET = atrophy + weakening of vessel wall (comp of Ath plaque).

CAUSES:

  • Marfan Sx (Ascending Aorta)
  • Tertiary Syphilis (Arch of Aorta)
  • Atherosclerosis (Descending + Ab Aorta)
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7
Q

Aortic Dissection

Causes (3), Pres (2), Imaging (CXR)?

A

CAUSES:

  • Pregnancy (double plasma vol -> weakening of aorta)
  • Ehler-Danlos (collagen defect)
  • Marfan (fibrillin defect = weakened elasticity of aorta)

PRES:

  • “Tearing pain radiating to back”
  • Diminished left pulse vs right

CXR: Widening of aortic knob.

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8
Q

Ruptured Abdominal Aortic Aneurysm

Pres (Triad)?

A

PRES:

  1. Sudden-onset severe L flank pain (aorta is retroperitoneal)
  2. Hypotension
  3. Pulsatile mass
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9
Q

Deep Venous Thrombosis (DVT)

Etiology (Virchow’s Triad), Pres (1 sign), Comp,
Prevention / RX?

A

Virchow’s Triad:
1. Stasis
2. Endothelial damage (b/c exposed collagen triggers
Clotting Cascade)
3. Hypercoagulability

Pulmonary embolus.

PRES:
- Homan’s Sign: Dorsiflexion of foot -> tender calf muscle

PREV + RX:

  • Heparin (short-term prevention + acute management)
  • Warfarin (long-term prevention)
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10
Q

Peripheral Vascular Disease

Etiology?

A

ET:
- Atherosclerotic plaques in Lower Extremity art ->
Impaired bl flow + Ischemia

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11
Q

Vasculites

Def’n, HS Type, Mech (location in vessel + 4 types of changes), Comp?

A

Group of disorders that DESTROY BL VESSELS by infl.
Both arteries + veins affected = ‘Arteritis’ + ‘Phlebitis’.

Type 3 HS.

MECH: Changes occur in WALLS of vessels and include:

  • Thickening
  • Narrowing
  • Scarring
  • Weakening

COMP:
- Coronary art vasospasm

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12
Q

Temporal (Giant Cell) Arteritis

Vessel, Pres (Epi + Triad), Comp (2)?

A

Temporal art. (Incl its branches, eg opthalmic art)

Granulomatous vasculitis.

PRES: Elderly Females

  1. Unilateral headache (Temporal art)
  2. Visual disturbances on same side as headache (Opthalmic art)
  3. Jaw claudication / pain (Temporal art)

COMP:

  • Polymyalgia Rheumatica
  • Irreversible ipsilateral Blindness (due to thrombosis / occlusion of Opthalmic art)
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13
Q

Takayasu’s Arteritis (“Pulseless Dz”)

Vessel, Pres (Epi)?

A

Aortic Arch. (Incl its branch points)

PRES: Young, Far-Eastern woman

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14
Q

Polyarteritis Nodosa

Mech of Vasculitis, Path (2), RX (2)?

A

THINK: p-anca, hepBsag, kidney, heart + infarct

Fibrinoid + necrotizing vasculitis. IC-mediated.
Involving multiple organs, however SPARING the LUNGS.

PATH:

  • Multiple aneurysms
  • Constrictions / spasms

RX: ** Fatal if not treated **

  • Cyclophosphamide
  • Corticosteroids
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15
Q

Kawasaki Dz

Vessel, Pres (Epi + 3), Comp?

A

Coronary art.

PRES: Asian Children

  • Mucocutaneous infl
  • Desquamation of skin
  • Lymphadenopathy

COMP = MI!

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16
Q

Buerger Disease (Thromboangitis Obliterans)

Location Affected, Mech of Vasculitis, Causes, Pres (2 Epi + 1)?

A

Digits (fingers + toes).

Acute Infl -> Autoinfarction / Autoamputation / Gangrene.

