Cardiac Pathology Part 2 - Dr. Hillard Flashcards
(138 cards)
1
Q
congenital heart disease cause
A
- mostly spontaneous genetics
- fetal alcohol syndrome
- most common type if birth defect
2
Q
most common type of congenital heart disease
A
Ventricular septal defect (VSD)
3
Q
Left to right shunts causes what and sx
A
- high P of left heart or aorta , lower P pulm trunk and right side
- Initially asymptomatic and not cyanotic**
4
Q
right to left shunts what and and sx
A
- bypassing pulmonary circulation, usually from right heart hypertrophy or Tetrology of fallot (causing higher P in right side)
- symptomatic and cyanotic
5
Q
left to right shunts top 3
A
- ASD
- VSD
3 Patent Ductus Asteriosus
6
Q
right to left shunt top 3
A
- Tetralogy of Fallot
- Transposition of Great Arteries
- Tricuspid Atresia
7
Q
ASD most common type
A
Ostium Secundum ASD (90%)
= hole in the middle of septum
8
Q
ASD sx
A
asymptomatic at birth and until adulthood
= you can here a systolic ejection murmur**
= small hole can close spontaneously
9
Q
VSD most common sx and most common type
A
membranous VSD (at the top of septum)** = asymptomatic until adulthood = Holosystolic murmur* = most close spontaneously = if child sx then other anomalies usually present
10
Q
Patent Ductuctus arteriosus happens from
A
increased P on right side or pulmonary P
- VSD
- hypoxia fetus
11
Q
Patent Ductuctus arteriosus location and sx
A
- Pulmonary A
12
Q
Patent Ductuctus arteriosus closed how
A
Indomethacin (drug)
13
Q
Patent Ductuctus arteriosus kept open how and when
A
some congenital malformations like Transposition of Great As you want to keep it open
(PGE E1)
14
Q
Patent Ductuctus arteriosus causes what to happen over time
A
- higher BF to lungs since it goes directly to Pulm A, higher Pulm P, = Pulmonary HTN
- Eisenmenger Syndrome
15
Q
Eisenmenger Syndrome what happens
A
= in long term Left –> Right shunts
1. l–>r increases Pulm BF
2. pulm vascular remodeling (thickening hypertrophy + irreversible)*
3. higher Pulm Resistance –> higher Right side P
4. Right –> Left shunt
5. Eisenmenger syndrome
4.
16
Q
Eisenmenger Syndrome age and sx
A
around 20-30yo
40% mortality = repare early
SOB, exercise intolerance, cyanosis
17
Q
Right to left SX
A
- Blue babies (blue lips, fingers, toes)
2. clubbing fingers = Hypertrophic ostearthropathy
18
Q
Tetrology of Fallot includes what
A
- VSD
- RV hypertrophy
- Subpulmonic stenosis
- Overriding Aorta (in middle of V so he gets the O2 poor and O2 rich blood
19
Q
Tetrology of Fallot prevalence and 5 sx
A
most common right to left
- cyanotic at birth
- holosystic murmur (VSD)
- Systolic Ejection murmur (subpulmonic stenosis)
- “Tet” Spell = cyanosis, syncope during emotional distress or excitement or high activity
- squatting
20
Q
Tetrology of Fallot prevalence and 5 sx
A
most common right to left
- cyanotic at birth
- holosystic murmur (VSD)
- Systolic Ejection murmur (subpulmonic stenosis)
- “Tet” Spell = cyanosis, syncope during emotional distress or excitement or high activity
- squatting
21
Q
Tetrology of Fallot what helps them
A
squatting = increases P on left side = more blood to go l–>r or prevent as much r—>l and allows them to catch breath
22
Q
imaging Tetrology of Fallot
A
Boot shaped heart
= concave on pulmonary A segment side
= upturned cardiac apex
23
Q
Transposition of Great Arteries what happens
A
Aorta and Pulm Trunk switch sides
1. Aorta and Right side
2. Pulmonary Trunk and Left side
= NEED shunt to survive
24
Q
Transposition of Great Arteries how can they survive
A
- PDA
- VSD
- Patent Foca Ovale
= if not shunt incompatible with life, EM surgery
25
Tricuspid Atresia what happens
X tricuspid valve, no BF from RA to RV
26
Tricuspid Atresia survival and sx
1. ASD/ PFO + VSD *** needed to survive
| 2. severe immediate cyanosis after birth, EM surgery
27
Coarctation of the Aorta what happens and the 2 types
narrowing of aorta right before ductes arteriosis
1. Infantile form : has PDA
2. Adult form : X PDA
28
Coarctation of the Aorta infantile and adult sx
1. infantile : BF from RV to PT through PDA to Aorta = cyanosis of lower Extr.
