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pathology > Heart Disorders 2 > Flashcards

Heart Disorders 2 Flashcards

1
Q

Preductal coarctation is associated with what congenital heart defects?

A

VSD & Turner syndrome

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2
Q

Post ductal coarctation of aorta is common in which age group?

A

Children> adults

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3
Q

What is cause of death in preductal coarctation of aorta?

A

CHF

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4
Q

Why are patients suffering from post ductal coarctation at an increased risk to develop aortic dissection & berry aneurysm?

A

Construction distal to ligament in arteriosum-increased blood flow to subclavian artery & upper extremity-dilation of aorta-aortic dissection

Berry aneurysm-increased blood flow to brain

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5
Q

Why is there a difference of >10mm Hg in blood pressure between upper extremity & lower extremity in post ductal coarctation?

A

Constriction distal to ligament in arteriosum-increased blood volume to subclavian artery & upper extremity-decreased blood volume to lower extremity

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6
Q

Why is there leg claudication in post ductal coarctation?

A

Decreased blood volume to lower extremities-under developed musculature as compared to upper extremities

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7
Q

Why is there hypertension in post ductal coarctation?

A

Decreased blood flow to kidneys-activation of renin-angiotensin-aldosterone system-hypertension

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8
Q

How is blood flow maintained via collaterals in post ductal coarctation?

A

Internal mammary & subclavian artery

Superior epigastrium & inferior epigastrium artery

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9
Q

Why is there rib notching in a chest radiograph of a post ductal coarctation of aorta patient?

A

Formation of collaterals-enlarged pulsating internal thoracic artery-wears bone away

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10
Q

Why do pharyngeal strains of group A streptococcus only cause rheumatic fever?

A

Posses M protein-virulence factor in cells wall

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11
Q

When do patients develop first attack of RF?

A

5-15years

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12
Q

Why is RF an example of molecular mimicry?

A

Host develops antibodies against M proteins of group A streptococci-cross react with human tissue (type 2 hypersensitivity reaction)

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13
Q

What is the most common initial clinical finding in rheumatic heart fever?

A

Migratory polyartheritis

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14
Q

Migratory polyartheritis involves what kind of joints?

A

Large joints-knee, ankle, wrist

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15
Q

Types of carditis in RF?

A

Fibrinous pericarditis
Myocarditis-MC death
Endocarditis

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16
Q

What are Aschoff bodies?

A

Lesions in myocardial tissue-central area of fibrinous necrosis surrounded by anitschkow cells(reactive histiocytes)

Seen in RF

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17
Q

Which valves are most commonly involved in RF?

A

MV>AV>TV

MV regurgitation/AV regurgitation
Recurrent infection-stenosis

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18
Q

What are clinical features of RF?

A
  1. Migratory polyartheritis
  2. Carditis
  3. Subcutaneous nodules-extensor surface of forearm, Central fibrinous necrosis
  4. Sydenham’s chorea
  5. Erythema marginatum
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19
Q

Diagnosis of RF?

A

2 major criteria + 1 minor criteria supported by antecedent pharyngeal group A streptococcus infection

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20
Q

Minor criteria for RF?

A
  1. Fever
  2. Previous attack of RF
  3. Arthralgia
  4. Increased acute phase reactants-ESR, C-reactive protein
  5. First degree heart block-??
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21
Q

Major criteria for RF?

A 
Migratory polyartheritis 
Carditis 
SC nodules 
Erythema marginatum 
Sydenham's chorea
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22
Q

Lab tests for RF?

A

ASO titres- >400 Todd units peak: 4-5 week after
Anti-DNAse B titres
Throat cultures

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23
Q

Most common type of coarctation?

A

Infantile (preductal) coarctation

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24
Q

Most common cause of mitral valve stenosis?

A

RF

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25
Q

Why is there dyspnea and rust coloured sputum with hemoptysis in mitral valve stenosis?

A

Mitral valve stenosis-increased work on LA during filling LV in diastole-hyper trophy and dilation of LA-backing of blood in lungs-increased pressure on pulm capillaries cause rupture-RBC enter alveoli & dyspnea due to congestion

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26
Q

Why is there systemic embolisation risk in mitral valve stenosis?

A

Atrial fibrillation is a complication-stasis of blood in LA-embolisation via aorta in systemic circuit

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27
Q

Why is there dysphagia for solids in mitral valve stenosis?

A

Mitral valve stenosis-increased work imposed on LA during filling of LV in diastole-hypertrophy and dilation-compression of esophagus

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28
Q

Why is there pulmonary venous HTN in mitral valve stenosis?

