Cardiac Pathology Part 2 - Dr. Hillard Flashcards
congenital heart disease cause
- mostly spontaneous genetics
- fetal alcohol syndrome
- most common type if birth defect
most common type of congenital heart disease
Ventricular septal defect (VSD)
Left to right shunts causes what and sx
- high P of left heart or aorta , lower P pulm trunk and right side
- Initially asymptomatic and not cyanotic**
right to left shunts what and and sx
- bypassing pulmonary circulation, usually from right heart hypertrophy or Tetrology of fallot (causing higher P in right side)
- symptomatic and cyanotic
left to right shunts top 3
- ASD
- VSD
3 Patent Ductus Asteriosus
right to left shunt top 3
- Tetralogy of Fallot
- Transposition of Great Arteries
- Tricuspid Atresia
ASD most common type
Ostium Secundum ASD (90%)
= hole in the middle of septum
ASD sx
asymptomatic at birth and until adulthood
= you can here a systolic ejection murmur**
= small hole can close spontaneously
VSD most common sx and most common type
membranous VSD (at the top of septum)** = asymptomatic until adulthood = Holosystolic murmur* = most close spontaneously = if child sx then other anomalies usually present
Patent Ductuctus arteriosus happens from
increased P on right side or pulmonary P
- VSD
- hypoxia fetus
Patent Ductuctus arteriosus location and sx
- Pulmonary A
Patent Ductuctus arteriosus closed how
Indomethacin (drug)
Patent Ductuctus arteriosus kept open how and when
some congenital malformations like Transposition of Great As you want to keep it open
(PGE E1)
Patent Ductuctus arteriosus causes what to happen over time
- higher BF to lungs since it goes directly to Pulm A, higher Pulm P, = Pulmonary HTN
- Eisenmenger Syndrome
Eisenmenger Syndrome what happens
= in long term Left –> Right shunts
1. l–>r increases Pulm BF
2. pulm vascular remodeling (thickening hypertrophy + irreversible)*
3. higher Pulm Resistance –> higher Right side P
4. Right –> Left shunt
5. Eisenmenger syndrome
4.
Eisenmenger Syndrome age and sx
around 20-30yo
40% mortality = repare early
SOB, exercise intolerance, cyanosis
Right to left SX
- Blue babies (blue lips, fingers, toes)
2. clubbing fingers = Hypertrophic ostearthropathy
Tetrology of Fallot includes what
- VSD
- RV hypertrophy
- Subpulmonic stenosis
- Overriding Aorta (in middle of V so he gets the O2 poor and O2 rich blood
Tetrology of Fallot prevalence and 5 sx
most common right to left
- cyanotic at birth
- holosystic murmur (VSD)
- Systolic Ejection murmur (subpulmonic stenosis)
- “Tet” Spell = cyanosis, syncope during emotional distress or excitement or high activity
- squatting
Tetrology of Fallot prevalence and 5 sx
most common right to left
- cyanotic at birth
- holosystic murmur (VSD)
- Systolic Ejection murmur (subpulmonic stenosis)
- “Tet” Spell = cyanosis, syncope during emotional distress or excitement or high activity
- squatting
Tetrology of Fallot what helps them
squatting = increases P on left side = more blood to go l–>r or prevent as much r—>l and allows them to catch breath
imaging Tetrology of Fallot
Boot shaped heart
= concave on pulmonary A segment side
= upturned cardiac apex
Transposition of Great Arteries what happens
Aorta and Pulm Trunk switch sides
1. Aorta and Right side
2. Pulmonary Trunk and Left side
= NEED shunt to survive
Transposition of Great Arteries how can they survive
- PDA
- VSD
- Patent Foca Ovale
= if not shunt incompatible with life, EM surgery
Tricuspid Atresia what happens
X tricuspid valve, no BF from RA to RV
Tricuspid Atresia survival and sx
- ASD/ PFO + VSD *** needed to survive
2. severe immediate cyanosis after birth, EM surgery
Coarctation of the Aorta what happens and the 2 types
narrowing of aorta right before ductes arteriosis
- Infantile form : has PDA
- Adult form : X PDA
Coarctation of the Aorta infantile and adult sx
- infantile : BF from RV to PT through PDA to Aorta = cyanosis of lower Extr.
