Cardiac Pathology Flashcards
(155 cards)
1
Q
How does the adult form of coarctation of the aorta present?
A
Hypertension in the upper extremities and hypotension with weak pulses in the lower extremities
2
Q
Hypertrophic cardiomyopathy
A
Massive hypertrophy of the left ventricle
3
Q
Acute Rheumatic fever minor criteria
A
Fever and elevated ESR
4
Q
Cause of roth spots
A
Due to embolization of septic vegetations
5
Q
How does myocarditis present in cases of acute rheumatic fever?
A
Myocarditis with Aschoff bodies that are characterized by foci of chronic inflammation, reactive histiocytes with slender, wavy nuclei (Anitschkow cells), giant cells, and fibronoid material
6
Q
_____________ is chest pain that arises with exertion or emotional stress.
A
Stable angina
7
Q
Patent ductus arteriosus is associated with congenital _____________.
A
Rubella
8
Q
Necrosis of cardiac myocytes
A
MI
9
Q
Benign mesenchymal tumor with a gelatinous appearance and abundant ground substance on histology
A
Myxoma
10
Q
Complications of aortic stenosis
A
- Concentric left ventricular hypertrophy
- Angina and syncope with excercise
- Microangiopathic hemolytic anemia
11
Q
Causes of aortic regurgitation
A
Aortic root dilation
Valve damage
12
Q
Clinical features of left-sided heart are due to..
A
Decreased forward perfusion and pulmonary congestion
13
Q
Major complication of atrial septal defects
A
Paradoxical emboli
14
Q
Which organisms are associated with endocarditis with negative blood cultures?
A
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
15
Q
Most common arteries infarcted in MI
A
LAD (1st)
Right coronary
Left circumflex
16
Q
Cause of acute rheumatic fever
A
Molecular mimicry; bacterial M protein resembles proteins in human
17
Q
What is the cause of syncope with excercise seen with in hypertrophic cardiomyopathy?
A
Subaortic hypetrophy of the ventricular septum results in function aortic stenosis
18
Q
Jones criteria
A
- Evidence of prior group A strep infection
- Elevated ASO or anti-DNase B titers
- Presence of major and minor criteria
19
Q
how is aortic stenosis treated?
A
Valve replacement after onset of complications
20
Q
How is MI treated?
A
- Aspirin and/or heparin
- Supplement O2
- Nitrates
- B-blockers
- ACE inhibitor
- Fibrinolysis of angioplasty
- Opens blocked vessel
21
Q
Cause of MI
A
- Rupture of an atherosclerotic plaque with thrombosis and complete occlusion of a coronary artery (most common)
- Coronary artery vasospasm
- Emobli
- Vasculitis
22
Q
What is the most common etiology of sudden cardiac death?
A
Acute ischemia
*90% of patients have pre-existing severe atherosclerosis
23
Q
In what part of the heart does a rhabdomyoma usually arise?
A
Ventricle
24
Q
Clinical features of right-sided heart failure are due to __________.
A
Congestion
25
Reperfusion of irreversibly damaged cells results in _______ influx. What is the result of this?
Calcium; leading to hypercontraction of myofibrils (contraction band necrosis)
26
Most common type of atrial septal defect
Ostium secundum
27
How is dilated cardiomyopathy treated?
Heart transplant
28
What trends of elevation does CK-MB follow in infarction?
* levels rise 4-6 hrs after infarction
* Peak at 24 hrs
* Return to normal by 72 hrs
29
How does transposition of the great vessels present?
Early cyanosis because pulmonary and systemic circuits do not mix
30
What distinguishes rheumatic disease from "wear and tear" causing aortic stenosis?
