Cardiac Pathology Part II Flashcards
(116 cards)
1
Q
what is the most common cause of arrhythmia?
A
ischemic heart disease aka MI
2
Q
what are other causes of arrhythmia?
A
cardiomyopathies
myocarditis
valvular disease
congenital disorders
3
Q
what is sick sinus syndrome?
A
damage to the SA node causing bradycardia
*AV node becomes pacemaker of the heart
4
Q
what is atrial fibrillation?
A
independent and sporadic atrial myocyte depolarization with variable transmission to the AV node
irregularly irregular rhythm
5
Q
what risks are associated with Afib?
A
thrombus formation and subsequent stroke
6
Q
what is a heart block?
A
dysfunction at the AV node
7
Q
what is the most severe heart block?
A
third degree
complete failure of AV node
8
Q
what can be seen on ECG with a first degree heart block?
A
prolonged PR interval
9
Q
what is the primary cause of hereditary arrhytmias?
A
ion channel disfunction (channelopathies)
K+ and Na+
10
Q
what is the typical presentation of hereditary channelopathies?
A
sudden death after exertion
11
Q
what is another name for hereditary channelopathies?
A
Long QT syndrome
12
Q
what can occur in patients with long QT syndrome?
A
Torsades de Pointes
13
Q
what is the most common cause of sudden death due to ischemia induced arrhythmia?
A
coronary artery disease
14
Q
what can cause sudden cardiac death in younger patients?
A
drug abuse (cocaine and meth) hereditary arrhythmias cardiomyopathies myocardial hypertrophy myocarditis mitral valve prolapse
15
Q
what changes in the heart occur with untreated hypertension?
A
left ventricular concentric hypertrophy
can lead to diastolic dysfunction –> CHF and Afib
16
Q
what causes right sided hypertensive heart disease?
A
pulmonary hypertension as a result of:
pulmonary parenchymal disease
pulmonary vessel disease
disorders of chest movement
17
Q
what changes occur in the heart as a result of pulmonary hypertension?
A
right ventricular hypertrophy
hypertrophied trabeculae
tricuspid stenosis
18
Q
what is the most common valve abnormality?
A
calcific aortic stenosis
19
Q
what is the demographic of calcific aortic stenosis?
A
60+ y/o with HTN, high cholesterol or chronic inflammation
20
Q
what is the risk associated with bicuspid aortic valves?
A
accelerated course of calcific aortic stenosis
may cause aortic valve dilation or prolapse
bacterial endocarditis is more frequent
21
Q
what cardiac changes occur with calcific aortic stenosis?
A
increased LV pressure resulting in concentric LV hypertrophy
22
Q
what is the clinical presentation of calcific aortic stenosis?
A
systolic murmur
angina
syncope
CHF
tx: valve replacement
23
Q
what risks are associated with mitral annular calcification?
A
more common in females 60+
regurgitation
stenosis
arrhythmias
prone to thrombus and infective endocarditis
24
Q
what is mitral valve prolapse?
A
valve leaflets prolapse back into the left atrium during systole
“floppy valve”
25
what causes mitral valve prolapse?
female predominance
can occur spontaneously without cause
connective tissue disease
complication of MI or rheumatic fever
26
what would be seen morphologically in mitral valve prolapse?
thickened, rubbery leaflets
| interchordal ballooning/hooding of the leafets
27
what would be seen on histology in mitral valve prolapse?
proteoglycan deposition
| myxomatous degeneration
28
what is the clinical presentation of mitral valve prolapse?
mid-systolic click +/- murmur
| dyspnea due to regurgitation
29
what are rare complications that can occur with MVP?
infective endocarditis
mitral insufficiency
arrhythmias
thromboembolism
30
what is rheumatic fever?
multisystem inflammatory disorder caused by group A strep pharyngitis
31
what is the immunological mechanism of rheumatic fever?
antibodies and CD4 cell reaction against M streptococcal antigen
causes reaction to self antigens in heart, joints, soft tissue, skin and nervous system
32
what is the clinical presentation of rheumatic fever?
```
fever
migratory polyarthritis
pancarditis
subcutatneous nodules
erythema marginatum
syndeham chorea
```
33
what is acute rheumatic heart disease?
pericarditis, myocarditis or endocarditis (pancarditis if all affected)
valvulitis with vegetation (verrucae formation)
MacCallum plaques
34
what would bee seen on histology in rheumatic heart disease?
Aschoff bodies with Anitschkow cells
35
what valves are primarily affected in rheumatic heart disease?
mitral > aortic > tricuspid
*MAT*
36
what is chronic rheumatic heart disease?
valvular thickening, short chordae tendinae, fusion and regurgitation
valvular stenosis
37
what is the clinical presentation of chronic rheumatic heart disease?
mitral stenosis causing diastolic rumbling murmur
38
what complications are associated with chronic rheumatic heart disease?
infective endocarditis
mitral stenosis –> left atrial enlargement –> thromboembolism
39
what causes infective endocarditis?
infectious organism, inflammation or fibrinous debris
40
where does infective endocarditis typically affect the heart?
valves or structural abnormalities
41
what risk factors are associated with infective endocarditis?
