Cardiac Path Flashcards

1
Q

What is a cardiomyopathy

A

heart disease resulting from a primary abn. in the myocardium

long standing pressure changes -> hypertrophy

long standing volume changes -> dilated

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2
Q

What are the 3 types of cardiomyopathies?

A

dilated, hypertrophic, restrictive

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3
Q

Describe dilated CM

A

progressive chamber dilated, results in reduced EF

causes: ABCD PIG

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4
Q

Most common type of CM?

A

dilated CM

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5
Q

Two classes of drugs that can cause dilated CM?

A

Adriamycin (Doxorubicin)

Cytoxin

(both CA drugs)

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6
Q

What would a dilated CM heart look like pathologically?

A

heavy heart which is large and flappy with dilation of all chambers

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7
Q

gross/microscopic findings of dilated CM?

A

thin walls partially replaced w/ fibrous tissue

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8
Q

How is genetic idiopathic dilated cardiomyopathy transmitted?

A

autosomal dominant, but also autosomal and sex linked recessive

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9
Q

What is the most common identifiable cause of secondary dilated CM in the U.S? other causes?

A

alcohol

cocaine use, cobalt exposure, viral myocarditis, pregnancy, high catecholamines (pheochromocytoma)

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10
Q

Describe hypertrophic CM

A

extensive hypertrophy of LV

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11
Q

HCM is also known as…

A

IHSS (idiopathic hypertrophic subaortic stenosis)

heart enlarged >1200g

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12
Q

What can you see grossly in HCM?

A

asymmetrical thickening of the ventricular septum

“banana septum”

+/- endocardial thickening with mural plaque formation of outflow track

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13
Q

Describe restrictive CM

A

Decreased in ventricular compliance so decreased V filling during diastole with normal systolic func.

cannot expand appropriately to receive blood

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14
Q

causes of restrictive CM?

A

idiopathic, amyloid, sarcoidosis, metastatic tumor (radiation)

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15
Q

Gross/microscopic findings of restrictive CM?

A

chambers not dilated, myocardium firm.

Histologically: patchy/diffuse interstitial fibrosis

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16
Q

CM dx?

A

ECG/echo

definitive: endomyocardial biopsy

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17
Q

What is acute rheumatic fever?

A

A systemic, immunologically mediated disease related to a streptococcal infection

our immune cells can’t tell the dif. btwn our cells and bacteria

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18
Q

What causes RF?

A

a serotype called a rheumatic stain by group A hemolytic strep (strep pyogenes)

usually followed by strep throat infection- not treated appropriately/noncompliance

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19
Q

rheumatic heart diseases causes…

A

fibrinous pancarditits- covering all 3 layers of the heart

  1. bread and butter pericarditis
  2. Myocarditis with histologic aschoff bodies
  3. Endocarditis- valvular problems
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20
Q

What is the number one cause of death in acute RF?

A

arrhythmias

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21
Q

How does our immune rxn cause disease in RF?

A

immune rxn damages connective tissue of heart and several other organs

abs against strep antigens may cross react with similar antigens in the heart

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22
Q

Who is most susceptible to ARF?

A

children 9-11 yrs

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23
Q

Why is RF no longer common?

A

better abx

less crowed conditions

still worldwide leading cause of heart disease in ppl 5-25

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24
Q

What is rheumatic heart disease?

A

major comp of ARF

also involves joints, subcutaneous CT of skin, blood vessel and occasionally brain

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25
Q

Pathology of RHD?

A

nonbacterial sterile, inflammatory lesions and granulomas throughout connective tissue of body

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26
Q

What is characteristic about the heart valve ulcerations in RHD with time?

A

sterile vegetations (no bacteria)

located along the lines of closure of the valve leaflets

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27
Q

What is characteristic of the vegetations of RHD?

A

no bacteria within the vegetations

ongoing inflammation inside of the valves leads to destruction of the valves, followed by fibrous scarring

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28
Q

What is fish mouth stenosis

A

fibrous adherence across the commissures produce a fish mouth stenosis due to the mitral valve which are shortened and thickened, and become fused to one another in RHD -> stenosis

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29
Q

What side of the heart is usually affected in RHD?

A

left

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30
Q

How do valve changes in RHD affect the heart?

A

valves become incompetent and do not close completely during systole (valvular insufficiency)- regurg

can also become stenotic

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31
Q

What is cor pulmonale?

