(5) HTN, Cardiac valve disease, Cardiomyopathy, Tumors, Transplantation Flashcards by Jaime Weber

What is the most common cause of arrhythmias?

Ischemic injury

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What is sick sinus syndrome?

SA node damaged which leads to bradycardia

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What is atrial fibrillation?

Myocytes depolarize independently and sporadically with variable transmission thru AV node –> irregular heart rate = atrial fibrillation

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What is a heart block?

Describe the three types

Dysfunctional AV node

1st degree = prolonged PR interval

2nd degree = intermittent transmission

3rd degree = complete failure

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What is the most common inherited arrhythmogenic disease?

Long QT syndrome

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What is sudden cardiac death?

Unexpected death from cardiac cause

Either: without symptoms or within 1-24 hrs of symptom onset

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What is hypertensive heart disease?

Left-sided systemic hypertensive disease occurs when pressure overload results in left ventricular hypertrophy

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What typically occurs with right-sided hypertensive disease?

Isolated right-sided hypertensive heart disease arises in the setting of pulmonary hypertension

*remember: most common cause of pulmonary hypertension is left-sided heart disease

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What are the 3 main types of pathologic change seen in cardiac valves?

Damage to collagen that weakens the leaflets –> mitral valve prolapse
Nodular calcification beginning in interstitial cells –> calcific aortic stenosis
Fibrotic thickening –> rheumatic heart disease

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What is valvular stenosis?

Valve doesn’t open completely, occurs chronically

This impedes forward flow

Chronic stenosis may cause pressure overload hypertrophy –> CHF

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What is valvular insufficiency?

Valve doesn’t close completely

Allows reversed flow

Chronic insufficiency may cause volume overload hypertrophy –> CHF

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What is (pretty much) the ONLY cause of mitral stenosis?

Postinflammatory scarring (rheumatic heart disease)

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What are causes of aortic stenosis?

Postinflammatory scarring (rheumatic heart disease)

Calcification of congenitally deformed valve

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What causes mitral regurgitation?

Abnormalities of leaflets and commissures

Mitral valve prolapse

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What causes aortic regurgitation?

Postinflammatory scarring (rheumatic heart disease)

Aortic insufficiency

Syphilitic aortitis

Marfan syndrome

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What is the most common valve abnormality?

Calcific aortic stenosis

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What is commonly seen with calcific aortic stenosis?

Increased prevalence with increased age (60-80years)

Bicuspid valves show an accelerated course due to increased mechanical stress

Mounded calcifications in cusps prevent complete opening of the valve

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What are the symptoms of calcific aortic stenosis?

Angina

CHF

Syncope

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Identify

A: Calcific aortic stenosis

B: Bicuspid aortic valve

C: Mitral annular calcification

D: Mitral annular calcification

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What is this an example of?

Aortic stenosis

*Remember: an aortic valve doesn’t NEED to be bicuspid to calcify. Sometimes in older adults, a normal aortic valve (three cusps) will undergo calcification, a so-called “senile calcific aortic stenosis”

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Describe mitral annular calcification

Calcific deposits occur in the fibrous annulus

Normally does not affect valve function

Typically mitral annular calcification causes –> ARRHYTHMIAS

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What are doctors referring to when they say, “floppy valve”?

Mitral valve prolapse

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What is occuring anatomically with mitral valve prolapse?

Valve leaflets prolapse back into left atrium during systole

How do the leaflets in mitral valve prolapse (MVP) become thickened and rubbery?

Proteoglycan deposits (myxomatous degeneration)

Elastic fiber disruption

What is the heart sound associated with **MVP?**

Mid systolic click

What is a characteristic anatomic change in **MVP?**

Interchordal ballooning (hooding)

What is **rheumatic fever?**

Multisystem inflammatory disorder following **pharyngeal infection** with **_group A streptococcus_**

What is the pathogenesis of **rheumatic fever?**

Immune response to **streptococal M proteins** cross reacts with **cardiac** self-antigens

What are the symptoms of **rheumatic fever?**

Pancarditis Migratory polyarthritis Rash (erythema marginatum) Sydenham chorea (neurolgic disorder with involuntary rapid, purposeless movements)

What is a major hallmark for acute rheumatic fever?

**Aschoff bodies** (Aschoff bodies are T-cells, occ plasma cells and activated macrophages called **Anitschkow cells**)

What is this image showing?

