PATHOLOGY

Cardiovascular

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Hypertension

Name the risk factors associated with hypertension: -?-↑ age; obesity; diabetes; smoking genetics, black > white > Asian

Features/hypertension: -?-90% of hypertension is primary (essential) and related to ↑ -?-CO or ↑ TPR; remaining % mostly 2° to -?-renal disease.

Predisposes to/hypertension: CAD, cerebrovascular accidents, -?-CHF, renal failure and aortic dissection

Pathology/hypertension: hyaline -?-thickening and atherosclerosis

Arteriosclerosis

-?-Mönckberg hyaline thickening of small arteries
-?-Mönckberg stiffening of the arteries; involve the media, often at radial or ulnar arteries
-?-atherosclerosis fibrous plaques & atheromas form in intima of arteries
Mönckberg Mönckberg atherosclerosis

Ischemic heart disease: Possible manifestations

angina: CAD narrowing > -?-75%

Angina/stable: mostly 2° to -?-atherosclerosis

Angina/Prinzmetal's variant: occurs at rest 2° to -?-coronary artery spasm

angina/unstable or crescendo: thrombosis in a -?-branch (worsening chest pain)

Matching: Ischemic heart disease - other possible manifestations

-?-myocardial infarction most often occurs in CAD involving the left anterior descending artery (LAD)
-?-chronic ischemic heart disease progressive onset of CHF over many years
-?-sudden cardiac death death from cardiac causes within 1 hour of onset of symptoms; most commonly due to lethal arrhythmia
myocardial infarction sudden cardiac death chronic ischemic heart disease

Diagnosis of MI

in the 1st 6 hours, -?-ECG is the gold standard.

Cardiac troponin I is used within the 1st -?-4 hours up to 7-10 days; more specific than other -?-protein markers.

-?-CK-MB is test of choice in the first 24 hours post-MI

-?-LDH1 (former test of choice) is also elevated from 2 to 7 days, post-MI

-?-AST is nonspecific & can be found in cardiac, liver and skeletal muscle cells

-?-ECG changes can include ST elevation (transmural infarct), ST depression (subendo- cardial infarct), and -?-Q waves (transmural infarct)

MI complications

Cardiac arrhythmia ( -?-90%); highest rise -?-2 days days post infarct

LV failure and -?-pulmonary edema (60%)

Thromboembolism -- -?-mural thrombus

Cardiogenic shock (large infarct ­ high risk of -?-mortality.

Rupture of ventricular free wall, interventricular septum, papillary muscle (4-10 days post-MI), cardiac -?-tamponade.

Fibrinous pericarditis -- -?-friction rub (3-5 days post-MI)

-?-Dresslers syndrome - autoimmune resulting in firbinous pericarditis (several weeks post-MI)

Matching: Cardiomyopathies

(item may be used more than once)
-?-hypertrophic cardiomyopathy often asymmetric & involving the intraventricular septum; 50% of cases are familial and are inherited as an autosomal-dominant trait
-?-restrictive/obliterative cardiomyopathy Löffler's
-?-hypertrophic cardiomyopathy cause of sudden death in young athletes
-?-restrictive/obliterative cardiomyopathy major causes include sarcoidosis, amyloidosis, schleroderma, hemochromatosis, endo-cardial fibroelastosis, and endomyocardial fibrosis
-?-dilated most common cardiomyopathy (90% of cases)
-?-hypertrophic cardiomyopathy walls of LV are thickened & chamber becomes banana-shaped on echocardiogram
-?-dilated etiologies include chronic alcohol abuse, beriberi, postviral myocarditis by coxsackievirus B, chronic cocaine use, Chagas' disease, doxorubicin toxicity, peripartum cardiomyopathy
-?-hypertrophic cardiomyopathy diastolic dysfunction ensues
-?-dilated systolic dysfunction ensues
-?-dilated heart dilates and looks like a balloon on chest X-ray
dilated hypertrophic cardiomyopathy restrictive/obliterative cardiomyopathy

