Pathology of the Heart IV

Question 1

LVH

Answer 1

with systemic hypertension (>140/90)***

CHF or arrhythmias

Question 2

cor pulmonale

Answer 2

pulmonary disorder causes pulmonary HTN

leads to right side hypertensive heart disease

COPD, interstitial lung disease, recurrent PE, kyphoscoliosis, obesity

Question 3

stenosis

Answer 3

valve can’t open completely

• cusp abnormality
• almost always chronic

Question 4

insufficiency

Answer 4

regurg or incompetence

-reverse flow

Question 5

functional regurg

Answer 5

valve fine

-dilated annulus

Question 6

most common cause of valve problems

Answer 6

rheumatic heart disease - mitral valve

Question 7

aortic stenosis

Answer 7

calcified aortic valve

Question 8

aortic insufficiency

Answer 8

dilation of ascending aorta - HTN and aging

Question 9

mitral stenosis

Answer 9

rheumatic heart disease

Question 10

mitral insufficiency

Answer 10

myxomatous degeneration - prolapse

Question 11

calcific aortic stenosis

Answer 11

senile - in elderly 60-80yo

calcium mass in sinuses of valsalva

lead to LVH (concentric)

Question 12

bicuspid aortic stenosis

Answer 12

in 2% population
-congeintal

more susceptible to calcification
-develps earlier

40-50yo

Question 13

mitral annular calcification

Answer 13

women over 60yo

• occasional associated with arrhythmias
• not often affect valvular function

Question 14

myxomatous degeneration of mitral valve

Answer 14

mitral valve prolapse

• ballooning of leaflets
• midsystolic click - leaflets hit inside vnetricle wall
• regurg murmur

secondary dilation of annulus, fibrosis of leaflets, jet lesions, thrombi

• marfan syndrome
• young women

Question 15

young women with midsystolic click, anxiety and depression

Answer 15

mitral valve prolapse

aka myxomatous dengeration of mitral valve

Question 16

acute rheumatic fever

Answer 16

from strep pharyngitis - 10 days - 6 weeks after
-antibodies for group A strep attack heart

pancarditis - every layer affected
-myocardium, endocardium, pericardium

also get polyarthritis

immune problem, NOT infection

Question 17

aschoff bodies

Answer 17

acute rheumatic fever

granuloma - macros, lymphos, other inflamm cells

Question 18

mononuclear in aschoff bodies

Answer 18

anitschkow cells

Question 19

multinucleated in aschoff bodies

Answer 19

achoff cells

Question 20

linear chromatin in aschoff bodies

Answer 20

caterpillar cells

Question 21

chronic rheumatic heart disease

Answer 21

rheumatic heart disease

• long term after acute rheumatic fever
• chronic valvular disease - mitral and aortic

often mitral stenosis**

Question 22

jones criteria

Answer 22

for acute rheumatic fever

previous group A strep infection
AND 2 major finding, or 1 major and 2 minor findings

Major - polyarthritis, carditis, subQ nodules, erythema marginatum of skin, chorea
minor - fever, arthralgia, acute phase reactants

Question 23

acute vs. chronic rheumatic?

Answer 23

acute - vegetations on valve (majority mitral)
chronic - diffuse fibrous thickening

VEGF - with revascularization

Question 24

rheumatoid heart disease

Answer 24

NOT rheumatic

-no aschoff bodies

Question 25

infective endocarditis organisms

Answer 25

strep viridans staph aureus HACEK - haemophilus, actinobacillus, cardiobacterioum, eikenella, kingella

Question 26

artificial valves

Answer 26

often strep epidermidis causing infective endocarditis

Question 27

infective endocarditis

Answer 27

bulky vegetations of fibrin/platelet clot and organisms - erode away valves - possible for systemic emboli usually left heart valves unless IV drug user - right side

Question 28

acute bacterial endocarditis

Answer 28

worse -very high fever, heart problems staph aureus IV drug users

Question 29

subacute bacterial endocarditis

Answer 29

- intermittent fevers - strep viridans more common

Question 30

diagnosis for infective endocarditis

Answer 30

3 cultures in 24 hours use duke criteria 2 major, 1 major/3 minor, 5 minor

Question 31

janeway lesions

Answer 31

new bumps on palms and soles of feet from infective endocarditis

Question 32

osler noes

Answer 32

nodes in pulp of digits from infective endocarditis

Question 33

roth spots

Answer 33

oval retinal hemorrhage with pale centers from infective endocarditis

Question 34

duke criteria

Answer 34

for diagnosis of infective endocarditis 2 major, 1 major/3 minor, 5 minor MAJOR - positive blood culture - EKG findings diagnostic - new murmur MINOR - IV drug use - fever - vascular lesions - immune - osler, roth, janesaw - EKG consistent

Question 35

nonbacterial thrombotic endocarditis

Answer 35

NBTE - along lines of closure of valve leaflets - sterile - no microorganisms - risk fx - hypercoag aka - marantic endocarditis thrombi can embolize

Question 36

libman sacks disease

Answer 36

non-infected vegetations - pt with SLE - malar rash - new murmur any surface of mitral/tricuspid valves

Question 37

vegetation both sides of valve

Answer 37

libman sacks - SLE

Question 38

vegetations that extend to chordae tendinae

Answer 38

infective endocarditis

Question 39

small bland vegetation at line of closure

Answer 39

NBTE

Question 40

small, warty vegetations, on line of closure

Answer 40

rheumatic heart disease

Question 41

carcinoid syndrome

Answer 41

metastatic tumor - releases substances - serotonin, kallikrein, bradykinin, prostaglandins, histamine - diarrhea, flushing, skin rash, bronchoconstriction - and fibrous intimal thickening of endocardial surfaces gut tumor - right heart -tumor in lung - left heart

Question 42

fen/phen

Answer 42

old drug for weight loss - can lead to thickening of endocardial surfaces

Question 43

cardiomyopathy

Answer 43

heart disease from primary abnormality of myocardium

Question 44

dilated cardiomyopathy

Answer 44

majority large flabby heart

Question 45

hypertrophic cardiomyopathy

Answer 45

thick left ventricle - banana shaped space

Question 46

restrictive cardiomyopathy

Answer 46

uncommon | -increase in mass without increased volume of left ventricle

Question 47

myocarditis

Answer 47

inflammation cause of myocardial injury

Question 48

coxsackie A and B

Answer 48

major cause of myocarditis

Question 49

major causes of myocarditis

Answer 49

``` coxsackie A and B viruses lyme disease - borrelia burgorferi hypersensitivity - eosions -trichinosis - helminths from undercooked meat -chagas disease - trypsanoma cruzi ```

Question 50

trypsanoma cruzi

Answer 50

chagas disease cause of myocarditis

Question 51

round nucleus myocarditis

Answer 51

lymphocyte -mononuclear viral infection

Question 52

bi-lobated nucleus myocarditis

Answer 52

eosinophils hypersensitivity myocarditis

Question 53

giant cells in myocarditis

Answer 53

giant cell myocarditis