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Pathology > Cardio Pathology > Flashcards

Cardio Pathology Flashcards

1
Q

How can the heart be related to dysphagia or hoarseness (of voice)?

A

The left atrium is the most posterior part, and if it is enlarged it can compress the esophagus.

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2
Q

What are the most commonly occluded coronary arteries?

A

LAD > RCA > circumflex

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3
Q

In what cases is pulse pressure low?

A
  • aortic stenosis
  • advanced HF
  • cardiac tamponade
  • cardiogenic shock
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4
Q

What is angina?

A

A condition that causes sporadic (intermittent) chest pain due to reversible myocardial ischemia.
(No necrosis of cardiac myocytes)

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5
Q

What is peripheral vascular disease?

A

Narrowing of vessels other than to brain and heart

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6
Q

What are the types of arteriolosclerosis?

What are their main causes?

A 
HYALIN caused by: 
- diabetes
-benign (long standing) hypertension
HYERPLASTIC caused by:
-malignant hypertension
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7
Q

What is thrombophlebitis?

A

Venous thrombosis due to inflammation and bacterial infection

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8
Q

What is phleothrombosis?

A

Venous thrombosis without inflammation or infection

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9
Q

What is kaposi sarcoma? Caused by?

A

Low-grade malignant proliferation of endothelial cells.

Caused by HHV-8

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10
Q

What are vascular types of tumours? List benign and malignant types.

A 
Benign = hemangioma
Malig = angiosarcoma (hemangiosarcoma)
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11
Q

What are the 3 types of angina? What are their causes?

A

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)

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12
Q

What is MI most commonly caused by?

Other causes?

A
  • -> rupture of atherosclerotic plaque causing total occlusion of coronary artery
  • -> Other causes: vasculitis, vasospasm of coronary artery (prinzmetal or cocaine use), emboli
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13
Q

What type of biomarkers are diagnostic for MI? How are they used (time wise)?

A
  • 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.

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14
Q

Where and in which condition do you find Aschoff bodies?

A

They are nodules found in hearts of individuals that have rheumatic fever (in myocarditis specifically)
–> They are granulomatous in structure, granuloma with giant cells

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15
Q

What is the JONES criteria? What is used for?

A 
Joints (migratory arthritis)
O-heart; pancarditis
N-odules (aschoff bodies)
E-rythema marginatum
S-ydenham chorea
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16
Q

What are Anitschkow cells?

A

Enlarged macrophages found within granulomas (Ashcoff bodies); associated with rheumatic fever

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17
Q

What is affected in chronic rheumatic heart disease?

A

The mitral valve. Scarring of the valve causes stenosis.

MITRAL STENOSIS

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18
Q

What is and what are the main causes of aortic stenosis?

A

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)
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19
Q

What are complications of aortic stenosis?

A
  • 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)
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20
Q

How does the myocardium try to compensate in aortic stenosis and in aortic regurgitation?

A

Aortic stenosis –> undergoes concentric hypertrophy (b/c higher pressure)
Aortic regurg –> undergoes eccentric hypertrophy (b/c higher volume) + LV dilation

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21
Q

What is mitral valve prolapse?

A

Ballooning of mitral valve into left atrium during systole

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22
Q

What type of murmurs are heard with aortic and mitral regurgitation? (SYS or DIAS?)

A

Aortic –> Diastolic

Mitral –> Systolic

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23
Q

What bacteria causes endocarditis in normal heart valves?

A

Staph aureus

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24
Q

What are clinical features of bacterial endocarditis?

A
  • 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)
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25
Q

What is non-bacterial endocarditis called?

A

Libman-Sacks endocarditis

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26
Q

What is the most common bacteria causing endocarditis?

A

Streptococcus viridans

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27
Q

What is the most common cardiomyopathy?

A

Dilated cardiomyopathy

28
Q

What are the causes of restrictive cardiomyopathy?

A
  • amyloidosis
  • sarcoidosis
  • hemochromatosis
  • endocardial fibroelastosis
  • Loffler syndrome
29
Q

What is Lofler syndrome?

A

Endomyocardial fibrosis with eosinophilic infiltrate

30
Q

What is sarcoidosis?

A

Abnormal collection of inflammatory cell forming lumps (granulomas)

31
Q

What is amyloidosis?

A

Amyloid = abnormal protein produced in bone marrow deposited in tissue organ.
Amyloidosis –> buildup of amyloid in organs

32
Q

Explain why hypertrophic cardiomyopathy is also called obstructive?

A

There is asymmetrical cardiac hypertrophy of the ventricular septum. The ventricular outflow tract is often obstructed by the septal hypertrophy.

33
Q

What is the most common benign tumour in adults in the heart? Where is it?

