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CPR Exam 1 > Cardio Pathology Part 2 > Flashcards

Cardio Pathology Part 2 Flashcards

1
Q

What are some causes of arrhythmias?

A
  • Ischemic heart disease
  • Cardiomyopathies
  • Myocarditis
  • Valvular disease
  • Familial/congenital disordes
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2
Q

What is sick sinus syndrome?

A
  • SA node is damaged leading to bradycardia
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3
Q

What is atrial fibrillation?

A
  • Myocytes depolarize independently and sporadically with variable transmission to the AV node leading to an irregular HR
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4
Q

What can atrial fibrillation cause?

A
  • Thrombus formation or thromboembolism (leading to stroke)
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5
Q

What is a heart block?

A
  • Dysfunctional AV node
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6
Q

What is a first degree heart block?

A
  • Prolonged PR interval
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7
Q

What is a second degree heart block?

A
  • Intermittent transmission
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8
Q

What is a third degree heart block?

A
  • Complete failure
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9
Q

What are hereditary channelopathies?

A
  • Abnormal ion channels which cause arrhythmogenic disease
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10
Q

What is the most common hereditary channelopathy?

A
  • Long QT syndrome
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11
Q

What is long QT syndrome?

A
  • Cause of sudden death after exercise

- K+ and Na+ channel dysfunction leads to improper conduction

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12
Q

What are some risk factors for sudden cardiac death in younger patients?

A
  • Drug abuse
  • Hereditary conduction abnormalities
  • Hypertrophic or dilated cardiomyopathy
  • Myocardial hypertrophy
  • Myocarditis
  • Mitral valve prolapse
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13
Q

What does hypertensive heart disease lead to?

A
  • Left ventricular hypertrophy
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14
Q

What can diastolic dysfunction lead to in hypertensive heart disease?

A
  • Atrial enlargement ultimately leading to A fib
  • Congestive heart failure
  • Sudden cardiac death
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15
Q

What can acute cor pulmonale arise from?

A
  • Large pulmonary embolus
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16
Q

What is the most common valve abnormality?

A
  • Calcific aortic stenosis
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17
Q

What age group has the highest prevalence of calcific aortic stenosis?

A
  • Older adults (60-80)
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18
Q

What causes the wear and tear on the valve in calcific aortic stenosis?

A
  • Chronic HTN
  • Hyperlipidemia
  • Inflammation
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19
Q

What is the consequence of the calcifications on the aortic valve?

A
  • Prevents complete opening
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20
Q

What is a caveat to bicuspid aortic valves in terms of calcification?

A
  • Show an accelerated course due to asymmetrical closing
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21
Q

When do the symptoms of calcific bicuspid stenosis show in a patient?

A
  • 1-2 decades earlier
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22
Q

What is more frequent on bicuspid valves?

A
  • Bacterial endocarditis
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23
Q

What are some signs and symptoms of calcific aortic stenosis?

A
  • Increased LV pressure causing concentric left ventricular hypertrophy
  • Systolic murmur
  • Angina
  • Syncope
  • CHF
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24
Q

What is the mortality rate of those with calcific aortic stenosis?

A
  • Die with 5 years of developing angina
  • Within 3 years of developing syncope
  • Within 2 years of CHF
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25
Q

What is the treatment of calcific aortic stenosis?

A
  • Surgical replacement of the valve
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26
Q

What is mitral annular calcification?

A
  • Calcific deposits in the fibrous annulus
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27
Q

Who is more affected by mitral annular calcification?

A
  • Females over 60 years old
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28
Q

What will the valve show in mitral annular calcification?

A
  • Usually show as normal
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29
Q

What could mitral annular calcification lead to?

A
  • Regurgitation
  • Stenosis
  • Arrhythmias (heart block, sudden death)
  • Nidus for thrombus, infective endocarditis
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30
Q

What is mitral valve prolapse?

A
  • When the valve leaflets prolapse back into the left atrium during systole
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31
Q

Who is mitral valve prolapse most likely seen in?

A
  • Female (7:1)
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32
Q

What are the causes of mitral valve prolapse?

A
  • No underlying cause identified
  • Could be caused by a connective tissue disease (marfan)
  • Complication of MI or rheumatic fever
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33
Q

What are the findings in someone with mitral valve prolapse?

