heart Flashcards

Question

chronic rheumatic heart disease

Answer 1

-Clinical manifestations appear years/decades after initial episode of RF: cardiac murmurs, cardiac hypertrophy and dilation, and heart failure -Mitral valve: leaflet thickening, commissural fusion and shortening, and thickening and fusion of tendinous cords; calcification and fibrous bridging across valvular commissures create “fish mouth” stenosis!!!!!!!! -MC CAUSE OF MITRAL STENOSIS IS CHRONIC RHEUMATIC HEART DISEASE !!!

Answer 2

-Microbial infection of heart valves; leads to formation of vegetations (thrombotic debris and organisms) often with destruction of underlying cardiac tissues; Most infections bacterial -Acute IE usually caused by infection of previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus ) that rapidly produces destructive lesions; Staph. aureus usually in IE among IV drug users -S. aureus commonly found on skin can infect either healthy or deformed valves; responsible for 20% to 30% of cases Subacute IE usually caused by organisms with lower virulence (e.g., viridans streptococci, usu oral cavity) that cause insidious infections of deformed valves with less destruction -Other bacterial causes: enterococci and the HACEK group (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella , and Kingella ), commensals in oral cavity -Disposing factor for endocarditis: bacteremia (or fungemia) from other infection, dental or surgical procedure, contaminated needle in IV drug abusers

Answer 3

-Vegetations on heart valves: friable, bulky, potentially destructive lesions containing fibrin, inflammatory cells, and bacteria; may be single or multiple, may involve more than one valve; can sometimes erode into underlying myocardium and produce an abscess (ring abscess) -Vegetations of subacute endocarditis associated with less valvular destruction (v. acute IE) -Acute endocarditis: rapid onset of fever, chills, weakness, and lassitude; in older adults only manifestations may be nonspecific fatigue, weight loss, and flulike syndrome -Sepsis, arrhythmias (suggesting invasion into underlying myocardium and conduction system), and systemic embolization associated with poor prognosis -If not treated, acute IE generally fatal -Treatment: long-term (6 weeks or more) antibiotic therapy and/or valve replacement; reduces mortality -For infections involving low-virulence organisms (e.g., S. viridans ), cure rate is 98%

Answer 4

-AKA marantic endocarditis -Deposition of small (1 to 5 mm) sterile thrombi on leaflets of cardiac valves; micro shows bland thrombi, loosely attached to underlying valve; vegetations are nondestructive, do not elicit any inflammatory reaction -Often in debilitated patients with cancer or sepsis -Usually occurs on previously normal valves -Hypercoagulable states predisposition: -chronic DIC -increased estrogen -underlying malignancy (esp. mucinous adenocarcinomas secondary to procoagulant effects of tumor-derived mucin factor- can cause migratory thrombophlebitis aka Trousseau syndrome) -indwelling catheters

Answer 5

-INFECTIVE >5mm -NON-Infective <5mm -dont need to memorize^ -Vegetations: -1) rheumatoid = small, at chordae tendinae junction -2) infectious = big (>5 mm) -3) NBTE = non-bacterial thrombotic endocarditis (<5 mm) -4) lupus (Libman-Saks) = BOTH sides

Answer 6

-DILATED (DCM) -Systolic dysfunction -HYPERTROPHIC (HCM) -Diastolic dysfunction -RESTRICTIVE (RCM) -Diastolic dysfunction

Answer 7

-Adults -Progressively declining LVEF -LVEF ~ prognosis -3 Main causes -Myocarditis -Alcohol -Adriamycin- chemo agent -cocksackies - viral ;. -Heart changes: -4 chamber dilatation -irregular hypertrophy -Interstitial Fibrosis

Answer 8

-Also called IHSS, (Idiopathic Hypertrophic Subaortic Stenosis) -GENETIC defects involving: -Beta-myosin heavy chain!!!!! -Troponin T -Alpha-tropomyosin -Myosin binding protein C -PATHOLOGY: Massive hypertrophy, Asymmetric septum, DISARRAY of myocytes, INTERSTITIAL fibrosis -CLINICAL: ↓chamber volume, ↓SV, ↓ diastolic filling -Sudden death in young athletes can occur -Disproportionate ventricular septal hypertrophy involving basal and midventricular regions

