Cardiac Pathology Flashcards
What are the six principal mechanisms that can cause heart failure?
1) Failure of the pump
2) Obstruction to flow
3)Regurgitant flow
4)Shuntedflow
5)Disorders of cardiac conduction.
6)Rupture of the heart or major vessel.
What is congenital heart disease and what percentage of birth defects does it account for?
Congenital heart disease includes structural abnormalities from faulty embryogenesis; it accounts for 20-30% of all birth defects.
What are the main groups of congenital heart disease based on hemodynamics?
1) Left-to-right shunt
2) Right-to-left shunt (cyanotic)
What is the most common type of left-to-right shunt in congenital heart disease?
Atrial septal defects (ASDs) ventricular septal defects (VSDs)
What is Eisenmenger syndrome?
A condition where prolonged left-to-right shunting leads to pulmonary hypertension and reversal to a right-to-left shunt causing cyanosis.
What is Tetralogy of Fallot?
The most common cyanotic congenital heart disease with four key features: VSD right ventricular outflow obstruction
What causes the “boot-shaped” heart in Tetralogy of Fallot?
Right ventricular hypertrophy.
What is transposition of the great arteries?
A condition where the aorta arises from the right ventricle and the pulmonary artery from the left ventricle causing separation of systemic and pulmonary circulation.
What are the two classic forms of aortic coarctation?
1) Infantile (preductal) form
2) Adult (postductal) form.
What are Berry aneurysms?
Thin-walled outpouchings in cerebral vessels usually at branch points around the Circle of Willis; can rupture and cause fatal hemorrhage.
What is hypertensive vascular disease and what are its main effects?
High blood pressure leading to risks of stroke
What is the essential feature of hypertensive heart disease?
Left ventricular hypertrophy causing diastolic filling impairment and increased oxygen demand.
What is cor pulmonale?
Right-sided heart disease due to pulmonary hypertension often secondary to chronic lung disease or pulmonary vascular disease.
What are the two main types of arteriosclerosis?
1) Arteriolosclerosis (small arteries) with hyaline and hyperplastic types
What is atherosclerosis?
An intimal lesion (atheromatous plaque) that can obstruct blood flow rupture
What are modifiable risk factors for atherosclerosis?
Modifiable Major Risk Factors
i. Hyperlipidemia and, more specifically, hypercholesterolemia ii.hypertension. iii.cigarette smoking. iv.Diabetes mellitus. v.Inflammation. vi. Hyperhomocysteinemia.
vii. Metabolic syndrome
What is Monckeberg medial calcific sclerosis?
Calcification of the media in medium-sized muscular arteries; usually not clinically significant.
What is an aortic dissection?
An intimal tear with blood dissecting through the aortic media often due to HTN or connective tissue disorders.
What are the types of aortic dissections?
Type A (proximal) involving ascending aorta; Type B (distal) starting beyond subclavian artery.
What are the common causes of ischemic heart disease?
Reduced coronary blood flow due to atherosclerosis coronary thrombosis
What is angina pectoris and what are its types?
Chest pain from ischemia without cell death; types include stable
What are transmural and subendocardial infarctions?
Transmural: full-thickness infarct with ST elevation (STEMI). Subendocardial: inner third infarct without ST elevation (NSTEMI).
What is reperfusion injury?
Additional injury when blood flow is restored to previously ischemic tissue leading to inflammation and capillary damage.
What is dilated cardiomyopathy (DCM)?
A disease with four-chamber hypertrophy and dilation causing systolic dysfunction and heart failure.
What is hypertrophic cardiomyopathy (HCM)?
A condition with thickened ventricular septum hypercontractile heart
What is restrictive cardiomyopathy?
A rare condition with rigid ventricles and reduced cardiac output but normal contractility.
What is arrhythmogenic right ventricular cardiomyopathy?
Right ventricular failure and arrhythmia caused by defective desmosomes leading to fatty infiltration of the RV wall.
What are the two main causes of vasculitis?
1) Immune-mediated inflammation
2) Direct vascular invasion by infectious pathogens.
What is Takayasu arteritis?
