HTN, cardiac valve DZ, cardiomyopathy, tumors, transplantation Flashcards
define functional regurgitation
-a secondary valve defect, not a primary valve defect, —-describes valvular incompetence stemming from abnormality in one of its support structures
when is a mid systolic click heard
MVP
most common cause of myocarditis ? other infectious causes ?
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
noninfectious causes of myocarditis
immune mediated rxns including RF, SLE, drug hyperactivity
define hypertensive heart dz
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
most common cause of arrthymias
ischemic injury to heart
define Aschoff bodies and Anitschkow cells and when are they seen
- 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” )
which cardiomyopathy is 100% due to genetic causes in sarcomeric proteins
hypertrophic cardiomyopathy
-sometimes involving myofiber disarray from the common mutation in B-MHC( beta myosin heavy chain)
most common primary pediatric cardiac tumor
rhabdomyloma
- 50% sporadic mutation
- 50% associated with tubureous sclerosis (hamartin or tubers tumor suppressor gene mutation)
which form of endocarditis is associated with mucinous adenocarcinomas (ovary, pancreas, and lungs)
nonbacterial thrombotic endocarditis
*also associated with sepsis or cather-induced endocardial trauma
key traits of hypertrophic cardiomyopathy
- 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
effusion rrelated pericardial dz
-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
most common cause of hemorrhagic pericarditis
malignant neoplasms spread into pericardial space
define sick sinus syndrome
when there is SA nodal damage leading to bradycardia (type of arrhythmia)
most common cause of mitral regurgitation
MVP ( seen with myomatous degeneration -spongiosa layer thickening with mucoid deposits and disruption of collagenous fibrous layer making the structural integrity compromised)
_____ is a valve defect particularly common and clinically significant in ischemic heart disease and dilated cardiomyopathy
functional mitral valve regurgitation (incompetence)
T/F
kyphoscoliosis can cause Cor pulmonale
true ; impairs chest motion and increases pressure in RV or lungs
most hereditary condition of arrthymias are autosomal recessive or dominant
dominant *unusal
rheumatic fever vs rheumatic Heart DZ
fever= multisystem inflammatory DO after pharyngeal group A strep infection DZ= when immune response to strep M proteins cross react with cardiac self-ags
most common type of valve dz and its causes
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
acute vs subacute infective endocarditis
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
Jones criteria from RHD
joints (migratory polyathralgia) pancarditis sub q nodules etheryema marginatum syndeham chorea (rapid movements)
valve stenosis vs insufficiency
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
dilation of the ascending aorta often second to HTN and/or again causes
aortic insufficiency (regurg)
sx of calcific aortic stenosis
angina, CHF, syncope
due to LVH
define cardiomyopathy
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
dilated vs hypertrophic vs restrictive cardiomyopathy mechanism of heart failure
dilated- systolic dysfunction (contractility impaired)
hypertrophic and restrictive diastolic dysfunction (impaired compliance)
degenerative calcific deposits in the fibrous annulus of the mitral valve is called
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
group A strep most common cause of what two vascular conditions
lymphangitis and rheumatic heart dz
bicuspid aortic valves are prone to __-
calcification –> aortic calcific stenosis
sympiltic aortitis can lead to what valve dz
aortic regurgitation
what are the most common types of pericarditis
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
deposits of amyloid in the heart (transthyretin) must be in the ____ to be considered restrictive cardiomyopathy
intersitium of the myocardium
-causes NL ventricular size but possible double atrial dilation
define sudden cardiac death
unexpected death from cardiac cause either without sx or within 1-24hrs of sx onset
most common causes of cardiac transplantation
DCM, or IHD
a-fib vs heart block
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
hemochromatosis causes what type of cardiomyopathy ? amyloidosis? sarcoidosis?
hema= dilated amyloid= restrict sarc= dilated
key traits of right-sided (pulmonary) hypertensive heart DZ
- “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)
only cause of mitral valve stenosis
postinflammatory scarring caused by rheumatic heart disease ( usually second to Group A strep)
types of heart block
*due to AV node dysfunction
first degree- prolonged PR interval
second degree- intermittent transmission
third degree- complete failure
define takotsubo cardiomyopathy
“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
key traits of left-sided (systemic) hypertensive heart DZ
- LVH concentrically
- diastolic dysfunction and left atrial enlargement
- a-fib
- can lead to CHF (left-sided heart failure)
- risk factor for SCD
Carcinoid Heart DZ vs carcinoid syndrome
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
valve DZ associated with MArfans syndrome
aortic regurgitation or MVP with mitral regurg
most common primary cardiac tumor
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”
fibrinous vs serofibrinous pericardial dz
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
define Naxos syndrome
this is ARVC and hyperkeratosis of palms and soles
-seen with genetic mutation of the plakoglobin (desmosome associated protein )
v-fib vs a-fib
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)
what is the leading cause of sudden cardiac death
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
what is dressler syndrome
secondary pericarditis due to post myocardial infarction
-autommmune response occurring days to weeks after an MI and causes serofibrinous pericarditis
when is interchordal ballooning (hooding) of mitral leaflets seen most often
MVP
define dilated cardiomyopathy (DCM) and its morphology, pathogenesis , and classic presentation
-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
classic features of infective endocarditis
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)
changes of mitral valve seen in chronic RHD
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
what is allograft arteriopathy
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)
relationship between staph infection and infective endocarditis. what is the other group that can cause IE by infection
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)
describe the different types of vegetative endocarditis
- 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
define arrythmogenic right ventricular cardiomyopathy (ARVC)
- 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)
what cardiomyopathy is seen with positive congo red stain for apple green biferengence
-highlights amyloid there is restrictive cardiomyopathy
define channelopathies in the context of primary causes of arrthymia
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
pre -existing sx associated with calcific aortic stenosis
bicuspid aorta
older age
hyperlipidema
chronic HTN
which cardio path is associated with syncope
calcific aortic stenosis
mechanical vs biosynthetic prosthetic valves risks
mechanical - thrombotic and hemorrhagic (use anti coals) and dehiscence (fall out)
biosynthenic - calcification, degeneration by wear and tear
