Cardiology- Pathology Flashcards
Describe persistent truncus arteriosus
Failure of truncus arteriosus to divide into pulm trunk and aorta; R to L shunt
Describe transposition of great vessels
Aorta leaves RV, pulm trunk leaves LV; separation of pulm and systemic circulation
What is the cause of transposition of great vessels
Failure of aorticopulmonary septum to spiral
Describe tricuspid atresia
abscence of tricuspid valve and hypoplastic RV
What two defects are required for viability of tricuspid atresia
ASD and VSD
What is the underlying defect of tetralogy of fallot
Displacement of infundibular septum
What are 4 defects associated with tetralogy of fallot
- pulmonary infundibular stenosis
- RVH (boot-shaped heart)
- overriding aorta
- VSD
A boot-shaped heart on CXR is assoc with what congenital heart defect
RVH, tetraology of fallot
Describe Total anomalous pulmonary venous return (TAPVR)
Pulmonary veins drain into R heart circulation; R to L shunt
What is the most common congenital heart defect
VSD
What congenital heart defect is associated with maternal diabetes?
Transposition of great vessels
What congenital heart defect is associated with fetal alcohol syndrome?
VSD
What septum is usually defective in an ASD?
Septum secundum
What cardiac defect is associated with congenital rubella?
PDA, septal defects, pulm artery stenosis
If uncorrected, can result in late cyanosis of the lower extremities
PDA
What causes Eisenmenger syndrome
Uncorrected L to R shunt
Pulm HTN
RVH
R to L shunt
Presents as late cyanosis, clubbing, polycythemia
eisenmenger syndrome
What aspect of the defect distinguishes infantile from adult type coarctation of the aorta
Infantile: proximal to ductus arteriosus
Adult: distal to ligamentum arteriosus
Infantile coarctation is associated with what chromosomal abnormality?
Turner syndrome
Presents with notching of the ribs, hypertension of the upper extremities, weak, delayed pulses of lower extremities
Coarctation of the aorta
Cardiac defects associated with 22q11 syndromes
truncus arteriosus, ToF
Cardiac defects associated with Down syndrome
ASD, VSD, AV septal defect (every kind of septal defect!)
What is corneal arcus
lipid deposits in the cornea
What are xanthomas
plaques of lipd-laden histiocytes
What is fibromuscular dysplasia? What is systemic consequence?
Dysplasia of renal arteries; common cause of hypotension in young adults
What is severe hypertension
> 180/120
What is Monckeberg arteriosclerosis
calcification of the media of arteries; usually radial or ulnar
What are the 2 causes of hyaline arteriosclerosis? Describe finding
essential hypertension and DM
thickening of small arteries
What is the cause of hyperplastic arteriosclerosis? What is the histologic finding?
Severe hypertension
“onion skinning”
Atherosclerosis vs arteriosclerosis
Arteriosclerosis: small blood vessels, hardening of arteriolar wall; thickening of wall
atherosclerosis: elastic arteries, large and medium-sized muscular arteries; deposits
What are the four most common arteries involved in atherosclerosis
Abdominal aorta
coronary artery
popliteal artery
carotid artery
What is the most common cause of abdominal aortic aneurysm?
Atherosclerosis (hypertensive male smoker)
What are the common causes of thoracic aortic aneurysms (3)?
Cystic medial degeneration due to hypertension
Marfan syndrome
Tertiary syphilis (obliterative endarteritis of vasa vasorum)
Presents with tearing chest pain of sudden onset, radiating to the back; may have unequal BP in arms
Aortic dissection
What are the worst complications of Aortic dissection
pericardial tamponade, aortic rupture
What ECG findings are indicative of stable angina
ST depression
How much occlusion is necessary for symptoms?
70%
What is Prinzmetal angina?
Episodes of chest pain associated with coronary artery spasm; assoc with tobacco, cocaine, triptans
What are ECG findings with Prinzmetal angina
transient ST elevation
What is Unstable/crescendo angina?