Granulomatous vasculitis of large arteries causing weakened pulses and ocular symptoms
What is Kawasaki disease?
A self-limited vasculitis in children that affects medium-sized arteries especially coronary arteries
What is ischemic heart disease (IHD)?
A group of syndromes related to myocardial ischemia; the leading cause of death in the US.
What is the most common cause of IHD?
Atherosclerosis of coronary arteries, which decreases blood flow to the myocardium.
What are risk factors for IHD?
Similar to those for atherosclerosis, with incidence increasing with age.
What is stable angina?
Chest pain arising with exertion or emotional stress due to >70% coronary artery stenosis.
What type of injury occurs in stable angina?
Reversible injury to myocytes (no necrosis).
What are symptoms of stable angina?
Chest pain lasting < 20 minutes, radiating to left arm or jaw, with diaphoresis and shortness of breath.
What does EKG show in stable angina?
ST-segment depression due to subendocardial ischemia.
How is stable angina relieved?
By rest or nitroglycerin.
What is unstable angina?
Chest pain that occurs at rest, usually due to rupture of an atherosclerotic plaque with thrombosis and incomplete coronary artery occlusion.
What type of injury occurs in unstable angina?
Reversible injury to myocytes (no necrosis).
What does EKG show in unstable angina?
ST-segment depression due to subendocardial ischemia.
How is unstable angina relieved?
By nitroglycerin.
What is the main risk associated with unstable angina?
High risk of progressing to myocardial infarction.
What is Prinzmetal angina?
Episodic chest pain unrelated to exertion, due to coronary artery vasospasm.
What does EKG show in Prinzmetal angina?
ST-segment elevation due to transmural ischemia.
How is Prinzmetal angina relieved?
Nitroglycerin or calcium channel blockers.
What is a myocardial infarction (MI)?
Necrosis of cardiac myocytes due to ischemia.
What is the most common cause of MI?
Rupture of an atherosclerotic plaque with thrombosis and complete occlusion of a coronary artery.
What are other causes of MI?
Coronary artery vasospasm (Prinzmetal angina or cocaine), emboli, and vasculitis (e.g., Kawasaki disease).
What are clinical features of MI?
Severe, crushing chest pain lasting > 20 minutes, radiating to the left arm or jaw, with diaphoresis and dyspnea.
Does nitroglycerin relieve pain in MI?
No, symptoms are not relieved by nitroglycerin.
What part of the heart is most commonly affected in MI?
The left ventricle (LV); right ventricle (RV) and atria are generally spared.
What does occlusion of the left anterior descending artery (LAD) cause?
Infarction of the anterior wall and anterior septum of the left ventricle; LAD is the most commonly involved artery in MI.
What does occlusion of the right coronary artery (RCA) cause?
Infarction of the posterior wall, posterior septum, and papillary muscles of the left ventricle; RCA is the second most commonly involved artery.
What does occlusion of the left circumflex artery cause?
Infarction of the lateral wall of the left ventricle.
What does the initial phase of infarction cause?
Subendocardial necrosis involving < 50% of myocardial thickness (subendocardial infarction).
What does EKG show in a subendocardial infarction?
ST-segment depression.
What does severe ischemia cause in MI?
Transmural necrosis involving most of the myocardial wall (transmural infarction).
What does EKG show in a transmural infarction?
ST-segment elevation.
What are the main cardiac enzymes in MI diagnosis?
Troponin I (most sensitive and specific) and CK-MB (useful for detecting reinfarction).
How do troponin I levels change after MI?
They rise 2-4 hours post-MI, peak at 24 hours, and normalize in 7-10 days.
What is CK-MB used for in MI?
Detecting reinfarction; levels rise 4-6 hours post-MI, peak at 24 hours, and normalize in 72 hours.
What are treatments for MI?
Aspirin/heparin, oxygen, nitrates, beta-blockers, ACE inhibitors, fibrinolysis or angioplasty.
What is contraction band necrosis?
Hypercontraction of myofibrils upon reperfusion of irreversibly-damaged cells.
What is reperfusion injury?
Free radical damage when oxygen and inflammatory cells return to ischemic tissue.
