Gen Path Exam 1 - Cardiovascular Path Flashcards
What disease?
Various diseases characterized by inability of the coronary arteries to deliver adequate oxygen to meet the needs of the myocardium
Ischemic heart disease
What disease?
Leading cause of ischemic heart disease
Coronary artery disease
What disease?
Causes include coronary artery disease, atherosclerosis, thromboemboli, coronary artery vasospasm, and conditions that increase workload and oxygen demand
Ischemic heart disease
What disease?
Clinical manifestations are chronic ischemic heart disease (most common), angina pectoris, and myocardial infarction
Ischemic heart disease
What disease?
Leads to congestive heart failure, angina pectoris, MI, sudden cardiac death
Chronic ischemic heart disease
What disease?
Episodic, paroxysmal, substernal or precordial chest pain or discomfort resulting from myocardial ischemia, usually due to the inability of diseased coronary vessels to provide adequate blood for myocardial oxygenation
Angina pectoris
What disease?
Caused by a fixed coronary artery obstruction secondary to atherosclerosis
Stable (classic) angina
What disease?
Symptoms are episodic, paroxysmal, substernal or precordial pressure, heaviness, pain or discomfort usually brought on by exertion and relieved by rest or nitrates (nitroglycerin).
Stable (classic) angina
What disease?
Attacks are no longer than 15-20 mins, predictable, and follow a precipitating event associated with temporary increase in demands of heart
Stable (classic) angina
What disease?
Symptoms are relieved by decreased cardiac demand or nitroglycerin
Stable (classic) angina
What disease?
Attacks occur more frequently, are longer, and produce more severe symptoms. Pain is more easily provoked and may occur at rest
Unstable (pre-infarction) angina
What disease?
Undistinguishable from NSTEMI
Unstable (pre-infarction) angina
What disease?
Pain occurs at rest and lasts longer than 20 mins
Pain is severe and of new onset
Pain occurs with a crescendo pattern
Unstable (pre-infarction) angina
What disease?
Coronary artery vasospasm is an important mechanism and pain occurs at rest
Variant (vasospastic) angina
What disease?
Characterized by symptoms of myocardial ischemia, persistent EKG changes, and release of biomarkers of myocardial necrosis resulting from an insufficient supply of oxygenated blood to an area of the heart
MI
What disease?
Caused by irreversible myocardial injury, occurring as a result of prolonged ischemia
MI
What disease?
Most frequently involves LV and leading cause is coronary artery atheroscleorsis
MI
What disease?
Initiating factor in most cases is sudden disruption of partially occlusive coronary artery atherosclerotic plaque
MI
What disease?
Classified by:
Degree of ventricular wall involvement
Location within heart or specific artery involved
Presence or absence of ST elevation on EKG
MI
What specific MI?
Involve full thickness of ventricle and result in ST segment elevation
Transmural MI
What specific MI?
Limited to inner third of myocardium and DO NOT exhibit ST segment elevation
Subendocardial MI
MI resulting from a blockage of which artery is most common?
L anterior descending coronary artery
T/F: STEMIs are more common than NSTEMIs
True
What disease?
MIs characterized by profound, acute transmural myocardial ischemia and associated with ST segment elevation on EKG
Acute MI
Describe the pathogenesis of acute MIs
Plaque is disrupted
Platelets adhere, aggregate, and are activated
Release of ADP + thromboxane A2
Thrombus grows and occludes coronary artery
Coagulative necrosis
Gross and microscopic appearance of an MI depends on _____ of the injury
age
Describe how the areas of damage after an MI change morphologically
Coagulative necrosis -> acute then chronic inflammation -> fibrosis
What disease?
Sudden onset of chest pain that is similar to the pain of angina but is more severe and prolonged, generally lasting more than 15-20 mins, and is unrelieved by nitroglycerin
Acute MI
What symptom of acute MI?
History of alteration in the pattern of angina, recent onset of typical or atypical (unstable) angina, or unusual “indigestion” or pressure or squeezing felt in the chest.
Premonitory pain
What symptom of acute MI?
