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Year 2 CV > Exam 2 heart part II gomez > Flashcards

Exam 2 heart part II gomez Flashcards

1
Q

what can infective endocardtitis lead to

A

bulky friable vegetations
destruction of underlying structures (valves)
risk of systemic microemboli
usually L valves

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2
Q

What organisms are most common to cause infective endocarditis

A

S viridans> S aureus> HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

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3
Q

What valve is affected in IV drug abusres

A

the right

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4
Q

what organism is the #1 culprit for infective endocarditis with an artifical valve

A

S epidermidis

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5
Q

Describe Acute bacterial endocarditis

A

rapildy progressive destruction
highly virulent vacteria
50% die in days or weeks with onset Sx

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6
Q

Describe subacture bacterial endocarditis

A

insidious onset and protracted clinical course
involved valve usually deformed or abnormal
low virulence bacteria like S viridans
most recover with antibiotic Tx

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7
Q

What are the major clinical criteria for Dx infective endocarditis

A

3 blood cultures in 24 hours (has to be +)
echocardiographic findings like mass or absecess
new murmur from regurgitation

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8
Q

What is the combination of Clinical criteria to Dx infective endocarditis

A

2 major, 1 major +3 minor or 5 minor

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9
Q

what are the minor findings of infective endocarditis

A 
predisposing heart lesion or IV drug use
fever
vascular lesions
immunologic phenomena
microbiologic evidence
echocardiographic findings not Dx of endocarditis
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10
Q

What is nonbacterial thrombotic endocarditis NBTE

A

valvular lesions that have no microorganisms

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11
Q

what is the major risk factor of NBTE nonbacterial thrombotic endocarditis

A

hypercoagulable state (debilitated patients with malignancy, DIC or sepsis)

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12
Q

what could occur because of NBTE

A

fragment and produce systemic emboli which could obstruct coronary aa or brain vasculature

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13
Q

what is marantic endocarditis

A

another name for NBTE in debilitated patients

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14
Q

What is Libman Sacks disease

A

Endocarditis of SLE
1-4 mm steril vegetaions on any surface
usually mitral and tricuspid

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15
Q

What SLE patients are at risk for libman sachs disease

A

with lupus anticoagulant (antiphospholipid Ab syndrome)

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16
Q

how do you differentiate NBTE and SLE endocarditis

A

SLE associated will be in many places in heart

NBTE is on sides of valve leaflets

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17
Q

How do you differentiate acute rheumatic heart disease endocarditis and infective endocarditis

A

acute rheumatic heart disease is marked by small warty verrucae along lines of closure of valve leaflets
infective endocarditis shows large irregular masses on valve cusps that can extend to chordae

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18
Q

What is carcinoid syndrome caused by

A

metastatic carcinoid tumor producing serotonins 5HT, kallikrein, bradykinin, histamine, PG

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19
Q

what does carcidnoid syndromer esult in

A

diarrhea, flushing, skin rash, bronchoconstriction and fibrous thickening of endocardial surfaces or right herat

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20
Q

where does the endocardial thickening tend to take place in carcinoid heart disease

A

right ventricle, tricuspid and pulmonic valves

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21
Q

what are the cons about mechanical prosthetic heart valces

A

require anticoagulation and cause mechanical hemolysis

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22
Q

what are complications of cardiac valve prostheses

A 
thrombosis/thromboembolism
anticoagulant-related hemorrhage
prosthetic valve endocarditis
structural deterioration
in adequate or excessive healing
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23
Q

majority of cardiomyopathies are primary or seconday?

A

primary or idiopathic

not secondary

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24
Q

What are the 3 groups of cardiomyopathies

A

dilated (90%)
hypertrophic
restrictive

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25
Q

what is restrictive cardiomyopathy

A

mild increase in cardiac mass without increase in volume of left ventricle

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26
Q

hwo do you differentiate idiopathic dilated cardiomyopathy from myocarditis secondary to virus

A

endomyocardial biopsy

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27
Q

what are toxins associated with heart muscle disease

A

alcohol, cobalt, catecholamines, CO, lithium, hydrocarbons, arsenic, cyclophosphamide
doxorubicin

