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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
Calcific Aortic Stenosis Results in resistance to left ventricle emptying during systole and _______during diastole
regurgitation
26
calcific aortic stenosis Results in resistance to left ventricle emptying during systole and regurgitation during diastole. this can result in what two things?
left ventricular hypertrophy, ischemia (related to decreased coronary artery blood flow)
27
how might someone with calcific aortic stenosis present?
angina pectoris, heart failure, syncope
28
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
fibrosis
29
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
annulus
30
Mitral Valve Stenosis Causes incomplete closure during ______ .
systole
31
Mitral Valve Stenosis Causes incomplete opening during ______.
diastole
32
Mitral Valve Stenosis causes incomplete ______ during systole and incomplete ______ during diastole
closure opening
33
in Mitral Valve Prolapse, One or both mitral valve leaflets are floppy and balloon (prolapse) into the atrium during _____.
systole
34
what percent of adult population has Mitral Valve Prolapse? is greater in women or men?
2% women
35
Mitral Valve Prolapse May lead to _____ with thickened, rubbery, enlarged valve leaflets (caused by connective tissue changes)
degeneration
36
inn Mitral Valve Prolapse, degeneration of mitral valve leaflets May be precipitated by elongated _______.
cordae tendineae
37
inn Mitral Valve Prolapse, degeneration of mitral valve leaflets May occur due to dysfunction or rupture of _______, such as following AMI
papillary muscles
38
Mitral valve prolapse predisposes to _______.
infectious endocarditis (bacterial growth on valve leaflets)
39
Infective Endocarditis is caused by Colonization or invasion of _____ by a microbe
heart valves
40
Infective Endocarditis is caused by microbe invasion of the heart valves, the infection may also include the ________.
mural endocardium (inner heart wall)
41
Infective Endocarditis Leads to the formation of bulky, easily fractured (“friable”) “vegetations” composed of what?
organisms and thrombotic debris
42
causes of Infective Endocarditis
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
_______ results from a destructive, active infection, usually of a previously healthy valve
Acute endocarditis
44
Acute endocarditis is generally caused by what?
Generally caused by a virulent organism
45
prognosis of Acute endocarditis?
Often leads to death, even with antibiotic treatment
46
Acute endocarditis Causes ______ valve destruction
erosive
47
what are physical exam signs of Acute endocarditis?
Subungual (under nails) splinter hemorrhages and Janeway lesions (in skin) are a sign of bacterial endocarditis these are caused by emboli from vegetations
48
_______ endocarditis (more protracted) is a more insidious, protracted infection
Subacute
49
Subacute endocarditis is generally caused by a less virulent organism. what is the prognosis of this disease?
patients Usually recover with antibiotic treatment
50
Subacute endocarditis causes erosive destruction although generally less than in ______.
acute endocarditis
51
the ______ pericardium is the tough outer fibrous layer
Parietal
52
the ______ pericardium is the inner serous membrane made of a single layer of mesothelial cells, attached to the epicardial fat
Visceral
53
Pericardial space contains ____ mL of plasma-like fluid
20-50
54
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
90-120
55
Functions of the pericardium? (5 things)
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
________ is Characterized by acute inflammation of the pericardium
Pericarditis
57
signs and symptoms of Pericarditis
1. Chest pain 2. Pericardial friction rub 3. Cardiac tamponade (reduced cardiac output) 4. Ultrasound findings 5. X-ray findings 6. ECG changes
58
what can identify pericardial effusion, impact on cardiac chamber filling, and vena cava collapse?
Ultrasound
59
Classical X-ray findings of pericarditis
a "water bottle" appearance of the heart (not diagnostic by itself)
60
ECG changes in pericarditis (4 things)
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
Five presentations of acute pericarditis
1. Serous 2. Fibrinous and serofibrinous 3. Purulent or suppurative 4. Hemorrhagic 5. Caseous
62
Describe serous presentation of acute pericarditis
clear inflammatory exudate produced by noninfectious causes (e.g., SLE, scleroderma) or by infection of adjacent tissues (e.g., bacterial pleuritis)
63
in serous presentation of acute pericarditis, how does this exudate look?
clear inflammatory exudate
64
Describe Fibrinous and serofibrinous presentation of acute pericarditis
characterized by serous fluid with fibrinous exudate, results in development of thick fibrinous deposits
65
in Fibrinous and serofibrinous presentation of acute pericarditis, how does this exudate look?
characterized by serous fluid with fibrinous exudate
66
if the patient has serous fluid with fibrinous exudate, resulting in development of thick fibrinous deposits, what presentation of acute pericarditis is seen?
Fibrinous and serofibrinous
67
if the patient has clear inflammatory exudate, what presentation of acute pericarditis is seen?
serous
68
Purulent or suppurative presentation of acute pericarditis is generally caused by what?
pericarditis caused by bacterial infection, generally with fever, etc.
69
if your patient has pericarditis caused by bacterial infection, generally with fever, what presentation of acute pericarditis is seen?
Purulent or suppurative
70
in Hemorrhagic presentation of acute pericarditis, how does this exudate look?
exudate of blood and fibrinous or suppurative effusion, often caused by malignant neoplastic involvement of the pericardium
71
if your patient has exudate of blood and fibrinous or suppurative effusion, what presentation of acute pericarditis is seen?
Hemorrhagic
72
Hemorrhagic presentations of acute pericarditis is usually caused by ______ of the pericardium
malignant neoplastic involvement
73
Caseous presentation of acute pericarditis can be identified by what?
caseous necrosis
74
Caseous presentation of acute pericarditis is generally caused by what?
tuberculosis
75
_________ occurs when atrial and ventricular filling is compromised by pericardial fluid accumulation (increases in pericardial pressure)
Cardiac tamponade
76
Cardiac tamponade results in what 4 things?
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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