Chest pain/discomfort at rest, nitroglycerin has no effect relieving pain
Pain of infarction
What disease?
Cold sweat, weak/apprehensive, light headed, syncope, dyspnea, orthopnea, cough, wheezing, nausea, vomiting, abdominal bloating
Acute MI
What disease?
Diagnosed by triad of:
Ischemic type discomfort
EKG abnormalities
Elevated serum cardiac markers
MI
Name the serum cardiac markers used to diagnose MI
Troponin I and T
Creatine Kinase isozyme MB
What disease?
Diagnosed with coronary artery angiography or perfusion scintigraphy test
MI
What disease?
Complications include arrhythmias, progressive heart failure, ventricular aneurysm, mural thrombus, rupture of myocardium, fibrinous pericarditis, heart chamber dilation
MI
Most common cause of sudden cardiac death in first hour after MI
Vfib
Most common cause of death among hospital patients with acute MI
Cardiogenic shock
Occurs between 4-7 days after MI and is responsible for 20% of all fatal MIs
Rupture of myocardium
What disease?
Refers to a spectrum of clinical symptoms compatible with acute myocardial ischemia
Acute coronary syndrome
What disease?
Includes unstable angina, NSTEMI, and STEMI
Acute coronary syndrome
Unexpected death due to cardiac causes occurring in a short time period (in 1 hour of symptom onset) in a person with known or unknown cardiac disease in whom no previously diagnosed fatal condition is apparent
Sudden cardiac death
Symptom complex, not a disease entity, that can result from a variety of cardiac disorders
Congestive heart failure
What disease?
Characterized by inability of the heart to pump blood sufficiently to keep pace with the body’s circulatory demands
Congestive heart failure
What disease?
Develops when the body’s compensatory mechanisms to correct intravascular and interstitial volume overload and/or inadequate tissue perfusion (oxygenation) become overwhelmed
Congestive heart failure
What disease?
Caused by decreased myocardial function/cardiac valvular dysfunction (from previous MI), increased vascular resistance, increased blood volume, or excessive metabolic demand
Congestive heart failure
What disease?
Classified by:
Systolic vs diastolic
L vs R sided
Backward vs forward
Congestive heart failure
What specific Congestive heart failure?
Reduced cardiac contractility
Systolic
What specific Congestive heart failure?
Impaired cardiac relaxation and abnormal ventricular filling
Diastolic
What specific Congestive heart failure?
Failure of LV or excessive pressure in LA
Left sided
What specific Congestive heart failure?
Failure of RV or excessive pressure in RA
Right sided
What specific Congestive heart failure?
Not simultaneous, develops over time due to increased stress placed on remaining ventricle
Biventricular
What is the most frequently used index of cardiac pump function?
Ejection fraction
Ejection fraction equation
EF = 100 x SV/EDV
Where is ejection fraction measured?
LV
What is normal adult LV ejection fraction?
50-70%
What ejection fraction is considered systolic dysfunction?
40%
What disease?
Symptomatic congestive heart failure with a normal ejection fraction
Congestive heart failure with preserved ejection fraction
What specific Congestive heart failure?
Exertional dyspnea, dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, cough, and hemoptysis (coughing up blood).
Left sided
What specific Congestive heart failure?
Pulmonary edema and hemosiderin-laden alveolar macrophages (heart failure cells)
Left sided
What specific Congestive heart failure?
Systemic venous congestion, jugular venous distention; enlarged and tender liver and spleen; ascites (abdominal edema); and pitting edema of the extremities
Right sided
What specific Congestive heart failure?
LV is hypertrophied and dilated
Left sided
What specific Congestive heart failure?
Lungs are heavy and boggy due to pulmonary congestion and edema
Left sided
What disease?
A gross structural abnormality of the heart or intrathoracic great vessels that is present at birth and that is actually or potentially of functional significance.
Congenital heart disease
What disease?
Associated with chromosomal abnormalities
Congenital heart disease
What is Turner syndrome associated with?
Coarctation of aorta
Which syndrome is associated with the following?
Atrial + ventricular septal defects
AV valve deformities
Down syndrome
What is pregnancy while living at high altitudes associated with?