Answer 9

-↓ ventricular compliance -May be caused by amyloid, radiation fibrosis, sarcoidosis, etc. -Chiefly affects DIASTOLE -NORMAL chamber size and wall thickness -THREE similar diseases affecting predominantly the SUBENDOCARDIAL area: -Endomyocardial Fibrosis (African children) -Loeffler Endomyocarditis (eosinophilic leukemia) -Endocardial Fibroelastosis (infants)

Answer 10

-INFLAMMATION of MYOCARDIUM -Mainly microbial -COXACKIE A & B, CMV, HIV -Trypanosoma cruzi (Chagas dis.), 80% -Trichinosis -Toxoplasmosis -Lyme disease (5%) -Diphtheria -IMMUNE: Post-viral, rheumatic, SLE, drug hypersensitivity->alpha-methyl dopa, sulfas

Answer 11

-MC cause in US: viral infections ; Coxsackie viruses A and B and other enteroviruses account for most cases -Less common causes: cytomegalovirus, HIV, and influenza -Depending on pathogen and host, viruses potentially cause myocardial injury either as a direct cytopathic effect, or by eliciting a destructive immune response -Myocardial injury produces inflammatory cytokines which can also cause myocardial dysfunction out of proportion to degree of actual myocyte damage

Answer 12

-Protozoan Trypanosoma cruzi (Chagas disease - endemic in some regions of South America -Trichinosis (Trichinella spiralis): most common helminthic disease associated with myocarditis -Parasitic diseases, including toxoplasmosis -Lyme disease caused by spirochete Borrelia burgdorferi (5% of patients affected): self-limited conduction system disorder -In diphtheritic myocarditis, myocardial injury results from diphtheria toxin release by Corynebacterium -AIDS-associated myocarditis may reflect inflammation and myocyte damage without clear etiologic agent, or myocarditis attributable directly to HIV or an opportunistic pathogen -Noninfectious causes of myocarditis: immunologically mediated (hypersensitivity myocarditis) or idiopathic conditions with distinctive morphology (giant cell myocarditis) probably of immunologic origin -Some chemotherapy may occasionally lead to fatal lymphocytic myocarditis

Answer 13

-Normally 30-50 ml clear serous fluid -Visceral (epicardium) -Parietal (Fibrous pericardium) -PERICARDIAL EFFUSIONS TAMPONADE -Ruptured MI -Traumatic perforation -Infective endocarditis -Ruptured aortic dissection

Answer 14

-SEROUS: Rheum. Fever (RF), SLE, scleroderma, tumors, uremia -FIBRINOUS: MI (Dressler), uremia, radiation, RF, SLE, s/p open heart surgery -PURULENT: infective, bacterial -HEMORRHAGIC: Malignancy, TB -CASEOUS: TB -CHRONIC: (ADHESIVE, CONSTRICTIVE) -The “bread and butter” pericarditis is classically and most often described in uremia or pericardial infections. What is the exudate? Ans: Fibrin “Bread and butter” pericarditis = fibrinous pericarditis.

Answer 15

-Primary cardiac tumors uncommon, most benign -Five most common: no malignant potential, account for almost 90% of all primary heart tumors: myxomas, fibromas, lipomas, papillary fibroelastomas, and rhabdomyomas. -Myxomas: most common primary tumor of the adult heart (benign) -About 90% in the atria, left/right ratio 4:1 -Major clinical manifestations due to valvular “ball-valve” obstruction, embolization, or syndrome of constitutional symptoms, such as fever and malaise (tumor may produce cytokine IL-6) -Surgical removal usually curative -Rhabdomyomas: most frequent primary tumor of the pediatric heart (benign) -50% of cases associated with tuberous sclerosis, with mutations in the tuberous sclerosis complex TSC1 or TSC2 tumor suppressor genes -Primary malignant cardiac tumors: very rare, usually an angiosarcoma

Answer 16

-Occur in approximately 5% of patients dying of cancer -Most frequent are lung and breast carcinomas, melanomas, leukemias, and lymphomas -Clinical symptoms: symptomatic pericardial effusions or a mass-effect restricting cardiac filling -Lung carcinoma or malignant lymphoma can infiltrate mediastinum, causing encasement, compression, or invasion of the superior vena cava with resultant obstruction to blood coming from head and upper extremities (superior vena cava syndrome) -Renal cell carcinoma often invades the renal vein; can grow as a continuous column of tumor up the inferior vena cava lumen and into the right atrium, blocking venous return to the heart