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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
Which part of the myocardium is most vulnerable to hypoperfusion and hypoxia, and therefor the first part affected?
The subendocardium (the inner 3rd of the myocardium)
26
An infarction involving the entire thickness of the ventricle is termed?
Transmural infarct - occurs in the absence of intervention
27
"crushing or Squeezing" chest pain with predictable episodes at particular levels of exertion - occurs for
Stable Angina - Lesions occluding \> 70% (critical stenosis) are symptomatic, causing stable angina
28
Clinical features of hypertrophic cardiomyopathy?
- Common cause of sudden cardiac death in young athletes\* - Decreased CO (hypertrophy prevents ventricle from filling) - Banana-shaped ventricular lumen
29
Secreted by macrophages and have the capability to destabilize atherosclerotic plaque and cause thrombosis?
Metalloproteinases
30
What can be done to limit the extent of myocardial necrosis caused by an MI?
1. Early thrombolytics 2. Angioplasty
31
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?
Myocardial infarction
32
Causes of Restrictive cardiomyopathy
1. Amylodosis 2. Hemochromatosis (via iron overload)
33
Morphology of restrictive cardiomyopathy
1. ventricles normal sized or slightly enlarged 2. No dilation 1. Biatrial dilation (due to poor ventricular filling and pressure overload)
34
Definition of myocarditis
infectious agents and/or inflammatory processes that target myocardium
35
What is the most common cause of myocarditis?
**Viral infections** (**Coxsackievirus A and B**, and also **enterovirus** as majority of cases)
36
Nonviral infectous causes of myocarditis?
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
Histological finding in Myocarditis
* Lymphocyte infiltration (Viral) * abcesses (Bacterial) General: * edema
38
non-infectous causes of myocarditis?
1. Immune mediated (i.e. Lupus) 2. Drug hypersensitiviy rxns 3. **Giant Cell myocarditis** * aggresive w/ poor prognosis
39
What is pericardial disease?
Disorders that include effusions and inflammatory conditions (usually secondary to other cardiac diseases)
40
What condition is most commonly associated with pericarditis?
**Uremia** (via renal failure)
41
What causes the majority of neoplasms within the heart?
Metastasis 1. Pleural mesothelioma (most likely) 2. melanoma 3. Lung adenocarcinoma 4. Lung squamous cell
42
Although Primary tumors of the heart are uncommon, what is the most common type?
Myxomas * most are found in left atria * Gelatinous * pedunculated forms swing into AV valve and damage leaflets
43
A primary tumor of the heart that is _most frequent in infants and children_ and commonly associated with _tubular sclerosis_
Rhabdomyomas
44
Tx for uncontrollable heart failure
Cardiac transplantation (heart transplant)
45
Major complications of a Cardiac transplant
1. acute rejection 2. allograft arteriopathy 3. Oppertunistic infection (immunosupression) 4. Malignancies (PTLD via EBV)
46
Most cases of CHF are due to:
Systolic Dysfunction - via inadequate myocardial contractile function (Can also be diastolic)
47
CHF due to systolic dysfunction is usually a consequence of?
1. Ischemic Heart disease 1. Hypertension
48
Pathological changes that can lead to diastolic dysfunction?
* LV Hypertrophy * Myocardial Fibrosis * Pericarditis * valve dysfunction * Abrupt volume overload
49
What causes Concentric Hypertophy?
**_Pressure_** overload states * HTN * Valvular stenosis
50
What causes ventricular Eccentric hypertrophy?
**_Volume_** overload states
51
Symptoms of Left-sided Heart failure?
* Pulmonary edema * dyspnea * orthopnea
52
Symptoms of right-sided heart failure?
* Peripheral edema * Abdominal edema (**ascites**) * Congestive Hepato- and splenomegaly * Ansarca (in advanced disease)
53
What is the major cause of Right heart failure?
Left heart failure
54
Most common causes of Left-sided heart failure?
1. Ischemic Heart disease 2. Hypertension 3. Mitral or Aortic valve disease 4. Primary diseases of the myocardium (amyloidosis)
55
Lung morphology in those with CHF?
Gross: * congestion * edema * Pleural effusion Micro: * Hemosiderin-laden Macrophages (Heart failure cells)
56
Causes of isolated right-heart failure
1. Severe pulmonary hypertension (cor pulmonale) 2. Primary pulmonic or Tricuspid disease 3. Congenital heart disease (L-to-R shunts)
57
Morphology of R-sided Heart failure
Gross (heart) 1. Dilation of RA and RV (acute) 2. RV hypertophy (Chronic) - R side looks like left Gross (Liver) 1. **Nutmeg liver**
58
What's the Kidney's role in CHF?
It activates the RAAS, which leads to increased water retention and edema - low CO =\> low renal perfusion (kidney thinks there is low BV)
59
Why does bed rest help PTs with CHF?
1. It increases venous return 2. It prevents the increase in Renin and aldosterone (renin and aldosterone increases when upright)
60
How does the temperature affect those with CHF?
Heat =\> skin vasodilation =\>decreased renal perfusion =\> increased aldosterone (water retention)
61
When do you see ansacara in pts w/ CHF?
Advanced/chronic HF * 30L interstitual fluid
62
In addition to its ability to cause edema in PTs with CHF, how else does the RAAS affect these patients?
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
Key physical findings of CHF
1. Dyspnea on exertion 2. External jugular vein distension 3. Peripheral edema

Cardiology (15 decks)

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