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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
what is restrictive cardiomyopathy
mild increase in cardiac mass without increase in volume of left ventricle
26
hwo do you differentiate idiopathic dilated cardiomyopathy from myocarditis secondary to virus
endomyocardial biopsy
27
what are toxins associated with heart muscle disease
alcohol, cobalt, catecholamines, CO, lithium, hydrocarbons, arsenic, cyclophosphamide doxorubicin
28
what metabolic conditions are associated wtih hear muscle disease
``` hyperthyroidism hypothyroidism hyper and hypo kalemia nutritional deficiencies hemochromatosis ```
29
what are the major causes of myocarditis in US
coxsackieviruses A and B lyme disease HS eosinophlic trichinosis
30
What is the major cause of myocarditis in south america
``` Chagas disease (trypanosoma cruzi) Brazil it is more common than ischemic heart disease ```
31
what type of cardiomyopathies have an impairement in compliance, "diastolic dysfunction"
hypertrophic and restrictive
32
what can cause restrictive cardiomyopathy
amyloidosis, radiation induced fibrosis
33
what are janeway lesions
small erythematous or hemorrhagic nontender lsesions on palms and soles from septic emboli events endocarditis
34
what are osler nodes
small tendet subcutansoue nodules in pulp of digits or more proximally on fingers and persist for hours to days endocarditis
35
what are roth spots
oval retinal hemorrhages with pale centers | endocarditis
36
what viruses can cause dilated cardiomyopathy
coxsackie B and other enteroviruses
37
What are some etiologic associations with dilated cardiomyopathy
alcohol, peripartum cardiomyopathy iron overload familial(genetic)
38
describe inheritance of familial dilated cardiomyopathy
presents in children in autosomal dominant pattern
39
what are clinical features of dilated cardiomyopathy
symptomatic CHF SOB DOE atrial and ventricular arrhythmias
40
what is the most common indication for cardiac transplantation
when dilated cardiomyopathy responds poorly to traditional CHF treatments left ejection fraction is <25% normal
41
what do dilated cardiomyopathic hearts look like
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
drugs that stimulate serotonina re used to treat what and can lead to what
treat migraines | can lead to carcinoid heart disease
43
what mutation is associated with arrhthmogenic right ventricular cardiomyopathy
autosomal dominant mutations: | plakoglobin on chrom 17 and desmoplakin on chr 6 (desmosomes)
44
What is Naxos syndrome
palmoplantar keratoderma with arrhythmogenic right ventricular mardiomyopathy and woolly hair (recessive plakoglobin mutation)
45
what is Carvajal syndrome
palmoplantar keratoderma with left ventricular cardiomyopathy and woolly hair (recessive desmoplakin mutation)
46
what are characteristics of arrythmogenic right ventricular cardiomyopathy
right sided heart failure and rhythm disturbances | replacement of myocytes with adipocytes and interstitial fibrous tissue
47
what are other names for hypertrophic cardiomyopathy
idiopathic hypertrophic subaortic stenosis | hypertrophic obstructive cardiomyopathy
48
what are features of hypertrophic cardiomyopathy
myocardial hypertrophy abnormal diastolic filling intermittent ventricular outflow obstruction (1/3 cases)
49
what mutations are associated with hypertrophic CM
dominant mutations with proteins of the sarcomere | B myosin heavy chain on Chr 14
50
what is the main clinical limitation with HCM
exertional dyspnea
51
what are the risks involved with HCM
10-20% a fib with risk mural thrombus formation | sudden cardiac death, usually younger individulas
52
describe gross structure of HCM
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
describe histo path of HCM
marked myocyte hypertrophy 40 microns (normal 15 microns) haphazard myofiber disarray interstitial and replacement fibrosis in myocardium
54
is HCM a diastolic or systolic dysfunction? dilated CM?
HCM diastolic | DCM systolic
55
what type of proteins are mutated in HCM? DCM?
HCM sarcomere proteins | DCM cytoskeleton proteins
56
what are the heart findings in restrictive cardiomyopathy
ventricles are normal size ventricular chambers are normal size biatrial enlargement common
57
what disorders are associated with restrictive in cardiomyopathy
amyloidosis endomyocardial fibrosis loeffler endomyocarditis endocardial fibroelastosis
58
what is loeffler endomyocarditis
endomyocardial fibrosis with large mural thrombi that occurs worldwide and is assoc with eosinophlic leukemia
59
what is endocardial fibroelastosis
multifactorial left ventricular endocardial fibrosis that usually occurs in first 2 years of life
60
what is systemic senile amyloidosis
amyloidosis of heart, in aged patients | localized to both ventricular and atrial myocardium or sometimes just atria
61
systemic senile amyloidosis is most common in what demographic
african americans with transthyretin mutation
62
what is amyloid composed of in senile form
transthyretin
63
what causes isolated atrial amyloidosis
ANP deposition
64
what is primary systemic amyloidosis
chronic disease that involves most visceral organs and almost always invovles interstitiu of myocardium
65
What is ayloid composed of in systemic form
Ig Light chain material
66
what does cardiac amyloidosis stain under polarized light
congo red stain shows apple green birefringence
67
eos have how many nuclear lobes
2
68
what are toxins that cause direct cardiac disease and mechanisms
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
the giant cell myocarditis is what type cells
macrophages
70
what does chagas myocarditis look like on cross section
myofiber distended with trypanosomes with necrosis and not much inflammation
71
what is most common cause of cardiaac tumors
metastatic malignancies
72
what is second most common cause cardiac tumor
myxoma (fever and malaise via IL 6)
73
what is a carney complex
myxomas, pigmened skin lesions and overactivity of endocrine organs (null utation PRKAR1A Chr 17)
74
what is the #1 cardiac tumor in chldren
rhabdomyoma | 50% assoc with tuberous sclerosis (TSC1 and 2 genes)
75
what are direct cardiac consequences of a noncardiac tumor
pericardial myocardial metastases large vessel obstruction pulmonary tumor emboli
76
what are the indirect cardiac consequences of noncardiac tumors
NBTE carcinoid heart disease pheochromocytoma associated myeloma associated amyloidosis
77
what are causes of serous pericardial effusions
CHF and hypoalbuminemia
78
what are causes of serosanguinous pericardial effusions
malignancy, trauma, ruptured MI, aortic dissection
79
what are causes of sanguinous pericardial effusions
hemopericardium (aortic/cardiac rupture)
80
what are causes of purulent pericardial effusions
infection
81
what cause chylous pericardial effusion
lymphatic obstruction
82
cardiac tamponade can occur with what amount og fluid accumulation
250 ml
83
what is the #1 cause of pericarditis
viruses
84
what are causes of serous pericarditis
Rheumatoid fever, SLE, scleroderma, tumors, uremia, Dressler syndrome
85
what are causes of fibrinous and serofibrinous pericarditis
MI, Dressler syndrome, uremia, radiation RF, SLE, trauma, cardiac surgery
86
What are causes of purulent pericarditis
infections
87
what are causes of constrictive pericarditis
pericardium is rigid, thickend, scarred and less elastic than normal
88
what are causes of hemorrhagic pericarditis
neoplasia, bacteria, TB, bleeding diathesis, cardiac surgery
89
what are causes of casseous pericarditis
TB or fungus
90
what are causes of adhesive pericarditis
fibrous or fibroelastic scar, "concretio cordis" if severe
91
cardiac allograft rejection looks like what on cross section
lymphocytic infiltrate
92
what is allograft arteriopathy
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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