- adult : BF from LV to aorta with high P = HTN of upper body and Hypotension and low Pulse lower Extr., pain with exertion (arterial insufficiency)
Coarctation of the Aorta associated with
- Turners Syndrome XO (check in women)
- Bicuspid aortic valve
- higher risk in males
Tetrology of Fallot vs Infantile Coarctation of the Aorta
Coarctation of the Aorta in infants causes cyanosis of ONLY lower extr.
adult Coarctation of the Aorta can cause what later
Rib notching = collateral intercostal Vessles made from and you get pressure erosion of rib margin
Congenital Aortic and Pulmonary Valve Stenosis/Atresia (AORTA) causes what
- LV hypertrophy
2. hypoplastic Left Heart syndrome = when LV in not developed enough to pump
Congenital Aortic and Pulmonary Valve Stenosis/Atresia (PULMONARY) usually seen when
- Tet of Fallot
2. Transposition of GAs
Congenital Aortic and Pulmonary Valve Stenosis/Atresia TX
EM surgery
preserve PDA*
PE types
- DVT, thrombus
- Bone marrow, fat from trauma
- Air from nurse not removing air in syringe
- infectious, foreign bodies
Paradoxical Embolism is what
when there is some shunt in heart like Tet of Fallot, or VSD, ASD
1. venous thrombi to Rigth heart crossed to left heart
2. to brain or other organ
= RIGHT –> LEFT SHUNT
Paradoxical Embolism in left to right shunt
usually to lungs only can cross over during those brief time that it switches to r–>l
when does a l–> r shunt switch briefly to r–>l
- cough, sneeze
- BM
- Valsalva (increasing Pulm P)
PFO is what and can open when
flap open r–>l only
- valsalva
- cough, sneeze
- BM
Trisomy 21 most common heart conditions
Septal defects : Atroventricular septal > VSD > ASD
Marfans Syndrome most common heart problems
Aortic aneurysm , Aortic dissection
Marfan Syndrome how it happens
Fibrillin-1 mutation = high TGF-B activity**
- high metalloprotease,
- degrades elastin**
DiGeorge Syndrome mutation and SX
CATCH22 C : cardiac probs A : Abnormal facies, increased pig levi, streak ovaries T : thymic aplasia C : cleft plate H : hypocalcemia 22 : 22q11
DiGeorge Syndrome heart problems
Conotruncal heart abnormalities = tetrology of Fallot ** (transposition of GA, ASD, VSD)
Turner Syndrome heart problems
Coarctation of aorta
Hypertensive Heart Disease criteria 2
- LV concentric hypertrophy (all around LV including septum and wall
- HTN other place, organ, peripheral, aortic stenosis = aorta htn)
Hypertensive Heart Diseasesx during systole and diastole
S : can’t pump as much, CHF, dilated Atria** (from higher P in A)
D : not relaxing = CHF, Atrial Fib (also from dilation of A) which can cause thrombus (LA)
Hypertensive Heart Disease cells looks like
larger and bigger nuclei
Cor Pulmonale is what
right side (pulmonary) HTN disease,
Cor Pulmonale can happen how
if alveoli is hypoxic then BV constricts there
= diffuse hypoxia –> all BV constrict and ==> high Pulm P
Cor Pulmonale can cause what
- isolated right side heart failure
Cor Pulmonale can be a cause of what event
PE
Cor Pulmonale 4 things causing hypoxia and this to happen
- pulmonary parenchyma disease
- Pulm vessle disease
- Chest movement problems
- Pulm Arterial constriction (Metabolic acidosis)
right heart hypertrophy causes what to wall
thickening of trabaculae, and wall
right CHF SX
- hepatospenomegally
- Distended jugular V
- effusions, ascites
- edema
most common valve abnormality
Calcific Aortic Stenosis
Calcific Aortic Stenosis risk and associations
- age 60yo-80yo
- HTN
- hyperlipidemia
- chronic trauma “wear and tear”
Calcific Aortic Stenosis causes what to happen
- Aortic valves cant open all the way
- harder to push blood from LV –>Aorta
- LV hypertrophy
Calcific Aortic Stenosis made of what
osteocalficication = bone can be found
heart valves have how many cusps
all have 3 except mitral has 2
Bicuspid aortic valve (BAV) can cause what 3 things
- early calcific aortic stenosis
- can stop working normal = aortic valve prolapse
- infective endocarditis easier to form
Bicuspid aortic valve (BAV) causes 2
- congenital
2. RF
any valve problem you have higher chance of
infective endocarditis
calcific aortic stenosis SX
- LV hypertrophy
- systolic murmur
- syncope (5years to live)
- Angina (ischemia in heart cells hypertrophy)
- left CHF (2 years to live)
calcific aortic stenosis TX
