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Hannah CPR > HTN, cardiac valve DZ, cardiomyopathy, tumors, transplantation > Flashcards

HTN, cardiac valve DZ, cardiomyopathy, tumors, transplantation Flashcards

1
Q

define functional regurgitation

A

-a secondary valve defect, not a primary valve defect, —-describes valvular incompetence stemming from abnormality in one of its support structures

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2
Q

when is a mid systolic click heard

A

MVP

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3
Q

most common cause of myocarditis ? other infectious causes ?

A 
MC= Coxsackie A and B viruses 
other = Chagas dz (trypanosoma cruzi) which causes parasitization (of amastigotes) of scattered myofibers and mixed inflammatory cell infiltrate (particularly of eosinophils) and positive giemsa-stain
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4
Q

noninfectious causes of myocarditis

A

immune mediated rxns including RF, SLE, drug hyperactivity

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5
Q

define hypertensive heart dz

A

cardiac pressure overload and ventricular hypertrophy as a consequence of increased demands on the heart due to HTN
*most commonly seen in left as a result of systemic HTN, but can be in right from pulmonary HTN

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6
Q

most common cause of arrthymias

A

ischemic injury to heart

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7
Q

define Aschoff bodies and Anitschkow cells and when are they seen

A
  • seen in morphological changes of acute rheumatic fever (before chronic RHD)
  • aschoff bodies= cardiac lesions comprised of tcells, plasma cells, and activated MOs
  • the activated MOs specific to RF are called anithsckow cells (aka “catipilar cells” )
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8
Q

which cardiomyopathy is 100% due to genetic causes in sarcomeric proteins

A

hypertrophic cardiomyopathy

-sometimes involving myofiber disarray from the common mutation in B-MHC( beta myosin heavy chain)

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9
Q

most common primary pediatric cardiac tumor

A

rhabdomyloma

  • 50% sporadic mutation
  • 50% associated with tubureous sclerosis (hamartin or tubers tumor suppressor gene mutation)
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10
Q

which form of endocarditis is associated with mucinous adenocarcinomas (ovary, pancreas, and lungs)

A

nonbacterial thrombotic endocarditis

*also associated with sepsis or cather-induced endocardial trauma

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11
Q

key traits of hypertrophic cardiomyopathy

A
  • genetic causes of sarcomeric mutations
  • leading to decreased stroke volume and often ventricular outflow obstruction
  • massive myocardial hypertrophy and marked asymmetric septal hypertrophy (without dilation)
  • **myocyte dissarray (B-mhc mutation
  • sx: harsh systolic ejection murmur
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12
Q

effusion rrelated pericardial dz

A

-common followingr ruptured MI or aortic dissection
acute symptomatic type is rapid accumulation (200-300ml) of fluid in pericardial sac leading to cardiac tamponade
sx: pain is sharp, pleuritic, and position dependent, fever, loud pericardial friction rub

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13
Q

most common cause of hemorrhagic pericarditis

A

malignant neoplasms spread into pericardial space

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14
Q

define sick sinus syndrome

A

when there is SA nodal damage leading to bradycardia (type of arrhythmia)

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15
Q

most common cause of mitral regurgitation

A

MVP ( seen with myomatous degeneration -spongiosa layer thickening with mucoid deposits and disruption of collagenous fibrous layer making the structural integrity compromised)

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16
Q

_____ is a valve defect particularly common and clinically significant in ischemic heart disease and dilated cardiomyopathy

A

functional mitral valve regurgitation (incompetence)

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17
Q

T/F

kyphoscoliosis can cause Cor pulmonale

A

true ; impairs chest motion and increases pressure in RV or lungs

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18
Q

most hereditary condition of arrthymias are autosomal recessive or dominant

A

dominant *unusal

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19
Q

rheumatic fever vs rheumatic Heart DZ

A 
fever= multisystem inflammatory DO after pharyngeal group A strep infection 
DZ= when immune response to strep M proteins cross react with cardiac self-ags
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20
Q

most common type of valve dz and its causes

A

calcific aortic stenosis
(can be congenitally related due to bicuspid valve, or from recurrent chronic injury second to hyperlipidemia, HTN, inflammation ; osteoblast -like cells deposit osteoid-like substance that ossifies in valve)
**mounded calcified masses within the aortic cusp

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21
Q

acute vs subacute infective endocarditis

A

acute- rapid progressing infection with destruction of previously normal valve; needs surgery and Abx; onset is seen with fever chills weakness

subacute- slower progression of infection of previously deformed valves (like in RHD); can be fixed usually with Abx alone ; less dangerous and have vague flu-like sx

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22
Q

Jones criteria from RHD

A 
joints (migratory polyathralgia) 
pancarditis 
sub q nodules 
etheryema marginatum 
syndeham chorea (rapid movements)
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23
Q

valve stenosis vs insufficiency

A

stenosis causes incomplete valve opening and impedes forward flow
insufficiency causes incomplete valve closure and allows reversed flow or “regurg”
*chronic insufficiency can cause volume overload–>hypertrophy–> CHF

