Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CPR Week 3 > 3.3.2. Cardiac Pathology Part 2: Valvular, Endocarditis, Cardiomyopathy and Tumors > Flashcards

3.3.2. Cardiac Pathology Part 2: Valvular, Endocarditis, Cardiomyopathy and Tumors Flashcards

1
Q

What is acute rheumatic fever? What causes it?

A

Systemic complication of pharyngitis due to group A Beta Hemolytic streptococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When does Rheumatic fever usually hit? Who does it target?

A

Children 2-3 weeks after strep throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What biological process is at work causing rheumatic fever?

A

Molecular mimicry.

Bacterial M protein resembles human tissues, so when you launch an attack to the bacterial m proteins, you start attacking yourself as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

To Diagnose Rheumatic Fever you use ____ ____.

A

Jones Criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe Jones Criteria

A
  1. Evidence of prior group A Beta Hemolytic strep infection (ASO or anti DNase B Titer, both markers for this)
  2. Minor Criteria (fever, elevated ESR)
  3. Major Criteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the major Jones Criteria?

A

Joint problems (migratory polyarthritis to large joints)

O is shaped like a heart…heart issues

Nodules in the skin (subcutaneous)

Erythema Marginatum - Annulus rash that appears redder at the margins

S Corea - Involuntary movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Key major problem with Jones Criteria

A

The heart issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is pancarditis?

A

Key heart issue with Rheumatic fever that involves inflammation of all three heart layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the endocarditis portion of the pancarditis we see in Rheumatic Fever

A

We get vegetation in the enflamed endocardium that look like little nodules at the mitral valve. Aortic valve may or may not be affected as well, Mitral always.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can the endocarditis cause in the heart?

A

Due to affecting the mitral valve it can call mitral valve regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do we see in the myocardium during pancarditis?

A

Aschoff bodies - granulomatous structures consisting of fibrinoid change, lymphocytic infiltration, occasional plasma cells, and characteristically abnormal macrophages surrounding necrotic centres.

Some of these macrophages may fuse to form multinucleated giant cells.

Others may become Anitschkow cells or “caterpillar cells”, so named because of the wavy appearing nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common cause of death in rheumatic fever?

A

The myocarditis part. So if you see Aschoff and Anitschow, be worried.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What issues do we see with the pericarditis portion of the pancarditis in Rheumatic Fever?

A

Friction rub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Discuss the timeline of Rheumatic fever a bit

A

Acute phase resolves but can progress to chronic disease.

Repeat exposure to group A Beta hemolytic streptococci results in relapse.

Can lead to rheumatic valvular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rheumatic valvular disease

A

Valve scarring that results from a bunch of acute attacksfrom Rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Result of rheumatic valvular disease

A

Stenosis, almost always of mitral valve. Due to thickening of the chordae tendinae and cusps

When involving the aortic valve, leads to fusion of commissures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complication of Rheumatic valvular disease

A

endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is aortic stenosis? Size change?

A

Narrowing of the aortic valve orifice

Becomes less than 1cm squared from 3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What usually causes aortic stenosis?

A

Fibrosis and calcification from wear and tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When does aortic stenosis present? What further complicates it?

A

Late adulthood, older than 60

Bicuspid Aortic valve increases risks and hastens disease onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can we distinguish whether the stenosis in the aorta is from wear and tear or rheumatic valvular disease?

A
  1. With RVD, the mitral stenosis must be present always

2. Aortic valve will have fused commisures, not seen in wear and tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Compensation by the LV in aortic stenosis leads to a ____ ____ stage.

A

Prolonged asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Auditory sounds with an aortic stenosis and why?

A

Systolic ejection click due to the blood breaking through the stenosis followed by a crescendo-decrescendo murmur caused by the blood rushing out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Complications of aortic stenosis

A
  1. Concentric Left ventricular hypertrophy
  2. Angina and Syncope with exercise
  3. Microangiopathic hemolytic anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Microangiopathic hemolytic anemia?

A

When blood rushes past a calcified stenosis, you can cut the RBCs up, causing cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for aortic stenosis

A

Valve replace but only after symptoms begin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is aortic regurgitation? What causes it?

A

Backflow of blood from the aorta into the LV during diastole

Arises due to aortic root dilation, like with a syphilitc aneurysm or valve damage like in infectious endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Clinical findings for aortic regurgitation

A
  1. Early blowing diastolic murmur caused by blood going backwards
  2. Bounding pulses, pulsating nail bed and head bobbing (hyperdynamic circulation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Discuss the pressure changes involved with aortic regurgitation

A

Systolic pressure goes up and diastolic falls casuing a widening (increase) in your pulse pressure which gives you the bounding pulses/hyperdynamic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Clinical features of aortic regurgitation

A

LV dilation and eccentric hypertrophy (one aspect of the ventricle, not the whole thing. We see this with volume issues in the ventricle)

31
Q

Treatment of aortic regurgitation

A

Valve replacement when LV dysfunction develops

32
Q

What is mitral valve prolapse?

A

Myxoid degeneration of the valve to cause the valve to become weaker/floppy.

LV pushes back towards the valve and balloons it back during systole (causes a click)

33
Q

Clinical findings for mitral valve prolapse

A

Mid Systolic click followed by regurgitation murmur

34
Q

Treatment for mitral valve prolapse

A

Valve replacement

35
Q

Complications of mitral valve prolapse

A

Infectious Endocarditis
Arrhythmia
Severe mitral regurgitation

But these are all rare

36
Q

What is mitral regurgitation?

