Heart II

Question 1

Left vs. Right Hypertensive Disease Morphology

Answer 1

Left Sided shows concentrically thickened LV hypertrophy

Right Sided shows RV dilation with no hypertrophy

Question 2

Arrhythmia

General and Specific (4) Causes

Answer 2

Caused by ischemia leading to:

Sick Sinus Syndrome: SA node damage (bradycardia)
Atrial Fibrillation: Irregularly irregular beats
Heart Block: dysfunctional AV node
Channelopathies: Long QT Syndrome (K+ and Na+)

Question 3

Heart Block Types with Descriptions (3)

Answer 3

1st Degree: Prolonged PR interval
2nd Degree: intermittent transmission
3rd Degree: complete failure

Question 4

Sudden Cardiac Death

General and Specific Causes (5)

Answer 4

Fatal arrhythmia from ischemia-induced myocardial irritability

Mainly 75%+ stenosis of Coronary As.
Also: Cardiomyopathies, Myocarditis, Conduction Defects, Hypertrophy

Question 5

Calcific Aortic Stenosis
Risk Factors (5), Location and Complications (4)

Answer 5

Age (60-80), Chronic HTN, Hyperlipidemia, Inflammation
Congenital bicuspid aortic valve

Calcifications on cusps

Angina
LVH
CHF
Syncope

Question 6

Mitral Annular Calcification
Risk Factors (3), Location and Complications (5)

Answer 6

Female over 60 years old
Mitral valve prolapse

Calcifications on fibrous annulus

Regurgitation
Stenosis
Arrhythmias
Thrombus
Infectious Endocarditis

Question 7

Mitral Valve Prolapse

Pathogenesis (3), Morphology, Complications (4)

Answer 7

Marfan Syndrome fibrillin defect makes floppy valve
Proteoglycan deposition (myxomatous degeneration)
and elastin disruption thicken leaflets

Interchordal ballooning of mitral leaflets

Mostly asymptomatic but can lead to:
Endocarditis, Thrombus, Insufficiency, Arrhythmias

Question 8

Rheumatic Fever

Pathogenesis, Morphology (4) and Complications (5)

Answer 8

Immune cross reaction between Strep A M proteins and cardiac self-Ags

Aschoff Bodies (T cells)
Anitschkow cells (macrophages)
Fibrinoid Necrosis
Verrucae

Pancarditis
Migratory Polyarthritis
Subcutaneous Nodules
Erythema Nodosa
Sydenham Chorea

Question 9

Rheumatic Heart Disease

Pathogenesis, Morphology and Complications (5)

Answer 9

Chronic rheumatic fever

Mitral valve stenosis

LA Dilation
Thromboembolism
Atrial Fibrillation
RV Hypertrophy
Infective Endocarditis

Question 10

Infective Endocarditis

Types (2) with Descriptions and Treatments

Answer 10

Acute: Rapid destruction of previously normal valve
Treat with surgery and antibiotics

Subacute: Slow infection of previously deformed valve
Treat with antibiotics

Question 11

Infective Endocarditis Morphology (5)

Answer 11

Friable, bulky valves
Destructive valvular vegetations
Septic emboli
Right side infected in IVDU’s

Question 12

Infective Endocarditis Presentation (5)

Answer 12

Murmurs present if lesion on Left Side

Subungual/Splinter hemorrhages
Janeway lesions
Roth spots
Osler nodes

Question 13

Non-Bacterial Thrombotic Endocarditis

Description, Association and Complication

Answer 13

Sterile thrombi along line of valve closure

Associated with mucin producing adenocarcinomas

Emboli

Question 14

Libman-Sacks Endocarditis (SLE)

Description

Answer 14

Mitral and Aortic valvulitis with eosinophilic granular vegetations

Question 15

Carcinoid Heart Syndrome

Presentation (5) and Complication

Answer 15

Flushing
Diarrhea
Dermatitis
Bronchoconstriction
High serotonin levels

Right sided carcinoid heart disease (left protected)

Question 16

Prosthetic Valve Complications (3)

Answer 16

Thomboembolism
Infective Endocarditis
Anticoagulant Hemorrhage

Question 17

Dilated Cardiomyopathy
Risk Factors (4), Morphology (3) and Complications (3)

Answer 17

Genetics
Alcohol abuse
Myocarditis
Hemochromatosis

Dilation
Myocyte Hypertrophy
Interstitial fibrosis

CHF
Mural Thrombi -> embolism
Arrhythmias

Question 18

Hypertrophic Cardiomyopathy

Morphology (3) and Complications (5)

Answer 18

Beta myosin heavy chain mutations
Septal Hypertrophy
Myocyte Disarray

Harsh systolic murmur
Ischemia
LA dilation
Mural Thrombi
Arrhythmias

Question 19

Takotsubo Cardiomyopathy

Cause and Morphology

Answer 19

Extreme stress causing massive catecholamine release in mostly women

Apical LV ballooning

Question 20

Arrhythmogenic R. Ventricular Cardiomyopathy (ARVC)

Morphology and Presentation (2)

Answer 20

Myocytes replaced with adipose and fibrosis

Ventricular Tachycardia or Fibrillation
Naxos Syndrome: hyperkeratosis of plakoglobin on palms and soles

Question 21

Restrictive Cardiomyopathy

Causes (2) and Diagnosis

Answer 21

Caused by amyloidosis or radiation exposure (fibrosis)

Apple green birefringence on congo red stain

Question 22

Myocarditis Causes

Infectious (3) and Non-Infectious (3)

Answer 22

Coxsackie A and B
Chagas Disease (Trypanosoma cruzi)

Rheumatic Fever
SLE
Drug Hypersensitivity

Question 23

Pericardial Effusions

Causes (2) Types (2) and Presentation (2)

Answer 23

Postinfarction, Uremia

Fibrinous
Serofibrinous (hemopericardium)

Hear loud pericardial friction rub
Rapid accumulation caused cardiac tamponade

Question 24

Pericarditis

Types (5) and Morphology

Answer 24

Serous
Purulent
Hemorrhagic
Caseous
Constrictive

Shaggy fibrinous exudate

Question 25

Cardiac Tumors

Types (5) with Complications and Morphology

Answer 25

Myxoma: ball-valve obstruction, hear tumor plop
Globular hard mass, mottled, translucent, papillary/villous with gelatinous appearance

Lipoma: localized and well circumscribed

Papillary Fibroelastoma: Lambl excrescences

Rhabdomyoma: frequent in pediatrics

Angiosarcoma: malignant, affects older adults

Question 26

Cardiac Transplant Complications (3)

Answer 26

Main complication is allograft rejection

Allograft Arteriopathy: stenosing intimal proliferation
Happens to all transplants by 10 years

EBV associated B cell lymphoma (immunosuppression)