What is sudden cardiac death?
Unexpected death due to cardiac disease, often from fatal ventricular arrhythmia.
What is the most common cause of sudden cardiac death?
Acute ischemia, with 90% of patients having severe preexisting atherosclerosis.
What is chronic ischemic heart disease?
Poor myocardial function due to chronic ischemic damage, leading to congestive heart failure (CHF).
What is congestive heart failure (CHF)?
A condition of pump failurewhich can involve either right- or left-sided heart failure.
What are common causes of left-sided heart failure?
Ischemia hypertension
What clinical features result from left-sided heart failure?
Decreased forward perfusion and pulmonary congestion.
What symptoms does pulmonary congestion cause in left-sided heart failure?
Dyspnea paroxysmal nocturnal dyspnea
What are “heart failure cells”?
Hemosiderin-laden macrophages resulting from burst capillaries in pulmonary congestion.
How does left-sided heart failure affect the kidneys?
Decreased renal perfusion activates the renin-angiotensin system leading to fluid retention and worsening CHF.
What is the mainstay treatment for left-sided heart failure?
ACE inhibitors.
What are common causes of right-sided heart failure?
Most commonly left-sided heart failure as well as left-to-right shunts and chronic lung disease (cor pulmonale).
What clinical features result from right-sided heart failure?
Congestion in systemic circulation causing symptoms such as JVD
What is “nutmeg liver”?
A congested liver appearance due to right-sided heart failure which may progress to cardiac cirrhosis.
What are congenital heart defects?
Structural abnormalities arising during embryogenesis typically between weeks 3-8.
What is the most common congenital heart defect?
Ventricular septal defect (VSD).
What is Eisenmenger syndrome?
A condition where prolonged left-to-right shunting causes pulmonary hypertension and shunt reversal leading to late cyanosis.
What are the main types of congenital heart defects based on shunting?
Left-to-right shunts and right-to-left shunts.
What is a ventricular septal defect (VSD)?
A defect in the septum dividing the right and left ventricles leading to a left-to-right shunt.
What congenital condition is VSD associated with?
Fetal alcohol syndrome.
What is the typical treatment for VSD?
Surgical closure though small defects may close spontaneously.
What is an atrial septal defect (ASD)?
A defect in the septum dividing the right and left atria most commonly of the ostium secundum type.
What congenital condition is the ostium primum type of ASD associated with?
Down syndrome.
What is a key complication of ASD?
Paradoxical emboli.
What is patent ductus arteriosus (PDA)?
Failure of the ductus arteriosus to close after birth leading to a left-to-right shunt.
What congenital condition is PDA associated with?
Congenital rubella.
What is the clinical presentation of PDA?
Asymptomatic at birth with a “machine-like” murmur may progress to Eisenmenger syndrome.
What is the treatment for PDA?
Indomethacin which decreases PGE to promote closure.
What is Tetralogy of Fallot?
A congenital heart defect characterized by four features: right ventricular outflow obstruction right ventricular hypertrophy
How does Tetralogy of Fallot typically present?
Early cyanosis due to right-to-left shunting.
What is a classic finding on X-ray for Tetralogy of Fallot?
“Boot-shaped” heart.
What is transposition of the great vessels?
A congenital condition where the pulmonary artery arises from the left ventricle and the aorta from the right ventricle.
What condition is associated with transposition of the great vessels?
Maternal diabetes.
What is required for survival in transposition of the great vessels?
Creation of a shunt (e.g. maintaining a PDA with PGE until surgery).
What is truncus arteriosus?
A single large vessel arising from both ventricles due to failure of truncus division.
What is tricuspid atresia?
Failure of the tricuspid valve to develop resulting in a hypoplastic right ventricle and an associated right-to-left shunt.
What is coarctation of the aorta?
Narrowing of the aorta which can present in infantile or adult forms.
What is infantile coarctation of the aorta associated with?
A patent ductus arteriosus (PDA) and is commonly seen in Turner syndrome.
How does infantile coarctation of the aorta present?
Cyanosis in the lower extremities in infancy.
What is the adult form of coarctation of the aorta associated with?
