Quiz 2 Flashcards
What is the most common type of non-ischemic
cardiomyopathy?
dilated
What are the three types of cardiomyopathy?
dilated, hypertrophic, restrictive
What is the ejection fraction of cardiomyopathy?
<40%
Most common cause of non-ischemic dilated cardiomyopathy?
chronic alcoholism
What are three characteristics of hypertrophic cardiomyopathy?
myocardial hypertrophy, abnormal diastolic filling, and intermittent ventricular outflow
Hypertrophic cardiomyopathy is classified as a __________disease.
genetic
What part of the ventricle enlarges with hypertrophic cardiomyopathy?
The walls < SEPTUM
What are the most common causes of restrictive cardiomyopathy?
amyloidosis, hemochromatosis
Which valves are most commonly infected in endocarditis?
Left side: mitral and aortic
Most common community acquired endocarditis is a result of what organism(s)?
1) S. aureus 2) AH Strep (S. viridans) 3) Culture negative
Most common nosocomial-acquired endocarditis is a result of what organism(s)?
1) S. aureas (mostly MRSA) 2) AH Strep. 3) Culture negative
Portals of entry for organisms that may cause endocarditis:
Poor dental health, dental procedures, genitourinary infections, procedures of the GU tract, skin infections, pulmonary infections, IV drug use
Sub-acute vs. Acute endocarditis
Acute: normal heart valve, highly virulent organism, 50% death in days-weeks.
Sub-acute: already damaged valve, less virulent, recovery
What is the most consistent sign of endocarditis?
Fever
Sub-acute endocarditis may result in what sequelae from embolized vegetations?
petechiae (mouth, tongue), splinter hemorrhages, Roth’s spots
What are the risk factors for endocarditis?
Artificial valves, immunocompromised, IV drug use, alcoholics, indwelling catheters, vascular grafts, AND rheumatic heart dz
What organism is associated with endocarditis of native valves which may be damaged?
S. viridans -main cause of sub-acute endocarditis
Which organism is associated with endocarditis involving prosthetic valves?
Staph epidermitis
Which organism is associated with endocarditis involving IV drug abuse?
Staph aureus
Which organism is associated with endocarditis involving alcoholism?
anaerobes and oral cavity bugs
Which organism is associated with endocarditis involving procedures or indwelling catheters?
Gm neg : E. coli
Which organism is associated with endocarditis involving patient with carcinoma of the colon?
Strep bovis
What is the endocarditis of SLE called?
Libman-Sacks endocarditis (collagen vascular inflammatory endocarditis)
What’s the gross appearance of Libman-Sacks lesions vs. infectious endocarditis?
Libman-Sacks: Flat and spreading
Infectious: Chunky and pedunculated
Endocarditis resulting from hypercoagulable state (Trousseau’s syndrome)?
Marantic endocarditis -pancreatic and lung cancers
Causes of myocarditis:
Infection (VIRAL-MOST COMMON), autoimmune, drugs, or transplant rejection
Most common infectious agents causing myocarditis?
1) Coxsackie virus (group B), HIV, Meningococcus, R. typhi, Borrelia burgdorferi, toxoplasmosis
What can be found microscopically in viral myocarditis?
Lymphocyte infiltrates
Define stenosis
Failure of a valve to open completely
Define insufficiency
Failure of valve to close completely
Most common valve dz?
Aortic stenosis and mitral regurg and insufficiency (MVP?_
Partial fusion of cusps
Raphe
Mitral valve prolapse affects what population more readily?
Women, 20-40yo
How is MVP often found?
Incidentally, during routine exam
Complications of MVP
Infective endocarditis, mitral insufficiency, stroke/systemic infarct, arrhythmias
Rheumatic fever follows infection by what organism?
Grp A beta-hemolytic strep (S. pyogenes)
What marker in the blood can indicate the likelihood of developing rheumatic heart dz?
ASO titers remaining high
Acute rheumatic fever is likely due to an immune response caused by what Ab which cross-react with cardiac myosin?
anti-streptococcal M protein
What are aschoff bodies and what are they pathognomonic for?
Rheumatic fever/heart dz
Aschoff bodies are granulomatous structures consisting of fibrinous material, lymphocytes, occasional plasma cells and macrophages with surround necrotic centers
What are fused macrophages called?
Caterpillar cells or Anitschkow cells, due to appearance of chromatin
Most important cardiac consequence of rheumatic heart dz?
Mitral stenosis (#2 aortic stenosis)
On physical exam, how is carditis most commonly detected?
Tachycardia (out of proportion with fever) and new murmur
What is the gross appearance of mitral stenosis?
“fish mouth”
What is the pathogenesis of chronic rheumatic heart dz?
Progressive deformity of the valve leading to stenosis combined with insufficiency.
Most common complications of prosthetic heart valves?
Thrombosis, infection, structural failure (bioprosthesis), dehiscence (prosthetic)
Non-cardiac manifestations of rheumatic heart dz?
polyarthritis (#1), Sydenham’s chorea, erythema marginatum, subcutaneous nodules
also: abdominal pain, arthralgias, fever, and development of pneumonia
Most common causes of pericarditis?
Idiopathic (viral?) -MOST COMMON Infectious Inflammatory Autimmune Drugs Trauma Misc -Tumors
What dz would you be concerned for if you appreciated a hemorrhagic pericardial effusion?
TB, cancer, trauma
What are the 5 types of pericarditis?
Serous, fibrinous, hemorrhagic, purulent, caseous
Characteristics of serous pericarditis?
Usually non-infectious (possibly viral)
Uremia
Autoimmune - SLE, RA
Often complete resolution
Characteristics of fibrinous pericarditis?
Post-MI or Dressler's syndrome Post-cardiac surgery Trauma Chronic uremia Autoimmune -SLE, RA Bread and butter appearance Audible friction rub
Characteristics of hemorrhagic pericarditis?
TB, Tumor, Trauma
Bacterial infection
Bleeding disorder
Characteristics of purulent pericarditis?
Septic infection
Exudative
Resolution often involves scarring
Most common heart tumor?
Atrial myxoma -benign
Most occur in the left atrium.
Microscopic findings of myxoma?
Polygonal or elongated cell shapes
Mono or multi nucleated
Eosinophilic cytoplasms
Most common primary pediatric tumor of the heart?
Rhabdomyoma -behavior benign, but positioning can lead to lethal arrhythmias and chamber obstruction
Spontaneous regression
Neoplasm with the greatest propensity to metastasize to the heart?
Melanoma
Most common malignancy found in the heart?
Lung cancer -proximity to heart, lymphatic invasion
Bronchogenic carcinoma