A

Mitral valve stenosis-pulmonary vein HTN-pulmonary artery HTN-RVH

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29
Q

Why is there an opening snap followed by an early-mid diastolic rumble in mitral stenosis?

A

Thickened valves-open with snap

Stenosis-increased blood volume in LA-gushes to LV-rumble mid diastolic (filling of ventricle)

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30
Q

What is the effect on atrial and ventricular volume and pressure in mitral valve stenosis?

A

Atrial volume and pressure elevated

Ventricular volume and pressure decreased

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31
Q

Mitral valve stenosis vs. mitral valve regurgitation occur in which phase of cardiac cycle?

A

Mitral valve stenosis-diastole of ventricle

Mitral valve regurgitation-systole of ventricle

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32
Q

Causes of MV regurgitation?

A
  1. Mitral valve prolapse (MC)
  2. LHF-stretching of valve ring (functional MV regurgitation)
  3. Rupture/dysfunction of posteromedial papillary muscle post MI
  4. Acute RF
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33
Q

Why is there eccentric hypertrophy of LA during mitral valve regurgitation?

A

Volume overload

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34
Q

Why is there pulmonary edema and cardiogenic shock in chronic de compensated phase of mitral regurgitation?

A

Muscle dysfunction-cannot accommodate volume-increases LV and LA pressure-backing up of blood in lungs-pulmonary edema

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35
Q

Why is there inspiratory crackles, cough & dyspnea in mitral valve regurgitation?

A

Increased pressure and volume of LA-backing up of blood in lungs

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36
Q

Mitral valve prolapse is commonly associated with which conditions?

A

Marfans, ehler-danlos, klinefelters

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37
Q

Why does mitral valve prolapse occur?

A

Defective embryogenesis-cells of meaenchymal origin-excess dermatan sulphate in MV leaflet-bulging of anterior & posterior leaflets into LA during systole

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38
Q

Why is there a mid systolic click followed by a mid systolic regurgitation murmur in mitral valve prolapse?

A

Mid systolic click-restraint by chordae tendinae

Mid systolic rumble-mitral regurgitation-gushing of blood from LA to LV

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39
Q

Why does decreased preload cause the murmur of mitral valve prolapse to shift towards s1 & increased preload to s2?

A

Decreased preload-shortens systole

Increased preload-prolongs systole

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40
Q

Manoeuvres/conditions that shift murmur of mitral valve prolapse towards S1?

A

Anxiety-increased hr-decreased filling-decreased VR-preload decreased

Standing-decreased VR

Valsalva manoeuver-holding breath with epiglottis closed-+intrathoracic pressure-decreased VR

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41
Q

Manoeuvres that shift murmur of mitral valve prolapse towards S2?

A

Reclining-increased VR-increased preload

Squatting- increased PVR-decreased emptying-increased preload

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42
Q

Most common cause of TV regurgitation?

A

Functional regurgitation due to stretching of ring in RHF

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43
Q

Most common cause of TV regurgitation in young adults?

A

Congenital heart disease

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44
Q

Most common cause TV regurgitation in IV drug abusers?

A

Infective endocarditis affecting TV

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45
Q

Why is a pulsating liver found in TV regurgitation?

A

TV regurgitation-RA dilatation and hypertrophy-back up of pressure in venous system-increased pressure in sinusoids & portal vein

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46
Q

What are the effects of back up of pressure in the venous system in a case of TV regurgitation?

A
  1. Pulsating liver
  2. Portal hypertension-ascites
  3. Dependent pitting edema
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47
Q

Why is the pansystolic murmur heard in TV regurgitation increased in intensity on holding deep inspiration?

A

Check

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48
Q

When is graham steell murmur heard?

A

Pulmonary HTN-stretching of PV ring-functional regurgitation

49
Q

Most common cause of carcinoid heart disease?

A

Liver metastasis from carcinoid tumour in small intestine to heart

50
Q

Why is the PV stenosis & TV regurgitation in carcinoid heart disease?

A

Carcinoid heart disease-metastasis of carcinoid tumour in SI to liver-serotonin in hepatic vein-IVC-right heart-serotonin cause fibrosis of PV and TV

51
Q

Most common cause of aortic stenosis in patients >60yrs?

A

Calcific stenosis (may involve a congenital bicuspid valve)

52
Q

Most common cause of aortic valve stenosis in adults

A

Congenital heart disease

53
Q

Most common cause for isolated aortic regurgitation?

A

Aortic root dilatation

54
Q

Causes of aortic valve regurgitation?