Not associated with PDA; presents with hypertension in the upper extremities and hypotension in the lower extremities.
What is a key X-ray finding in adult coarctation of the aorta?
“Rib notching” due to collateral circulation across intercostal arteries.
What is congestive heart failure (CHF)?
A condition where the heart’s pump function is inadequate divided into right- and left-sided failure.
What are common causes of left-sided heart failure?
Ischemia
hypertension
What symptoms does pulmonary congestion cause in left-sided heart failure?
Dyspnea paroxysmal nocturnal dyspnea
What are “heart failure cells”?
Hemosiderin-laden macrophages resulting from burst capillaries in the lungs due to left-sided heart failure.
How does left-sided heart failure affect the kidneys?
Decreased renal perfusion activates the renin-angiotensin system leading to fluid retention and worsening CHF.
What is the main treatment for left-sided heart failure?
ACE inhibitors.
What are common causes of right-sided heart failure?
Most often secondary to left-sided heart failure but also left-to-right shunt and chronic lung disease (cor pulmonale).
What clinical features are associated with right-sided heart failure?
Jugular venous distension painful hepatosplenomegaly with “nutmeg” liver
What is congenital heart defect?
Structural abnormalities of the heart that arise during embryogenesis typically between weeks 3-8.
What is Eisenmenger syndrome?
A condition where prolonged left-to-right shunting leads to pulmonary hypertension and shunt reversal resulting in late cyanosis.
What are the types of congenital heart defects based on shunting?
Left-to-right shunts and right-to-left shunts.
What is a ventricular septal defect (VSD)?
A defect in the wall separating the right and left ventricles causing left-to-right shunting.
What condition is associated with VSD?
Fetal alcohol syndrome.
What is atrial septal defect (ASD)?
A defect in the septum separating the right and left atria leading to a left-to-right shunt.
What type of ASD is most common?
Ostium secundum type (90% of cases).
What condition is associated with ostium primum type of ASD?
Down syndrome.
What are potential complications of ASD?
Paradoxical emboli due to the shunt.
What is patent ductus arteriosus (PDA)?
A condition where the ductus arteriosus fails to close resulting in a left-to-right shunt.
What congenital condition is associated with PDA?
Congenital rubella.
What is the clinical presentation of PDA?
Asymptomatic at birth with a “machine-like” murmur which may progress to Eisenmenger syndrome.
What is the treatment for PDA?
Indomethacin which decreases PGE and promotes ductus arteriosus closure.
What is Tetralogy of Fallot?
A congenital heart defect with four features: (1) right ventricular outflow tract stenosis
2) right ventricular hypertrophy
What symptom is associated with Tetralogy of Fallot?
Early cyanosis due to right-to-left shunting.
What is the classic x-ray finding in Tetralogy of Fallot?
“Boot-shaped” heart.
What is transposition of the great vessels?
A congenital defect where the pulmonary artery arises from the left ventricle and the aorta from the right ventricle.
What condition is associated with transposition of the great vessels?
Maternal diabetes.
What is required for survival in transposition of the great vessels?
A shunt to allow blood mixing; PGE can be given to maintain a PDA until surgery.
What is truncus arteriosus?
A single large vessel arising from both ventricles failing to divide.
What is tricuspid atresia?
Absence of the tricuspid valve leading to a hypoplastic right ventricle and right-to-left shunt.
What is coarctation of the aorta?
Narrowing of the aorta which can present in an infantile or adult form.
What condition is associated with infantile coarctation of the aorta?
A patent ductus arteriosus (PDA) and Turner syndrome.
What are symptoms of infantile coarctation of the aorta?
Lower extremity cyanosis in infancy.
What is the adult form of coarctation of the aorta?
A condition without a PDA characterized by upper extremity hypertension and lower extremity hypotension.
What is a classic x-ray finding in adult coarctation of the aorta?
“Rib notching” due to collateral circulation across the intercostal arteries.
What are the two main types of valvular lesions?
Stenosis (narrowing) and regurgitation (backflow).
What is acute rheumatic fever?
A systemic complication of group A beta-hemolytic streptococcal pharyngitis affecting children 2-3 weeks after strep throat.
