CV Pathology

Question 1

Ischemic Heart Disease

Answer 1

leading cause of mortality and morbidity in developed world

>95% due to coronary atherosclerosis

Question 2

Unstable plaque

Answer 2

risk of rupture with partial or complete lumen occlusion by aggregated platelets
- results in Acute Coronary Syndrome

Question 3

MI

Answer 3

complete thrombotic occlusion or hypotensive (hemorrhage) event
> 30 minutes of ischemia - myocardial death
-Transmural vs. non-transmural

Question 4

Acute sequelae of MI

Answer 4

severe angina, acute CHF, dyspnea, dysrhthmia, death

Question 5

Subacute sequelae of MI

Answer 5

mural thrombosis, embolism, LV rupture, valvular dysfunction

Question 6

Chronic sequelae of MI

Answer 6

LV aneurysm –> CHF, secondary RV CHF, post-cardiac syndrome (Dressler’s)

Question 7

Hypertensive Heart Disease

Answer 7

Left Sided
- secondary to chronic hypertension (decades)
- causes concentric LVH
- increased risk of sudden death
Right Sided (cor pulmonale)
- due to chronically elevated pulmonary artery pressure (COPD), chronic hypoxia, pulmonary vasoconstriction, pulmonary vascular disease
- usually due to LV failure

Question 8

Valvular Disease

Answer 8

stenosis = obstruction with pressure overload
regurgitation = insufficiency with volume overload
principal finding = MURMUR

Question 9

Developed countries valvular disease

Answer 9

calcific aortic stenosis and mitral valve prolapse

Question 10

Developing countries valvular disease

Answer 10

Rheumatic fever –> mitral stenosis

- group A strep pharyngitis

Question 11

Infective endocarditis

Answer 11

Normal valves - acute IE, staph aureus, rapid destruction
Damaged valves - subacute IE, strep viridans, slow destruction
- either can cause vegetations, regurgitatioins, embolism, murmur

Question 12

Other valvular disease causes

Answer 12

RA, AS, aortic aneurysm or dissection

Question 13

Cardiomyopathy

Answer 13

intrinsic myocardial disease NOT caused by ischemia, valves, hypertensive, or structural disease
3 Types
- dilated, hypertrophic (100% genetic causation), restrictive
Ex.) myocarditis, drug effects, hemochromatosis, amyloidosis

Question 14

Pericardial disease

Answer 14

1. Cardiac tamponade (increased fluid in pericardial sac compresses heart)
2. Constrictive pericarditis (progressive pericardial space fibrosis)
   Causes: effusion or blood (hemopericardium is almost always fatal)

Question 15

Primary cardiac tumors

Answer 15

RARE

Atrial myxoma - LA, causes prolapse into obstruction of AV valves or embolization

Question 16

Rhabdomyomas

Answer 16

children **TUBEROUS SCLEROSIS

Question 17

Cardiac Disease Symptoms

Answer 17

Dyspnea (heart failure)
Chest discomfort/pain (ischemia)
Edema (heart failure)
Syncope (hypotension, arrhythmias, pump failure)
Fatigue (decreased CO)
Cyanosis (<85%, heart failure or shunts)

often overlap with respiratory diseases

Question 18

Studies to evaluate chest pain/discomfort

Answer 18

Pulse Oximetry (>95%)
EKG
CXR
Echo (LV Ejection Fraction)
Chest CT(PE)

Question 19

Labs for chest pain/discomfort

Answer 19

Troponin (KING) -- triaging
CK-MB - less specific than troponin
D-dimer - rule out a clot
Hemoglobin - anemia
BNP - heart failure
Arterial blood gases - hypoxia and COPD

Question 20

Risk Factors of Athersclerosis

Answer 20

Hyperlipidemia
Diabetes
Renal Disease
Smoking
HTN
Obesity
Diet
Inactivity

Question 21

Acquired Heart Disease

Answer 21

MAJOR cause of human mortality in developed countries
*CAD*
Acute myocadial infarction
- nonSTEMI
- STEMI - emergency --> get to cath lab

Question 22

Left Ventricular Hypertrophy

Answer 22

caused by systemic/arterial hypertension
may cause sudden cardiac death
control of hypertension can reverse LVH

Question 23

Right Sided hypertensive disease

Answer 23

commonly secondary to L heart failure

• cor pulmonale* - if due to COPD or pulmonary hypertension
• chronic hypoxia can also lead to hypertension

Question 24

Valvular disease

Answer 24

stenosis - pressure overload
regurgitation - volume overload
know which is associated with which murmur

