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General Pathology > Diseases Of The Heart > Flashcards

Diseases Of The Heart Flashcards

1
Q

Normal histology of the heart

A

Pericardium

  • cellophane-like structure covering the heart
  • 2 histologic parts: parietal and visceral (in between is the pericardial cavity filled with 50mL pericardial fluid)

Epicardium

  • fibroelastic CT, BV, lymphatics, adipose tissue
  • simple sq ep

Myocardium

  • cardiac myocyte
  • thickest layer

Endocardium

  • luminal side of the myocardium
  • thickness varies inversely with the thickness of the myocardium
  • Subendocardial layer: contains veins, nerves and Purkinje fibers
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2
Q

Often called CONGESTIVE HEART FAILURE

Occurs when the heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the tissues

A

Heart failure

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3
Q

Classification of heart failure

A

Right-sided and left-sided heart failure

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4
Q

Right sided vs Left sided heart failure

A

Right-sided

  • most commonly caused by left-sided heart failure
  • occur in patients with any disorder affecting the lungs (cor pulmonale)
  • pronounced engorgement of the systemic and portal venous system; pulmonary congestion is minimal
  • chiefly related to peripheral edema and visceral congestion
  • nutmeg liver

Left-sided

  • often caused by ischemic heart dse, HTN, aortic & mitral valve dse, 1’ myocardial dse
  • consequence of passive congestion (blod backing up in the pulmonary circulation), stasis of the blood in the left-sided chambers, inadequate perfusion of downstream tissues
  • congestion in the pulmonary side ➡️ pulmonary edema (long standing, lead ro hemorrhage producing heart failure cells)
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5
Q
  • most commonly caused by left-sided heart failure
  • occur in patients with any disorder affecting the lungs (cor pulmonale)
  • pronounced engorgement of the systemic and portal venous system; pulmonary congestion is minimal
  • chiefly related to peripheral edema and visceral congestion
  • nutmeg liver
A

Right-sided heart failure

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6
Q
  • often caused by ischemic heart dse, HTN, aortic & mitral valve dse, 1’ myocardial dse
  • consequence of passive congestion (blod backing up in the pulmonary circulation), stasis of the blood in the left-sided chambers, inadequate perfusion of downstream tissues
  • congestion in the pulmonary side ➡️ pulmonary edema (long standing, lead ro hemorrhage producing heart failure cells)
A

Left-sided heart failure

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7
Q

Increased weight and thickness of myocardium

A

Hypertrophy

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8
Q

Enlarged chamber size

A

Dilatation

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9
Q

Increased cardiac weight or size resulting from hypertrophy and dilatation

A

Cardiomegaly

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10
Q

Diseases of Pericardium

A 
Effusion
Pericarditis
Neoplasm
     - rare
     - constrictive pericarditis
     - mesothelioma, angiosarcoma
     - sarcoma
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11
Q

Increase of pericardial fluid from the normal 50mL
May be serous, pus, blood, fibrinous
Globoid heart in chest radiographs
“Swinging” heart
Rapid accummulation of fluid ➡️ cardiac tamponade
Cause: viral myopericarditis, metastatic malignancy, autoimmune, drug-induced, renal failure, bleeding,TB

A

Effusion

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12
Q

Can occur 2’ to a variety of cardiac, thoracic, or systemic d/o, metastases from remote neoplasms, or cardiac surgical procedures
Primary- viral origin
Chronic- TB,fungal
Triad: chest pain, pericardial rub, ECG findings

A

Pericarditis

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13
Q

Type of fluid in Pericarditis may be a clue to an underlying dse:

  1. ______________ - RF, SLE, scleroderma, tumors, uremia
  2. ______________ - MI (Dressler ➡️ post MI), uremia, radiation,RF, SLE, open heart surgery
  3. ______________ - infective, bacterial
  4. ______________ - malignancy, TB
  5. ______________ - TB
A
  1. Serous
  2. Fibrinous
  3. Purulent
  4. Hemorrhagic
  5. Caseous
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14
Q

Diseases of the myocardium

A

Myocarditis
Cardiomyopathies
Ischemic/Hypertensive Heart Dse
Tumors

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15
Q

A diverse group of pathologic entities in which infectious microorganisms/inflam processes cause myocardial injury

Dilated, flabby
Pale patches with hemorrhage (mottled appearance)
All chambers may show dilatation