Mitral stenosis and fusion of the aortic valve commissures
31
Consequences of patent ductus arteriosus
"Machine-like" murmur
Eisenmenger syndrome
* Lower extremity cyanosis
32
Clinical features of mitral stenosis
* Opening snap followed by diastolic rumble
* Volume overload leads to dilation of the left atrium, resulting in:
* Pulmonary congestion with edema and alveolar hemorrhage
* Pulmonary hypertension and eventual right-sided heart failure
* Atrial fibrillation with associated risk for mural thrombi
33
Benign hamartoma of cardiac muscle
Rhabomyoma
34
Cause of unstable angina
Usually due to rupture of an atherosclerotic plaque with thrombosis and _incomplete_ occlusion of a coronary artery
35
Migratory polyarthritis
Swelling and pain in a large joint that resolves within days and "migrates" to involve another large joint
36
Major cause of mitral stenosis
Chronic rheumatic valve disease
37
Which chamber of the heart is typically involved in MI?
Left ventricle
\*Right ventricle and both atria are generally spared
38
Cause of mitral valve prolapse
Myxoid degeneration (accumulation of ground substance) of the valve making it floppy
39
Occlusion of the left circumflex artery results in infarction of which structures?
Lateral wall of the LV
40
Biopsy seen in hypertrophic cardiomyopathy
Myofiber hypertrophy with disarray
41
Tricuspid atresia is often associated with what defect?
Atrial septal defect; resulting in a right-to-left shunt. presents with early cyanosis
42
Major cause of hypertrophic cardiomyopathy
Genetic mutations in sarcomere proteins (autosomal dominant)
43
Murmur heard in aortic stenosis
Cardiac compensation leads to a prolong asymptomatic stage during which a **systolic ejection click followed by a crescendo-decrescendo murmur**
44
Acute rheumatic fever major criteria
* Migratory polyarthritis
* Pancarditis
* Subcutaneous nodules
* Erythema marginatum
* Syndenham chorea
45
\_\_\_\_\_\_\_\_\_\_\_\_ is useful for detecting lesions on valves.
Transesophageal echocardiogram
46
Stable angina is relieved by \_\_\_\_\_\_\_\_.
Nitroglycerin
\*Same for unstable angina
47
Nonbacterial thrombotic endocarditis is due to sterile vegetations that arise in association with a _______________ or \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Hypercoagulable state; underlying adenocarcinoma
48
\_\_\_\_\_\_\_\_\_\_\_\_\_ is associated with endocarditis in patients with underlying colorectal carcinoma.
Strep. Bovis
49
Complications of mitral valve prolaspe
Infectious endocarditis
Arrythmia
Severe mitral regurgitation
\*Complications are rare
50
Does stable angina result from reversible or irreversible injury?
Reversible injury to myocytes (no necrosis)
51
osler nodes
Tender lesions on fingers or toes
52
narrowing of the aorta
Coractation of the aorta
53
Clinical features of right sided heart failure
* JVD
* Painful hepatosplenomegaly with characteristic nutmeg liver
* Dependent pitting edema
54
Mechanism by which strep viridians causes endocarditis
* Damaged endocardial surface develops thrombotic vegetations (platelets and fibrin)
* Transient bacteremia leads to trapping of bacteria in the vegetations
55
Laboratory findings in endocarditis
* Positive blood cultures
* Anemia of chronic disease (Decreased Hb, Decreased MCV, increased ferritin, decreased TIBC, decreased serum iron, and decreased % saturation
*
56
Quincke pulse
Pulsating nail bed
57
Clinical features of left-sided heart failure
* Pulmonary edema
* Dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and crackes
* Intralveolar hemorrhage
* Decreased flow to kidneys
58
Cause of prinzmetal angina
Due to coronary artery vasoplasm
59
Characterized by a single large vessel arising from both ventricles
Truncus arteriosus
60
Loeffler syndrome
Endomyocardial fibrosis with an eosionphilic infiltrate and eosinophilia
61
\_\_\_\_\_\_\_\_\_ is the most common cause of endocarditis in IV drug abusers.
S.aureus
62
Treatment for ventricular septal defect
Surgical closure
\*Small defects may close spontaneously
63
How does a mitral valve prolapse present?
* Incidental mid-systolic click followed by a regurgitation murmur; usually asymptomatic
64
Infantile form of coarctation of the aorta is associated with ________ and \_\_\_\_\_\_\_\_.