Patent ductus arteriosus
What is rubella syndrome associated with?
Patent ductus arteriosus
Pulmonary artery stenosis
Which form of Congenital heart disease?
R to L shunt because of increased pulmonary artery pressure
Cyanotic
Which form of Congenital heart disease?
L to R shunt
Non-cyanotic
What type of Congenital heart disease?
A hole from a septum secundum or septum primum defect in the interatrial septum normally produces a modest L to R, non-cyanotic shunt.
Atrial septal defect
Name the 1st, 2nd, and 3rd most common types of Congenital heart disease
1st = ventricular septal defect
2nd = atrial septal defect
3rd = patent ductus arteriosus
What type of atrial septal defect?
Smooth-walled defects near the foramen ovale, typically without other associated cardiac abnormalities.
Ostium secundum
What type of atrial septal defect?
Occur at the lowest part of the atrial septum and can be associated with mitral and tricuspid valve abnormalities
Ostium primum
What type of atrial septal defect?
affects the upper part of the atrial septum near the entrance of the SVC; accompanied by anomalous drainage of the pulmonary veins into the right atrium or SVC
Sinus venosus
What type of Congenital heart disease?
Clinical presentation includes heart failure, exertional fatigue, dyspnea, afib
Atrial septal defect
What type of Congenital heart disease?
Flaplike opening between the atrial septa primum and secundum at the location of the fossa ovalis that persists after age 1 year
Patent foramen ovale
What type of Congenital heart disease?
No clinical significance except when it leads to paradoxical embolism and cryptogenic strokes
Patent foramen ovale
What type of Congenital heart disease?
Transient R to L blood flow can occur, such as with Valsalva-type maneuvers
Patent foramen ovale
What type of Congenital heart disease?
Hole within the membranous or muscular portions of the intraventricular septum that produces a L to R, non-cyanotic shunt.
Ventricular septal defect
What type of Congenital heart disease?
Clinical presentation in infants: tachypnea, tachycardia, heart failure
Clinical presentation in adults: L sided heart failure, shortness of breath, orthopnea, dyspnea on exertion
Ventricular septal defect
What type of Congenital heart disease?
Can lead to pulmonary artery hypertension (reverses blood flow to R to L shunt) and R sided heart failure
Ventricular septal defect
What type of Congenital heart disease?
Failure of closure of the fetal ductus arteriosus within 1 to 2 days of birth resulting in a high-pressure L to R, non-cyanotic shunt
Patent ductus arteriosus
What type of Congenital heart disease?
Risk factors include premature / low birth weight, low oxygen tension (pregnancy while living at high altitude), and first-trimester maternal rubella
Patent ductus arteriosus
What type of Congenital heart disease?
Narrowing or constriction of the aorta leading to left ventricular outflow obstruction
Coarctation of aorta
What type of Congenital heart disease?
The narrowing can be preductal (“infantile”) or postductal (“adult”) in relation to the ductus arteriosus
Coarctation of aorta
What type of Congenital heart disease?
Patent ductus arteriosus is usually present
Coarctation of aorta
What type of coarctation of aorta?
Symptomatic early in life, classically as cyanosis localized to the lower half of the body
Preductal (“infantile”) coarctation of aorta WITH patent ductus arteriosus
What type of coarctation of aorta?
Hypertension is limited to the upper extremities and cerebral vessels
Postductal (“adult”) coarctation of aorta WITHOUT patent ductus arteriosus
Name the 1st and 2nd most common types of R to L cyanotic congenital heart disease
1st = tetralogy of fallot
2nd = transposition of great arteries
What type of Congenital heart disease?
Presents with:
-Obstruction of the RV outflow tract due to subpulmonic stenosis, pulmonary valve stenosis or complete atresia
-Concentric RV hypertrophy
-Ventricular septal defect
-Dextroposition of the aorta
Tetralogy of fallot
What type of Congenital heart disease?
Aorta arises from the RV and the pulmonary artery emanates from the LV (they’re switched)
Transposition of great arteries
What type of Congenital heart disease?