2. adult : BF from LV to aorta with high P = HTN of upper body and Hypotension and low Pulse lower Extr., pain with exertion (arterial insufficiency)
29
Coarctation of the Aorta associated with
1. Turners Syndrome XO (check in women)
2. Bicuspid aortic valve
3. higher risk in males
30
Tetrology of Fallot vs Infantile Coarctation of the Aorta
Coarctation of the Aorta in infants causes cyanosis of ONLY lower extr.
31
adult Coarctation of the Aorta can cause what later
Rib notching = collateral intercostal Vessles made from and you get pressure erosion of rib margin
32
Congenital Aortic and Pulmonary Valve Stenosis/Atresia (AORTA) causes what
1. LV hypertrophy
| 2. hypoplastic Left Heart syndrome = when LV in not developed enough to pump
33
Congenital Aortic and Pulmonary Valve Stenosis/Atresia (PULMONARY) usually seen when
1. Tet of Fallot
| 2. Transposition of GAs
34
Congenital Aortic and Pulmonary Valve Stenosis/Atresia TX
EM surgery
| preserve PDA*
35
PE types
1. DVT, thrombus
2. Bone marrow, fat from trauma
3. Air from nurse not removing air in syringe
4. infectious, foreign bodies
36
Paradoxical Embolism is what
when there is some shunt in heart like Tet of Fallot, or VSD, ASD
1. venous thrombi to Rigth heart crossed to left heart
2. to brain or other organ
= RIGHT --> LEFT SHUNT
37
Paradoxical Embolism in left to right shunt
usually to lungs only can cross over during those brief time that it switches to r-->l
38
when does a l--> r shunt switch briefly to r-->l
1. cough, sneeze
2. BM
3. Valsalva (increasing Pulm P)
39
PFO is what and can open when
flap open r-->l only
1. valsalva
2. cough, sneeze
3. BM
40
Trisomy 21 most common heart conditions
Septal defects : Atroventricular septal > VSD > ASD
41
Marfans Syndrome most common heart problems
Aortic aneurysm , Aortic dissection
42
Marfan Syndrome how it happens
Fibrillin-1 mutation = high TGF-B activity**
1. high metalloprotease,
2. degrades elastin**
43
DiGeorge Syndrome mutation and SX
```
CATCH22
C : cardiac probs
A : Abnormal facies, increased pig levi, streak ovaries
T : thymic aplasia
C : cleft plate
H : hypocalcemia
22 : 22q11
```
44
DiGeorge Syndrome heart problems
Conotruncal heart abnormalities = tetrology of Fallot **** (transposition of GA, ASD, VSD)
45
Turner Syndrome heart problems
Coarctation of aorta
46
Hypertensive Heart Disease criteria 2
1. LV concentric hypertrophy (all around LV including septum and wall
2. HTN other place, organ, peripheral, aortic stenosis = aorta htn)
47
Hypertensive Heart Diseasesx during systole and diastole
S : can't pump as much, CHF, dilated Atria** (from higher P in A)
D : not relaxing = CHF**, Atrial Fib** (also from dilation of A) which can cause thrombus (LA)
48
Hypertensive Heart Disease cells looks like
larger and bigger nuclei
49
Cor Pulmonale is what
right side (pulmonary) HTN disease,
50
Cor Pulmonale can happen how
if alveoli is hypoxic then BV constricts there
| = diffuse hypoxia --> all BV constrict and ==> high Pulm P
51
Cor Pulmonale can cause what
1. isolated right side heart failure
52
Cor Pulmonale can be a cause of what event
PE
53
Cor Pulmonale 4 things causing hypoxia and this to happen
1. pulmonary parenchyma disease
2. Pulm vessle disease
3. Chest movement problems
4. Pulm Arterial constriction (Metabolic acidosis)
54
right heart hypertrophy causes what to wall
