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Cardio Step 1 > Pathology Part 3 > Flashcards

Pathology Part 3 Flashcards

1
Q

What is the most common cardiomyopathy (90%)

A

Dilated Cardiomyopathy

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2
Q

What percentage of cases of dilated cardiomyopathy are idiopathic?

A

50%

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3
Q

What are the etiologies of dilated cardiomyopathy?

A 
ABCCCD-HP
Alcohol abuse
wet Beriberi
Coxsackie B virus myocarditis
Cocaine use (chronic)
Chagas disease
Doxorubicin toxicity
Hemochromatosis
Peripartum cardiomyopathy
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4
Q

What are the diagnostic findings in dilated cardiomyopathy?

A
  • S3
  • Dilated heart on ultrasound
  • Balloon appearance on CXR
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5
Q

What is the treatment for dilated cardiomyopathy?

A
  • Na restriction
  • ACE I
  • Diuretics
  • digoxin
  • heart transplant
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6
Q

Dilated cardiomyopathy is characterized by ________ dysfunction and _________

A

systolic, eccentric hypertrophy (sarcomeres added in series)

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7
Q

What does hypertrophied cardiomyopathy look like?

A

hypertrophied interventricular septum is “too close” to mitral valve leaflet, leading to outflow obstruction

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8
Q

60-70% of hypertrophied cardiomyopathy are familial and are what inheritance pattern?

A

Autosomal dominant

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9
Q

Familial hypertrophied cardiomyopathy is due to a mutation in what?

A

Beta-myosin heavy chain

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10
Q

Hypertrophied cardiomyopathy is associated with what disease?

A

Friedreich’s ataxia

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11
Q

What do the myocardial fibers look like in hypertrophied cardiomyopathy?

A

disoriented
tangled
hypertrophied

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12
Q

Hypertrophic cardiomyopathy is the cause of _______ in young athletes

A

sudden death

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13
Q

What are the findings in hypertrophic cardiomyopathy?

A
  • Normal sized heart
  • S4
  • Apical impulses
  • Systolic murmur
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14
Q

What is the treatment in hypertrophic cardiomyopathy?

A
  • Beta blocker

- Non-dihydropyrimidine CCB (ex. verapamil)

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15
Q

Hypertrophied cardiomyopathy is characterized by ______ dysfunction and ________

A

Diastolic, Asymmetric concentric hypertrophy (sarcomeres added in parallel)

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16
Q

The proximity of the hypertrophied interventricular septum to the mitral leaflet obstructs the outflow tract and results in _______ and _______.

A

Systolic murmur,

Syncope

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17
Q

What are the major causes of Restrictive/obliterative cardiomyopathy?

A
  • Sarcoidosis
  • Amyloidosis
  • Postradiation fibrosis
  • Endocardial fibroelastosis
  • Loffler’s syndrome
  • hemochromatosis
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18
Q

What is endocardial fibroelastosis?

A

Thick fibroelastic tissue in endocardium of young children

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19
Q

What is Loffler’s syndrome?

A

Endomyocardial fibrosis with a prominent eosinophilic infiltrate

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20
Q

What 2 cardiomyopathys is hemochromatosis also associated with?

A

Dilated and Restrictive

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21
Q

REstrictive/obliterative cardiomyopathy is characterized by _______ dysfunction

A

Diastolic

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22
Q

CHF is a clinical syndrome that occurs in patients with an inherited or acquired abnormality of cardiac structure or function and is characterized by what smyptoms and what physical signs?

A

symptoms: dyspnea, fatigue
Signs: edema, rales

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23
Q

Right heart failure is usually a result of what?

A

Left heart failure

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24
Q

Isolated Right heart failure is usually do to what?

