Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
165 Cards in this Set
- Front
- Back
Bacterial endocarditis of which valve is associated with IV drug abuse?
|
Tricuspid
|
|
Characterize EKG changes in an MI
|
ST elevation (transmural ischemia); ST depression (endocardial infarct); and Q waves (transmural infarct)
|
|
characterize the AST levels in an MI
|
Elevated 1-3 days post MI. Nonspecific enzyme found in heart, liver, and skeletal muscle
|
|
Characterize the cardiac troponin I levels in an MI.
|
Elevated between 4 hrs. and 7-10 days post MI most specific protein marker for MI
|
|
Characterize the CK-MB levels in an MI
|
Elevated in the first 24 hrs. post MI
|
|
Characterize the LDH1 levels in an MI
|
Elevated from 2 to 7 days post MI
|
|
Describe a mitral prolapse murmur?
|
Systolic murmur: most frequent valvular lesion, esp. in young women; late systolic murmur ending with 2nd heart sound
|
|
Describe a mitral regurgitation murmur?
|
Systolic murmur: high pitched holosystolic (continuous sound throughout systole); loudest at apex
|
|
Describe a mitral stenosis murmur
|
Diastolic murmur: rumbling late diastolic murmur following opening snap; LA > LV during diastole
|
|
Describe a VSD murmur.
|
Systolic murmur: Holosystolic murmur (continuous throughout systole)
|
|
Describe an aortic regurgitation murmur
|
Diastolic murmur: high-pitched 'blowing' murmur, beginning immediately in diastole; wide pulse pressure
|
|
Describe an aortic stenosis murmur
|
Systolic murmur: crescendo-decrescendo following ejection click; LV > aortic pressure during systole.
|
|
Describe an Patent ductus arteriosus (PDA) murmur.
|
Continuous murmur (systolic/diastolic): machine-like murmur; loudest at the time of 2nd heart sound
|
|
Describe the bacterial growths in subacute bact. Endocarditis.
|
Small vegetations on congentially abnormal valves
|
|
Describe the onset of Staph. Aureus endocarditis.
|
Rapid, acute onset
|
|
Describe the onset of Streptoccus viridans endocarditis.
|
Insidious, subacute onset
|
|
Describe the S.aureus bacterial growths of acute bact. endocarditis?
|
Large vegetations on previously normal valves
|
|
During what weeks of pregnancy does preeclampsia present?
|
20 weeks gestation to 6 weeks postpartum
|
|
early/late posttransplant endocarditis
|
S. epidermis/S. aureus
|
|
How can pericarditis progress?
|
It can resolve without scarring or it can lead to chronic adhesive or chronic constrictive pericarditis
|
|
How does atherosclerosis progress?
|
Fatty streaks in arteries-> Proliferative plaques-> Complex atheromas
|
|
How does Prinzmental's variant angina present?
|
Chest pain at rest
|
|
How does stable angina present?
|
Chest pain with exertion
|
|
How does syphilis change the aorta?
|
Causes dilation of the aorta and valve ring; can result in aortic aneurysm or aortic valve incompetence
|
|
How does unstable/crescendo angina present?
|
Worsening chest pain
|
|
In what condition do you find Libman-Sacks endocarditis?
|
Lupus (SLE causes LSE)
|
|
Osler-Weber-Rendu syn. (hereditary hemorrhagic telangiectasia)
|
AR, telangiectasia in skin, mucous membranes, respiratory tract, GI tract, urinary tract
|
|
signs to differeniate ascites from cardiomegaly or cirrosis
|
JVP
|
|
To what does HTN predispose one?(5)
|
Coronary heart dz, atherosclerosis, CHF, stroke, renal failure, retinopathy, and aortic dissection
|
|
What are associations of preeclampsia?(3)
|
1.Hemolysis 2.Elevated LFT (liver fxn test) 3.Low platelets
|
|
What are clinical features of preeclampsia?(6)
|
1.Headache 2.Blurred vision 3.Abdominal pain 4.Edema of face and extremities 5.Altered mentation 6.Hyperreflexia
|
|
What are complications from an MI?(7)
|
1.Card. Arrhythmia 2.LV failure/pul. edema 3.Thromboembolism: mural thrombus 4.Cardiogenic shock 5.Rupture of ventricular wall, interventricular septum, papillary muscle or cardiac tamponade 6.Fibrinous pericarditis (friction rub) 7.Dressler's syndrome
|
|
What are complications of bacterial endocarditis?(4)
|
1.Chordae rupture 2.Glomerulonephritis 3.Suppurative pericarditis 4.Emboli
|
|
What are examples traumatic MI complications?(4)
|
1.Vent wall rupture 2.Interventricular/Septum rupture 3.Papillary muscle rupture (4-10 days post-MI) 4.Cardiac tamponade (heart compression)
|
|
What are fat emboli associated with?(2)
|
Long bone fractures and liposuction
|
|
What are Janeway lesions?
