Cardio Pathology Flashcards
How can the heart be related to dysphagia or hoarseness (of voice)?
The left atrium is the most posterior part, and if it is enlarged it can compress the esophagus.
What are the most commonly occluded coronary arteries?
LAD > RCA > circumflex
In what cases is pulse pressure low?
- aortic stenosis
- advanced HF
- cardiac tamponade
- cardiogenic shock
What is angina?
A condition that causes sporadic (intermittent) chest pain due to reversible myocardial ischemia.
(No necrosis of cardiac myocytes)
What is peripheral vascular disease?
Narrowing of vessels other than to brain and heart
What are the types of arteriolosclerosis?
What are their main causes?
HYALIN caused by: - diabetes -benign (long standing) hypertension HYERPLASTIC caused by: -malignant hypertension
What is thrombophlebitis?
Venous thrombosis due to inflammation and bacterial infection
What is phleothrombosis?
Venous thrombosis without inflammation or infection
What is kaposi sarcoma? Caused by?
Low-grade malignant proliferation of endothelial cells.
Caused by HHV-8
What are vascular types of tumours? List benign and malignant types.
Benign = hemangioma Malig = angiosarcoma (hemangiosarcoma)
What are the 3 types of angina? What are their causes?
1) Stable -> caused by atherosclerosis of coronary arteries (>70% stenosis)
(subendocardial ischemia ie inner 1/3rd)
2) Unstable –> caused by rupture of an atherosclerotic plaque causing partial blockage with thrombi
(subendocardial ischemia)
3) Prinzmetal –> caused by vasospasm of coronary artery
(transmural ischemia)
What is MI most commonly caused by?
Other causes?
- -> rupture of atherosclerotic plaque causing total occlusion of coronary artery
- -> Other causes: vasculitis, vasospasm of coronary artery (prinzmetal or cocaine use), emboli
What type of biomarkers are diagnostic for MI? How are they used (time wise)?
- troponin (T and I)
- CK-MB (creatine kinase myocardial isoform)
Troponin rises 2-4 hrs post infarct, lasts for 7-10 days. BEST marker!
CK-MB rise 4-6 hours post infarct, peak at 24 hrs and return to normal by 72 hrs.
* Useful for detecting re-infarction.
Where and in which condition do you find Aschoff bodies?
They are nodules found in hearts of individuals that have rheumatic fever (in myocarditis specifically)
–> They are granulomatous in structure, granuloma with giant cells
What is the JONES criteria? What is used for?
Joints (migratory arthritis) O-heart; pancarditis N-odules (aschoff bodies) E-rythema marginatum S-ydenham chorea
What are Anitschkow cells?
Enlarged macrophages found within granulomas (Ashcoff bodies); associated with rheumatic fever
What is affected in chronic rheumatic heart disease?
The mitral valve. Scarring of the valve causes stenosis.
MITRAL STENOSIS
What is and what are the main causes of aortic stenosis?
Aortic stenosis = narrowing of the aortic valve orifice
- fibrosis and calcification (from wear and tear)
- consequence of chronic rheumatic valve disease (likely occurring with mitral stenosis and fusion of the aortic valve commissures)
What are complications of aortic stenosis?
- Left ventricular hypertrophy; concentric
- Angina + syncope w/ exercise (b/c less tissue perfusion meeting higher demand)
- Microangiopathic hemolytic anemia (RBCs damaged as cross calcified valve)
How does the myocardium try to compensate in aortic stenosis and in aortic regurgitation?
Aortic stenosis –> undergoes concentric hypertrophy (b/c higher pressure)
Aortic regurg –> undergoes eccentric hypertrophy (b/c higher volume) + LV dilation
What is mitral valve prolapse?
Ballooning of mitral valve into left atrium during systole
What type of murmurs are heard with aortic and mitral regurgitation? (SYS or DIAS?)
Aortic –> Diastolic
Mitral –> Systolic
What bacteria causes endocarditis in normal heart valves?
Staph aureus
What are clinical features of bacterial endocarditis?
- fever
- murmur
- Janeway lesions (erythematous lesions on palms + soles)
- Osler nodes (on fingers or toes)
- splinter hemorrahge on nail bed
- anemia of chronic disease (b/c chronic inflammation)
What is non-bacterial endocarditis called?
Libman-Sacks endocarditis
What is the most common bacteria causing endocarditis?
Streptococcus viridans
What is the most common cardiomyopathy?
Dilated cardiomyopathy
What are the causes of restrictive cardiomyopathy?
- amyloidosis
- sarcoidosis
- hemochromatosis
- endocardial fibroelastosis
- Loffler syndrome
What is Lofler syndrome?
Endomyocardial fibrosis with eosinophilic infiltrate
What is sarcoidosis?
Abnormal collection of inflammatory cell forming lumps (granulomas)
What is amyloidosis?
Amyloid = abnormal protein produced in bone marrow deposited in tissue organ.