Patent ductus arteriosus and Turner syndrome
65
Gross appearance of a myxoma
usually forms a pedunculated mass in the left atrium that cuase syncope due to obstruction of the mitral valve
66
Causes of right sided heart failure
Left sided heart failure **(most common)**
Left-to-right shunt
Chronic lung disease (cor pulmonale)
67
EKG of stable angina
ST-segment depression due to subendocardial ischemia
**NOTE:**Unstable angina presents the same way on EKG
68
Clinical features of hypertrophic cardiomyopathy
* Decreased cardiac output
* Sudden death due to ventricular arrythmias
* Syncope with exercise
69
Which valve is more commonly involved in endocarditis?
Mitral valve more commonly than the aortic valve
70
\_\_\_\_\_\_\_\_\_\_ maintains patency of the ductus arteriosus.
PGE
71
What are the gross changes, mircoscopic changes, and complications months after MI?
Gross: White scar
Micro: Fibrosis
Complcations: Aneurysm, mural thrombus, or dressler syndrome
72
Indomethacin mechanism of action
Decreased PGE, resilting in PDA closure
73
Ostium primum type of atrial septal defect is associated with \_\_\_\_\_\_\_\_\_\_.
Down Syndrome
74
Which valve is mosst commonly affected by S. aureus?
Tricupsid
**NOTE:** S. Aureus infects normal valves
75
What are the gross changes, mircoscopic changes, and complications 1-3 wks after MI?
Gross: Red border emerges as granulation tissue enters from edge on infarct
Micro: Granulation tissue with plump fibroblasts, collagen, and blood vessels
76
Treatment for patent ductus arteriosus
Indomethacin
77
What are the gross changes, mircoscopic changes, and complications 4-7 days after MI?
Gross: Yellow pallor
Micro: Macrophages
Complications: Rupture of ventricular free wall (leads to cardiac tamponade), interventricular septum (leads to shunt), or papillary muscle (leads to mitral insufficiency)
78
Clinical feautures of MI
* Severe crushing chest pain (lasting \>20 mins) that radiates to the left arm or jaw
* Diaphoresis
* Dyspnea
\*Symptoms NOT relieved by nitroglycerin
79
Sudden cardiac death is usually due to \_\_\_\_\_\_\_\_\_\_\_\_.
Fatal ventricular arrhythmia
80
Chronic ischemic heart disease progresses to \_\_\_\_\_\_\_\_\_\_.
Congestive heart failure
81
Janeway lesions
Erthematous nontender lesions on palms and soles
82
Where do vegetations arise in nonbacterial thrombotic endocarditis? What is the result of this?
Vegetations arise on the mitral valve along lines of closure and result in mitral regurgitation
83
Ventricular septal defects are associated with \_\_\_\_\_\_\_\_\_\_\_.
Fetal alcohol syndrome
84
How does the adult form of coarctation of the aorta present on X-ray? Why?
"Notching" of ribs, due to engorged arteries from collateral circulation that develops across the intercostal arteries
85
What lab tests are used to detect MI?
* Elevated troponin I
* CK-MB
86
Symptoms of myocarditis
Chest pain
Arrythmia with sudden death, or heart failure
87
How does truncus arteriosus present? Why?
Early cyanosis; deoxygenated blood from right ventricle mixes with oxygenated blood from let ventricle before pulmonary and aortic circulations separate
88
What viruses cause myocarditis?
Coxsackie A or B
89
Causes of restrictive cardiomyopathy
Amyloidosis
Sarcoidosis
Endocardial fibroelastosis
Loeffler syndrome
90
Classic gross apperance of chronic rheumatic heart disease
* Stenosis with a classic "fish mouth" appearance
* Mitral valve (most common): Results in thickening of chordae tendinae and cusps
* Aortic valve: leads to fusion of the commissures
91
Criteria for classification of Sudden Cardiac Death
Unepected death due to cardiac disease; occurs without symptoms or \<1 hr after symptoms arise
92
\_\_\_\_\_\_\_\_\_\_ aortic valve increases risk and hastens onset of aortic stenosis.
Bicupsid
93
How does the infantile form of coarctation of the aorta present?
Lower extremity cyanosis in infants, often at birth
94
How does fibrinous pericarditis present?
