Cardiac Pathology Flashcards
Stable angina
.Chest pain with exertion or emotional stress
.due to atherosclerosis (>70% stenosis )
. Represent reversible injury
Stable angina EKG shows
ST-segment depression (subendocardial ischemia)
Unstable angina
.Chest pain occur at rest
.Due to rapture of atherosclerotic plaque with thrombosis and **incomplete occlusion of coronaries
.Represent reversible injury
Unstable angina EKG shows
ST-segment depression
Prinzmetal angina
Episodic Chest pain unrelated to exertion
Represent reversible injury
Prinzmetal angina EKG shows
ST-segment elevation (due to transmural ischemia)
Myocardial infarction
.Necrosis of cardiac myocytes
MI occur due to
Rupture of atherosclerotic plaque with thrombosis and **complete occlusion of coronary artery
Other causes of MI include
Vasospasm , emboli and vasculitis
MI clinical features
Severe crushing chest pain (>20min)
Diaphoresis
Dyspnea
MI usually involve
The left ventricle
Cardiac enzymes include
Troponin I (the most sensitive and specific marker ) CK-MB (useful for detecting reinfarction)
MI treatment
Aspirin/heparin Supplemental O2 Nitrate B blocker ACE inhibitor
Fibrinlysis / angioplasty complication
Result in 1.contraction band necrosis
2.Reperfusion injury
Microscopic changes during MI
………1Day……………..1week…………….1month
Coagulative necrosis /1day/inflammation /1week/granulation tissue/1month/Scar formation
Complication of MI during coagulative necrosis phase
Arrhythmia
Complication of MI during neutrophilic infiltration
Fibrinous pericarditis
Complication of MI during macrophages infiltration
Rupture of ventricular free wall (lead to cardiac tamponade) Interventricular septum (shunt) papillary muscle (insufficiency)
Complication of MI during Scar phase
Aneurysm , mural thrombus , **Dressler syndrome(autoimmune pericarditis)
Fibrinous pericarditis only seen with
Transmural infarction
Sudden cardiac death usually due to
Fatal ventricular arrhythmia
Most common etiology of SCD is
Acute ischemia
Causes of left sided heart failure
Ischemia MI Dilated cardiomyopathy Restrictive cardiomyopathy HTN
Consequences of HF
Pulmonary congestion
Decreased forward perfusion
Right sided HF most commonly due to
Left failure
Other important causes of Right sided HF
Left to right shunt , chronic lung disease
Right sided HF clinical features
Jagular venous distension
Painful hepatosplenomegally may lead to cardiac cirrhosis
Dependent pitting edema
Most common congenital heart defect is
VSD , associated with **fetal alcohol syndrome
VSD small defects are ………………
VSD large defects can lead to ……………….
Asymptomatic , Eisenmenger syndrome
Most common type of ASD is
Ostium secundum
Ostium primum type of ASD is associated with
**Down syndrome
ASD splits
S2 on auscultation
PDA associated with
Congenital rubella
Left to right shunts include
VSD , ASD and patent ductus arteriosus
PDA symptoms include
- Holosystolic machine-like murmur
2. **Eisenmenger syndrome(reversal of shunt ) result in lower extremity cyanosis
Treatment of PDA
Indomethacin (decrease PGE, result in PDA closure)
Tetralogy of Fallot is
Stenosis of RV outflow
Right ventricular hypertrophy
VSD
Aorta overrides the VSD
TOF patients learn to squat in response to cyanotic spell
Result in
Increased arteriolar vascular resistance decrease shunting
Allow more blood to reach the lung
Boot shaped heart on x-ray associated with
TOF
Transposition of great vessels definition
Pulmonary artery arises from LV and aorta arises from RV
Transposition of great vessels associated with
****Maternal diabetes
Creation of shunt after birth is required for survival of
Transposition of great vessels patients by PGE until surgery
Single large vessel arise from both ventricles is
Truncus arteriosus
Coarctation of aorta has two forms
Infantile and adult form
Infantile form fo coarctation of aorta
Associated with PDA
Distal to the aortic arch but proximal to the PDA
Present as lower extremity cyanosis
Associated with ***Turner syndrome
Adult form of coarctation of aorta
Not associated with PDA
Coarctation distal to the aortic arch
Present as HTN in UE and hypotension in LE
Associated with ****bicuspid aortic valve
Engorged arteries cause *****notching of ribs on X-ray occur with
Adult form of coarctation of aorta
Acute rheumatic fever definition
Systemic complication of pharyngitis due to group A beta haemolytic streptococci
RF caused by
***Molecular mimicry ; bacterial M protein resemble human tissues
Acute RF affect
Children 2-3weeks after strep throat
RF JONES major criteria
Polyartheritis , pancarditis , subcutaneous nodules ,Erythema marginatum , Sydenham chorea
Fusion of the aortic valve commissures (fish mouth appearance) result in stenosis Occur with
Rheumatic Fever
Aortic stenosis usually from
Wear and tear (bicuspid aortic valve increase risk)
………………………………………………………. distinguish rheumatic disease from wear and tear
Coexisting mitral stenosis and fusion of aortic valve commissure
………………………………………………………. distinguish rheumatic disease from wear and tear
Coexisting mitral stenosis and fusion of aortic valve commissure
Hallmark of aortic stenosis