What causes acute rheumatic fever?
Molecular mimicry where streptococcal M protein resembles human tissue proteins.
How is acute rheumatic fever diagnosed?
Using the Jones criteria: evidence of prior streptococcal infection plus major and minor criteria.
What are the major criteria in the Jones criteria?
Migratory polyarthritis
pancarditis
What are the components of pancarditis in rheumatic fever?
Endocarditis (mitral valve) myocarditis (Aschoff bodies)
What are Aschoff bodies?
Chronic inflammation Anitschkow cells
What is chronic rheumatic heart disease?
Valve scarring from repeated acute rheumatic fever episodes often causing mitral stenosis.
What is the classic appearance of valves in chronic rheumatic heart disease?
“Fish mouth” appearance due to thickened and fused valve cusps.
What are complications of chronic rheumatic heart disease?
Most commonly infectious endocarditis.
What is aortic stenosis?
Narrowing of the aortic valve often due to age-related “wear and tear.”
What increases the risk for aortic stenosis?
A bicuspid aortic valve which causes more “wear and tear” on each cusp.
How does rheumatic aortic stenosis differ from age-related stenosis?
Rheumatic stenosis usually involves both the mitral and aortic valves and features commissural fusion.
What are key symptoms of aortic stenosis?
Systolic ejection click with crescendo-decrescendo murmur angina
What is aortic regurgitation?
Backflow of blood from the aorta into the left ventricle during diastole.
What causes aortic regurgitation?
Aortic root dilation or valve damage; most commonly isolated root dilation.
What are clinical features of aortic regurgitation?
“Blowing” diastolic murmur bounding pulses (water-hammer pulse)
What is mitral valve prolapse?
Ballooning of the mitral valve into the left atrium during systole often due to myxoid degeneration.
What conditions are associated with mitral valve prolapse?
Marfan syndrome and Ehlers-Danlos syndrome.
What are clinical features of mitral valve prolapse?
Mid-systolic click with regurgitation murmur; louder with squatting.
What is mitral regurgitation?
Backflow of blood from the left ventricle to the left atrium during systole.
What causes mitral regurgitation?
Mitral valve prolapse left ventricular dilation
What are the clinical features of mitral regurgitation?
Holosystolic “blowing” murmur that becomes louder with squatting and expiration.
What is mitral stenosis?
Narrowing of the mitral valve orifice usually due to chronic rheumatic heart disease.
What are symptoms of mitral stenosis?
Opening snap with diastolic rumble pulmonary congestion
What are risks associated with left atrial dilation in mitral stenosis?
Atrial fibrillation and mural thrombi formation.
What are the two main types of valvular lesions?
Stenosis (narrowing) and regurgitation (backflow).
What is acute rheumatic fever?
A systemic complication of group A beta-hemolytic streptococcal pharyngitis occurring 2-3 weeks after strep throat.
What causes acute rheumatic fever?
Molecular mimicry where the bacterial M protein resembles human tissue proteins.
How is acute rheumatic fever diagnosed?
Using the Jones criteria: evidence of prior streptococcal infection plus major and minor criteria.
What are the major criteria in the Jones criteria?
Migratory polyarthritis
pancarditis
What is migratory polyarthritis?
Swelling and pain that moves from one large joint to another resolving within days.
What is pancarditis in rheumatic fever?
Inflammation of the heart involving endocarditis
What is the most common cause of death in acute rheumatic fever? .
Myocarditis
What are Aschoff bodies?
Areas of chronic inflammation with Anitschkow cells giant cells
What is erythema marginatum?
Annular non-itchy rash with red borders
What is Sydenham chorea?
Rapid involuntary muscle movements due to CNS involvement in rheumatic fever.
What is chronic rheumatic heart disease?
Valve scarring from repeated acute rheumatic fever episodes usually causing mitral stenosis.
What is the characteristic appearance of valves in chronic rheumatic heart disease?
“Fish mouth” appearance due to thickened and fused valve cusps.
Which valves are most affected in chronic rheumatic heart disease?
Mitral valve (most common) and sometimes the aortic valve.
