1. Heart
   1. Basic info
      1. Weight
         1. M:250:300
         2. F:200-250
      2. Wall thickness
         1. RV:3-5 mm
         2. LV:10-15
      3. Layers
         1. Epicardium
         2. Myocardium
         3. Endocardium
         4. Pericardium
      4. Valves
         1. Atrioventricular Valves
            1. Closed During Sytole
            2. First Heart Sound
            3. Mitral/Tricupsid
            4. Have Cordae tendineae
         2. Semilunar Valves
            1. Open During Styole
            2. 2nd Hrt sound
            3. Aortic/Pulmonary
      5. Blood Supply
         1. LCA
            1. LCrfA
            2. LAD
         2. RCA
         3. Most flow during Diastole
   2. Disease
      1. Heart
         1. Congestive Heart Failure
            1. Types and Causes
            2. Systolic dysfuction
            3. MI
            4. Cardiogenic shock
            5. Hypertension
            6. Volume Overload
            7. Cardiomyopathy
            8. Dilated Heart
            9. Diastolic dysfunction
            10. Hypertensive Heart Disease
            11. Cardiomyopathy
            12. Hypertrophic
            13. Amyloidosis
            14. Constrictive Pericarditis
            15. Tamponade
            16. Chamber failure
            17. Left Sided
            18. Causes
            19. Systemic Hypertension
            20. Mitral/Aortic valve disease
            21. Ischemic Heart Disease
            22. Features
            23. Paroxysmal nocturnal dyspnea
            24. Orthopnea
            25. Dyspnea
            26. Right sided
            27. Left Sided Failure
            28. Cor Pulmonale (primary lung disease)
            29. Compensatory Mechanisms
            30. Myocardial Hypertrophy
            31. Catecholamine stimulation
            32. Concentric hypertrophy
            33. Eccentric hypertrophy
            34. Myocardial dilation
            35. Frank Starlings law
            36. Dilation to increase contraction force
            37. Compensated Heart Failure
            38. Decompensated Heart Failure
            39. Even at rest the heart cant perfuse sufficently for needs
            40. Systemic Edema
            41. Foward Heart Failure
            42. Decreased CO
            43. Renal Hypoperfusion
            44. RAS activation
            45. Na+/ H2O retention
            46. Backward failure
            47. Pulmonary edema
            48. Pulmonary Hypertension
            49. Right Sided failure
            50. Systemic Venous congestion
         2. Ischemic Heart Disease
            1. Syndromes
            2. Angina pectoris
            3. Types
            4. Typical
            5. Most Common
            6. Physical activity/ emotional excitement
            7. Fixed critical stenosis
            8. Relieved by rest/Vasodialators
            9. Prinzmetal
            10. Occurs at rest
            11. ST segement elevation
            12. Coronary artery Spasm
            13. Relieved by Vasodialators
            14. Unstable
            15. Crescendo pain
            16. Occurs at rest
            17. AMI
            18. Characteristics
            19. 5:1 M 45-55 2:1 M 55-80 1:1 80+
            20. Other 10% causes
            21. Vasospasm
            22. Emboli
            23. Left sided mural thrombus
            24. Transmural infarcts
            25. More serious
            26. Subendocardial
            27. Can occure with prolonged hypotension
            28. Effects
            29. Myocardial function
            30. Loss of contractility (2 mins)
            31. Loss of ATP from (0-40 mins)
            32. Irreversible injury (20-40 mins)
            33. Microvascular injury (1hr+)
            34. Gross- Micro Changes
            35. Dark Mottling (4-24hrs)
            36. Wavy fibers (1-4hrs)
            37. Early Coagulation Necrosis (4-12hrs)
            38. Early PMNs/ Coaug Necr/Contraction bands (12-24)
            39. Mottling (1-3 days)
            40. PMNs
            41. Central softening/ (3-7 days) Hyperemic border
            42. Early Macs / Myofibers destruction
            43. Maximum softening (7-10 days)
            44. Phago/ Hella macs
            45. Red/Grey depressed border (10-14 days)
            46. Granulation tissue form
            47. Firm/Grey, Scarring (2-8 wks)
            48. More collagen than cells
            49. Scarring (2 mths+)
            50. Dense collagenous scar
            51. Not relieved by vasodilators
            52. Complications
