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PATHOphys Exam 2 > Cardiac 4 Shea > Flashcards

Cardiac 4 Shea Flashcards

1
Q
  • Progressive chamber dilation and ____ dysfunction, resulting in a reduction of EF to less than ___%.
  • The most common type of cardiomyopathy.
A
  • Systolic dysfunction
  • 25%
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2
Q

3 secondary causes of Dilated Cardiomyopathy

A
  • Alcohol induced
  • Viral myocarditis
  • Anti-cancer drugs (Adriamycin) *cardiotoxic drug*
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3
Q

Morphology reveals a “heavy heart” which is large and flabby and would collapse if placed on hard surface.

A

Dilated Cardiomyopathy (dilation of all chambers)

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4
Q

Walls are thin and partially replaced by fibrous tissue as a result of what?

A
  • This is Dilated Cardiomyopathy.
  • As a result of dilation.
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5
Q
  • Heart is 2 - 3 times normal size
  • Impaired contractility
  • CHF eventually occurs
A

Dilated cardiomyopathy

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6
Q

Describe the coronary arteries of a heart w/ dilated cardiomyopathy.

A

Usually normal

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7
Q

Is Dilated Cardiomyopathy Primary or Genetic or Idiopathic?

A

All 3

  • Primary
  • Genetic
  • Idiopathic
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8
Q
  • How is genetic form of Dilated Cardiomyopathy most often transmitted?
  • What are the other 2 ways?
  • Which sex are carriers?
  • Which sex have disease?
A
  • Autosomal Dominant trait (most common)
  • Autosomal recessive
  • Sex linked recessive
  • Carriers: females
  • Have disease: males
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9
Q

What are the 4 causes of Secondary Dilated Cardiomyopathy?

A
  • Toxic
  • Viral Myocarditis
  • Pregnancy
  • High Catecholamines (pheochromocytoma)
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10
Q
  • What is the most common substance for Toxic Secondary Dilated Cardiomyopathy?
  • What are the other 3 causes?
A
  • # 1 ethanol
  • Anticancer drugs (Adriamycin and Cytoxin)
  • Long standing Cocaine use
  • Cobalt exposure (inhaled usually from occupation)
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11
Q

Extensive hypertophy of the LV myocardium

A

Hypertrophic Cardiomyopathy

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12
Q

What are other names for hypertrophic cardiomyopathy?

A
  • Hypertrophic Obstructive Cardiomyopathy, bc/ possible LV outflow tract obstruction
  • Idiopathic Hypertrophic Subaortic Stenosis (IHSS) - heart is enlarged, heavy, muscular, exceeding 1200 grams with or without chamber dilation
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13
Q
  • Heart is enlarged, heavy, muscular, exceeding 1200 grams with or without chamber dilation
  • Genetic
A

Idiopathic Hypertrophic Subaortic Stenosis (IHSS)

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14
Q
  • Usually asymmetrical thickening of the ventricular septum as compared to the left ventricular free wall
  • On cross-section, septum looks like what?
  • May be endocardial thickening w/ mural plaque formation of outflow tract. What % travel to the brain?
A
  • Hypertrophic Cardiomyopathy
  • Septum looks like “banana shaped”
  • 70%
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15
Q
  • Decrease in ventricular compliance which results in impaired ventricular filing during ____ w/ normal ____ function.
  • The heart cannot expand adequately to receive the inflowing blood.
A

Restrictive Cardiomyopathy

  • Impaired during diastole
  • Normal Systolic
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16
Q

What are the 5 etiologies of Restrictive Cardiomyopathy?

A
  • Idiopathic
  • Radiation fibrosis
  • Abnormal infiltrate:
    • Amyloid
    • Sarcoidosis
    • Metastatic Tumor (breast cancer)
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17
Q

Abnormal protein which deposits in kidney or heart

A

“amyloid”

(Cardiac Amyloid)

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18
Q

Metastatic Colon Cancer spreading to heart is what type of heart condition?

A

Restrictive Cardiomyopathy

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19
Q

Gross findings:

  • Ventricles normal in size or slightly enlarged
  • Chambers usually not dilated
  • Myocardium is firm

Histologically/Microscopic:

  • Patchy or diffuse interstitial fibrosis
A

Restrictive Cardiomyopathy

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20
Q

What are 3 methods of diagnosing Cardiomyopathies?

