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MED233 Cardiovascular > Cardiac Pathology 2, Valvular Dz, Cardiomyopathies, Congenital HD, Shunts,Obstructive Lesions > Flashcards

Cardiac Pathology 2, Valvular Dz, Cardiomyopathies, Congenital HD, Shunts,Obstructive Lesions Flashcards

1
Q

Mechanical difference between stenosis and insufficiency.

A

Stenosis - valve doesn’t open completely (Chronic) = PRESSURE overload hyptertrophy
Insufficiency - valve doesn’t close completely (AorC) = VOLUME overload hyptertrophy

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2
Q

Chronically, what do both stenosis and insufficiency result in?

A

Both result in overload hyperTrophy&raquo_space; CHF

Stenosis = pressure, Insufficiency = volume

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3
Q

What is the most common valve abnormality, and why?

A

Calcific Aortic Stenosis. BICUSPID Valves accelerated course. Ossification and calcification prevent valve opening. “Wear and tear” with age, chronic HTN

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4
Q

Describe calcification in Mitral Annular Calcification and common results of this condition.

A

F>M, 60yo. Calcific deposits in the fibrinous annulus around MV. MV-PROLAPSE common.
Nodules may become sites for IE or thrombus formation.

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5
Q

What is MV-Prolapse? Describe physical characteristics.

A 
MV leaflets prolapse back into LA during systole = "systolic click".
Myxomatous degeneration (thickened/rubbery leaflets)
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6
Q

Describe the presentation of MV-Prolapse.

A

Females. Most asymptomatic, but may mimic angina-like pain or dyspnea.
May be the result of other regurgitation defects (dilated hypertrophy).

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7
Q

What are rare, but SERIOUS complications of MV-Prolapse?

A

IE, Mitral Insufficiency, Thromboembolism, Arrhythmias

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8
Q

Describe Rheumatic Fever (RF): What is it and what can it lead to?

A

Multisystem inflammatory disorder. Acute RF can evolve into chronic rheumatic heart disease.

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9
Q

RF Pathogenesis

A

Caused by grp A strep M proteins cross reacting with cardiac self-Ag.

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10
Q

Anti-streptolysin O, think what? And how long ago?

A

Grp A strep infection 10days-6wks ago, now Acute RF

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11
Q

What cardiac morphologic features are associated with Acute RF?

A

PANCARDITIS with ASCHOFF BODIES. Fibrinoid necrosis of endocardium and L-valves, with vegetations (VERRUCAE).

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12
Q

What are cardiac morphologic features are associated with Chronic RF?

A

Mitral leaflet thickening, fusion/shortening of commissures, fusion/thickening of tendinous cords. All resulting in MITRAL STENOSIS

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13
Q

If you see Mitral Stenosis, think what?

A

Chronic RHD!

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14
Q

What are clinical features of Chronic RHD?

A

LA enlargement leads to afib/thrombosis; pulm congestion/RHF.

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15
Q

What is Infective Endocarditis (IE)?

A

Infection of valves and endocardium with vegetations consisting of microbes and debris, associated with underlying tissue destruction.

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16
Q

Describe acute IE.

A

Rapidly progressing destruction of previously normal valve. Tx requires surgery and antibiotics.

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17
Q

Describe subacute IE.

A

Slowly progressing destruction of previously deformed valve (i.e. chronic RHD). Tx requires only antibiotics.

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18
Q

What predisposing conditions can lead to IE?

A

(1) Valvular abnormalities - RHD, prosthetic valve, MV-prolapse, calcific stenosis, bicuspid AV. (2) Bacteremia - dental work, needle, compromised epithelium, another site of infection.

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19
Q

What are the classic morphologic features of IE?

A

Friably, bulky, destructive valvular vegetations that lead to septic emboli.
Left-valves more often affected.

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20
Q

Clinical presentation of IE.

A

SICK, but nonspecific symptoms - fever, weight loss, fatigue.
Murmurs usually present with left-sided lesions.

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21
Q

Organisms that are often involved in IE.

A

Strep viridans, Staph aureus, Staph epidermidis, **HACEK (Hemophilus, Actinobacillus, Cardiobaterium, Eikenella, Kingella)

22
Q

Associate mucinous-adenocarcinomas (MALIGNANCIES), sepsis, or catheter induced endocardial trauma with what type of valvular disease?

A

NBTE

23
Q

What is NBTE?

A

Nonbacterial thrombotic endocarditis.

Small, sterile thrombi of cardiac valve leaflets, along line of closure.

24
Q

What are the 3 major categories of cardiomyopathies?

A

(1) Dilated cardiomyopathy - most common! (2) Hypertrophic cardiomyopathy (3) Restrictive cardiomyopathy.

