Chapter 12- The Heart Flashcards
What are syndromes of ischemic heart disease usually due to
Atherosclerosis of coronary
What is the term for chest pain that arises with exertion or emotional stress (no pain at rest)
Stable angina
What is the hallmark of stable angina
Cellular swelling
What is the typical presentation of stable angina
Chest pain lasting less than 20 minutes that radiates to left arm or jaw; diaphoresis; SOB
What is the EKG finding with stable angina
ST segment depression
What is the term for chest pain that occurs at rest
Unstable angina
What is unstable angina due to
Atherosclerotic plaque with thrombosis and incomplete occlusion of a coronary artery
What is the EKG finding with unstable angina
ST segment depression
What is prinzmetal angina due to
Coronary artery vasospasm
What is the EKG finding with prinzmetal angina
ST segment elevation due to transmural ischemia
What part of the heart does MI usually involve
Left ventricle (usually spares RV and both atria)
Describe levels of troponin I
Rises 2-4 hrs after infarction; peaks at 24 hours and returns to normal in 7-10 days
Describe levels of Ck-MB
Rises 4-6 hours after infarction; peaks at 24 hours; returns to normal by 72 hours
What is happening less than 4 hours after an MI
Carcinogenic shock, CHF, arrhythmias
What is happening 4-24 hours after infarction
Gross change (dark discoloration), micro change (coagulative necrosis), complication is arrhythmia
What is happening 1-3 days after infarction
Gross change (yellow pallor), micro (neutrophils), complication is fibrinous pericarditis
What is happening 4-7 days after infarction
Yellow pallor, macrophages
What is happening 1-3 weeks after infarction
Red border; granulation tissue with plump fibroblasts, collagen and blood vessels
What is sudden cardiac death usually due to
Fatal ventricular arrhythmia
What is the most common etiology of sudden cardiac death
Acute ischemia
What should you think of with heart failure cells
Left sided congestive heart failure
What is heart failure cells
Iron build-ups in macrophages (hemosiderin)
What is R sided heart failure usually due to
L-sided heart failure
Is left or right sided heart failure associated with nutmeg liver
Right
What are clinical presentations of eisenmenger syndrome
Right ventricular hypertrophy, polycythemia, clubbing
What is the most common ASD
Ostium secundum
What is the ostium primum type of ASHD associated with
Down syndrome
What congenital infection is associated with PDA
Congenital rubella
What type of murmur is heard with PDA
Machine like
What should you think of with boot shaped heart
TOF
What are the features of TOF
Stenosis of RV outflow tract, RV hypertrophy, VSD, overriding aorta
What disorder is transposition of great vessels associated with
Maternal diabetes
What is the presentation of truncus arteriosus
Early cyanosis
What is infantile coarctation of aorta associated with
PDA
How does infantile coarctation of aorta present
Lower extremity cyanosis; associated with turners syndrome
Wher does the coarctation in adult form coarctation of aorta occur
Lies distal to aortic arch
What is the presentation of adult coarctation of aorta
HTN in upper extremity and hypotension with weak pulses in lower extremity
What are the jones characteristics associated with acute rheumatic fever
Joint (migratory polyarthritis), heart (pancarditis-shaped like an “o”), nodules (subcutaneous), erythema marginatum, sindenhemps (in muscle) corona
What should you think of with ashoff bodies
Pancarditis of acute rheumatic fever
What should you think of with anitchcall cells
Acute rheumatic fever
What valve is almost always involved in chronic rheumatic valvular disease
Mitral valve
What should you think of with fish mouth appearance of valves
Chronic rheumatic valvular disease
What is aortic stenosis usually due to
Fibrosis and calcification from wear and tear; presents in late adulthood (60yo+)
What murmur is associated with aortic stenosis
Systolic ejection click followed by a crescendo-decrescendo murmur
What is the term for backflow of blood from aorta into LV during diastole
Aortic regurgitation
What are some things that can cause aortic regurgitation
Aortic root dilation (syphilitic aneurysm) or valve damage (IE)
What is the clinical presentation of aortic regurgitation
Early blowing diastolic murmur
What is the clinical presentation of mitral valve prolapse
Mid-systolic click followed by regurgitation murmur; usually asymptomatic
What is the term for reflux of blood from LV into LA during systole
Mitral regurgitation
What is mitral regurgitation usually a complication of
Mitral valve prolapse
What type of murmur is heard with mitral regurgitation
Holosystolic blowing murmur
What does mitral regurgitation result in
Volume overload and left sided HF
What is the most common overall cause of infectious endocarditis
S. Viridans
What does S. viridans IE result in
Small vegetations that do NOT destroy valves
What is the most common cause of IE in IV drug users
S aureus