thickening of trabaculae, and wall
55
right CHF SX
1. hepatospenomegally
2. Distended jugular V
3. effusions, ascites
4. edema
56
most common valve abnormality
Calcific Aortic Stenosis
57
Calcific Aortic Stenosis risk and associations
1. age 60yo-80yo
2. HTN
3. hyperlipidemia
4. chronic trauma "wear and tear"
58
Calcific Aortic Stenosis causes what to happen
1. Aortic valves cant open all the way
2. harder to push blood from LV -->Aorta
3. LV hypertrophy
59
Calcific Aortic Stenosis made of what
osteocalficication = bone can be found
60
heart valves have how many cusps
all have 3 except mitral has 2
61
Bicuspid aortic valve (BAV) can cause what 3 things
1. early calcific aortic stenosis
2. can stop working normal = aortic valve prolapse
3. infective endocarditis easier to form
62
Bicuspid aortic valve (BAV) causes 2
1. congenital
| 2. RF
63
any valve problem you have higher chance of
infective endocarditis
64
calcific aortic stenosis SX
1. LV hypertrophy
2. systolic murmur
3. syncope (5years to live)
4. Angina (ischemia in heart cells hypertrophy)
5. left CHF (2 years to live)
65
calcific aortic stenosis TX
surgery to replace valves
66
Mitral annular calcification what
calcific deposits on fibrous annulus (base of leaflet valves)
67
Mitral annular calcification risk
females
| over 60yo
68
Mitral annular calcification sx
1. asymp
2. mild regurgitation
3. arrhythmia (deep calcification into myocytes) = HEART BLOCK
4. infectious endocarditis
69
Mitral Valve Prolapse what
one of valve leaflets balloon back into LA during SYSTOLE = "floppy valve"
70
Mitral Valve Prolapse risks + associations
1. female
2. connective tissue problem = Marfan syndrome
3. past MI, RF
71
Mitral Valve Prolapse valves looks like dont need to know
1. thick rubbery (myxomatous degeneration)
| 2. Interchordal ballooning (hooding)*
72
Mitral Valve Prolapse auscultation and SX
1. mid systolic click (can also have murmur), MITRAL REGURG
2. dyspnea
3. higher A P = atrial dilation ----> Atrial Fib, thrombus
4. Infective endocarditis
73
rheumatic fever is from what
strep pharyngitits Group A
74
Rheumatic fever SX
1. recurrent strep throat ----> CD4+ react with M strep Ag
2. fever
3. migratory polyarthritis
4. pancarditis
5. Erythma marginatum
6. Syndenham chorea
7. subQ noduels
75
Rheumatic fever + rash is what
scarlet fever
76
Rheumatic fever DX
Ab to streptolysin O + DNaseB
77
Rheumatic fever heart problem
1. Fibrinous pericarditis**, myocrditis, endocarditis = if all its pancarditis**
2. Valvulitits (verrucae at mitral V)**
3. MacCallum Plaques****
4. Aschoff Body + Antischkow cells*
78
fibrinous pericarditis seen in
Rheumatic fever
| MI
79
Rheumatic fever most common valves affected
mitral** > aortic > tricuspid
80
Antischkow cells
macrophage bodies
81
Rheumatic fever chronic does what to heart
repeated strep infections
| = mitral stenosis (DIASTOLIC rumbling) (looks like a fish mouth)
82
2 valve things that can cause LA dilation
mitral stenosis
| mitral regurg/ prolapse
83
infective endocarditis from what
1. bacteria at valves (firbinous debri)
| 2. prosthetic valves
84
infective endocarditis risks
dental poor hygiene
IV drugs
Prosthetic heart
valvular disease (Rheumatic heart, stenosis, MVP)
85
acute infective endocarditis sx
FAST fever, chills, weak
| = STAPH AUREUS
86
subacute infective endocarditis
low fever (unknown origin), fatigue
