CV Pathology Flashcards
Ischemic Heart Disease
leading cause of mortality and morbidity in developed world
>95% due to coronary atherosclerosis
Unstable plaque
risk of rupture with partial or complete lumen occlusion by aggregated platelets
- results in Acute Coronary Syndrome
MI
complete thrombotic occlusion or hypotensive (hemorrhage) event
> 30 minutes of ischemia - myocardial death
-Transmural vs. non-transmural
Acute sequelae of MI
severe angina, acute CHF, dyspnea, dysrhthmia, death
Subacute sequelae of MI
mural thrombosis, embolism, LV rupture, valvular dysfunction
Chronic sequelae of MI
LV aneurysm –> CHF, secondary RV CHF, post-cardiac syndrome (Dressler’s)
Hypertensive Heart Disease
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
Valvular Disease
stenosis = obstruction with pressure overload
regurgitation = insufficiency with volume overload
principal finding = MURMUR
Developed countries valvular disease
calcific aortic stenosis and mitral valve prolapse
Developing countries valvular disease
Rheumatic fever –> mitral stenosis
- group A strep pharyngitis
Infective endocarditis
Normal valves - acute IE, staph aureus, rapid destruction
Damaged valves - subacute IE, strep viridans, slow destruction
- either can cause vegetations, regurgitatioins, embolism, murmur
Other valvular disease causes
RA, AS, aortic aneurysm or dissection
Cardiomyopathy
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
Pericardial disease
- Cardiac tamponade (increased fluid in pericardial sac compresses heart)
- Constrictive pericarditis (progressive pericardial space fibrosis)
Causes: effusion or blood (hemopericardium is almost always fatal)
Primary cardiac tumors
RARE
Atrial myxoma - LA, causes prolapse into obstruction of AV valves or embolization
Rhabdomyomas
children **TUBEROUS SCLEROSIS
Cardiac Disease Symptoms
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
Studies to evaluate chest pain/discomfort
Pulse Oximetry (>95%) EKG CXR Echo (LV Ejection Fraction) Chest CT(PE)
Labs for chest pain/discomfort
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
Risk Factors of Athersclerosis
Hyperlipidemia Diabetes Renal Disease Smoking HTN Obesity Diet Inactivity
Acquired Heart Disease
MAJOR cause of human mortality in developed countries *CAD* Acute myocadial infarction - nonSTEMI - STEMI - emergency --> get to cath lab
Left Ventricular Hypertrophy
caused by systemic/arterial hypertension
may cause sudden cardiac death
control of hypertension can reverse LVH
Right Sided hypertensive disease
commonly secondary to L heart failure
- cor pulmonale* - if due to COPD or pulmonary hypertension
- chronic hypoxia can also lead to hypertension
Valvular disease
stenosis - pressure overload
regurgitation - volume overload
know which is associated with which murmur
Stenosis causes
Valvulitis - RF, SLE, RA
Calcific degenerative change, radiation
Regurgitation causes
bacterial endocarditis (almost always regurg), myxomatous degeneration
Left heart valves
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
Calcific Aortic Stenosis
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*
Mitral Prolapse
systolic click murmur syndrome
- myxomatous degeneration
Infective Endocarditis
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
Staph aureus or strep viridans bacteremia
bacterial endocarditis until proven otherwise
Complications of artificial heart valves
- Thromboembolism (need anticoagulation)
- Infective Endocarditits (staph)
- Structural deterioration (calcification and tearing)
- Intravascular hemolysis
Valve disease diagnosis
Echocardiography
Acute Aortic Regurgitation
urgent valve-replacement surgery
- acute bacterial endocarditits
- acutely dilated aortic root secondary to aortic dissection
Acute Mitral Regurgitation
Acute pulmonary edema from suddenly elevated left atrial pressure causing increased pulmonary capillary pressure
- papillary/chordal rupture following AMI
- acute bacterial endocarditis
Cardiomyopathy
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
Primary vs. Secondary Cardiomyopathy
Primary - disease limited to the heart
Secondary - associated with systemic disorders
Dilated Cardiomyopathy
systolic LV dysfunction –> dilated ventricles (impaired contractility) –> symptoms of HF, 50% mortality in 2 years, young population (20-50)
Dilated LA leads to increased risk of what?
Atrial fibrillation!!!
Hypertrophic Cardiomyopathy
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!!!!
Restrictive Cardiomyopathy
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
Stress-induced cardiomyopathy
Takotsubo CM - transient systolic dysfunctioning due to “myocardial stunning” from stress-induced catecholamine surge (FEMALES)
Iron Overload
hemochromatosis = accumulation of excess iron –> increased transferrin
- can induce myocyte toxicity
Immune-mediated Myocarditis
Rheumatic carditis following group A strep pharyngitis Post-viral infection SLE, polymyositis drug hypersensitivity heart transplant rejection
Myocarditis
Acute heart failure within several weeks of VIRAL PRODOME
need ECHO and endomyocardial biopsy for diagnosis
- supportive treatment
Pericarditis
4 disease categories
- Acute pericarditis (usually benign)
- pericardial effusion
- cardiac tamponade
- constrictive pericarditis
Vascular Pathology
- Gradual lumen obstruction (atherosclerosis)
- Sudden lumen obstruction (emboli, thrombus)
- Aneurysm/dissection (larger vessels)
- Vasculitis (all vessels)
- Extrinsic vascular compression
Atherosclerosis
COMMONEST vascular disease
- RF: male, age, familial tendency, hypercholesterolemia, HTN, diabetes, smoking
Aortic Dissection
dissecting hemorrhage/hematoma within aortic wall
Type A - ascending aorta (MOST LETHAL)
Type B - descending aorta/aortic arch
Aortic Dissection predisposing factors
HTN, CT disease (marfan’s)