Matching: Heart murmurs

-?-aortic stenosis Crescendo-decrescendo systolic ejection murmur following ejection click
-?-mitral stenosis Continuous machine-like murmur; loudest at time of S2
-?-aortic regurgitation Immediate high-pitched "blowing" diastolic murmur; wide pulse pressure
-?-mitral regurgitation Holosystolic high-pitched "blowing" murmur
-?-PDA Follows opening snap; delayed rumbling late diastolic murmur
-?-VSD Holosystolic murmur
-?-mitral prolapse Late systolic murmur with midsystolic click; most frequent valvular lesion
mitral regurgitation aortic stenosis VSD mitral prolapse aortic regurgitation mitral stenosis PDA

Cardiac tumors

-?-myxomas are the most common 1° cardiac tumor in adults; -?-90% occur in the atria; usually are described as a " -?-ball valve" obstruction in the LA.

-?-rhabdomyomas are the most frequent 1° cardiac tumor in children.

-?-metastases are the most common heart tumor.

CHF/ abnormality → cause

Abnormality Cause
Ankle, sacral, eduma -?-RV failure → ↑ venous pressure → fluid transudation
Hepatomegaly (nutmeg liver) -?-↑ central venous pressure → ↑ resistance to portal flow; rarely, leads to cardiac cirrhosis
Pulmonary congestion -?-LV failure → ↑ pulmonary venous pressure → pulmonary venous distention & transudation of fluid; presence of hemosiderin-laden macrophages (heart failure cells)
Dyspnea on exertion -?-Failure of LV output to ↑ during exercise
Paroxysmal nocturnal dyspnea, pulmonary edema -?-Failure of left heart output to keep up with right heart output → acute rise in pulmonary venous & capillary pressure → transudation of fluid
Orthopnea (shortness of breath when supine) -?-Pooling of blood in lungs in supine position adds volume to congested pulmonary vascular system; ↑ venous return not put out by LV
Cardiac dilation -?-Greater ventricular end-diastolic volume

Embolus types:

"An embolus moves like a FAT BAT." What does this mnemonic stand for? -?-Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor

Fat emboli are associated with long bone fractures and -?-liposuction.

Amniotic fluid can lead to DIC, especially -?-postpartum

Pulmonary embolus are associated with chest pain, tachypnea, and -?-dyspnea

Approximately -?-95% of pulmonary emboli arise from deep leg veins.

Deep venous thrombosis: predisposed by Virchow's triad

s -?-statis
h -?-hypercoagulability
e -?-endothelial damage

Bacterial endocarditis:

-?-mitral valve is most frequently involved

Tricuspid valve endocarditis is associated with -?-IV drug abuse

Complications: chordae rupture, glomerulonephritis, suppurative pericarditis, -?-emboli

Rheumatic fever/rheumatic heart disease

A consequence of -?-pharyngeal infection with group A β-hemolytic streptococci

Late sequelae include rheumatic heart disease,which affect heart valves - mitral > aortic >> -?-tricuspid

Associated with -?-Aschoff bodies, migratory polyarthritis, erythema marginatum, elevated -?-ASO titers

Due to -?-cross-reactivity, not direct effect of bacteria

Buerger's disease:

Known as smoker's disease and -?-thromboangiitis obliterans

Treatment? -?-quit smoking

Matching

(items may be used more than once)
-?-polyarteritis nodosa associated with hepatitis B infection in 30% of patients
-?-Wegener's granulomatosis C-ANCA is a strong marker of disease; chest x-ray may reveal large nodular densities; hematuria and red cell casts
-?-Takayasu's arteritis known as the "pulseless disease"; associated with an elevated ESR
-?-Kawasaki disease acute, self-limiting disease of infants & kids
-?-polyarteritis nodosa treatment with corticosteroids, azathioprine, and/or cyclophosphamide
-?-Takayasu's arteritis fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances ("FAN MY SKIN On")
-?-temporal arteritis most common vasculitis that affects medium and small arteries, usually branches of carotid artery
Takayasu's arteritis temporal arteritis polyarteritis nodosa Wegener's granulomatosis Kawasaki disease
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