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Block 4: Pathophys > Cardiac Disorders: Inflammatory and Valvular > Flashcards

Cardiac Disorders: Inflammatory and Valvular Flashcards

1
Q

Myocarditis is Inflammation of the______.

A

cardiac muscle

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2
Q

Myocarditis has what kind of tissue involvement?

A

Acute or chronic, and focal or diffuse tissue involvement

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3
Q

describe Acute tissue involvement in Myocarditis

A

active inflammation with infiltrating WBC, areas of necrosis, more severe with abrupt presentation

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4
Q

describe chronic tissue involvement in Myocarditis

A

inflammation with WBC but without necrosis, sometimes with fibrosis

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5
Q

inflammation with WBC but without necrosis, sometimes with fibrosis

is what type of tissue involvement in myocarditis?

A

chronic tissue involvement

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6
Q

active inflammation with infiltrating WBC, areas of necrosis, more severe with abrupt presentation

is what type of tissue involvement in myocarditis?

A

Acute tissue involvement

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7
Q

Presentation of myocarditis is frequently similar to other cardiac disorders such as?

A

heart failure, AMI, heart block, tachyarrhythmia

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8
Q

some caused of Myocarditis (4)

A
  1. infectious (adeno- and enterovirus infection most common, also bacterial, fungal, protozoal, rickettsial, spirochete)
  2. Toxins (e.g., alcohol, cocaine)
  3. Hypersensitivity reactions (e.g., some drugs and toxins)
  4. Systemic autoimmune (e.g., lupus, sarcoidosis, IBD, Celiac ) and non-immune (e.g., thyrotoxicosis)
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9
Q

Myocarditis May result in what other diseases of the heart?

A

persistent ventricular dysfunction and dilated cardiomyopathy, also pericarditis

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10
Q

how do you diagnose myocarditis?

A

endomyocardial biopsy

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11
Q

Myocarditis Laboratory findings

A
  1. Elevated troponin I in 35% of patients
    Sensitivity 35%, specificity 90%, + predictive value 82%
  2. Elevated ESR
    Low sensitivity and specificity
  3. Leukocytosis in 25% of cases
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12
Q

what are some characteristics on an EKG with someone that has Myocarditis?

A

T waves in the lateral chest leads (V5, V6) may become flattened or inverted with reduced QRS amplitude

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13
Q

what studies might you order for diagnosis of myocarditis? (not labs)

A 
Echocardiography
MRI
Cardiac catherization
Endomyocardial biopsy
ECG
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14
Q

Valvular Heart Disease Results from

what two things?

A
  1. Insufficiency (regurgitation or incompetence)

2. Stenosis

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15
Q

the failure of a valve to open completely, reducing forward blood flow is a result of ______.

A

stenosis

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16
Q

the failure of a valve to close completely, allowing backward flow is a result of ______.

A

Insufficiency (regurgitation or incompetence)

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17
Q

Regurgitation may develop from what two things?

A
  1. Ventricular dilation

2. Dilation of the pulmonary artery or aorta

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18
Q

in regurgitation- Ventricular dilation, causing the papillary muscle to be pulled down and outward, prevents complete closing during ____ (mitral, tricuspid)

A

systole

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19
Q

in regurgitation- Dilation of the pulmonary artery or aorta, increasing the annulus diameter and pulling the valves apart, preventing closure during _____ (pulmonic, aortic)

A

diastole

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20
Q

Secondary to damage, valves may undergo calcification causing reduced _______(ability to open and close freely)

A

compliance

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21
Q

Secondary to damage, valves may undergo calcification causing reduced compliance, this generally results in _______.

A

stenosis

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22
Q

Calcification Most frequently occurs to the _______valve and _____ annulus.

A

aortic valve (calcific aortic stenosis) and mitral annulus (mitral annular calcification)

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23
Q

what is the most common valve abnormality?

A

Calcific Aortic Stenosis

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24
Q

when does Calcific Aortic Stenosis usually manifest?