A

Non-invasive:

  • ECGs
  • Echocardiograms

Invasive:

  • Endomyocardial Biopsy *punch biopsy* to obtain 3 - 4 pieces for pathologist
    • (inserting catheter through groin such as femoral artery or vein)
    • (insterting catheter through neck such as jugular vein to the left or right side of heart)
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21
Q

Systemic, immunologically mediated disease related to a streptococcal infection

A

Acute Rheumatic Fever

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22
Q

A delayed non-suppurative sequelae to an upper respiratory infection w/ Group A. beta hemolytic Streptococcus (not active) (dead)

A

Acute Rheumatic Fever

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23
Q

Typically, how soon does Acute Rheumatic Fever occur after a Strept throat infection?

A

2 weeks

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24
Q

The immune response elicted by the streptococcus antigens provides the body w/ a defense mechanism against which organism?

A

Strept. Pyogenes

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25
Q

Gram positive cocci, purple, chains

A

Strep

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26
Q

What lab value will be high if patient has rheumatic fever?

A

ASO titer (Antistreptolysin O antibodies)

27
Q

10 to 14 days after strep infection, the patient develops what 3 sxs of rheumatic fever?

A
  • Cardiac issues
  • Joint issues
  • Rash
28
Q
  • What is the #1 reason for heart disease WORLWIDE?
  • Which age range?
  • Why is this not the #1 for the U.S. ?
A
  • Rheumatic Fever
  • 5 to 25 years
  • Good abx, compliance, less crowded living conditions
    *
29
Q

How does our immune reaction cause Acute Rheumatic Fever after a strep infection?

A
  • Strep leaves behind a protein, then our B and T cells produce antibodies which destroy all 3 layers of heart (pancarditis)
  • Damages connective tissue of heart and several other organs/tissues
30
Q

Most people who need a ___ valve replacement had this as a child in 1950 - 1960s.

A
  • Rheumatic Fever
  • Left valve replacement
31
Q

Not acute, it is DELAYED

A

Rheumatic Fever

32
Q
  • What % of manifestations of rheumatic fever are in the brain?
  • What cardiac issues does the patient usually have?
A
  • 20%
  • Fatal arrhythmias
  • Bread/Butter
33
Q
  • Who is most susceptible to ARF?
  • Age, sex, race?
  • How many out of 100,000 is the current rate of the US?
A
  • Children (9-11 yrs), but can occur in adults
  • Not related to sex or race
  • 2
34
Q

A major feature and complication of Acute Rheumatic Fever (ARF)

A

Rheumatic Heart Disease

35
Q

In addition to the heart, what 4 areas of the body are affected by Rheumatic Heart Disease?

A
  • Joints (migratory poly-arthritis)
  • Subcutaneous connective tissue of skin
  • Blood vessels
  • Brain (occasionally)
36
Q

What is the chief cause of heart disease in persons under 50 yrs?

A

Rheumatic Heart Disease

37
Q

What disease is “chorea” associated with? What is it?

A

Rheumatic Heart Disease

  • abnormal involuntary movement disorder
38
Q
  • Non-bacterial sterile inflammatory lesions and granulomas throughout the connective tissue of the body.
  • Where are the lesions mostly located?
A
  • Pathology of Rheumatic Heart Disease
  • Heart
39
Q

What is the characteristic heart pathology of RHD?

A

Pancarditis, involving all 3 layers of the heart

40
Q

Which disease and what is this?

  • Tenacious deposits of fibrin
  • Shaggy surfaces of 2 slices of bread
  • Pericardial friction rub
  • If severe, leads to an adhesive type
A

Rheumatic Heart Disease

Pancarditis (Pericarditis)

41
Q

What is this and what disease is it associated with?

  • heart tends to be dilated
  • Presence of Aschoff Bodies within the myocardium (histologically)
  • With time –> granulomatous appearance, eventually replaced by scar causing dysrhythmias.
A

Myocarditis, associated w/ RHD

42
Q

What is this? Which disease?

