Quiz 2 Flashcards by Emily wiggins

What are the 3 major cardiomyopathies?

dilated: 90% of cases
hypertrophic
restrictive

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What is the ejectrion fraction of a pt. with cardiomyopathy?

<40%

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What is the most common cause of non-ischemic DCM in the US?

chronic alcholism

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Which chambers of the heart are dilated in DCM?

all of them

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What is the most common specific cause of DCM?

ischemic cardiomyopathy

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What does DCM looks like histologically?

nonspecific cellular abnormalities

variations in myocyte size, vacuolation, and loss of myofibrillar material and/or fibrosis

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What are the characteristics of HCM?

myocardial hypertrophy
abnormal diastolic filling
intermittent ventricular outflow obstruction (1/3 of cases)

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What ventricle is most affected in HCM?

left

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What does HCM looks like histologically?

prominent dark nuclei

interstitial fibrosis

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What causes HCM?

genetic disease

mutation in genes that encode proteins for sarcomere

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With HCM does the heart hyper-contract or hypo-contract?

hyper-contract

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With DCM does the heart hyper-contract or hypo-contract?

hypo-contract

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What is the essential feature of HCM?

massive myocardial hypertrophy without ventricular dilation

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Classically, is the septum or the free wall usually thickened in HCM?

septum

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What causes restrictive cardiomyopathy (RCM)?

infiltration of myocardium with abnormal tissue that results in impaired ventricular wall motion (ie. contraction/relaxation)

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2 most common causes of RCM?

amyloidosis and hemochromatosis

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What is deposited excessively in hemochromatosis?

IRON, of course!

stained with prussian blue

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What does amyloidosis look like histologically?

pale pink material deposited between myocardial fibers

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What is inflamed with IE?

mainly the leaflets of the heart

maybe endocardial lining

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What does colonization of microbes lead to?

VEGETATIONS

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What valves are most commonly affected?

left-sided valves, equally

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What are two potential causes of sterile vegetations?

SLE

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Who is at particular risk for IE?

IV drug users

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what does IE show histologically?

friable vegetations. bleh.

fibrin and platelets mixed with inflammatory cells

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What do friable vegetations increase the potential for?

vegetations breaking off and emobolizing, carrying infection to other parts of the body

Most common cause of IE?

bacteria

What organisms causes community-acquired IE?

``` Staph. aureus (30-50%): not so much MRSA Alpha-hemolytic Strep (s. viridans) enterococci culture negative staph. epidermidis misc. organisms fungi (<5%) ```

What organisms are associated with nosocomial IE?

``` Staph aureus (60-80%): so much MRSA otherwise same as community acquired but a higher percentage is caused by fungi (10%) ```

What causes often causes community-acquired IE to be culture negative (7-33%) ?

antibiotic tx prior to dx

is there an association between culture negativity and underlying etiology or risk factors?

nope

What is that most common cause of culture negative endocarditis?

fungi 10%

what are some portals of entry for organisms regarding endocarditis?

``` poor dental health/dental health procedures GU infections/catheterization Skin infections pulmonary infections IV drug use ```

What is the percentage of people who die in days to weeks from acute endocarditis?

50% | even with tx

In sub-acute endocarditis is the valve affected likely already damaged or previously normal?

``` already damaged (opposite in acute) usually involves a less virulent organism ```

do most people with sub-acute endocarditis recover?

yep

What is the most consistent sign of endocarditis?

fever

What are the affects of microemboli in circulation as is seen with sub-acute endocarditis

they may reach the skin and cause petechiae (splinter hemorrhages) or they go to the retina (roth's spots)

Risk factors for endocarditis?

``` rheumatic heart disease artificial valves immunocompromised IV drug users alcoholics indwelling catheters vascular grafts ```

what is the most common organism in the case of endocarditis involving native valves?

s. viridens

main organism in subacute endocarditis?

s. viridens

What organism causes endocarditis involving prosthetic valves?

staph. epidermidis

What organism causes endocarditis involving iv drug users?

s. aureus

What organism causes endocarditis involving alcoholics?

anaerobes and oral cavity bugs

What organism causes endocarditis after cystoscopy/prostatectomy/indwelling catheters?

gram neg. (e. coli)

What organism is involved with carcinoma of the colon?

s. bovis | always do colonoscopy when this is cultured

What do you call endocarditis from SLE?

LIbman-sacks endocarditis

When else might we see non-infectious endocarditis?

pancreatic CA (hypercoagulable state)

what is marantic endocarditis?

endocarditis from hypercoagulable state aka trousseau's syndrome (associated with malignancies)

what does the vegetation look like with non-infectious endocarditis?

small (less than 0.5 cm) | prone to embolize

What causes myocarditis?