A
  • Leaflets are thickened and rubbery

- Interchondral ballooning of mitral leaflets

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34
Q

What are some clinical presentations of mitral valve prolapse?

A
  • Most are asymptomatic

- Could lead to dyspnea due to mitral regurgitation

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35
Q

What are some serious complications of mitral valve prolapse?

A
  • Infective endocarditis
  • Mitral insufficiency
  • Arrhythmias
  • Thromboembolism
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36
Q

What is rheumatic fever?

A
  • Multisystem inflammatory disease following a group A strep pharyngitis
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37
Q

What causes rheumatic fever?

A
  • Antibodies and CD4+ T cell reactions against M streptococcal antigen which are reactive against antigens in the heart, joints, soft tissue, skin, and nervous system
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38
Q

When is the acute phase of rheumatic fever?

A
  • 10 days to 6 weeks after the strep infection
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39
Q

What are the signs and symptoms of rheumatic fever?

A
  • Fever
  • Migratory polyarthritis
  • Pancarditis
  • Subcutaneous nodules
  • Erythema marginatum
  • Sydenham chorea (hopping, halting gait, asymmetric jerk, grimacing)
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40
Q

How is a rheumatic fever diagnosis confirmed?

A
  • Looking at antibodies to streptolysin O and DNase B
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41
Q

Which valve is most likely to be affected in acute rheumatic heart disease?

A
  • Mitral

- MAT (mitral>aortic>tricuspid)

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42
Q

What are the symptoms of acute rheumatic heart disease?

A
  • Pancarditis
  • Valvulitis with vegetation
  • MacCallum Plaques
  • Aschoff bodies with Anitschkow cells on histo
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43
Q

What is seen in chronic rheumatic fever disease?

A
  • Valvular leaflet thickening
  • Short chordae tendineae
  • Fusion
  • Regurgitation
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44
Q

Which valve is most likely to be affected in chronic rheumatic fever disease?

A
  • Mitral
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45
Q

What is infective endocarditis?

A
  • An infectious organism causes inflammation and fibrinous debris
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46
Q

Where does infective endocarditis usually affect?

A
  • Valves or structural abnormalities
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47
Q

What is the most likely cause of infective endocarditis?

A
  • Bacterial
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48
Q

What are some risk factors to infective endocarditis?

A
  • Injection drug use
  • Body piercings
  • Male gender
  • Poor dentition
  • Invasive dental procedures
  • Age >60
  • Pre-existing heart conditions (rheumatic heart disease, MVP, calcific stenosis)
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49
Q

Which organism causes infective endocarditis that is native, structurally abnormal valves?

A
  • Strep viridans
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50
Q

Which organism causes infective endocarditis from poor dentition or invasive dental procedures?

A
  • HACEK organisms
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51
Q

Which organism causes infective endocarditis that affects prosthetic heart valves?

A
  • Staph epidermidis
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52
Q

Which organism causes infective endocarditis in patients who abuse IV drugs?

A
  • Staph aureus (causes right sided endocarditis due to traveling in veins)
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53
Q

What is the clinical presentation of someone with acute endocarditis?

A
  • Rapid development of fever, chills, and weakness
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54
Q

What is the clinical presentation of someone with subacute endocarditis?

A
  • Low grade fever and fatigue
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55
Q

How is infective endocarditis diagnosed?

A
  • Duke criteria

- May have subungual/splinter hemorrhages, Janeway lesions, Osler nodes, or Roth spots

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56
Q

What is nonbacterial thrombotic endocarditis?

A
  • A sterile, non-inflammatory valvular thrombi that is asymptomatic until embolization occurs
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57
Q

What causes a nonbacterial thrombotic endocarditis?

A
  • Sepsis (proinflammatory, procoagulant cytokines)
  • Cancer
  • Antiphospholipid syndrome
  • SLE (Libman-Sacks)
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58
Q

What is antiphospholipid syndrome?

A
  • Autoantibodies against endothelial membranes
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59
Q

How does antiphospholipid syndrome manifest?

A
  • Could manifest through fetal loss during pregnancy

- Could be primary or associated with lupus

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60
Q

What is Libman-Sacks endocarditis?

A
  • Nonbacterial endocarditis associated with lupus
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61
Q

What is carcinoid heart disease?

A
  • When bioactive compounds (serotonin) are secreted from carcinoid tumors, they induce plaque-like endocardial and valvular thickening
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62
Q

Why does carcinoid heart disease happen?

