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PATHPROS > HEART PATHOLOGY -2 > Flashcards

HEART PATHOLOGY -2 Flashcards

Myocardium, Valvular Heart Disease, Pericardium, Neoplasms

1
Q

List all possible cardiac causes responsible for this finding

Deborah Dalmeida MD

A
  1. The gross image shows a pale infarct in the kidney. The infarct could be caused secondary to an embolus. Cardiac conditions assoc with embolism include:

a. Dilated cardiomyopathy

b. Patent Foramen ovale

c. Artificial valve

d. Infective endocarditis, Non Bacterial Thrombotic endocarditis

e. Mural thrombus following an MI

f. Mitral valve prolapse, mitral annular calcification

g. Myocarditis.

Deborah Dalmeida MD

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2
Q

Using the clues provided, identify the valvular lesion

a sudden rise and then drop in pulse pressure

Head bobbing

murmur perceived best along the left sternal border- best heard with the patient leaning forward, after exhaling

Deborah Dalmeida MD

A

Aortic regurgitation

Deborah Dalmeida MD

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3
Q

List cardiac and vascular conditions assoc with increased risk for Infective endocarditis

Deborah Dalmeida MD

A

Rheumatic heart disease with valvular scarring

mitral valve prolapse

degenerative calcific valvular stenosis

bicuspid aortic valve (whether calcified or not)

artificial (prosthetic) valves

unrepaired and repaired congenital defects.

Deborah Dalmeida MD

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4
Q

1. What is this morphologic lesion called?

foci of T lymphocytes, occasional plasma cells, and plump activated macrophages called Anitschkow cells

2. Which condition is it seen?

Deborah Dalmeida MD

A
  1. Aschoff bodies
  2. Seen in acute rheumatic fever

Deborah Dalmeida MD

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5
Q

1. Identify the lesion

50 year old male, history of dyspnea. History of hospitalization with fever associated joint pain and subcutaneous nodules 20 years ago.

Listen to the heart sound and observe Wigger’s Diagram

2. What is the change seen in the Wigger’s diagram that clinches the diagnosis?

Deborah Dalmeida MD

A
  1. Mitral regurgitation
  2. Abrupt rise in left atrial pressure indicated by the tall v wave.

Deborah Dalmeida MD

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6
Q

List the complications of prosthetic valves

Deborah Dalmeida MD

A

Prosthetic valve endocarditis

Anticoagulant related hemorrhage

Thrombosis/thromboembolism

Deborah Dalmeida MD

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7
Q

50% to 70% of patients with this lesion provide a history of which condition?

Deborah Dalmeida MD

A

acute rheumatic fever

Deborah Dalmeida MD

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8
Q

1. Identify the lesion

70 year old male, history of exertional syncope and angina.

Listen to the heart sound and observe Wigger’s Diagram

2. What is the change seen in the Wigger’s diagram that clinches the diagnosis?

Deborah Dalmeida MD

A
  1. Aortic stenosis
  2. Left ventricular pressure (LVP) > Left atrial pressure (LAP)

Deborah Dalmeida MD

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9
Q

Identify this lesion that develops following papillary muscle rupture after an MI

Deborah Dalmeida MD

A

Mitral regurgitation

Deborah Dalmeida MD

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10
Q

1. What’s the most likely cardiac tumor to be associated with this condition?

5 year old child

Physical examination reveals mutliple hypomelanotic macules

USG abdomen shows multiple renal cysts

2. What is the syndrome/disease described above?

Deborah Dalmeida MD

A
  1. Rhabdomyoma
  2. Tuberous sclerosis

Deborah Dalmeida MD

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11
Q
  1. What’s the etiology?

bronchospasm, flushing, diarrhea

tricuspid regurgitation

2. What are the elevated biomarkers?

Deborah Dalmeida MD

A
  1. Carcinoid heart disease due to a carcinoid tumor
  2. serotonin, metabolite 5-hydroxyindoleacetic acid (5HIAA)

Deborah Dalmeida MD

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12
Q

What pathologic pattern of cardiomyopathy best fits this description?

abnormally stiffened myocardium (because of fibrosis or an infiltrative process) leading to impaired diastolic relaxation, but systolic contractile function is typically normal or near normal

Deborah Dalmeida MD

A

Restrictive cardiomyopathy

Deborah Dalmeida MD

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13
Q

Fever

Pleuritic chest pain localized to the retrosternal area

pericardial friction rub

diffuse ST segment elevation

Deborah Dalmeida MD

A

Acute Pericarditis

Deborah Dalmeida MD

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14
Q

1. Identify the lesion

left ventricular cavity compressed into a “banana-like” configuration

Asymmetric septal hypertrophy

harsh systolic ejection murmur- heard best at the left lower sternal border, intensity increases on Valsalva

2. What is the cause of the dynamic LV outflow tract obstruction in this lesion?

Deborah Dalmeida MD

A
  1. Hypertrophic cardiomyopathy
  2. Asymmetric hypertrophy of the ventricular septum leading to abnormal motion of the anterior mitral valve leaflet

Deborah Dalmeida MD

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15
Q

1. Identify the lesion

52 year old male, history of palpitations and exertional dyspnea. History of hospitalization with fever associated joint pain and subcutaneous nodules 20 years ago.