A

Reflux of blood from LV to LA during systole. Many causes.

37
Q

Clinical findings for mitral regurgitation

A

Holosystolic “blowing” murmur
Louder with squatting and expiration
Results in volume overload and left sided heart failure

38
Q

Clinical features of mitral stenosis?

A

Opening snap followed by a diastolic murmur

39
Q

Bad results due to mitral stenois

A 
Volume overload leading to dilation of the LA
Causes:
 - Pulmonary congestion
 - Pulmonary HTN
 - Atrial fibrillation
40
Q

What is endocarditis

A

Inflammation of the endocardium, in particular the surface of valves

41
Q

Usual cause of endocarditis?

A

Bacterial infection

42
Q

Most common bacteria in endocarditis? What does it target and present as?

A

S viridans

Targets previously damaged valves (low virulence organism)

Results in small vegetations that do not destroy the valve

43
Q

How does bacteria get caught in the valve?

A

Previously damaged valve leads to thrombosis for healing, which traps the bacteria i nthe thrombotic vegetations

44
Q

Describe the high virulence bacteria associated with endocarditis

A

S Aureus

Most common cause in IV drug abuse

Affects normal valves, particularly the tricuspid

Results in large vegetations that destroy the valve ( = acute endocarditis)

45
Q

When do we see S epidermidis?

A

Affects patients with prosthetic valves

46
Q

When do we see S Bovis?

A

Endocarditis in patients with underlying colorectal carcinoma

47
Q

What are HACEK organisms and why do we care about them? List them out.

A

Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Negative blood cultures

48
Q

Clinical featurs of endocarditis

A 
Fever
Murmur
Janeway lesions
Olser Nodes
Anemia of Chronic Disease
49
Q

What are Janeway lesions? Osler nodes? What causes them?

A

Vegetations on the valves can be shot off into circulation, leading to septic emboli of these bacterial clumps.

Patients will present with red lesions on the palms and soles (Janeway Lesions) or painful lesions on fingers and toes (Osler nodes)

50
Q

Lab findings for endocarditis

A
  • Typically positive blood cultures
  • Anemia of chronic disease
  • Trans Esophageal Echo (TEE) can be used to see
51
Q

What is nonbacterial thrombotic endocarditis

A

Sterile vegetations that arise with hypercoagulable state or underlying adenocarcinoma

52
Q

What is Libman Sacks Endocarditis? What does it lead to?

A

Sterile vegetations associated with SLE

Presents on both surfaces of the mitral valve

Results in mitral regurg

53
Q

What is dilated cardiomyopathy? Result?

A

Dilation of all chambers in the heart

Causes systolic dysfunction due to incredible stretching

54
Q

Complications of dilated cardiomyopathy

A

Causes biventricuar CHF with mitral and tricuspid valve regurgitation and arrhythmia

55
Q

Most common causes of dilated cardiomyopathy?

A
  1. Genetic mutations
  2. Myocarditis
  3. Alcohol abuse
  4. Drugs
  5. pregnancy

General idiopathic, i.e., we don’t know

56
Q

Most common cause of myocarditis

A

coxsakie virus

57
Q

Treatment for dilated cardiomyopathy?

A

Heart replacement

58
Q

What is hyertrophic cardiomyopathy? Cause?

A

Massive hypertrophy of the left ventricle due to genetic mutations in sarcomere protins in an Autosomal Dominant condition

59
Q

Clinical findings of Hypertrophic ardiomyopathy

A
  1. Decreased CO
  2. Sudden death due to Ventricular arrhythmia
  3. Syncope with exercise
60
Q

Biopsy of hypertrophic cardiomyopathy?

A

Myofiber hypertrophy with disarray - cells going in all directions, not together in the same direction like usual

61
Q

Explain restrictive cardiomyopathy

A

Decreased compliance of ventricular endomyocardium that restricts filling during diastole

62
Q

Causes of restrictive cardiomyopathy

A
  1. myloidosis
  2. Sarcoidosis - granulomas get in there
  3. hematochromatosis - iron deposition
  4. Endocardial fibroelastosis in kids - Dense layer of fibrous tissue in the endocardium, so you can’t stretch the ventricle during filling
  5. Loeffler syndrome - eosinophilic infiltrate in the heart leading to fibrosis of the endocardium AND myocardium
63
Q

Presentation of restrictive cardiomyopathy.

A

Presents as CHF

Low voltage EKG with diminished QRS amplitudes

64
Q

Myxoma tumor?

A

Benign mesenchymal proliferation with a gelatinous appearence

65
Q

Histology of a myxoma?

A

Abundant ground substance on histology

66
Q

The most primary cardiac tumor in adults

A

Myxoma

67
Q

Why is the myxoma of the mesenchyme and not the myocyte?

A

Myocytes are permanent and established in adults so theres no real chance for cells to proliferate to make a tumor

68
Q

Effects and location of myxoma

A

Usually a pedunculated mass in the left atrium that can cause syncope due to obstruction of the mitral valve

69
Q

Rhabdomyoma

A

Benign hemartoma in cardiac muscle

70
Q

Most common primary cardiac tumor in children?

A

Rhabdomyoma

71
Q

Rhabdomyoma is associated with what?

A

Tuberous sclerosis

72
Q

Where do rhabdomyomas usually arise?

A

Venticle

73
Q

Common metastases of the heart include what? Where do they go specifically?

A

Lung cancer
Breast cancer
Melanoma
Lymphoma

Usually go to the pericardium resulting in pericardial effusion,

CPR Week 3 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions