Cardio: Pathology Flashcards
1
Q
- Ischemia, Hypertension, Dilated cardiomyopathy, Myocardial infarction, and Restrictive cardiomyopathy
- Decreased forward perfusion
- Pulmonary congestion –> Pulmonary edema
- Dyspnea, Paroxysmal nocturnal dyspnea (increased venous return), Orthopnea, Crackles
- Bursting of congested capillaries –> intraaveolar hemorrhage w/ hemosiderin-laden macrophages (‘Heart-failure cells’)
- *Decreaesd *flow to Kidneys –> Renin-angiotensin system –> exacerbates CHF
- Tx: ACE inhibitor
A
Left-sided Heart Failure
2
Q
- Most commonly due to Left-sided heart failure but also include Left-to-right shunt and Chronic lung disease (cor pulmonale)
- Jugular venous distention
- Painful hepatosplenomegaly –> ‘Nutmeg Liver’ –> cardiac cirrhosis
- Dependent pitting edema (‘Dropsy’) due to increased hydrostatic pressure
A
Right-sided Heart Failure
3
Q
- Due to coronary artery vasospasm
- Represents reversible injury to myocytes (no necrosis)
- EKG shows ST-segment elevation due to transmural ischemia
- Relieved by Nitroglycerin or Calcium channel blockers
A
Prinzmetal Angina
4
Q
- Necrosis of cardiac myocytes (irreversible)
- Rupture of atherosclerotic plaque with thrombosis and complete occlusion of a coronary artery
- vasospasm, cocaine use, emboli, vasculitis (kawasaki disease)
- Severe, crushing chest pain > 20 minutes that radiates to the left arm or jaw, diaphoresis, and dyspnea
- Symptoms not relieved by nitroglycerin
- LAD –> anterior and anterior septum (most common)
- RCA –> posterior wall and posterior septum and papillary muscles of LV
- Left Circumflex –> lateral wall of LV
A
Myocardial Infarction
5
Q
- Unexpected death due to cardiac disease; occurs without symptoms or < 1 hour after symptom arise
- Usually due to fatal ventricular arrhythmia
- Most common etiology is acute ischemia; 90% of patients have preexisting sever atherosclerosis
- Less common causes include Mitral valve prolapse, **Cardiomyopathy, ** and Cocaine abuse
A
Sudden Cardiac Death
6
Q
- Poor myocardial function due to chronic ischemic damage (with or without infarction)
- Progresses to congestive heart failure (CHF)
A
Chronic Ischemic Heart Disease
7
Q
- Defect in the Septum that divides the Right and Left Ventricles → Left to Right shunt
- Most common congenital heart defect and may be asymptomatic at birth
- A/w Fetal alcohol syndrome
- Size of defect determines extent of shunting and age at presentation
- Large defects –> Eisenmenger syndrome –> Right ventricular hypertrophy, LV overload, and Heart Failure
- Tx: surgical closure; small defects may close spontaneously
A
Ventricular Septal Defect (VSD)
8
Q
- Defect in interatrial septum that divides Right and Left atria; most common type is Ostium Secundum (90%)
- **Ostium primum **type is associated with Down syndrome
- Results in Left-to-Right shunt w/ Loud S1 and **Split S2 **on auscultation (increased blood in right heart delays closure of pulmonary valve)
- Paradoxical emboli are an important complication –> Right sided embolie –> arrive at brain or distal extrudate
- Usually occurs in Septum Secundum or Septum Primum w/ other anomalies
A
Atrial Septal Defect (ASD)
9
Q
- Failure of closure is associated with congenital rubella
- Results in Fetal R2L shunt, Neonatal w/ ↓ lung resistance L2R** shunt** between the Aorta and the Pulmonary artery → RVHand/orLVH, Heart Failure
- The ductus arteriosus normally shunts blood from the pulmonary artery to the Aorta, bypassing lungs
- Asymptomatic at birth w/ continuous ‘machine-like’ murmur; may lead to Eisenmenger syndrome, resulting in lower extremetiy cyanosis
- Tx: Indomethacin, which **decreases PGE, resulting in PDA closure (PGE K’EEEE’Ps open patency**)
A
Patent Ductus Arteriosus (PDA)
10
Q
- Pulmonary infundibular stenosis (most imporant) → forces Right to Left flow across VSD → cyanotic ‘tet spells’
- VSD
- Overiding Aorta of the VSD
- Right-to-Left shunt leads to early Cyanosis, degree of stenosis determines the extent of shunting and cyanosis
- Patients learn to squat in response to a cyanotic spell; increased arterial resistance decreasing shunting and allows more blood to reach the lungs
- RVH → ‘Boot-shaped’ heart on CXR
A
Tetralogy of Fallot
11
Q
- Characterized by pulmonary artery arising from the Left Ventricle and Aorta arising from the Right Ventricle