|
Small erythematous lesions on palms or soles
|
|
What are nonbacterial causes of endocarditis?(2)
|
Secondary to metastasis or renal failure (marantic/thrombotic endocarditis)
|
|
What are Olser's nodes?
|
Tender raised lesions on finger or toe pads
|
|
What are possible manifestations of ischemic heart disease?(4)
|
1.Angina(CAD narrowing > 75%) 2.Myocardial infarction 3.Sudden cardiac death 4.Chronic ischemic heart disease
|
|
What are risk factors for HTN?(6)
|
Age, obesity, diabetes, smoking, genetics, race (black>white>asian)
|
|
What are Roth's spots?
|
Round white spots on retina surrounded by hemorrhage
|
|
What are some atherosclerosis symptoms?
|
Angina and claudication, but can be asymptomatic
|
|
What are some risk factors for preecalmpsia?(4)
|
1.Preexisting HTN 2.Diabetes 3.Chronic renal dz 4.Autoimmune dz
|
|
What are the 2 major causes of HTN?
|
1.Primary (essential) HTN, related to inc cardiac output or TPR 2.Secondary HTN, usually related to renal dz
|
|
What are the 3 most common sites of an MI?
|
LAD > RCA > Circumflex
|
|
What are the 3 types of Angina in ischemic heart dz?
|
Stable angina, Prinzmetal's variant, and Unstable/crescendo
|
|
What are the 7 types of heart murmurs?
|
1.Aortic stenosis 2.Aortic regurgitation 3.Mitral stenosis 4.Mitral regurgitation 5.Mitral prolapse 6.VSD 7.Patent ductus arteriosus (PDA)
|
|
What are the causes/associations of cardiogenic shock?
|
A large infarct with a high incidence of mortality
|
|
What are the complications of atherosclerosis?(6)
|
Aneurisms, ischemia, infarcts, peripheral vasc dz, thrombus, and emboli
|
|
What are the etiologies of dilated cardiomyopthy?(6)
|
1.Chronic alcohol abuse 2.Beriberi (wet) 3.Coxacke virus B postviral myocarditis 4.Cocaine use 5.Chagas dz. 6.Doxirubicin toxicity 7.Peripartum caridiomyopathy 8.Hemochromatosis
|
|
What are the finding in temporal arteritis?
|
1.Unilateral headache 2.Jaw claudication 3.Impaired vision (opthalmic a. occlusion) 4.Systemic involvement and polymyalgia rheumatica (proximal muscle pain, periarticular pain)
|
|
What are the findings in Buerger's dz?
|
Intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynauld's phenom.), severe pain in affected part; may lead to gangrene.
|
|
What are the findings in pericarditis?(5)
|
1.Pericardial pain 2.Friction rub 3.ECG changes (diffuse ST elevations) 4.Pulsus paradoxicus 5.Distant heart sounds
|
|
What are the findings of polyarteritis nodosa?(3)
|
Hepatitis B infection (30% of patients), multiple aneurysms and constrictions on arteriogram, NO assoc w/ ANCA
|
|
What are the findings of Wegener's granulomatosis?(3)
|
1.C-ANCA positive 2.Chest x-ray reveals large nodular densities 3.Hematuria and red cell casts
|
|
What are the major causes of Restrictive/obliterative cardiomyopathy?(4)
|
1.Sarcoidosis 2.Amyloidosis 3.Post-radiation fibrosis 4.Endocardial fibroelastosis 5.Endomyocardial fibrosis (Loffler's)
|
|
What are the possible lab findings in preeclampsia?(2)
|
Thrombocytopenia and hyperuricemia
|
|
What are the risk factors of atherosclerosis?(4)
|
Smoking, HTN, diabetes mellitus hyperlipidemia, and family history
|
|
What are the signs and symp of rheumatic fever or rheumatic heart dz?(7)
|
FEVERSS: 1.Fever 2.Erythema marginatum 3.Valvular damage 4.ESR increase 5.Red hot joints (Polyarthritis) 6.Subcutaneous nodules 7.St Vitus' dance (Chorea)
|
|
What are the signs and symp. of bacterial endocarditis?(8)
|
1.Janeway lesions 2.Roth's spots 3.Nail bed hemorrhages 4.Osler's nodes 5.Fever 6.Anemia 7.Murmur 8.Emobli
|
|
What are the symptoms of a pulmonary embolus (PE)?(3)
|
Chest pain, tachypnea, and dyspnea
|
|
What are the symptoms of an MI?(5)
|
Severe retrosternal pain, pain in left arm and/or jaw, shortness of breath, fatigue, and adrenergic symptoms
|
|
What are the symptoms of polyarteritis nodosa?
