Cardio recal

Monckeberg

calcification in the media of the aa, esp radial and ulnar.
usually benign; 'pipestem' arteries

Arteriolosclerosis

Hyaline thickening of small aa in essential HTN. Hyperplastic "onion skinning" in malignant HTN

Atherosclerosis

Fibrous plaques and atheromas form in intima of aa

corneal arcus

ring of lipid in the cornea - nospecific can could demonstrate hyperlipidemia

atheroma

plaque w/in a bd vessel wall (seen in atherosclerosis)

4 hrs post MI micro characteristics

Coagulative necrosis: contraction bands
*release of contents of necrotic cells into bd stream and the beginning of PMN migration

2-4 days post MI micro characteristics

*risk for arrhythmia
*tissue surrounding infarct = acute inflamm
*hyperemia = dilated vessels
*PMN emigration
*mm shows extensive coagulative necrosis

5-10 days post MI micro characteristics

*highest risk for free wall rupture
*outer zone (ingrowth of granulation tissue) - maximally yellow and soft at 10 days
*macs
*PMNs

7 wks post MI micro characterisitics

*risk ofr ventricular aneurysm
*contracted scar complete

Cardiac troponin I time line (most sp protein marker for MI)

rises after 4 hrs; peaks w/in 24 hrs; elevated fro a total of 7-10 days

Why aren't the following markers best for MI assessment:
CK-MB (peaks just after troponin but gone by 24 hrs)
AST (peaks at about 48 hrs)

CK-MB: predominantly found in myocardium but also released from skeletal mm
AST: nonspecific b/c it can be found in liver and sk mm cells as well

At what time period post MI are these complications most likely:
Arrhythmia
Vent free wall rupture
Aneurysm
fibrinous pericarditis
Dressler's syndrome (autoimmune pericarditis)

2-4 days post
5-10 days post
7 wks post (after scar is done)
3-5 days post
several wks post

Causes of pulsus paradoxus = Kussmaul's pulse = decreased amp of pulse during inspiration

TAMPONADE
astma
obstructive sleep apnea
pericarditis
croup

Signs of Bacterial endocarditis
(FROM JANE

Fever
Roth's spots (white, retinal spots)
osler's nodes (finger pad lesions)
Murmur
Janeway lesions (palm & soles)
anemia
Nail-bed hemorrhages (splinter)
emboli

Causes of serous peicarditis

SLE
RA
viral infection
uremia

Causes of fibrinous pericarditis

Uremia
MI (Dressler's syn - autoimmune, wks later)
Rheumatic fever

Causes of hemorrhagic pericarditis

TB
malignancy (melanoma)

Signs of the the hereditary hemorrhagic telangectasia (Osler-WEber-Tendu syn)

frequent nosebleeds and skin discolorations

Wegener's pathophys triad:

presenting signs

*focal necrotizing vasculitis, necrotizing granulomas in teh lung and URT, necrotizing glomerulonephritis
*nasal septum perforation, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, hematuria

Diagnostic findins in wegener's (3)

c-ANCA
c-xray: large nodular densities
hematuria + red cell casts

PAN notes
*pathophys
*presentation
*labs
*Rx

*immune complex mediated fibrinoid necrosis of med aa
*fever, weight loss, HTN, neuro, abd pain, etc
*Hep B + in 30%, bx: multiple aneurysms and constrictions
*rx: immun suppression

Takayasu's arteritis notes
*pathophys
*presentation
*labs

*granulomatous aorta and large aa w/ fibrosis and significant narrowing
*"pulseless" dx (85% have no/low UE pulses; fever, malaise; ocular distrubances, night sweats
*<40 yo asian females
*labs: elevated ESR

Temporal arteritis / giant cell arteritis
*pathophys
*presentation
*labs

*granulomatous inflamm of med/large aa off the carotids, cranial aa, intimal fibrosis
*elderly females, unilateral headache, jaw claudication, impaired vision
*elevated ESR, C reactive protein

Thromboangiitis obliterans aka Buerger's dx
*pathophys
*path
*presentaiton
*rx

*no signs of inflamm or autoimmune attack (but usually HLA A9 or B5 +)
*segmental, thrombosing vasculitis of small and med aa & vv
*SMOKERS, MALE, <40>s, migrating throbophelbitis
*smoking cessation

Hypercoaguable states

*Inherited dx of coag: resistance of APC (factor V leidden); prothrombin gene mutation; AT III def; def of protein C or S
*antiphospholipid Ab's (SLE)
*neoplastic dx (lung, pancreatic, breast, stomach)
*preggers / oral contraceptive (high E states)
*meyloproliferative dx
*smoking

Kawasaki disease
*pathophys
*presentation
*complication

necrotizing vasculitis of sm/med vessels
*infants/kids, fever, congested conjunctiva, changes in lips/mucosa (strawberry tongue) [acute and self-limiting]
*coronary aneurysms

Henoch-Schonlein purpura (most common form of childhood systemic vasculitis) triad:

skin: (palpable purpura)
jts: (arthrlagia
GI: intestinal hemorrhage, abd pain, melena

*multiple lesions at same age*

Churg-Strauss syn
path/presentation/lab

Granulomatous vasculitis w/ eosinophila. Involves: lung, heart, skin, kidneys, nn
p-ANCA