CV Pathology Flashcards
What is the leading cause of mortaility/morbidity in the developed world?
Ischemic Heart Disease
What usually causes ischemic heart disease?
> 95% due to coronary atherosclerosis
- Causing myocardial ischemia and angina pectoris with: dysrhythmias, left ventricular failure, and sudden death
- May involve unstable plaques (and stable)
What is an unstable plaque?
Risk of rupture with partial or complete lumen occlusion by aggregated platelets/thrombosis = Acute Coronary Syndrome
What is an MI?
Complete thrombotic occlusion of an atherosclerotic coronary artery OR
Hypotensive event: superimposed on a coronary artery partially occluded by atherosclerosis:
>30 minutes of complete ischemia = myocardial death
Subendocardial infarction vs. Transmural infarction:
Subendocardial: typically non-STEMI
Transmural: more likley STEMI (ST elevation myocardial infarction): older term Q wave infarct
What are ACUTE sequelae of MI?
-Severe/unrelenting angina, acute congestive heart failure (CHF) with dyspnea (pulmonary edema/oxygen desaturation), cariogenic shock, dysrhythmias, sudden death
What are SUBACUTE sequelae of MI?
(several days - 2 weeks)
-Mural thrombosis/risk of embolism, left ventricular rupture = free wall, septal, or papillary muscle: fatal hemoperricardium, acute VSD, or acutely flail/regurgitant mitral valve; peri-infarct pericarditis
What are CHRONIC sequelae of MI?
-LV aneurysm; if infarct large enough or multiple infarcts = chronic CHF: LV ejection fraction usually
What are the risks for sudden death in atherosclerotic coronary disease?
Greatest risk: w/acute coronary occlusion
BUT ALSO with: stable chronic atherosclerotic disease:
-Presumably due to sudden/fatal ventricular dysrhythmia from ischemic aggravation to the conducting system
What causes Left-sided hypertensive heart disease?
- Secondary to chronic systemic (arterial) hypertension usually over decades of time
- Causing concentric left ventricular hypertrophy (LV free wall > 1.5 cm) and eventually LV dilation/failure (CHF)
- Cardiac hypertrophy of whatever cause: carries an Inc. risk of sudden death
What causes isolated/pure RIGHT-SIDED hypertensive heart disease?
(Cor pulmonale)
- Due to chronically inc. pulmonary artery pressure from:
- ***Chronic pulmonary parenchymal disease: COPD, interstitial fibrosing disease
- Chronic hypoxia with or without lung disease (e.g. sleep apnea)
- -Causing pulmonary vasoconstriction
- Pulmonary vascular disease: primary pulmonary hypertension and chronic recurrent thromboemboli
What happens with RV hypertrophy?
(RV free wall > 0.5 cm) =/- dilation
-Eventual RV failure: Symptoms include systemic venous and portal venous congestion with peripheral edema, JVD, hepatosplenomegaly, ascites
What is RV heart failure usually secondary to?
LV heart failure - that caused chronic pulmonary venous HTN with secondary pulmonary arterial HTN
What side is the majority of valve disease on?
Left sided (AV and MV)
What are the three main types of Valvular Heart Disease?
- Valve stenosis/obstruction with pressure overload behind diseased valve
- Valve regurgitation/insuffieicny with volume overload behind diseased valve
- Can see mixed stenotic/regurgitant features - SEVERE disease: left and or right sided Heart Failure
- Principle exam finding: cardiac MURMUR
What causes most valvular heart disease in developed countries?
-Calcified aortic stenosis & mitral valve prolapse dominate valve replacement surgery
What causes most valvular heart disease in developing countries?
Rheumatic fever valvulitis
- Affecting typically multiple cardiac valves = dominant valve deforming disease (exp. mitral stenosis)
- Multiple/recurrent episodes of group A streptococcal pharyngitis: with abberrant immune response: cross-reactivity against endocardial and valvular surfaces = progressive valve damage over years of time –> common in older women, click murmurs
What are the two main types of infectious endocarditis (IE)?
- Previously normal valves: usually acute IE from virulent organisms - esp. staph. aureus
- Previously damaged/deformed or artificial valves: typically subacute IE from usually communal oral bacterial: esp. strep viridians
What is usually associated with right sided IE?
IV drug abuse
What is the pathophysiology of IE?
Producing valve compromising/destructive vegetations
-Causing valvular regurgitation (acute or subacute) and/or peripheral septic embolization: e.g. stroke and infectious peripheral arterial aneurysms
What are the two classical traits of IE?
Fever and cardiac murmur
What can connective tissue diseases cause?
[e.g. RA, AS (ankylzing spondylosis)]
Can have valvulitis/valve deformation: stenosis or regurgitation
What can aortic regurgitation be seen secondary to?
Thoracic aortic aneurysm or dissection
What can atrioventricular valve insufficiency be due to?
- CHF (causing valve ring dilation)
- Papillary muscle dysfunction (from LV ischemia due to coronary disease)
What is cardiomyopathy?
Intrinsic myocardial disease NOT associated with ischemia, valvular, hypertensive, or structural congenital heart disease
-Either primary (heart-limited) or secondary to a systemic disorder
What risk comes with cardiomyopathy?
Heart failure and sudden death
What are the types of cardiomyopathy?
Dilated, hypertrophic or restrictive types
What does cardiomyopathy include?
Myocarditis (esp. viral), drug effects (e.g. alcohol, chemo Rx), hemochromatosis, and amyloidosis
What cardiomyopathy is 100% casted by genetic/mutation?
Hypertrophic cardiomyopathy
What makes pericardial disease clinically dominant/life-threatening?
- Acute pericarditis with chest pain
- Inc. pericardial sac fluid critically compresses the heart (tamponade)
- Progressive pericardial space fibrosis critically compresses the heart: constrictive pericarditis
What are the causes of increased pericardial fluid in pericarditis?
- Effusion: from infection or non-infectious disease: CHF, neoplastic infiltration, uremia
- Hemopericardium: ruptured MI, retrograde rupture of aortic dissection, or penetrating chest trauma
Primary cardiac tumors are. . .
rare
What are the majority of clinically significant/surgically resected adult cardiac tumors?
Atrial myxomas (usually left atrium) -Most serious clinical sequelae caused by tumor: prolapse into and obstruction of AV valves or systemic embolization (e.g. stroke)
Rhabdomyomas:
Children - esp. tuberous sclerosis
Cardaic sarcomas:
very rare and usually lethal
Does metastases occur onto heart tissue?
Metastases to myocardium from common visceral cancers are very uncommon: pericardium much more likely to be site of clinically important metastases
Congenital Heart Disease is present in up to. . .
2% of live births
25% of CHD cases =
“critial CHD”: shock, cyanosis, or resp. distress/pulmonary edema
-At birth or at closure of ductus arterioles within several days of birth = “duct dependent” CHD
What are the 3 categories of CHD?
- Left to right shunts: e.g. ventricular septal defect (VSD), atrial septal defect (ASD)
- Right to left shunts: cyanotic CHD: e.g. Tetralogy of Fallot, transposition of great arteries
- Obstructive anomalies: e.g. coarctation of aorta and pulmonic or aortic valve atresia (born closed)/stenosis