**Aschoff nodules**

What is a cute way to remember histologically what **anitschkow cells** look like?

Anitschkow (**caterpillar**) cells

What is a cute way to remember what mitral **stenosis** looks like?

Stenosis looks like a fishy mouth awwww

What is **infective endocarditis (IE)?**

An infection of valves or endocardium, characterized by **vegetations** consisting of **microbes** and **debris**, associated with underlying _tissue destruction_

What is the difference between a **acute and subacute infective endocarditis?**

Acute = rapidly progressing and destructive infection of a previously normal valve --\> requires SURGERY Subacute = slower progressing infection of a previously deformed valve --\> antibotics are treatment

Identify the associated infection with the vegetative patterns

What are 4 important clinical findings for **infective endocarditis?**

Splinter hemorrhages Janeway lesions Osler nodes Roth spots

What is **nonbacterial thrombotic endocarditis (NBTE)?**

Small, sterile thrombi on cardiac valve leaflets **along the line of closure** Loosely attached, NOT invasive, does NOT illicit an inflammatory reaction May be a source of **emboli** \*\*\*Associated with malignancies, especially _mucinous adenocarcinomas_

What is **carcinoid heart disease?**

A systemic disorder marked by... **flushing, diarrhea, dermatitis** and **bronchoconstriction** ; _Right endocardium and valves degrade_ Bioactive compounds such as **SEROTONIN** are released by carcinoid tumors (this disorder is *paraneoplastic*)

What is the most common functional pattern of **cardiomyopathy?**

Dilated

What is **dilated cardiomyopathy (DCM)?** What is strongly linked to DCM?

Progressive cardiac dilation and sytolic dysfunction, usually with dilated hypertrophy Alcohol, myocarditis, cardiotoxic drugs, **iron overload**

What is the other name for "broken heart syndrome"?

Takotsubo cardiomyopathy (a dilated cardiomyopathy)

What causes **takotsubo cardiomyopathy?** Population affected? Sx? Anatomy?

Excess **catecholamines** following extreme emotional or psychological stress \>90% women, ages 58-75 Similar to acute MI Apical ballooning of the left ventricle

What is **arrhythmogenic right ventricular cardiomyopathy (ARVC)**? When you got this, what happens? What syndrome is associated w/ what symptoms?

Myocardium of the **right ventricular wall** is replaced by **adipose and fibrosis** Ventricular tachycardia/fibrillation --\> SUDDEN DEATH Naxos syndrome (ARVC w/ **hyperkeratosis** of plantar and palmar skin surfaces)

What is **hypertrophic cardiomyopathy?** What is the mutation associated? What is the microscopic hallmark?

A **genetic** disorder leading to myocardial hypertrophy and diastolic dysfunction leading to **decreased stroke volume** and often **ventricular outflow obstruction** Beta-myosin heavy chain MYOCYTE DISARRAY

What is a common population associated with **hypertrophic cardiomyopathy?**

Otherwise unexplained sudden death in young atheletes

What is **restrictive cardiomyopathy?** What primarily causes?

Decreased ventricular compliance (increased stiffness), leading to **diastolic dysfunction** (impaired filling), while systolic function of the LV remains normal AMYLOID

What stain is typically used for amyloid?

Congo red stain \*Apple green birefringence is the key reaction you'll see with (+) amyloid

What is **myocarditis?** What are the most common causes?

Inflammation of the myocardium, most commonly due to a virus in the US Coxsackie A and B viruses

What is this?

Amastigotes from **chagas dz** Amastigotes form INSIDE THE MYOCARDIUM

What is the most striking feature associated with **fibrinous & serofibrinous pericardial disease?**

Loud pericardial friction rub

What is the general anatomical presentation of a heart that experienced **acute suppurative pericarditis?**

Pericardial will not want to come off of the heart Rough, granular "Shaggy"

What is the most common primary cardiac tumor? What is it? What are the symptoms?

**_Myxoma_** Pedunculated usually in region of fossa ovalis. Globular hard mass, mottled with hemorrhage to soft, translucent, papillary or villous with a **gelatinous appearace.** "Ball-valve" obstruction, auscultation = **tumor "plop"**

What is the most important long term limitation of **cardiac transplantation?**

Allograft arteriopathy