Robbins Ch 12 Cardiac Pathology Part 1 Flashcards
Mitral valve prolapse is caused by damage to?
Collagen that weakens the leaftlets
Calcific aortic stenosis is caused by?
What mutation is it associated with?
1) Nodular calcification beginning in interstitial cells
2) NOTCH1
What is the key pathologic feature associated with rheumatic heart disease?
Fibrotic thickening
What is the role of the SA node?
The AV node?
1) Pacemaker of the heart
2) Ensures atrial contraction precedes ventricular systole
When is the heart perfused?
During diastole
What changes are seen in the heart as it ages?
1) Epicardial fat
2) Intracellular lipofuscin accumulations
What changes are seen in the valves as it ages probably as the result of organization of small thrombi?
Lambl excrescences
Pump failure which is a mode of cardiovascular dysfunction has what effect on the myocardium?
What does this ultimately lead to?
1) Contracts weakly during systole and relaxes incompletely
2) Inadequate cardiac output
What is the mechanism where increased filling volumes dilate the heart and thereby increase preload and subsequent actin-myosin cross-bridge formation, enhancing contractility and stroke volume?
Frank-Starling Mechanism
Systolic dysfunction is a progressive deterioration of?
It is reflected as a decrease in?
1) Myocardial contractile function
2) Ejection fraction
Diastolic dysfunction is the inability of?
The heart chamber to expand and fill sufficiently during diastole
What causes pressure-overload hypertrophy?
HTN or aortic stenosis
What leads to volume-overload hypertrophy?
What is the best measure of this hypertrophy?
1) Ventricular dilation
2) Heart weight in dilated hearts
What causes physiologic hypertrophy of the heart?
Aerobic exercise
In terms of congestive heart failure, what causes forward failure?
What causes backward failure?
1) Decreased cardiac output and tissue perfusion
2) Pooling of blood in the venous capacitance system
What is a common cause of left sided heart failure?
HTN
What effect does left sided heart failure have on the lungs?
How is this visualized on CXR?
What is pathognomonic for this condition?
1) Pulmonary edema
2) Kerley B and C lines
3) Hemosiderin-laden macrophages
What effect does left sided heart failure have on the kidneys?
Prerenal azotemia
What effect does left sided heart failure have on the brain in severe cases?
Hypoxic Encephalopathy
Insufficient ejection fraction is seen in what stage of the heartbeat due to left sided heart failure?
Stiff left ventricle that cannot relax is seen during?
Cardiac function is relatively preserved at rest during?
1) Systolic
2) Diastolic
3) Diastolic
What population is left sided heart failure most common in?
Women over 65
What is the most common cause of right sided heart failure?
Left sided heart failure
What is the term for isolated right-sided heart failure that typically occurs in patients with a disorder that affects the lungs?
What lung disorder is most common?
1) Cor Pulmonale
2) Pulmonary HTN
Which sided heart failure is much more associated with systemic edema?
Right sided
What effect does right sided heart failure have on the liver?
Nutmeg liver
What is the hallmark sign of right sided heart failure?
Ankle (pedal) and pretibial edema
How does DiGeorge syndrome present?
CATCH-22:
1) Cardiac abnormality
2) Abnormal facies
3) Thymic aplasia
4) Cleft palate
5) Hypocalcemia
6) All found on chromosome 22
What gene found on chromosome 22 is involved with DiGeorge syndrome?
What does it regulate?
1) TBX1
2) NCC migration
A right to left shunt is a type of congenital heart disease that can lead to?
1) Paradoxical embolism
2) Tetralogy of Fallot
3) Transposition of the great arteries (TGA)
4) Persistent truncus arteriosus
5) Tricuspid atresia
6) Total anomalous pulmonary venous connection
All but paradoxical embolism have a T in them
A left to right shunt can lead to?
1) ASD
2) VSD
3) PDA
All have D’s in the acronym
What term is defined as when pulmonary vascular resistance approaches systemic levels, the original left-to-right shunt becomes a right-to-left shunt and introduces poorly oxygenated blood into the systemic circulation?
Eisenmenger syndrome
What is the difference between hypoplasia and atrophy?
Hypoplasia happens before birth and atrophy happens after
Which sided shunts are the more common congenital heart disease?
Left to right shunts
Left to right shunts are characterized by?
Insufficient cardiac output
90% of atrial septal defect cases are due to defect of the?
Septum secundum
What is present in all cases of ASD?
Murmur is present from excessive fluid
What is the most common congenital cardiac abnormality?
Ventricular septal defect (VSD)
Majority of VSD cases occur with?
Tetralogy of Fallot
90% of VSD cases are termed?
The other 10%?
1) Membranous VSD
2) Infundibular VSD
Where does membranous VSD occur?
Infundibular VSD?
1) Membranous intermuscular septum
2) Below the pulmonary artery or in the area of the muscular septum
In the neonate, the ductus arteriosus closes due to?
Declining local levels of prostaglandin E2
Preservation of ductal patency by giving PGE2 can be life-saving for infants with various congenital malformations that?
Obstruct the pulmonary or systemic outflow tracts
How is patent ductus arteriosus detected?
What is it described as?
1) Continuous harsh murmur
2) Machine like
What do right to left shunts cause early in postnatal life?
Cyanosis
Tetralogy of fallot is defined as?
1) Ventral Septal Defect
2) Obstruction of Right Ventricular Outflow
3) Overriding aorta
4) Right Ventricular Hypertrophy
What does ToF look like on CXR due to right ventricular hypertrophy?
Boot shaped
What is ToF caused by?
Anterior superior displacement of infundibular septum
Clinical consequences of ToF depend primarily on the severity of?
Why?
1) The subpulmonary stenosis
2) B/c this determines the direction of the blood flow
How do the infants present from birth or soon thereafter with ToF?
Cyanotic
With transposition of great arteries, the blood circulating to system is purely?
Deoxygenated
Without any other defect, what is the likelihood of survival with transposition of great arteries?
Low, it is incompatible with life
How does tricuspid atresia present at birth?
Cyanosis is present and there is a great chance of early mortality
