Path III Quiz 2 Flashcards
What is the shape of the heart in dilated cardiomyopathy? What champers are affected?
Enlargement of all 4 chambers
- thin floppy walls don’t contract well
- hypocontract
What is the most common cause of non-ischemic dilated cariomyopathy?
alcoholism
What does the heart look like in hypertrophic cardiomyopathy?
- Left ventricle wall thickens
- septum thickens
- hypercontracts
What is the cause of hypertrophic cardiomyopathy?
Genetic
- mutation of one of several genes that code for proteins within sarcomere
What cariomyopathy is most common in young boys?
hypertrophic
Is hypertrophic caused by HTN?
No
What does heart look like in restrictive cariomyopathy?
Looks normal, but can’t contract properly
What is most common cause of restrictive m?
amyloidosis and hemochromatosis
You see pale, pink, amorphous material between myocardial fibers. What is this indicative of?
Restrictive cardiomyopathy due to amyloidosis
What valves are affected by endocarditis?
Left side valves (M + A)
What is the exception to left heart valves being affected in endocarditis?
IV drug users have right sided valves effected
What is most common bacteria in community acquired IE
Staph aureus (non-MRSA)
What is most common bacteria in nosocomial IE
Staph aureus (MRSA)
What is the second most common bacterial cause of IE in both nosocomial and community aquired?
Alpha hemolytic strep viridans
bacteria causing IE in prosthetic valves?
St epidermitis
bacteria causing subacute IE?
S. Viridans
bacteria causing acute IE?
Staph
What causes vegetations
colonization of microbes
What are risk factors for IE?
- poor dental health
- GU infections
- skin infections
- pulmonary infections
- IV drug use
Risk factors for endocarditis?
- artificial valves
- immunocompromised
- IV drug abusers
- alcoholics
- catheters
- vascular grafts
bacteria causing alcoholics to get IE?
anaerobes and oral cavity bugs
bacteria causing pt with catheter to get IE?
E. Coli.
bacteria causing IV drug users to get IE?
Staph aureus
What causes Libman-Sacks Endocarditis?
SLE (SLE causes LSE)
If you see strep bovis what would you be worried that the pt has?
carcinoma of the colon
The causative organism is not found on blood cultures in what % of cases of pt with IE?
5-20%
What type of endocarditis is caused by SLE and other autoimmune disease. It may also not have any symptoms.
Libman-Sacks Endocarditis
Marantic Endocarditis
Hypercoagulative state
- can be cancerous state
What type of cancers are common with mar antic endocarditis?
Lung or pancreatic
What is another term for an underlying hypercoagulative state in Marantic endocarditis?
Trousseau’s syndrome
What is number one cause of myocarditis?
Coxsackie virus
If viral cause, what do you see in the tissue of myocarditis?
lymphocytes
What are the 3 most common types of valvular disorder in order?
- aortic stenosis
- MVP
- Mitral Regurgitation
Which side is more likely to stenos?
Left
What is one pan systolic pan diastolic murmur?
patent ductus arteriosus
Who is more at risk for MVP
Young women 20-40
What is a risk factors for aortic stenosis?
- bicuspid valve
- calcification from age
What is happening to valves in MVP?
One or both leaflets are floppy and prolapse back into left atrium during systole. Click sound.
What are some complications of MVP?
- IE
- Mitral insufficiency
- Stroke
- arrhythmias
What bacteria causes Rheumatic fever
Group A Beta hemolytic strep
What causes rheumatic fever?
autoimmune response due to anti strep M protein antibodies cross-reacting with cardiac myosin
What is pathognomic for thematic heart disease?
Aschoff bodies
-nodules found in heart
What is most important sequelae of rheumatic fever?
mitral stenosis with fish mouth
What is a skin rash associated with rheumatic heart disease?
Erythema marginatum
What are major non-cardiac diagnostic criteria for diagnosis of Rheumatic fever?
carditis polyarthritis chorea erythema marginatum subcutaneous nodules
What is the most common cause of paricarditis?
idiopathic
What is Dresslers Syndrome?