- A/w maternal diabetes
- Presents w/ **early cyanosis; **pulmonary and systemic circuits do not mix
- Creation of Shunt (allowing blood to mix) after birth is required for survival
- PGE can be administered to maintain PDA until difinitve surgical repair is performed
- Hypertrophy of RV and Atrophy of LV
A
Transposition of the Great Vessels
12
Q
- Characterized by a single large vessel arising form both ventricles
- Truncus fails to divide
- Presents with early cyanosis; deoxygenated blood from right ventricle mixes with oxygenated blood from left ventricle before pulmonary and aortic circulations separate
- Most patients have accompanying VSD
A
Truncus Arteriosus
13
Q
- Absence of Tricuspid valve or Tricuspid valve orifice fails to develop
- Hypoplastic Right ventricle
- Often associated with ASD, resulting in a Right-to-Left shunt; presents with early cyanosis
- Requires both ASD and VSD for viability
A
Tricuspid Atresia
14
Q
- Narrowing of the Aorta; classically divided into infantile and adult forms
-
Infantile form a/w PDA; coarctation lies after (distal to) the Aortic arch, but before (proximal to) the PDA
- Presents as lower extremity cyanosis in infants at birth; a/w Turner syndrome
- Tx: PGE2<strong></strong>
A
Infantile Coarctation of the Aorta
15
Q
- Pharyngitis due to **Group A β-hemolytic streptocci **affects children 2 - 3 weeks after an episode of streptococcal pharygitis ‘strep throat’
- **Molecular mimicry; **of bacterial M protein resembles proteins in human tissue –> Type II hypersensitivity
- J♥nes criteria (Joints migratory polyarthritis, ♥ pancarditis, Nodules subcutaneous, Erythema marginatum, Sydenham chorea (St. Vitus’ dance), *Increased *ESR
- Pancarditis w/ pericarditis, Endocarditis, and Myocarditis w/ Aschoff bodies (granuloma with giant cells), **Anitschkow cells **(enlarged macrophages)
- Repeat exposure results in relapse of the acute phase –> chronic disease –> antistreptolysin O titer increase
A
Acute Rheumatic Fever
16
Q
- Valve scarring that arises as a consequence
- Stenosis w/ classic ‘Fish-mouth’ appearance
- Almost always involves the Mitral valve; leads to thickening of Chordae tendineae and Cusps
- Occasionally involves the Aortic valve; leads to fusion of the commissures
- Other valves are less commonly involved
- Complications include infectious endocarditis
A
Chronic Rheumatic Heart Disease
17
Q
- Narrowing of the Aortic valve orifice
-
Fibrosis and Calcification from “wear and tear”
- Late adulthood (> 60 y.o.)
- Chronic rheumatic valve disease; coexisting mitral stenosis and fusion of the aortic valve commissures
- Systolic ejection click followed by a crescendo-decrescendo murmur
- Concentric left ventricular hypertophy
- Angina and Syncope with exercise
- Microangiopathic hemolytic anemia - RBCs damaged producing Schistocytes while crossing the calcified valve
- Tx: Valve replacement after complications onset
A
Aortic Stenosis
18
Q
- Backflow of blood from Aorta –> Left Ventricle during Diastole
- Aortic root dilation (**syphilitic aneurysm **and aortic dissection) or **Valve damage **(inf. endocarditis) –> isolated root dilation
- Blowing diastolic murmur
-
Hyperdynamic circulation due to increased pulse pressure
- Increase Systole, *decrease *Diastole
- Bounding pulse (water-hammer) Pulsating nail bed (Quincke pulse), and Head bobbing (De Musset’s sign)
- LV dilation and Eccentric hypertrophy (volume overload)
- Tx: valve replacement once LV dysfunction develops
A
Aortic Regurgitation
19
Q
- Ballooning of Mitral valve into LA during Systole
-
Myxoid degeneration (accumulation of ground substance) of the valve, floppy
- Marfan syndrome or Ehlers-Danlos syndrome
- Incidental mid-systolic ‘click’ followed by regurgitation murmur
- ‘Click’ softer with squating
- Complications include Infectious endocarditis, Arrhythmia, Severe Mitral regurgitation
- Tx: valve replacement
A
Mitral Valve Prolapse
20
Q
- Reflux of blood from LV –> LA during Systole
- Arisises as a complication of Mitral valve prolapse
- LV dilation (Left-sided cardiac failure)
- Inf. endocarditis
- Acute rheumatic heart disease
- Papillary muscle rupture after myocardial infarction
- **Holosystolic ‘blowing’ murmur – louder w/ squating **and **expiration **(increased return to LA)
- Volume overload and Left-sided heart failure
A
Mitral Regurgitation