A diffuse, mononuclear (lymphocytic) infiltrate is most common
Interstitial inflam infiltrate with myocyte necrosis, fibrosis, viral inclusion bodies
- mononuclears (idiopathic, viral)
- neutrophils (bacterial)
- eosinophils (HPS, protozoa)

A

Myocarditis

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16
Q

Etiology of myocarditis

A

Infective:
Most- Virus (Coxsackie A)
Trypanosoma, Trichinella

Non-infectious causes

  • hypersensitivity myocarditis
    • SLE, RHD, Graft rejection, drugs (PCN)
    • interstitial infiltrates composed of lympho, mø, many eosino
  • idiopathic (giant cell myocarditis)
    • widespread inflam cellular infiltrates with giant cells
    • fulminant end of myocarditis spectrum, poor prognosis
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17
Q

Heterogenous group of diseases of myocardium assocd w/ mechanical and/or electrical dysfunction that usu exhibit inappropriate ventricular hypertrophy or dilatation due to a variety of causes (freq genetics)

A

Cardiomyopathies

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18
Q

Heart muscle disease of unknown origin assocd w cardiac dysfunction
Can be genetic or acquired dses of myocardium

A

Primary cardiomyopathies

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19
Q

Conditions in which the cardiac abnormality results fron another CVD, such as MI

Most common causes include hemochromatosis and amyloidosis

A

Secondary cardiomyopathies

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20
Q

Classification of 1’ cardiomyopathies accdg to anatomic appearance and abnormal physio

A
  1. Dilated cardiomyopathy (DCM)
  2. Hypertrophic cardiomyopathy (HCM)
  3. Restrictive cardiomyopathy (RCM)
  4. Arrhythmogenic cardiomyopathy/ arrhythmogenic right ventricular dysplasia (ARVD)
  5. Unclassified cardiomyopathies
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21
Q

Chard morph’ly and fxnly by progressive cardiac dilation and contractile (systolic) dysfunction, usu w concomitant hypertrophy

Most common type

Heart is dilated (biventriculat dilatation) and poorly contractile, weak

Thin-walled

A

Dilated cardiomyopathy

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22
Q

Chard by myocardial hypertrophy, poorly compliant L ventricular myocardium leading to abnormal diastolic filling and intermittent ventricular outflow obstruction

Thick-walled, heavy, hypercontracting

Marked hypertrophy of LV, IVS, and RV; nondilated chamber

Diastolic dysfunction

Most common inherited cardiac dse

Most common cause of sudden cardiac death in young athletes

Myocyte hypertrophy and disarray

A

Hypertrophic cardiomyopathy

23
Q

Major abnormality is restriction of ventricular filling, thus an increase in filling pressures

Impaired relaxation and compliance

Stiff/rigid walls but not thickened

Biatrial dilatation due to increased filling pressure; ventricular wall has a rubbery texture

Myocyte hypertrophy, focal and diffuse perimyocytic fibrosis and focal myofiber disarray

Patchy or diffused interstitial fibrosis

A

Restrictive cardiomyopathy

24
Q

Dse of myocardihm causing R ventricular failure and rhythm disturbances (ventricular tachycardia or fibrillation)

R ventricular wall is severely thinned due to los sof myocytes, extensive fatty infiltration and fibrosis

R and LV wall thinning

Mutation in plakoglobin (PKP2)

A

Arrhythmogenic cardiomyopathy

25
Q

A disorder chard by ARVD and hyperkeratosis of plantar palmar skin surfaces spec assocd w mutations in gene encoding desmosome-assocd CHON, plakoglobin

Clin mx: wooly hair, palmoplantar keratosis

A

Naxos syndrome

26
Q

Represents a group of pathophysiologically related syndromes resulting from MI (an imbalance bet myocardial sulllh and cardiac demand for oxygenated blood)

Aka CORONADY ARTERY DISEASE

Can present as:

  • MI
  • angina pectoris
  • Sudden cardiac death
A

Ischemic heart disease (IHD)

27
Q

Three types of angina

A
  1. Stable angina/Classic angina/Effort angina
  2. Unstable angina/Crescendo angina
  3. Variant angina/Prinzmetal angina
28
Q