A concurrent compensatory anomaly such VSD, ASD, or PDA with R to L shunting is needed for extrauterine survival
Transposition of great arteries
What disease?
Bulging of one or both mitral valve leaflets
Mitral valve prolapse
What disease?
Most frequently due to myxomatous degeneration of connective tissue
Mitral valve prolapse
What disease?
Complications include mitral regurgitation, infective endocarditis, sudden cardiac death, and stroke
Mitral valve prolapse
What disease?
Retrograde blood flow through the left atrium secondary to an incompetent mitral valve
Mitral regurgitation
What disease?
Caused by organic disease (e.g., myxomatous degeneration/mitral valve prolapse) or a functional abnormality
Mitral regurgitation
What disease?
Increased risk for afib
Mitral regurgitation
What disease?
May cause LV failure
Mitral regurgitation
What disease?
Narrowing of the mitral valve orifice that prevents proper opening during diastole and obstruction of blood flow from the left atrium to the left ventricle
Mitral stenosis
What disease?
Caused by rheumatic fever
Mitral stenosis
What disease?
Clinical presentation includes fatigue and exertional dyspnea
Mitral stenosis
What disease?
Retrograde blood flow into the left ventricle from the aorta secondary to an inadequately closing aortic valve
Aortic regurgitation
What disease?
Obstruction to systolic left ventricular outflow across the aortic valve
Aortic valve stenosis
What disease?
Most commonly acquired, due to idiopathic calcification of the aortic valve (calcific aortic stenosis) or rheumatic fever, or congenital
Aortic valve stenosis
What disease?
Early symptoms: decreased exercise tolerance, dyspnea and dizziness on exertion
Late symptoms: exertional angina, L sided heart failure
Aortic valve stenosis
What disease?
Small, sterile lesions (vegetations) which develop on the damaged or denuded cardiac endothelium, and are along the line of closure of the cardiac valve leaflets (and/or adjacent endocardium).
NBTE
What disease?
Caused by rheumatic fever and any structural heart disease with increased turbulence of blood flow resulting in endothelial damage (cardiac valvular dysfunction, congenital heart disease)
NBTE
What disease?
Complications include peripheral embolization (but emboli are sterile)
NBTE
What disease?
Increases the risk for development of IE
NBTE
What disease?
Microbial infection of the endocardial surfaces of the heart, usually affecting of one or more cardiac valves
IE
What disease?
Mainly caused by bacteria
IE
What bacteria are most common in IE?
Staph aureus
Streptoccoci viridans
What type of IE?
Caused by Staph aureus
Acute
What type of IE?
Caused by Strep viridans
Subacute
What disease?
Most cases occur on an altered, injured or damaged endothelial surface (most often on a cardiac valve leaflet), that makes the surface suitable for pathogenic bacterial attachment and colonization.
IE
What disease?
Risk factors include prosthetic cardiac valve, heart surgery using a prosthetic patch or prosthetic device, heart surgery with a residual hemodynamic defect, IV drug abuse, and history of previous IE
IE
In IE, bacteria must then reach the site of endothelial damage via the ____________, adhere to the damaged endothelial surface, and invade the involved tissue to produce bacterial colonization and persistence
bloodstream
What disease?
Complications include valvular damage and insufficiency, congestive heart failure, myocardial abscesses, and cardiac arrhythmias
IE
Portions of vegetations on valves affected by IE can easily detach forming septic (infected) _________ and may travel through the bloodstream and cause tissue and organ _____________ and infections such as ________
emboli; infarctions; stroke
What disease?
Symptoms are fever, heart murmurs, bacteremia, immunological responses, and emboli
IE
What is the most common sign of IE?
Fever
What disease?
Multisystem autoimmune inflammatory disease with major cardiac manifestations and sequelae, most often affecting children between 5 and 15 years of age.
Rheumatic fever
What disease?
Caused by group A strep
Rheumatic fever
What disease?
Symptoms include carditis, migratory polyarthritis, subcutaneous nodules, erythema marginatum, and chorea
Rheumatic fever
What is evidence of a recent strep infection?
Elevated anti-streptolysin O
What disease?
