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
| -?-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 -?-statish -?-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
| -?-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 | |