What does S aureus caused IE result in
Large vegetations that destroy valves
What is the major cause of IE in prosthetic valves
S. Epidermidis
What is the leading cause of IE in patients with underlying colorectal carcinoma
S. Bovis
What are some causes of endocarditis with negative blood cultures
Hemophilus, actinobacillus, Cardiobacterium, Eikenella, Kingella
Where do the vegetations appear with nonbacterial thrombotic endocarditis
Mitral valve along lines of closure
What is the term for sterile vegetations associated with SLE
Libyan-sacks endocarditis
What is the result of Libman sacks endocarditis
Mitral regurgitation
What is the most common form of cardiomyopathy
Dilated cardiomyopathy
What are some complications of dilated cardiomyopathy
Mitral and tricuspid regurgitation and arrhythmia
What drug is associated with dilated cardiomyopathy
Cocaine
What is mutated in hypertrophic cardiomyopathy
Sarcomeres proteins
What is common cause of sudden death in young athletes
Hypertrophic cardiomyopathy
What is found on biopsy of hypertrophic cardiomyopathy
Myofiber hypertrophy with disarray
When is filling restricted with restrictive cardiomyopathy
Restricts filling during systole
How does restrictive cardiomyopathy present
CHF
What is the classic finding on EKG with restrictive cardiomyopathy
Low voltage EKGs; diminished QRS amplitudes
What is the term for a cardiac tumor of benign mesenchymal proliferation with a gelatinous apperance
Myxoma
What is the most common primary cardiac tumor in adults
Myxoma
What is the presentation of myxoma
Pedunculated mass in LA (causes syncope due to obstruction of mitral valve)
What is the term for benign hamartoma of cardiac muscle
Rhabdomyoma
What is the most commmon primary cardiac tumor in kids
Rhabdomyoma
What cardiac tumor is assocated with tuberous sclerosis
Rhabdomyoma
What are some common metastasis to the Heart
Breast and lung carcinoma, melanoma, lymphoma
What is the collagenous ventricularis largely responsible for
Mechanical integrity of the valve
What is the pacemaker of the heart
SA node
What is systolic dysfunction
Progressive deterioration of myocardial contractile function
What is diastolic dysfunction
Inability of the chamber to expand and fill during diastole
How are the sarcomeres in pressure overload hypertrophy arranged
Concentric increase in wall thickness, sarcomeres in parallel
How are the sarcomeres arranged in volume over load hypertrophy
Sarcomeres in series
What are some major pathologic indications of pulmonary edema
Heart failure cells, Kerley B lines
What happens with systolic failure in left sided heart failure
Insufficient ejection fraction
What happens with diastolic failure in L-sided heart failure
LV is abnormally stiff and cannot relax during diastole (unable to increase output during exercise)
What transcription factors are important for the first heart field and what does the first heart field give rise to
TBX5, hand1; mainly LV
What transcription factors are involved in the second heart field and what does the second heart field give rise to
Hand2, FGF-10; outflow tract, RV, most of atria
What genes are involved in ASD or conduction defects
NKX2.5
What gene is involved in ASD or VSD
GATA4
What genes are involved in TOF
ZFPM2 or NKX2.5
What genes are involved in alagille syndrome (pulmonary artery stenosis or TOF)
JAG1 or NOTCH2
What gene is involved in char syndrome (PDA)
TFAP2B
What gene is involved in Holt-Oran syndrome
TBX5
What is the main culprit legion in Digeorge syndrome
TBX1
What are the multiple deficits associated with Digeorge syndrome
CATCH-22: cardiac abnormality, abnormal face, thymic aplasia, cleft palate, hypocalcemia, on chromosome 22
What is the most common genetic cause of congenital heart disease
Trisomy 21
What do ASD typically increase
Only RV and pulmonary outflow volumes
What do VSD and PDA cause increase in
Pulmonary blood flow and pressure
What type are most VSDs
Membranous
Where do infundivular VSD occur
Below pulmonary valve or within muscular septum
What CHD can lead to paradoxical embolism
Right to left shunts
What CHD produces ventriculoarterial discordance
Transposition of great arteries
Describe the murmur with subaortic stenosis
Prominent systolic murmur and sometimes thrill
What is subaortic stenosis caused by
Thickened ring or collar of dense endocardial fibrous tissue below the level of the cusps
What is the term for congenital aortic dysplasia with thickening of ascending aortic wall and consequent luminal constriction
Supravalvular aortic stenosis
What disorder is supravalvular aortic stenosis sometimes part of
Chromosome 7 deletion disorder
What is the leading cause of death worldwide for both men and women
Ischemic heart disease
What is the dominant cause of ischemic heart disease
Insufficient coronary perfusion relative to myocardial demand
What does stable angina result from
Increases in myocardial oxygen demand that outstrip the ability of stenosis coronary arteries to increase O2 delivery
What is unstable angina caused by
