Random Cardio Path HY Flashcards
heart originates from which germ cell layer
mesoderm
heartbeat established when during gestation?
3th wk
changes occurring at birth in baby
lungs expand –> inc BF, dec R, higher partial P of O2
inc SVR (removal of placenta)
inc systemic BP
inc LVP
tissue that becomes infolding of muscular roof of common atrium, and door of foramen ovale
septum secundum
origin of aorticopulmonary septum
neural crest cells
trisomy 21
associated disorders
endocardial cushion defects (common AV canal), VSD, ASD, PDA
Turner syndrome
associated disorders
coarctation of aorta
trisomy 18
associated disorders
VSD
LV hypOplasia
associated disorders
aortic stenosis
persistent trucus arteriosus
associated disorders
aortic and pulmonic outflow tract
portion of atrial septum adjacent to AV valves is developed from
endocardial cushion tissue
secundum ASD
patent foramen ovale (most common ASD)
muscular VSD
harsh, pan systolic murmur
little functional disturbances
paramembranous VSD
most common form VSD
involves the membranous septum
TOF mechanism
abnormal endocardial cushion development of conotruncus
@ which level does mixing occur w/ untreated D-TGA
ASD or VSD
T/F
D-TGA –> mixing of blood occurs at ductus arteriosus level
false
BUT keeping DA open does inc VR to LA and improve mixing at atrial level
hypOplastic left heart can lead to
MS/atresia
AS/atresia
RVH
coarctation of aorta
___ aneurysms most commonly involve aortic arch, abd aorta, iliac a.
fusiform aneurysms
aortic aneurysms predisposing condn
ATHEROSCLEROSIS
cystic medial degeneration
other (trauma/congenital defects/vasculitis/infections)
AAA rarely develop before age
AAA rarely develop before age 50
AAA usual location
below renal a., above bifurcation of aorta
AAA freq contains a
laminated mural thrombus
T. palladium
syphilitic aneurysm
condition leading to obliterative endarteritis (freq. involv vasovasorum)
syphilitic aneurysm
–> results in ischemic medial injury –> aneurysmal dilatation of the aorta and aortic annulus
Homan sign
pain w/ dorsiflexion of foot
poss DVT
myxomas
primary cardiac tumor
benign
most in LA
“ball in valve” (MS sx, syncope, sudden death)
myxoma histo
mesenchymal cells
abundant ground substance (gelatinous appearance –> myxoid, fibrous, slender cells)
rhabdomyoma
most comm primary tumor in infants/children
benign hamartoma
valvular obstruction
TUBEROUS SCLEROSIS
rhabdomyoma histo
large round polygonal myocytes w/ glycogen-rich vacuoles (CLEAR cytoplasm)
(spider-cells)
tuberous sclerosis
AD, mut TSC1 (hamartin) or TSC2 (tuberin)
mostly TSC2: more severe –> seizures, ash leaf spots, facial skin spots (angiofibromas), mental retardation
Kaposi sarcoma
caused by Kaposi sarcoma herpesvirus (HHV-8)
most common HIV-related malignancy
often involves lymph nodes and disseminates widely to viscera early in course
Kaposi sarcoma histo
dilated, irregular, not well-formed vascular channels w/ extravasated erythrocytes, hemosiderin-laden macrophages
mutations in sarcolemma and nuclear membrane proteins
dilated cardiomyopathy
mutations in b-myosin heavy chain sarcomeric protein
HCM
global LV systolic dysfunction
inc LV cavity diameter
absence of HTN, valve disease, significant CAD
DCM
inc weight of heart, may be 3x
four chamber dilatation
flabby, pale myocardium w/ subendocardial scars
DCM
anthracycline toxicity
DCM
pregnancy/peripartum –> _CM
DCM
HCM clinical features
sudden cardiac death (arrhythmia) syncope (LVOT obstruction) mitral regurgitation (LVOT tugs MV)
asymmetric bulging of lg inter ventricular septum into LV chamber
HCM
microfiber disarray, especially in interventricular septum
HCM
disarray via xs branching–> block beneath AV, can’t get blood across –> syncope during exercise
_____ may mimic constrictive pericarditis
RESTRICTIVE CM may mimic constrictive pericarditis
R sided sx
cardiomegaly w/ thickened myocardial wall, dec contractility
amyloidosis
(systemic senile amyloidosis) –> RCM
apple green birefringence, Congo red, pink amorphous material
causes of myocarditis
influenza
rocky mounted spotted fever
Chagas
drug rxns (penicillin, sulfonamide)
Coxsackie B
viral myocarditis
URI hx w/ + throat culture for specific virus
most pts recover, few die of congestive HF/arrhythmias
unusually severe in preg women/children
viral myocarditis
patchy/diffuse interstitial infiltrate of T lymphocytes, macrophages, rare giant cells, focal myocyte necrosis
viral myocarditis
T. Cruzi
chagas disease
pseudocyst in myocardial fiber –> MYOCARDITIS
flabby/dilated heart
giant cell myocarditis
rare, unkown cause (seen w/ SLE, hypERthyroidism, thymoma)
young/mid age pts
histo: chronic inflamm w/ many giant cells
most pericarditis are acute or chronic?
acute
post-MI (Dressler’s) can lead to
pericarditis
most viral causes of acute pericarditis
likely coxsackie virus
hyperemic border (red) around infarct
age of infarct?
3-7 d
2-4 d post MI
PMNs
interstitial edema, hemorrhage, necrotic myocytes (nuclei disappear)
5-7 d post MI
macrophages
disintegration of dead myofibers
2-8 wks post MI
well-stab granulation tissue
new blood vessels
increased collagen dec
dec cellularity
MVP
mid systolic click
rheumatic fever dx criteria
2 major
or 1 major, 2 minor Jones criteria
minor jones
fever
arthralgia
acute phase reactants
___ occurs as pancarditis
acute rheumatic carditis
caterpillar cells
anitschkow cells
acute rheumatic carditis
Aschoff body
focus of fibrinoid necrosis surr by inflamm cells (plasma cells, lymphocytes, anitschkow cells, Aschoff giant cells)
acute rheumatic endocarditis
vegetations on closure line of cusps
infective endocarditis (subacute)
most come organism
strep viridans
usu w/ predisposing factor (MVP etc)
infective endocarditis (acute)
most come organism
staph aureus
high virulence, can occur w/o predisposing factor
infective endocarditis
bulky, friable, destructive vegetations anywhere in valve
vegetations = fibrin, inflamm cells, bacteria ….later… fibrosis calcification
Which form of AV block may be physiologic?
mobitz I Wenckebach
cardiogenesis is completed by
6th week
cardiogenesis weeks of gestation
3-6 wk
closes archway of septum secundum, becomes valve of foramen ovale
remainder of septum primum
T/F
EtOH abuse contributes to risk of intracranial aneurysm
True
DCM is associated with which viruses
likely caused by AI attack on myocardium (viral myocarditis)
Is HCM a common cause of CM?
No
Restrictive CM usually presents with R or L sided sx?
R
most comm cause of acute pericarditis in immunocompromised
CMV
causes of fibrinous pericarditis
MI uremia chest radiation rheumatic fever lupus trauma
2-4 d post MI
mottling w/ yellow-tan softening
risk for arrythmia