A

Myxoma

–> In the left atrium (thus can cause compression of esophagus causing dysphagia)

34
Q

What is the most common primary cardiac tumour in children? Where is it?

A

Rhabdomyoma

–> in the ventricle

35
Q

What is the main cause of myocarditis?

A

Viral

36
Q

List the types of vasculitis:

1) Large vessel
2) Medium
3) Small

A

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

37
Q

What are the typical clinical presentations for vasculitis?

A

Inflammation: fever, myalgia, fatigue, weight loss

Symptoms of organ ischemia - due to luminal narrowing or thrombosis of inflamed vessels

38
Q

Which vasculitis presents as “pulseless disease” w/ weak or absent pulse in upper extremities?

A

Takayasu (large-vessel)

39
Q

Which vessels are affected in:

a) giant cell arteritis
b) Takayasu

A

a) Aorta + branches + carotids

b) Aortic arch at branch points

40
Q

Symptoms of giant cell arteritis?

A
  • headache (Temporal a)
  • visual disturbances (ophthalmic a involved)
  • jaw-claudication (pain)
  • flu-like symptoms
41
Q

Which vasculitis has high risk of blindness without treatment?

A

Giant cell (temporal)

42
Q

Symptoms of Takaysu?

A
  • visual and neurologic symptoms
43
Q

Type of pts. affected in the large vessel vasculitis’?

A

Giant cell (temporal) –> older adults, usually females (>50 yrs)

Takayasu –> younger adult female asians (<50 yrs)

44
Q

What type of vasculitis occurs in the large vessels?

A

Granulomatous vasculitis

45
Q

Symptoms of polyarteritis nodosa? What type of patients affected?

A
  • -> Young adults affected
  • abdo pain w/ melena
  • hypertension
  • neurologic disturbances
  • fever
  • skin lesions (of varying stages)
46
Q

What organs are affected in polyarteritis nodosa?

A
  • multiple organs: kidney, skin, gut, joints

- -> LUNGS are SPARED !

47
Q

Explain lesions polyarteritis nodosa:

A

Early lesions consist of transmural inflammation which cause fibrinoid necrosis

48
Q

What type of patients does Kawasaki vasculitis affect?

A

Asian children <4 yrs old

49
Q

Presentation of Kawasaki vasculitis? Complications?

A 
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
50
Q

What type of pts affected in Buerger’s disease (thromboangiitis obliterans)?

A

Smokers!! Males aged <40 yrs

51
Q

What part of the body does Buerger’s disease affect? Presents with?

A 
Necrotizing vasculitis of digits.  Mainly affects arteries of lower extremities. 
Presents with: 
- ulceration
- gangrene
- autoamputation of fingers and toes
- (Raynaud phenomenon)
52
Q

What is the Wegener triad?

A
  • granulomas in lung and upper resp tract (nasopharynx)
  • (focal necrotizing) vasculitis
  • glomerulonephritis
53
Q

What type of pts does Wegener granulomatosis affect?

A

Middle aged men

54
Q

Presentation of wegener granulomatosis?

A
  • nasopharyngeal ulceration
  • bilateral nodular lung infiltrates
  • hemoptysis
  • hematuria (from the rapid progression of glomerulonephritis)
55
Q

What do lab tests reveal in wegener granulomatosis?

A

c-ANCA levels

56
Q

What does microscopic polyangiitis mainly affect?

A
  • lungs and kidney (presents in multiple organs)
57
Q

Describe the lesions of microscopic polyangiitis…

A

All lesions are of SAME age (vs polyarteritis nodosa, lesions of different age)

58
Q

What do lab tests reveal in microscopic polyangiitis?

A

p-ANCA levels

59
Q

What part of the body does Churg-Strauss syndrome involve mainly?

A
  • multiple organs: mainly heart and lungs
    –> Resp inflammation with necrotic vessel vasculitis + ASTHMA
    (necrotizing granulomatous inflamm w/ eosinophils)
60
Q

What do lab tests reveal in Churg-Strauss syndrome?

A

p-ANCA levels

61
Q

Explain Henoch-Schonlein purpura.

A

Vasculitis due to IgA immune complex deposition

62
Q

What is the most common vasculitis in children?

A

Henoch-Schonlein purpura

63
Q

Presentation of henoch-schonlein purpura?

A
  • fever
  • joint pain
  • IgA nephropathy
  • palpable purpura on buttocks, legs
  • GI pain + bleeding, and melena
  • hematuria
64
Q

What is mitral stenosis caused by?

A

Chronic rheumatic valve disease

65
Q

What is mitral regurgitation caused by?

A
  • LV dilatation (i.e. from L-sided HF)
  • rupture of papillary muscles (post MI)
  • infective endocarditis
  • acute rheumatic disease

Pathology (13 decks)

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