CAUSES:
- Smoking

PRES: Males, Heavy Smokers
- Raynaud’s Phenomenon

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17
Q

Microscopic Polyangitis

Locations Affected (3), Mech of Vasculitis, Ab, RX (2)?

A
  • Skin (palpable purpura)
  • Lungs
  • Kidneys (pauci-immune glomerulonephritis / RPGN)

Necrotizing vasculitis.

AB:
- p-ANCA: correlate with disease activity

RX:

  • Corticosteroids
  • Cyclophosphamide
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18
Q

Wegener Granulomatosis (Granulomatosis with Polyangitis)

Mech of Vasculitis (2), Pres (4 Locations), Ab, RX?

A

Granulomatous infl + Necrotizing vasculitis.

PRES:

  • Nose:
    • “Saddle nose” deformity
    • Chronic Sinusitis
  • Ears:
    • Mastoiditis
    • Otitis Media
  • Lung: Nodular masses. URIs (-> cough, hemoptysis, dyspnea).
  • Kidneys:
    • Hematuria
    • RBC Casts

AB:
- c-ANCA / PR3-ANCA

RX = Cyclophosphamide

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19
Q

Churg-Strauss Sx

Mech of Vasculitis, Ab (2)?

A

Granulomatous vasculitis with EOSINOPHILS. Involving multiple organs.

AB:

  • MPO-ANCA / p-ANCA
  • IgE ↑
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20
Q

Angina

Path, Pres, 2 Subtypes?

A

PATH: Atherosclerotic plaque in Coronary art -> Impaired bl flow -> Ischemia.

PRES = Chest pain on exertion

Stable Angina (chest pain with moderate exertion) ;
Unstable Angina (chest pain with minimal exertion)
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21
Q

Acute MI #1

Def’n, Mech (2)?

A

Necrosis of cardiac myocytes, usually in ventricles.

MECH:

    • THROMBUS (group of platelets bound together with fibrin)
  • Coronary art vasospasm
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22
Q

Acute MI #2

Classic Pres (5)?

A 
PRES:
- SUBSTERNAL "crushing chest pain" lasting > 20 mins and
   "radiating to L arm and/or jaw"
- Dyspnea
- Diaphoresis
- Fatigue
- Nausea + Vomiting

** NOT relieved by Nitro **

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23
Q

Acute MI #3

Cardiac Enzymes↑(6), Dx (1 + 2 special circumstances)?

A

ENZ:

  • AST ** Nonspecific **
    • CKMB (EARLY: rises after 6 hrs, peaks at 24 hrs, lasts for 48 h)
  • Myoglobin (EARLY) ** Nonspecific **
  • LD1 > LD2 = ‘LDH Flip’ (18 hrs, peaks at 3 days, lasts for 7 days)
  • LD1 + LD5 (MI compounded with LIVER CONGESTION)
    • Troponin I (EARLY: rises after 4 hrs, peaks at 24 hrs, lasts for 7 days)

DX:

  • EKG (however only 80% sensitivity): ST elevation + new q wave
  • Dx of p/t that comes in 2-3 days after symptoms: ‘LDH Flip’
  • Dx of Reinfarction: CK-MB (b/c levels return to normal after 48 h)
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24
Q

Acute MI #4

General Comp + their Conseq (11, incl 3 ruptures)?

Study These Flashcards
A

COMP: ALL can result in Hypotension
- Reperfusion injury
- Bradycardia / Tachycardia (RV inf wall MI)
- Arrhythima (common in 1st few days) ->
- Embolus (from mural thrombus)
- Ventricular Aneurysm (“systolic bulge of pericardium”)
- Cardiogenic Shock
- LHF (incl Pulm Edema)
- Dressler’s Sx
- Post-Infarct Fibrinous Pericarditis
- Extension of Infarct / Reinfarction
- Ruptures: ** Heart softest = greatest chance of rupture b/w 3-7 days (-> hemopericardium) **
- Ventricular wall -> Cardiac Tamponade
(Several days after. “Sudden loss of pulse”.)
- Septum / Valve -> “New onset of murmur (M.R)” +
“Pulm congestion” +
VSD (Step-Up in O2 Sat from R.A to R.V)
- Papillary muscle -> Mitral Regurg