  • Aggregates of lymphocytes and macrophages around a central zone of fibrinoid necrosis
A

Aschoff Bodies, Myocarditis, RHD

43
Q

What is responsible for the majority of deaths in the acute phase of this disease (RHD) due to conduction system fibrosis?

A

Myocarditis, RHD

44
Q

The most prominent changes are seen on the valves of the left heart. This valvulitis begins w/ inflammation of the valve surfaces, leading to what?

A

Endocarditis, RHD

Leads to ulceration

45
Q

3 pathologic findings of RHD?

A

Pancarditis:

  • Pericarditis
  • Myocarditis
  • Endocarditis
46
Q

The surface defects of heart valve ulcerations are covered w/ what over time?

  • Which valves are affected?
  • Which side of heart? %?
A

Fibrin thrombi (they grow and assume form of larger vegetations along the lines of closure of valve leaflets).

  • Mitral valve stenosis
  • Aortic valve stenosis
  • 95% left heart
47
Q
  • What are the 2 types of Acute Rheumatic Mitral Valvulitis?
  • Which is early and which is late stage?
A
  • Mitral Valve Regurgitation (insufficiency)/floppy = early
  • Stenosis/stiffening, thickened chordae tendinae, so they shorten. Calcifications = late
48
Q

Which bacteria causes pancarditis/RHD?

A

NONE, this is not bacterial. Strep died.

49
Q
  • Ongoing inflammation inside the valves, leads to destruction of the valves, followed by fibrous scarring that causes valve deformities
  • NO bacteria
A

Vegetations of RHD

50
Q

RHD

  • The chordae tendinae inserting into the mitral valve are typically shortened/thickened and become fused. This fibrous adherence across the “commissures” of the valve produce a _____.
  • Which valve is mostly affected?
A
  • “Fish-Mouth Stenosis”
  • Aortic/Semilunar valve
51
Q

RHD

  • Deformity of leaflets, changes of chordae tendinae, valves become incompetent and do not close completely during ____.
  • What is this called?
A
  • Valvular insufficiency

(redundancy, floppy, regurgitant)

  • Systole
52
Q

RHD

  • Orifice may become stenotic, preventing normal flow of blood from one chamber into another
A

stiffness, stenosis

53
Q

Which chambers of the heart are most likely to become dilated due to aortic valve stenosis?

A

LV and LA

54
Q

Valvular heart disease is a very common cause of ____. ***

A

CHF

55
Q

RHD

What are the 2 end results of valve insufficiencies?

A
  • Mitral Valve Insufficiency
  • Aortic Insufficiency
56
Q

RHD

  • Causes reflux of blood across the ___ from the left ventricle into the left atrium during systole.

(floppy/regurg)

A

Mitral Valve Insufficiency

57
Q

RHD

  • In this condition, blood flows back from the aorta into the left ventricle during diastole, leading to left ventricular hypertrophy and dilation
A

Aortic insufficiency

58
Q

RHD

  • Is the pulmonary system high or low pressure?
A

Low

59
Q

RHD

  • What condition causes “stagnation of blood in left atrium,” with possible clot formation, which is later transmitted into the pulmonary circulation and into the right ventricle?
A

Mitral Stenosis

60
Q

RHD

Which type of stenosis leads to:

  • Left atrial HTN
  • Pulmonary HTN
  • Right ventricular HTN

(which all lead to what?)

A

Mitral Stenosis

  • All lead to Cor Pulmonale (right heart failure) - right ventricle
61
Q

RHD

Which type of stenosis:

  • Impedes blood flow from left ventricle into the aorta
A

Aortic Stenosis

62
Q

RHD

What is the end result of aortic stenosis?

  • There is increased resistance at the outflow tract, so to overcome this, the left ventricle increases the ejection pressure causing LVH (left ventricular hypertrophy)
  • When the hypertrophic heart fails, the back pressure of the blood is transmitted from the LV to LA and into _______–> resulting in _______.
A
  • pulmonary circulation–>
  • resulting in Cor Pulmonale
63
Q

What is responsible for the most deaths after the acute phase of RHD?

A

Endocarditis

PATHOphys Exam 2 (22 decks)

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