Systolic ejection click followed by crescendo-decrescendo murmur
Hallmark of aortic stenosis
Systolic ejection click followed by crescendo-decrescendo murmur
Complications of aortic stenosis
Concentric left ventricular hypertrophy
Angina and syncope with exercise
Microangiopathic haemolytic anemia
Aortic regurgitation definition
Back flow of blood from aorta into LV during diastole
Aortic regurgitation arises due to
Aortic root dilation (syphilitic aneurysm ) or valve damage (IE)
Aortic regurgitation clinical features
Early blowing diastolic murmur
Bounding pulses ; pulsating nail beds and head bobbing(**hyperdynamic circulation)
LV delation and eccentric hypertrophy
Complications of aortic stenosis
Concentric left ventricular hypertrophy
Angina and syncope with exercise
Microangiopathic haemolytic anemia
Aortic regurgitation definition
Back flow of blood from aorta into LV during diastole
Aortic regurgitation arises due to
Aortic root dilation (syphilitic aneurysm ) or valve damage (IE)
Mitral valve prolapse definition
Ballooning of mitral valve into left atrium during systole
Complications of aortic stenosis
Concentric left ventricular hypertrophy
Angina and syncope with exercise
Microangiopathic haemolytic anemia
Aortic regurgitation definition
Back flow of blood from aorta into LV during diastole
Aortic regurgitation arises due to
Aortic root dilation (syphilitic aneurysm ) or valve damage (IE)
Aortic regurgitation clinical features
Early blowing diastolic murmur
Bounding pulses
Aortic regurgitation definition
Back flow of blood from aorta into LV during diastole
Aortic regurgitation arises due to
Aortic root dilation (syphilitic aneurysm ) or valve damage (IE)
Mitral valve prolapse definition
Ballooning of mitral valve into left atrium during systole
Mitral valve prolapse due to
Myxoid degeneration in valve making it floppy
Mitral valve prolapse clinical feature
Mid-systolic click followed by regurgitation murmur
Mitral valve prolapse clinical feature
Mid-systolic click followed by regurgitation murmur
Mitral regurgitation definition
Reflux of blood from LV into LA during systole
Mitral regurgitation Usually arises as a complication of
Mitral valve prolapse
Mitral regurgitation clinical feature
Holosystolic blowing murmur “louder with squatting or expiration”
Mitral regurgitation Usually arises as a complication of
Mitral valve prolapse
Mitral valve prolapse clinical feature
Mid-systolic click followed by regurgitation murmur
*****Chronic RHD create ……………. while acute RHD create ………………..
Mitral stenosis , mitral regurgitation
Mitral stenosis clinical feature
Opening snap followed by diastolic rumble (طنين)
Mitral stenosis clinical feature
Opening snap followed by diastolic rumble
*****Chronic RHD create ……………. while acute RHD create ………………..
Mitral stenosis , mitral regurgitation
Mitral stenosis leads to
Volume overload and dilatation of the LA
Pulmonary congestion
Pulmonary HTN
Atrial fibrillation
Mitral stenosis leads to
Volume overload and dilatation of the LA
Pulmonary congestion
Pulmonary HTN
Atrial fibrillation
Most common overall cause cause of infective endocarditis is
S.viridans (infect previously damaged valves)
Most common cause of IE in drug abuse
Staph aureus ( infect tricuspid)
Endocarditis of prosthetic valve is caused by
S.epidermidis
Endocarditis in patients with underlying colorectal carcinoma caused by
****S.bovis
Endocarditis with negative blood cultures include
HACEK organisms ( Hemophilus, Actinobacillus , cardiobacterium ,Eikenella , Kingella)
Infective Endocarditis clinical features
Fever Murmur Janeway lesions Osler nodes (painful) Anemia of chronic disease
Non bacterial Thrombotic endocarditis definition
Sterile vegetations that arise with hypercoagulable state or underlying adenocarcinoma
Sterile vegetation associated with SLE
Vegetations present on both sides of mitral valve
****Libman-sacks endocarditis
Most common form of cardiomyopathy
Dilated cardiomyopathy
Dilated cardiomyopathy results in ……………dysfunction lead to biventricular CHF
Systolic
Dilated cardiomyopathy complications include
Mitral and tricuspid valve regurgitation , and arrhythmia
Causes of Dilated cardiomyopathy include
Idiopathic (most commonly ) Genetic mutation Myocarditis (Coxsackie B virus ) *****Alcohol abuse Drugs *****pregnancy
Cause of Hypertrophic cardiomyopathy
****Genetic mutation in sarcomere protein (most commonly AD)
A common cause of sudden death in young athletes
Hypertrophic cardiomyopathy (by ventricular arrhythmia )
Hypertrophic cardiomyopathy biopsy
Myofiber hypertrophy with *****disarray
Causes of Resrtictive cardiomyopathy
Amyloidosis Sarcoidosis Hemochromatosis Endocardial fibroelastosis (children) Loeffler syndrome
Classic finding of Restrictive cardiomyopathy
Low voltage EKG , diminished QRS amplitudes
Most common primary cardiac tumour in adults
Myxoma (benign mesenchymal proliferation )
Myxoma present as
Pedunculated mass in the left atrium
Causes syncope due to obstruction of mitral valve
Rhabdomyoma associated with
***Tuberous sclerosis
Most common primary cardiac tumour in children is
Rhabdomyoma