A
  • The liver normally metabolizes serotonin, but if the tumor metastasis to the liver, serotonin travels to the lungs.
63
Q

Where do the lesions occur in carcinoid heart disease?

A
  • Right side of the heart due to MAO being present in the lungs
64
Q

What are the signs and symptoms of carcinoid heart disease?

A
  • Flushing
  • Diarrhea
  • Dermatitis
  • Bronchoconstriction
65
Q

What are the different types of mechanical prosthetic valves?

A
  • Caged ball
  • Tilting disk
  • Hinged flap
66
Q

What is a complication of having a mechanical prosthetic valve?

A
  • Risk of thromboembolism
67
Q

What are the different types of tissue prosthetic valves?

A
  • Bovine or Porcine
68
Q

What is a complication of having a tissue prosthetic valve?

A
  • Mechanical failure like tearing or incompetence could occur
69
Q

What is a complication that can affect both types of prosthetic valves?

A
  • Infective endocarditis
70
Q

What are some other risks involved in prosthetic valves?

A
  • Anticoagulant related hemorrhage (mechanical require life long anticoag therapy)
  • Dysfunction
  • Hemolysis (hemolytic anemia)
71
Q

What kind of a murmur does a calcific aortic stenosis cause?

A
  • Harsh systolic murmur (crescendo-decrescendo)
72
Q

What kind of a murmur does a mitral regurgitation cause?

A
  • Holosystolic murmur
73
Q

What kind of a murmur does a aortic regurgitation cause?

A
  • Diastolic decrescendo murmur
74
Q

What kind of a murmur does a PDA cause?

A
  • Machine-like murmur
75
Q

What are the three types of cardiomyopathy?

A
  • Dilated
  • Hypertrophic
  • Restrictive
76
Q

What is dilated cardiomyopathy?

A
  • Progressive cardiac dilation and systolic dysfunction, usually with dilated hypertrophy
77
Q

What are some causes of dilated hypertrophy?

A
  • Familial 30-50% (mutation in Titin gene)
  • Peripartum cardiomyopathy
  • Alcohol
  • Myocarditis
  • Cardiotoxic drugs (doxorubicin)
  • Iron overload (hereditary hemochromatosis or multiple transfusions)
78
Q

What kind of cardiac morphology is seen in dilated cardiomyopathy?

A
  • Dilation of all four chambers
  • Often hypertrophic
  • Functional regurgitation of valves
79
Q

What are some clinical features of dilated cardiomyopathy?

A
  • Manifests between ages 20-50
  • Progressive CHF leading to dyspnea, exertional fatigue, and decreased EF
  • Systolic dysfunction
  • Arrhythmias (sudden death)
  • Thrombi formation with embolism
80
Q

What is Takotsubo cardiomyopathy?

A
  • AKA broken heart syndrome

- Associated with emotional distress which causes sudden surge of catecholamines

81
Q

What are the signs and symptoms of takotsubo cardiomyopathy?

A
  • Apical ballooning of the left ventricle

- Similar presentation to MI

82
Q

Who is most likely to suffer from takotsubo cardiomyopathy?

A
  • Women 60-75 YO
83
Q

What is arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A
  • Defective cell adhesion proteins in desmosomes that link adjacent cardiac myocytes
84
Q

What is seen clinically in ARVC?

A
  • Right ventricular failure and arrhythmias
85
Q

What is Naxos syndrome?

A
  • ARVC with plantar and palmar hyperkeratosis and wooly hair
86
Q

What gene is affected in Naxos syndrome?

A
  • Plakoglobin
87
Q

What happens to the right ventricular wall in naxos syndrome?

A
  • Adipose and fibrosis leading to v tach/fib causing sudden death
88
Q

Who is affected by hypertrophic cardiomyopathy?

A
  • Genetic disorder that affects predominantly males
89
Q

What is hypertrophic cardiomyopathy characteristically marked by?

A
  • Myocyte hypertrophy and myocyte disarry
90
Q

What mutations are associated with hypertrophic cardiomyopathy?

A
  • Numerous mutations are known, involving sarcomeric proteins
  • Most common is B-myosin heavy chain
91
Q

What are the signs and symptoms of hypertrophic cardiomyopathy?

