Cardiac Path Robbins Part 4 Flashcards Preview

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Flashcards in Cardiac Path Robbins Part 4 Deck (48)
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31

caseous pericarditis

-tb! (fungal infections- less common)
-antecedent of disabling, fibrocalcific, chronic constrictive pericarditis!

32

adhesive mediastinopericarditis

-may follow infectious pericarditis, cardiac surgery, or mediastinal irradiation
-pericardial sac is obliterated
-adherence to external aspect of parietal layer to surrounding structures- strains cardiac fxn
-heart pulls against parietal pericardium and surrounding structures- rib cage and diaphragm (pulsus paradoxus)

33

constrictive pericarditis

-dense, fibrous or fibrocalcific scar- limits diastolic expansion and CO
-cardiac hypertrophy and dilation cannot occur
-muffled heart sounds, elevated jugular venous pressure, peripheral eema

34

rheumatic arthritis

-joint disorder
-subcutaneous rheumatoid nodules
-vasculitis
-neutropenia
-heart involved in 20-40% of cases

35

rheumatic arthritis- heart involvement

-most common- fibrinous pericarditis- may progress to fibrous thickening of visceral and parietal pericardium
-granulomatous rheumatoid nodules
-rheumatoid valvulitis- marked fibrous thickening and secondary calcification of aortic valve cusps

36

primary tumors of heart

rare!
-most common- myxoma, lipoma, papillary fibroelastoma, rhabdomyoma, angiosarcoma
-benign!- 80-90% of primary tumors of herat

37

metastatic tumors of heart

5% of ppl dying of cancer

38

myxomas

-most common primary tumor of adult heart!
-benign
-arise from primitive multipotent mesenchymal cells
-familial- act mutations in GNAS1 gene or null mutations in PRKAR1A
-90% arise in atria; 4:1 left:right ratio!

39

myxoma- morphology

-usually single
-fossa ovalis in atrial septum- favorited site!- can extend into mitral valve orifice
-sessile or pedunculated lesions
-clinical manifestations due to valvular "ball-valve" obstruction, embolization

40

lipoma

-localized, well-circumscribed, benign tumors
-composed of mature fat cells that can occur in subendocardium, subepicardium, or myocardium
-asymptomatic or can produce ball-valve obstructions or arrhythmias
-most often in left ventricle, right atrium or atrial septum
-in atrial septum- depositions of fat- "lipomatous hypertrophy"

41

papillary fibroelastoma

-incidental, sea-anemone-like lesions- most ID'ed at autopsy
-may embolize!
-resemble Lambl excrescences
-usually on valves
-distinctive cluster of hairlike projections

42

rhabdomyoma

-most frequent primary tumor of pediatric heart!
-commonly found in 1st year- obstruction of valvular orifice or cardiac chamber
-1/2 sporadic
-1/2 assoc with tuberous sclerosis (TSC1/2 mutations- hamartin and tuberin)
-regress spontaneously

43

angiosarcoma

-not clinically or morphologically distinctive from their counterparts

44

most frequent metastatic tumors involving the herart

-carcinomas of lung and breast, melanomas, leukemias, lymphomas
-retrograde lymphatic extension, hematogenous seeding, direct contiguous extension, venous extension

45

noncardiac neoplasms- clinical syptoms

-pericardial spread- pericardial effusions or mass-effect that is sufficient to restrict cardiac filling

46

major complication of cardiac transplantation

-allograft rejection
-endomyocardial biopsy- only reliable means of diagnosing acute cardiac rejection before substantial myocardial damage has occured

47

cellular rejection- characterized by

-interstitial lymphocytic infl with assoc myocyte damage

48

single most important long-term limitation for cardiac transplantation?

allograft arteriopathy
-late, progressive, diffusely stenosing intimal proliferation in the coronary a's- leading to ischemia
-5 yrs of transplantation- 50% of pts develop allograft arteriopathy; all pts by 10 yrs!\
-can lead to a silent MI (pts have denervated hearts)