Necrosis of heart muscle caused by ischemia

A

Myocardial infarction/heart attack

29
Q

First sign of MI

A

Rapid pulse

30
Q

First symptom of MI

A

Dyspnea

31
Q

Cardiac marker important in checking for reinfarction

A

CK-MB

32
Q

Very specific cardiac marker

A

Troponins

33
Q

LDH in MI

A

LDH 1 > LDH 2

34
Q

Types of MI based on involvement

A

 Subendocardial (NSTEMI)
- Non-ST segment elevation myocardial Infarction
- Ischemic necrosis limited to 1/3 of ventricular
wall
- result of of a plaque disruption followed by a coronary thrombus that becomes lysed before myocardial necrosis extends across the full thickness of the wall
- Incomplete coronary artery occlusion

 Transmural (STEMI)
- ST segment elevation myocardial infarction
- Myocardial infarcts caused by occlusion of an
epicardial vessel
- Full thickness of ventricular wall
- Severe coronary atherosclerosis, with acute
plaque rupture and superimposed occlusive thrombus

35
Q

Essential feature is left ventricular hypertrophy

A

HYPERTENSIVE HEART DISEASE

36
Q
  • Increased width of myocytes
  • Prominent nuclear enlargement with
    hyperchromasia (“box-car” nuclei)
  • Intercellular fibrosis
A

Atrial dilation

37
Q

Most common primary benign tumor of the heart in children,

A

Rhabdomyoma

38
Q

Most common primary malignant tumor in children

A

Angiosarcoma

39
Q

An acute immunologically- wdiated multisystem inflam dse of the CT involving heart, BV, joints, SQ, CNS

Occurs a few weeks after group A strep pharyngitis episode

A

Rheumatic fever

40
Q

Common manifestation of active RF

A

Acute rheumatic carditis

41
Q

Acute rheumatic carditis, a common mx of active RF may progress over time to…

A

Chronic rheumatic heart dse

42
Q

Only cause of mitral stenosis

Chard by deforming fibrotic valvular dse, involving mitral valve

A

RHD

43
Q

Clinical manifestations of ARF

A
  1. Polyarthritis
  2. Carditis
  3. Erythema marginatum
  4. Chorea
  5. Subcutaneous nodules
44
Q

Manifestation of infective endocarditis

A

FROMJANE

Fever (most consistent sign)
Roth spots (due to retinal emboli)
Osler nodes (painful, sq nodules of fingers & toes)
Murmur
Janeway lesions (painless lesions on palms and soles)
Anemia
Nail-bed hges
Emboli (left-sided — brain, spleen, kidney)
(Right-sided — lung infarct, lung abscess)

45
Q

Most common and early manifestation of ARF

Adults > children

Acute lainful asymmetric and migratory inflammation of the large joints (knees, ankles, elbows, wrists)

A

Polyarthritis

46
Q

Involves the endocardium, myocardium and pericardium

Fibrinous/serofibrinous exudate (Bread and butter)

Manifests as:

  • breathlessness
  • palpitations, tachycardia
  • aortic regurgutation
  • cardiac enlargement
  • new/changed heart murmurs
  • syncope
A

Carditis

47
Q

Occurs in 5% of px
Lesions start as rec macules (blotches) thta fade in the center but remain red at edges
Mainly on the runk and prox extremities but no face

A

Erythema marginatum

48
Q

A neurologic d/o w involuntary rapid, purposeless movement

A

Sydenham’s chorea/ St. Vitus dance

49
Q

Occur in 5-7% of px

Best felt over extensor surfaces of bone or tendons

A

Subcutaneous nodules

50
Q

A microbial infection of the heart valves or the mural endocardium that leads to the formstion of vegetations composed of thrombotic debris amd organisms

Assocd w the destruction of underlying cardiac tissues

A

Infective endocarditis

51
Q

Most commonly affected valves in Infective Endocarditis

Native - ?
Prosthetic valve - ?
IV users - ?

A

Native - mitral valve
Prosthetic valve- aortic
IV users - tricuspid

52
Q

Abnormalities of heart/greta vessels lresent from birth

A

Congenital heart dse

53
Q

Most common cause of cyanotic congenital heart disease

A

Tetralogy of Fallot

54
Q

Four features of TOF

A

VSD
Obstruction to RV outflow tract
Overriding of aorta
RV hypertrophy

General Pathology (2 decks)

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