Cardiac Flashcards
Lipid changes inc risk atherosclerosis
increased LDL levels,
increased levels of lipoprotein-a
decreased HDL levels.
Most common cause rv failure
Lv failure, mitral stenosis specifically
Heart changes aging
inc LA size, dec LV size
calcific deposits
brown atrophy and amyloid deposition myocardium
aorta tortuous
diastolic failure
heart failure with preserved EF and normal valves
LVH, amyloid, myocardial fibrosis, constrictive pericarditis
>65 female HTN, risk flash pulm oedema
hypertrophic myocytes
enlarged nuclei
Pulmonary changes LHF
- perivasc and interstitial oedema
- oedematous widening alveolar septa
- oedema in alveolar spaces
hemosiderin laden macrophages (heart failure cells)
Cyanotic congenital heart disease
R->L shunts: TOF, TGA, eisenmenger
cyanotic
pulmonary stenosis
tricuspid atresia
anomalous pulmonary venous return
Coarctation
pre ductal infantile, assoc PDA (asymptomatic if no PDA) hypoplastic aortic arch
adult post ductal
50% + bicuspid aortic valve
male > female, turners
TOF
pulmonary stenosis
RVH
VSD
Overriding aorta
VSD
most common defect
20-30% isolated
thrill on examination
PFO
80% closed by 2y
loud S1 with fixed splitting S2
PDA examination
machinery murmur
Aortic stenosis and atresia
isolated in 80%
Typical LCA and RCA lesions
LCA - proximal and isolated
RCA diffuse
patterns cardiac infarction
transmural - stemi, plaque
subendocardial - inner 1/3 wall, hypotension, plaque
multi focal microinfarction - smaller intramural vessels, micro embolism, takutsubo
reversible damage MI
30m
<4h post MI
tissue looks normal, sarcolemma disruption
4-12h post MI
tissue dark mottling, coagulative necrosis
12-24h post MI
tissue dark mottling, pyknosis nuclei, neutrophil infiltration, oedema, haemorrhage
1-3d post MI
tissue yellow with mottling, loss of nucelei, neutrohils present, risk fibrinous pericarditis
3-7d post MI
hyperemic tissue with yellow core, disintegration dead myofibres, ding neutrophils, macrophages peripherally (weaken vent wall)
7-10d post MI
yellow/ tan soft tissue, phagocytes with granulation tissue at margins
10-14d post MI
red grey borders tissue, granulation tissue with new blood vessels, collagen deposition,
2-8w post MI
grey white scar, increased collagen and celularity, 2m scarring complete
Coagulative necrosis post MI
4-12h
Neutrophil infiltration post MI
12-24h
Macrophage infiltration post MI
3-7d
Collagen deposition post MI
10-14d
Dark mottling of heart post MI
4-24h
Mortality from MI
30% in first year
50% of deaths in <1h due to arrhythmia
Myocardial rupture
2-4d post MI
wall weakned by macrophages
Assoc transmural
vent free wall rupture most common
vent septa rupture
papillary muscle rupture (least common)
dressler syndrome
2-3d post, fibrinous/ fibrinohaemorrhagic pericarditis
Most common valve diseases in order
Aortic stenosis
Aortic insufficiency (dilated ascending aorta)
mitral stenosis
mitral insufficiency (prolapse)
Calcific AS
age 70+ younger if bicuspid
calcified masses in cusps, free edges not involved
50% due to bicuspid valve
Myxomatous degeneration mitral valve
assoc marfans
thinning fibrosa layer with expansion spongiosa layer
Rheumatic heart disease lesions
Mitral stenosis
Askoff bodies (t lymph)
Anishkow cells - activated macrophages
stretoplysin O, DNAase
Jones criteria rheumatic heart disease
major: migratory polyarthritis large joints, pancarditis, subcutaneous nodules, erythema marginatum, sydenham correa
minor: fever, arthralgia, acute phase proteins
2 major/ 1 major 2 minor
Normal valve endocarditis organisms
staph aureus, enterococci, HACEK, oral cavity commensals
Damaged valve endocarditis organism
strep viridans 60%
Prosthetic valve endocarditis organism
staph epidermidis
Fungal endocarditis organism
candida
Duke criteria
endocarditis
2 maj, 1 maj 3 min, 5 min
maj (BE): Blood culture >2, Echo/ new valve regurge
Min (timer): Temp, Immunological phenomena, 1x Micro, , Embolic lesions, Echo consistent but not diagnostic, Risk factors - predisposing lesion/ IVDU
Liebmann sachs
mitral and tricuspid endocarditis, sterile vegetations, assoc SLE
Dilated cardiomyopathy
,pst common (90%), reduced EF systolic dysfunction
genetic AD, viral, alcoholic, doxyrubicin cobalt, takutsubo
2y survival 50%
mitral regurge
Hypertrophic cardiomyopathy
preserved EF, diastolic
genetic, friedrich ataxia, maternal DM,
2 yr mort 50% , 5y 75%
Restrictive cardiomyopathy
rare, diastolic, preserved EF
amyloid, radiation, idiopathic
Myocarditis
viral - coxsacki + enteroviruses, HIV, flu, CMV
chagas (protozoan)
Lyme
drug, SLE, can become dilated cardiomyopathy
Pericardial effusion
normal 30-50ml
300 can cause rupture
can accomodate p to 500
Pressure vs volume overload effect on heart
pressure - hypertrophy
volume - dilation
Contractile bands evidence of
recent reperfusion injury
genetic risk factor atherosclerosis
apolipoprotein beta gene mutation
age changes of heart
bigger LA, smaller LV, sigmoid shaped septum
uraemic pericarditis type
serous
Bicuspid aortic valve associations
Early calcification and symptomatic stenosis by 50y
50% of AS due to bicuspid valve
Location of valve calcification rheumatic / not
Within cusps normal
Rheumatic free edges
Mitral annular at annulus
