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Pathology > 5 Cardiac part 4 > Flashcards

5 Cardiac part 4 Flashcards

1
Q

Etiology of pericarditis

A 
Viral, bacterial, fungal 
Secondary to autoimmune (rheumatic fever) 
Systemic or contiguous inflammatory processes
CT disease (RA)
Neoplasm
Uremia
MI, cardiac surg
Some drugs
Radiation therapy to chest
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2
Q

Pericarditis pathogenisis

A

Inflammation of pericardium causes increased cap perm and exudate formation which is fibrin rich and scar tissue/adhesion results
Increase friction and restriction to cardiac filling

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3
Q

Pericarditis pain presentation

A

Sharp chest pain over precordial with radiation to back neck abdo or side
Exacerbated by breathing coughing swallowing positional changes, tripod helps

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4
Q

Pericarditis presentation aside from pain

A 
Auscultated friction rub
Fever, chills, sweating (if caused by infection)
Ankle/feet/leg swelling
Anxiety
Dry cough
Fatigue
Orthopnea
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5
Q

Amount of fluid needed for deficits from pericardial effusion

A

200mL

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6
Q

Causes of pericardial effusion

A 
Infection/inflammation
Neoplasm
Cardiac surgery/MI
Trauma
Dissected AA
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7
Q

Patho of pericardial effusion

A

Decrease SV and CO as RV then LV effected and reduced diastolic filling from pressure backing up system (JVD)

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8
Q

Clinical manifestations of pericardial effusion

A

JVD, decreased CO decreased SBP, narrow PP, muffled heart sounds and eventually decreased in end organ perfusion
Pulsus pardoxus
(decreased thoracic pressure during insp plus increased pressure on LV)

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9
Q

ECG changes pericardial effusion

A

Global, decreased QRS voltage

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10
Q

Constrictive pericarditis

A

Signifiant amounts of scar tissue in pericardial cavity, contraction of scar tissue causes overall impairment of diastolic filling results in systemic edema (especially ascites and JVD)

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11
Q

Which disease causes Rheumatic fever

A

Group A streptococcal throat infection (3% with strep develop RF)

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12
Q

Rheumatic Fever

A

Diffuse inflammatory disease caused by delayed immune response to pharyngeal infection

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13
Q

Rheumatic fever presentation

A 
Fever and inflammation in
Joints
Skin
CNS
Heart
Can be acute, recurrent, or chronic and if untreated scarring and deformity of tissues
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14
Q

Pathogenesis theory of RF

A

GAS contains M protein (antigen) which either are similar to heart/skin/CNS/joints tissue or the M proteins are seeded onto those surfaces by GAS

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15
Q

Aschoff bodies

A

Characteristic of RF.

Localized areas of tissue necrosis surrounded by immune cells

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16
Q

Clinical presentation of RHD

A 
A recent hx (takes 2-3 weeks) of strept with S&S of polyarthritis (migratory inflammation of large joints)
Carditis
Subq nodules
Erythema marginatum
Sydenham Chorea
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17
Q

Subcutaneous nodules

A

From RF. Painless, freely moveable nodules on muscle of wrist, elbow, ankle, knee

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18
Q

Erythema marginatum

A

Splotchy rash on trunk or inner aspects of thigh or arm (never on face)
Early on with RF and usually with subq nodules

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19
Q

Sydenham Chorea

A

Usually in girls
Rarely after 20 y.o
Usually self limiting but can recur CNS events
Starts with irritability, crying, dropping things then spontaneous rapid purposeless jerking movements and facial grimaces

20
Q

Jones 5 major criteria of RF

A 
Polyarthritis
Carditis
Erythema Marginatum
Chorea
Sub q nodules
(Last two start later)
21
Q

Carditis from RHD can involve which layers of the heart

A

Pancarditis - all three

22
Q

Endocarditis effects of RHD

A

Swelling of valve leaflets, vegetation deposited on valve tissue/chordae tendinae

23
Q

Vegetation of RHD and valvular outcomes

A

Vegetation (excresecences) are sterile wart like small clumps of platelets/fibrin
Scarring/shortening of structures with loss of elasticity.
More often L side
Can cause cardiomegaly and CHF if untreated

24
Q

Myocarditis from RHD

A 
Aschoff bodies (bits of lymphocytes/macrophages around zone of fibroid necrosis)
Rarely cause contraction dysfunction but will cause dysrhythmia and conduction defects
25
Q

