ALL THINGS CARDIO- FINAL Flashcards
What’s the first sign of atherosclerosis that’s visible without magnification?
fatty streaks
A fatty streak consists of lipid-containing foam cells in the arterial wall just beneath the endothelium
what develops on the second third or fourth day following a transmural myocardial infarction?
A fibrinous or fibrino-hemorrhagic pericarditis
Pericarditis following myocardial infarction usually resolves over time with no serious consequence or sequelae
what is the form of pericarditis that occurs weeks to months after injury to the heart or the pericardium?
Dressler’s syndrome
what is the predominant cause of renal artery stenosis, usu in those with acute onset of hypertension 50 years or older?
Atherosclerosis
what is the predominant cause of renal artery stenosis, usu in those with acute onset of hypertension 40 years old and female?
Fibromuscular dysplasia
__________ and ________are vessels in which aneurysm development has the greatest potential for increased morbidity and mortality
aorta
the circle of Willis
someone with a Berry Aneurysm might say?
“this is the worse h/a ever”
dissection usually occurs through which layers?
medial tissue layer of the aorta
blood penetrates the intima and enters the media
aneurysm usually refers to?
the “ballooning out” of a vessel wall due to underlying weakness of the wall and/ or the force of increased blood pressure.
Marfan’s syndrome is a genetic connective tissue disorder that results from abnormal production of what?
fibrillin-1 protein
histologically, Marfan’s syndrome demonstrates_________
cystic medial necrosis, where pink elastic fibers, instead of running in parallel arrays, are disrupted by pools of blue mucinous ground substance.
Another cause of cystic medial necrosis (besides Marfan’s syndrome) is_________
copper deficiency
what is the name of the pathology that originates in the lungs and leads to CHF?
cor pulmonale
3 major categories of cardiomyopathy are?
dilated (most common)
hypertrophic
restrictive
dilated cardiomyopathy is characterized by
enlargement and dilatation of all four chambers of the heart
most common non-ischemic cause is alcoholism
Histology of dilated cardiomyopathy reveals
nonspecific abnormalities, including variations in myocyte size, myocyte vacuolation, loss of myofibrillar material, and fibrosis
hypertrophic cardiomyopathy (HCM) is characterized by
myocardial hypertrophy, abnormal diastolic filling (due to reduce chamber size) and in about one third of cases, intermittent ventricular outflow obstruction (due to bulging septum)
its genetic
Histology of hypertrophic cardiomyopathy reveals
hypertrophy of myocardial fibers (which also have prominent dark nuclei) along with interstitial
fibrosis.
restrictive cardiomyopathy is characterized by
cardiomyopathy infiltrated by abnormal tissue that results in impaired contractility
The most common causes of restrictive cardiomyopathy are
amyloidosis and hemochromatosis
histology of restrictive cardiomyopathy demonstrates
amorphous deposits of pale pink material between myocardial fibers. This is characteristic for amyloid.
Endocarditis generally refers to inflammation on the
valves
The vegetations of infectious endocarditis are
collections of infected thrombotic debris deposited on and around the affected valve
Microscopic view of valve in patient with infectious
endocarditis demonstrates
friable vegetations of fibrin and platelets mixed with inflammatory cells and bacterial colonies
Organisms commonly associated with community-acquired endocarditis include
Staphylococcus aureus (30-50%, minority MRSA)
Alpha-hemolytic Strep (S. viridans) (10-35%)
Enterococci (5-10%)
Culture negative (5-30%)
Staphylococcus epidermidis
Misc. organisms including Escherichia coli, Klebsiella sp., Corynebacterium (<5%)
Organisms commonly associated with nosocomial endocarditis include
Staph. aureus (60-80%; majority MRSA)
Alpha hemolytic streptococci (<5%)
Misc. others including: E coli, Klebsiella, Corynebacterium; 5-10%)
Portals of entry for organisms that may cause endocarditis include but are not limited to:
Poor dental health, dental procedures or pharyngeal infection
Genitourinary infections and instrumentation of the GU tract
Skin infections such as impetigo
Pulmonary infections
IV drug use
acute endocarditis vs subacute endocartiditis
acute - virulent bug
subacute- not that virulent, already damaged valve
subacute endocarditis has systemic sx such as
petechiae in such areas as the mouth or under the tongue, the finger nail beds (called splinter hemorrhages) or Microemboli in to the retina (known as Roth’s spots)
risk factors for endocarditis are
RF - used to be leading cause Patients with artificial valves Immunocompromised patients IV drug abusers Alcoholics Patients with indwelling catheters Patients with vascular grafts
Risk factors and associated endocarditis organisms
Prosthetic valves - Staph epidermitis
IV drug abusers – Staph aureus
Alcoholics – anaerobes and oral cavity bugs
After procedures such as cystoscopy or prostatectomy or with indwelling catheters with Gram negative organisms such as E. coli are more common.
The gram negative organism, ___________, is more commonly seen in patients with carcinoma of the colon
Strep bovis
The endocarditis of S.L.E. is sometimes referred to as_________
(it’s a non-infectious inflammatory endocarditis)
Libman-Sacks endocarditis
endocarditis when the vegetations are due to a hypercoagulable state is called __________________
Marantic endocarditis
The small pink vegetation on the rightmost cusp
margin represents the typical finding with non-bacterial endocarditis in a patient with__________
Marantic endocarditis
infective endocarditis can lead to serious damage of the valves that looks like___________
Irregular reddish tan vegetations overlie valve cusps that are being destroyed
virus associated with myocarditis is
Coxsackie virus
histologic characteristic appearance in viral myocarditis
interstitial lymphocytic infiltrates
What is a possible sequelae to group A Streptococcal pharyngitis (strep throat)?
Rheumatic fever, can progress to rheumatic heart disease
Rheumatic fever develops following pharyngitis with
group A beta-hemolytic Streptococcus
Strep throat is usu diagnosed by
antistrepotolysin O or ASO titer
post-streptococcal acute rheumatic fever is likely due to an autoimmune response caused by
anti-streptococcal M protein antibodies which cross-react with cardiac myosin
________ nodules are found in the hearts of individuals with RF
Aschoff bodies (granulomatous structures) pathognomonic for RF
the most important cardiac related consequence of rheumatic heart disease is
mitral stenosis (“fish mouth”)
common systemic consequences of rheumatic heart disease are
polyarthritis (the most common sign and symptom), chorea, erythema marginatum, and subcutaneous nodules
pericarditis is characterized as being
Serous Fibrinous- Post-MI or Dressler’s syndrome Hemorrhagic Purulent Caseous - TB
the most common tumor of the heart is______
atrial myxoma (a benign tumor) occur within the chambers of the heart, usually the left atrium
histologic findings of atrial myxoma
cells that are polygonal or have an elongated cell shape. These cells may be mononuclear or multinucleated and usually have finely vacuolated eosinophilic cytoplasms.
whats the most common pediatric tumor the heart?
Cardiac rhabdomyoma (benign tumor)
histologic findings of cardiac rhabdomyoma
Cells are clear, compared with normal myocardium. The cells are round or polygonal in shape and are enlarged, with clear cytoplasm
the neoplasm with the greatest propensity to METS to the heart is
melanoma