            53. Arrhythmias (75% - 90%)
            54. Papillary muscle dysfunction
            55. Rupture
            56. Wall
            57. Septum
            58. Acute Heart Failure
            59. Mural Thrombi
            60. Ventricular aneurysms
            61. Dressler's syndrome
            62. Sudden Cardiac Death
            63. Chronic Ischemic Heart disease
            64. Causes
            65. Anemia
            66. Hypoxemia
            67. Hypotension
            68. Watershed infarct of brain
            69. Circumflex infarct of heart
            70. Increased cardiac demand
            71. Mechanisms
            72. Fixed Coronary obstruction
            73. Critical stenosis
            74. 70% of 1 or more major coronaries
            75. Collaterals
            76. When insufficent leads to disease
            77. Acute plaque changes
            78. Rupture/Ulveration
            79. Hemorrhage
            80. Initating event
            81. Types
            82. Stable
            83. Unstable
            84. Thin fibrous cap
            85. Rich lipid and inflammatory cell core
            86. Low SMC
            87. Eccentric
            88. Cornary intraluminal thrombosis
            89. Superimposed due to acute plaque changes
            90. Complete occulsion
            91. Vasoconstriction
            92. Contributes to acute plaque changes
            93. Stimulated by
            94. increase Thromboxane A2
            95. increase Endothelin
            96. Decrease NO
            97. A1 Activation
2. Blood Vessels
   1. Layers
      1. Intima
         1. Endothelial cells
            1. Function
            2. Maintain permeablity
            3. Release Anti/Pro thrombic factors
            4. Modulate flow
            5. NO/ Endothelin
            6. Inflammatory/Immunity regulation
            7. IL-1
            8. IL-6
            9. VCAM1/ ICAM1
            10. Regulate Cell Growth
            11. PDGF
            12. TGF-Beta
            13. Fibroblast Prolif
            14. Oxidize LDLs
            15. Lipids are cytotoxic to endothelium
            16. Dysfunction
            17. Stimulation
            18. Activation
            19. gene expression/protein synth
            20. Impaired vasodilation/ anti inflammatory
            21. Release prothrombin factors
            22. Activators
            23. Cytokines
            24. Bacterial products
            25. Hypertension
            26. Viruses
            27. MHC molecues
      2. Media
         1. Smooth Muscle Cells
            1. Function
            2. Vaso- constriction/dialtion
            3. Change function upon intima migration
            4. Elaborate ECM
            5. Make Fatty Streak to Fibrofatty atheroma
      3. Adventitia
         1. Connective Tissue
   2. Diseases
      1. Narrowing
         1. Arteriosclerosis
            1. Atherosclerosis
            2. Other associated risk
            3. homocystenemia
            4. ROS damage
            5. Folate (B-9) or Colbamine (B-12) defiency
            6. Lipoprotein (a)
            7. Persistent prothombic events
            8. High PA-1 inhibitor
            9. C reactive protien
            10. Lack of exercise
            11. Type A personality
            12. Postmenopausal estrogen deficiency
            13. High carb diet
            14. Chlamydia pneumoniae
            15. Major Risk Factors
            16. Hyperlipidemia
            17. Hypercholesterolemia
            18. Cigarette smoking
            19. Diabetes mellitus
            20. AS induced gangrene
            21. Hypertension
            22. More impotant after age 45
            23. Pathogensis
            24. Chronic inflammatory response to intima/ Endothliel injury
            25. Macrophages
            26. Foam Cells
            27. TNF
            28. Progression
            29. Fatty Dots
            30. Fatty Streaks
            31. Atherosclerotic plaque
            32. Hyper thrombotic
            33. Superimposed thrombis
            34. Components
            35. Cells
            36. ECM
            37. Intra/extracellular lipids
            38. Fibrin Cap
            39. Rupture
            40. Thickness of Cap
            41. Presence of inflammatory cells
            42. Hemodynamic Stress
            43. Size of nectrocic plaque core
            44. Complications
            45. Stable plaque
            46. Unstable
            47. Clinical mainfestations
            48. Coronary Heart Disease
            49. AMI
            50. Angina
