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Pathology (Melicia) > Cardiac Path > Flashcards

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
Pathology of RHD?
nonbacterial sterile, inflammatory lesions and granulomas throughout connective tissue of body
26
What is characteristic about the heart valve ulcerations in RHD with time?
sterile vegetations (no bacteria) located along the lines of closure of the valve leaflets
27
What is characteristic of the vegetations of RHD?
no bacteria within the vegetations ongoing inflammation inside of the valves leads to destruction of the valves, followed by fibrous scarring
28
What is fish mouth stenosis
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
29
What side of the heart is usually affected in RHD?
left
30
How do valve changes in RHD affect the heart?
valves become incompetent and do not close completely during systole (valvular insufficiency)- regurg can also become stenotic
31
What is cor pulmonale?
right heart failure
32
What is responsible for the most deaths after the acute phase in RHD?
endocarditis
33
What are the extracardiac findings in RHD?
Polyarthritis Subcutaneous Nodules erythema marginatum Sydenhams chorea
34
Describe erythema marginatum
maculopapular erythematous rash mostly on truck and extremities, spares faces
35
Lab findings in RHD?
increasing ASO titers elevated ESR and CRP (nonspecific inflammatory marker)
36
Lab findings in RHD?
increasing ASO titers elevated ESR and CRP, leukocytosis (nonspecific inflammatory marker)
37
How is dx of RHD made?
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
Complications of RHD?
secondary bacteria infetion, valvular vegetation -> emboli-> infarct
39
Tx of RHD?
cant be cured valve replacement prompt tx of strep pharyngitis
40
What is infective endocarditis?
bacterial infections of cardiac valves causing erosions of the surface layers, allowing entry of bacteria into the valve
41
characteristics of subacute bacterial endocarditis?
slower, less virulent disease (St. viridans) can cause inf. in previously abn. heart valves.....
42
Pre-exisiting causes for endocarditis?
Artificial valves, congenital defects, degenerative calcified valvular stenosis, bicuspid aortic valves, myxomatous mitral valve (MVP)
43
Which organism is responsible for the most cases of prosthetic valve endocarditis?
staph epidermidis others: enterococci, gram - bacteria and fungi
44
Clinical features of infective endocarditis
fever quick onset chills, night sweats, weakness murmur SBE: low grade fever, fatigue, flu sxs
45
complications of infective endocarditis
Septic embolic episodes CHF....
46
IE dx?
clinical presentation US, + blood cultures
47
What is pericarditis?
Inflammation of the pericardium, either the visceral or parietal layers (inflammation of one causes inflammation of the other)
48
What causes pericarditis?
bacteria, viruses, rarely fungi, severe autoimmune disease (SLE), CKD (uremia-> waste products in blood ->inflammation)
49
How does pericarditis appear pathologically?
always associated with exudation of fluid into the pericardial sac serous pericarditis (viral): clear/yellow fluid Bacterial: purulent exudate
50
serofibrinous exudate in pericarditis is associated with...
more severe damage, such as in RF or in early bacterial infections
51
What does fibrinous pericarditis look like?
surface of heart is covered with shaggy, yellowish layers of fibrin btwn the 2 layers of the pericardial sac bread and butter!
52
What is myocarditis?
acute inflammation of the myocardium, typically caused by viruses -most often due to Coxsacki B virus
53
In pancarditis...
all 3 layers of the heart are affected
54
Can bacteria causes myocarditis?
relatively rare, usually due to a secondary disorder (diphtheria, meningococcus) or other causes such as radiation, and hypersensitivity rxns.
55
How do viruses cause myocardial disease?
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
Why is it bad that lymphokines are secreted in myocarditis?
they are supposed to kill the virus but also destroy the myocardial cells, contributing to HF
57
Pathology in viral myocarditis?
pale and congested areas (where virus was) with mild hypertrophy, bi dilated and generalized hypokineasis of myocardium = Tiger effect Flabby and dilated!
58
What does viral myocarditis look like histologically?
patchy, diffuse interstitial infiltrate mostly composed of T-lymphocytes and macrophages inflammatory cells often surround ind. myocytes with focal/patchy acute myocyte necrosis
59
Myocarditis presentation?
mild fever, SOB, malaise if severe: HF sxs males > females
60
Myocarditis dx and tx
definitive: endomyocardial biopsy supportive care
61
What is the etiology of atherosclerosis?
first damage at interface btwn blood and arterial wall + deposition of platelets and serum lipoproteins under the endothelium which stimulates macrophages
62
What role do platelets play in atherogenesis?
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
What role do macrophages play in atherogenesis?
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
In atherosclerosis, what is the name for the bulge in the vessel wall?
atheroma central part: soft and consists of lipids and cellular debris covered by fibrous tissue that forms a fibrous or surface cap
65
What is the major complication of the atheroma?
hardening of the vessel precipitated by local tissue degeneration, lipids released from dead cells attract calcium salts
66
Risk factors for atherosclerosis?
Age, Sex (male > females), heredity, lipid metabolism, HTN, obesity, DM, smoking, stress
67
mildest form of atherosclerosis of the aorta
found in young/middle aged ppl have fatty streaks which are slightly raised fibrotic plaques
68
progression of fatty streaks in atherosclerosis...
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
Atherosclerosis effect on BP
increases BP, which leads to the formation of aneurysms
70
Where do aneurysms of the aorta most commonly occur?
in abd aorta, usually clinically silent most often fusiform, saccular or spindle-shaped
71
What are small saccular aneurysm at the base of the brain, involving the circle of willis called?
berry aneurysms
72
Are primary cardiac tumors common?
no but when they occur can result in serious problems usually benign and are pedunculated (have a stalk)
73
What are the 3 types of cardiac tumors?
cardiac myxomas, rhabdomyomas, metastatic tumors
74
Describe cardiac myxomas
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
1/3 of pts with a myxoma of the LA or LV die of...
embolization of the tumor to the brain surgical removal is usually successful
76
What is a rhabdomyoma and where are they found?
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
What do rhabdomyomas look like grossly?
pale gray masses, up to several cm
78
What cancers typically metastasize to the heart?
lung, breast, GI lymphomas, leukemias and malignant melanomas may also
79
metastatic CA of the myocardium can result in manifestations of....
restrictive cardiomyopathy
80
What is CAD?
artherosclerosis of the coronaries which presents as myocardial ischemia due to the narrowing by atherosclerosis or sudden onset due to thrombus
81
What is an anterior wall infarct typically caused by?
occlusion of the LAD
82
What is an infarct of the lateral wall of LV usually caused by?
occlusion of the left circumflex coronary artery
83
Where do occlusions most often occur?
LAD, RCA, left circumflex a.
84
What is an acute MI?
rapid sudden occlusion of a coronary a. 80-90% of transmural infarcts are caused by thrombosis of a coronary a.
85
Define transmural
all 3 layers of the heart are necrotic
86
Cause of sudden cardiac death?
(occurs in 25% of MI) usually due to major arrhythmia (vfib) or later complete heart block and pump failure
87
Grossly, what are the 2 types of MIs?
1. Transmural: all 3 layers of heart | 2. Subendocardial/intramural: infarction is usually concentric around the subendocardial layer of the LV

Pathology (Melicia) (6 decks)

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