Pericarditis from RHD

A

Only in severe cases

26
Q

Definition of infection endocarditis

A 
Direct infection of inner surface of heart due to colonization of microbial agents
Staphylococci
Streptococci
Enterococci
Causing vegetation
27
Q

Causes of infectious endocarditis

A 
Bacteremia
Mitral valve prolapse
Congenital Defects
Prosthetic valves
Pacemaker
Internal defibs
Immunodeficiency
Neoplasms
IV drug use
28
Q

Endocarditis not from RHD

A

Vegetation NOT sterile
Greater number of vegetations than RHD
Risk of thrombi forming from vegetations

29
Q

Clinical manifestations from endocarditis

A 
Valve defects/decreased CO
Systemic infection signs (fever, malaise, fatigue, positive blood values)
S/S related to release of systemic emoblic
Petechiae
Dark red lines under nail beds
Chest/abdo pain
SOB/Cough
Arthralgia, blindness, paralysis
30
Q

Definition of cardiomyopathies

A

Group of diseases causes mechanical or electrical cardiac defects either primary or secondary in nature

31
Q

Genetic primary cardiomyopathies

A

Hypertrophic cardiomyopathy
Arrhythemogenic RV cardiomyopathy
LV noncompaction
Ion channelopathies

32
Q

Hypertrophic cardiomyopathy

A

Common cause of sudden cardiac arrest in young athletes
Decreased diastolic filling and SV due to LVH, IV septum enlargement and decreased LV chamber size
AMI, HF, A-fib, stroke

33
Q

Arrhythmogenic RV cardiomyopathy

A

Loss of myocytes in RV, replaced by fibrous or fatty tissue

Leads to R failure and formation of R-sided re-entrant circuit causing V-tach

34
Q

LV noncopaction

A

Congenital condition with no “trabecular compaction” of myocardium during embryonic development leading to spongy and ineffective tissue

35
Q

Primary mixed cardiomyopathies are

A

Dilated cardiomyopathy

Primary restrictive cardiomyopathy

36
Q

Dilated cardiomyopathy

A

Genetically linked or caused by ETOH (long term)

enlarged and atrophied cardiac cells, most frequently manifests as HF

37
Q

Primary restrictive cardiomyopathy

A

Genetic, or linked to fibrosis from radiation therapy

Diastolic filling reduced due to excessive rigidity and thickness of ventricular atrial walls

38
Q

Acquired cardiomyopathy

A

Myocarditis usually from viral infetion

39
Q

Secondary cardiomyopathies

A 
Drug use
The BEETIES
Muscular dystrophy
Autoimmune
Cancer treatments
40
Q

Mitral valve stenosis

A

Most common cause is RF but it can be congenital
Decreased ventricular filling
Leads to diastolic murmur, decreased CO, pulmonary congestion, R HF, A-fib, emboli

41
Q

Mitral valve regurg

A

Most common cause is RF
Can also be rupture of chordae, pap muscle dyfunction, valve perforation, LV dilation.
Leads to systolic murmur, and manifestations to MVS but more pronounced

42
Q

Mitral valve prolapse

A

Complete reversal of valve into L atrium from genes or CT disorder
Degen in leaflets causes them to be large and floppy, similar symptoms to mitral regurg

43
Q

Aortic stenosis

A

Increases resistance to ejection of blood from congenital defects or calcification (common cause is bicuspid aortic valve))
leads to systolic murmur, LVH, decreased CO and increased MVO2

44
Q

Aortic valve regurg

A

Incomplete aortic closure during diastole causing increased LV stroke volume
From RF, congenital, aortic dissection, htn, trauma
Leads to diastolic murmur, voluve overload, CO decrease and pulmonary backup
Catechol response worsens regurg

45
Q

RHD valves

A

Rigidity and thickening of valves from RF causes issues with both opening and closing

46
Q

Cardiac tamponade

A 
From penetrating injury, filling of pericardial sac with blood which compressed ventricles decreasing filling and CO
Becks triad:
Hypotension
Distended neck veins
Muffled heart soounds
(pulsus paradoxus)
47
Q

Cardiac contusion

A

Blunt injury to anterior chest via sternum, presents same as MI
Valve rupture
Pericardial tamponade
Cardiac rupture

Pathology (24 decks)

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