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Cardiology > Cardiac Pathology > Flashcards

Cardiac Pathology Flashcards

1
Q

Other causes of IHD?

A
  1. Increased Demand (HTN) 2. Diminished blood volume (Shock or Hypotension) 3. Diminished oxygenation (CHF) 4. Diminished O2 carrying capacity (Anemia or carbon monoxide poisoning)
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2
Q

What is the most common type of the cardiomyopathies?

A

Dilated Cardiomyopathy *(systolic dysfunction - low ejection fraction)

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3
Q

Restrictive cardiomyopathy is characterized by:

A

Decreased ventricular compliance, resulting in impaired ventricular filling during diastole (I.e. Stiff ventricles)

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4
Q

Main cause of a Myocardial Infarction?

A

Acute coronary thrombosis Usually due to a rupture of an atheroslcerotic plaque with thrombosis and COMPLETE occlusion of coronary artery

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5
Q

Other causes of MI (other than the main cause)

A
  1. Coronary artery vasospasm (Prinzmetal angina or cocaine use)
  2. Emboli
  3. Vasculitis (e.g. Kawazaki’s disease)
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6
Q

What type of Angina is associated with chest pain at rest and a > 90% occlusion?

A

Unstable Angina

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7
Q

How long before ischemia due to an MI causes irreversible damage?

A

20 to 40 minutes

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8
Q

Characteristics of hypertrophic cardiomyopathy

A

Myocardial hypertrophy resulting in diastolic dysfunction

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9
Q

What laboratory test is the gold standard for a MI?

A

Troponin I enzyme levels

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10
Q

What histological finding is associated with reperfusion? -what causes it? - where is it most likely seen?

A

Contraction bands *a. hypercontraction due to massive calcium influx *b. seen at margin of infarct

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11
Q

Causes of dilated cardiomyopathy?

A
  1. genetic ( AD) (Dystrophin gene mutations)
  2. chronic alcoholism
  3. Drugs (Doxorubicin)
  4. Myocarditis (Coxsackie A or B)
  5. Iron overload
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12
Q

Describe the gross morphology of the heart in dilated cardiomyopathy:

A
  • Flabby, with dilation of all 4 chambers (All type of ventricular thickness can be seen) - Mural thrombi and embolism can occur
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13
Q

How long does it take to loos cardiac function after an MI?

A

1 minutes

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14
Q

Main cause of Ischemic Heart Disease

A

Atherosclerotic vascular disease that leads to reduced coronary blood floow Proximal worse than distal

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15
Q

Histological finding in hypertrophic cardiomyopathy

A

Myofiber disarray (surrounded by collagen) - usually in interventricular septum

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16
Q

Who is MOST likely to have a MI?

A

Men ages 40-65 - incidence between men and women become close to equal after menopause

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17
Q

Chest pain that occurs at rest and caused by coronary artery spasm

A

Prinzmetal angina

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18
Q

Name the major groups of syndromes related to myocardial ishemia/

A
  1. Angina
  2. Myocardial Infarction (MI)
  3. Sudden Cardiac death
  4. Chronic Ischemic heart disease
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19
Q

(Wet) Beriberi heart disease is caused by?

A

Thiamine deficiency - usually due to chronic alcoholism *leads to CHF

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20
Q

What is the underlying cause of plaque formation and eventual rupture leading to MI?

A

Inflammation

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21
Q

Main cause of hypertrophic cardiomyopathy

A

mutations in genes encoding sarcomeric proteins (beta-myosin heavy chain)

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22
Q

What is the most commonly involved coronary artery involved in MI, and which part of the heart does the infarction consequently occur?

A
  1. LAD - leads to infarction of the anterior wall and anterior septum
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23
Q

Increasingly frequent or worse pain w/ progressively less exertion or eventually occurring at rest

A

Unstable Angina

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24
Q

T or F: Angina is a type of ischemia associated with reversible injury to the myocyte (I.e. No necrosis)

A

T

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25
Q

Which part of the myocardium is most vulnerable to hypoperfusion and hypoxia, and therefor the first part affected?

A

The subendocardium (the inner 3rd of the myocardium)

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26
Q

An infarction involving the entire thickness of the ventricle is termed?

A

Transmural infarct - occurs in the absence of intervention

27
Q

“crushing or Squeezing” chest pain with predictable episodes at particular levels of exertion - occurs for

A

Stable Angina - Lesions occluding > 70% (critical stenosis) are symptomatic, causing stable angina

28
Q

Clinical features of hypertrophic cardiomyopathy?

A
  • Common cause of sudden cardiac death in young athletes* - Decreased CO (hypertrophy prevents ventricle from filling) - Banana-shaped ventricular lumen
29
Q

Secreted by macrophages and have the capability to destabilize atherosclerotic plaque and cause thrombosis?

A

Metalloproteinases

30
Q

What can be done to limit the extent of myocardial necrosis caused by an MI?

A
  1. Early thrombolytics 2. Angioplasty
31
Q

54 yo man presents w/ severe crushing chest pain that has lasted > 20 min and radiates to left arm; diaphoreis, and dyspena what is the most likely Dx?

