Cardiac Pathology (Part 2) Flashcards
what is the most common type of atrial septal defect?
ostium secundum ASD
what is the most common VSD?
membranous
what does left-to-right shunt lead to?
eisenmenger syndrome
what are the four principal features of tetralogy of fallot?
VSD, right ventricular hypertrophy, subpulmonic stenosis, overriding aorta
what drives the degree of symptoms in tetralogy of fallot?
the degree of stenosis
what are some classic symptoms of kids with tetralogy of fallot?
tet spells, compensatory squatting; two murmurs: holosystolic from the VSD and systolic ejection murmur from the subpulmonic stenosis
what is the xray finding consistent with tetralogy of fallot?
boot shaped heart
how can one stay alive with a tricuspid atresia?
ASD and VSD must be present
what is coarctation of the aorta associated with?
1) turner syndrome 2) additional cardiovascular abnormalities (bicuspid aortic valve, berry aneurysm)
how does the infantile form of coarctation of the aorta present?
cyanosis at birth of lower half of the body
how does the adult form of coarctation of the aorta present?
upper body: hypertension; lower body: hypotension, weak pulses; rib notching
how can congenital aortic stenosis present?
hypoplastic (small) valves; dysplastic (nodular) valves; abnormal cusp number; results in LVH
where does a paradoxical embolism of a PDA involve?
the lower body
when is one at risk for a paradoxical embolism?
if there is a transient increase in right pressure, bright right –> left shunt
what is the most common genetic cause of congenital heart disease?
down syndrome
what are the most common heart defects seen in down syndrome patients?
septal defects: atrioventricular > ventricular> atrial
what are the cardiovascular effects of marfan syndrome?
aortic aneurysm and dissection
what is the mechanism of marfan syndrome?
fibrillin 1 mutation, excessive TGF-beta activity, which causes increased metalloprotease (degrades elastin)
what causes Digeorge syndrome?
a deletion in chromosome 22
what are the characteristics of digeorge syndrome?
CATCH 22: cardiac abnormality, abnormal facies, thymic aplasia, cleft palate, hypocalcemia
what heart abnormality is associated with digeroge?
conotruncal heart abnormalities (TOF, transposition of the great arteries), ASD, VSD
what type of hypertrophy is seen in hypertensive heart disease?
concentric
how does hypertensive heart disease also lead to systolic dysfunction?
there is a lack of vascularization with muscle–> ischemia–> failure
how does cor pulmonale present?
initially cor pulmonale shows dilation of the right ventricle; later there is compensatory hypertrophy of the right ventricle
what is the most common valve abnormality?
calcific aortic stenosis
what causes the calcifications in calcific aortic stenosis?
chronic progressive injury driven by similar factors which cause atherosclerotic disease (chronic HTN and hyperlipidemia)
when does calcific aortic stenosis typically manifest?
7-9th decade of life
a bicuspid aortic valve is caused by what?
1) acquired (typically rheumatic heart disease)
2) congenital abnormality
what is the effect of bicuspid aortic valve?
there is an accelerated course of calcific aortic stenosis; the bicuspid valves may become incompetent: aortic valve porlapse
having valve abnormalities predisposes individuals to what?
infective endocarditis
what effect does calcific aortic stenosis have on the heart?
it increases LV pressure–> concentric left ventricular hypertrophy
what are the signs and symptoms of calcific aortic stenosis?
systolic murmur, syncope, angina, CHF
what is mitral annular calcifications?
calcific deposits in the fibrous annulus; usually presents in females >60 especially those with mitral valve prolapse
how does mitral annular calcification affect the heart?
arrhythmias (heart block, sudden death)
what is mitral valve prolapse?
the valve leaflets prolapse back into the left atrium
what does the histology show in cases of mitral valve prolapse?
thickened and rubbery valve with myxomatous degeneration caused by increased proteoglycan deposits; hooding of the mitral leaflets
how does mitral valve prolapse present?
asymptomatic with a mid systolic click; dyspnea
how do you confirm suspected case of rheumatic fever?
test for antibodies against streptolysin O and DNase B
what are the signs and symptoms of rheumatic fever?
migratory polyarthritis, subcutaneous nodules, erythema marginatum, and chorea
what is the histology of acute rheumatic heart disease?
aschoff bodies with anitschkow cells
what are the characteristics of cute rheumatic heart disease?
pericarditis, myocarditis, endocarditis, valvulitis, MacCallum plaques
what are the characteristics of chronic rheumatic heart disease?
valvular leaflet thickening, short chordae tendineae, fusion, regurgitation
how does mitral stenosis sound on auscultation?
diastolic rumbling murmur
what can mitral stenosis and mitral regurgitation lead to?
left atrial enlargement–> leads to a fib
what are the signs of infective endocarditis?
splinter hemorrhages janeway lesions, osler nodes, and roth spots
