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Path 3 > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What are the 3 major cardiomyopathies?

A

dilated: 90% of cases
hypertrophic
restrictive

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2
Q

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

A

<40%

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3
Q

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

A

chronic alcholism

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4
Q

Which chambers of the heart are dilated in DCM?

A

all of them

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5
Q

What is the most common specific cause of DCM?

A

ischemic cardiomyopathy

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6
Q

What does DCM looks like histologically?

A

nonspecific cellular abnormalities

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

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7
Q

What are the characteristics of HCM?

A

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

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8
Q

What ventricle is most affected in HCM?

A

left

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9
Q

What does HCM looks like histologically?

A

prominent dark nuclei

interstitial fibrosis

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10
Q

What causes HCM?

A

genetic disease

mutation in genes that encode proteins for sarcomere

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11
Q

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

A

hyper-contract

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12
Q

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

A

hypo-contract

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13
Q

What is the essential feature of HCM?

A

massive myocardial hypertrophy without ventricular dilation

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14
Q

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

A

septum

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15
Q

What causes restrictive cardiomyopathy (RCM)?

A

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

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16
Q

2 most common causes of RCM?

A

amyloidosis and hemochromatosis

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17
Q

What is deposited excessively in hemochromatosis?

A

IRON, of course!

stained with prussian blue

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18
Q

What does amyloidosis look like histologically?

A

pale pink material deposited between myocardial fibers

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19
Q

What is inflamed with IE?

A

mainly the leaflets of the heart

maybe endocardial lining

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20
Q

What does colonization of microbes lead to?

A

VEGETATIONS

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21
Q

What valves are most commonly affected?

A

left-sided valves, equally

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22
Q

What are two potential causes of sterile vegetations?

A

SLE

CA

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23
Q

Who is at particular risk for IE?

A

IV drug users

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24
Q

what does IE show histologically?

A

friable vegetations. bleh.

fibrin and platelets mixed with inflammatory cells

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25
Q

What do friable vegetations increase the potential for?

A

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

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26
Q

Most common cause of IE?

A

bacteria

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27
Q

What organisms causes community-acquired IE?

A 
Staph. aureus (30-50%): not so much MRSA
Alpha-hemolytic Strep (s. viridans)
enterococci
culture negative
staph. epidermidis
misc. organisms
fungi (<5%)
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28
Q

What organisms are associated with nosocomial IE?

A 
Staph aureus (60-80%): so much MRSA
otherwise same as community acquired but a higher percentage is caused by fungi (10%)
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29
Q

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

A

antibiotic tx prior to dx

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30
Q

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

A

nope

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31
Q

What is that most common cause of culture negative endocarditis?

A

fungi 10%

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32
Q

what are some portals of entry for organisms regarding endocarditis?

A 
poor dental health/dental health procedures
GU infections/catheterization
Skin infections
pulmonary infections
IV drug use
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33
Q

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

A

50%

even with tx

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34
Q

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

A 
already damaged (opposite in acute)
usually involves a less virulent organism
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35
Q

do most people with sub-acute endocarditis recover?

A

yep

36
Q

What is the most consistent sign of endocarditis?

A

fever

37
Q

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

A

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

38
Q

Risk factors for endocarditis?

A 
rheumatic heart disease
artificial valves
immunocompromised
IV drug users
alcoholics
indwelling catheters
vascular grafts
39
Q

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

A

s. viridens

40
Q

main organism in subacute endocarditis?

A

s. viridens

41
Q

What organism causes endocarditis involving prosthetic valves?

A

staph. epidermidis

42
Q

What organism causes endocarditis involving iv drug users?

A

s. aureus

43
Q

What organism causes endocarditis involving alcoholics?

A

anaerobes and oral cavity bugs

44
Q

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

A

gram neg. (e. coli)

45
Q

What organism is involved with carcinoma of the colon?

A

s. bovis

always do colonoscopy when this is cultured

46
Q

What do you call endocarditis from SLE?

A

LIbman-sacks endocarditis

47
Q

When else might we see non-infectious endocarditis?

A

pancreatic CA (hypercoagulable state)

48
Q

what is marantic endocarditis?

A

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

49
Q

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

A

small (less than 0.5 cm)

prone to embolize

50
Q

What causes myocarditis?

A 
infection of the heart
autoimmune phenomena (RHD, SLE, RA, drugs, transplant rejection)
51
Q

What is the most common infectious agent in myocarditis?

A

Enterovirus (coxsackie virus)

52
Q

What is the characteristic histological finding in viral myocarditis?

A

interstitial lymphocyte infiltrates

53
Q

What does valvular involvement by disease cause?

A

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

54
Q

What valve is most susceptible to to disease?

A

aortic

it is exposed to greatest forces

55
Q

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

A

rapid, fatal cardiac failure

56
Q

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

A

years usually

57
Q

What does a pansystolic, pandiastolic murmur indicate?

A

patent ductus arteriosus

58
Q

What are the most frequent noted valvular abnormalities?

A

acquired stenosis of aortic and mitral valves

2/3 of all valvular disease

59
Q

What is the most common of all valvular diseases?

A

aortic stenosis

60
Q

What is a characteristic finding of mitral stenosis with CVD?

A

Fish Face Closure

61
Q

Who is most likely to get MVP?

A

women 20-40yo

62
Q

Is left or right sided heart disease more common?

A

left

63
Q

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

A

myxomatous degeneration (weakening of CT) of the mitral valve

64
Q

What are the potential complications of MVP?

A

IE
Mitral insufficiency
stroke
arrhythmias

65
Q

What organism is involved with Rheumatic Fever?

A

Group A betahemolytic Streptococcus pyogenes

respiratory droplets

66
Q

What two ways can you dx strep?

A

throat culture

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

67
Q

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

A

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

68
Q

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

A

1/3

69
Q

What is pathegnomonic for rheumatic fever?

A

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

70
Q

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

A

chronic valvular deformities

mostly, mitral stenosis

71
Q

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

A

rheumatic heart disease

72
Q

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

A

polyarthritis

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

73
Q

what is erythema marginatum? how common?

A

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)

74
Q

What is the most common cause of pericardial disease?

A

idiopathic

75
Q

I say caseous, you say…

A

TB

76
Q

Is serous pericarditis usually infectious or not?

A

not

77
Q

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

A

fibrinous pericarditis

78
Q

What are the most common causes of hemorrhagic pericarditis?

A

TB
Tumor
Bacterial infection
bleeding disorders

79
Q

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

A

exudate

80
Q

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

A

Pericarditis due to TB

81
Q

What is the most common heart tumor?

A

atrial myxoma (benign)

82
Q

Are heart tumors usually benign of malignant?

A

benign (70%)

83
Q

What is the risk of atrial myxoma?

A

produces ball valve effect and occludes the valve orifice

84
Q

What is the most common site of an atrial myxoma?

A

left atrium 80-90%

85
Q

What are the histological features of an atrial myxoma?

A

hypocellular
polygonal cells
elongated cell shape

86
Q

What is the most common pediatric tumor of the heart?

A

cardiac rhabdomyoma

often spontaneously regresses

87
Q

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

A

melanoma

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