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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
Q

What drugs will only reduce mortality in CHF?

A

Ace Inhibitors
Beta blockers (except in acute decompensated HF)
Angiotensin receptor antagonist
Spironolactone

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26
Q

what drugs will only reduce symptoms in CHF?

A

Thiazines

Loop diuretics

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27
Q

What drugs are used for both symptom and mortality relief in CHF?

A

Hydralazine + Nitrate therapy

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28
Q

What is the cause of cardiac dilation?

A

Greater ventricular end-diastolic volume

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29
Q

What is the cause of dyspnea on exertion?

A

Failure of CO to increase during exercise

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30
Q

Left heart failure often leads to what?

A
  • Pulmonary edema
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
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31
Q

What is the physiology behind pulmonary edema/paroxysmal nocturnal dyspnea?

A

Increased pulm. venous P –> Pulmonary venous distension –> Transudation of fluid

32
Q

Pulmonary edema/paroxysmal nocturnal dyspnea is characterized by what in the lung?

A

Hemosiderin-laden macrophages (heart failure cells)

33
Q

What is the physiology behind orthopnea?

A

Increased venous return in supine position exacerbates pulmonary vascular congestion

34
Q

Right heart failure often heads to what?

A
  • Hepatomegaly (nutmeg liver)
  • Peripheral edema
  • JVD
35
Q

What is the physiology behind hepatomegaly?

A

Increased central venous P –> increased resistance to portal flow

36
Q

hepatomegaly rarely leads to what?

A

cardiac cirrhosis

37
Q

What is the physiology behind peripheral edema?

A

Increased venous pressure –> fluid transudation

38
Q

What is the physiology behind JVD?

A

Increased venous pressure

39
Q

What are the symptoms of bacterial endocarditis?

A 
FROM JANE
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail-bed (splinter) hemorrhage
Emboli
40
Q

What are Roth’s spots?

A

Round white spots on retina surrounded by hemorrhage

41
Q

What are Osler’s nodes?

A

Tender raised lesions on finger or toe pads

42
Q

What are janeway lesions?

A

Small, painless erythematous lesions on palm/sole

43
Q

What is necessary for bacterial endocarditis diagnosis?

A

Multiple blood cultures

44
Q

Acute bacterial endocarditis is from a high virulence bacteria called ______ and is _______ onset

A

Staph aureus, Rapid

45
Q

Acute bacterial endocarditis looks like what on valves?

A

Large vegetations on previously normal valves

46
Q

Subacute bacterial endocarditis is from a low virulence bacteria called ______ and is a _________ onset

A

Viridans streptococci, more insidious

47
Q

Subacute bacterial endocarditis looks like what on valves?

A

Smaller vegetations on congenitally abnormal or diseased valves

48
Q

Subacute bacterial endocarditis is a sequela of what?

A

Dental procedures

49
Q

Nonbacterial endocarditis is secondary to what?

A

Malignancy
hypercoagulable states
lupus

50
Q

What bacteria is present in colon cancer?

A

S. Bovis

51
Q

What bacteria is present on prosthetic valves?

A

S. Epidermis

52
Q

What is the most frequent valve involved with bacterial endocarditis?

A

mitral valve

53
Q

Tricuspid valve bacterial endocarditis is associated with what? And what bacteria?

A

IV drug abuse

S. Aureus, Pseudomonas, Candida

54
Q

What are the complications of bacterial endocarditis?

A

Chordae rupture
Glomerulonephritis
Suppurative pericarditis
Emboli

55
Q

What is rheumatic fever a consequence of?

A

Pharyngeal infection with group A Beta-hemolytic streptococci

56
Q

What are early deaths and late deaths due to in rheumatic fever?

A

Early: myocarditis
Late: Rheumatic heart disease

57
Q

Rheumatic heart disease affects valves in what order?

A

Mitral>Aortic»Tricuspid

58
Q

Early and late lesions lead to what consequences in the heart?

A

Early: Mitral valve regurgitation
Late: Mitral stenosis

59
Q

Rheumatic fever is associated with _____ and ____ and elevated _______ titers

A

Aschoff bodies, Anitschkow’s cells, ASO

60
Q

What are Aschoff bodies?

A

granuloma with giant cells

61
Q

What are anitschkow bodies?

A

Activated histiocytes

62
Q

What is the cause of the rheumatic heart disease?

A

Immune mediated type II HS reaction (not direct effect of bacteria)

63
Q

Rheumatic heart disease leads to Abs against what?

A

M-protein

64
Q

What are the symptoms of rheumatic fever?

A 
FEVERSS
Fever
Erythema Marginatum
Valvular damage (vegetation and fibrosis)
ESR increased
Red-hot joints (migratory polyarthritis)
Subcutaneous nodules
St. Vitus' dance (syndenham chorea)
65
Q

How does acute pericarditis commonly present?

A

Sharp pain with friction rub

66
Q

What aggravates acute pericarditis?

A

Inspiration

67
Q

What relieves acute pericarditis?

A

Sitting up and leaning forward

68
Q

What are the ECG changes included in acute pericarditis?

A

ST-segment elevation

PR-segment depression

69
Q

What are the types of acute pericarditis?

A

Fibrinous, Serous, Suppurative/purulent

70
Q

What is the causes of fibrinous acute pericarditis?

A

Dressler’s syndrome, uremia, radiation

71
Q

How does fibrinous acute pericarditis present?

A

Loud friction rub

72
Q

What are the causes of serous acute pericarditis?

A

Viral pericarditis

Non-infectious inflammatory disease

73
Q

Viral serous pericarditis often resolves how?

A

spontaneously

74
Q

Noninfectious inflammatory diseases that cause serous pericarditis are what?

A

RA, SLE

75
Q

Suppurative/purulent acute pericarditis is usually caused by what?

A

Bacterial infections

76
Q

What bacteria often cause suppurative/purulent acute pericarditis (although rare now with antibiotics)?

A

Pneumococcus, Streptococcus

Cardio Step 1 (14 decks)

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