Pathoma - Cardiac Pathology Flashcards Preview

STEP 1 STUFF > Pathoma - Cardiac Pathology > Flashcards

Flashcards in Pathoma - Cardiac Pathology Deck (39)
Loading flashcards...
1
Q

VSD

A

most common congenital heart abnormality

associated with fetal alcohol syndrome

2
Q

VSD size and clinical manifestation

A

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.

3
Q

Morphologic changes and complications in myocardial infarction: 4 hrs

A

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

4
Q

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

A

Gross: dark discoloration
Microscopic: coagulative necrosis
Complication: arrhythmia

5
Q

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

A

Gross: yellow pallor
Microscopic: neutrophils
Complication: fibrinous pericarditis

6
Q

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

A

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

7
Q

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

A

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

8
Q

Morphologic changes and complications in myocardial infarction: Months

A

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

9
Q

ASD

A

most common type is ostium secundum.

ostium primum type is associated with Trisomy 21.

10
Q

ASD clinical findings

A

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

paradoxical embolism

11
Q

PDA associated with…

A

associated with congenital rubella

12
Q

PDA clinical presentation

A

machine like murmur

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

13
Q

PDA treatment

A

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

14
Q

Tetralogy of Fallot

A

stenosis of pulmonary outflow tract
VSD
over riding aorta
RVH

15
Q

Tetralogy of Fallot clinical features

A

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

16
Q

Coarctation of the aorta infantile and adult form associations

A

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

17
Q

Coarctation of the aorta clinical presentation

A
  • 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.
18
Q

Pancarditis of Acute Rheumatic Fever

A
  • 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.
19
Q

S Viridans endocarditis

A

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

  • small vegetations, will not destroy the valves.
20
Q

Pathogenesis of endocarditis

A
  • 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.
21
Q

S. Aureus endocarditis

A

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

22
Q

S. epidermidis endocarditis

A

causes endocarditis of prosthetic valves

23
Q

S. Bovis endocarditis

A

associated with colorectal carcinoma

24
Q

HACEK organism endocarditis

A
  • will have negative blood cultures
25
Q

non-bacterial thrombotic endocarditis

A
  • sterile vegetations associated with hypercoaguable state or underlying carcinoma
26
Q

Libman- Sacks endocarditis

A

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

27
Q

Dilated cardiomyopathy

A

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.

28
Q

Dilated cardiomyopathy etiology

A
  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)
29
Q

Restrictive cardiomyopathy - causes

A
amyloidosis 
sarcoidosis 
hemochromatosis 
Loeffler syndrome (endomyocardial fibrosis with eosinophilic infiltrate and eosinophilia)
30
Q

Restrictive cardiomyopathy - presentation

A

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

31
Q

Myxoma

A

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.

32
Q

Rhabdomyoma

A

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

33
Q

Most common cardiac tumor

A
  • metastasis
  • breast, lung, melanoma, lymphoma
  • most commonly involve the pericardium resulting in pericardial effusion.
34
Q

Causes of dilated cardiomyopathy ABCCCD

A
Alcohol
Beriberi (wet)
Cocaine
Coxsackie
Chagas disease 
Drugs (doxyrubicin)
35
Q

Causes of restrictive cardiomyopathy

A
sarcoidosis 
amyloidosis 
postradiation fibrosis 
endocardial fibroelastosis
Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate)
Hemochromatosis
36
Q

Heart Failure Cells

A

hemosiderin laden macrohphages in the lungs

37
Q

nutmeg liver

A

seen in right heart failure

38
Q

Treatment for acute coronary syndrome

A

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

39
Q

heart failure medications

A

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.