Pathoma - Cardiac Pathology

Question 1

VSD

Answer 1

most common congenital heart abnormality

associated with fetal alcohol syndrome

Question 2

VSD size and clinical manifestation

Answer 2

small - asymptomatic
large - left to right shunting increasing blood volume in pulmonary circuit leading to pulmonary hypertension.
–> after increased pulmonary hypertension over time you get right ventricular hypertrophy, and reversal of the shunt, a right to left shunt. cyanosis. Eisenmengers syndrome.

Question 3

Morphologic changes and complications in myocardial infarction: 4 hrs

Answer 3

Gross: none
Microscopic: none
complication: cardiogenic shock, congestive heart failure, arrhythmia

Question 4

Morphologic changes and complications in myocardial infarction: 4 -24 hours

Answer 4

Gross: dark discoloration
Microscopic: coagulative necrosis
Complication: arrhythmia

Question 5

Morphologic changes and complications in myocardial infarction: 1-3 days

Answer 5

Gross: yellow pallor
Microscopic: neutrophils
Complication: fibrinous pericarditis

Question 6

Morphologic changes and complications in myocardial infarction: 4-7 days

Answer 6

Gross: yellow pallor
Microscopic: macrophages
Complication: rupture (free wall, septum, chordae)

Question 7

Morphologic changes and complications in myocardial infarction: 1-3 weeks

Answer 7

Gross: red border from granulation tissue
Microscopic: grnulation tissue with fibroblasts, collagen, blood vessels
Complication: none

Question 8

Morphologic changes and complications in myocardial infarction: Months

Answer 8

Gross: white scar
Microscopic: fibrosis
Complication: aneurysm (potentially with mural thrombus), Dressler syndrome (autoimmune pericarditis).

Question 9

ASD

Answer 9

most common type is ostium secundum.

ostium primum type is associated with Trisomy 21.

Question 10

ASD clinical findings

Answer 10

fixed split S2 from extra volume on the right side resulting in delayed closure of the pulmonic valve.

paradoxical embolism

Question 11

PDA associated with…

Answer 11

associated with congenital rubella

Question 12

PDA clinical presentation

Answer 12

machine like murmur

can also get reversal of the shunt presenting with lower extremity cyanosis later in life.

Question 13

PDA treatment

Answer 13

indomethacin - inhibits prostaglandin E, which is responsible for keeping the PDA open.

Question 14

Tetralogy of Fallot

Answer 14

stenosis of pulmonary outflow tract
VSD
over riding aorta
RVH

Question 15

Tetralogy of Fallot clinical features

Answer 15

cyanotic baby due to right to left shunting.

squating increases vascular resistance decreasing the shunt, thus sending more oxygen to the lung and decreasing the cyanosis.

Boot shaped heart on X-ray

Question 16

Coarctation of the aorta infantile and adult form associations

Answer 16

narrowing of the aorta classically divided into infantile and adult forms.
infantile form associated with turners syndrome
adult form associated with bicuspid aortic valve

Question 17

Coarctation of the aorta clinical presentation

Answer 17

• infant: presents with lower extremity cyanosis, often at birth. The coarctation occurs after aortic arch (the upper extremity branches), but before the PDA. Hypotension after the coarctation allows for right to left shunting through PDA leading to cyanosis.
• adult: hypertension in the upper extremities and weak pulses/hypotension in the lower extremities.
• -> collateral circulation accommodating upper extremity hypertension leads to rib notching on X-ray.

Question 18

Pancarditis of Acute Rheumatic Fever

Answer 18

• Mitral valve is involved more commonly than the aortic valve. Vegetations are seen on the leaflet.
• Myocarditis is the most common cause of death from acute rheumatic fever. On histology can see Aschoff bodies: foci of chronic inflammation. In these areas there are reactive histiocytes with wavy nuclei (caterpillar nuclei).
• Pericarditis leading to friction rub and chest pain.

