Cardiac Pathology

Question 1

VSD

Answer 1

Defect in septum that divides R and L ventricles
L–> R shunt
Associated with fetal alcohol syndrome
Increased blood in pulm circuit –> pulm HTN –> reversal of shunt later on (Eisenmenger Syndrome)

Question 2

ASD

Answer 2

Defect in septum that divides R and L atria
Most common is ostium secundum
Ostium primum is associated with Down syndrome
L–>R shunt and split S2 on auscultation (delayed pulmonic closure)
Paradoxical emboli are complication

Question 3

PDA

Answer 3

Associated with congenital rubella
L–>R shunt btw aorta and pulmonary artery
Asymptomatic at birth with continuous machine-like murmur; may lead to Eisenmenger syndrome with lower extremity cyanosis
Tx. Indomethacin, which decreases PGE

Question 4

Tetrology of Fallot

Answer 4

Characterized by: 1) stenosis of the R ventricular outflow tract; 2) R ventricular hypertrophy; 3) VSD; 4) An aorta that overrides the VSD
R–> L shunt lead to early cyanosis
Squatting in response to cyanosis increases arterial resistance and decreases shunting allowing more blood to reach lungs
Boot-shaped heart

Question 5

Transposition of the Great Vessels

Answer 5

Pulm artery arising from the L ventricle and aorta arising from the R ventricle
Associated with maternal diabetes
Presents with early cyanosis
Creation of shunt, allowing blood to mix, is required for survival; PGE given to maintain PDA until repair
Results in hypertrophy of R ventricle and atrophy of L ventricle

Question 6

Truncus Arteriosus

Answer 6

Single large vessel arising from both ventricles
Early cyanosis - deoxygenated blood from R ventricle mixes with oxygenated blood from L ventricle before pulmonary and aortic circulations separate

Question 7

Coarctation of the Aorta: Infantile

Answer 7

Narrowing of the aorta distal to the aortic arch but proximal to the PDA; Associated with PDA
Presents with lower extremity cyanosis in infants
Associated with Turner syndrome

Question 8

Coarctation of the Aorta: Adult

Answer 8

Narrowing of aorta after the aortic arch
Presents as hypertension in upper extremities and hypotension with weak pulses in lower extremities
Collateral circulation develops across the intercostal arteries – “notching of ribs” on x-ray
Associated with bicuspid aortic valve

Question 9

Strep. Viridans Endocarditis

Answer 9

Infects previously damaged valves (eg. rheumatic heart disease, MV prolapse;
Small vegitations that do not destroy valve (subacute endocarditis); Damaged endocardial surface develops thrombotic vegetations (platelets and fibrin)
Associated with dental work

Question 10

Staph Aureus Endocarditis

Answer 10

Most common in IV drug abusers;
Infects normal valves, most commonly tricuspid and leads to septic embolism to the lungs–> pulmonary abscess; Can cause rapid decompensated CHF with septic emboli to brain and other end organs
Results in large vegetations that destroy valved (acute endocarditis)

Question 11

Staph. Epidermidis Endocarditis

Answer 11

Assocaited with endocarditis of prosthetic valves within 60 days

Question 12

Strep. Bovis Endocarditis

Answer 12

Associated with underlying colorectal carcinoma

Question 13

HACEK Endocarditis

Answer 13

Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella associate with negative blood cultures

Question 14

Libman-Sacks Endocarditis

Answer 14

Due to sterile vegetations that arise in association with SLE
Present on surface and undersurface of mitral valve–> regurge

Question 15

Mitral Valve Prolapse

Answer 15

Due to myxoid degeneration (accumulation of ground substance)
Mid-systolic click followed by regurge murmur - softer with squatting

Question 16

Aortic Regurge

Answer 16

Arises due to aortic root dilation (symphilic aneurysm, aortic dissection) or valve damage
Early blowing diastolic murmur, hyperdynamic circulation, increased pulse pressure, water-hammer pulse, head bobbing, eccentric LV hypertrophy

Question 17

Hypertrophic Cardiomyopathy

Answer 17

Massive hypertrophy of L ventricle usu due to genetic mutations in sarcomere proteins (AD)
Decreased CO –> diastolic dysfunction; Sudden death due to arrhythmias; Syncope with exercise
Biopsy shows myofiber hypertrophy with dissarray

Question 18

Restrictive Cardiomyopathy

Answer 18

Decreased compliance of ventricular endomyocardium –> restricted filling during diastole;
Caused by amyloidosis, sarcoid, endocardial fibroelastosis, Loeffler syndrome (endomyocardial fibrosis + eosinophilic infiltrate)
Presents as CHF with low voltage EKG with diminished QRS amplitude

Question 19

Myxoma

Answer 19

Benign mesenchymal tumor (connective tissue) with gelatinous appearance and abundant ground substance
Most common primary cardiac tumor in adults
Usu. forms pedunculated mass in L atrium that causes syncope due to obstruction of mitral valve

Question 20

Rhabdomyoma

Answer 20

Benign hamartoma of cardiac muscle; Most commonly seen in children; Associated with Tuberous Sclerosis
Usu. arises in ventricles

Question 21

Cardiac Mets

Answer 21

Most commonly from breast, lung, melanoma or lymphoma

Most commonly involve the pericardium –> effusion