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CPR Exam 1 > Cardiac Pathology Part II > Flashcards

Cardiac Pathology Part II Flashcards

1
Q

what is the most common cause of arrhythmia?

A

ischemic heart disease aka MI

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2
Q

what are other causes of arrhythmia?

A

cardiomyopathies
myocarditis
valvular disease
congenital disorders

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3
Q

what is sick sinus syndrome?

A

damage to the SA node causing bradycardia

*AV node becomes pacemaker of the heart

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4
Q

what is atrial fibrillation?

A

independent and sporadic atrial myocyte depolarization with variable transmission to the AV node

irregularly irregular rhythm

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5
Q

what risks are associated with Afib?

A

thrombus formation and subsequent stroke

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6
Q

what is a heart block?

A

dysfunction at the AV node

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7
Q

what is the most severe heart block?

A

third degree

complete failure of AV node

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8
Q

what can be seen on ECG with a first degree heart block?

A

prolonged PR interval

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9
Q

what is the primary cause of hereditary arrhytmias?

A

ion channel disfunction (channelopathies)

K+ and Na+

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10
Q

what is the typical presentation of hereditary channelopathies?

A

sudden death after exertion

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11
Q

what is another name for hereditary channelopathies?

A

Long QT syndrome

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12
Q

what can occur in patients with long QT syndrome?

A

Torsades de Pointes

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13
Q

what is the most common cause of sudden death due to ischemia induced arrhythmia?

A

coronary artery disease

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14
Q

what can cause sudden cardiac death in younger patients?

A 
drug abuse (cocaine and meth)
hereditary arrhythmias
cardiomyopathies
myocardial hypertrophy
myocarditis
mitral valve prolapse
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15
Q

what changes in the heart occur with untreated hypertension?

A

left ventricular concentric hypertrophy

can lead to diastolic dysfunction –> CHF and Afib

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16
Q

what causes right sided hypertensive heart disease?

A

pulmonary hypertension as a result of:
pulmonary parenchymal disease
pulmonary vessel disease
disorders of chest movement

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17
Q

what changes occur in the heart as a result of pulmonary hypertension?

A

right ventricular hypertrophy
hypertrophied trabeculae
tricuspid stenosis

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18
Q

what is the most common valve abnormality?

A

calcific aortic stenosis

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19
Q

what is the demographic of calcific aortic stenosis?

A

60+ y/o with HTN, high cholesterol or chronic inflammation

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20
Q

what is the risk associated with bicuspid aortic valves?

A

accelerated course of calcific aortic stenosis
may cause aortic valve dilation or prolapse
bacterial endocarditis is more frequent

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21
Q

what cardiac changes occur with calcific aortic stenosis?

A

increased LV pressure resulting in concentric LV hypertrophy

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22
Q

what is the clinical presentation of calcific aortic stenosis?

A

systolic murmur
angina
syncope
CHF

tx: valve replacement

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23
Q

what risks are associated with mitral annular calcification?

A

more common in females 60+

regurgitation
stenosis
arrhythmias
prone to thrombus and infective endocarditis

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24
Q

what is mitral valve prolapse?

A

valve leaflets prolapse back into the left atrium during systole

“floppy valve”

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25
Q

what causes mitral valve prolapse?

A

female predominance
can occur spontaneously without cause
connective tissue disease
complication of MI or rheumatic fever

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26
Q

what would be seen morphologically in mitral valve prolapse?

A

thickened, rubbery leaflets

interchordal ballooning/hooding of the leafets

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27
Q

what would be seen on histology in mitral valve prolapse?

A

proteoglycan deposition

myxomatous degeneration

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28
Q

what is the clinical presentation of mitral valve prolapse?

A

mid-systolic click +/- murmur

dyspnea due to regurgitation

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29
Q

what are rare complications that can occur with MVP?

A

infective endocarditis
mitral insufficiency
arrhythmias
thromboembolism

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30
Q

what is rheumatic fever?