Chest pain with friction rub
95
What ailment is transposition of the great vessels associated with?
maternal diabetes
96
Valve scarring that arises as a consequence of rheumatic fever
Chronic rheumatic fever
97
What part of the heart most commonly involved in metastasis? What is the result?
Metastasis to the heart, commonly involve the pericardium, resulting in a pericardial effusion
98
Adult form of coarctation of the aorta is associated with \_\_\_\_\_.
Bicupsid aortic valve
99
What condition is rhabdomyoma associated?
Tuberous sclerosis
100
Dilation of all four chambers of the heart
Dilated cardiomyopathy
101
Cause of stable angina
Due to atherosclerosis of coronary arteries with \>70% stenosis, results in decreased blood flow that is unable to meet the metabolic demands of the myocardium during exertion
102
Most common cause of endocarditis
Strep viridans: results in small vegetations that do not destroy the valve (subacute endocarditis)
\*Infects previously damaged valves
103
How does stable angina present?
Chest pain that radiates tot he left arm or jaw
Diaphoresis
Shortness of breath
104
Prinzmetal angina is relieved by \_\_\_\_\_\_\_\_\_\_\_\_
Nitroglycerin or calcium channel blockers
105
Where does the coartication of the aorta lie in the infantile form?
After the aortic arch but before the PDA
106
What are the gross changes, mircoscopic changes, and complications \<4hrs after MI?
Gross: none
Micro: none
Complications
* Cardiogenic shock
* Congestive heart failure
* Arrhythmia
107
How does restrictive cardiomyopathy present?
Congestive heart failure
Low-voltage EKG with diminished QRS amplitude
108
\_\_\_\_\_\_\_\_\_\_\_\_ is useful for detecting reinfarction that occurs days after and initial MI.
Creatine kinase MB (CK-MB)
109
Complications of chronic rheumatic heart disease
Infectious endocarditis
110
How is endocarditis characterized?
Small vegetations along lines of closure that lead to regurgitation
111
Hypertrophic cardiomyopathy is a common cause of sudden death in young \_\_\_\_\_\_\_.
Athletes
112
What are the gross changes, mircoscopic changes, and complications 4-24 hrs after MI?
Gross: Dark discoloration
Micro: Coagulative necrosis
Complications: Arrythmias
113
Which congenital defects are associaed with right-to-left shunts?
Tricuspid atresia
Tetralogy of Fallot
114
What causes an increase in pulse pressure?
* Diastolic pressure decreases due to regurgitation
* Systolic pressure increases due to increased stroke volume
115
Acute rheumatic fever is based on \_\_\_\_\_\_\_\_\_\_\_.
Jones criteria
116
Lymphocytic infiltrate in the myocardium
Myocarditis
117
Cause of paroxysmal nocturnal dyspnea
Due to increased venous return when lying flat
118
How is aortic regurgitation treated
Valve replacement once LV dysfunction develops
119
\_\_\_\_\_\_\_\_\_\_\_\_ angina is episodic chest pain unrelated to exertion.
Prinzmetal
120
\_\_\_\_\_\_\_\_\_\_\_\_\_ is associated with endocarditits of prostetic valves.
S. epidermidis
121
Common cause of aortic stenosis
Fibrosis and calcification from "wear and tear"
122
During development, the ductus arteriosus normally shunts blood from the _________ to the \_\_\_\_\_\_\_\_\_, bypassing the lungs.
Pulmonary artery; aorta
123
Does unstable angina result from reversible or irreversible injury?
Reversible injury to myocytes (no necrosis)
124
Common metastases to the heart
Breast and lung carcinoma
Melanoma
Lymphoma
125
Heart sounds of atrial septal defects
Split S2
126
\_\_\_\_\_\_\_\_\_\_ angina is chest pain that occurs at rest.
Unstable
127
Decreased compliance of the ventricular endomyocardium that restricts filling during diastole
Restrictive cardiomyopathy
128
Which chambers of the heart are effected by transposition of the great vessels?
Hypertrophy of the right ventricle
Atrophy of the left ventricle
129
Treatment for left-sided heart failure
ACE inhibitor
130
What are the diff phases of MI? What are the characteristics of each?