A
  • Ventricular arrhythmias
  • Systolic ejection murmur
  • Exertional dyspnea
  • Exertional chest pain
  • Palpitations
92
Q

What can the ventricular arrhythmias cause in hypertrophic cardiomyopathy?

A
  • Unexplained death in athletes (most common presentation)
93
Q

What causes the systolic ejection murmur in hypertrophic cardiomyopathy?

A
  • Mitral valve pushed toward septum
94
Q

What causes the exertional chest pain in hypertrophic cardiomyopathy?

A
  • Microvascular thrombi
95
Q

What causes the exertional dyspnea in hypertrophic cardiomyopathy?

A
  • Impaired diastolic filling– diminished cardiac output and pulmonary congestion
96
Q

What is restrictive cardiomyopathy?

A
  • Decreased ventricular compliance leading to diastolic dysfunction
97
Q

What happens to the left ventricle in restrive cardiomyopathy?

A
  • Systolic function of LV remains normal
98
Q

What could cause restrictive cardiomyopathy?

A
  • Could be secondary to deposition of material within the wall (amyloid) or increased fibrosis (radiation)
99
Q

What do the atria look like in restrictive cardiomyopathy? How do they compare to the ventricles?

A
  • Atria are enlarged

- Ventricles are normal

100
Q

What is amyloidosis?

A
  • Extracellular deposition of proteins which form an insoluble B-pleated sheet
101
Q

What stain is used to show amyloidosis?

A
  • Congo red stain
102
Q

How does amyloidosis show up on stain?

A
  • Apple green birefirngence
103
Q

What are some causes of amyloidosis?

A
  • Myeloma
  • Chronic inflammatory states
  • Mutated version of transthyretin
  • Senile amyloidosis
104
Q

What what endomyocardial fibrosis? Where is it found?

A
  • Fibrosis of endocardium and subendocardium

- Found in children and young adults in tropical or subtropical areas

105
Q

What is Loeffler endocarditis?

A
  • Part of spectrum of endomyocardial fibrosis
  • Shows eosinophilic infiltration
  • Associated with myeloproliferative disorders
106
Q

What is endocardial fibroelastosis? When does it show up?

A
  • Fibroelastic thickening of left ventricle endocardium
  • Shows up in first 2 years of life
  • Associated with congenital heart defects
107
Q

What is myocarditis?

A
  • Inflammatory disease of cardiac muscle
108
Q

What is the most common cause of myocarditis?

A
  • Viral infection (coxsackievirus B)
109
Q

What causes chagas disease?

A
  • Parasite: Triatomine bug
110
Q

What causes trichinosis?

A
  • Eating undercooked pork
111
Q

What causes lyme disease

A
  • Ixodes tick in NE US
112
Q

When is myocarditis seen in lyme disease?

A
  • In the early disseminated phase
113
Q

What other symptoms are seen in lyme disease?

A
  • Migratory polyarthritis
  • Facial palsy
  • Meningitis
114
Q

What is lymphocytic myocarditis?

A
  • Most common form of myocarditis

- Due to viral/post viral infection, autoimmune process, or idiopathic

115
Q

What is eosinophilic myocarditis? What must you exclude from differential?

A
  • Marked increased eosinophils
  • There is a hypersensitivity reaction due to an underlying allergy
  • Could be idiopathic and must exclude parasitic infection
116
Q

What is idiopathic giant cell myocarditis?

A
  • Giant cells are admixed with variable inflammation (typically increased eosinophils)
117
Q

What is the prognosis of idiopathic giant cell myocarditis?

A
  • Poor with survival rate of less than 3 months
118
Q

What is myocardial sarcoidosis?

A
  • An idiopathic process, rare cause with variable presentation
  • Giant cells with non-necrotizing granulomas
119
Q

What are the two cardiotoxic drugs that cause dilated cardiomyopathy?

A
  • Doxorubicin

- Daunorubicin

120
Q

What is the normal volume of fluid surrounding the heart?

121
Q

How much fluid can build up in a slow accumulation? Is the patient symptomatic or asymptomatic?

A
  • <500mL can build up

- Patients are typically asymptomatic

122
Q

What happens in an acute pericardial effusion?

A
  • Occurs in less than a week

- 200-300 mL rapidly accumulate and causes symptomatic cardiac tamponade

123
Q

What are some examples of pericardial effusions?

