Cardio - Pathology (Part 2) Flashcards
What is the cause of cardiac dilation in congestive heart failure?
Increased ventricular end-diastolic volume
Increased venous return in the supine position causes what common symptom of congestive heart failure?
Orthopnea, in which patients have difficult breathing when not upright
How does the blood pressure on the right side of the heart affect portal venous blood flow?
As the pressure in the right heart (and, therefore, the central venous system) increases, portal flow decreases
Increased right-sided heart pressure can lead to what finding on abdominal physical exam?
Hepatomegaly (nutmeg liver on pathology) and rarely cardiac cirrhosis
Does left ventricular failure increase or decrease pulmonary venous pressure?
Increase
What are heart failure cells?
Hemosiderin-laden macrophages in the lungs due to microhemorrhages caused by increased pulmonary capillary pressure
What is congestive heart failure?
Congestive heart failure is the constellation of signs and symptoms that occur as a result of poor cardiac function; its severity can be defined symptomatically and with imaging
What are physical signs of right-sided heart failure?
Ankle edema, jugular venous distention, and hepatomegaly
What is the most common cause of right-sided heart failure?
Left-sided heart failure
What is the most common cause of right-sided heart failure in the absence of left-sided heart failure?
Cor pulmonale, in which the right ventricle fails because of increased pulmonary arterial pressure
How does the body compensate for the decreased left ventricular contractility (and therefore decreased cardiac output) that occurs with left-sided heart failure?
The kidneys increase the activity of the renin-angiotensin-aldosterone system, and sympathetic tone is increased, both of which ultimately increase preload and cardiac output
Tender, red, raised lesions on the finger or toe pads in the setting of endocarditis are known as what?
Oslers nodes
A round white spot on the retina that is surrounded by hemorrhage in the setting of endocarditis is known as what?
Roth spot
A small, painless erythematous lesion on the palm or sole in a patient with endocarditis is called what?
Janeway lesion
In a case of acute bacterial endocarditis, which organism is most likely responsible?
Staphylococcus aureus
Is Staphylococcus aureus bacterial endocarditis rapid or insidious in onset?
Rapid; it has a high virulence and results in large vegetations on previously normal valves
Is Streptococcus viridans bacterial endocarditis rapid or insidious in onset?
Insidious; smaller vegetations appear on congenitally abnormal or diseased valves
Which type of endocarditis is associated with dental procedures: acute or subacute bacterial endocarditis?
Subacute; smaller vegetations appear on congenitally abnormal or diseased valves, with insidious onset
Nonbacterial endocarditis can be the result of which two causes?
Malignancy or hypercoagulable state (marantic/thrombotic endocarditis)
Which valve is most likely to be involved in bacterial endocarditis?
The mitral valve
In a patient with tricuspid valve involvement as a part of bacterial endocarditis, what is the suspected source of the infection?
Intravenous drug abuse (remember: dont tri drugs)
What symptoms and signs do the letters in the mnemonic FROM JANE represent in bacterial endocarditis?
Fever, Roth spots, Oslers nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhages, and Emboli
What is the classic renal complication that can occur after a case of bacterial endocarditis?
Glomerulonephritis
What is the name for the group of bacteria that cause endocarditis but will not grow in standard culture medium?
HACEK
Which pathogen is often responsible for bacterial endocarditis on prosthetic heart valves?
Staphylococcus epidermidis
Other than Staphylococcus aureus, which organisms are known to cause endocarditis in intravenous drug users?
Pseudomonas and Candida
What type of endocarditis is seen in patients with lupus?
Libman-Sacks endocarditis (remember: SLE causes LSE)
How do the vegetations in Libman-Sacks endocarditis differ from those in bacterial endocarditis?
Sterile, verrucous, and occur on both sides of the valve
In Libman-Sacks endocarditis, which valve is commonly affected?
The mitral valve
Which murmurs are associated with Libman-Sacks endocarditis?
Mitral regurgitation, and less commonly mitral stenosis
Rheumatic heart disease is a sequela of infection with which organism?
Group A β-hemolytic streptococci
Which heart valve is most often affected by rheumatic heart disease?
The mitral valve
Histopathology on a biopsy of a valve affected by rheumatic heart disease would show what findings?