Question 19

S Viridans endocarditis

Answer 19

most common cause of endocarditis, low virulence organism. infects previously damaged valves.

• small vegetations, will not destroy the valves.

Question 20

Pathogenesis of endocarditis

Answer 20

• damaged valve has THROMBOTIC vegetations on the surface (platelets and fibrin). Transient bacteremia (such as a dental procedure) can lead to bacteria being caught in these thrombotic vegetations.

Question 21

S. Aureus endocarditis

Answer 21

Most common cause of endocarditis in IV drug users. virulent organism. will cause vegetations that do damage the valve.

–> most commonly damages the tricuspid valve

Question 22

S. epidermidis endocarditis

Answer 22

causes endocarditis of prosthetic valves

Question 23

S. Bovis endocarditis

Answer 23

associated with colorectal carcinoma

Question 24

HACEK organism endocarditis

Answer 24

• will have negative blood cultures

Question 25

non-bacterial thrombotic endocarditis

Answer 25

• sterile vegetations associated with hypercoaguable state or underlying carcinoma

Question 26

Libman- Sacks endocarditis

Answer 26

sterile vegetations on both atrial and ventricular side of the mitral valve in association with SLE.

Question 27

Dilated cardiomyopathy

Answer 27

A dilation of all 4 chambers of the heart. Resulting in systolic dysfunction leading to biventricular CHF.

Complications in include mitral and tricuspid regurgitation and arrhythmia.

Question 28

Dilated cardiomyopathy etiology

Answer 28

1. most commonly idiopathic
2. myocarditis, usualy coxsackie B virus. On histology can see lymphocytic infiltrate of the myocardium.
3. Alcohol abuse
4. drugs (doxorubicin)
5. Pregnancy (late in pregnancy or weeks to months after birth)

Question 29

Restrictive cardiomyopathy - causes

Answer 29

amyloidosis 
sarcoidosis 
hemochromatosis 
Loeffler syndrome (endomyocardial fibrosis with eosinophilic infiltrate and eosinophilia)

Question 30

Restrictive cardiomyopathy - presentation

Answer 30

congestive heart failure, low voltage EKG with diminished QRS amplitude.

Question 31

Myxoma

Answer 31

benign mesenchymal tumor. gelatinous appearance. abdundant ground substance on histology.

Most common primary cardiac tumor in adults.

Usually arises in the left atrium as a pedunculated mass that causes syncope due to obstruction of the mitral valve.

Question 32

Rhabdomyoma

Answer 32

benign hamartoma of the cardiac muscle.
most common primary cardiac tumor in children.
associated with tuberous sclerosis.
often arises in the ventricle.

Question 33

Most common cardiac tumor

Answer 33

• metastasis
• breast, lung, melanoma, lymphoma
• most commonly involve the pericardium resulting in pericardial effusion.

Question 34

Causes of dilated cardiomyopathy ABCCCD

Answer 34

Alcohol
Beriberi (wet)
Cocaine
Coxsackie
Chagas disease 
Drugs (doxyrubicin)

Question 35

Causes of restrictive cardiomyopathy

Answer 35

sarcoidosis 
amyloidosis 
postradiation fibrosis 
endocardial fibroelastosis
Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate)
Hemochromatosis

Question 36

Heart Failure Cells

Answer 36

hemosiderin laden macrohphages in the lungs

Question 37

nutmeg liver

Answer 37

seen in right heart failure

Question 38

Treatment for acute coronary syndrome

Answer 38

anticoagulation (heparin)
antiplatelet therapy (aspirin and clopidogrel)
B-blockers
ACE inhibitors
statins
symptoms control with nitroglycerin and morphine

Question 39

heart failure medications

Answer 39

ACE inhibitors
Beta blockers (d/c for acute decompensated heart failure)
spironolactone
– all these decrease mortality
Thiazide or loop diuretics are used for symptomatic relief.