Cardiac Pathology 2

Question 1

Aetiology of Right Sided Heart Failure?

Answer 1

• Left heart failure

- Cor pulmonale

Question 2

What are the two types of Valvular heart disease

Answer 2

Opening problems - stenosis normally due to chronic abnormal of valvular leaflet
Closing problems - regurgitation due to failure of valve to close properly

Question 3

CONGENITAL - ASD

Answer 3

NOT patent foramen ovale
Usually asymptomatic until adulthood
SECUNDUM (90%): Defective fossa ovalis
PRIMUM (5%): Next to AV valves, mitral cleft
SINUS VENOSUS (5%): Next to SVC with anomalous pulmonary veins draining to SVC or RA

Question 4

CONGENITAL - VSD

Answer 4

Most common CHD defect
Only 30% are isolated
Often with TETRALOGY of FALLOT
90% involve the membranous septum
If muscular septum is involved, can have multiple holes (“swiss-cheese”septum)
SMALL ones often close spontaneously
LARGE ones progress to pulmonary hypertension

Question 5

CONGENITAL - Coarctation of aorta

Answer 5

M>F
But XO’s frequently have it
INFANTILE FORM (proximal to PDA) (SERIOUS)‏
ADULT FORM (CLOSED DUCTUS, i.e., NO PDA)‏
Bicuspid aortic valve 50% of the time

Question 6

CONGENITAL - Fallot’s Tetralogy

Answer 6

Most COMMON
1) VSD, large
2) OBSTRUCTION to RV outflow
3) Aorta OVERRIDES the VSD
4) RVH
SURVIVAL DEPENDS on SEVERITY of SUBPULMONIC STENOSIS

Can be a “PINK” tetralogy if pulmonic obstruction is small, but the greater the obstruction, the greater is the R->L shunt

Question 7

What are clinical effects of low cardiac output in Left sided cardiac output?

Answer 7

1. Reduced kidney perfusion
   - pre-renal azotemia (high N)
   - renin-angiotension-aldosterone activation = salt and fluid retension- expansion of interstitial and intravascular fluid volume.
2. Advanced cardiac failure can lead to cerebral hypoxia - irritability, restlessness, stupor, coma

Question 8

What are signs and symptoms of right sided heart failure?

Answer 8

• engorgement of system and portal venous systems
• liver and spleen (portal congestion); passive congestion (nutmeg liver), congestive splenomegaly, ascites
• Pleura/ pericardium (systemic venous congestion); pleural and pericardial effusions, transudates
• Oedema of peripheral and dependent parts of the body

Question 9

What are the cardiac changes that take pace in CHF?

Answer 9

cardiomegaly, chamber dilatation, hypertrophy of myocardial fibres, BOXCAR nuclei

Question 10

What make up 70% of all VHD’s?

Answer 10

AS Aortic stenosis - caused by calcification of a deformed (congenital bicuspid) valve - 50-70 Y/O
MS Mitral stenosis - caused by rheumatic heart disease

Question 11

What is Rheumatic heart disease?

Answer 11

Follows a group A strep infection, a few weeks later
DECREASE in “developed” countries
PANCARDITIS: 1) Endocarditis,
2) Myocarditis, 3) Pericarditis

Question 12

What make up 70% of all VHD’s?

Answer 12

AS Aortic stenosis - caused by calcification of a deformed (congenital bicuspid AV) valve - 50-70 Y/O.
- hyperlipidaemia, hypertension and inflammation may also play a role
MS Mitral stenosis - caused by rheumatic heart disease

Question 13

What are two types of RHD?

Answer 13

ACUTE:
-Inflammation
-Aschoff bodies
-Anitschkow cells
-Pancarditis
-Vegetations on chordae tendinae at leaflet junctionCHRONIC:
THICKENED VALVES
COMMISURAL FUSION
THICK, SHORT, CHORDAE TENDINAE

Question 14

What are characteristics of aortic stenosis?

Answer 14

2x gradient pressure, LVH but no hypertension ischaemia, cardiac decompensation, angina, CHF

Question 15

What are causes of aortic regurgitation?

Answer 15

Rheumatic
Infectious
Aortic dilatations
Syphilis
Rheumatoid Arthritis
Marfan

Question 16

What are causes of mitral regurgitation?

Answer 16

MVP Mitral Valve Prolapse- main
Infectious
Fen-Phen
Papillary muscles, chordae tendinae
Calcification of mitral ring (annulus)

Question 17

What is MVP?

Answer 17

MYXOMATOUS degeneration of the mitral valve
Associated with connective tissue disorders
“Floppy” valve
3% incidence, F»M
Easily seen on echocardiogram

Question 18

What are clinical features of MVP?

Answer 18

Usually asymptomatic
Mid-systolic “click”
Holosystolic murmur if regurg. present
Occasional chest pain, dyspnea
97% NO untoward effects
3% Infective endocarditis, mitral insufficiency, arrythmias, sudden death

Question 19

What is mitral annular calcification?

Answer 19

Calcification of mitral skeleton. Usually NO dysfunction.
Regurgitation usually but stenosis possible.
F»M

Question 20

What are congenital heart defects?

Answer 20

Faulty embryogenesis (week 3-8)‏
Usually MONO-morphic (i.e., SINGLE lesion) (ASD, VSD, hypo-RV, hypo-LV)
May not be evident until adult life (Coarctation, ASD)

Question 21

What role do genetics play in cardiac heart diseases?

Answer 21

• only in 10%Trisomies 21, 13, 15, 18, XO
  Mutations of genes which encode for transcription factors-TBX5->ASD,VSD
  NKX2.5->ASD
  Region of chromosome 22 important in heart development, 22q11.2 deletion->conotruncus, branchial arch, face

Question 22

What are environmental factors contributing to congenital heart defects?

Answer 22

Teratogens, rubella

Question 23

How can you classify congenital heart diseases?

Answer 23

LR SHUNTS: all “D’s” in their names
NO cyanosis
Pulmonary hypertension
SIGNIFICANT pulmonary hypertension is IRREVERSIBLE
RL SHUNTS: all “T’s” in their names
CYANOSIS (i.e., “blue” babies)
VENOUS EMBOLI become SYSTEMIC “paradoxical”
OBSTRUCTIONS: aorta or pulmonary artery