25
Acute MI #5- Bradycardia COMP 2 Types?
- Sinus Bradycardia (ischemia of SA node) | - 3rd Degree / Complete AV Block ("cannon A waves")
26
LAD MI Infarct Type, Pres (3), Comp?
Pale Infarct. PRES: - 'Classic' MI Pres - Heart Block (most of conduction bundles in Ant 2/3 of IV septum = supplied by LAD) - Mural thrombi COMP: - Rupture -> Hemopericardium (Day 3 or 4- "chest pain, muffled heart sounds, neck vein distension")
27
RCA MI Path / Pres (2)?
PRES: - AV Node dysfunction -> Sinus Bradycardia + Atypical chest pain (eg epigastric pain, mimics GERD) - Posteromedial papillary muscle dysfunction -> Mitral Regurg that *arises b/w days 3-7*
28
Post-Infarction Fibrinous Pericarditis Etiology, Pres (2, based on timing), RX?
ET: Transmural infarct PRES: "3-component Friction Rub" that can occur 2 times post-MI: 1) 1st week: Chest pain- relieved when leaning fwd / worse when leaning back 2) 6 wks: Fever + Muscle aches/pains (Dressler's Sx: auto-ab against pericardial tis) RX: NSAIDs
29
Coronary art Vasospasm Causes (4)?
CAUSES: - Cocaine use - Emboli - Variant / Prinzmetal Angina - Vasculites
30
Dilated / Congestive Cardiomyopathy Def'n, Etiologies (9: "ABCCCDD" + 2), Mech (3 steps), Pres, Findings (1 + Imaging), Comp (2)?
Dilation of all 4 heart chambers. Effusions at both lung bases. ET: - Alcohol abuse - Wet Beriberi - Chagas dz - Coxsackie B virus Myocarditis - Cocaine abuse - Doxorubicin toxicity - Duchenne Muscular Dystrophy - Hemochromatosis - Peripartum Cardiomyopathy (6 wks postpartum) MECH = ECCENTRIC hypertrophy (sarcomeres added in series) -> Ventricles unable to pump -> SYSTOLIC dysfunction. PRES = HF FINDINGS: - S3 - "Balloon" appearance of heart on CXR / Dilated heart on U/S COMP: - Mitral / Tricuspid Regurg - Arrhythmia
31
Hypertrophic Cardiomyopathy Location, Mech (5 steps), Inher, Genetics, Pres (3), Findings (2)?
LV MECH: CONCENTRIC hypertrophy (sarcomeres added in parallel) -> Hypertrophied IV SEPTUM -> Outflow obstruction thr Mitral valve + Altered conduction bundles -> Ventricles unable to fill + Conduction defects -> DIASTOLIC dysfunction + Conduction defects. AD. 60-70% cases familial. β-myosin heavy chain mutation in sarcomere proteins. PRES: - Conduction defects - Sudden death in young athletes (due to ventricular arrhythmia) - Dyspnea - Syncope (esp with exercise) FINDINGS: * Normal-sized heart * - S4 + Aortic Regurg - Apical impulses
32
Restrictive / Obliterative Cardiomyopathy Etiologies (6), Pres, EKG (2)?
ET: "oses" - Amyloidosis - Sarcoidosis - Post-Radiation fibrosis - Endocardial Fibroelastosis (fibrosis in endocardium of "young child") - Hemochromatosis - Loffler's Sx (fibrosis with prominent "eosinophilic infiltrate") PRES = LHF EKG: - Low-Voltage EKG - ↓QRS amplitude
33
Cardiac Dilation Cause?
CAUSE =↑Ventricular EDV
34
Shock 3 Types + Causes of each, Conseq of all (2)?
CARDIOGENIC Shock: Loss of myocardial CONTRACTILITY -> HF. HYPOVOLEMIC Shock: Hypovolemia due to BL LOSS. SEPTIC Shock: Loss of VASCULAR TONE due to infl / infection. CONSEQ: - Hypotension - ↓organ perfusion