A

multisystem inflammatory disorder caused by group A strep pharyngitis

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31
Q

what is the immunological mechanism of rheumatic fever?

A

antibodies and CD4 cell reaction against M streptococcal antigen

causes reaction to self antigens in heart, joints, soft tissue, skin and nervous system

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32
Q

what is the clinical presentation of rheumatic fever?

A 
fever
migratory polyarthritis
pancarditis
subcutatneous nodules
erythema marginatum
syndeham chorea
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33
Q

what is acute rheumatic heart disease?

A

pericarditis, myocarditis or endocarditis (pancarditis if all affected)

valvulitis with vegetation (verrucae formation)

MacCallum plaques

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34
Q

what would bee seen on histology in rheumatic heart disease?

A

Aschoff bodies with Anitschkow cells

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35
Q

what valves are primarily affected in rheumatic heart disease?

A

mitral > aortic > tricuspid

MAT

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36
Q

what is chronic rheumatic heart disease?

A

valvular thickening, short chordae tendinae, fusion and regurgitation

valvular stenosis

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37
Q

what is the clinical presentation of chronic rheumatic heart disease?

A

mitral stenosis causing diastolic rumbling murmur

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38
Q

what complications are associated with chronic rheumatic heart disease?

A

infective endocarditis

mitral stenosis –> left atrial enlargement –> thromboembolism

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39
Q

what causes infective endocarditis?

A

infectious organism, inflammation or fibrinous debris

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40
Q

where does infective endocarditis typically affect the heart?

A

valves or structural abnormalities

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41
Q

what risk factors are associated with infective endocarditis?

A 
drug use
body piercings
male gender (haha)
poor dentition
invasive dental procedures
pre-existing heart conditions
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42
Q

what pre-existing conditions are pre-disposed to infective endocarditis?

A

valvular disease
prosthetic heart valve
structural heart disease

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43
Q

what causes are associated with left sided infective endocarditis?

A

structural valve abnormalities
poor dentition/dental procedure
prosthetic valves

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44
Q

what organism is the cause of infective endocarditis in valvular abnormalities?

A

Strep viridans

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45
Q

what organism is the cause of infective endocarditis in poor dentition/dental procedures?

A 
HACEK group:
hemophilus
actinobacillus
cardiobacterium
eikenella
kingella
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46
Q

what organism is the cause of infective endocarditis in prosthetic valves?

A

staph epidermidis

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47
Q

what is the only cause of right sided infective endocarditis?

A

IV drug abuse

48
Q

what organism is the cause of infective endocarditis in IV drug abuse?

A

staph aureus

49
Q

what is the clinical presentation of acute infective endocarditis?

A 
rapid onset fever chills and weakness
subungual splinter hemorrhages (nails)
Janeway lesions (palms and soles)
osler nodes (hands)
roth spots (eyes)
50
Q

what is nonbacterial thrombotic endocarditis?

A

sterile, non-inflammatory valvular thrombi that is asymptomatic until embolization occurs

51
Q

what causes nonbacterial thrombotic endocarditis?

A

sepsis
cancer
antiphospholipid syndrome
SLE (Libman-Sacks endocarditis)

52
Q

what is carcinoid heart disease?

A

compounds secreted by carcinoid tumors induce plaque-like endocardial and valvular thickening

53
Q

what part of the heart is affected by carcinoid heart disease?

A

right sided valves and endocardial tissue

left side is protected by pulmonary vascular degradation of compounds

54
Q

what is the clinical presentation of carcinoid heart disease?

A

flushing
diarrhea
dermatitis
bronchoconstriction

55
Q

what can be seen on histology in carcinoid heart disease?

A

plaque-like thickening with mucopolysaccharide deposition

56
Q

what is a potential complication in someone with a prosthetic valve (mechanical or biotic)?

A

infective endocarditis
anticoagulant related hemorrhage
dysfunction or exuberant healing
hemolytic anemia

57
Q

what condition is associated with a harsh systolic murmur?

