first aid: cardio pathology

4 components of tetralogy of fallot: _____
Pulmonary infundibular stenosis (most
important determinant for prognosis)
Right ventricular hypertrophy (RVH)—
boot-shaped heart on CXR A
Overriding aorta
VSD

Squatting: SVR, right-to-left shunt, improves
cyanosis: ____
TOF

Pulmonary veins drain into right heart
circulation (SVC, coronary sinus, etc.);
associated with ASD and sometimes PDA to
allow for right-to-left shunting to maintain
CO: _____
Total anomalous
pulmonary venous
return (TAPVR)

Right-to-Left shunts: _____ cyanosis.
Left-to-Right shunts: _____ cyanosis
eaRLy , “LateR”

____ can eventually result in late cyanosis in
the lower extremities (differential cyanosis)
PDA

Uncorrected left-to-right shunt (VSD, ASD,
PDA) pulmonary blood fow pathologic
remodeling of vasculature pulmonary
arterial hypertension. RVH occurs to
compensate shunt becomes right to
left: _____
eisenmieger syndrome

Hypertension in upper extremities and weak,
delayed pulse in lower extremities : _____
coarctation of aorta

collateral arteries erode ribs
(notched appearance on CXR): ____
coarctation of aorta

Congenital defect diabetic mother: ____
Transposition of great vessels

MVP, thoracic aortic aneurysm and dissection,
aortic regurgitation: _____
marfan

congenital defect: Prenatal lithium exposure
ebstein anomoly

Bicuspid aortic valve, coarctation of aorta: _____
turner syndrome

Supravalvular aortic stenosis: _____
williams syndrome

22q11 syndromes
Truncus arteriosus, tetralogy of Fallot

Hypertensive urgency—severe (_____mmHg) hypertension without acute end-organ
damage
≥180/≥120

palpable
pulsatile abdominal mass: ____
AAA

markedly unequal
BP in arms: _____
aortic dissection

Stanford type A(proximal): involves
Ascending aorta. May extend to aortic arch
or descending aorta. Treatment is _____
surgery

Stanford type B (distal): involves descending
aorta and/or aortic arch. No ascending
aorta involvement. Treat ____
medically with
β-blockers, then vasodilators

Stable angina—usually 2° to atherosclerosis; exertional chest pain in classic distribution (usually with
ST _____ on ECG), resolving with rest or nitroglycerin
depression

occurs at rest 2° to coronary artery spasm; transient ST elevation on
ECG: _____ angina
prinzmetal

+/−ST depression and/or
T-wave inversion on ECG but no cardiac biomarker elevation (unlike NSTEMI); in frequency
or increase intensity of chest pain or any chest pain at rest. :_____ angina
unstable

MI If transmural,
ECG may show ST _____; if subendocardial, ECG may show ST _____
elevations (STEMI), depressions
(NSTEMI)

Time: _____ wavy fbers.
Neutrophils appear.
Reperfusion injury may cause
contraction bands (due to free
radical damage)
4-24 hours

Time: _____ Extensive coagulative necrosis.
Tissue surrounding infarct
shows acute infammation
with neutrophils
1-3 days

Macrophages, then granulation
tissue at margins time: _____
3-14 days

Cardiac ____ rises after 4 hours and is for 7-10 days; more specifc than other protein
markers
troponin I

_____ rises after 6-12 hours and is predominantly found in myocardium but can also be released
from skeletal muscle. Useful in diagnosing reinfarction following acute MI because levels return
to normal after 48 hours
CK-MB

Anteroseptal (LAD) infarct leads: _____
V1-V2

Anteroapical (distal LAD) infarct leads: ____
V3-V4

Anterolateral (LAD or LCX) infarct leads: _____
V5-V6

Lateral (LCX) infarct leads: _____
I, aVL

InFerior (RCA) infarct leads: _____
II, III, aVF

Ventricular free wall rupture cardiac tamponade; papillary muscle rupture severe mitral
regurgitation; and interventricular septum rupture VSD. Greatest risk _____ days post-MI.
3-14

_____—outward bulge during contraction (“dyskinesia”), associated with
fbrosis; arises 2 weeks to several months after MI
True ventricular aneurysm

Postinfarction fbrinous pericarditis—friction rub (____post-MI)
1-3 days

_____—autoimmune phenomenon resulting in fbrinous pericarditis
Dressler syndrome

_____
(endomyocardial fibrosis with a prominent
eosinophilic infltrate)
Löfer syndrome

_____ (round white spots
on retina surrounded by hemorrhage)
Roth spots

tender raised lesions on
fnger or toe pads: _____
osler nodes

small,
painless, erythematous lesions on palm or
sole: _____
janeway lesions

endocarditis: Acute—_____.
Large vegetations on previously normal
valves C. Rapid onset
S. aureus(high virulence)

endocarditis Subacute—_____ Smaller vegetations on
congenitally abnormal or diseased valves.
Sequela of dental procedures. Gradual
onset.
viridans streptococci (low
virulence).

rhuematic fever Associated
with _____ (granuloma with giant
cells), _____
(enlarged macrophages with ovoid, wavy,
rod-like nucleus), antistreptolysin O (ASO) titers
Aschoff bodies, Anitschkow cells

J♥NES(major criteria):
_____
Joint (migratory polyarthritis)
♥(carditis)
Nodules in skin (subcutaneous)
Erythema marginatum
Sydenham chorea

Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up and
leaning forward: _____
acute pericarditis

ECG changes include widespread ST-segment
elevation and/or PR depression: _____
acute pericarditis

cardiac tamponade Beck triad _____
(hypotension, distended neck veins, distant heart sounds)

_____— in amplitude of systolic BP by >10 mmHg during inspiration. Seen in
cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
Pulsus paradoxus

Most common heart tumor is a _____
metastasis

Most common 1° cardiac tumor in adults
90% occur in the atria: ____
myxoma

_____ are usually described as
a “ball valve” obstruction in the left atrium
(associated with multiple syncopal episodes).
May hear early diastolic “tumor plop” sound
Myxomas

Most frequent 1° cardiac tumor in children
(associated with tuberous sclerosis): _____
rhabdomyoma

increase in JVP on inspiration instead of a normal decrease: _____
kussmaul sign

Rare blood vessel malignancy typically occurring in the head, neck, and breast areas. Usually in
elderly, on sun-exposed areas. Associated with radiation therapy and chronic postmastectomy
lymphedema: _____
angiosarcoma

_____ Benign capillary skin papules found in AIDS patients. Caused by Bartonella henselaeinfections.
Frequently mistaken for Kaposi sarcoma, but has neutrophilic infltrate
Bacillary angiomatosis

_____ Benign capillary hemangioma of the elderly. Does not regress
Cherry hemangioma

_____ Cavernous lymphangioma of the neck. Associated with Turner syndrome.
Cystic hygroma

_____ Benign, painful, red-blue tumor under fngernails. Arises from modifed smooth muscle cells of the
thermoregulatory
Glomus tumor

_____ Polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and
pregnancy.
Pyogenic granuloma

_____
Benign capillary hemangioma of infancy. Appears in frst few weeks of life (1/200 births); grows
rapidly and regresses spontaneously by 5-8 years old
Strawberry
hemangioma

raynaud tx: _____
calcium channel blockers

Vasculitis Hepatitis B seropositivity in 30% of patients: _____
PAN

Presentation similar to granulomatosis with
polyangiitis but without nasopharyngeal
involvement: _____
microscopic polyangitis

Asthma, sinusitis, skin nodules or purpura,
peripheral neuropathy: _____
churg struass

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