|
Fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neurologic dysfunction, cutaneous eruptions
|
|
What are the symptoms of Takaysu's arteritis?(6)
|
Fever, Arthritis, Night sweats, Myalgia, Skin nodules, Ocular disturbances, Weak pulses in upper extremities
|
|
What are the symptoms of Wegeners granulomatosis?(8)
|
1.Perforation of nasal septum 2.Chronic sinusitis 3.Otitis media 4.Mastoiditis 5.Cough 6.Dyspnea 7.Hemoptysis 8.Hematuria
|
|
What are the symptoms/signs of Kawasaki Disease?
|
Fever, congested conjunctiva, changes in lips/oral mucosa, lymphadenitis, and may develop coronary aneurysms
|
|
What are the types of emboli?(6)
|
1.Fat 2.Air 3.Thrombus 4.Bacteria 5.Amniotic fluid 6.Tumor
|
|
What can cause Fibrinous Pericarditis?(3)
|
1.Uremia 2.MI 3.rheumatic fever
|
|
What can cause Hemorrhagic Pericarditis?(2)
|
1.TB 2.Malignancy (eg melanoma)
|
|
What can cause Serous Pericarditis?(4)
|
1.SLE 2.rheumatoid arthritis 3.infection 4.uremia £®SIRUous£©
|
|
What causes acute bact. Endocarditis?
|
Staphyloccus aureus
|
|
What causes cardiac dilation in CHF?
|
Greater ventricle end-diastolic volume
|
|
What causes dyspnea on exertion in CHF?
|
Failure of LV output to increase during exercise
|
|
What causes hepatomegaly in CHF?
|
Inc central venous press-> inc resistance to portal flow (rarely leads to 'cardiac cirrhosis')
|
|
What causes othopenea (dyspnea when supine) in CHF?
|
Pooling of blood in lungs when supine that adds volume to congested pul. vasculature system
|
|
What causes Paroxysmal nocturnal dyspnea/pulmonary edema in CHF?
|
Failure of left heart to keep up with rt. Heart output-> acute rise pul. venous and capillary pressure-> transudation of fluid
|
|
What causes prinzmental's variant angina?
|
Coronary artery spasm
|
|
What causes pulmonary edema in CHF?
|
LV failure-> inc pul. venous press-> pul. venous distention/transudation of fluid
|
|
What causes pulmonary emboli?
|
95% of pulmonary emboli arise from deep leg veins: DVTs
|
|
What causes Rheumatic fever?
|
Pharyngeal infection with group A, beta-hemolytic streptococci; leads to cross reactivity with self (not due to direct effects of bacteria)
|
|
What causes stable angina?
|
Atherosclerosis
|
|
What causes sudden cardiac death?
|
Most commonly from lethal arrhythmia
|
|
What causes the edema seen in CHF?
|
RV failure-> inc venous press-> fluid transudation
|
|
What causes Unstable/crescendo angina?
|
Thrombosis but no necrosis in a branch of the coronary artery
|
|
What happens 2-4 days after an MI?(5)
|
1.Infarct appears pale 2.Tissue surrounding infarct shows acute inflammation 3.Dilated vessels (hyperemia) in infarct 4.Neutrophil emigration 5.Extensive coagulative necrosis
|
|
What happens 5-10 days after an MI?(4)
|
1.A hyperemic boarder forms around the infarct 2.The infarct shows central softening with brown/yellow color 3.An outer zone (ingrowth of granulation tissue) forms around infarct 4.Neutrophils and macrophages infiltrate infarcted tissue
|
|
What happens by 7 weeks post-MI?(3)
|
1.The Occluded artery causing the MI is recanalized 2.The infarct area is gray/white 3.The infarcted tissue shows contracted, complete scarring
|
|
What happens to contractility, cardiac output, and effective atrial blood volume in CHF?
|
All decrease
|
|
What happens to renal blood flow in CHF?
