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cpr ii exam 1 > Cardiac Pathology > Flashcards

Cardiac Pathology Flashcards

1
Q

What changes occur within 30mins to 4 hours of injury?

A

Waviness of fibers at the border due to sarcolemmal disruption

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2
Q

What changes occur from 4-12 hours of injury?

A

Early coagulation necrosis and edema can become prominent

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3
Q

What changes occur from 12-24 hours of injury?

A 
Coagulation necrosis increases 
Nuclei begin to shrink and become pyknotic 
Myocytes appear very hypereosinophilic 
Heart appears darkly mottled
Early neutrophilic infiltrate
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4
Q

What changes can be seen at 1-3 days of injury?

A

Marked neutrophil infiltrate

Coagulation necrosis with loss of nuclei that manifests as a yellow tan infarct surrounding mottling

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5
Q

The period from 3 days to a week are characterized by the presence of what?

A

Macrophages which are present to phagocytize the dead myofibers

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6
Q

What changes occur from 7-10 days of injury?

A

Well developed phagocytosis of dead cells

Granulation tissue at margins

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7
Q

What changes occur from 10-14 days?

A

Well established granulation tissue with new blood vessels and collagen deposition

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8
Q

What changes occur from 2-8 weeks?

A

Gray white scar develops

Increased collagen deposition with decreased cellularity

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9
Q

What changes occur after two months from injury?

A

Scarring is complete and consists of a dense collagenous scar

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10
Q

Which substance begins to leak out of the dead myocytes after 2-3 hours of injury?

A

Lactate dehydrogenase which can be seen by staining the heart tissue with triphenyltetrazolium chloride (stains tissue bright red where LDH is present and areas of infarction do not turn bright red)

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11
Q

What is contraction band necrosis?

A

With repercussion an influx of Ca causes sarcomeres to contract appearing as contraction bands on light microscopy

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12
Q

What is the most common cause of death due to MI?

A

Fatal arrhythmia
Half of all deaths due to MI occur within 1 hour of onset and are due to fatal arrhythmia (v fib)
(Early complication)

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13
Q

What is the second most common cause of death due to MI?

A 
Contractile dysfunction (early complication) 
Dependent on size of the infract and associated loss of function 
Leads to cardiogenic shock
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14
Q

What are the causes of chronic ischemic heart disease?

A

A healing infarct with fibrosis, Ventricular remodeling and Hypertrophy of the remaining muscle

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15
Q

What is a good way to differentiate between NSTEMI and unstable angina?

A

NSTEMI will have have elevated troponin and unstable angina will not

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16
Q

Sudden onset of dyspnea, SOB, and crushing stabbing or squeezing CP which radiates to the jaw, less than 3 hours with typical EKG changes (ST elevation) should be assumed to be a what?

A

Transmural acute MI (STEMI)

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17
Q

What is the MC type of pericarditis?

A

Fibrinous and serofibrinous pericarditis (bread and butter appearance); Fibrinous inflammatory exudate, variable amount of fluid (serofibrinous)

18
Q

What are the causes of fibrinous and serofibrinous pericarditis?

A

Acute MI, Dressler’s syndrome, uremia (CKD with elevated BUN); Others include chest irradiation, RF, SLE, trauma

19
Q

What is serous pericarditis?

A

Viral or non infectious inflammatory diseases

20
Q

An active infection caused by microbial invasion can lead to which type of pericarditis?

A

Purulent or suppurative pericarditis

21
Q

What is caseous pericarditis?

A

Tuberculous in origin
Occasionally fungal
Necrotizing granuloma

22
Q

What is hemorrhagic pericarditis?

A

Most commonly caused by the spread of a malignant neoplasm

Also trauma

23
Q

What is constrictive pericarditis?

A

Heart is encased in a dense, fibrous or fibrocalcific scar that limits diastolic expansion and CO
Features that mimic a restrictive cardiomyopathy

24
Q

What are some common benign cardiac tumors?

A

Myxoma, fibroma, lipoma, papillary fibroelastoma, rhadbomyoma

25
Q

What is the #1 cardiac tumor in adults?

A

Myxoma

26
Q

What is the #1 cardiac tumor in children?

A

Rhabdomyoma

27
Q

What is the MC malignant tumor?

A

Sarcoma (angiosarcoma)

28
Q

What is a lipoma?

A

Localized mass composed of mature lobulated fat

Occur throughout the heart (subendocardium, subepicardium, or myocardium)

29
Q

What is a papillary fibroelastoma?

A

Typically incidental
Sea anemone like lesions
Often >80% located on valves
Resemble Lambl excrescences (probable remote organized thrombus)

30
Q

What is a rhadbomyoma?

A

Considered a hamartoma of developing cardiac myocytes;
50% sporadic mutations;
50% associated with tuberous sclerosis (mutations in TSC1 (hamartin) or TSC2 (tuberin) tumor suppressor genes);
Has spider cell histo appearance;
Gray white mass that protrudes into ventricles

31
Q

What is angiosarcoma?

A

Malignant endothelial neoplasm that primarily affects older adults

32
Q

Which cancers common involve the heart?

A

Metastatic lung and breast carcinoma, melanoma, lymphoma to the heart are more common than primary tumor
Breast, lung and esophageal can involve through direct extension

33
Q

Cardiac involvement of a tumor can result in what?

A

Mass effect (limiting cardiac filing);
Decreased myocardial contractility;
Symptomatic pericardial effusion;
Superior vena cava syndrome

34
Q

What type of allograft rejection can occur weeks to a couple years after a heart transplant?

A

Cellular mediated rejection (T cell mediated, lymphocytic response)
Ab mediated rejection (Ab mediated, vascular neutrophilic inflammation)

35
Q

What is allograft vasculopathy?

A

Late (many years), progressive, diffusely stenosing intimal proliferation
50% develop in 5 years, in virtually all pts within 10 years
Silent MI: denervated transplanted heart (no angina)

36
Q

What are the complications due to chronic immunosuppression in transplants?

A

Infection (hospital acquired, community acquired, reactivated viral infection, opportunistic, etc)
Malignancy
-skin cancers (squamous cell carcinoma, BCC)
-EBV positive lymphoproliferative disorder

37
Q

What are some general changes that occur in an aging heart?

A

Reduction in compliance and elasticity occurs in vessels and the heart

38
Q

What changes occur within the valves of an aging heart?

A

Fibrous mitral valve —> buckling prolapse during systole —> atrial dilation and arrhythmia
Calcific deposits —> aortic stenosis
Lambl excrescences

39
Q

What changes occur within the chambers of an aging heart?

A 
Left ventricle cavity sized reduced (esp with HTN)
Atrial dilation (fibrous mitral valve)
40
Q

What are some atherosclerotic changes that occur in an aging heart?

A

Significant stenosis (MI, aortic dissection, etc)

41
Q

What are some epicardial and myocardial changes that occur in an aging heart?

A 
Increase in epicardial fat 
Lipofuscin accumulates 
Basophilic degeneration 
Myocyte loss 
Amyloid deposition (transthyretin) —> senile amyloidosis (heart failure)

cpr ii exam 1 (11 decks)

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