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28
Q

what metabolic conditions are associated wtih hear muscle disease

A 
hyperthyroidism
hypothyroidism
hyper and hypo kalemia
nutritional deficiencies
hemochromatosis
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29
Q

what are the major causes of myocarditis in US

A

coxsackieviruses A and B
lyme disease
HS eosinophlic
trichinosis

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30
Q

What is the major cause of myocarditis in south america

A 
Chagas disease (trypanosoma cruzi)
Brazil it is more common than ischemic heart disease
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31
Q

what type of cardiomyopathies have an impairement in compliance, “diastolic dysfunction”

A

hypertrophic and restrictive

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32
Q

what can cause restrictive cardiomyopathy

A

amyloidosis, radiation induced fibrosis

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33
Q

what are janeway lesions

A

small erythematous or hemorrhagic nontender lsesions on palms and soles from septic emboli events
endocarditis

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34
Q

what are osler nodes

A

small tendet subcutansoue nodules in pulp of digits or more proximally on fingers and persist for hours to days
endocarditis

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35
Q

what are roth spots

A

oval retinal hemorrhages with pale centers

endocarditis

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36
Q

what viruses can cause dilated cardiomyopathy

A

coxsackie B and other enteroviruses

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37
Q

What are some etiologic associations with dilated cardiomyopathy

A

alcohol, peripartum cardiomyopathy
iron overload
familial(genetic)

38
Q

describe inheritance of familial dilated cardiomyopathy

A

presents in children in autosomal dominant pattern

39
Q

what are clinical features of dilated cardiomyopathy

A

symptomatic CHF
SOB DOE
atrial and ventricular arrhythmias

40
Q

what is the most common indication for cardiac transplantation

A

when dilated cardiomyopathy responds poorly to traditional CHF treatments
left ejection fraction is <25% normal

41
Q

what do dilated cardiomyopathic hearts look like

A

increased size 2-3x
large flabby
dilation of all chambers
ventricular wall thickness decreased or mildy increased
mural thrombi common
normal valves and coronary arteries are normal lumen size

42
Q

drugs that stimulate serotonina re used to treat what and can lead to what

A

treat migraines

can lead to carcinoid heart disease

43
Q

what mutation is associated with arrhthmogenic right ventricular cardiomyopathy

A

autosomal dominant mutations:

plakoglobin on chrom 17 and desmoplakin on chr 6 (desmosomes)

44
Q

What is Naxos syndrome

A

palmoplantar keratoderma with arrhythmogenic right ventricular mardiomyopathy and woolly hair (recessive plakoglobin mutation)

45
Q

what is Carvajal syndrome

A

palmoplantar keratoderma with left ventricular cardiomyopathy and woolly hair (recessive desmoplakin mutation)

46
Q

what are characteristics of arrythmogenic right ventricular cardiomyopathy

A

right sided heart failure and rhythm disturbances

replacement of myocytes with adipocytes and interstitial fibrous tissue

47
Q

what are other names for hypertrophic cardiomyopathy

A

idiopathic hypertrophic subaortic stenosis

hypertrophic obstructive cardiomyopathy

48
Q

what are features of hypertrophic cardiomyopathy

A

myocardial hypertrophy
abnormal diastolic filling
intermittent ventricular outflow obstruction (1/3 cases)

49
Q

what mutations are associated with hypertrophic CM

A

dominant mutations with proteins of the sarcomere

B myosin heavy chain on Chr 14

50
Q

what is the main clinical limitation with HCM

A

exertional dyspnea

51
Q

what are the risks involved with HCM

A

10-20% a fib with risk mural thrombus formation

sudden cardiac death, usually younger individulas

52
Q

describe gross structure of HCM

A

massic hypertrophy without ventricular dilation
disproportionate thickening of L ventricula septum compated to LV free wall
L ventricular chamber dec in size
hypertrophic septum is prominent in subaortic region where could cause obstruction to LV outlflow

53
Q

describe histo path of HCM

A

marked myocyte hypertrophy 40 microns (normal 15 microns)
haphazard myofiber disarray
interstitial and replacement fibrosis in myocardium

54
Q

is HCM a diastolic or systolic dysfunction? dilated CM?

A

HCM diastolic

DCM systolic

55
Q

what type of proteins are mutated in HCM? DCM?