```
drug use
body piercings
male gender (haha)
poor dentition
invasive dental procedures
pre-existing heart conditions
```
42
what pre-existing conditions are pre-disposed to infective endocarditis?
valvular disease
prosthetic heart valve
structural heart disease
43
what causes are associated with left sided infective endocarditis?
structural valve abnormalities
poor dentition/dental procedure
prosthetic valves
44
what organism is the cause of infective endocarditis in valvular abnormalities?
Strep viridans
45
what organism is the cause of infective endocarditis in poor dentition/dental procedures?
```
HACEK group:
hemophilus
actinobacillus
cardiobacterium
eikenella
kingella
```
46
what organism is the cause of infective endocarditis in prosthetic valves?
staph epidermidis
47
what is the only cause of right sided infective endocarditis?
IV drug abuse
48
what organism is the cause of infective endocarditis in IV drug abuse?
staph aureus
49
what is the clinical presentation of acute infective endocarditis?
```
rapid onset fever chills and weakness
subungual splinter hemorrhages (nails)
Janeway lesions (palms and soles)
osler nodes (hands)
roth spots (eyes)
```
50
what is nonbacterial thrombotic endocarditis?
sterile, non-inflammatory valvular thrombi that is asymptomatic until embolization occurs
51
what causes nonbacterial thrombotic endocarditis?
sepsis
cancer
antiphospholipid syndrome
SLE (Libman-Sacks endocarditis)
52
what is carcinoid heart disease?
compounds secreted by carcinoid tumors induce plaque-like endocardial and valvular thickening
53
what part of the heart is affected by carcinoid heart disease?
right sided valves and endocardial tissue
*left side is protected by pulmonary vascular degradation of compounds*
54
what is the clinical presentation of carcinoid heart disease?
flushing
diarrhea
dermatitis
bronchoconstriction
55
what can be seen on histology in carcinoid heart disease?
plaque-like thickening with mucopolysaccharide deposition
56
what is a potential complication in someone with a prosthetic valve (mechanical or biotic)?
*infective endocarditis*
anticoagulant related hemorrhage
dysfunction or exuberant healing
hemolytic anemia
57
what condition is associated with a harsh systolic murmur?
calcific aortic stenosis
58
what conditions are associated with a holosystolic murmur?
mitral regurgitation
| VSD
59
what condition is associated with a diastolic decrescendo murmur?
aortic regurgitation
60
what condition is associated with a diastolic rumbling murmur?
rheumatic heart disease (mitral valve stenosis)
61
what condition is associated with a continuous machine-like murmur?
PDA
62
what does cardiomyopathy mean in general?
heart muscle disease
63
what are the three major types of cardiomyopathy?
1. dilated (most common)
2. hypertrophic
3. restricted (least common)
64
what causes dilated cardiomyopathy?
```
AD hereditary TTN gene
peripartum cardiomyopathy
alcoholism with wet beri-beri
myocarditis
cardiotoxic drugs
hemochromatosis
```
65
what morphology is associated with dilated cardiomyopathy?
dilation of all heart chambers
hypertrophy without wall thickening
functional valve regurgitation
66
what is the clinical presentation of dilated cardiomyopathy?
```
20-50 y/o
progressive CHF with decreased EF
systolic dysfunction
arrhythmias
thromboembolism
```
67
what is takotsubo cardiomyopathy?
broken heart syndrome :(
associated with sudden surge of catecholamines due to emotional distress
most likely to occur in women because we are emotional AF
68
what would be seen on CXR in someone with takotsubo cardiomyopathy?
apical ballooning of left ventricle
looks like Japanese fishing pot!
69
what is arrhythmogenic right ventricular cardiomyopathy (ARVC)?
AD hereditary disorder with defective cell adhesion proteins in the desmosomes that link adjacent cardiac myocytes
70
what morphological changes are associated with ARVC?
right ventribular wall is replaced by adipose and fibrosis causing right ventricular failure and arrhythmia
V tach or V fib causes sudden cardiac death
71
what is Naxos syndrome?
ARVC with plantar and palmar keratosis and wooly hair
caused by mutation in the desmosome associated protein *plakoglobin*
72
what is hypertrophic cardiomyopathy?
GENETIC ONLY
myocyte hypertrophy and disarray with septal prominence
73
what mutation is most common in hypertrophic cardiomyopathy?