A

cor pulmonale

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25
What drugs will only reduce mortality in CHF?
Ace Inhibitors Beta blockers (except in acute decompensated HF) Angiotensin receptor antagonist Spironolactone
26
what drugs will only reduce symptoms in CHF?
Thiazines | Loop diuretics
27
What drugs are used for both symptom and mortality relief in CHF?
Hydralazine + Nitrate therapy
28
What is the cause of cardiac dilation?
Greater ventricular end-diastolic volume
29
What is the cause of dyspnea on exertion?
Failure of CO to increase during exercise
30
Left heart failure often leads to what?
- Pulmonary edema - Paroxysmal nocturnal dyspnea - Orthopnea
31
What is the physiology behind pulmonary edema/paroxysmal nocturnal dyspnea?
Increased pulm. venous P --> Pulmonary venous distension --> Transudation of fluid
32
Pulmonary edema/paroxysmal nocturnal dyspnea is characterized by what in the lung?
Hemosiderin-laden macrophages (heart failure cells)
33
What is the physiology behind orthopnea?
Increased venous return in supine position exacerbates pulmonary vascular congestion
34
Right heart failure often heads to what?
- Hepatomegaly (nutmeg liver) - Peripheral edema - JVD
35
What is the physiology behind hepatomegaly?
Increased central venous P --> increased resistance to portal flow
36
hepatomegaly rarely leads to what?
cardiac cirrhosis
37
What is the physiology behind peripheral edema?
Increased venous pressure --> fluid transudation
38
What is the physiology behind JVD?
Increased venous pressure
39
What are the symptoms of bacterial endocarditis?
``` FROM JANE Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail-bed (splinter) hemorrhage Emboli ```
40
What are Roth's spots?
Round white spots on retina surrounded by hemorrhage
41
What are Osler's nodes?
Tender raised lesions on finger or toe pads
42
What are janeway lesions?
Small, painless erythematous lesions on palm/sole
43
What is necessary for bacterial endocarditis diagnosis?
Multiple blood cultures
44
Acute bacterial endocarditis is from a high virulence bacteria called ______ and is _______ onset
Staph aureus, Rapid
45
Acute bacterial endocarditis looks like what on valves?
Large vegetations on previously normal valves
46
Subacute bacterial endocarditis is from a low virulence bacteria called ______ and is a _________ onset
Viridans streptococci, more insidious
47
Subacute bacterial endocarditis looks like what on valves?
Smaller vegetations on congenitally abnormal or diseased valves
48
Subacute bacterial endocarditis is a sequela of what?
Dental procedures
49
Nonbacterial endocarditis is secondary to what?
Malignancy hypercoagulable states lupus
50
What bacteria is present in colon cancer?
S. Bovis
51
What bacteria is present on prosthetic valves?
S. Epidermis
52
What is the most frequent valve involved with bacterial endocarditis?
mitral valve
53
Tricuspid valve bacterial endocarditis is associated with what? And what bacteria?
IV drug abuse | S. Aureus, Pseudomonas, Candida
54
What are the complications of bacterial endocarditis?
Chordae rupture Glomerulonephritis Suppurative pericarditis Emboli
55
What is rheumatic fever a consequence of?
Pharyngeal infection with group A Beta-hemolytic streptococci
56
What are early deaths and late deaths due to in rheumatic fever?
Early: myocarditis Late: Rheumatic heart disease
57
Rheumatic heart disease affects valves in what order?
Mitral>Aortic>>Tricuspid
58
Early and late lesions lead to what consequences in the heart?
Early: Mitral valve regurgitation Late: Mitral stenosis
59
Rheumatic fever is associated with _____ and ____ and elevated _______ titers
Aschoff bodies, Anitschkow's cells, ASO
60
What are Aschoff bodies?
granuloma with giant cells
61
What are anitschkow bodies?
Activated histiocytes
62
What is the cause of the rheumatic heart disease?
Immune mediated type II HS reaction (not direct effect of bacteria)
63
Rheumatic heart disease leads to Abs against what?
M-protein
64
What are the symptoms of rheumatic fever?
``` FEVERSS Fever Erythema Marginatum Valvular damage (vegetation and fibrosis) ESR increased Red-hot joints (migratory polyarthritis) Subcutaneous nodules St. Vitus' dance (syndenham chorea) ```
65
How does acute pericarditis commonly present?
Sharp pain with friction rub
66
What aggravates acute pericarditis?
Inspiration
67
What relieves acute pericarditis?
Sitting up and leaning forward
68
What are the ECG changes included in acute pericarditis?
ST-segment elevation | PR-segment depression
69
What are the types of acute pericarditis?
Fibrinous, Serous, Suppurative/purulent
70
What is the causes of fibrinous acute pericarditis?
Dressler's syndrome, uremia, radiation
71
How does fibrinous acute pericarditis present?
Loud friction rub
72
What are the causes of serous acute pericarditis?
Viral pericarditis | Non-infectious inflammatory disease
73
Viral serous pericarditis often resolves how?
spontaneously
74
Noninfectious inflammatory diseases that cause serous pericarditis are what?
RA, SLE
75
Suppurative/purulent acute pericarditis is usually caused by what?
Bacterial infections
76
What bacteria often cause suppurative/purulent acute pericarditis (although rare now with antibiotics)?
Pneumococcus, Streptococcus

Cardio Step 1 (14 decks)

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