A
  1. Infective endocarditis
  2. Chronic RF
  3. Aortic dissection
  4. Dilated AV ring
  5. Syphilitic aortitis, aortitis in ankylosing spondylitis & takayasu disease
55
Q

Hyperdynamic signs in chronic AV regurgitation?

A

Bounding pulse- corrigan water hammer pulse
Head nodding with systole-de musset sign
Pulsating nail bed with elevation of nail-quincke pulse

56
Q

Why is Austin Flint murmur heard in AV regurgitation?

A

Regurgitation stream from AV hits anterior leaflet of mitral valve

+-indication for replacement

57
Q

Why is a hyper dynamic circulation present in chronic AV regurgitation?

A

Chronic AV regurgitation-LVEDV increased-LV size increased-DBP decreases-SBP increase-pulse pressure increase

58
Q

Risk factors for infective endocarditis?

A
  1. immunosuppression-HIV,DM
  2. dental infections
  3. IV catheters, IVDA
  4. MVP,AS
  5. prosthetic heart valve
59
Q

Staphylococcus aureus is the most common cause of what types of Infective endocarditis?

A

Acute endocarditis, nosocomial endocarditis, endocarditis in IVDA, endocarditis associated with artificial heart valves (late)

60
Q

Most common cause of subacute endocarditis?

A

Streptococcus viridans

61
Q

Most common cause of endocarditis due to artificial valves (early

A

Staphylococcus epidermidis

62
Q

Most common cause of endocarditis associated with ulcerative lesion in colon?

A

Streptococcus bovis (gallolyticus)

63
Q

Which valves are most commonly affected in IE?

A

Left sided; mitral valve

64
Q

Which valves are most commonly affected in IVDA with IE?

A

Tricuspid & aortic valves

65
Q

Why does IE cause valvular vegetations?

A

Turbulent blood flow-damage to valve-fibrin & platelets adhere to area of damage-trapping of circulating organism-proliferation of pathogens+encasing of pathogens in fibrin-vegetations

66
Q

Why are there regurgitation murmurs in IE?

A

Vegetations on valve leaflets & chordae tendinae destroy valves-incompetent closing during systole

67
Q

Why are there splinter hemorrhages, janeway lesions & oslers nodes in IE?

A

Bacteria in micro abscesses-micro embolisation

68
Q

What are splinter hemorrhages? Where are they seen?

A

Linear haemorrhages in nail bed. Seen in IE

69
Q

What are janeway lesions? Where are they seen?

A

Painless haemorrhages in palms and soles. Seen in IE

70
Q

What are oslers nodes? Where are they seen?

A

Painful hemorrhagic nodules on pads of fingers & toes. Seen in IE

71
Q

Why is there glomerulonephritis in IE?

A

Immune mediated vasculitis that follows microembolisation

72
Q

What are Roth spots? Where are they seen?

A

Irregular red area with white spot due to immune vasculitis seen in IE

73
Q

Lab findings in acute IE vs. subacute IE?

A

Acute IE-neutrophil if leukocytosis

Subacute IE-monocytosis

74
Q

Why is there anaemia in IE?

A

Anaemia of chronic disease

75
Q

How is IE diagnosed?

A

Positive blood cultures-3 sets in 24hrs

Echocardiography-visualise vegetations

76
Q

Ddx of sterile vegetations of valves?

A

Libman sacks endocarditis

Nonbacterial thrombotic endocarditis

77
Q

Why is the MV regurgitation seen in SLE patients

A

Libman sacks endocarditis-sterile vegetations on MV valve

78
Q

Why do mucin producing tumours of colon and pancreas cause non bacterial thrombotic endocarditis?

A

Procoagulant effect of circulating mucin-sterile non destructive vegetations

79
Q

Drugs causing myocarditis?

A

SCD-sulphonamides, doxorubicin, cocaine

80
Q

Toxins causing myocarditis?

A

Diphtheria, toxin from black widow spider & scorpion

81
Q

Bacteria causing myocarditis?

A

Mycoplasma, borrelia burgdoferi, rickettsia rickettsi

82
Q

Parasites causing myocarditis?

A

Toxoplasma gondii, trypanosoma cruzi

83
Q

Viruses causing myocarditis?

A

Adenovirus, coxsackie B virus, HIV

84
Q

Fungi causing myocarditis?

A

Candida, mucor, aspergillus

85
Q

Causes of myocarditis?

A
  1. Infections
  2. Drugs
  3. Toxins
  4. Systemic collagen diseases
  5. Acute RF
  6. Sarcoidosis
86
Q

What findings are highly predictive of viral etiology in myocarditis?

