10/26 - Pathology of the Heart

Question 1

infective endocarditis can be subacute or acute depending on what

Answer 1

virulence of organism
1. low virulence
2. high virulence

Question 2

what virulence has low-grade fever, malaise, and weight loss?

Answer 2

low virulence

Question 3

what virulence has high fever, shaking chills, and overt septicemia?

Answer 3

high virulence

Question 4

what are organisms of high virulence in acute endocarditis? what valves involved

Answer 4

staph aureus; normal valves

Question 5

how do people get acute infective endocarditis

Answer 5

IV drug use

Question 6

what valves are involved in acute infective endocarditis

Answer 6

tricuspid and pulmonary valves (rather than left heart valves)

Question 7

what is caused by low virulence organisms on previously damaged valves and streptococcus viridans?

Answer 7

subacute infective endocarditis

Question 8

who gets subacute infective endocarditis

Answer 8

Pre-existing cardiac abnormalities, especially valvular disease:

Small Ventriculoseptal defects
Calcific aortic stenosis
Mitral valve prolapse (most common predisposing factor)
Chronic rheumatic valvular disease

Question 9

what is involved in noninfective endocarditis

Answer 9

1. lupus erythematous
2. usually mitral valve (“Libman-Sacks Disease”)

Question 10

which condition in which libman sacks endocarditis is seen

Answer 10

systemic lupus erythematosus

Question 11

what layer involved in cardiomyopathy

Answer 11

muscular layer

Question 12

what are the different functional patterns of cardiomyopathy

Answer 12

1. dilated
2. hypertrophic
3. restrictive

Question 13

functional pattern: DILATED

left ventricular ejection fraction
mechanism of failure
CAUSES
secondary myocardial dysfunction

Answer 13

especially know: genetics, alcoholism, and sarcoidosis

Question 14

functional pattern: HYPERTROPHIC

left ventricular ejection fraction
mechanism of failure
CAUSES
secondary myocardial dysfunction

Answer 14

especially know genetics and diabetic mothers

Question 15

functional pattern: RESTRICTIVE

left ventricular ejection fraction
mechanism of failure
CAUSES
secondary myocardial dysfunction

Answer 15

especially know amyloid (protein) and radiation

Question 16

what is the inflammatory process causing myocardial injury (middle heart)

Answer 16

myocarditis

Question 17

causes of myocarditis

Answer 17

1. infection mediated (viral, bacterial, parasistic, fungal)
2. immune mediated myocardial injury (not well understood)

Question 18

how does myocarditis present

Answer 18

1. arrythmias, congestive heart failure
2. dilated cardiomyopathy

Question 19

what infiltrate and damage myocardial fibers

Answer 19

lymphocytes

Question 20

what are abnormalities of the pericardium

Answer 20

1. pericarditis
2. pericardial effusion
3. hemopericardium

Question 21

causes of pericarditis

Answer 21

1. infectious agents
2. presumably immunilogically mediated
3. misc

Question 22

infectious agents that cause pericarditis

Answer 22

1. Viruses
2. Pyogenic bacteria
3. TB
4. Fungi
5. Other parasites

Question 23

immunologically mediated causes of pericarditis

Answer 23

1. Rheumatic fever
2. SLE
3. Scleroderma
4. Drug hypersensitivity reaction

Question 24

what are misc. causes of pericarditis

Answer 24

1. MI
2. Uremia
3. After cardiac surgery
4. Neoplasia
5. Trauma
6. Radiation

Question 25

what is the most frequent type of pericarditis

Answer 25

fibrinous and serofibrinous pericarditis

Question 26

what is fibrinous and serofibrinous pericarditis associated with

Answer 26

1. Acute myocardial infarction 2. Systemic lupus erythematosus (SLE) 3. Chest irradiation 4. Trauma

Question 27

what can develop a loud pericardial friction rub

Answer 27

fibrinous and serofibrinous pericarditis

Question 28

what can comprimise cardiac output due to fluid accumulation in percardcial sac

Answer 28

fibrinous and serofibrinous pericarditis

Question 29

what can purulent (bacterial) pericarditis complicate?

Answer 29

1. Empyema (pleural space infection) 2. Lobar pneumonia 3. Mediastinal infections 4. Infective endocarditis ALSO: bacterial septicemia

Question 30

is chronic, fibrosing pericarditis a constrictive pericarditis?

Answer 30

YES

Question 31

what is fibrosis with obliteration of pericardial cavity

Answer 31

constrictive pericarditis

Question 32

is chronic, fibrosing pericarditis idiopathic

Answer 32

yes

Question 33

causes of chronic, fibrosing pericarditis

Answer 33

radiation therapy, infection post surgery

Question 34

what may represent the result of any pericarditis which resolved with scarring

Answer 34

chronic, fibrosing pericarditis

Question 35

what occurs when fluid accumulation in the pericardial space occurs

Answer 35

pericardial effusions

Question 36

the nature of pericardial effusion is determined by what causes?

Answer 36

1. Serous: congestive heart failure, hypoalbuminemia 2. Serosanguineous (watery, blood tinged): blunt chest trauma, malignancy 3. Chylous (milky): mediastinal lymphatic obstruction, usually by mediastinal neoplasm

Question 37

clinical features of pericardial effusions

Answer 37

1. Often asymptomatic 2. Cardiac tamponade; heart unable to expand during diastole due to fluid in sac 3. Relatively common in SLE

Question 38

what occurs when heart is unable to expand during diastole due to fluid in sac

Answer 38

cardiac tamponade

Question 39

what happens in hemopericardium

Answer 39

1. Ruptured infarction 2. Penetrating cardiac trauma 3. Cardiac tamponade results