surgery to replace valves
Mitral annular calcification what
calcific deposits on fibrous annulus (base of leaflet valves)
Mitral annular calcification risk
females
over 60yo
Mitral annular calcification sx
- asymp
- mild regurgitation
- arrhythmia (deep calcification into myocytes) = HEART BLOCK
- infectious endocarditis
Mitral Valve Prolapse what
one of valve leaflets balloon back into LA during SYSTOLE = “floppy valve”
Mitral Valve Prolapse risks + associations
- female
- connective tissue problem = Marfan syndrome
- past MI, RF
Mitral Valve Prolapse valves looks like dont need to know
- thick rubbery (myxomatous degeneration)
2. Interchordal ballooning (hooding)*
Mitral Valve Prolapse auscultation and SX
- mid systolic click (can also have murmur), MITRAL REGURG
- dyspnea
- higher A P = atrial dilation —-> Atrial Fib, thrombus
- Infective endocarditis
rheumatic fever is from what
strep pharyngitits Group A
Rheumatic fever SX
- recurrent strep throat —-> CD4+ react with M strep Ag
- fever
- migratory polyarthritis
- pancarditis
- Erythma marginatum
- Syndenham chorea
- subQ noduels
Rheumatic fever + rash is what
scarlet fever
Rheumatic fever DX
Ab to streptolysin O + DNaseB
Rheumatic fever heart problem
- Fibrinous pericarditis, myocrditis, endocarditis = if all its pancarditis
- Valvulitits (verrucae at mitral V)**
- MacCallum Plaques**
- Aschoff Body + Antischkow cells*
fibrinous pericarditis seen in
Rheumatic fever
MI
Rheumatic fever most common valves affected
mitral** > aortic > tricuspid
Antischkow cells
macrophage bodies
Rheumatic fever chronic does what to heart
repeated strep infections
= mitral stenosis (DIASTOLIC rumbling) (looks like a fish mouth)
2 valve things that can cause LA dilation
mitral stenosis
mitral regurg/ prolapse
infective endocarditis from what
- bacteria at valves (firbinous debri)
2. prosthetic valves
infective endocarditis risks
dental poor hygiene
IV drugs
Prosthetic heart
valvular disease (Rheumatic heart, stenosis, MVP)
acute infective endocarditis sx
FAST fever, chills, weak
= STAPH AUREUS
subacute infective endocarditis
low fever (unknown origin), fatigue
few weeks
STREP, ENTEROCCOCI
infective endocarditis major criteria
+ Blood culture
mass or abscess on valve (echocardiogram)
infective endocarditis minor sx **
- Roth spots
- Splinter hemorrhages
- Osler nodes (tips on finger : red nodular painful)
- Janeway lesions (red purple dots on sole or palm)
subacute infective endocarditis from dental cause
strep viridans
subacute infective endocarditis from prosthetic valves usually from
staph epidermidis
staph aureus if acute
subacute infective endocarditis from dental and more rare
HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)
infective endocarditis tricuspid valve cause
IV drug use , staph aureus
infective endocarditis most common valve effected
mitral or aortic
Nonbacterial Thrombotic Endocarditis (Hypercoagulable)
sterile non-inflammatory valvular thrombi —-> embolizes
Nonbacterial Thrombotic Endocarditis (Hypercoagulable) causes
- cancer releasing procoags (mucinous adenocarcinoma)
- primary anti-phospholipid syndrome
- SLE
- proinflammatory
Antiphospholipid syndrome vs SLE
APS : auto ABs to endothelial BVs causing thrombus + fetal loss*
SLE : malar rash, ABs to vessel endothelial –>preocoags
====Nonbacterial Thrombotic Endocarditis`
Carcinoid heart Disease
- serotonin secreated from tumor
- plaque like endocardial and valvular thickening
- RIGTH SIDE heart lesions
Carcinoid heart Disease SX and type of tumor
neuroendocrine tumor 1. flushing 2. D 3. Dermatits 4. Bronchoconstriction ==== only after liver is effected and cant breakdown bioactive serotonin
Carcinoid heart Disease is right sided why
left side has lung vessels that breakdown bioactive serotonin before it gets to heart
Prosthetic valves : mechanical vs bioprostheses
- mechanical : life long life, life long anti-coags (25yrs)
2. Bioprosthetic : need to be replaced, only anticoags first 3-6 months (10-15yrs)
Aortic stenosis murmur
harsh systolic
creascendo, decrescendo
mitral regurgitation murmur
holosytisolic (pansystolic) throughout systole
VSD murmur
holosytisolic (pansystolic) throughout systole
aortic regurg vs mitral stenosis murmur
diastolic both
- A : decreascendo all the way