Angina increasing in frequency or at rest; thrombosis with incomplete occlusion
ECG findings for unstable angina
ST depression
Coronary steal syndrome
vessels are maximally dilated at baseline distally to the coronary stenosis
Vasodilators dilates only normal vessels and shunts blood to wellperfused areas
Most common cause of sudden cardiac death
lethal arrythmia
ECG findings after MI
Transmural: ST elevation
Subendocardial: ST depression
3 most commonly occluded coronary arteries
LAD>RCA>circumflex
Dressler syndrome
autoimmune phenomenon; fibrinous pericarditis several weeks post-MI
What time point post MI do you see gross findings of dark mottling, pale with tetrazolium staining?
4-12h
What time point post MI do you see gross findings of hyperemia?
1-3d
What time point post MI do you see gross findings of a hyperemic border with central yellow-brown softening?
3-14d
What time point post MI do you see gross findings of gray-white tisseu with recanalized artery?
> 2 weeks
What causes contraction bands and what time are they seen?
12-24h post MI
from reperfusion injury (Ca2+ back)
Describe the immune cell/ Healing process for an MI Hours Days Weeks A month
Hours- Coagulative necrosis
Days- Neutrophils then macrophages
Weeks- granulation tissue
A month- scar tissue
At what time point post MI is the heart susceptible to wall rupture and aneurysm?
3-14 d (macrophages eat up dieing tissue)
What markers are used to diagnose MI and what timepoints are the elevated?
Troponin I: 4hr to 7-10 days
CK-MB: returns to normal in 48h
good for diagnosing reinfarct
What leads are changed for an MI of the anterior wall?
V1-V4 (LAD)
What leads are changed for an MI of the lateral wall?
I, aVL (LCX)
What leads are changed for an MI of the inferior wall?
II, III, aVF (RCA)
Which types of cardiomyopathy (3) cause systolic vs diastolic dysfunction?
Cystolic: Dilated
Diastolic: Hypertrophic, restrictive
What are the auscultatory findings for dilated vs hypertrophic cardiomyopathy
Dilated: S3
Hypertrophic: S4, systolic murmur
What type of cardiac defect is a common cause of sudden death in young althletes?
Hypertrophic Cardiomyopathy
What is the defect and inheritance of hypertrophic cardiomyopathy?
b-myosin heavy chain
autosomal dominant
What is Loffler syndrome?
at type of restrictive/infiltrative cardiomyopathy
endomyocrdial fibrosis with prominent eosinophilic infiltrate
What is the presentation/ECG finding of restrictive cardiomyopathy?
CHF, low-voltage ECG
Describe the gross and molecular findings of hypertrophic cardiomyopathy?
Gross: concentric hypertrophy of ventricles
Microscopic: myofibrillar disarray and fibrosis
What type of hypertrophy is seen in dilated cardiomyopathy?
Eccentric hypertrophy (sarcomeres added in series)`
What infectious etiologies are causes of dilated cardiomyopathy?
Coxsackie B virus myocarditis
Chagas disease
Compare EF, contractility and compliance in systolic vs diastolic dysfunction
Systolic: Low EF and contractility
Diastolic: normal EF and contractility; decr compliance
What are hemosiderin-laden macrophages a sign of?
Pulmonary edema, LH failure
What are signs of Left heart failure (3)
Pulmonary edema
orthopnea
paroxysmal nocturnal dyspnea
What are signs of right heart failure (3)
Hepatomegaly (nutmeg liver)
Peripheral edema
JVD
What 4 treatments decrease mortality in CHF?
ACE inh, bblock, ang II R block, spironolactone
What do Roth spots, Osler nodes, and Janeway lesions indicate and describe each?
Bacterial endocarditis
Roth spots: round white spots on retina, surrounded by hemorrhage
Osler nodes: tender raised lesions on finger or toe pads
Janeway: small, painless, erythematous lesions on palm or sole
What is the main causative organism of acute endocarditis
S. aureus
What is the main causative organism of subacute endocarditis
viridans streptococci
What is the most common causative organism seen with prosthetic valves?
S. epidermidis
What type of endocarditis indicates colon cancer
S. bovis
What type of hypersensitivity is associated with rheumatic fever and what is causative antigen?
Type II hypersensitivity
M protein
What organisms are associated with culture negative endocarditis?