A

Myocardial infarction

32
Q

Causes of Restrictive cardiomyopathy

A
  1. Amylodosis
  2. Hemochromatosis (via iron overload)
33
Q

Morphology of restrictive cardiomyopathy

A
  1. ventricles normal sized or slightly enlarged
  2. No dilation
    1. Biatrial dilation (due to poor ventricular filling and pressure overload)
34
Q

Definition of myocarditis

A

infectious agents and/or inflammatory processes that target myocardium

35
Q

What is the most common cause of myocarditis?

A

Viral infections

(Coxsackievirus A and B, and also enterovirus as majority of cases)

36
Q

Nonviral infectous causes of myocarditis?

A

Any microbe but following are important:

1. Trypanosoma cruzi (protazoa)

  • Found in Central and South America (Dx via recent travel)
  • Causes Chagas disease

2. Toxoplasma gondii

  • household cat are common vector
  • affect immunocompromised or pregnant women

3. Borrelia burgdorferi

  • bacteria that causes lyme disease
  • Ixodes tick = vector!
37
Q

Histological finding in Myocarditis

A
  • Lymphocyte infiltration (Viral)
  • abcesses (Bacterial)

General:

  • edema
38
Q

non-infectous causes of myocarditis?

A
  1. Immune mediated (i.e. Lupus)
  2. Drug hypersensitiviy rxns
  3. Giant Cell myocarditis
  • aggresive w/ poor prognosis
39
Q

What is pericardial disease?

A

Disorders that include effusions and inflammatory conditions

(usually secondary to other cardiac diseases)

40
Q

What condition is most commonly associated with pericarditis?

A

Uremia (via renal failure)

41
Q

What causes the majority of neoplasms within the heart?

A

Metastasis

  1. Pleural mesothelioma (most likely)
  2. melanoma
  3. Lung adenocarcinoma
  4. Lung squamous cell
42
Q

Although Primary tumors of the heart are uncommon, what is the most common type?

A

Myxomas

  • most are found in left atria
  • Gelatinous
  • pedunculated forms swing into AV valve and damage leaflets
43
Q

A primary tumor of the heart that is most frequent in infants and children and commonly associated with tubular sclerosis

A

Rhabdomyomas

44
Q

Tx for uncontrollable heart failure

A

Cardiac transplantation (heart transplant)

45
Q

Major complications of a Cardiac transplant

A
  1. acute rejection
  2. allograft arteriopathy
  3. Oppertunistic infection (immunosupression)
  4. Malignancies (PTLD via EBV)
46
Q

Most cases of CHF are due to:

A

Systolic Dysfunction

  • via inadequate myocardial contractile function

(Can also be diastolic)

47
Q

CHF due to systolic dysfunction is usually a consequence of?

A
  1. Ischemic Heart disease
    1. Hypertension
48
Q

Pathological changes that can lead to diastolic dysfunction?

A
  • LV Hypertrophy
  • Myocardial Fibrosis
  • Pericarditis
  • valve dysfunction
  • Abrupt volume overload
49
Q

What causes Concentric Hypertophy?

A

Pressure overload states

  • HTN
  • Valvular stenosis
50
Q

What causes ventricular Eccentric hypertrophy?

A

Volume overload states

51
Q

Symptoms of Left-sided Heart failure?

A
  • Pulmonary edema
  • dyspnea
  • orthopnea
52
Q

Symptoms of right-sided heart failure?

A
  • Peripheral edema
  • Abdominal edema (ascites)
  • Congestive Hepato- and splenomegaly
  • Ansarca (in advanced disease)
53
Q

What is the major cause of Right heart failure?

A

Left heart failure

54
Q

Most common causes of Left-sided heart failure?

A
  1. Ischemic Heart disease
  2. Hypertension
  3. Mitral or Aortic valve disease
  4. Primary diseases of the myocardium (amyloidosis)
55
Q

Lung morphology in those with CHF?

A

Gross:

  • congestion
  • edema
  • Pleural effusion

Micro:

  • Hemosiderin-laden Macrophages (Heart failure cells)
56
Q

Causes of isolated right-heart failure

A
  1. Severe pulmonary hypertension (cor pulmonale)
  2. Primary pulmonic or Tricuspid disease
  3. Congenital heart disease (L-to-R shunts)
57
Q

Morphology of R-sided Heart failure

A

Gross (heart)

  1. Dilation of RA and RV (acute)
  2. RV hypertophy (Chronic) - R side looks like left

Gross (Liver)

  1. Nutmeg liver
58
Q

What’s the Kidney’s role in CHF?

A

It activates the RAAS, which leads to increased water retention and edema

  • low CO => low renal perfusion (kidney thinks there is low BV)
59
Q

Why does bed rest help PTs with CHF?

A
  1. It increases venous return
  2. It prevents the increase in Renin and aldosterone

(renin and aldosterone increases when upright)

60
Q

How does the temperature affect those with CHF?

A

Heat => skin vasodilation =>decreased renal perfusion => increased aldosterone (water retention)

61
Q

When do you see ansacara in pts w/ CHF?

A

Advanced/chronic HF

  • 30L interstitual fluid
62
Q

In addition to its ability to cause edema in PTs with CHF, how else does the RAAS affect these patients?

A

Renin, Angiotensin II and Aldosterone have direct cardiotoxic affects on the heart

Other processes that have direct damaging effects

  • Increased sympathetic activity
  • Increased afterload
63
Q

Key physical findings of CHF

A
  1. Dyspnea on exertion
  2. External jugular vein distension
  3. Peripheral edema

Cardiology (15 decks)

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