Valvular pathology Flashcards
Cardiomyopathy definition
heart disease resulting from abnormality in myocardium, excludes ischemic heart disease, valve related heart disease, hypertensive heart disease
Dilated cardiomyopathy -Define the macroscopic appearance of the heart
enlarged ventricle +/- atria with thinning of the wall
Name the mechanism of heart failure in dilated cardiomyopathy and myocardial pathological changes
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Name several examples of associated disease processes with dilated cardiomyopathy
Idiopathic, toxic (ethanol, adriamycin), metabolic (hemochromatosis), inflammatory (sarcoidosis), traumatic or degenerative (dystrophy)
Hypertorphic cardiomyopathy -Define the macroscopic appearance of the heart and pathological changes
•Thickened interventricular septum bulges into the left ventricle outflow tract during early systole. outflow obstruction through aortic valve (~25%) / ejection murmur. Anterior leaflet of the mitral valve may also impinge on septal wall during systole. Pathologic Changes: Non-specific hypertrophy & disarray of fibers
Name the mechanism of heart failure in hypertrophic cardiomyopathy
Impaired compliance - diastolic / relaxation
Name several examples of associated disease processes with hyertrophic cardiomyopathy
Genetic: Degenerative (dystrophy); metabolic (glycogen storage disease); infants of diabetic mothers
Define macroscopic appearance of heart in restrictive cardiomyopathy and pathologic changes and mechanism of failure
- Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
- Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
- Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
- Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
Name several examples of associated disease processes with restrictive cardiomyopathy
Idiopathic, Metabolic-Ischemic (amyloidosis); Traumatic (radiation); inflammatory (sarcoidosis)
Describe the anatomic finding in myofibers in the setting of hypertrophy
Hypertrophy and disarray of fibers. Same number of myocytes but more sarcomeres
Name the most common form of hypertension (~90%)
Essential (or primary) HTN is idiopathic and found in 90% of cases. Secondary HTN is related to renal disease, endocrine disease or cardiovascular disease
Name several renal disease processes that manifest as systemic hypertension
Chronic renal disease (trauma), glomerulonephritis (inflam), vasculitis (inflam), renal artery stenosis (trauma), polycystic renal disease (developmental), neoplasm
Name a developmental process involving the aorta that leads to hypertension
Coarctation of arota - developmental
Name at least one hypertension-associated disease process in each of the following organs a. Pituitary b. Thyroid c. Adrenal
Pituitary- acromegaly (neoplasm). Thyroid: hyperthyroidism- thyrotoxicosis (inflam). Adrenal: adenoma- aldosterone (neooplasm) and pheochromocytoma (neoplasm)
Complications of systemic HTN
- Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
- Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
- Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
- Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
- Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
- Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
- Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
- Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
Define the most common cause of right heart failure
left heart failure
Define “cor pulmonale”
Pulmonary HTN due to pulmonary parenchyma disease, pulmonary vessel disease, or Chest movement alterations. Plus exclusion of left heart failure
Name at least two diseases leading to pulmonary hypertension resulting from a. Pulmonary parenchymal disease
b. Pulmonary vascular diseases
c. Chest movement-associated diseasesName at least two diseases leading to pulmonary hypertension resulting from a. Pulmonary parenchymal disease
b. Pulmonary vascular diseases
c. Chest movement-associated diseasesName at least two diseases leading to pulmonary hypertension resulting from a. Pulmonary parenchymal disease
b. Pulmonary vascular diseases
c. Chest movement-associated diseases
pulmonary parenchyma disease: a. Emphysema b. Interstitial lung disease c. Bronchiectasis d. Pneumoconiosis. pulmonary vessel disease: a. Pulmonary Emboli b. Primary pulmonary hypertension c. Radiation d. Tumor in vessels. Chest movement alterations: obesity, muslce diseases, denervating diseases
give examples of etiologies that can manifest with left heart failure
Ischemic cardiomyopathy, nonischemic cardiomyopathy, HTN, valve disease (aortic or mitral)
Name complications of left heart failure
Right hear failure, edema, reduced kidney perfusion, hypoxic encephalopathy
Recognize that congenital heart disease can manifest with right heart failure
OK
Distinguish pulmonary causes of right heart failure
pulmonary parenchyma disease, pulmonary vessel disease, or Chest movement alterations.