A

it usually manifest in the 6th-7th decade

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25
Q

Calcific Aortic Stenosis Results in resistance to left ventricle emptying during systole and _______during diastole

A

regurgitation

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26
Q

calcific aortic stenosis Results in resistance to left ventricle emptying during systole and regurgitation during diastole. this can result in what two things?

A

left ventricular hypertrophy, ischemia (related to decreased coronary artery blood flow)

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27
Q

how might someone with calcific aortic stenosis present?

A

angina pectoris, heart failure, syncope

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28
Q

Injury to the mitral valve results in _______ (thickening) and calcium deposition in the mitral valve leaflet tissue and in the fibrous annulus surrounding the valve

A

fibrosis

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29
Q

Injury to the mitral valve results in fibrosis (thickening) and calcium deposition in the mitral valve leaflet tissue and in the fibrous ________ surrounding the valve

A

annulus

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30
Q

Mitral Valve Stenosis Causes incomplete closure during ______ .

A

systole

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31
Q

Mitral Valve Stenosis Causes incomplete opening during ______.

A

diastole

32
Q

Mitral Valve Stenosis causes incomplete ______ during systole and incomplete ______ during diastole

A

closure

opening

33
Q

in Mitral Valve Prolapse, One or both mitral valve leaflets are floppy and balloon (prolapse) into the atrium during _____.

A

systole

34
Q

what percent of adult population has Mitral Valve Prolapse? is greater in women or men?

A

2%

women

35
Q

Mitral Valve Prolapse May lead to _____ with thickened, rubbery, enlarged valve leaflets (caused by connective tissue changes)

A

degeneration

36
Q

inn Mitral Valve Prolapse, degeneration of mitral valve leaflets May be precipitated by elongated _______.

A

cordae tendineae

37
Q

inn Mitral Valve Prolapse, degeneration of mitral valve leaflets May occur due to dysfunction or rupture of _______, such as following AMI

A

papillary muscles

38
Q

Mitral valve prolapse predisposes to _______.

A

infectious endocarditis (bacterial growth on valve leaflets)

39
Q

Infective Endocarditis is caused by Colonization or invasion of _____ by a microbe

A

heart valves

40
Q

Infective Endocarditis is caused by microbe invasion of the heart valves, the infection may also include the ________.

A

mural endocardium (inner heart wall)

41
Q

Infective Endocarditis Leads to the formation of bulky, easily fractured (“friable”) “vegetations” composed of what?

A

organisms and thrombotic debris

42
Q

causes of Infective Endocarditis

A

Bacteremia is the major cause, resulting from gingival disease, pneumonia, pyelonephritis, invasive procedures (colonoscopy, endoscopy, dental extraction), injected street drugs

Most commonly bacterial (Staphylococci, Streptococci, Enterococci) although other microbes can cause infective endocarditis

43
Q

_______ results from a destructive, active infection, usually of a previously healthy valve

A

Acute endocarditis

44
Q

Acute endocarditis is generally caused by what?

A

Generally caused by a virulent organism

45
Q

prognosis of Acute endocarditis?

A

Often leads to death, even with antibiotic treatment

46
Q

Acute endocarditis Causes ______ valve destruction

A

erosive

47
Q

what are physical exam signs of Acute endocarditis?

A

Subungual (under nails) splinter hemorrhages and Janeway lesions (in skin) are a sign of bacterial endocarditis

these are caused by emboli from vegetations

48
Q

_______ endocarditis (more protracted) is a more insidious, protracted infection

A

Subacute

49
Q

Subacute endocarditis is generally caused by a less virulent organism. what is the prognosis of this disease?

A

patients Usually recover with antibiotic treatment

50
Q

Subacute endocarditis causes erosive destruction although generally less than in ______.