A

right heart failure

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32
Q

What is responsible for the most deaths after the acute phase in RHD?

A

endocarditis

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33
Q

What are the extracardiac findings in RHD?

A

Polyarthritis

Subcutaneous Nodules

erythema marginatum

Sydenhams chorea

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34
Q

Describe erythema marginatum

A

maculopapular erythematous rash mostly on truck and extremities, spares faces

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35
Q

Lab findings in RHD?

A

increasing ASO titers

elevated ESR and CRP (nonspecific inflammatory marker)

36
Q

Lab findings in RHD?

A

increasing ASO titers

elevated ESR and CRP,
leukocytosis (nonspecific inflammatory marker)

37
Q

How is dx of RHD made?

A

based on Jones Criteria (2 M or 1M and 2m)

Major criteria: pancarditits, polycarditis, syndenhams choarea, subcutaneous nodules, erythema marginatum

Minor: hx RF, fever, arthragias, ECG changes, evidence of prior strep

38
Q

Complications of RHD?

A

secondary bacteria infetion, valvular vegetation -> emboli-> infarct

39
Q

Tx of RHD?

A

cant be cured

valve replacement

prompt tx of strep pharyngitis

40
Q

What is infective endocarditis?

A

bacterial infections of cardiac valves causing erosions of the surface layers, allowing entry of bacteria into the valve

41
Q

characteristics of subacute bacterial endocarditis?

A

slower, less virulent disease (St. viridans)

can cause inf. in previously abn. heart valves…..

42
Q

Pre-exisiting causes for endocarditis?

A

Artificial valves, congenital defects, degenerative calcified valvular stenosis, bicuspid aortic valves, myxomatous mitral valve (MVP)

43
Q

Which organism is responsible for the most cases of prosthetic valve endocarditis?

A

staph epidermidis

others: enterococci, gram - bacteria and fungi

44
Q

Clinical features of infective endocarditis

A

fever

quick onset chills, night sweats, weakness

murmur

SBE: low grade fever, fatigue, flu sxs

45
Q

complications of infective endocarditis

A

Septic embolic episodes

CHF….

46
Q

IE dx?

A

clinical presentation

US, + blood cultures

47
Q

What is pericarditis?

A

Inflammation of the pericardium, either the visceral or parietal layers (inflammation of one causes inflammation of the other)

48
Q

What causes pericarditis?

A

bacteria, viruses, rarely fungi, severe autoimmune disease (SLE), CKD (uremia-> waste products in blood ->inflammation)

49
Q

How does pericarditis appear pathologically?

A

always associated with exudation of fluid into the pericardial sac

serous pericarditis (viral): clear/yellow fluid

Bacterial: purulent exudate

50
Q

serofibrinous exudate in pericarditis is associated with…

A

more severe damage, such as in RF or in early bacterial infections

51
Q

What does fibrinous pericarditis look like?

A

surface of heart is covered with shaggy, yellowish layers of fibrin btwn the 2 layers of the pericardial sac

bread and butter!

52
Q

What is myocarditis?

A

acute inflammation of the myocardium, typically caused by viruses

-most often due to Coxsacki B virus

53
Q

In pancarditis…

A

all 3 layers of the heart are affected

54
Q

Can bacteria causes myocarditis?

A

relatively rare, usually due to a secondary disorder (diphtheria, meningococcus) or other causes such as radiation, and hypersensitivity rxns.

55
Q

How do viruses cause myocardial disease?

A

viruses cannot survive outside of the cells so they must invade the myocardium, damaging the myocardial cells

The myocardium is also invaded by t-lymphocytes which secrete lymphokines interleukins and TNF

56
Q

Why is it bad that lymphokines are secreted in myocarditis?

A

they are supposed to kill the virus but also destroy the myocardial cells, contributing to HF

57
Q

Pathology in viral myocarditis?

A

pale and congested areas (where virus was) with mild hypertrophy, bi dilated and generalized hypokineasis of myocardium = Tiger effect

Flabby and dilated!

58
Q

What does viral myocarditis look like histologically?

A

patchy, diffuse interstitial infiltrate mostly composed of T-lymphocytes and macrophages

inflammatory cells often surround ind. myocytes with focal/patchy acute myocyte necrosis

59
Q

Myocarditis presentation?

