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CVM II > Cardiac Path II > Flashcards

Cardiac Path II Flashcards

(53 cards)

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1
Q

What is the most common valve abnormality ?

A

calcific aortic stenosis

2% of population

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2
Q

What is calcific aortic stenosis ?

A

affected valves contain osteoblast-like cells, deposit osteoid-like substance ->ossifies
Prevent complete opening of valve
cusp free edges spared

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3
Q

What causes the wear and tear of calcific aortic stenosis and what can show an accelerated course?

A

Wear and tear - hyperlipidemia, chronic HTN, inflammation
Bicuspid valve accelerates; responsible for half of stenosis
usually manifest in 60-80 but with bicuspid, 50-70s

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4
Q

What causes mitral annular calcification?

A

Degenerative, noninflammatory calcific deposits

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5
Q

Describe mitral annular calcificaton

A

Deposits in fibrous annulus
Does not affect valve function
Nodules may become sites fro thrombus formation or IE
Female, older, and with MVP

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6
Q

What is MVP?

A

myxomatous degeneration (PG deposit)
valve leaflets prolapse back into LA during systole
leaflets thick, rubbery due to proteoglycan deposits and elastic fiber disruption
Can cause thrombi to form

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7
Q

Who does MVP usually affect?

A

2-3% adults in US

Female, usually incidental

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8
Q

What are the symptoms and complications of MVP?

A

usually asymptomatic
Some may have angina-like pain or dyspnea
Complications: rare - IE, mitral insufficieny, Thromboemolism, arrhythmias

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9
Q

What is Rheutamic fever?

A

multisystem inflammatory disorder follwoing pharyngeal infection with group A streptococcus
Incidence decreased

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10
Q

What is the only cause of acquired mitral valve stenosis?

A

RHD

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11
Q

What is the pathogenesis of RHD?

A

immune response to streptococcal M proteins cross reacts with cardiac self antigens
T cells/Abs/and Mo

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12
Q

What is acute RF?

A

Acute RF occurs 10 days - 6 weeks after grp A strepinfection
Anti-strep O; anti-DNase B
can include pancarditis, migratory polyarthritis, subcutaneous nodules, rash, syndenham chorea

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13
Q

What are cardiac features of Acute RF?

A

pancarditis, featuring Aschoff bodies (Mo)
Vegetations
Inflammation, fibrinoid necrosis

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14
Q

What are the cardiac features of Chronic RHD?

A

mitral leaflet thickening, fusion, shortening of commisures, fusion and thickening of tendinous cords,
Mitral stenosis -> LA enlargement-> atrial fib/thrombosis; pulm cong/RHF
Fishmouth

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15
Q

What is infective endocarditis?

A

An infection of valves and endocardium

Vegetations consisting of microbes and debris, associated with underlying tissue destruction

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16
Q

What is acute infective endocarditis?

A

rapidly progressing, destructive infection of a previously normal valve
Mainly due to Staph aureus
Requires surgery and Antibiotics

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17
Q

What is subacute IE

A

Slower-progressing infection of a previously deformed valve
Cured with antibiotics alone
Strep viridans

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18
Q

What are the predisposing conditions of IE?

A

valvular abnormalities - RHD, prosthetic valves, MV prolapse, calcific stenosis, bicuspid AV
Bacteremia from another site, dental work, needles

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19
Q

What are the classic features of IE?

A

friable, bulky destructive valvular vegetations
Left-sided valves more common
Septic emboli - can seed at another spot
Invasion of adjacent myocardium or aorta can cause abscesses

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20
Q

What are some classic features of IE in a drug user?

A

Right sided valves involved

Staph aureus

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21
Q

What are symptoms of IE?

A

nonspecific - fever, weight loss, fatigue

Murmur with left-sided lesions

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22
Q

What are the organisms involved in IE?

Study These Flashcards
A

S. viridans - valve abnormal
S. Aureus - normal valves, IV drug, abnormal valves
S. epidermidis - prosthetic valves
HACEK

23
Q

What is nonbacterial thrombotic endocarditis?

Study These Flashcards
A

small, sterile thrombi on cardiac valve leaflets, along the line of closure
May be a source of emboli
Associated with malignancies (especially adenocarcinomas), sepsis, or catheter trauma

24
Q

What is Libman-Sacks disease?