Name examples of diseases of the lung that lead to increased right heart work
Pulmonary Parenchymal Disease, Pulmonary vessel disease
Name complications of right heart failure
Organ congestion (liver, spleen, others), peripheral edema
A. Name examples of disease that result in the following types of endocarditis: 1. Serous, 2. Fibrinous, 3. Purulent, 4. Hemorrhagic, 5. Caseating
Serous: Metabolic (uremia), inflammatory (SLE, rheumatic fever, sarcoid), infectious. Fibrinous: metabolic (uremia), inflammatory (SLE, rheumatic fever, RA), ischemic (dressler syndrome), truama. Purulent: infection. Caseous: TB infection. Hemorrhagic: neoplasm, trauma, infection
Name a collagen vascular disease (CVD) / connective tissue disease (CTD) which can manifest with pericarditis
Rheumatoid arthritis
Name variant of pericarditis most commonly seen in CVD / CTD
fibrinous
Name infectious etiologies that can manifest with pericarditis
Bacteria (staph, Neisseria meningitidis, TB), viral (influenza, HIV, adenovirus), fungal
How does Chronic renal failure / uremia (uremic pericarditis) affect pericardium
dont know
Most common variant of pericarditis in chronic renal failure
Serous or fibrinous
Recognize the implications of pericardium of trauma
Hemorrhagic pericarditis due to blunt force tauma. Fibrinous pericarditis from radiation
Recognize the implications of pericardium of ischemic disease
Dressler syndrome: results in fibrinous pericarditis several weeks after MI
Name the “syndrome” (possibly immune-related) that can manifest with pericarditis after a myocardial infarct
Dressler syndrome
List examples of neoplasms that most commonly metastasize to the pericardium
breast carcinoma, lung, carcinoma, other carcinomas, lymphomas, leukemias
Name the specific variant of pericarditis most commonly seen in neoplastic pericarditis
hemorrhagic
Name the primary neoplastic disease arising from mesothelial cells
Mesothelioma
Define cardiac tamponade
Pericardial sac accumulation of blood, fibrinopurulent exudate or effusion which reduces volume of expansion during diastole and results in inadequate blood volume circulating.
List the name of the process where the parietal and visceral pericardium fuse
Adhesion of visceral and parietal pericardium results in constrictive pericarditis
Name a complication of this fusion of the pericardial fusion
Reduced CO leads to hyptension, fatigue, elevated systemic venous pressure (hepatomegaly, ascites, peripheral edema, jugular venous distenstion)
Name treatment for constrictive pericarditis
Pericardial window is cut to relieve constriction
List the long-term implications of a bicuspid aortic valve
stenosis, calcification
Complications of prolapse of mitral valve
Regurgitation, infective endocarditis
Describe the dystrophic mineralization process, asymptomatic vs. symptomatic, that occurs in the setting of aortic stenosis in relation to aging, abnromal valves,
Aging (asymptomatic early; can serve as substrate for vegetations), Abnormal valve (e.g. bicuspid aortic valve)
Describe the primary complications of stenosis of the aortic valve
LV outflow deficit and LV hypertrophy. Mycoardial oxygen demand is increased in hypertrophied ventricle, but blood supply is limited due to reduced outflow, this leads to angina. Also reduced flow to systemic circulation results in syncope and dizziness
Describe the key features of rheumatic valvular disease with respect to the leaflets and chordae tendinae
Valve Leaflets and Cusps: fibrosis, fusion, calcification. Chordae Tendinea: fibrosis, fusion, and shortening
List several complications of rheumatic valve disease
Valve stenosis / incompetence … can progress to heart failure. Susceptibility to infective endocarditis. Mural thrombus formation in atrium leads to thromboemboli
Valves most commonly involved in rheumatic valve disease
Mitral is most common, followed by aortic valve
Distinguish the two major classes of vegetations and their etiologies
Non-infectious vegetations (Non-Infectious endocarditis): - Marantic: solid neoplasms, or thrombus formation on valve. Caused by Libman-Sachs endocarditis from Lupus (CVD, or rheumatic heart disease. . Infectious vegetations = “Infectious endocarditis”
List complications of vegetations
Obstruction of the coronary sinuses / embolism to heart, Embolize systemically (called septic emboli if from infectious vegetation), Destruction of valve integrity (infectious endocarditis)