Question 25

Stenosis causes

Answer 25

Valvulitis - RF, SLE, RA | Calcific degenerative change, radiation

Question 26

Regurgitation causes

Answer 26

bacterial endocarditis (almost always regurg), myxomatous degeneration

Question 27

Left heart valves

Answer 27

COMMONEST source of clinically significant valve disease Developed countries: 1. calcific aortic stenosis --> ECHO is key 2. mitral prolapse Developing countries: 1. rheumatic fever --> group 1 strep pharyngitis 2. acquired stenosis of aortic or mitral

Question 28

Calcific Aortic Stenosis

Answer 28

commonest acquired valve disease in developed countries - age related atherosclerosis or aortic cusps with secondary calcification --> eventual LVH - LVH leads to decreased CO --> CHF * bicuspid aortic valve can lead to premature atherosclerosis*

Question 29

Mitral Prolapse

Answer 29

systolic click murmur syndrome | - myxomatous degeneration

Question 30

Infective Endocarditis

Answer 30

FEVER and MURMUR Acute endo - staph, destructive, kills in days/weeks Subacture endo - strep viridans, indolent, kills slowly Infected Vegetations - regurg, septic emboli Macroemboli - CNS, renal, GI, splenic Microemboli - splinter hemorrhages, janeway, oslers, roths

Question 31

Staph aureus or strep viridans bacteremia

Answer 31

bacterial endocarditis until proven otherwise

Question 32

Complications of artificial heart valves

Answer 32

1. Thromboembolism (need anticoagulation) 2. Infective Endocarditits (staph) 3. Structural deterioration (calcification and tearing) 4. Intravascular hemolysis

Question 33

Valve disease diagnosis

Answer 33

Echocardiography

Question 34

Acute Aortic Regurgitation

Answer 34

urgent valve-replacement surgery - acute bacterial endocarditits - acutely dilated aortic root secondary to aortic dissection

Question 35

Acute Mitral Regurgitation

Answer 35

Acute pulmonary edema from suddenly elevated left atrial pressure causing increased pulmonary capillary pressure - papillary/chordal rupture following AMI - acute bacterial endocarditis

Question 36

Cardiomyopathy

Answer 36

disease of the heart muscle that is EXCLUSIVE of secondary effects from HTN, CAD, MI, valvular disease - often a diagnosis of exclusion and idiopathic - increased risk of sudden death

Question 37

Primary vs. Secondary Cardiomyopathy

Answer 37

Primary - disease limited to the heart | Secondary - associated with systemic disorders

Question 38

Dilated Cardiomyopathy

Answer 38

systolic LV dysfunction --> dilated ventricles (impaired contractility) --> symptoms of HF, 50% mortality in 2 years, young population (20-50)

Question 39

Dilated LA leads to increased risk of what?

Answer 39

Atrial fibrillation!!!

Question 40

Hypertrophic Cardiomyopathy

Answer 40

diastolic dysfunction --> thickened LV wall and reduced chamber size (sudden death in young athletes) - septum is asymmetrically thickened - impaired diastolic filling --> decreased CO and exercise intolerance - 100% genetically caused!!!!

Question 41

Restrictive Cardiomyopathy

Answer 41

diastolic LV dysfunction with non-dilated, non-hypertrophic ventricles, impaired ventricular filling - manifests as RHF RARE subtype = arrhythmogenic RV cardiomyopathy - RV is replaced by fat

Question 42

Stress-induced cardiomyopathy

Answer 42

Takotsubo CM - transient systolic dysfunctioning due to "myocardial stunning" from stress-induced catecholamine surge (FEMALES)

Question 43

Iron Overload

Answer 43

hemochromatosis = accumulation of excess iron --> increased transferrin - can induce myocyte toxicity

Question 44

Immune-mediated Myocarditis

Answer 44

``` Rheumatic carditis following group A strep pharyngitis Post-viral infection SLE, polymyositis drug hypersensitivity heart transplant rejection ```

Question 45

Myocarditis

Answer 45

Acute heart failure within several weeks of VIRAL PRODOME need ECHO and endomyocardial biopsy for diagnosis - supportive treatment

Question 46

Pericarditis

Answer 46

4 disease categories 1. Acute pericarditis (usually benign) 2. pericardial effusion 3. cardiac tamponade 4. constrictive pericarditis

Question 47

Vascular Pathology

Answer 47

1. Gradual lumen obstruction (atherosclerosis) 2. Sudden lumen obstruction (emboli, thrombus) 3. Aneurysm/dissection (larger vessels) 4. Vasculitis (all vessels) 5. Extrinsic vascular compression

Question 48

Atherosclerosis

Answer 48

COMMONEST vascular disease | - RF: male, age, familial tendency, hypercholesterolemia, HTN, diabetes, smoking

Question 49

Aortic Dissection

Answer 49

dissecting hemorrhage/hematoma within aortic wall Type A - ascending aorta (MOST LETHAL) Type B - descending aorta/aortic arch

Question 50

Aortic Dissection predisposing factors

Answer 50

HTN, CT disease (marfan's)