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CRRAB Week 3 > CV Pathology > Flashcards

CV Pathology Flashcards

1
Q

What is the leading cause of mortaility/morbidity in the developed world?

A

Ischemic Heart Disease

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2
Q

What usually causes ischemic heart disease?

A

> 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)
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3
Q

What is an unstable plaque?

A

Risk of rupture with partial or complete lumen occlusion by aggregated platelets/thrombosis = Acute Coronary Syndrome

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4
Q

What is an MI?

A

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

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5
Q

Subendocardial infarction vs. Transmural infarction:

A

Subendocardial: typically non-STEMI
Transmural: more likley STEMI (ST elevation myocardial infarction): older term Q wave infarct

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6
Q

What are ACUTE sequelae of MI?

A

-Severe/unrelenting angina, acute congestive heart failure (CHF) with dyspnea (pulmonary edema/oxygen desaturation), cariogenic shock, dysrhythmias, sudden death

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7
Q

What are SUBACUTE sequelae of MI?

A

(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

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8
Q

What are CHRONIC sequelae of MI?

A

-LV aneurysm; if infarct large enough or multiple infarcts = chronic CHF: LV ejection fraction usually

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9
Q

What are the risks for sudden death in atherosclerotic coronary disease?

A

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

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10
Q

What causes Left-sided hypertensive heart disease?

A
  • 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
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11
Q

What causes isolated/pure RIGHT-SIDED hypertensive heart disease?

A

(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
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12
Q

What happens with RV hypertrophy?

A

(RV free wall > 0.5 cm) =/- dilation
-Eventual RV failure: Symptoms include systemic venous and portal venous congestion with peripheral edema, JVD, hepatosplenomegaly, ascites

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13
Q

What is RV heart failure usually secondary to?

A

LV heart failure - that caused chronic pulmonary venous HTN with secondary pulmonary arterial HTN

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14
Q

What side is the majority of valve disease on?

A

Left sided (AV and MV)

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15
Q

What are the three main types of Valvular Heart Disease?

A
  1. Valve stenosis/obstruction with pressure overload behind diseased valve
  2. Valve regurgitation/insuffieicny with volume overload behind diseased valve
    - Can see mixed stenotic/regurgitant features
  3. SEVERE disease: left and or right sided Heart Failure
    - Principle exam finding: cardiac MURMUR
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16
Q

What causes most valvular heart disease in developed countries?

A

-Calcified aortic stenosis & mitral valve prolapse dominate valve replacement surgery

17
Q

What causes most valvular heart disease in developing countries?

A

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
18
Q

What are the two main types of infectious endocarditis (IE)?

A
  1. Previously normal valves: usually acute IE from virulent organisms - esp. staph. aureus
  2. Previously damaged/deformed or artificial valves: typically subacute IE from usually communal oral bacterial: esp. strep viridians
19
Q

What is usually associated with right sided IE?

A

IV drug abuse

20
Q

What is the pathophysiology of IE?

A

Producing valve compromising/destructive vegetations
-Causing valvular regurgitation (acute or subacute) and/or peripheral septic embolization: e.g. stroke and infectious peripheral arterial aneurysms

21
Q

What are the two classical traits of IE?

A

Fever and cardiac murmur

22
Q

What can connective tissue diseases cause?

A

[e.g. RA, AS (ankylzing spondylosis)]

Can have valvulitis/valve deformation: stenosis or regurgitation

23
Q

What can aortic regurgitation be seen secondary to?

A

Thoracic aortic aneurysm or dissection

24
Q

What can atrioventricular valve insufficiency be due to?

A
  • CHF (causing valve ring dilation)

- Papillary muscle dysfunction (from LV ischemia due to coronary disease)

25
Q

What is cardiomyopathy?

A

Intrinsic myocardial disease NOT associated with ischemia, valvular, hypertensive, or structural congenital heart disease
-Either primary (heart-limited) or secondary to a systemic disorder

26
Q

What risk comes with cardiomyopathy?

A

Heart failure and sudden death

27
Q

What are the types of cardiomyopathy?

A

Dilated, hypertrophic or restrictive types

28
Q

What does cardiomyopathy include?

A

Myocarditis (esp. viral), drug effects (e.g. alcohol, chemo Rx), hemochromatosis, and amyloidosis

29
Q

What cardiomyopathy is 100% casted by genetic/mutation?

A

Hypertrophic cardiomyopathy

30
Q

What makes pericardial disease clinically dominant/life-threatening?

A
  • Acute pericarditis with chest pain
  • Inc. pericardial sac fluid critically compresses the heart (tamponade)
  • Progressive pericardial space fibrosis critically compresses the heart: constrictive pericarditis
31
Q

What are the causes of increased pericardial fluid in pericarditis?

A
  • Effusion: from infection or non-infectious disease: CHF, neoplastic infiltration, uremia
  • Hemopericardium: ruptured MI, retrograde rupture of aortic dissection, or penetrating chest trauma
32
Q

Primary cardiac tumors are. . .

A

rare

33
Q

What are the majority of clinically significant/surgically resected adult cardiac tumors?

A 
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)
34
Q

Rhabdomyomas:

A

Children - esp. tuberous sclerosis

35
Q

Cardaic sarcomas:

A

very rare and usually lethal

36
Q

Does metastases occur onto heart tissue?

A

Metastases to myocardium from common visceral cancers are very uncommon: pericardium much more likely to be site of clinically important metastases

37
Q

Congenital Heart Disease is present in up to. . .

A

2% of live births

38
Q

25% of CHD cases =

A

“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

39
Q

What are the 3 categories of CHD?

A
  1. Left to right shunts: e.g. ventricular septal defect (VSD), atrial septal defect (ASD)
  2. Right to left shunts: cyanotic CHD: e.g. Tetralogy of Fallot, transposition of great arteries
  3. Obstructive anomalies: e.g. coarctation of aorta and pulmonic or aortic valve atresia (born closed)/stenosis

CRRAB Week 3 (12 decks)

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