Plaque disruption that results in thrombosis and vasoconstriction, and leads to severe but transient reductions in coronary blood flow
What type of MIs are most common
Transmural
What do LAD infarcts involve
Anterior wall of LV near the apex; anterior portion of ventricular septum; apex circumferential
What part of the Heart does Right coronary infarcts involve
Inferior/posterior wall of LV; posterior portion of ventricular septum; inferior/posterior RV free wall
What is the most common trigger for fatal arrhythmias
Acute myocardial ischemia
What is the cause of arrhythmias in most cases
Ischemic injury
What is pulmonary hypertensive heart disease (cor pulmonale) characterized by
RV hypertrophy, dilation and potentially right sided Heart failure
What is calcification aortic stenosis usually the consequence of
Age associated wear and tear
What does calcification stenosis of congenitally bicuspid aortic valve involve loss of function mutations in
NOTCH1
What is the most frequent site of calcific deposits in calcific stenosis of congenitally bicuspid aortic valve
Raphe
What overload does stenosis cause
Pressure overload
What overload does insufficiency/regurgitation cause
Volume overload
What degeneration is key in mitral valve prolapse
Myxomatous degeneration
What is the characteristic anatomical change in mitral valve prolapse
Interchordal ballooning (hooding) of mitral leaflets or portions thereof
What are common complications of mitral valve prolapse
Infective endocarditis, MI, stroke, arrhythmias
How many minor and major criteria of jones criteria must be met for rheumatic fever
2 major or 1 major and 2 minor + evidence of preceding strep infection
What should you think of when you see maccallum plaques
Acute rheumatic fever
What is the term for erythematous or hemorrhagic non-tender lesions on palms or soles (non-painful)
Janeway lesions
What is the term for subcutaneous nodules in the pulp of the digits
Osler nodes
What is the term for retinal hemorrhages in the eyes (round white spots surrounded by hemorrhage)
Roth spots
Who are noninfectious vegetations usually encountered in
Debilitated patients (ie cancer or sepsis)
What does carcinoid heart disease primarily affect
Endocardium and valves of right heart
Describe the lesions of carcinoid heart disease
Distinctive, glistening white intimal plaque-like thickening of the endocardial surfaces of the cardiac chambers and valve leaflets
What mutation is common in dilated cardiomyopathy
TTN (gene that encodes titin)
What is progression of myocarditis to dilated cardiomyopathy strongly associated with
Alcohol use
What is the most common manifestation of iron excess
Dilated cardiomyopathy
What disorder is characterized by LV contractile dysfunction following extreme psychological stress, which leads to apical ballooning
Takotsubo cardiomyopathy
What is the term for inherited disease of mycoardium causing RV failure and rhythm disturbances with sudden death
Arrhythmogenic RV cardiomyopathy
What is the disorder that is characterized by arrythmogenic RV cardiomyopathy and hyperkeratosis of plantar palmar skin surfaces specifically associated with mutations in the gene encoding the desmosome-associated protein plakoglobin
Naxos syndrome
Describe the RV in arrhythmogenic RV cardiomyopathy
Due to loss of myocytes, accompanied by extensive fatty infiltration and fibrosis
What genetic disorder is characterized by myocardial hypertrophy, poorly compliant LV myocardium leading to abnormal diastolic filling and intermittent ventricular outflow obstruction
Hypertrophy cardiomyopathy
What is typically mutated in hypertrophy cardiomyopathy
Mutations in sarcomere (beta-MHC)
What should you think of when there is banana-like configuration of the ventricular cavity
Hypertrophy cardiomyopathy
Describe the auscultation heard with hypertrophy cardiomyopathy
Harsh systolic ejection murmur caused by ventricular outflow obstruction as anterior mitral leaflet moves toward the ventricular septum during systole
How is endomyocardial fibrosis most common in
Children and young adults in Africa
What does loeffler endomyocarditis result in
Edomyocardial fibrosis, typically with large mural thrombi; often also peripheral eosinophilia
What is inhabited in the mechanics of hypertrophic and restrictive cardiomyopathy
Compliance (diastolic dysfunction)
What is the most common viral cause of myocarditis
Coxsachie viruses A and B
What is the most common helminthic cause of myocarditis
Trichinosis
What are the activating mutations involved in myxomas
GNAS1
What is the favorite site for myxoma
Fossa ovalis of atrial septum
What should you think of with wrecking ball effect
Pedunculated form of myxoma
What are localized, well-circumscribed, benign tumors composed of mature fat cells
Lipomas
What should you think of as sea-anemone lesions
Papillary fibroelastoma
What do the lesions involved in papillary fibroelastoma consist of
Cluster of hairlike projections
What should you think of with spider cells
Rhabdomyoma