Coxiella burnetti, Bartonella sp
What are the causes of fibrinous pericarditis? (3)
Dressler syndrome (post MI)
uremia
radiation
What causes serous pericarditis?
viral pericarditis
What causes suppurative pericaraditis?
bacterial infxn
What is associated with ECG changes of widespread ST-segment elevation and/or PR depression?
pericarditis
What is pulsus paradoxus?
Decr amplitude of systolic BP by >10mmHg during inspiration
What is Kussmaul sign?
Incr JVP on inspiration; indicative of limited RV filling
What valves are affected by Rheumatic fever?
mitral>aortic»tricuspid
What are Aschoff bodies and Anitschkow cells associated with?
Rheumatic fever
What is Beck’s triad? What disease does it indicate?
Hypotension
Distended neck veins
Distant heart sounds
What is associated with ECG findings of low-voltage QRS and electrical alterans
Cardiac tamponade
Where do myxomas commonly occur?
atria
What cardiac defect is associated with tuberous sclerosis?
Rhabdomyomas
Compare Raynaud disease vs Raynaud syndrome
Disease: primary, idiopathic
Syndrome: secondary to a disease process, eg SLE, CREST
What ages are strawberry vs cherry hemangiomas seen?
Strawberry: children, regress by 5-8y
Cherry: elderly, does not regress
What chromosomal abnormality is cystic hygroma associated with?
Turner syndrome (cavernous lymphangioma of the skin)
What populatio are bacillary angiomatoses seen in and what is the causative organism?
AIDS
Bartonella henselae
What cells do glomus tumors arise from?
Where are they located?
smooth muscle cells of the glomus body
underneath fingernails
What malignancy is associated with persistent lymphedema (eg post-radical mastectomy)?
Lymphangiosarcoma
What organ other than the skin can one find hemangiomas and angiosarcomas?
Liver
How does one distinguish a purpura from a hemangioma?
Hemangioma blanches on compression
What systems other than the skin are Kaposi sarcoma associated with?
GI tract, respiratory tract
What blood vessels does temporal arteritis most commonly effect?
Branches of he carotid artery (temporal, ophthalmic)
What disease presents with unilateral headache and jaw claudication?
Temporal arteritis
What population is most commonly affected by Takayasu arteritis
Asian females, <40
What disease presents with weak upper extremity pulses, fever, night sweats, arthritis, myalgias, skin nodues, and ocular disturbances?
Takayasu arteritis
What are the histologic/ gross findings of Takayasu arteritis?
Granulomatous thinckening and narrowing of the aortic arch
What population typically gets polyarteritis nodosa (age and exposure)
Young adults, Hep B+
What vessels are most commonly involved in polyarteritis nodosa? What is usually spared?
Involved: renal (HTN), visceral
Spared: lung
muscular arteries
What is the immune mechanims of polyartertitis nodosa?
Immune complex mediated
What population is Kawasaki disease seen in?
Asian children < 4 years old
What vascular disease is associated with fever, cervical lymphadenitis, conjuctival injectin, strawberry tongue, and hand-foot erythema
Kawasaki disease
What is the most dangerous complication of Kawaski disease?
coronary artery aneurysm and thrombosis (MI, rupture)
What population is Buerger disease associated with?
Heavy smoker males <40y
Describe buerger disease
necrotizing vasculitis of the digits
What organs are typically involved in Graunlomatosis with polyangitis?
nasopharynx (perforation septum, sinusitis)
Lung (hemoptysis, dyspnea)
kidney (hematuria, RBC casts)
What presents with the triad of:
- focal necrotizing vasculitis
- necrotizing granuloma of the lung and upper airway
- necrotizing glomerulonephritis
Graunlomatosis with polyangitis
How is microscopic polyangitis distinguished from Graunlomatosis with polyangitis?
No nasopharyngeal involvement
No granulomas
What presents with asthma, sinusitis, palpable purpura, peripheral neuropathy?
Churg-Strauss syndrome
What is the underlying immune cause of Henoch-schonlein purpura?
IgA complex deposition
What is usually the inciting event for Henoch-schonlein purpura?
URI
What presents with
Palpable purpura of bottocks/legs
arthralgias
adominal pain and melena
Henoch-schonlein purpura