A

Focal area of necrosis with lymphocytic infiltrate

87
Q

Why is there dyspnea in myocarditis?

A

Myocarditis-global enlargement of heart-dilatation of chambers-volume overload-backing up of blood in pulmonary vessels-edema-dyspnea

88
Q

Clinical features of myocarditis?

A

Arrhythmias, biventricular heart failure, chest pain, fever, pericardial friction rub (associated pericarditis), Murmurs due to MV regurgitation

89
Q

Why is MV regurgitation seen in patients with myocarditis?

A

Dilatation of all chambers of heart-volume overload-stretching of mitral valve ring-MV regurgitation

90
Q

Diagnosis of Myocarditis?

A

CK-MB
Troponin I & T
ECG, cardiac catheterisation, electrocardiogram

91
Q

Most common cause of pericarditis?

A

Idiopathic

92
Q

How can pericardial friction rub be differentiated from pleural friction rub?

A

Pericardial friction rub does not disappear on holding breath

93
Q

Why is kussmaul sign seen in pericardial effusion?

A

Kussmaul sign-on inspiration, neck vein distension.

On inspiration-VR increases-pericardial effusion decreases RA filling-blood reflux into internal jugular vein

94
Q

Why is pulsus paradoxus seen in patients with pericardial effusion?

A

Inspiration-VR increases-IVS pushed to left-decreaases LV volume-stroke volume decreases-systolic pressure decreased >10mm Hg

95
Q

Characteristic finding in chest radiograph of patient with pleural effusion?

A

Water bottle configuration with I distinct borders of heart

96
Q

Most common cause of constructive pericarditis?

A

TB

97
Q

Most common cause of pericarditis in the U.S.?

A

Idiopathic/surgery

98
Q

Why is pericardial knock heard in constructive pericarditis?

A

Ventricles hitting thickened pericardium

99
Q

Characteristic chest radiograph in patient with constructive pericarditis?

A

Dystrophic calcification of parietal pericardium

100
Q

Most common cause of dilated cardiomyopathy?

A

Idiopathic

Previous myocarditis-most common known cause

101
Q

Arrhythmias & biventricular heart failure seen in alcohol abuser. What is the cause?

A

Dilated cardiomyopathy

102
Q

Patients with acromegaly has biventricular heart failure & arrhythmias. What is the cause?

A

Dilated cardiomyopathy

103
Q

Why is screening of first degree relatives imperative in patient suffering from hypertrophic cardiomyopathy?

A

Autosomal dominant disorder-misense mutation, substitution of a single amino acid in contractile protein of cardiac sarcomere-familial form most common

104
Q

Most common cause of sudden death in young athletes?

A

Hypertrophic cardiomyopathy

105
Q

Dilated cardiomyopathy is most common in which age group?

A

Young adults

106
Q

Sporadic form of hypertrophic cardiomyopathy occurs in which age group?

A

Elderly

107
Q

Why do arrhythmias occur in hypertrophic cardiomyopathy?

A

Aberrant myofibrils

108
Q

Why does harsh systolic ejection murmur intensity increase with valsalva manoeuvre & standing up?

A

Obstruction to blood flow in hypertrophic cardiomyopathy is due to drawing of MV against asymmetrically enlarged IVS-decreasing preload-increases obstruction

IVS hypertrophy>ventricular hypertrophy

109
Q

How can sudden cardiac death be prevented in hypertrophic cardiomyopathy?

A

SCD-ventricular fibrillation-prevented by implantable defibrillator

110
Q

Why are digitalis & diuretics (drugs used for heart failure) avoided in hypertrophic cardiomyopathy?

A

Digitalis-increased contractility

Diuretics-decrease preload-increase obstruction

111
Q

Most common cause of restrictive cardiomyopathy?

A

Amyloidosis

112
Q

Most common cause of restrictive cardiomyopathy?

A

Amyloidosis
Fibrosis post open heart surgery
Radiation

113
Q

Most common site of metastasis in heart?

A

Pericardium

114
Q

Primary tumours of heart?

A

Cardiac myxoma

Rhabdomyoma

115
Q

Why does cardiac myxoma simulate MV stenosis?

A

MC site-LA-ball valve effect obstructs MV

116
Q

Why is transesophaheal USG used to diagnose cardiac myxoma?

A

MC site of cardiac myxoma is LA-most posterior lay located chamber-best viewed by this method

117
Q

What is Rhabdomyoma of heart associated with?

A

Tuberous sclerosis

118
Q

Most common primary tumour of heart in children/infants?

A

Rhabdomyoma

pathology (6 decks)

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