cardio 3

Question 1

what is Acquired stenosis

Answer 1

failure of valve to open completely, resulting in blockage of forward flow

Question 2

mitral valve stenosis is usually due to ________

Answer 2

chronic (recurrent) rheumatic valvular disease

Question 3

what is the underlying systemic disease that causes this mitral valve stenosis?

Answer 3

Acute rheumatic fever

Question 4

acute rheumatic fever is caused by what

Answer 4

group A beta-hemolytic streptococcal pharyngitis.

Question 5

myocarditis, pericarditis, arthralgia or arthritis, and other manifestations are caused by what

Answer 5

acute rheumatic fever

Question 6

The myocarditis is characterized microscopically by _______ which are

Answer 6

Aschoff bodies

Question 7

Aschoff bodies

Answer 7

are collections of mononuclear inflammatory cells and fibroblasts (essentially granulomatous inflammation).

Question 8

Recurrent bouts of RF eventually lead to….

Answer 8

severe FIBROSIS and CALCIFICATION of the mitral valve and possibly other heart valves.

Question 9

The disease is thought to be due to the production of _______ against the streptococcal bacteria which cross react with various antigens in the heart, joints and other sites.

Answer 9

antibodies

Question 10

Regurgitation (insufficiency) is what

Answer 10

refers to a valve that fails to close completely, allowing backflow of blood

Question 11

what is Mitral valve prolapse

Answer 11

is a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole).

Question 12

T/F Severe prolapse may be associated with valvular regurgitation

Answer 12

TRUE!!!!!!!!!

Question 13

severe prolapse is also called what

Answer 13

floppy mitral valve

Question 14

T/F patients usually dont experience chest pain and palpitations with mitral valve prolapse

Answer 14

false, they sometimes do

Question 15

in severe prolapse the mitral valves are large and floppy because….

Answer 15

microscopically show 1) fragmentation,

2) separation and 3) loss of collagen (myxomatous degeneration).

Question 16

T/F Floppy mitral valve may be an isolated abnormality or part of a systemic connective tissue disorder such as Marfan syndrome.

Answer 16

TRUE

Question 17

what is a systemic CT disorder

Answer 17

marfan syndrome

Question 18

T/F aortic valve stenosis is very similar to mitral valve stenosis

Answer 18

TRUE, Fibrosis and calcification reduce the valve cusp mobility.

Question 19

causes of aortic valve stenosis?

Answer 19

1. chronic rheumatic valvular disease

2. may occur with advanced age (over 65 years)

Question 20

The mechanisms include valve cusp destruction (endocarditis), myxomatous
degeneration and dilation of the aortic root.

Answer 20

aortic valve regurgitation

Question 21

Infective Endocarditis usually caused by what

Answer 21

bacterial infection in a heart valve, although it may also be caused by fungus or other unusual infections

Question 22

The three factors that

have been identified as having importance in the pathogenesis of infective endocarditis include:

Answer 22

1 ) endocardial or endothelial injury due to abnormalities in blood flow;
2 ) fibrin thrombi; and
3 ) organisms in the blood.

Question 23

Clinical manifestations of infective endocarditis include:

Answer 23

fever, heart murmur, fatigue, anemia,
arthralgia, myalgia, splinter hemorrhages (nail bed) and Roth spots (retinal) hemorrhages, not absolutely specific to IE)

Question 24

complications of infective endocarditis

Answer 24

a. rupture of chordae tendineae
b. spread of infection into myocardium or aorta
c. thromboembolism with infarction
d. septic thrombi with metastatic abscesses
e. valvular dysfunction and CHF

Question 25

Acute Endocarditis

Answer 25

short time and large destruction with highly virulent pathogen on normal valves

Question 26

subacute endocarditis

Answer 26

long time and little destruction with low virulent pathogen on abnormal valves

Question 27

Vasculitis

Answer 27

inflammation of the blood vessels, causes changes in the vessel wall, caused my infection of the endothelial cells usually

Question 28

other causes of vasculitis

Answer 28

microorganisms and Other causes include mechanical trauma, toxins, caustic substances, radiation and immune complexes.

Question 29

vasculitis classifications

Answer 29

large vessel medium vessel small vessel

Question 30

large vessel

Answer 30

``` Giant cell (temporal) arteritis- vasculitis of vessels in the head. Takayasu arteritis- vasculitis of the aorta and sometimes pulmonary artery. affecting young and middle aged asian women. ```

Question 31

medium vessels

Answer 31

``` Polyarteritis nodosa (classic)- ("vasculitis") causing injury to organ systems. The areas most commonly affected by PAN include the nerves, intestinal tract, heart, and joints Kawasaki syndrome - includes coronary arteries. ```

Question 32

small vessels

Answer 32

Microscopic polyarteritis - affects mainly capillaries and arterioles Wegener’s granulomatosis - generally affects your kidneys, lungs and upper respiratory tract.