What are complications of chronic rheumatic heart disease?
Increased risk of infectious endocarditis.
What is aortic stenosis?
Narrowing of the aortic valve often due to age-related calcification or chronic rheumatic disease.
What increases the risk of aortic stenosis?
A bicuspid aortic valve which causes faster “wear and tear.”
What murmur is associated with aortic stenosis?
Systolic ejection click followed by a crescendo-decrescendo murmur.
What are complications of aortic stenosis?
Concentric LV hypertrophy angina
What is aortic regurgitation?
Backflow of blood from the aorta into the left ventricle during diastole.
What causes aortic regurgitation?
Aortic root dilation (e.g. syphilitic aneurysm
What are clinical features of aortic regurgitation?
Blowing diastolic murmur bounding pulse
What is the treatment for aortic regurgitation?
Valve replacement once left ventricular dysfunction develops.
What is mitral valve prolapse?
Ballooning of the mitral valve into the left atrium during systole often due to myxoid degeneration.
What conditions are associated with mitral valve prolapse?
Marfan syndrome and Ehlers-Danlos syndrome.
What are clinical features of mitral valve prolapse?
Mid-systolic click with a regurgitation murmur louder with squatting.
What is mitral regurgitation?
Backflow of blood from the left ventricle into the left atrium during systole.
What are common causes of mitral regurgitation?
Mitral valve prolapse LV dilation
What murmur is associated with mitral regurgitation?
Holosystolic blowing murmur louder with squatting and expiration.
What are consequences of mitral regurgitation?
Volume overload and left-sided heart failure.
What is mitral stenosis?
Narrowing of the mitral valve orifice usually due to chronic rheumatic heart disease.
What murmur is associated with mitral stenosis?
Opening snap followed by a diastolic rumble.
What are complications of mitral stenosis?
Pulmonary congestion
pulmonary hypertension
What is endocarditis?
Inflammation of the endocardium often affecting the surface of cardiac valves
What is the most common cause of endocarditis?
Streptococcus viridans a low-virulence organism that infects previously damaged valves
How does Streptococcus viridans cause endocarditis?
It adheres to thrombotic vegetations on damaged valves often following transient bacteremia.
What is the most common cause of endocarditis in IV drug users?
Staphylococcus aureus a high-virulence organism that infects normal valves (commonly tricuspid)
What organism is associated with endocarditis in prosthetic valves?
Staphylococcus epidermidis.
What organism is associated with endocarditis in patients with colorectal carcinoma?
Streptococcus bovis.
What are HACEK organisms?
Haemophilus Actinobacillus
What are common clinical features of bacterial endocarditis?
Fever murmur
What are Janeway lesions?
Erythematous non-tender lesions on palms and soles due to septic emboli.
What are Osler nodes?
Tender lesions on fingers or toes due to immune complex deposition.
What is nonbacterial thrombotic endocarditis?
Sterile vegetations that arise in hypercoagulable states or adenocarcinoma typically on the mitral valve
What is Libman-Sacks endocarditis?
Sterile vegetations on both surfaces of the mitral valveassociated with SLE
What is dilated cardiomyopathy?
Dilation of all four heart chambers causing systolic dysfunction and often leading to biventricular CHF.
What are causes of dilated cardiomyopathy?
Idiopathic genetic mutations
What is the treatment for dilated cardiomyopathy?
Heart transplant.
What is hypertrophic cardiomyopathy?
Massive hypertrophy of the left ventricle commonly due to genetic mutations in sarcomere proteins (autosomal dominant).
What are clinical features of hypertrophic cardiomyopathy?
Decreased cardiac output sudden death (ventricular arrhythmias)
What is a common cause of sudden death in young athletes?
Hypertrophic cardiomyopathy.
What does biopsy show in hypertrophic cardiomyopathy?
Myofiber hypertrophy with disarray.
What is restrictive cardiomyopathy?
Decreased ventricular compliance due to stiff endomyocardium restricting diastolic filling.
What are causes of restrictive cardiomyopathy?
sarcoidosis Amyloidosis
What is a classic EKG finding in restrictive cardiomyopathy?