A
  • Hemopericardium (blood in pericardial space)
  • Serous effusion (CHF)
  • Purulent pericarditis (pus)
124
Q

What is pericarditis?

A
  • Inflammation of the pericardial sac
125
Q

What are some signs and symptoms of pericarditis?

A
  • Chest pain
  • Pericardial friction rub
  • Pericardial effusion
  • EKG changes
  • Low grade fever
126
Q

What are the different types of pericarditis?

A
  • Fibrinous and serofibrinous
  • Serous pericarditis
  • Purulent or suppurative pericarditis
  • Caseous pericarditis
  • Hemorrhagic pericarditis
  • Constrictive pericarditis
127
Q

What is the most common type of pericarditis?

A
  • Fibrinous and serofibrinous
128
Q

What causes the fibrinous and serofibrinous pericarditis?

A
  • A fibrinous inflammatory exudate causing a variable amount of fluid build up
129
Q

What can cause a fibrinous or serofibrinous pericarditis?

A
  • Acute MI
  • Dressler’s syndrome
  • Uremia
  • Chest irradiation
  • RF
  • SLE
  • Trauma
130
Q

What causes a serous pericarditis?

A
  • Viral or noninfectious inflammatory diseases
131
Q

What causes a purulent or suppurative pericarditis?

A
  • Active infection caused by microbial invasion
132
Q

What causes a caseous pericarditis?

A
  • Tuberculosis

- Occasionally fungal

133
Q

What causes a hemorrhagic pericarditis?

A
  • Most commonly due to malignant tumor spread

- Could be due to trauma

134
Q

What causes a constrictive pericarditis?

A
  • Occurs when the heart is encased in a dense, fibrous or fibroelastic scar that limits diastolic expansion and cardiac output
135
Q

What is a cardiac myxoma?

A
  • Most common primary tumor

- Stromal tumor of mesenchymal origin

136
Q

Where is a cardiac myxoma usually located?

A
  • Left atrium and begins in septal region near fossa ovalis
137
Q

What are some signs and symptoms of a cardiac myxoma?

A
  • “ball-valve” obstruction
  • mechanical valve damage
  • Embolization
  • Fever
  • Malaise
  • IL-6 elaboration by tumor (acute phase response)
138
Q

What will you hear on auscultation with a cardiac myxoma?

A
  • Tumor “plop”
139
Q

What familial syndromes are cardiac myxomas associated with?

A
  • McCune-Albright syndrome

- Carney complex

140
Q

What is McCune-Albright syndrome?

A
  • A GNAS1 mutation

- Symptoms include: polyostotic fibrous dysplasia, cafe au lait spots, endocrine abnormalities

141
Q

What is Carney complex?

A
  • PRKAR1A mutation

- Symptoms include: skin changes, endocrine dysfunction

142
Q

What is a lipoma?

A
  • Localized mass composed of mature lobulated fat

- Occurs throughout the heart

143
Q

What is a papillary fibroelastoma?

A
  • Typically incidental

- Often located on valves

144
Q

What does a papillary fibroelastoma look like?

A
  • Sea anemone
145
Q

What is a rhabdomyoma?

A
  • Most frequent primary tumor of the pediatric heart
146
Q

What causes a rhabdomyoma?

A
  • 50% are sporadic

- 50% are associated with tuberous sclerosis

147
Q

What is an angiosarcoma?

A
  • Malignant endothelial neoplasm that primarily affects older adults
148
Q

How can non-cardiac tumors affect the heart?

A
  • Mass effect (limiting cardiac filling)
  • Decreased myocardial contractility
  • Symptomatic pericardial effusion
  • SVC syndrome
149
Q

What is an allograft rejection?

A
  • Rejection that can be cellular mediated or antibody mediated
150
Q

What is the cellular mediated rejection?

A
  • T cell mediated, lymphocytic response
151
Q

What is the antibody mediated rejection?

A
  • Antibody mediated with vascular neutrophilic infiltration
152
Q

What is allograft vasculopathy?

A
  • A late, progressive, and diffusely stenosing intimal proliferation
  • In 50% of patients in 5 years, in all patients after 10 years
153
Q

What does allograft vasculopathy cause?

A
  • Silent MI due to denervated transplanted heart (no angina)
154
Q

What are some complications to chronic immunosuppression?

A
  • Infection

- Malignancy

CPR Exam 1 (21 decks)

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