            51. Stable
            52. Unstable
            53. CHF
            54. Sudden Cardiac Death
            55. AAA
            56. Cerebreal vascular disease
            57. Stroke
            58. TIA
            59. Chronic ischemic encephalopathy
            60. Peripheral vascular disease
            61. Ischemic Bowel Disease
            62. Gangrene
            63. Locations
            64. 1. Distal abdominal Aorta
            65. 2. Coronary Arteries
            66. 3. Thoracic Aorta, Femoral, Popliteal arteries
            67. Internal Carotid
            68. Circle of Willis
            69. Medial Calcific Sclerosis
            70. Arteriolosclerosis
            71. Hyaline
            72. Chronic Benign HTN
            73. Plasma protein leakage
            74. Hyperplastic
            75. Severe Chronic HTN
            76. Response to trauma
            77. Necrotizing Arteritiolitis
            78. Fibrinoid Necrosis
         2. Hypertension
            1. Types
            2. Stage I (140-159/90-99)
            3. Stage II (160/100)
            4. Malignant (210/120)
            5. End organ failure
            6. Regulation/ Arterioles
            7. Factors
            8. Endocrine
            9. Neural
            10. Cardiac
            11. Blood Volume
            12. Complications
            13. Nephrosclerosis-Kidney
            14. Eyes- HTN retinopahty
            15. Brain- infarction/haemorrhage
      2. Weakening
         1. Anyeurms
            1. Weakness of Media
            2. Congenital
            3. Marfan's syndrome
            4. Berry aneuryms
            5. Acquired Weakness
            6. Mycotic (infective)
            7. Common sites
            8. Aorta
            9. Cerebral vessels
            10. Renal
            11. Mesenteric
            12. Splenic
            13. Causes
            14. Endocarditis
            15. TB/Bacterial Abscess
            16. Sepsis
            17. Salmonella Gastroenteritises/ Aorta
            18. Syphilis
            19. Tertiary stage
            20. Obliterative endarteritis Vaso Vasorum
            21. Aorta Arch
            22. Valve ring dialation
            23. Valvular insufficiency / most commone cause death
            24. Massive left vent hypertrophy
            25. Valvular Regurgation
            26. Tree bark appearance in intima
            27. Complications
            28. Encroachment Mediastinum
            29. Recurrent laryngeal nerve
            30. Difficulty Swallowing
            31. Persistent Cough
            32. Respiratory difficulties
            33. Iatrogenic (disease due to medical treatment)
            34. Atherosclerosis
            35. Abdominal aorta
            36. Age 50 and older
            37. Distal to renal arteries/Proximal to bifurcation
            38. Abdominal mass
            39. Impingement on adjacent structures
            40. Urter
            41. Erosion of verebrea
            42. Complications
            43. Aysmptomatic
            44. Occlusion of branch vessels
            45. Renal/Mesenteric/Vertebral
            46. Emboli
            47. Rupture
            48. Chances increase as size of increases
            49. Large (5cm))-Prostehtic grafts
            50. Into retroperitoneal space
            51. Timing of intervention
            52. 5% death rate unruptured
            53. Over 50% death rate ruptured
            54. Types
            55. True
            56. Fusiform
            57. Saccular
            58. False/Pseudoaneurysm
            59. Hematoma
         2. Aortic Dissection
            1. Characteristics
            2. Intimal tear
            3. ascending aorta
            4. First two layers
            5. Execruting radiating back pain
            6. Causes
            7. Ruptures
            8. Men, 40-60
            9. Hypertension
            10. Arterial cannulation
            11. Pregnancy
            12. Complications
            13. Rupture
            14. Lumen
            15. "Double bareled" aorta
            16. Adventia
            17. Hemorrhage
            18. Pericardial
            19. Pleural
            20. Peritoneal
            21. Compress spinal ateries
            22. Transverse myelitis
            23. Tamponade
            24. MI
            25. Types
            26. Type A
            27. Most common/ Dangerous
            28. Ascending portion/ Ascending + Descending
            29. Type B
            30. Beginning distal subclavian
            31. Retrograde
            32. Aortic Root