Amyloidosis –> buildup of amyloid in organs
Explain why hypertrophic cardiomyopathy is also called obstructive?
There is asymmetrical cardiac hypertrophy of the ventricular septum. The ventricular outflow tract is often obstructed by the septal hypertrophy.
What is the most common benign tumour in adults in the heart? Where is it?
Myxoma
–> In the left atrium (thus can cause compression of esophagus causing dysphagia)
What is the most common primary cardiac tumour in children? Where is it?
Rhabdomyoma
–> in the ventricle
What is the main cause of myocarditis?
Viral
List the types of vasculitis:
1) Large vessel
2) Medium
3) Small
1) - Giant cell (temporal) arteritis
- Takayasu
2) - Polyarteritis Nodosa
- Kawasaki disease
- Buerger (thromboangitiis obliterans)
3) - Wegener granulomatosis
- microscopic polyangitis
- Churg-Strauss syndrome (eosinophilic granulomatosis w/ polyangitis)
- Henoch Schonlein purpura
What are the typical clinical presentations for vasculitis?
Inflammation: fever, myalgia, fatigue, weight loss
Symptoms of organ ischemia - due to luminal narrowing or thrombosis of inflamed vessels
Which vasculitis presents as “pulseless disease” w/ weak or absent pulse in upper extremities?
Takayasu (large-vessel)
Which vessels are affected in:
a) giant cell arteritis
b) Takayasu
a) Aorta + branches + carotids
b) Aortic arch at branch points
Symptoms of giant cell arteritis?
- headache (Temporal a)
- visual disturbances (ophthalmic a involved)
- jaw-claudication (pain)
- flu-like symptoms
Which vasculitis has high risk of blindness without treatment?
Giant cell (temporal)
Symptoms of Takaysu?
- visual and neurologic symptoms
Type of pts. affected in the large vessel vasculitis’?
Giant cell (temporal) –> older adults, usually females (>50 yrs)
Takayasu –> younger adult female asians (<50 yrs)
What type of vasculitis occurs in the large vessels?
Granulomatous vasculitis
Symptoms of polyarteritis nodosa? What type of patients affected?
- -> Young adults affected
- abdo pain w/ melena
- hypertension
- neurologic disturbances
- fever
- skin lesions (of varying stages)
What organs are affected in polyarteritis nodosa?
- multiple organs: kidney, skin, gut, joints
- -> LUNGS are SPARED !
Explain lesions polyarteritis nodosa:
Early lesions consist of transmural inflammation which cause fibrinoid necrosis
What type of patients does Kawasaki vasculitis affect?
Asian children <4 yrs old
Presentation of Kawasaki vasculitis? Complications?
Non-specific signs: - fever - conjunctivitis - enlarged lymphatic nodules - erythematous rash on palms + soles Complication: -CORONARY a. involved: --> risk of thrombosis causing MI --> aneurysm, leading to rupture
What type of pts affected in Buerger’s disease (thromboangiitis obliterans)?
Smokers!! Males aged <40 yrs
What part of the body does Buerger’s disease affect? Presents with?
Necrotizing vasculitis of digits. Mainly affects arteries of lower extremities. Presents with: - ulceration - gangrene - autoamputation of fingers and toes - (Raynaud phenomenon)
What is the Wegener triad?
- granulomas in lung and upper resp tract (nasopharynx)
- (focal necrotizing) vasculitis
- glomerulonephritis
What type of pts does Wegener granulomatosis affect?
Middle aged men
Presentation of wegener granulomatosis?
- nasopharyngeal ulceration
- bilateral nodular lung infiltrates
- hemoptysis
- hematuria (from the rapid progression of glomerulonephritis)
What do lab tests reveal in wegener granulomatosis?
c-ANCA levels
What does microscopic polyangiitis mainly affect?
- lungs and kidney (presents in multiple organs)
Describe the lesions of microscopic polyangiitis…
All lesions are of SAME age (vs polyarteritis nodosa, lesions of different age)
What do lab tests reveal in microscopic polyangiitis?
p-ANCA levels
What part of the body does Churg-Strauss syndrome involve mainly?
- multiple organs: mainly heart and lungs
–> Resp inflammation with necrotic vessel vasculitis + ASTHMA
(necrotizing granulomatous inflamm w/ eosinophils)
What do lab tests reveal in Churg-Strauss syndrome?
p-ANCA levels
Explain Henoch-Schonlein purpura.
Vasculitis due to IgA immune complex deposition
What is the most common vasculitis in children?
Henoch-Schonlein purpura
Presentation of henoch-schonlein purpura?
- fever
- joint pain
- IgA nephropathy
- palpable purpura on buttocks, legs
- GI pain + bleeding, and melena
- hematuria
What is mitral stenosis caused by?
Chronic rheumatic valve disease
What is mitral regurgitation caused by?
- LV dilatation (i.e. from L-sided HF)
- rupture of papillary muscles (post MI)
- infective endocarditis
- acute rheumatic disease