Question 33

anti-endothelial cell antibodies associated with...

Answer 33

kawasaki syndrome

Question 34

Anti-proteinase-3 (anti-PR3) - diffuse cytoplasmic distribution (formerly known as cANCA) associated with....

Answer 34

Wegeners granulomatosis

Question 35

Anti-myeloperoxidase (anti-MPO) - perinuclear localization (formerly known as pANCA) associated with...

Answer 35

Microscopic polyarteritis

Question 36

Fever, weight loss, headache, visual problems (including blindness), claudication of jaw (weakness when chewing due to decreased blood supply), pain and tenderness over temporal artery, polymyalgia rheumatica. Rare under the age of 50 years.

Answer 36

Giant cell (temporal) arteritis

Question 37

Giant cell arteritis pathology

Answer 37

giant cell involved in Granulomatous inflammation and fibrosis, leading to narrowing of vessels and decreased blood flow to affected areas

Question 38

Thickening of the wall reduces blood flow in the major branches off the aortic arch (“pulseless disease” due to weak pulses in the arms). Usually affects young women. May be the same disease as temporal arteritis, but in a younger patient.

Answer 38

Takayasu Arteritis

Question 39

Takayasu Arteritis pathology

Answer 39

Granulomatous inflammation with fibrosis involving the aortic arch and the arch branches.

Question 40

Fever, weight loss, hematuria, renal failure, hypertension, abdominal pain, melena. Clinical presentation may be very confusing due to involvement of multiple organ systems.

Answer 40

Polyarteritis nodosa

Question 41

Polyarteritis nodosa pathology

Answer 41

Acute lesions show fibrinoid necrosis, thrombosis, neutrophils, aneurysms. With healing there is predominance of macrophages and plasma cells; progressive fibrous scarring.

Question 42

Polyarteritis nodosa usually occurs....

Answer 42

kidneys (85%), heart (75%), liver (65%), and GI tract (50%).

Question 43

Affects infants and young children (80% of patients

Answer 43

Kawasaki Disease

Question 44

Etiology- It is suspected that a viral infection triggers a hypersensitivity reaction. AKA: mucocutaneous lymph node syndrome

Answer 44

Kawasaki disease

Question 45

Microscopic Polyangiitis etiology

Answer 45

Often due to antigen-antibody complexes.

Question 46

Fever, rash, joint swelling, pleural effusion, pulmonary infiltrates, myocarditis, GI bleeding, renal failure, presence of circulating anti-neutrophilic cytoplasmic antibodies (MPO-ANCA). May be precipitated by drugs, microorganisms, foreign proteins or tumor proteins.

Answer 46

Microscopic Polyangiitis

Question 47

Pathology: Involves arterioles, capillaries, venules. Fibrinoid necrosis, neutrophils (leukocytoclastic vasculitis).

Answer 47

Microscopic Polyangiitis

Question 48

Involves sinuses, lungs and kidneys (glomerulonephritis). Associated with the presence of anti-neutrophilic cytoplasmic antibodies direct against proteinase 3 (PR3-ANCA).

Answer 48

Wegener Granulomatosis

Question 49

Thromboangiitis obliterans (Buerger Disease)

Answer 49

Endothelial injury from a substance in cigarette smoke

Question 50

Usually begins before age 35. Pain and ischemia in extremities

Answer 50

Thromboangiitis obliterans (Buerger Disease)

Question 51

Thromboangiitis obliterans (Buerger Disease)

Answer 51

Segmental acute and chronic vasculitis mainly in extremities with thrombosis.

Question 52

another name for DISSECTING AORTIC HEMATOMA

Answer 52

aneurysm

Question 53

what is DISSECTING AORTIC HEMATOMA

Answer 53

Longitudinal tear of the aortic media which begins in the ascending aorta and extends variable distance proximal (toward the heart) and distal to the descending aorta.

Question 54

complications with dissecting aortic hematoma

Answer 54

severe hemorrhage from rupture, organ ischemia due to luminal compression by the expanding hematoma.

Question 55

predisposing factors for dissecting aortic hematoma

Answer 55

1. hypertension, | 2. inherited connective tissue disorders (i.e., Marfan’s syndrome) with medial degeneration.