B-MHC
74
what can be seen morphologically in hypertrophic cardiomyopathy?
septal hypertrophy > ventricular wall hypertrophy
septum and anterior mitral valve obstruct blood flow
75
what is the classical presentation of hypertrophic cardiomyopathy?
sudden unexplained death in athlete during exercise
76
what can be seen clinically in hypertrophic cardiomyopathy?
```
ventricular arrhythmia
systolic ejection murmur
exertional dyspnea
exertional CP
palpitations
```
77
what is restrictive cardiomyopathy?
decreased ventricular compliance resulting in diastolic dysfunction
78
what causes restrictive cardiomyopathy?
deposition of material within cardiac walls
amyloid due to amyloidosis
OR
fibrosis due to radiation
79
what histological findigs are associated with amyloidosis?
apple green birefringence on congo red stain
80
what is the most common cause of myocarditis?
VIRAL:
| coxsackievirus B
81
what is the clinical presentation of myocarditis?
ranges from asymptomatic to heart failure
may present as arrhythmia causing sudden death
+/- fever
82
what are other infectious causes of myocarditis?
```
Chagas disease (trypanosoma cruzi)
Trichinosis (pork helminth)
Lyme disease (spirochete)
```
83
what is more common: lymphocytic or eosinophilic myocarditis?
lymphocytic (viral, autoimmune or idiopathic cause)
84
what is the prognosis of idiopathic giant cell myocarditis?
very poor prognosis
| survival typically less than 3 monst from onset
85
what are the classic cardiotoxic drugs?
doxorubicin and daunorubicin
cause dilated cardiomyopathy and HF
86
what is pericardial effusion?
acute or chronic accumulation of fluid within the pericardium
87
when is pericardial effusion dangerous?
```
acute onset (<1 week)
causes cardiac tamponade
```
88
what are the subtypes of pericardial effusions?
hemopericardium
serous effusion
purulent pericarditis
89
what causes hemopericardium?
trauma
ruptured MI
aortic dissection
90
what causes serous effusion?
CHF
91
what causes purulent pericarditis?
necroinflammatory debris
acute inflammation
secondary to infectious process
92
what is pericarditis?
inflammation of the pericardial sac
93
what is the clinical presentation of pericarditis?
sharp, pleuritic and position dependent chest pain
pericardial friction rub
pericardial effusion
ECG changes (ST elevation with PR depression)
fever
94
what is the most common type of pericarditis?
fibrinous/serofibrinous
95
what is fibrinous/serofibrinous pericarditis?
fibrinous inflammatory exudate with variable amount of serous fluid accumulates within pericardial sac
96
what causes fibrinous/serofibrinous pericarditis?
Acute MI
Dressler's syndrome (post-infarction)
uremia (CKD with elevated BUN)
97
what is seen morphologically in fibrinous/serofibrinous pericarditis?
bread and butter appearance on pericardium
98
what causes serous pericarditis?
virus
| inflammatory disease
99
what causes purulent/suppurative pericarditis?
active infection by bacterial invasion
100
what is seen histologically in purulent/suppurative pericarditis?
bacteria
neutrophils
fibrinopurulent debris
101
what causes caseous pericarditis?
tuberculosis
102
what causes hemorrhagic pericarditis?
malignant neoplasm
| trauma
103
what is constrictive pericarditis?
heart becomes encased in dense, fibrous or fibrocalcific scar
limits diastolic expansion and cardiac output
mimics restrictive cardiomyopathy
104
what is the most common cardiac tumor in adults?
myxoma (benign)
105
what is the most common cardiac tumor in children?
rhabdomyoma (benign)
106
what is the most common malignant cardiac tumur?
angiosarcoma
107
what is a cardiac myxoma?
stromal tumor of mesenchymal origin
| ranges from globular/hard to gelatinous
108
where does a myxoma typically occur?
left atrium beginning in the septal region of the fossa ovalis
109
what is the clinical presentation of myxoma?
```
"ball-valve" obstruction
mechanical valve damage
tumor embolization
fever and malaise (IL-6 released from tumor)
tumor "plop" on ausculation
```
110
what familial syndromes are associated with myxomas?
```
McCune-Albright syndrome (GNAS1)
Carney complex (PRKAR1A)
```
111
what is a papillary fibroelastoma?
incidental "sea-anemone-like" lesion
| usually located on valves
112
what genes are associated with rhabdomyomas?
TSC1
| TSC2
113
which is more likely: a primary cardiac tumor or metastasis?
metastasis from lung, breast, melanoma or lymphoma
114
what are potential complications associated with cardiac tumors?
```
mass effect (limiting cardiac filling)
decreased myocardial contractility
symptomatic pericardial effusion
superior vena cava syndrome
production of circulating mediators
```
115
what is allograft vasculopathy?
late, progressive, diffusely stenosing intimal proliferation
*silent MI* – denervation of transplanted heart causes MI without angina
116
what complications are associated with heart transplant?
infection
malignancy
skin cancers
EBV positive lymphoproliferative disorder