Example of a type II hypersensitivity reaction, sharing common antigenic determinants resulting in tissue injury
Rheumatic fever
What disease?
Characterized by nonsuppurative inflammatory lesions of the joints, heart, subcutaneous tissue, and central nervous system
Rheumatic fever
What disease?
Microscopic findings include Aschoff body (focal interstitial myocardial inflammation) and large activated macrophages known as Anitschkow cells
Rheumatic fever
Rheumatic fever causes inflammation of the pericardium, myocardium, and endocardium. What does each result in?
Pericarditis = serous effusions
Myocarditis = congestive heart failure
Endocarditis = valvular damage
Where does rheumatic fever endocarditis usually occur?
Areas subject to great hemodynamic stress (ex: points of valve closure)
What disease?
Noncardiac manifestations are fever, malaise, increased erythrocyte sedimentation rate, joint involvement, skin lesions, and CNS involvement
Rheumatic fever
Name one type of joint involvement in rheumatic fever. How many patients does this affect?
Migratory polyarthritis; 75%
Name two types of skin lesions in rheumatic fever
Subcutaneous nodules
Erythema marginatum
Name one type of CNS involvement in rheumatic fever
Sydenham’s chorea
What disease?
Results from single or repeated attacks of RF and consists of the cardiac valve damage
Rheumatic heart disease
What disease
As a consequence of fibrotic healing, the valves eventually become thickened, fibrotic, rigid and deformed, often with fusion of valve commissures and calcification, as well as thickening of the chordae tendineae
Rheumatic heart disease
What valve is most frequently involved in rheumatic heart disease?
Mitral valve
What disease?
MacCallum plaques appear on endocardium in L atrium, caused by regurgitant jets of blood flow due to incompetence of damaged mitral valve
Rheumatic heart disease
What other valves besides the mitral valve can be affected by Rheumatic heart disease?
Aortic valve (+ mitral)
Tricuspid valve (+ mitral and aortic)
What disease?
An alteration of the normal site or rate of electrical impulse generation within the heart or an alteration of the impulse’s orderly spread through the cardiac conducting system
Arrhythmia
What disease?
Vary greatly in their clinical significance
Arrhythmia
What disease?
Caused by primary cardiovascular disease, ischemic injury (ex: MI), and drugs
Arrhythmia
What type of arrhythmia?
100 bpm +
Tachyarrhythmia
What type of arrhythmia?
Originating above AV node
Supraventricular tachyarrhythmia
What type of arrhythmia?
Originating below AV node
Ventricular tachyarrhythmia
What type of arrhythmia?
Less than 60 bpm
Bradyarrhytmia
What type of arrhythmia?
Examples are:
Sinus + atrial tachycardia
Premature atrial contractions
Paroxysmal supraventricular tachycardia
Atrial flutter
Afib
Supraventricular tachyarrhythmia
What type of arrhythmia?
Premature ventricular contraction
Vtach
Vfib
Torsades de pointes
Ventricular tachyarrhythmia
What type of arrhythmia?
Sinus bradycardia
Sick sinus syndrome
First, second, third degree heart block
Bradyarrhythmia
What disease?
Heart muscle disease attributable to intrinsic myocardial dysfunction
Cardiomyopathy
What disease?
3 types are:
Dilated (congestive) - most common
Hypertrophic
Restrictive (obliterative or infiltrative)
Cardiomyopathy
What disease?
Caused by a specific identifiable etiology, or can be idiopathic
Cardiomyopathy
What type of cardiomyopathy?
Characterized by dilation and impaired, ineffective contraction of one or both ventricles
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Systolic function of the heart is impaired and patients may develop overt heart failure, atrial and/or ventricular arrhythmias, and can experience sudden cardiac death.
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Caused by idiopathic, genetic, alcoholism, ischemic heart disease, uncontrolled tachyarrhythmia, cirrhosis, end-stage renal disease, sleep apnea, infections, cardiotoxic drugs, toxins, substance abuse, peripartum, endocrine disease, collagen-vascular autoimmune disease, hematologic disease
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Symptoms of congestive heart failure, but can also be asymptomatic, leading to incidental finding on a chest X-ray
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Clinical presentation includes mitral regurgitation and ventricular or atrial arrhythmias
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Heart is enlarged, heavy, and flabby due to dilation of all 4 chambers
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Myocardial cells are hypertrophied; interstitial and endocardial fibrosis is present
Dilated (congestive) cardiomyopathy
What type of cardiomyopathy?