|
Decreases
|
|
What happens to renin, angiotensin II, and aldosterone in CHF
|
All increase
|
|
What happens to sympathetic nervous activity in CHF?
|
Increases
|
|
What happens to the heart 1 day after an MI?(5)
|
1.Infarct area: Dark mottling; pale w/ tetrazolium stain (no visible change by light microscopy in first 2-4hrs) 2.Coagulative necrosis in the infarct 3.Release of necrotic cell contents into the blood 4.Beginning of neutrophil emigration 5.Contraction bands visible after 4 hrs 6.Artery supplying infarcted tissue is occluded
|
|
What happens to urinary excretion of water and Na in CHF?
|
Decreases: (Na+/H20 reabsorption)
|
|
What happens to venous pressure in CHF?
|
Increases
|
|
What histologic part of the aorta is affected by syphilis?
|
Vasa vasorum
|
|
What is 'pulseless disease'?
|
Takayasu's arteritis
|
|
What is a Cardiac Tamponade?
|
Compression of the heart by fluid in pericardium, leading to dec cardiac output
|
|
What is a Red infarct?
|
A hemorrhagic infarct occurring in loose tissue with collaterals, such as lungs, liver, intestines, or following REperfusion
|
|
What is Arteriolosclerosis?
|
Hyaline thickening of small arteries in essential HTN; Hyperplastic 'onion skin' in malignant HTN
|
|
What is associated with Rheumatic fever?
|
Aschoff bodies, migratory polyarthritis, erythema marginatum, elevated ASO titers
|
|
What is Atherosclerosis?
|
Fibrous plaques and atheromas form in intima of arteries
|
|
What is Buerger's disease?
|
Known as Thromboangitis obliterans; idiopathic, segmental, thrombosing vasculitis of intermediate and small peripheral arteries and veins.
|
|
What is chronic ischemic heart dz?
|
Progressive onset of CHF over several years due to chronic ischemic myocardial damage
|
|
What is Churg-Strauss Syndrome?
|
Granulomatous vasculitis with eosinophilia
|
|
What is Dressler's syndrome?
|
Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI
|
|
What is eclampsia?
|
The addition of seizures to the preeclampsia triad
|
|
What is fibrinous pericarditis?
|
A friction rub of the pericardium usually 3-5 days post-MI
|
|
What is Hypertrophic Cardiomyopathy (formerly IHSS: idiopathic hypertrophic subaortic stenosis)?
|
Familial hypertrophy, usually asymmetric, involving the interventricular septum
|
|
What is Kawasaki Disease?
|
Acute, self-limited necrotizing vasculitis of small/medium sized vessels in infants/kids
|
|
What is Libman-Sacks endocarditis?
|
Vegetations found on both sides of valve but do not embolize (->mitral valve stenosis)
|
|
What is malignant HTN?
|
Severe/rapidly progressing HTN
|
|
What is Microscopic Polyangiitis?
|
Like Wegener's, but lacks granulomas; P- or C-ANCA
|
|
What is Monckeberg arteriosclerosis?
|
Calcification of the arteries (especially radial/ulnar); usually benign
|
|
What is necessary to make bacterial endocarditis diagnosis?
|
Multiple blood cultures
|
|
What is Polyarteritis Nodosa (PAN)?
|
Necrotizing immune complex inflammation of small or medium-sized muscular arteries; typically involving renal/visceral vessels.
|
|
What is preeclampsia?
|
A triad of HTN, protenuria, and edema that occurs in pregnancy
|
|
What is Primary Pauci-immune Crescentic Glomerulonephritis?
|
Vasculitis limited to kidney
|
|
What is sudden cardiac death?
|
Death from cardiac causes within 1 hr. of onset of symptoms
|
|
What is Takayasu's arteritis?
|
Thickening of aortic arch and proximal great vessels causing weak pulses in extremities and ocular disturbances.
|
|
What is temporal arteritis?
|
Vasculitis that affects medium/small arteries, usually branches of the carotid artery.
|
|
What is the appearance of a heart with Hypertrophic cardiomyopathy?
|
Walls of LV are thickened, chamber becomes banana shaped on echocardiogram
|
|
What is the appearance of an aorta affected by syphilis?
|
Tree bark appearance
|
|
What is the incidence of preeclampsia?
|
7% of pregnant women
|
|
What is the inheritance pattern of Hypertrophic cardiomyopathy?
|
Autosomal Dominant
|
|
What is the most common cardiomyopathy?