A

HCM sarcomere proteins

DCM cytoskeleton proteins

56
Q

what are the heart findings in restrictive cardiomyopathy

A

ventricles are normal size
ventricular chambers are normal size
biatrial enlargement common

57
Q

what disorders are associated with restrictive in cardiomyopathy

A

amyloidosis
endomyocardial fibrosis
loeffler endomyocarditis
endocardial fibroelastosis

58
Q

what is loeffler endomyocarditis

A

endomyocardial fibrosis with large mural thrombi that occurs worldwide and is assoc with eosinophlic leukemia

59
Q

what is endocardial fibroelastosis

A

multifactorial left ventricular endocardial fibrosis that usually occurs in first 2 years of life

60
Q

what is systemic senile amyloidosis

A

amyloidosis of heart, in aged patients

localized to both ventricular and atrial myocardium or sometimes just atria

61
Q

systemic senile amyloidosis is most common in what demographic

A

african americans with transthyretin mutation

62
Q

what is amyloid composed of in senile form

A

transthyretin

63
Q

what causes isolated atrial amyloidosis

A

ANP deposition

64
Q

what is primary systemic amyloidosis

A

chronic disease that involves most visceral organs and almost always invovles interstitiu of myocardium

65
Q

What is ayloid composed of in systemic form

A

Ig Light chain material

66
Q

what does cardiac amyloidosis stain under polarized light

A

congo red stain shows apple green birefringence

67
Q

eos have how many nuclear lobes

A

2

68
Q

what are toxins that cause direct cardiac disease and mechanisms

A

adriamycin- lipid peroxidaiton of myocyte membrane
cyclophosphamide (cytoxan)- vascular lesion with myocardial hemorrhage
high dose catecholamines (vasopressors)- Ca overload or vasoconstriction and increased cardiac load
iron overload (hemochromatosis)- interferes with metal dependent enzyme systems

69
Q

the giant cell myocarditis is what type cells

A

macrophages

70
Q

what does chagas myocarditis look like on cross section

A

myofiber distended with trypanosomes with necrosis and not much inflammation

71
Q

what is most common cause of cardiaac tumors

A

metastatic malignancies

72
Q

what is second most common cause cardiac tumor

A

myxoma (fever and malaise via IL 6)

73
Q

what is a carney complex

A

myxomas, pigmened skin lesions and overactivity of endocrine organs (null utation PRKAR1A Chr 17)

74
Q

what is the #1 cardiac tumor in chldren

A

rhabdomyoma

50% assoc with tuberous sclerosis (TSC1 and 2 genes)

75
Q

what are direct cardiac consequences of a noncardiac tumor

A

pericardial myocardial metastases
large vessel obstruction
pulmonary tumor emboli

76
Q

what are the indirect cardiac consequences of noncardiac tumors

A

NBTE
carcinoid heart disease
pheochromocytoma associated
myeloma associated amyloidosis

77
Q

what are causes of serous pericardial effusions

A

CHF and hypoalbuminemia

78
Q

what are causes of serosanguinous pericardial effusions

A

malignancy, trauma, ruptured MI, aortic dissection

79
Q

what are causes of sanguinous pericardial effusions

A

hemopericardium (aortic/cardiac rupture)

80
Q

what are causes of purulent pericardial effusions

A

infection

81
Q

what cause chylous pericardial effusion

A

lymphatic obstruction

82
Q

cardiac tamponade can occur with what amount og fluid accumulation

A

250 ml

83
Q

what is the #1 cause of pericarditis

A

viruses

84
Q

what are causes of serous pericarditis

A

Rheumatoid fever, SLE, scleroderma, tumors, uremia, Dressler syndrome

85
Q

what are causes of fibrinous and serofibrinous pericarditis

A

MI, Dressler syndrome, uremia, radiation RF, SLE, trauma, cardiac surgery

86
Q

What are causes of purulent pericarditis

A

infections

87
Q

what are causes of constrictive pericarditis

A

pericardium is rigid, thickend, scarred and less elastic than normal

88
Q

what are causes of hemorrhagic pericarditis

A

neoplasia, bacteria, TB, bleeding diathesis, cardiac surgery

89
Q

what are causes of casseous pericarditis

A

TB or fungus

90
Q

what are causes of adhesive pericarditis

A

fibrous or fibroelastic scar, “concretio cordis” if severe

91
Q

cardiac allograft rejection looks like what on cross section

A

lymphocytic infiltrate

92
Q

what is allograft arteriopathy

A

after transplant, ahve severe diffuse concentric intinal thickening causing critical stenosis. 50% within 5 years, 100% within 10 years

Year 2 CV (31 decks)

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