Characterized by marked thickening of the left ventricular wall without dilation, not explained by another cardiac or systemic disorder.
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
Ventricular septum is also profoundly enlarged and hypertrophied and there may be obstruction within the left ventricular outflow tract
Hypertrophic cardiomyopathy
This type of cardiomyopathy associated with LVOT obstruction is called idiopathic hypertrophic subaortic stenosis
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
Reduced stroke volume due to left ventricular diastolic dysfunction
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
Caused by genetics - mutation in proteins of the cardiac sarcomere and Ca2+ regulation
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
Clinical presentation can be asymptomatic or dyspnea, syncope, presyncope, ventricular arrhythmias, sudden cardiac death, and stroke
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
L ventricle is banana shaped and there is obstruction of L ventricular outflow tract
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
Miscroscopic findings include massive myocyte hypertrophy, disorganized myocyte architecture, interstitial and replacement fibrosis
Hypertrophic cardiomyopathy
What type of cardiomyopathy?
Characterized by restrictive ventricular filling
Restrictive cardiomyopathy
What type of cardiomyopathy?
Decrease in ventricular compliance and distensibility (the ventricles are abnormally “stiff”), resulting in impaired ventricular filling during diastole (diastolic dysfunction) and the atria become enlarged
Restrictive cardiomyopathy
What type of cardiomyopathy?
Caused by amyloidosis, progressive systemic sclerosis (scleroderma), myocardial fibrosis
Restrictive cardiomyopathy
What type of cardiomyopathy?
Clinical presentation is biventricular congestive heart failure
Restrictive cardiomyopathy
What type of cardiomyopathy?
Gross finding is that both atria are dilated
Restrictive cardiomyopathy
What type of cardiomyopathy?
Microscopic finding is interstitial fibrosis
Restrictive cardiomyopathy
What disease?
Accumulation of serous transudate in the pericardial space
Hydropericardium
What disease?
Caused by congestive heart failure, nephritic syndrome, or chronic liver disease
Hydropericardium
What disease?
Accumulation of blood in the pericardial sac
Hemopericardium
What disease?
Caused by trauma to chest resulting in rupture of myocardium, coronary arteries or aortic root, or myocardial rupture secondary to MI
Hemopericardium
What disease?
Acute inflammation (or infiltration) of the pericardium
Acute pericarditis
What disease?
Characterized by at least 2 of the following 4 criteria:
Chest pain
Specific EKG changes
Pericardial friction rub
New/worsening pericardial effusion
Acute pericarditis
What disease?
Classified as:
Serous
Fibrinous
Purulent
Hemorrhagic
Acute pericarditis
What type of acute pericarditis?
Protein-rich exudate
Serous pericarditis
What type of acute pericarditis?
Associated with lupus, rheumatic fever, or viral infections
Serous pericarditis
What type of acute pericarditis?
Fibrin-rich exudate
Fibrinous pericarditis
What type of acute pericarditis?
Caused by uremia, MI, or rheumatic fever
Fibrinous pericarditis
What type of acute pericarditis?
Purulent inflammatory exudate
Purulent pericarditis
What type of acute pericarditis?
Caused by bacterial infection
Purulent pericarditis
What type of acute pericarditis?
Blood inflammatory exudate
Hemorrhagic pericarditis
What type of acute pericarditis?
Caused by metastatic tumor invasion of pericardium, TB, or other bacterial infection
Hemorrhagic pericarditis
Common heart tumor of adults
Myxoma
Common heart tumor of infants and children
Rhabdomyomas
Which cardiac tumor occurs with high frequency in patients with tuberous sclerosis?
Rhabdomyomas
Most common malignancy of the heart
Metastatic tumors
This type of cancer has a higher predilection for cardiac metastatic tumors
Lung cancer