|
Dilated (congested) cardiomyopathy (90%)
|
|
What is the most common heart tumor
|
Metastases
|
|
What is the most common primary cardiac tumor in adults?
|
Myxoma
|
|
What is the most common primary cardiac tumor in children
|
Rhabdomyoma (associated w/ tuberous sclerosis)
|
|
What is the most common vasculitis?
|
Temporal arteritis
|
|
What is the physiologic consequence of a cardiac tamponade?
|
Equilibration of pressures in all 4 chambers
|
|
What is the treatment for Buerger's dz?
|
Stop smoking
|
|
What is the treatment for temporal arteritis?
|
Responds well to steroids
|
|
What is the treatment of eclampsia?
|
IV Magnesium sulfate/diazepam; this is a medical emergency
|
|
What is the treatment of polyarteritis nodosa?
|
Corticosteroids, Cyclophosphamide
|
|
What is the treatment of preeclampsia?
|
Deliver the fetus ASAP; otherwise rest, salt restriction, treatment of HTN
|
|
What is the treatment of Wegener's granulomatosis?
|
cyclophosphamide and Corticosteroids
|
|
What is the x-ray appearance of a heart with dilated myopathy?
|
Dilated: looks like a balloon on x-ray
|
|
What is Wegner's granulomatosis?
|
Focal necrotizing vasculitis and necrotizing granulomas in the lung and upper airway and by necrotizing glomerulonephritis
|
|
What lab finding is present w/ Temporal arteritis?
|
Elevated ESR
|
|
What lab finding is seen in Takayasu's arteritis or temporal arteritis?
|
Elevated ESR
|
|
What organs does Churg-Strauss Syndrome affect?
|
Lung, heart, skin, kidneys, nerves
|
|
What part of the heart/vasculature can be damaged by syphilis?
|
Aortic root and ascending aorta
|
|
What pathology do you find w/ pulmonary edema in CHF?
|
Presence of hemosiderin-laden macrophages (heart failure cells).
|
|
What percentage of HTN is primary?
|
90%
|
|
What percentage of HTN is secondary?
|
10%
|
|
What population is associated with sudden death from Hypertrophic cardiomyopathy?
|
Young athletes
|
|
What population is Churg-Strauss syndrome found in?
|
Often found in atopic pts
|
|
What population typically has Buerger's disease?
|
Heavy smokers
|
|
What predisposes one to deep vein thromosis (DVT)?(3)
|
Virchow's triad: 1.Stasis 2.Hypercoagulability 3.Endothelial damage
|
|
What stage of Syphilis can affect the heart?
|
Tertiary
|
|
What symptoms are associated with CHF?(8)
|
1.Ankle and sacral edema 2.Hepatomegaly (nutmeg liver) 3.Pulmonary edema 4.Paroxysmal nocturnal dyspnea 5.Dyspnea on exertion 6.Orthopnea (dyspnea when supine) 7.Cardiac dilation
|
|
What tests are used to diagnose an MI?(5)
|
1.EKG (the gold standard) 2.Cardiac troponin I 3.CK-MB 4.LDH1 5.AST
|
|
What type of bacterial endocarditis/organism is associated with dental procedures?
|
Subacute endocarditis from Strep. Viridans infection
|
|
What type of embolus is associated with DIC?
|
Amniotic fluid, especially postpartum
|
|
What visual complication can temporal arteritis cause?
|
Occlusion of ophthalmic artery leading to blindness
|
|
Where do myxomas occur?
|
90% occur in the atria, mostly LA; myxomas are described as a 'ball valve' obstruction.
|
|
Where do Pale infarcts occur?
|
Solid tissues with single blood supply: brain, heart, kidneys, and spleen
|
|
Where do Red infarcts occur?
|
Loose tissue with collaterals: lungs, liver, intestines
|
|
Where does a MI usually occur?
|
In the left anterior descending coronary artery (LAD)
|
|
Where histologically does atherosclerosis occur?
|
The elastic arteries and medium to large muscular arteries
|
|
Where, anatomically, does atherosclerosis most occur?(4)
|
Abdominal aorta > coronary a. > popliteal a. > carotid a.
|
|
Which valve is most frequently involved in bacterial endocarditis?
|
Mitral
|
|
Which valves are most affected by rheumatic heart dz?
|
Mitral > aortic >> tricuspid (high pressure valves most affected)
|
|
Who gets Takayasu's arteritis?
|
Primarily affects young Asian females
|
|
Who gets temporal arteritis?
|
Affects elderly females
|