Aschoff bodies (giant cell-containing granulomas) and anitschkow cells
What laboratory findings are associated with rheumatic heart disease?
Elevated antistreptolysin O titers and elevated erythrocyte sedimentation rate
Name the components of the FEVERSS mnemonic for rheumatic heart disease.
Fever, Erythema marginatum, Valvular damage (vegetation and fibrosis), ESR increase, Red-hot joints (migratory polyarthritis), Subcutaneous nodules (Aschoff bodies), and St. Vitus dance (chorea)
Rheumatic heart disease is an example of type _____ hypersensitivity and involves creation of anti- _____ _____ antibodies.
II; M protein
How are the pressures of the four heart chambers affected during cardiac tamponade?
They equilibrate, leading to an inability to move blood forward in the circulation
What is pulsus paradoxus (Kussmauls pulse)?
The condition in which pulse amplitude is decreased by inspiration
Which conditions can cause the finding of pulsus paradoxus?
Severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup
What is cardiac tamponade?
Compression of the heart by fluid, such as blood or effusions, which leads to decreased cardiac output
What are six physical findings associated with cardiac tamponade?
Hypotension, jugular venous distention, distant heart sounds, increased heart rate, and pulsus paradoxus
Which conditions can cause serous pericarditis?
Systemic lupus erythematosus, rheumatoid arthritis, viral infections, and uremia
Which two types of pericarditis does uremia cause?
Serous and fibrinous
In a patient with hemorrhagic pericarditis, what will be seen on an electrocardiogram?
ST-segment elevations in multiple leads
What are the potential long-term sequelae of pericarditis?
Pericarditis can resolve without scarring or lead to chronic adhesive or chronic constrictive pericarditis
What are three causes of fibrinous pericarditis?
Uremia, myocardial infarction (Dresslers syndrome), and rheumatic fever
What are four causes of serous pericarditis?
Uremia, systemic lupus erythematosus, rheumatoid arthritis, and viral infection
Tertiary syphilis disrupts the vasa vasorum and subsequently leads to what complications?
Dilation of the aorta leading to aneurysm or aortic valve incompetence
Calcification takes place of which two structures in patients with syphilitic heart disease?
The aortic root and the ascending aortic arch
In tertiary syphilis, what is the characteristic appearance of the aortic root on gross pathology?
It is described as having a tree bark appearance
A 70-year-old former prostitute presents with chest pain radiating to the back and worsening shortness of breath on exertion. Her cardiac enzymes are negative and she has no ST changes on electrocardiogram. An echocardiogram shows aortic regurgitation and and a dilated aortic root. Her labs are significant for a positive rapid plasma reagin. What is the likely cause of her pain and shortness of breath?
Ascending aortic aneurysm due to tertiary syphilis
What is the most common malignant tumor affecting the heart?
Metastases, often from melanoma or lymphoma
What is the most common primary heart tumor in adults?
Myxoma
Where in the heart do most myxomas tend to occur?
90% occur in the left atrium
What is the most common primary heart tumor in children?
Rhabdomyoma
Cardiac rhabdomyomas in children are associated with what genetic disorder?
Tuberous sclerosis
Which cardiac tumor may present with syncopal episodes? Why?
Myxoma; syncope can occur with ball-valve obstruction of the mitral valve
Which neoplasms have the greatest propensity of metastasizing to the heart?
Melanoma, lymphoma
What are telangiectasias?
Arteriovenous malformations in the small blood vessels
Describe the physical appearance of telangiectasias.
Dilated vessels on skin and mucous membranes
What is hereditary hemorrhagic telangiectasia?
An autosomal dominant disorder that presents with spontaneous nosebleeds and skin discolorations; also called Osler-Weber-Rendu syndrome
A patient presents to her physician with complaints of recurrent spontaneous nosebleeds, black stools and permanent red discolorations of the mouth and skin. She reports that her father and younger brother have the same symptoms. What is the most likely diagnosis?
Hereditary hemorrhagic telangiectasia (also called Osler-Weber-Rendu syndrome)
What are varicose veins?
Dilated, tortuous superficial veins due to chronically increased venous pressure, usually in the legs
Varicose veins may eventually lead to which other, more serious, conditions?