few weeks
STREP, ENTEROCCOCI
87
infective endocarditis major criteria
+ Blood culture
| mass or abscess on valve (echocardiogram)
88
infective endocarditis minor sx ****
1. Roth spots
2. Splinter hemorrhages
3. Osler nodes (tips on finger : red nodular painful)
4. Janeway lesions (red purple dots on sole or palm)
89
subacute infective endocarditis from dental cause
strep viridans
90
subacute infective endocarditis from prosthetic valves usually from
staph epidermidis
| staph aureus if acute
91
subacute infective endocarditis from dental and more rare
HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella)
92
infective endocarditis tricuspid valve cause
IV drug use , staph aureus
93
infective endocarditis most common valve effected
mitral or aortic
94
Nonbacterial Thrombotic Endocarditis (Hypercoagulable)
sterile non-inflammatory valvular thrombi ----> embolizes
95
Nonbacterial Thrombotic Endocarditis (Hypercoagulable) causes
1. cancer releasing procoags (mucinous adenocarcinoma)
2. primary anti-phospholipid syndrome
3. SLE
4. proinflammatory
96
Antiphospholipid syndrome vs SLE
APS : auto ABs to endothelial BVs causing thrombus + fetal loss*
SLE : malar rash, ABs to vessel endothelial -->preocoags
====Nonbacterial Thrombotic Endocarditis`
97
Carcinoid heart Disease
1. serotonin secreated from tumor
2. plaque like endocardial and valvular thickening
3. RIGTH SIDE heart lesions
98
Carcinoid heart Disease SX and type of tumor
```
neuroendocrine tumor
1. flushing
2. D
3. Dermatits
4. Bronchoconstriction
==== only after liver is effected and cant breakdown bioactive serotonin
```
99
Carcinoid heart Disease is right sided why
left side has lung vessels that breakdown bioactive serotonin before it gets to heart
100
Prosthetic valves : mechanical vs bioprostheses
1. mechanical : life long life, life long anti-coags (25yrs)
| 2. Bioprosthetic : need to be replaced, only anticoags first 3-6 months (10-15yrs)
101
Aortic stenosis murmur
harsh systolic
| creascendo, decrescendo
102
mitral regurgitation murmur
holosytisolic (pansystolic) throughout systole
103
VSD murmur
holosytisolic (pansystolic) throughout systole
104
aortic regurg vs mitral stenosis murmur
diastolic both
1. A : decreascendo all the way
2. M : rumbling at the end more
105
PDA murmur
continous machine like all the time (crescendo during systole)
106
3 main cardiomyopathies
1. Dilated
2. Hypertrophic
3. Restrictive
(heart structually and functionally abnormal with no congenital or diseases effecting heart)
107
Dilated cardiomyopathy type of problem and what happens to heart
1. Systolic
| 2. Enlargement in all chambers
108
Hypertrophic cardiomyopathy type of problem and what happens to heart
1. Diastolic
2. LV thickening of SEPTUM
= sudden death in young athletes
109
Hypertrophic cardiomyopathy mutation
B-myosin heavy chain = involving sarcomere protein *
110
Restrictive cardiomyopathy type of problem and what happens to heart
1. Diastolic
| 2. Rigid Ventricular walls
111
Restrictive cardiomyopathy usually from
amyloidosis
112
Dilated cardiomyopathy familial mutation
TTN gene (titin mutation) = sarcomere making
113
Dilated cardiomyopathy causes besides familial 4
1. V overload after birthing child
2. alcohol
3. Fe overload (HFE gene, hereditary hemochromatosis)
4. Takotsubo (catecholamine overload)
114
Dilated cardiomyopathy what is seen