A

mild fever, SOB, malaise

if severe: HF sxs

males > females

60
Q

Myocarditis dx and tx

A

definitive: endomyocardial biopsy

supportive care

61
Q

What is the etiology of atherosclerosis?

A

first damage at interface btwn blood and arterial wall + deposition of platelets and serum lipoproteins under the endothelium which stimulates macrophages

62
Q

What role do platelets play in atherogenesis?

A

platelets release growth factors -> proliferation of smooth muscle cells in wall of artery -> promotes accumulation of cholesterol and lipids -> LDL transformed to foam cells

63
Q

What role do macrophages play in atherogenesis?

A

lesions attract macrophages which take up the released lipids, also secrete cytokines/TNF which cause more damage by stimulating collagen production along with the damaged smooth muscle cells

64
Q

In atherosclerosis, what is the name for the bulge in the vessel wall?

A

atheroma

central part: soft and consists of lipids and cellular debris

covered by fibrous tissue that forms a fibrous or surface cap

65
Q

What is the major complication of the atheroma?

A

hardening of the vessel

precipitated by local tissue degeneration, lipids released from dead cells attract calcium salts

66
Q

Risk factors for atherosclerosis?

A

Age, Sex (male > females), heredity, lipid metabolism, HTN, obesity, DM, smoking, stress

67
Q

mildest form of atherosclerosis of the aorta

A

found in young/middle aged ppl

have fatty streaks which are slightly raised fibrotic plaques

68
Q

progression of fatty streaks in atherosclerosis…

A

fatty streak-> atheroma -> atheroma may rupture, become calcified and fibrosed -> rigid calcified tube that has a rough, jagged, ulcerated internal surface covered focally with thrombi

69
Q

Atherosclerosis effect on BP

A

increases BP, which leads to the formation of aneurysms

70
Q

Where do aneurysms of the aorta most commonly occur?

A

in abd aorta, usually clinically silent

most often fusiform, saccular or spindle-shaped

71
Q

What are small saccular aneurysm at the base of the brain, involving the circle of willis called?

A

berry aneurysms

72
Q

Are primary cardiac tumors common?

A

no but when they occur can result in serious problems

usually benign and are pedunculated (have a stalk)

73
Q

What are the 3 types of cardiac tumors?

A

cardiac myxomas, rhabdomyomas, metastatic tumors

74
Q

Describe cardiac myxomas

A

most common primary tumor

most arise from left atrium

appears as a glistening, gelatinous, polypoid mass, usually 5-6cm with a short stalk

sometimes mobile and can obstruct the mitral valve orifice

75
Q

1/3 of pts with a myxoma of the LA or LV die of…

A

embolization of the tumor to the brain

surgical removal is usually successful

76
Q

What is a rhabdomyoma and where are they found?

A

most common primary cardiac tumor in infants and children and forms nodular masses in the myocardium

almost all are multiple and involve both ventricles

77
Q

What do rhabdomyomas look like grossly?

A

pale gray masses, up to several cm

78
Q

What cancers typically metastasize to the heart?

A

lung, breast, GI

lymphomas, leukemias and malignant melanomas may also

79
Q

metastatic CA of the myocardium can result in manifestations of….

A

restrictive cardiomyopathy

80
Q

What is CAD?

A

artherosclerosis of the coronaries which presents as myocardial ischemia due to the narrowing by atherosclerosis or sudden onset due to thrombus

81
Q

What is an anterior wall infarct typically caused by?

A

occlusion of the LAD

82
Q

What is an infarct of the lateral wall of LV usually caused by?

A

occlusion of the left circumflex coronary artery

83
Q

Where do occlusions most often occur?

A

LAD, RCA, left circumflex a.

84
Q

What is an acute MI?

A

rapid sudden occlusion of a coronary a.

80-90% of transmural infarcts are caused by thrombosis of a coronary a.

85
Q

Define transmural

A

all 3 layers of the heart are necrotic

86
Q

Cause of sudden cardiac death?

A

(occurs in 25% of MI)

usually due to major arrhythmia (vfib) or later complete heart block and pump failure

87
Q

Grossly, what are the 2 types of MIs?

A
  1. Transmural: all 3 layers of heart

2. Subendocardial/intramural: infarction is usually concentric around the subendocardial layer of the LV