Listen to the heart sound and observe Wigger’s Diagram

2. What is the change seen in the Wigger’s diagram that clinches the diagnosis?

Deborah Dalmeida MD

A
  1. Mitral Stenosis
  2. Left atrial pressure (LAP) exceeds left ventricular pressure (LVP)

Deborah Dalmeida MD

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16
Q

Using the clues provided, identify the valvular lesion and the most likely cause of this lesion in patients <60 years old

weakened and delayed upstroke of carotid

murmur heard best at the base of the heart but often radiates to the neck and apex

Deborah Dalmeida MD

A

The lesion is aortic stenosis

The cause is a congenital bicuspid aortic valve which has developed calcific deposits (look at the image carefully)

Deborah Dalmeida MD

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17
Q
  1. most frequent primary tumor of the pediatric heart
  2. Condition assoc with this tumor

Deborah Dalmeida MD

A
  1. Rhabdomyoma
  2. Tuberous sclerosis

Deborah Dalmeida MD

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18
Q

Causes for “culture-negative” endocarditis

Deborah Dalmeida MD

A
  • Coxiella burnetti
  • Bartonella sp
  • HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)

Deborah Dalmeida MD

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19
Q

1. Identify the lesion

30 year old male, history of exertional dyspnea. History of loose joints, stretchy skin, since childhood.

Listen to the heart sound and observe Wigger’s Diagram

2. What is the change seen in the Wigger’s diagram that clinches the diagnosis?

Deborah Dalmeida MD

A
  1. Aortic regurgitation
  2. Wide pulse pressure (Increased systolic aortic pressure and decreased aortic diastolic pressure)

Deborah Dalmeida MD

20
Q

most common primary tumor of the adult heart

Deborah Dalmeida MD

A

Myxoma

Deborah Dalmeida MD

21
Q

What pathologic pattern of cardiomyopathy best fits this description?

ventricular chamber enlargement with impaired systolic contractile function

Deborah Dalmeida MD

A

Dilated cardiomyopathy

Deborah Dalmeida MD

22
Q

1. Using the clues provided, identify the valvular lesion and the most likely cause of this lesion in patients >70 years old

weakened and delayed upstroke of carotid

murmur heard best at the base of the heart but often radiates to the neck and apex

Deborah Dalmeida MD

A

The valvular lesion is aortic stenosis

The cause is degenerative

Deborah Dalmeida MD

23
Q

What pathologic pattern of cardiomyopathy best fits this description?

abnormally thickened ventricular wall with abnormal diastolic relaxation but usually intact systolic function

Deborah Dalmeida MD

A

Hypertrophic cardiomyopathy

Deborah Dalmeida MD

24
Q

List 4 possible causes for the condition seen in this image.

Deborah Dalmeida MD

A
  • Alcohol
  • Beri beri (wet)
  • Coxsackie myocarditis
  • Chronic cocaine use
  • Chagas disease
  • Doxorubicin

Deborah Dalmeida MD

25
Q

jugular venous distention

systemic hypotension

pulsus paradoxus

EKG – Low voltage QRS and electrical alternans

Deborah Dalmeida MD

A

Cardiac tamponade

Deborah Dalmeida MD

26
Q

This lesion is associated with concentric or eccentric hypertrophy?

Deborah Dalmeida MD

A

Aortic regurgitation- assoc with eccentric hypertrophy due to volume overload

Deborah Dalmeida MD

27
Q

What is the mechanism responsible for findings seen in the attached image?

28 year old female presenting with fever, Tender, subcutaneous nodules in the pulp of the digits and hemorrhagic nontender lesions on the palms or soles

Deborah Dalmeida MD

A

The vignette described is of infective endocarditis. The image shows splinter hemorrhages. The mechanism responsible is microthromboemboli.

Deborah Dalmeida MD

28
Q

What is the Microscopic morphology of the tumor described below?

left atrial mass

sessile or pedunculated lesions

position dependent intermittent valvular “ball-valve” obstruction

Deborah Dalmeida MD

A

•Microscopic features:

stellate or globular myxoma cells embedded within an abundant acid mucopolysaccharide ground substance

Peculiar vessel-like or gland-like structures

The diagnosis is atrial myxoma

Deborah Dalmeida MD

29
Q

List 4 causes for restrictive cardiomyopathy

Deborah Dalmeida MD

A

Amyloidosis

hemochromatosis

glycogen storage disorders

endomyocardial fibrosis

Metastatic tumors

radiation

Deborah Dalmeida MD

30
Q

seen in rheumatic mitral stenosis due to calcification and fibrous bridging across the valvular commissures

Deborah Dalmeida MD

A

“fish mouth” or “buttonhole” stenosis

Deborah Dalmeida MD

31
Q

What is the complication of infective endocarditis shown in the image?