Early
* Subendothelial necrosis involving \<50 % of the myocardial thickness
* EKG: ST-segment depression
Severe
* Transmural necrosis involving most of the myocardial wall (transmural infartion)
* EKG: ST- segment elevation
131
Clinical features of bacterial endocarditis
* Fever
* Due to bacteremia
* Murmur
* Due to vegetations on heart valve
* Janeway lesions
* Osler nodes
* Splinter hemorrhages in nail bed
* Roth spots
* Anemia of chronic disease
132
Most commonly involved artery in MI. What is the consequence of this?
**LAD**
* Occlusion of LAD leads to infarction of the anterior wall and anterior septum of the left ventricle
133
Erythema marginatum
Annular, nonpruritic rash with erythematous borders, commonly involving trunk and limbs
134
Concentric left ventricular hypertrophy, due to aortic stenosis, may progress to \_\_\_\_\_\_\_\_\_\_.
Cardiac failure
135
What are the gross changes, mircoscopic changes, and complications 1-3 days after MI?
Gross: Yellow pallor
Micro: neutrophils
Complications: Fibrinous pericarditis; presents as chest pain with friction rub
136
Histo sign of intraalveolar hemorrhage
Hemosiderin-laden macrophages
137
EKG on prinzmetal angina?
ST-segment elevation due to transmural ischemia
138
\_\_\_\_\_\_\_\_\_ is the most sensitive and specific marker for MI
Troponin I
139
Why is a split S2 seen in atrial septal defects?
Increased blood in right heart delays closure of pulmonary valve
140
Aside from acute ischemia, what are other causes of sudden cardiac death?
Mitral valve prolapse
Cardiomyopathy
Cocaine abuse
141
Occlusion the right coronary artery results in infarction of which structures?
Posterior wall, posterior septum, and papillary muscles of the LV
142
What causes the click and murmur seen in mitral valve prolaspe to become softer?
Squatting (increased systemic resistance decreases left ventricular emptying)
143
Complications of dilated cardiomyopathy
* Results in systolic dysfunction (ventricles cannot pump), leading to biventricular CHF
* Mitral and tricupside valve regurgitation and arrhythmia
144
Which congenital defects are associaed with left-to-right shunts?
Ventricular septal defect
Atrial septal deect
Patent ductus arteriosus
145
Why is CO decreased in hypertrophic cardiomyopathy?
Left ventricular hypertrophy leads to diastolic dysfunction (ventricle cannot fill)
146
Clinical features of mitral regurgitation
* Holosystolic "blowing" murmur
* Louder with squatting and expiration
* Volume overload
* left sided heart failure
147
Causes of dilated cardiomyopathy
* Genetic mutation (usually autosomal dominant)
* Myocarditis
* Alcohol abuse
* Drugs
* Pregnancy
* Hemochromotosis
148
Where do vegetations arise in Libman-Sacks endocarditis? What is the result of this?
Vegetations are present on the surface and undersurface of the mitral valve and result in mitral regurgitation
149
Decreased flow to ________ leads to activation of renin-angiotensin system.
Kidneys
\*Fluid retention exacerbates CHF
150
Large ventricular septal defects can lead to \_\_\_\_\_\_\_\_\_\_.
Eisenmenger syndrome
151
What trends of elevation does troponin follow in MI?
* Levels rise 2-4 hrs after infarction
* Peak at 24 hrs
* Return to normal by 7-10 days
152
What does left-sided heart failure lead to?
Ischemia
Hypertension
Dilated cardiomyopathy
MI
Restrictive cardiomyopathy
153
Causes of mitral regurgitation
Mitral valve prolapse **(most common)**
LV dilation
Infective endocarditis
Acute rheumatic heart disease
Papillary muscle rupture after a MI
154
Clinical features of aortic regurgitation
* Early, blowing diastolic murmur
* Hyperdynamic circulation due to increased pulse pressure
* Bounding pulse
* Pulsating nail bed
* Head bobbing
* LV dilation
* Eccentric hypertrophy
155
Ballooning of mitral valve into left artium during systole
Mitral valve prolapse