A

calcific aortic stenosis

58
Q

what conditions are associated with a holosystolic murmur?

A

mitral regurgitation

VSD

59
Q

what condition is associated with a diastolic decrescendo murmur?

A

aortic regurgitation

60
Q

what condition is associated with a diastolic rumbling murmur?

A

rheumatic heart disease (mitral valve stenosis)

61
Q

what condition is associated with a continuous machine-like murmur?

A

PDA

62
Q

what does cardiomyopathy mean in general?

A

heart muscle disease

63
Q

what are the three major types of cardiomyopathy?

A
  1. dilated (most common)
  2. hypertrophic
  3. restricted (least common)
64
Q

what causes dilated cardiomyopathy?

A 
AD hereditary TTN gene 
peripartum cardiomyopathy
alcoholism with wet beri-beri
myocarditis
cardiotoxic drugs
hemochromatosis
65
Q

what morphology is associated with dilated cardiomyopathy?

A

dilation of all heart chambers
hypertrophy without wall thickening
functional valve regurgitation

66
Q

what is the clinical presentation of dilated cardiomyopathy?

A 
20-50 y/o
progressive CHF with decreased EF
systolic dysfunction
arrhythmias
thromboembolism
67
Q

what is takotsubo cardiomyopathy?

A

broken heart syndrome :(

associated with sudden surge of catecholamines due to emotional distress

most likely to occur in women because we are emotional AF

68
Q

what would be seen on CXR in someone with takotsubo cardiomyopathy?

A

apical ballooning of left ventricle

looks like Japanese fishing pot!

69
Q

what is arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A

AD hereditary disorder with defective cell adhesion proteins in the desmosomes that link adjacent cardiac myocytes

70
Q

what morphological changes are associated with ARVC?

A

right ventribular wall is replaced by adipose and fibrosis causing right ventricular failure and arrhythmia

V tach or V fib causes sudden cardiac death

71
Q

what is Naxos syndrome?

A

ARVC with plantar and palmar keratosis and wooly hair

caused by mutation in the desmosome associated protein plakoglobin

72
Q

what is hypertrophic cardiomyopathy?

A

GENETIC ONLY

myocyte hypertrophy and disarray with septal prominence

73
Q

what mutation is most common in hypertrophic cardiomyopathy?

A

B-MHC

74
Q

what can be seen morphologically in hypertrophic cardiomyopathy?

A

septal hypertrophy > ventricular wall hypertrophy

septum and anterior mitral valve obstruct blood flow

75
Q

what is the classical presentation of hypertrophic cardiomyopathy?

A

sudden unexplained death in athlete during exercise

76
Q

what can be seen clinically in hypertrophic cardiomyopathy?

A 
ventricular arrhythmia
systolic ejection murmur
exertional dyspnea
exertional CP
palpitations
77
Q

what is restrictive cardiomyopathy?

A

decreased ventricular compliance resulting in diastolic dysfunction

78
Q

what causes restrictive cardiomyopathy?

A

deposition of material within cardiac walls

amyloid due to amyloidosis
OR
fibrosis due to radiation

79
Q

what histological findigs are associated with amyloidosis?

A

apple green birefringence on congo red stain

80
Q

what is the most common cause of myocarditis?

A

VIRAL:

coxsackievirus B

81
Q

what is the clinical presentation of myocarditis?

A

ranges from asymptomatic to heart failure
may present as arrhythmia causing sudden death
+/- fever

82
Q

what are other infectious causes of myocarditis?

A 
Chagas disease (trypanosoma cruzi)
Trichinosis (pork helminth)
Lyme disease (spirochete)
83
Q

what is more common: lymphocytic or eosinophilic myocarditis?

A

lymphocytic (viral, autoimmune or idiopathic cause)

84
Q

what is the prognosis of idiopathic giant cell myocarditis?

A

very poor prognosis

survival typically less than 3 monst from onset

85
Q

what are the classic cardiotoxic drugs?