Study These Flashcards
A

endocarditis of SLE

Small fibrinous sterile vegetations on either side of valve leaflets

25
what are the complications of prosthetic valves?
IE, occlusion Mechanical - thromboembolic complications Bioprosthetic - calcification or tears
26
What is the most common type of cardiomyopathies?
dilated - 90%
27
What are some causes of dilated cardiomyopathy?
Familial 30-50%: TTN, AD Alcohol Myocarditis Cardiotoxic drugs: doxorubicin, cobalt, iron overload
28
What is the morphology of DCM
Dilation of all chambers Mural thrombi are common - LA and LV Functional regurgitation of valves
29
what is the clinical presentation of DCM
age 20-50 progressive CHF->dyspnea, exertional fatique, decrease EF (less than 40%) Arrhythmias Embolism
30
What is takotsubo cardiomyopathy?
broken heart syndrome Excess catecholamines following extreme emotional or psychological stress Mostly women 58-75 Symptoms similar to MI Apical ballooning of LV with abnormal wall motion and contractile dysfunction
31
what is arrhythmogenic right ventricular cardiomyopathy?
right ventricular failure and arrhytmias Myocardium of RV wal replaced by adipose and fibrosis Desmosome gene involved at intercalated disc Causes ventricular tachycardia and fibrillation, SCD Familial - AD
32
What is hypertrophic cardiomyopathy ?
genetic disorder leading to myocardial hypertrophy and diastolic dysfunction, leading to reduced SV and ventricular outflow obstruction Mutation: b-myosin collapse of young athlete
33
What is the morphology of hypertrophic CM?
massive myocardial hypertrophy Marked septal hypertrophy Myocyte disarray banana like ventricle
34
What are the consequences of extensive hypertrophy with HCM?
``` foci of myocardial ischemia left atrial dilation and mural thrombus Diminished CO and Increased pulmonary congestion - extertional dyspnea Arrhythmia SCD ```
35
What is restrictive cardiomaypathy?
decreased ventricular compliance leading to diastolic dysfunction may be secondary to deposition of material in wall (amyloid) or increased fibrosis (radiation) Ventricles normal size but atria can be enlarged
36
What is amyloid?
extracellular deposition of proteins which form an insoluble beta-pleated sheet May be systemic (myeloma) or restricted to heart (transthyretin) When in interstitium of myocardium->RCM green in plain polarized light (congo red)
37
What is myocarditis? what is it most commonly due to?
Inflammation of myocardium Due to virus - Cox A and B Lymphocyte infiltration Other infections: trypanosomes (chagas), bacteria or fungi
38
What is the single most common genetic cause of congenital HD. what are they at increased risk for?
Trisomy 21 40% of pts with own syndrome have at least 1 heart defect Chronic illness and IE
39
Describe atrial septal defect
L-> usually asymptomatic until adulthood Most common congenital cardiac anomalies seen in adults Fossa ovalis most common
40
What can left to right shunting cause?
volume overload on right side -> pulmonary HTN, RHF, paradoxial embolization
41
Describe ventricular septal defect/
L->R most common form of congenital heart disease Many small VSDs close spontaneously Large VSDs may cause shunting -> RV hypertrophy, Pulm HTN which may reverse flow through shunt-> cyanosis
42
Describe patent ductus arteriosis
L->R may fail to close when infants are hypoxic, and/or have defects associated with increased pulmonary vascular pressure (VSD) Harsh, machinery-like murmur Large shunts increase pulmonary pressure and eventually shunt reversal and cyanosis
43
What happens with persistent Left to right shunting?
pulmonary HTN forms Causes Right to left shunting then cyanosis = eisenmenger syndrome
44
What causes cyanosis to be seen soon postnatally?
Right to left shunt
45
Tetrology of Fallot?
VSD Obstruction of RV outflow tract Aorta overrides the VSD RV hypertrophy Boot shaped heart Severity depends on subpulmonary stenosis Right to left shunt with cyanosis
46
What is transposition of great arteries?
results in two separate circuits when aorta goes to right atrium and pulmonary artery to left 1/3 have VSD 2/3 have PDA, or patent foramen ovale right ventricle become hypertrophy Left ventricle atrophies Dies w/i few months
47
What is coarctation of the aorta?
Narrowing of the aorta, generally seen with PDA in infants or w/o PDA in adults M>F Common in Turners syndrome Cyanosis in lower half of body
48
Coarctation without PDA
usually asymptomatic HTN in upper extremities, Hypotension in LE Claudication in cold LE may see LV hypertrophy
49
Myxomas
most common primary cardiac tumor in adults Left atria benign mostly single
50
Lipomas
well-circumscribed benign accumulation of adipose tissue | Left venticle, righ atrium or septum
51
Papillary fibroelastomas
``` sea-anemone-like lesions On valves can cause emboli usually incidental Core of myxoid ```
52
Rhabdomyomas
most common primary heart tumor in children Valvular or outflow tract obstruction Half associated with tuberous sclerosis (TSC1/2) spider clls
53
Angiosarcoma
malignant neoplasm | Not distiinctive from counterparts in other locations

CVM II (4 decks)

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