A

acute endocarditis

51
Q

the ______ pericardium is the tough outer fibrous layer

A

Parietal

52
Q

the ______ pericardium is the inner serous membrane made of a single layer of mesothelial cells, attached to the epicardial fat

A

Visceral

53
Q

Pericardial space contains ____ mL of plasma-like fluid

A

20-50

54
Q

Pericardial space contains 20-50 mL of plasma-like fluid. Approximately _____ mL of additional pericardial fluid can accumulate without an increase in pressure in the space

A

90-120

55
Q

Functions of the pericardium? (5 things)

A
  1. Limits acute cardiac dilation by distributing hydrostatic forces
  2. Maintains ventricular compliance and aids in atrial filling
  3. Reduces friction from heart motion
  4. Barrier against extension of infection and malignancy
  5. Fixes the heart in the thorax
56
Q

________ is Characterized by acute inflammation of the pericardium

A

Pericarditis

57
Q

signs and symptoms of Pericarditis

A
  1. Chest pain
  2. Pericardial friction rub
  3. Cardiac tamponade
    (reduced cardiac output)
  4. Ultrasound findings
  5. X-ray findings
  6. ECG changes
58
Q

what can identify pericardial effusion, impact
on cardiac chamber filling, and
vena cava collapse?

A

Ultrasound

59
Q

Classical X-ray findings of pericarditis

A

a “water bottle”
appearance of the heart (not
diagnostic by itself)

60
Q

ECG changes in pericarditis (4 things)

A
  1. Diffuse ST elevation except in “right-sided” leads (III, aVR, V1)
  2. PR segment depression with PR segment elevation in lead aVR
  3. Lead I looks like lead II (rather than leads II and III looking similar as occurs with inferior MI )
  4. The expected findings for STEMI are absent (ST elevation is diffuse rather than localized; there are no Q waves; reciprocal ST depression is absent)
61
Q

Five presentations of acute pericarditis

A
  1. Serous
  2. Fibrinous and serofibrinous
  3. Purulent or suppurative
  4. Hemorrhagic
  5. Caseous
62
Q

Describe serous presentation of acute pericarditis

A

clear inflammatory exudate produced by noninfectious causes (e.g., SLE, scleroderma) or by infection of adjacent tissues (e.g., bacterial pleuritis)

63
Q

in serous presentation of acute pericarditis, how does this exudate look?

A

clear inflammatory exudate

64
Q

Describe Fibrinous and serofibrinous presentation of acute pericarditis

A

characterized by serous fluid with fibrinous exudate, results in development of thick fibrinous deposits

65
Q

in Fibrinous and serofibrinous presentation of acute pericarditis, how does this exudate look?

A

characterized by serous fluid with fibrinous exudate

66
Q

if the patient has serous fluid with fibrinous exudate, resulting in development of thick fibrinous deposits, what presentation of acute pericarditis is seen?

A

Fibrinous and serofibrinous

67
Q

if the patient has clear inflammatory exudate, what presentation of acute pericarditis is seen?

A

serous

68
Q

Purulent or suppurative presentation of acute pericarditis is generally caused by what?

A

pericarditis caused by bacterial infection, generally with fever, etc.

69
Q

if your patient has pericarditis caused by bacterial infection, generally with fever, what presentation of acute pericarditis is seen?

A

Purulent or suppurative

70
Q

in Hemorrhagic presentation of acute pericarditis, how does this exudate look?

A

exudate of blood and fibrinous or suppurative effusion, often caused by malignant neoplastic involvement of the pericardium

71
Q

if your patient has exudate of blood and fibrinous or suppurative effusion, what presentation of acute pericarditis is seen?

A

Hemorrhagic

72
Q

Hemorrhagic presentations of acute pericarditis is usually caused by ______ of the pericardium

A

malignant neoplastic involvement

73
Q

Caseous presentation of acute pericarditis can be identified by what?

A

caseous necrosis

74
Q

Caseous presentation of acute pericarditis is generally caused by what?

A

tuberculosis

75
Q

_________ occurs when atrial and ventricular filling is compromised by pericardial fluid accumulation (increases in pericardial pressure)

A

Cardiac tamponade

76
Q

Cardiac tamponade results in what 4 things?

A
  1. Reduced stroke volume
  2. Decreased cardiac output
  3. Hypotension
  4. Faster fluid accumulation
    associated with more dramatic
    presentation

Block 4: Pathophys (5 decks)

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