(5) HTN, Cardiac valve disease, Cardiomyopathy, Tumors, Transplantation Flashcards
What is the most common cause of arrhythmias?
Ischemic injury
What is sick sinus syndrome?
SA node damaged which leads to bradycardia
What is atrial fibrillation?
Myocytes depolarize independently and sporadically with variable transmission thru AV node –> irregular heart rate = atrial fibrillation
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
What is the most common inherited arrhythmogenic disease?
Long QT syndrome
What is sudden cardiac death?
Unexpected death from cardiac cause
Either: without symptoms or within 1-24 hrs of symptom onset
What is hypertensive heart disease?
Left-sided systemic hypertensive disease occurs when pressure overload results in left ventricular hypertrophy
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
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
What is valvular stenosis?
Valve doesn’t open completely, occurs chronically
This impedes forward flow
Chronic stenosis may cause pressure overload hypertrophy –> CHF
What is valvular insufficiency?
Valve doesn’t close completely
Allows reversed flow
Chronic insufficiency may cause volume overload hypertrophy –> CHF
What is (pretty much) the ONLY cause of mitral stenosis?
Postinflammatory scarring (rheumatic heart disease)
What are causes of aortic stenosis?
Postinflammatory scarring (rheumatic heart disease)
Calcification of congenitally deformed valve
What causes mitral regurgitation?
Abnormalities of leaflets and commissures
Mitral valve prolapse
What causes aortic regurgitation?
Postinflammatory scarring (rheumatic heart disease)
Aortic insufficiency
Syphilitic aortitis
Marfan syndrome
What is the most common valve abnormality?
Calcific aortic stenosis
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
What are the symptoms of calcific aortic stenosis?
Angina
CHF
Syncope
Identify
A:
B:
C:
D:
A: Calcific aortic stenosis
B: Bicuspid aortic valve
C: Mitral annular calcification
D: Mitral annular calcification
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”
Describe mitral annular calcification
Calcific deposits occur in the fibrous annulus
Normally does not affect valve function
Typically mitral annular calcification causes –> ARRHYTHMIAS
What are doctors referring to when they say, “floppy valve”?
Mitral valve prolapse
What is a characteristic anatomic change in MVP?
Interchordal ballooning (hooding)
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
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 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 stain is typically used for amyloid?
Congo red stain
*Apple green birefringence is the key reaction you’ll see with (+) amyloid
What is this?
Amastigotes from chagas dz
Amastigotes form INSIDE THE MYOCARDIUM
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”