35
Dyspnea on Exertion Cause?
CAUSE = Failure of CO to↑during exercise
36
Congestive Heart Failure (CHF) Def'n, Mech (Starling's Law + 1), Pres (3), Comp?
Failure of heart to pump out enough blood. MECH: Starling's Law: Force of CONTRACTION directly proportional to length of muscle fiber up until a certain limit. Beyond this limit muscles undergo dilatation and failure. -↑venous pressure PRES: - Dyspnea - Fatigue - S3 COMP: - 2ry Hyperaldosteronism
37
Systolic CHF Def'n, Causes?
Low EF heart failure. CAUSES: - IHD / MI
38
Diastolic CHF Def'n, Causes, Findings?
Normal EF,↓ventricular Compliance heart failure. CAUSES: - Long-standing Htn FINDINGS: - S4
39
↑Venous Pressure Conseq (4), Seen In?
``` CONSEQ: -↑CENTRAL venous pressure ->↑resistance to portal flow -> Hepatomegaly / Nutmeg Liver -↑PULM venous pressure -> Pulm Edema - Peripheral Edema - Jugular Venous Distention (JVD) ``` SEEN IN: - HF
40
Orthopnea + Paroxysmal Nocturnal Dyspnea Def'n, Mech, Seen In?
Shortness of breath when supine / Breathless awakening from sleep. MECH: Pulm vascular congestion EXACERBATED by↑venous return (due to redistribution of blood from 'immediate gravity effect'). SEEN IN: - LHF
41
LHF Mech (3), Path (2), Causes (2 general), Pres (2)?
MECH: - ↑Preload - ↑Afterload - ↓Contractility (multiple infarcts -> fibrous tis) PATH: Clinical features due to↓forward perfusion: - > pulmonary congestion - >↓bl flow to kidneys -> Activation of RAA Sys -> Fluid retention CAUSES: - Htn / Ischemia / MI - Cardiomyopathy (Dilated or Restrictive) PRES: - Pulm Edema - > Dyspnea - > PND + Pillow Orthopnea - > Bilat basal crackles - > Blood-tinged frothy sputum (chronic LHF) - 'Pulsus Alternans'
42
RHF Mech, Causes (3), Pres (5)?
MECH: RH can't get bl thr the pulm vessels. CAUSES: - LHF - L-to-R shunt - Cor Pulmonale PRES: - JVD - Ascites - Hepatomegaly (painful) + 'Nutmeg Liver' - Pitting Edema of lower ext - 'Pulsus Paradoxus'
43
High-Output HF Mech, Causes (3)?
MECH: ↑Venous Return -> Heart gives up. CAUSES: (ALL↑Venous Return) - ↓TPR - Vasodilation of peripheral arterioles - Septic Shock - Thiamine def - Hydralazine - ↑Sym activity /↑Contractility - Hyperthyroidism / Graves - AV Fistula
44
Bacterial Endocarditis Def'n, Causes / Assoc (4), H-S Type, Pres (4)?
Mitral valve w big bulky vegetations + ruptured chordae tendinae. CAUSES / ASSOC: - IV drug abuse (Tricuspid Valve) - Sequela of dental procedures (Strep viridans) - Prosthetic heart valves (Staph epidermidis) - Patients with underlying Colorectal Carcinoma (Strep bovis) Type III H-S (IC vasculitis). PRES: - Fever - Glomerulonephritis - Roth Spots (Eye) - "Splinter hemorrhages in fingernails": - Painless = Janeway Lesion - Painful = Osler Nodes
45
Libman-Sacks Endocarditis Def'n, Ab, Seen In?
WART-like sterile vegetations on both sides of heart valve. AB: - ANA SEEN IN: - SLE
46
Acute Rheumatic Fever MC Valve Involved, Path, Pres (Jones Criteria: 6)?