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24
Q

dilation of the ascending aorta often second to HTN and/or again causes

A

aortic insufficiency (regurg)

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25
Q

sx of calcific aortic stenosis

A

angina, CHF, syncope

due to LVH

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26
Q

define cardiomyopathy

A

heart muscle disease with mechanical or electrical dysfunction, usually seen with ventricular hypertrophy or dilation

  • most common cause is genetic (primary) vs secondary component of multiorgan disorder
  • most common type is dilated cardiomyopathy
  • most often lead to sudden cardiovascular death , a-fib, stroke, or progressive heart failure
27
Q

dilated vs hypertrophic vs restrictive cardiomyopathy mechanism of heart failure

A

dilated- systolic dysfunction (contractility impaired)

hypertrophic and restrictive diastolic dysfunction (impaired compliance)

28
Q

degenerative calcific deposits in the fibrous annulus of the mitral valve is called

A

mitral annular calcification

  • does not NL affect valve fxn but can lead to regurgitation, stenosis, or arrhythmia (and SCD)
  • nodules are site for thrombus formation and increase risk of embolic stroke
  • can become a site for infective endocarditis
  • more common in women and MVP pts
29
Q

group A strep most common cause of what two vascular conditions

A

lymphangitis and rheumatic heart dz

30
Q

bicuspid aortic valves are prone to __-

A

calcification –> aortic calcific stenosis

31
Q

sympiltic aortitis can lead to what valve dz

A

aortic regurgitation

32
Q

what are the most common types of pericarditis

A

most common types are fibrinous and serofibrinous

sx: pain is sharp, pleuritic, and position dependent, fever, loud pericardial friction rub
* both seen with fibrin deposits
* common causes are post MI (dresseler syndrome); uremia ; radiation, RF; SLE and trauma

33
Q

deposits of amyloid in the heart (transthyretin) must be in the ____ to be considered restrictive cardiomyopathy

A

intersitium of the myocardium

-causes NL ventricular size but possible double atrial dilation

34
Q

define sudden cardiac death

A

unexpected death from cardiac cause either without sx or within 1-24hrs of sx onset

35
Q

most common causes of cardiac transplantation

A

DCM, or IHD

36
Q

a-fib vs heart block

A

a-fib has variable AV node transmission due to atrial myocytes that depolarize independently and sporadically due to atrial irritability

if AV node is dysfunctional then varying degrees of heart block occur

37
Q

hemochromatosis causes what type of cardiomyopathy ? amyloidosis? sarcoidosis?

A 
hema= dilated 
amyloid= restrict 
sarc= dilated
38
Q

key traits of right-sided (pulmonary) hypertensive heart DZ

A
  • “Cor pulmonale”
  • caused by pulmonary HTN; but most commonly second to left-sided heart dz
  • acute cor pulmonate usually from large PE which is seen with RV dilation and no hypertrophy
  • chronic cor pulmonale = RV hypertrophy, RV dilation, possible Right-Sided CHF. usually caused by lung disorder in isolated type (i.e. COPD, CF)
  • possible cause due to DO affecting chest movement (i.e. kyphoscoliosis, obesity)
39
Q

only cause of mitral valve stenosis

A

postinflammatory scarring caused by rheumatic heart disease ( usually second to Group A strep)

40
Q

types of heart block

A

*due to AV node dysfunction
first degree- prolonged PR interval
second degree- intermittent transmission
third degree- complete failure

41
Q

define takotsubo cardiomyopathy

A

“broken heart syndrome”
a type of dilated cardiomyopathy seen as a result of myocardial vasospasm brought on by excess catecholamines released during emotional or physiological stress
-common in women (58-75yo)
-sx similar to acute MI
-see apical ballooning of the left ventricle
-consequence can be sudden cardiac death

42
Q

key traits of left-sided (systemic) hypertensive heart DZ

A
  • LVH concentrically
  • diastolic dysfunction and left atrial enlargement
  • a-fib
  • can lead to CHF (left-sided heart failure)
  • risk factor for SCD
43
Q

Carcinoid Heart DZ vs carcinoid syndrome

A

carcinoid syndrome is a paraneoplastic syndrome secondary to carcinoid tumors. the increased releasee and circulation of bioactive compounds such as serotonin causes flushing, diarrhea, dermatitis, and bronchocontriction

  • carcinoid heart DZ is the clinical cardiac manifestation of cardiac lesions those with the systemic syndrome. usually seen after massive hepatic lesion formation. usually affects right endocardium and valves (left is protected from pulmonary circulation)
  • intimal thickening (glistening and plaque-like ) on valves and inside chambers
  • usually seen tricuspid regurg or pulmonary stenosis
44
Q

valve DZ associated with MArfans syndrome

A

aortic regurgitation or MVP with mitral regurg

45
Q

most common primary cardiac tumor

A

myxoma; benign

  • globular hard mass, mottled with hemorrhages; or soft, translucent, papillary or villous with gelatinous appearance
  • sx: ball-valve obstruction
  • pedunculated (moving) form causes intermittent occlusions during AV valve systole ; or a wrecking ball damage to valve leaflets
  • high IL-6 possible
  • auscltate tumor = “plop”
46
Q

fibrinous vs serofibrinous pericardial dz

A

F = dry, fine, granular
SF- yellow-brown turbid (chunky) fluid with WBC, RBC< and fibrin
*both seen with fibrin deposits
*common causes are post MI (dresseler syndrome); uremia ; radiation, RF; SLE and trauma
*fibrinous = pleural friction rub sound, but serous form can prevent rubbing