            33. disrupt Aortic Valvular apparatus
      3. Inflammatory disorders
         1. Vasculitis
            1. Types
            2. Large-Medium
            3. Giant Cell (Temporal) Arteritis
            4. Lead to blindness
            5. Granulomatous inflam of intima/ inner media
            6. Temporal artery/ Head
            7. Fragmentation of internal elastic lamina
            8. Elevated ESR (blood sed-rate)
            9. Polymyalgia rheumatica
            10. Elastin of Large Arteries
            11. 50 and above, M:F 1:1
            12. Papaular nodular temporal artery
            13. Therapeutic trail of steroids
            14. Takayasu arteritis
            15. Granulomatous vasculitis(media) w/ obliteration of lumen
            16. Arch of Aorta
            17. great vessels of arch
            18. Pulmonary/coronary/Renal arteries
            19. Females over 40
            20. Blindness
            21. Upper limp pulselessness, coldness, and numbness
            22. Low BP Upper limbs
            23. Dizziness
            24. Hemiparesis to focal weakness
            25. Patchy necrosis
            26. Fibrosis involving all layers
            27. Medium to Small
            28. Polyarteritis Nodosa
            29. Characteristics
            30. Systemic
            31. Spares pulmonary circulation
            32. Doesn't involve Arterioles, Caps, and Vens (mainly medium)
            33. No glomerulonephritis
            34. 1) Kidney, 2) Heart, 3) Liver, and then 4) GI
            35. Branching points/ Bifurcations
            36. Temporal Variability
            37. Acute Stage
            38. Transmural inflammation
            39. Inner half fibrinoid necrosis
            40. Later Stage
            41. Fibrosis replacement of transmural inflmmation
            42. Transmural necrotizing inflammation
            43. Young Adults
            44. Complications
            45. Ulcerations
            46. Infarcts
            47. Atrophy
            48. Hemorrhages
            49. Burgers Disease/Thromboangitis obliterans
            50. Characteristics
            51. Cigarette smoking
            52. Hypersenstivity reaction to tobacco
            53. Genetic influences
            54. Segmental, thrombosing, acute/chronic inflammation
            55. Thrombosis has microabscesses
            56. Granulomatis formation
            57. Tibial/Radial arteries
            58. extending to V/N
            59. Ulcerations of fingers and toes
            60. Mainly males
            61. Wegners Granulotomous
            62. Classic Triad
            63. Acute Necrotizing Granulomas of URT and LRT
            64. Focal necrotizing or granulomatous vasculitis
            65. Mainly in lungs
            66. Focal or Necrotizing Renal Disease
            67. Crescentic Glomerulitis
            68. Limited Wegners Granulotomous
            69. No renal involvement but other two classic symptoms
            70. Characteristics
            71. M > F around 40
            72. Persistent pneumonitis
            73. Bilateral nodular and cavitar infiltrates
            74. Chronic sinusitis
            75. Mucosal ulcerations of nasalpharynx
            76. Untreated- Death 1yr
            77. All vessels
            78. Kawasaki Syndrome/Mucocutaneous Lymph Node Syndrome
            79. Characteristics
            80. Often affecting coronary arteries
            81. Children
            82. Japanese epidemic
            83. Autoantibodies against endothelium and SMC
            84. Treat with IVIG
            85. Oversaturate neutrophil Fc receptor
            86. Increase AB clearance
            87. Aneuryms, MI, and thrombosis in children
            88. Severe segmental transmural necrotizing destruction
            89. Causes
            90. Immunological
            91. Type III
            92. Hep B induced
            93. Drug induced
            94. SLE/Rheumatoid arthritis
            95. Type II
            96. Goodpasture syndrome
            97. ANCA
            98. c-ANCA
            99. p-ANCA
            100. Microcropic Polyangiitis
            101. Necrotizing vasculitis
            102. PAN, but involves small vessels
            103. Hematuria
            104. Hemoptysis
            105. No Temporal Variability in lesions
            106. Churg-Strauss
            107. Esonophil mediated
            108. Type IV
            109. Graft rejection
            110. Direct infection
            111. Rickettsia
            112. Unknown
      4. Neoplasms