25
Q

Dilated cardiomyopathy causes

A

Familial (TTN mutation), ALCOHOL (cirrhosis), Cardiotoxic drugs, myocarditis/Coxsackie.

26
Q

What is dilated cardiomyopathy (3 things)?

A

(1) Progressive cardiac dilated hypertrophy of ALL chambers (GLOBULAR). (2) SYSTOLIC dysfunction. (3) Mural thrombi common. (4) Functional regurgitation of valves.

27
Q

What is this describing? Ages 20-50, progressive CHF leads to dyspnea, exertional fatigue, and decreased EF. Arrythmias and embolism. S3/systolic dysfunction.

A

Presentation of dilated cardiomyopathy.

28
Q

What is arrhythmogenic right ventricular cardiomyopathy - what part of heart and what morphological changes?

A

Right ventricular failure and arrhythmias. Myocardium of right ventricular wall replaced by adipose and fibrosis.

Muscle replaced by fat

29
Q

What results from arrhythmogenic RVcardiomyopathy? What is its cause?

A

Causes ventricular tachycardia and fibrillation, sudden death.
Familial.

30
Q

What is hypertrophic cardiomyopathy?

A

DIASTOLIC dysfunction. Often causes ventricular outflow obstruction.

31
Q

Morphology of hypertrophic cardiomyopathy

A

Massive myocardial hypertrophy, often with SEPTAL hypertrophy.
Microscopically=myocyte disarray.

32
Q

What is restrictive cardiomyopathy? What causes it?

A

DIASTOLIC dysfunction. Decreased ventricular compliance (stiff), leading to diastolic dysfunction - leads to ATRIAL enlargement.
Causes: amyloid or fibrosis (radiation).

33
Q

Associate b-pleated sheets with what. This causes what?

A

Amyloid = restrictive cardiomyopathy.

Systemic=myeloma; restricted to heart=transthyretin

34
Q

Testing for amyloidosis?

A

Apple green birefrigence.

35
Q

Definition of myocarditis and most common causes of myocarditis.

A

Def - inflammation of myocardium, caused by:
Viral - **COXSACKIE A and B, echovirus
Also - Trypanosome (Chagas), RF, SLE

36
Q

What do you see microscopically in viral myocarditis.

A

Lymphocytic infiltrate is seen in viral myocarditis.

37
Q

Associate trisomy 21 with what?

A

Congenital heart disease

38
Q

Three things that result in left-to-right shunts.

A

ASD, VSD, PDA.

39
Q

When are ASDs dx?
Atrial septal defects may lead to what 3 things?
Tx?

A

Asymptomatic until adulthood. MUMUR and RV hypertrophy or dilated RA.
Vol. overload on right = Pulmonary HTN, right HF, paradoxical embolization (i.e. dt DVT)
Surgical closure.

40
Q

Large VSDs may lead to what?

A

RV hypertrophy. Pulm HTN, which can reverse flow through the shunt and lead to to CYANOSIS.

41
Q

Seen in infants - cyanosis and harsh, machinery-like murmur.

A

PDA

42
Q

Postnatal cyanosis is associated with what type of shunt?

A

Right to left shunt!

43
Q

Tetrology of Fallot is what type of shunt (classically) and what 4 cardinal features?

A

R-L shunt.

4 Features: VSD, obstruction of RV outflow tract, aorta overrides VSD, RV hypertrophy.

44
Q

Associate a boot shape with what specific shunt and what anatomic feature?

A

Tetrology of Fallot, RV HYPERTROPHY

45
Q

Transposition of the great arteries results in what?

Compatible with life?

A

Two sepearte circuits, incompatible with life after birth UNLESS SHUNT IS PRESENT! (Tx: surgery)
often VSD, PDA, or PFO present

46
Q

What is an example of an obstructive lesion of the heart?

A

Coarctation of the aorta.

47
Q

What L-R shunt is narrowing of the aorta associated with?

A

PDA

48
Q

Difference between coarctation of aorta (distal to arterioles to UE/head) with PDA and without PDA. Each manifests at what stage of life?

A 
With PDA (birth): cyanosis in lower half of body.
Without PDA (adult): asymptomatic - UE HTN, LE hypoT and cold, concentric LV hypertrophy
49
Q

All are clinical features of what?

Pancarditis, Syndham chorea, migratory polyarthritis, subcutanous nodules, rash.

A

RF

50
Q

Worsening fatigue with dyspnea, palpitations (arrhythmias), fever over the past week. Elevated Troponin-I. Full recovery.

A

Viral myocarditis

51
Q

Causes of NBTE

A

Hypercoagulable state, CANCER

MED233 Cardiovascular (18 decks)

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