Poor wound healing and venous stasis ulcers
A 60-year-old female with varicose veins develops chest pain and shortness of breath in the hospital after left knee replacement surgery. A computed tomography angiogram reveals multiple pulmonary emboli. What was the likely cause of her pulmonary emboli?
Thromboembolism from stasis in a deep veins of the leg; despite her varicose veins, thromboembolism from superficial veins is very rare
What is Raynauds disease?
A disease characterized by decreased blood flow to the skin due to vasospasm of the arterioles in response to cold exposure or emotional stress
Raynauds disease occurs most often in which parts of the body?
Fingers and toes
Raynauds disease may be associated with which rheumatologic diseases?
Mixed connective tissue disease, systemic lupus erythematosus, or CREST syndrome
Define Raynauds phenomenon.
Arteriolar vasospasm in response to cold or stress secondary to underlying rheumatologic disease
What is Wegeners granulomatosis?
A granulomatous vasculitis characterized by a triad of focal necrotizing vasculitis, granulomas in the lung and upper airway, and glomerulonephritis
What two therapies are used to treat Wegeners granulomatosis?
Corticosteroids and cyclophosphamide
Name eight signs or symptoms associated with Wegeners granulomatosis.
Perforation of the nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, and hematuria
Which molecule is a strong serum marker of Wegeners granulomatosis?
Antineutrophil cytoplasmic antibodies (c-ANCA)
In Wegeners granulomatosis, x-ray of the chest may reveal what finding?
Large nodular densities
Wegeners granulomatosis affects _____ (small/medium/large) vessels.
Small
Which p-ANCA-positive vasculitis is similar to Wegeners granulomatosis but lacks granulomas?
Microscopic polyangiitis
In microscopic polyangiitis, the patient will test positive for _____ (p-ANCA/c-ANCA) in serum, and in Wegeners granulomatosis, the patient will test positive for _____ (p-ANCA/c-ANCA).
P-ANCA; c-ANCA
Which ANCA-positive vasculitis is limited to the kidney?
Primary pauci-immune crescentic glomerulonephritis
Which ANCA-positive vasculitis is a granulomatous vasculitis with eosinophilia?
Churg-Strauss syndrome
Which five organs are involved in Churg-Strauss syndrome?
Lungs, heart, skin, kidneys, and nerves
All ANCA-positive vasculitides affect _____ (small/medium/large) vessels.
Small
In Churg-Strauss syndrome, the patient will test positive for ______ (p-ANCA/c-ANCA) in serum.
P-ANCA
Patients with Churg-Strauss syndrome usually present with which signs or symptoms?
Asthma, skin lesions, sinusitis, and peripheral neuropathy (eg, wrist/foot drop)
What is Sturge-Weber disease?
Congenital capillary malformations manifesting as port-wine stains, intracerebral arteriovenous malformations, and seizures
A patient is diagnosed with Sturge-Weber disease. What neurologic manifestation might be present?
Leptomeningeal angiomatosis (intracerebral arteriovenous malformations) and seizures
What is the most common childhood systemic vasculitis?
henoch-schﾚnlein purpura
What five findings are associated with henoch-schﾚnlein purpura?
Skin rash (palpable purpura) on buttocks and legs, arthralgias, intestinal hemorrhage, abdominal pain, and melena
What renal pathology is associated with henoch-schﾚnlein purpura?
Immunoglobulin A nephropathy
What inciting event commonly precedes henoch-schﾚnlein purpura?
Upper respiratory infection
A 7-year-old has a viral urinary tract infection followed by worsening abdominal and joint pain. He develops purpura on his legs. What is your diagnosis?
henoch-schﾚnlein purpura
What is Buergers disease?
A thrombosing vasculitis affecting the small and medium-sized peripheral arteries and veins of heavy smokers
Buergers disease also has what other name?
Thromboangiitis obliterans
Buergers disease may lead to what serious sequela?
Gangrene and autoamputation of digits
What is the treatment for Buergers disease?
Cessation of cigarette smoking
What are four clinical findings associated with Buergers disease?
Intermittent claudication, superficial nodular phlebitis, Raynauds phenomenon and severe pain in the digits
What dangerous vascular lesion can patients with Kawasaki disease develop?
