Cardiac Pathology (Part 2)

Question 1

what is the most common type of atrial septal defect?

Answer 1

ostium secundum ASD

Question 2

what is the most common VSD?

Answer 2

membranous

Question 3

what does left-to-right shunt lead to?

Answer 3

eisenmenger syndrome

Question 4

what are the four principal features of tetralogy of fallot?

Answer 4

VSD, right ventricular hypertrophy, subpulmonic stenosis, overriding aorta

Question 5

what drives the degree of symptoms in tetralogy of fallot?

Answer 5

the degree of stenosis

Question 6

what are some classic symptoms of kids with tetralogy of fallot?

Answer 6

tet spells, compensatory squatting; two murmurs: holosystolic from the VSD and systolic ejection murmur from the subpulmonic stenosis

Question 7

what is the xray finding consistent with tetralogy of fallot?

Answer 7

boot shaped heart

Question 8

how can one stay alive with a tricuspid atresia?

Answer 8

ASD and VSD must be present

Question 9

what is coarctation of the aorta associated with?

Answer 9

1) turner syndrome 2) additional cardiovascular abnormalities (bicuspid aortic valve, berry aneurysm)

Question 10

how does the infantile form of coarctation of the aorta present?

Answer 10

cyanosis at birth of lower half of the body

Question 11

how does the adult form of coarctation of the aorta present?

Answer 11

upper body: hypertension; lower body: hypotension, weak pulses; rib notching

Question 12

how can congenital aortic stenosis present?

Answer 12

hypoplastic (small) valves; dysplastic (nodular) valves; abnormal cusp number; results in LVH

Question 13

where does a paradoxical embolism of a PDA involve?

Answer 13

the lower body

Question 14

when is one at risk for a paradoxical embolism?

Answer 14

if there is a transient increase in right pressure, bright right –> left shunt

Question 15

what is the most common genetic cause of congenital heart disease?

Answer 15

down syndrome

Question 16

what are the most common heart defects seen in down syndrome patients?

Answer 16

septal defects: atrioventricular > ventricular> atrial

Question 17

what are the cardiovascular effects of marfan syndrome?

Answer 17

aortic aneurysm and dissection

Question 18

what is the mechanism of marfan syndrome?

Answer 18

fibrillin 1 mutation, excessive TGF-beta activity, which causes increased metalloprotease (degrades elastin)

Question 19

what causes Digeorge syndrome?

Answer 19

a deletion in chromosome 22

Question 20

what are the characteristics of digeorge syndrome?

Answer 20

CATCH 22: cardiac abnormality, abnormal facies, thymic aplasia, cleft palate, hypocalcemia

Question 21

what heart abnormality is associated with digeroge?

Answer 21

conotruncal heart abnormalities (TOF, transposition of the great arteries), ASD, VSD

Question 22

what type of hypertrophy is seen in hypertensive heart disease?

Answer 22

concentric

Question 23

how does hypertensive heart disease also lead to systolic dysfunction?

Answer 23

there is a lack of vascularization with muscle–> ischemia–> failure

Question 24

how does cor pulmonale present?

Answer 24

initially cor pulmonale shows dilation of the right ventricle; later there is compensatory hypertrophy of the right ventricle

Question 25

what is the most common valve abnormality?

Answer 25

calcific aortic stenosis

Question 26

what causes the calcifications in calcific aortic stenosis?

Answer 26

chronic progressive injury driven by similar factors which cause atherosclerotic disease (chronic HTN and hyperlipidemia)

Question 27

when does calcific aortic stenosis typically manifest?

Answer 27

7-9th decade of life

Question 28

a bicuspid aortic valve is caused by what?

Answer 28

1) acquired (typically rheumatic heart disease) | 2) congenital abnormality

Question 29

what is the effect of bicuspid aortic valve?

Answer 29

there is an accelerated course of calcific aortic stenosis; the bicuspid valves may become incompetent: aortic valve porlapse

Question 30

having valve abnormalities predisposes individuals to what?

Answer 30

infective endocarditis

Question 31

what effect does calcific aortic stenosis have on the heart?

Answer 31

it increases LV pressure--> concentric left ventricular hypertrophy

Question 32

what are the signs and symptoms of calcific aortic stenosis?

Answer 32

systolic murmur, syncope, angina, CHF

Question 33

what is mitral annular calcifications?

Answer 33

calcific deposits in the fibrous annulus; usually presents in females >60 especially those with mitral valve prolapse

Question 34

how does mitral annular calcification affect the heart?

Answer 34

arrhythmias (heart block, sudden death)

Question 35

what is mitral valve prolapse?

Answer 35

the valve leaflets prolapse back into the left atrium

Question 36

what does the histology show in cases of mitral valve prolapse?

Answer 36

thickened and rubbery valve with myxomatous degeneration caused by increased proteoglycan deposits; hooding of the mitral leaflets

Question 37

how does mitral valve prolapse present?

Answer 37

asymptomatic with a mid systolic click; dyspnea

Question 38

how do you confirm suspected case of rheumatic fever?

Answer 38

test for antibodies against streptolysin O and DNase B

Question 39

what are the signs and symptoms of rheumatic fever?

Answer 39

migratory polyarthritis, subcutaneous nodules, erythema marginatum, and chorea

Question 40

what is the histology of acute rheumatic heart disease?

Answer 40

aschoff bodies with anitschkow cells

Question 41

what are the characteristics of cute rheumatic heart disease?

Answer 41

pericarditis, myocarditis, endocarditis, valvulitis, MacCallum plaques

Question 42

what are the characteristics of chronic rheumatic heart disease?

Answer 42

valvular leaflet thickening, short chordae tendineae, fusion, regurgitation

Question 43

how does mitral stenosis sound on auscultation?

Answer 43

diastolic rumbling murmur

Question 44

what can mitral stenosis and mitral regurgitation lead to?

Answer 44

left atrial enlargement--> leads to a fib

Question 45

what are the signs of infective endocarditis?

Answer 45

splinter hemorrhages janeway lesions, osler nodes, and roth spots