Mitral Valve > Aortic Valve PATH: *Post-Pharyngitis*. Culture NEGATIVE (immunologic mech) = sterile vegetations. PRES: Jones Criteria: - Young person, post-pharyngitis - Polyarthritis + Nodules on joint surfaces - Erythema Marginatum - Rales in lungs + Dyspnea - Mitral Regurg murmur + Friction Rub + Endocarditis and Myocarditis - Syndham's Chorea (LATE)
47
Constrictive Pericarditis Causes (3), Assoc, Pres, Comp
CAUSES: - Coxsackie virus - Previous cardiac surgery (U.S) - TB (3rd World) ASSOC: - Lupus PRES: - Pericardial Knock on inspiration COMP: - Cardiac Tamponade
48
Cardiac Tamponade Cause, Assoc, Pres (Beck Triad), ECHO (2), RX?
CAUSE: Pericarditis -> Pericardial Effusion ASSOC: - Lupus PRES: Beck Triad 1. Hypotension +... - Pulsus Paradoxus: radial pulse↓on inspiration 2. Distended neck veins (Kussmaul's Sign) 3. Muffled heart sounds ECHO: - Pericardial fluid accumulation - Collapse of R.A RX: Pericardiocentesis
49
Myxomas Def'n, Location, Pres (Epi + 1)?
Benign mesenchymal cardiac tumor. "Ball-valve obstruction" in L.A. 90% occur in Atria (MC = L.A). PRES: *MC 1ry cardiac tumor in Adults* - Syncope (due to obstruction of mitral valve) COMP: - Embolization (soft tumors w small pieces inside them)
50
Rhabdomyomas Def'n, Location, Assoc, Pres (Epi)?
Benign HAMARTOMA of cardiac muscle. Usually occur in Ventricles. ASSOC: - Tuberous Sclerosis PRES: *MC 1ry cardiac tumor in Children*
51
Carcinoid Heart Dz Def'n (incl Location + Mech), Causes, Pres (2: valvular)?
R-sided valvular fibrosis due to↑COLLAGEN. CAUSES: - Carcinoid Tumor / Carcinoid Sx PRES: - Tricuspid regurg - Pulm Valve stenosis
52
Sturge-Weber Dz Def'n, Pres (CLUE + 4)?
Congenital vascular disorder that affects small / capillary-sized vessels. PRES: - "Port-Wine stain": trigeminal nerve distribution - IPSILATERAL leptomeningeal angiomas (= AV malformation on same side of brain) - Slight mental retardation - Seizures - Early-Onset Glaucoma
53
Strawberry vs Cherry Hemangioma Def'n of both, Differences (3)?
Benign capillary hemangiomas. - Age of Onset: Infancy (first few wks of life) vs Elderly - Course + Regression: Grows rapidly + regresses spontaneously vs NO regression - Frequency: 1/200 births vs↑Freq with age
54
Pyogenic Granuloma Def'n, Assoc (2)?
Polypoid capillary hemangioma that can ulcerate + bleed. ASSOC: - Pregnancy - Trauma
55
Lymphangiosarcoma Def'n?
Lymphatic malignancy associated with persistent lymphedema | eg post-radical mastectomy
56
Cystic Hygroma Def'n, Assoc?
Cavernous lymphangioma of neck. ASSOC: - Turner Sx
57
Torsades de Pointes Def'n, Causes (2 + 2), Pres on EKG, RX?
V-Tach that can progress to V-Fib. CAUSES: - Anything that prolongs QT interval: - Congenital Long QT Sx - Drugs (Antiarrhythmics- Class IA + Class III) - ↓Ca - ↓Mg PRES ON EKG: - "Shifting" sinusoidal waveforms RX: - Mg Sulfate
58
Pulsus Paradoxus Def'n, Seen In (4)?
Exaggerated drop ( > 10 mmHg) in SYS bp during INSP. SEEN IN: * - Cardiac Tamponade - Constrictive Pericarditis - Asthma (severe) / COPD - Hypovolemic Shock
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