Coronary aneurysms
What are the five clinical findings associated with Kawasaki disease?
Fever, congested conjunctivae, changes in the lips and oral mucosa (strawberry tongue), and lymphadenitis
Kawasaki disease is a(n) _____ (acute/chronic) vasculitis of the small and medium-sized vessels that is ______ (progressive/self-limited).
Acute; self-limited
Kawasaki disease is an acute, self-limited disease of what patient population?
Infants and children; there is higher incidence in East Asian populations
A 7-year-old Japanese child has 1 week of fever, palpable lymph nodes, erythema of the conjunctiva and tongue, and desquamation of the palms of the hands. What is the diagnosis? How should you treat?
Kawasaki disease; treat with intravenous immunoglobulin and aspirin
What is polyarteritis nodosa?
A vasculitis characterized by immune complex-induced necrosis of medium-sized muscular arteries, typically the renal and visceral vessels
Name 10 clinical findings associated with polyarteritis nodosa.
Fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, hypertension, neurologic dysfunction, cutaneous eruption
Polyarteritis nodosa is strongly associated with which infectious disease?
Hepatitis B
Which two therapies are used to treat polyarteritis nodosa?
Corticosteroids and cyclophosphamide
What findings on arteriogram are seen in patients with polyarteritis nodosa?
Multiple aneurysms and constrictions
Takayasus arteritis is also known as what?
Pulseless disease
Which vessels are typically affected in Takayasus arteritis?
Aortic arch and proximal great vessels
With what laboratory finding is Takayasus arteritis associated?
An elevated erythrocyte sedimentation rate
Which demographic is most affected by Takayasus arteritis?
Asian women younger than 40 years of age
A 35-year-old female presents with fever, knee and muscle pain, night sweats, and vision change. On physical exam, you notice that her fingers are cold and she has weak radial pulses (compared to the lower extremities). What is the diagnosis?
Takayasus arteritis. The patient has Fever, Arthritis, Night sweats, MYalgia, SKIN nodules, Ocular disturbances, and Weak pulses in the upper extremities (remember: FAN MY SKIN On Wednesdays)< body>
What is the most common vasculitis affecting medium and large-sized vessels?
Temporal arteritis
Name three findings commonly associated with temporal arteritis.
Unilateral headache, jaw claudication, and impaired vision
Impaired vision in giant cell arteritis is the result of the occlusion of which artery?
The ophthalmic artery
One half of patients with temporal arteritis also have which rheumatologic condition?
Polymyalgia rheumatica
Temporal arteritis is associated with what laboratory test results?
Erythrocyte sedimentation rate
What is the treatment for temporal arteritis?
High-dose steroids
What population is most commonly affected by temporal arteritis?
Elderly women
Temporal arteritis is also known as what?
Giant cell arteritis
Temporal arteritis affects which vessels?
Medium and large arteries; usually branches of the carotid artery
What is the most serious sequela of giant cell arteritis?
Permanent blindness
What findings on temporal artery biopsy would confirm a diagnosis of giant cell arteritis?
Focal, granulomatous inflammation
A 75-year-old female presents with new-onset right jaw pain and headache at the right temple. What is the diagnosis?
Temporal arteritis
What is a strawberry hemangioma?
A benign capillary hemangioma of infancy, which initially grows and then spontaneously regresses by a few years of age
What is a cherry hemangioma?
A benign capillary hemangioma of the elderly; they become more numerous with age
What is a pyogenic granuloma?
A common polypoid hemangioma, often seen in the mouth in pregnancy, which can ulcerate and bleed
What is a cystic hygroma?
A cavernous lymphangioma found in the neck; associated with Turners syndrome
What is a glomus tumor?
A rare, benign, painful, red-blue tumor found under the fingernails; arises from smooth muscle cells of the glomus body
What is bacillary angiomatosis?
Benign capillary skin papules found in AIDS patients; similar appearance to Kaposi sarcoma; caused by Bartonella infection
What is angiosarcoma?
Aggressive malignancy of the liver; associated with vinyl chloride, arsenic, and thallium exposure
What is lymphangiosarcoma?
A lymphatic malignancy that is associated with persistent lymphedema; seen after axillary lymph node dissection for breast cancer