Autoimmune condition that shows up weeks to months after MI
What is Post MI Pericarditis?
Inflammatory reaction occurs 1-2 days after MI
What are the 5 categories of pericarditis?
Serous Fibrinous Hemorrhagic Purulent Caseous
Serous Pericarditis
non-infectious
autoimmune
uremia
Fibrinous Pericarditis
Bread and Butter Post MI and Dresslers Syndrome Post cardiac surgery Autoimmune uremia
Hemorrhagic pericarditis
TB Tumor Bacterial Infection Bleeding disorders Trauma
Purulent Pericarditis
exudative fluid
infectious
resolution = scarring and potential constrictive pericarditis
What would you see on a CXR of someone with pericarditis due to TB?
calcified area within pericardium
What is most common tumor of the heart?
Atrial Myxoma
What is the histology of dilated cardiomyopathy?
non-specific cellular abnormalities including variation in myocyte size, myocyte vaculolization, fibrosis
What is the histology of hypertrophic cardiomyopathy?
Hypertrophy of myocardial fibers, prominent dark nuclei, interstitial fibrosis
What is the histology of restrictive cardiomyopathy?
excessive iron deposits for hemachromatosis
deposits of pale pink material between myocardial fibers for amyloidosis
What are two types of culture negative endocarditis?
Libman-Sacks endocarditis
Marantic endocarditis
What do vegetations of Libman-Sacks endocarditis look like?
flat, spreading vegetations
What do vegetations of Marantic endocarditis look like?
small, pink vegetations
What is the histology of dilated cardiomyopathy?
non-specific cellular abnormalities including variation in myocyte size, myocyte vaculolization, fibrosis
What is the histology of hypertrophic cardiomyopathy?
Hypertrophy of myocardial fibers, prominent dark nuclei, interstitial fibrosis
What is the histology of restrictive cardiomyopathy?
excessive iron deposits for hemachromatosis
deposits of pale pink material between myocardial fibers for amyloidosis
What are two types of culture negative endocarditis?
Libman-Sacks endocarditis
Marantic endocarditis
What do vegetations of Libman-Sacks endocarditis look like?
flat, spreading vegetations
What do vegetations of Marantic endocarditis look like?
small, pink vegetations
Atrial Myxoma
benign
left atrium
amorphous hypocellular mass
What is the most common cancer that metastases to the heart?
Melanoma
What does melanoma look like in the heart?
Brown black pigment
What is most common cancer that moves through blood or lymph to get to heart?
lung
what is most common benign tumor in children?
rhabdomyoma
What percentage of untreated pharyngeal strep lead to RF?
.3 to 3%
How many pt with acute RF develop some type of cardiac pathology?
1/3 of pt
What causes cardiomyopathy?
ischemic heart disease, hypertension, and valvular heart disease.
What is the most identified specific cause of dilated cardiomyopathy?
Ischemic Cardiomyopathy
What types of symptoms are seen in subacute endocarditis?
Petechiae
splinter hemorrhages
roth spots
What is the cause of endocarditis in native heart valves?
Strep viridans
What is a paraneoplastic syndrome associated with malignancies?
Marantic endocarditis or Trouseau’s syndrome
Asside from coxackie virus, what else causes myocarditis?
infection of the heart
autoimmune (RHD SLE RA)
drugs
transplant rejection
What could cause aortic stenosis?
IE or other infection
What could cause mitral stenosis?
RHD
What percentage of valvular diseases are found in aortic and pulmonic valves?
2/3
What is another word for MVP?
Myxomatous degeneration (accumulation of derma tan sulfate) a glycosaminoglycan.
What do fully developed aschoff bodies consist of?
Granulomatous structures consisting of fibrinous material, lymphocytes, plasma cells, and macrophages surrounding necrotic center.
What valve/disease is most affected/caused by RHD?
Mitral valve with mitral stenosis (fish mouth)
aortic is second most affected
What is the second most common complication of RHD?
Carditis
dx: new murmur and tachycardia out of proportion to fever.
What are new or changing murmurs consistent with?
rheumatic valvular disease
What is the most common malignant heart tumor?
angiosarcoma