Low-voltage EKG with diminished QRS amplitude.
What is myxoma?
A benign mesenchymal tumor with gelatinous appearance usually forming a pedunculated mass in the left atrium.
What are clinical symptoms of a cardiac myxoma?
Syncope due to mitral valve obstruction.
What is rhabdomyoma?
A benign hamartoma of cardiac muscle most common primary cardiac tumor in children.
What condition is associated with rhabdomyomas?
Tuberous sclerosis.
Where do rhabdomyomas usually arise?
In the ventricles.
What are common sites of metastatic cardiac tumors?
Most commonly the pericardium leading to pericardial effusion.
What are common primary cancers that metastasize to the heart?
Breast and lung carcinoma melanoma
What is endocarditis?
Inflammation of the endocardium lining the heart valves often due to bacterial infection.
What is the most common cause of endocarditis overall?
Streptococcus viridans a low-virulence organism that infects previously damaged valves
How does Streptococcus viridans cause endocarditis?
It infects thrombotic vegetations on damaged valves often following transient bacteremia.
What is the most common cause of endocarditis in IV drug users?
Staphylococcus aureus a high-virulence organism infecting normal valves
What type of endocarditis does Staphylococcus aureus cause?
Acute endocarditis with large vegetations that destroy the valve.
What organism is associated with endocarditis of prosthetic valves?
Staphylococcus epidermidis.
What organism is associated with endocarditis in patients with colorectal carcinoma?
Streptococcus bovis.
What are HACEK organisms?
Haemophilus Actinobacillus
What are clinical features of bacterial endocarditis?
murmur Fever
What are Janeway lesions?
Non-tender erythematous lesions on palms and soles due to septic emboli.
What are Osler nodes?
Tender lesions on fingers or toes often due to immune complex deposition.
What laboratory findings are typical in bacterial endocarditis?
Positive blood cultures anemia of chronic disease
What is nonbacterial thrombotic endocarditis?
Sterile vegetations on the mitral valve in hypercoagulable states or adenocarcinoma causing mitral regurgitation.
What is Libman-Sacks endocarditis?
Sterile vegetations on both surfaces of the mitral valve associated with SLE
What are cardiomyopathies?
A group of diseases affecting the myocardium causing cardiac dysfunction.
What is dilated cardiomyopathy?
Dilation of all four heart chambers leading to systolic dysfunction and often biventricular CHF.
What are common causes of dilated cardiomyopathy?
Idiopathic genetic mutations
What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurgitation arrhythmia
What is the treatment for dilated cardiomyopathy?
Heart transplant.
What is hypertrophic cardiomyopathy?
Massive left ventricular hypertrophy often due to genetic mutations in sarcomere proteins (autosomal dominant).
What are clinical features of hypertrophic cardiomyopathy?
Decreased cardiac output sudden death (ventricular arrhythmias)
What is a common cause of sudden death in young athletes?
Hypertrophic cardiomyopathy.
What does biopsy show in hypertrophic cardiomyopathy?
Myofiber hypertrophy with disarray.
What is restrictive cardiomyopathy?
Decreased compliance of the ventricular endomyocardium causing restricted filling during diastole.
What are causes of restrictive cardiomyopathy?
sarcoidosis Amyloidosis
What is a classic EKG finding in restrictive cardiomyopathy?
Low-voltage EKG with diminished QRS amplitude.
What is a cardiac myxoma?
A benign mesenchymal tumor with a gelatinous appearance most commonly a pedunculated mass in the left atrium.
What are clinical features of cardiac myxoma?
Syncope due to obstruction of the mitral valve by the tumor.
What is rhabdomyoma?
A benign hamartoma of cardiac muscle the most common primary heart tumor in children.
What condition is associated with rhabdomyomas?
Tuberous sclerosis.
Where do rhabdomyomas typically arise?
In the ventricles.
What is the most common type of heart tumor?
Metastatic tumors more common than primary tumors.
What are common sites of metastasis to the heart?
Breast and lung carcinoma melanoma
What are the common effects of metastatic heart tumors?
Pericardial involvement often leading to pericardial effusion.