1. hypretrophic (heavy and more muscle from large heart)
| 2. big dilated chambers
115
Dilated cardiomyopathy SX
1. 20yo-50yo progressive CHF
2. Systolic prob
3. arrhythmia sudden death
4. thrombus formation
116
Dilated cardiomyopathy can be caused by what drug
Doxorubicin, daunorubicin (for leukemia, sarcoma, lymphoma)**
= Anthrocyclines*
= important to keep track of medical records
117
HFE iron overload sx
1. Dilated cardiomyopathy
2. skin bronze pigment
3. Bronze DM (effects pancreas)
4. hypogonadism
118
Takotsubo Cardiomyopathy happens how
1. "broken heart syndrome"
2. from emotional distress = sudden surge of catacholamines
3. can cause ischemia and death
= Dilated cardiomyopathy
119
Takotsubo Cardiomyopathy LOOKS LIKE AND PREVALENCE
apical (lower) ballooning in LV like a Octopus Pot
| = women (90%), 60yo-75yo
120
Hypertrophic Cardiomyopathy looks like
myocyte hypertrophy = septal prominance, myocyte disarray**** dont line up
121
Hypertrophic Cardiomyopathy prevalence
male , genetic
122
Hypertrophic Cardiomyopathy SX
none
= early 20s, sudden V arrhythmia
= young athlete sudden death (from such thick septum --> V arrhythmia)
123
Hypertrophic Cardiomyopathy murmur
systolic ejection murmur from mitral valve pushed against septum
124
Restrictive Cardiomyopathy what
V walls get very stiff
hard to Diastole
= Amylodiosis
= fibrosis from radiation therapy
125
Hypertrophic Cardiomyopathy heart looks like
Atrial dilation since Vs cant fill properly
| = arrhythmia
126
Amyloid is what
apple, green, congo red **
insoluable B-pleated sheets
(myeloma, chronic inflammation, transthyretin)
127
rare causes of Restrictive Cardiomyopathy
1. Endomyocardial fibrosis (Africa)
2. Loeffler endocarditis (esosinophilic infiltration, AML, CML)
3. Endocardial fibroelastosis (congenital stenosis aorta)
128
Arrhythmogenic RV cardiomyopathy what is it
sudden death young adults
| RV wall replaced by fat and fibrosis + dilation
129
Arrhythmogenic RV cardiomyopathy defective what and can cause what sx
1. desmosomes adhesion Proteins
| 2. V tachy, Premature contractions or fibrillation = sudden death
130
Naxos Syndrome
```
= Arrhythmogenic RV cardiomyopathy
1. plantar and palmar hyperkeratosis
2. wooly hair
3. mutated plakoglobin
= how it was first seen
```
131
Myocarditis is what and usually from what
inflammation of cardiac muscle
1. Coxsackie B virus
2. COVID19
132
Myocarditis sx
1. asymp ----> HF
2. arrythmia, fever
3. high troponin
4. dilated cardiomyopathy can happen
133
Chagas Disease
"kissing bug"
1. releasing Triatomine, Trypanosoma cruzi
2. can collect in muscle --> BS--> heart = myocarditis
3. achalasia
134
Trichinosis
worm from pork muscle
| = can get into heart muscle = myocarditis
135
Lyme disease sx
1. myocarditis with heart block (spirochetes)
2. migratory erythma
3. migratory polyarthrtis, fascial palsy, meningitis
136
most common type of myocarditis
Lymphocytic myocarditis = from viral or post viral infection
137
Eosinophilic Myocarditis
Hypersensitivity myocarditis
from allergy, (usually drug reaction), hypersensitivity
= EXCLUDE parasitic infection first
138
2 Giant Cell myocarditis
1. Idiopathic Giant Cell Myocarditis : agressive and deadly, 3mo life, Giant Cells + inflammation (high E)
2. Myocardial Sarcoidosis : Giant cells and non-necrotizing granulomas , hiliar lymphadenopathy (AA prevalence)