A

doxorubicin and daunorubicin

cause dilated cardiomyopathy and HF

86
Q

what is pericardial effusion?

A

acute or chronic accumulation of fluid within the pericardium

87
Q

when is pericardial effusion dangerous?

A 
acute onset (<1 week)
causes cardiac tamponade
88
Q

what are the subtypes of pericardial effusions?

A

hemopericardium
serous effusion
purulent pericarditis

89
Q

what causes hemopericardium?

A

trauma
ruptured MI
aortic dissection

90
Q

what causes serous effusion?

A

CHF

91
Q

what causes purulent pericarditis?

A

necroinflammatory debris
acute inflammation
secondary to infectious process

92
Q

what is pericarditis?

A

inflammation of the pericardial sac

93
Q

what is the clinical presentation of pericarditis?

A

sharp, pleuritic and position dependent chest pain
pericardial friction rub
pericardial effusion
ECG changes (ST elevation with PR depression)
fever

94
Q

what is the most common type of pericarditis?

A

fibrinous/serofibrinous

95
Q

what is fibrinous/serofibrinous pericarditis?

A

fibrinous inflammatory exudate with variable amount of serous fluid accumulates within pericardial sac

96
Q

what causes fibrinous/serofibrinous pericarditis?

A

Acute MI
Dressler’s syndrome (post-infarction)
uremia (CKD with elevated BUN)

97
Q

what is seen morphologically in fibrinous/serofibrinous pericarditis?

A

bread and butter appearance on pericardium

98
Q

what causes serous pericarditis?

A

virus

inflammatory disease

99
Q

what causes purulent/suppurative pericarditis?

A

active infection by bacterial invasion

100
Q

what is seen histologically in purulent/suppurative pericarditis?

A

bacteria
neutrophils
fibrinopurulent debris

101
Q

what causes caseous pericarditis?

A

tuberculosis

102
Q

what causes hemorrhagic pericarditis?

A

malignant neoplasm

trauma

103
Q

what is constrictive pericarditis?

A

heart becomes encased in dense, fibrous or fibrocalcific scar
limits diastolic expansion and cardiac output
mimics restrictive cardiomyopathy

104
Q

what is the most common cardiac tumor in adults?

A

myxoma (benign)

105
Q

what is the most common cardiac tumor in children?

A

rhabdomyoma (benign)

106
Q

what is the most common malignant cardiac tumur?

A

angiosarcoma

107
Q

what is a cardiac myxoma?

A

stromal tumor of mesenchymal origin

ranges from globular/hard to gelatinous

108
Q

where does a myxoma typically occur?

A

left atrium beginning in the septal region of the fossa ovalis

109
Q

what is the clinical presentation of myxoma?

A 
"ball-valve" obstruction
mechanical valve damage
tumor embolization
fever and malaise (IL-6 released from tumor)
tumor "plop" on ausculation
110
Q

what familial syndromes are associated with myxomas?

A 
McCune-Albright syndrome (GNAS1)
Carney complex (PRKAR1A)
111
Q

what is a papillary fibroelastoma?

A

incidental “sea-anemone-like” lesion

usually located on valves

112
Q

what genes are associated with rhabdomyomas?

A

TSC1

TSC2

113
Q

which is more likely: a primary cardiac tumor or metastasis?

A

metastasis from lung, breast, melanoma or lymphoma

114
Q

what are potential complications associated with cardiac tumors?

A 
mass effect (limiting cardiac filling)
decreased myocardial contractility
symptomatic pericardial effusion
superior vena cava syndrome
production of circulating mediators
115
Q

what is allograft vasculopathy?

A

late, progressive, diffusely stenosing intimal proliferation

silent MI – denervation of transplanted heart causes MI without angina

116
Q

what complications are associated with heart transplant?

A

infection
malignancy
skin cancers
EBV positive lymphoproliferative disorder

CPR Exam 1 (19 decks)

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