- M : rumbling at the end more
PDA murmur
continous machine like all the time (crescendo during systole)
3 main cardiomyopathies
- Dilated
- Hypertrophic
- Restrictive
(heart structually and functionally abnormal with no congenital or diseases effecting heart)
Dilated cardiomyopathy type of problem and what happens to heart
- Systolic
2. Enlargement in all chambers
Hypertrophic cardiomyopathy type of problem and what happens to heart
- Diastolic
- LV thickening of SEPTUM
= sudden death in young athletes
Hypertrophic cardiomyopathy mutation
B-myosin heavy chain = involving sarcomere protein *
Restrictive cardiomyopathy type of problem and what happens to heart
- Diastolic
2. Rigid Ventricular walls
Restrictive cardiomyopathy usually from
amyloidosis
Dilated cardiomyopathy familial mutation
TTN gene (titin mutation) = sarcomere making
Dilated cardiomyopathy causes besides familial 4
- V overload after birthing child
- alcohol
- Fe overload (HFE gene, hereditary hemochromatosis)
- Takotsubo (catecholamine overload)
Dilated cardiomyopathy what is seen
- hypretrophic (heavy and more muscle from large heart)
2. big dilated chambers
Dilated cardiomyopathy SX
- 20yo-50yo progressive CHF
- Systolic prob
- arrhythmia sudden death
- thrombus formation
Dilated cardiomyopathy can be caused by what drug
Doxorubicin, daunorubicin (for leukemia, sarcoma, lymphoma)**
= Anthrocyclines*
= important to keep track of medical records
HFE iron overload sx
- Dilated cardiomyopathy
- skin bronze pigment
- Bronze DM (effects pancreas)
- hypogonadism
Takotsubo Cardiomyopathy happens how
- “broken heart syndrome”
- from emotional distress = sudden surge of catacholamines
- can cause ischemia and death
= Dilated cardiomyopathy
Takotsubo Cardiomyopathy LOOKS LIKE AND PREVALENCE
apical (lower) ballooning in LV like a Octopus Pot
= women (90%), 60yo-75yo
Hypertrophic Cardiomyopathy looks like
myocyte hypertrophy = septal prominance, myocyte disarray** dont line up
Hypertrophic Cardiomyopathy prevalence
male , genetic
Hypertrophic Cardiomyopathy SX
none
= early 20s, sudden V arrhythmia
= young athlete sudden death (from such thick septum –> V arrhythmia)
Hypertrophic Cardiomyopathy murmur
systolic ejection murmur from mitral valve pushed against septum
Restrictive Cardiomyopathy what
V walls get very stiff
hard to Diastole
= Amylodiosis
= fibrosis from radiation therapy
Hypertrophic Cardiomyopathy heart looks like
Atrial dilation since Vs cant fill properly
= arrhythmia
Amyloid is what
apple, green, congo red **
insoluable B-pleated sheets
(myeloma, chronic inflammation, transthyretin)
rare causes of Restrictive Cardiomyopathy
- Endomyocardial fibrosis (Africa)
- Loeffler endocarditis (esosinophilic infiltration, AML, CML)
- Endocardial fibroelastosis (congenital stenosis aorta)
Arrhythmogenic RV cardiomyopathy what is it
sudden death young adults
RV wall replaced by fat and fibrosis + dilation
Arrhythmogenic RV cardiomyopathy defective what and can cause what sx
- desmosomes adhesion Proteins
2. V tachy, Premature contractions or fibrillation = sudden death
Naxos Syndrome
= Arrhythmogenic RV cardiomyopathy 1. plantar and palmar hyperkeratosis 2. wooly hair 3. mutated plakoglobin = how it was first seen
Myocarditis is what and usually from what
inflammation of cardiac muscle
- Coxsackie B virus
- COVID19
Myocarditis sx
- asymp —-> HF
- arrythmia, fever
- high troponin
- dilated cardiomyopathy can happen
Chagas Disease
“kissing bug”
- releasing Triatomine, Trypanosoma cruzi
- can collect in muscle –> BS–> heart = myocarditis
- achalasia
Trichinosis
worm from pork muscle
= can get into heart muscle = myocarditis
Lyme disease sx
- myocarditis with heart block (spirochetes)
- migratory erythma
- migratory polyarthrtis, fascial palsy, meningitis
most common type of myocarditis
Lymphocytic myocarditis = from viral or post viral infection
Eosinophilic Myocarditis
Hypersensitivity myocarditis
from allergy, (usually drug reaction), hypersensitivity
= EXCLUDE parasitic infection first
2 Giant Cell myocarditis
- Idiopathic Giant Cell Myocarditis : agressive and deadly, 3mo life, Giant Cells + inflammation (high E)
- Myocardial Sarcoidosis : Giant cells and non-necrotizing granulomas , hiliar lymphadenopathy (AA prevalence)
