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CVPR II > Valvular pathology > Flashcards

Valvular pathology Flashcards

1
Q

Cardiomyopathy definition

A

heart disease resulting from abnormality in myocardium, excludes ischemic heart disease, valve related heart disease, hypertensive heart disease

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2
Q

Dilated cardiomyopathy -Define the macroscopic appearance of the heart

A

enlarged ventricle +/- atria with thinning of the wall

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3
Q

Name the mechanism of heart failure in dilated cardiomyopathy and myocardial pathological changes

A

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

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4
Q

Name several examples of associated disease processes with dilated cardiomyopathy

A

Idiopathic, toxic (ethanol, adriamycin), metabolic (hemochromatosis), inflammatory (sarcoidosis), traumatic or degenerative (dystrophy)

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5
Q

Hypertorphic cardiomyopathy -Define the macroscopic appearance of the heart and pathological changes

A

•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

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6
Q

Name the mechanism of heart failure in hypertrophic cardiomyopathy

A

Impaired compliance - diastolic / relaxation

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7
Q

Name several examples of associated disease processes with hyertrophic cardiomyopathy

A

Genetic: Degenerative (dystrophy); metabolic (glycogen storage disease); infants of diabetic mothers

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8
Q

Define macroscopic appearance of heart in restrictive cardiomyopathy and pathologic changes and mechanism of failure

A
  • 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
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9
Q

Name several examples of associated disease processes with restrictive cardiomyopathy

A

Idiopathic, Metabolic-Ischemic (amyloidosis); Traumatic (radiation); inflammatory (sarcoidosis)

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10
Q

Describe the anatomic finding in myofibers in the setting of hypertrophy

A

Hypertrophy and disarray of fibers. Same number of myocytes but more sarcomeres

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11
Q

Name the most common form of hypertension (~90%)

A

Essential (or primary) HTN is idiopathic and found in 90% of cases. Secondary HTN is related to renal disease, endocrine disease or cardiovascular disease

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12
Q

Name several renal disease processes that manifest as systemic hypertension

A

Chronic renal disease (trauma), glomerulonephritis (inflam), vasculitis (inflam), renal artery stenosis (trauma), polycystic renal disease (developmental), neoplasm

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13
Q

Name a developmental process involving the aorta that leads to hypertension

A

Coarctation of arota - developmental

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14
Q

Name at least one hypertension-associated disease process in each of the following organs a. Pituitary b. Thyroid c. Adrenal

A

Pituitary- acromegaly (neoplasm). Thyroid: hyperthyroidism- thyrotoxicosis (inflam). Adrenal: adenoma- aldosterone (neooplasm) and pheochromocytoma (neoplasm)

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15
Q

Complications of systemic HTN

A
  1. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
  2. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
  3. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
  4. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
  5. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
  6. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
  7. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
  8. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
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16
Q

Define the most common cause of right heart failure

A

left heart failure

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17
Q

Define “cor pulmonale”

A

Pulmonary HTN due to pulmonary parenchyma disease, pulmonary vessel disease, or Chest movement alterations. Plus exclusion of left heart failure

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18
Q

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

A

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

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19
Q

give examples of etiologies that can manifest with left heart failure

A

Ischemic cardiomyopathy, nonischemic cardiomyopathy, HTN, valve disease (aortic or mitral)

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20
Q

Name complications of left heart failure

A

Right hear failure, edema, reduced kidney perfusion, hypoxic encephalopathy

21
Q

Recognize that congenital heart disease can manifest with right heart failure

A

OK

22
Q

Distinguish pulmonary causes of right heart failure

A

pulmonary parenchyma disease, pulmonary vessel disease, or Chest movement alterations.

23
Q

Name examples of diseases of the lung that lead to increased right heart work

A

Pulmonary Parenchymal Disease, Pulmonary vessel disease

24
Q

Name complications of right heart failure

A

Organ congestion (liver, spleen, others), peripheral edema

25
Q

A. Name examples of disease that result in the following types of endocarditis: 1. Serous, 2. Fibrinous, 3. Purulent, 4. Hemorrhagic, 5. Caseating

A

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

26
Q

Name a collagen vascular disease (CVD) / connective tissue disease (CTD) which can manifest with pericarditis

A

Rheumatoid arthritis

27
Q

Name variant of pericarditis most commonly seen in CVD / CTD

A

fibrinous

28
Q

Name infectious etiologies that can manifest with pericarditis

A

Bacteria (staph, Neisseria meningitidis, TB), viral (influenza, HIV, adenovirus), fungal

29
Q

How does Chronic renal failure / uremia (uremic pericarditis) affect pericardium

A

dont know

30
Q

Most common variant of pericarditis in chronic renal failure

A

Serous or fibrinous

31
Q

Recognize the implications of pericardium of trauma

A

Hemorrhagic pericarditis due to blunt force tauma. Fibrinous pericarditis from radiation

32
Q

Recognize the implications of pericardium of ischemic disease

A

Dressler syndrome: results in fibrinous pericarditis several weeks after MI

33
Q

Name the “syndrome” (possibly immune-related) that can manifest with pericarditis after a myocardial infarct

A

Dressler syndrome

34
Q

List examples of neoplasms that most commonly metastasize to the pericardium

A

breast carcinoma, lung, carcinoma, other carcinomas, lymphomas, leukemias

35
Q

Name the specific variant of pericarditis most commonly seen in neoplastic pericarditis

A

hemorrhagic

36
Q

Name the primary neoplastic disease arising from mesothelial cells

A

Mesothelioma

37
Q

Define cardiac tamponade

A

Pericardial sac accumulation of blood, fibrinopurulent exudate or effusion which reduces volume of expansion during diastole and results in inadequate blood volume circulating.

38
Q

List the name of the process where the parietal and visceral pericardium fuse

A

Adhesion of visceral and parietal pericardium results in constrictive pericarditis

39
Q

Name a complication of this fusion of the pericardial fusion

A

Reduced CO leads to hyptension, fatigue, elevated systemic venous pressure (hepatomegaly, ascites, peripheral edema, jugular venous distenstion)

40
Q

Name treatment for constrictive pericarditis

A

Pericardial window is cut to relieve constriction

41
Q

List the long-term implications of a bicuspid aortic valve

A

stenosis, calcification

42
Q

Complications of prolapse of mitral valve

A

Regurgitation, infective endocarditis

43
Q

Describe the dystrophic mineralization process, asymptomatic vs. symptomatic, that occurs in the setting of aortic stenosis in relation to aging, abnromal valves,

A

Aging (asymptomatic early; can serve as substrate for vegetations), Abnormal valve (e.g. bicuspid aortic valve)

44
Q

Describe the primary complications of stenosis of the aortic valve

A

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

45
Q

Describe the key features of rheumatic valvular disease with respect to the leaflets and chordae tendinae

A

Valve Leaflets and Cusps: fibrosis, fusion, calcification. Chordae Tendinea: fibrosis, fusion, and shortening

46
Q

List several complications of rheumatic valve disease

A

Valve stenosis / incompetence … can progress to heart failure. Susceptibility to infective endocarditis. Mural thrombus formation in atrium leads to thromboemboli

47
Q

Valves most commonly involved in rheumatic valve disease

A

Mitral is most common, followed by aortic valve

48
Q

Distinguish the two major classes of vegetations and their etiologies

A

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”

49
Q

List complications of vegetations

A

Obstruction of the coronary sinuses / embolism to heart, Embolize systemically (called septic emboli if from infectious vegetation), Destruction of valve integrity (infectious endocarditis)

CVPR II (25 decks)

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