``` infection of the heart autoimmune phenomena (RHD, SLE, RA, drugs, transplant rejection) ```

What is the most common infectious agent in myocarditis?

Enterovirus (coxsackie virus)

What is the characteristic histological finding in viral myocarditis?

interstitial lymphocyte infiltrates

What does valvular involvement by disease cause?

stenosis (failure of valve to open = impede forward flow) insufficiency (failure of valve to close = reverses flow) or both

What valve is most susceptible to to disease?

aortic | it is exposed to greatest forces

What might result from destruction of an aortic valve cusp by infection?

rapid, fatal cardiac failure

How long does it take for mitral stenosis to develop following rheumatic heart disease?

years usually

What does a pansystolic, pandiastolic murmur indicate?

patent ductus arteriosus

What are the most frequent noted valvular abnormalities?

acquired stenosis of aortic and mitral valves | 2/3 of all valvular disease

What is the most common of all valvular diseases?

aortic stenosis

What is a characteristic finding of mitral stenosis with CVD?

Fish Face Closure

Who is most likely to get MVP?

women 20-40yo

Is left or right sided heart disease more common?

left

what is one of the most common forms of valvular heart disease?

myxomatous degeneration (weakening of CT) of the mitral valve

What are the potential complications of MVP?

IE Mitral insufficiency stroke arrhythmias

What organism is involved with Rheumatic Fever?

Group A betahemolytic Streptococcus pyogenes | respiratory droplets

What two ways can you dx strep?

throat culture | elevated or rising step ab titer (higher titer, more likely to get rheumatic fever)

What protein is thought to be involved in the autoimmune response that causes acute rheumatic fever?

anti-streptococcal M protein (cross react with cardiac myosin)

what fraction of patients with acute rheumatic fever develop some type of cardiac pathology?

1/3

What is pathegnomonic for rheumatic fever?

aschoff bodies: foci of enlarged cells surrounded by lymphocytes and occ. plasma cells

What is the mom important cardiac related consequence of rheumatic heart disease?

chronic valvular deformities | mostly, mitral stenosis

If you see a stenotic mitral valve with a fish mouth appearance what are you thinking?

rheumatic heart disease

what is the most common non-cardiac manifestation of acute rheumatic fever?

polyarthritis | also, chorea (discoordinated muscle movements), subacute nodules, erythema marginatum

what is erythema marginatum? how common?

characteristic rash of rheumatic fever (pink-red, non-pruritic macules/papules on trunk and proximal limbs. rarely on the face. spread outwards into serpiginous ring)

What is the most common cause of pericardial disease?

idiopathic

I say caseous, you say...

Is serous pericarditis usually infectious or not?

not

The pathologist tells you your patient has bread and butter pericarditis. After puking, you think...

fibrinous pericarditis

What are the most common causes of hemorrhagic pericarditis?

TB Tumor Bacterial infection bleeding disorders

In purulent pericarditis, is the fluid usually exudate or transudate?

exudate

you see notable calcification surrounding the heart on CT or CXR. What might this indicate?

Pericarditis due to TB

What is the most common heart tumor?

atrial myxoma (benign)

Are heart tumors usually benign of malignant?

benign (70%)

What is the risk of atrial myxoma?

produces ball valve effect and occludes the valve orifice

What is the most common site of an atrial myxoma?

left atrium 80-90%

What are the histological features of an atrial myxoma?

hypocellular polygonal cells elongated cell shape

What is the most common pediatric tumor of the heart?

cardiac rhabdomyoma | often spontaneously regresses

What is the neoplasm with the greatest propensity to metastasize to the heart?

melanoma