47
Q

define Naxos syndrome

A

this is ARVC and hyperkeratosis of palms and soles

-seen with genetic mutation of the plakoglobin (desmosome associated protein )

48
Q

v-fib vs a-fib

A

v-fib = chaotic depolarization of nodes without functional ventricular contract therefore no pumping of blood makes this a medical emergency ;arises from ventricles

a-fib = chaotic myocyte depolarization deriving from atria leading to variable AV node transmission and irregular rate and rhythm but not immediate emergency (irregular irregular HR)

49
Q

what is the leading cause of sudden cardiac death

A

CAD

  • usually seen with >75% stenosis of 1 arm ore of 3 main coronary arteries
  • mechanism behind it is usually fatal arrhythmia brought on by ischemia-induced myocardial irritability
  • *therefore most common cause of SCD is IHD due to fatal arrhythmia deriving from CAD
50
Q

what is dressler syndrome

A

secondary pericarditis due to post myocardial infarction

-autommmune response occurring days to weeks after an MI and causes serofibrinous pericarditis

51
Q

when is interchordal ballooning (hooding) of mitral leaflets seen most often

A

MVP

52
Q

define dilated cardiomyopathy (DCM) and its morphology, pathogenesis , and classic presentation

A

-progressive cardiac dilation and systolic dysfunction (contractility dysfunction) usually with dilated hypertrophy
-morphology: dilation of all chambers, mural thrombi are common, functional regurg of valves
pathogenesis: *genetic cause = TTN mutation (AD); *linked to alcohol ; *can be bc of myocarditis or
cardiotoxic substances (doxorubicin, cobalt, iron toxicity)
-presentation = ages 20-50yo, progressive CHF with dyspnea, PA fatigue, and low EF; arrhythmias, and embolisms

53
Q

classic features of infective endocarditis

A

friable, bulky, destructive valvular vegetations

  • usually of left-sided valves; but right-side common in IV drug abusers
  • risk of septic emboli (or PE if on right)
  • murmurs with left sided lesions
  • most commonly caused by staph
  • Janeway lesions (on palms and soles)
  • Osler nodes( sub q nodules pulp of digits)
  • Roth spots (retinal hemorrhages)
54
Q

changes of mitral valve seen in chronic RHD

A

mitral leaflet thickening, commissure fusion, shortening/thickening/ fusion of cords
all leads to mitral stenosis
MS–>LA enlarged–>a-fib or pulm congestion–>RVH

*fish mouth mitral stenosis, neovascularization

55
Q

what is allograft arteriopathy

A

long term limitation of cardiac transplants,

  • causes late, progressive stenosing intimal proliferation
  • can cause a silent MI due to denervated transplant (i.e. no angina)
56
Q

relationship between staph infection and infective endocarditis. what is the other group that can cause IE by infection

A

S. viridian’s = previously damaged or abnormal valves
S. epidermidis = prosthetic valves
S. aureus = normal or abnormal valves, IV drug users

HACEK bacteria found in oral cavity
(haemophilus, actinobaciilus, cardiobacterium, eikenella, kingella)

57
Q

describe the different types of vegetative endocarditis

A
  • RHD associated- verrucae on line of closure in a thing row
  • IE associated- vegetations are large irregular clumps
  • nonbacterial endocarditis - vegetations are small sterile clumps along line of closure,
  • Leidman Sac endocaridits- on both sides
58
Q

define arrythmogenic right ventricular cardiomyopathy (ARVC)

A
  • right ventricular arrhythmias and failure; myocardium of RV REPLACED with adipose and fibrosis
  • leads to V-tach and V-fib —> sudden cardiac death
  • genetic AD DO with defective cardiac desmosomes (cell adhesion protein)
59
Q

what cardiomyopathy is seen with positive congo red stain for apple green biferengence

A

-highlights amyloid there is restrictive cardiomyopathy

60
Q

define channelopathies in the context of primary causes of arrthymia

A

mutations in genes that are required for normal ion channel function

  • NL ion channels are need for cardiac electrical transmission therefore these can lead to arrhythmias (usually AD) ; most common is long QT interval
  • can be associated with skeletal muscle DO or diabetes, but most commonly is an isolated DO of the heart
  • can lead to sudden cardiac death
61
Q

pre -existing sx associated with calcific aortic stenosis

A

bicuspid aorta
older age
hyperlipidema
chronic HTN

62
Q

which cardio path is associated with syncope

A

calcific aortic stenosis

63
Q

mechanical vs biosynthetic prosthetic valves risks

A

mechanical - thrombotic and hemorrhagic (use anti coals) and dehiscence (fall out)
biosynthenic - calcification, degeneration by wear and tear

Hannah CPR (7 decks)

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