Deborah Dalmeida MD

A

Ring abscess

Deborah Dalmeida MD

32
Q

1. Diagnosis?

most common recognized cause of restrictive cardiomyopathy in nontropical countries

Small, semitranslucent nodules resembling drips of wax may be seen on the atrial endocardial surface

•Congo red stain - characteristic apple green birefringence under polarized light

2. What is the composition of this deposit?

Deborah Dalmeida MD

A
  1. Cardiac amyloidosis
  2. Transthyretin

Deborah Dalmeida MD

33
Q
  • single or multiple vegetations
  • along the line of closure of the leaflets or cusps
  • not invasive and do not elicit any inflammatory reaction.

Deborah Dalmeida MD

A

Nonbacterial Thrombotic Endocarditis

Deborah Dalmeida MD

34
Q
  • asymptomatic or fatigue, dyspnea, palpitations, precordial discomfort, and fever.
  • Findings in attached image

Diagnosis?

Deborah Dalmeida MD

A

Lymphocytic myocarditis (think of viral etiology)

Deborah Dalmeida MD

35
Q

1. Identify this valvular lesion

associated with heritable disorders of connective tissue

mid systolic click

associated with heritable disorders of connective tissue – Marfan Syndrome

2. Describe the gross finding seen in this condition

Deborah Dalmeida MD

A
  1. Mitral valve prolapse
  2. interchordal ballooning (hooding) of the mitral leaflets

Deborah Dalmeida MD

36
Q
  1. single most important long-term limitation for cardiac transplantation
  2. Microscopic feature of this lesion

Deborah Dalmeida MD

A
  1. Allograft arteriopathy
  2. diffusely stenosing intimal proliferation

Deborah Dalmeida MD

37
Q

•history of prior radiation to left side of the chest.

fatigue, hypotension, and reflex tachycardia

jugular venous distention, hepatomegaly with ascites, and peripheral edema

Kussumaul sign +

Deborah Dalmeida MD

A

Constrictive pericarditis

Deborah Dalmeida MD

38
Q

What is the composition of the exudate responsible for the gross appearance seen in this image?

Deborah Dalmeida MD

A

Fibrinous pericarditis- exudate contains plasma proteins, including fibrinogen, yielding a grossly rough, granular, dry and shaggy appearance (termed “bread and butter” pericarditis)

Deborah Dalmeida MD

39
Q

The attached image is a cross section of myocardium.

What pattern of cardiomyopathy would one be likely to see in this condition - restrictive/ dilated / hypertrophic cardiomyopathy?

Deborah Dalmeida MD

A

Restrictive cardiomyopathy

Deborah Dalmeida MD

40
Q
  1. What is the gross appearance of the affected valve in Carcinoid heart disease?
  2. Which metabolites will be elevated?

Deborah Dalmeida MD

A
  1. pearly white fibrosis of the tricuspid valve
  2. Serotonin, 5HIAA

Deborah Dalmeida MD

41
Q

Why does the Valsalva maneuver increase the intensity of the murmur of HOCM?

A

Valsalva–>decreased preload to right side of the heart–>decreased LVEDV–>further approximates the interventricular septum to the mitral apparatus –>worsens outflow obstruction at systole –>increased murmur intensity

42
Q

Why does the Valsalva maneuver increase the intensity of the murmur of MVP?

A

Valsalva–>decreased preload to right side of the heart–>decreased LVEDV–>the critical volume at which prolapse begins is reached earlier at systole –>click and murmur occur closer to the first heart sound–>intensity of mumur increases

43
Q

How does sustained handgrip decrease the intensity of the murmur of aortic stenosis?

A

Sustained handgrip–>increased afterload –>decreased forward flow from the heart into the aorta–>decreased murmur intensity.

44
Q

How does squatting increase the intensity of the murmur in mitral regurgitation?

A

Squatting–>rise in afterload–> movement of blood in the left ventricle across the regurgitant mitral valve–> into the left atrium rather than entering the systemic circulation across the aortic valve –> increased intensity of murmur

45
Q

How does squatting decrease the intensity of the murmur of HOCM?

A

Squatting–> Increased preload –>Increased LV volume and stretching of LV walls –> increased distance between mitral valve leaflet and inter-ventricular septum –> decreased LV outflow obstruction –> decreased intensity of HOCM murmur

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