Ch 12-Cardiac Path-Galbraith PDF's Flashcards by Kelley Perry

Describe morphologic changes of heart valves as you age:

Aortic and mitral valve annular calcification
Fibrous thickening
MV leaflets buckling toward LA —> increased LA size
Lambl excrescences

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Describe the vascular changes in the heart as you age:

Coronary atherosclerosis

Stiffening of the aorta

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Loss of myocardial contractile function is a __ dysfunction

Loss of ability to fill the ventricles during ventricular filling is a ___ dysfunction

Systolic

Diastolic

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In the setting of pressure overload, myocytes become ___ and the LV wall thickness increases concentrically

In the setting of volume overload, myocytes ___, and ventricular dilation is seen

Thicker

Elongate

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What is left-sided heart failure commonly a result of?

Myocardial ischemia
HTN
Left-sided valve disease
Primarily myocardial disease

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In left ventricular dysfunction, you can get left atrial dilation which can lead to:

A fib, stasis, thrombus

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What are some symptoms of pulmonary congestion and edema from left-sided heart failure?

Cough
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea (pillow orthopnea)

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Describe what happens to glomerular perfusion in left-sided failure and its consequences:

Decreased ejection fraction may result in decreased glomerular perfusion –> stimulates release of renin –> increased volume

Prerenal azotemia

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What is the most common cause of right-sided heart failure?

Left-sided heart failure

Isolated right-sided heart failures results from any cause of pulmonary HTN (parenchymal lung disease, primary pulm HTN, pulm vasoconstriction)

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In primary right-sided heart failure, describe what happens to the following as the venous system becomes markedly congested:
Liver: __
Spleen: __
Peritoneal, pleural, and pericardial spaces: ___
Edema?
Renal: __

Liver congestion (NUTMEG liver)
Splenic congestion (SPLENOMEGALY)
Effusions
Edema in dependent areas (ankle)
Renal congestion

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___ is described as a stenosis occlusion of a coronary artery with a “squeezing” or burning sensation (when walking up stairs/exercising), relieved by rest or vasodilators

Stable angina

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__ is characterized as an episodic coronary spasm, relieved with vasodilators

Prinzmetal angina

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__ is characterized by pain, increasing in frequency, duration, and severity, eventually at rest. There is usually a rupture of a plaque, with a partial thrombus. Up to 50% may have evidence of myocardial necrosis

Unstable or “crescendo” angina

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Nearly 90% of infarcts are caused by ___

Atheromatous plaque

Other causes: embolus, vasospasm, ischemia secondary to vasculitis, shock ,hematologic abnormalities

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Describe the classic presentation of an MI:

PROLONGED CHEST PAIN (>30 min) --> crushing, stabbing, squeezing, tightness; radiating down left arm or to left jaw
DIAPHORESIS
Dyspnea
Nausea-vomiting
Up to 25% are asymptomatic

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Describe the levels of lactate and ATP during an MI

Lactate increases, ATP decreases

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What are the areas of infarct with permanent occlusion of the LAD?

Apex, LV anterior wall, anterior 2/3 of septum

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What are the areas of infarct with permanent occlusion of the RCA?

RV free wall, LV posterior wall, posterior 1/3 of septum

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What are the areas of infarct with permanent occlusion of the LCX?

LV lateral wall

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Describe the damage in a transient/partial obstruction non-transmural infarct:

Regional subendocardial infarct

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Describe the damage in a global hypotension non-transmural infarct:

Circumferential subdendocardial infarct

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Describe the damage in a small intramural vessel occlusion non-transmural infarct:

Microinfarcts

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___ stains tissue containing lactate dehydrogenase red (after an MI)

Triphenyltetrazolium chloride

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What are some gross and microscopic morphologic changes seen immediately after an MI?

Nothing

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When will you see microscopic granulation tissue after an MI?

7-10 days it begins to form, can last up to 14 days

About how long does it take to form a dense collagenous scar following an MI?

~2 months

Contraction band necrosis is associated with ___

Reperfusion injury; dead myocytes contract d/t Ca influx

What is the most cardiac myocyte-specific lab test to determine an MI?

Troponin I and T

When does Troponin I typically peak after onset of chest pain in an MI?

About 24-30 hours

When does CK-MB usually peak after onset of chest pains with an MI?

About 18 hours

Half of all MI deaths occur within 1 hour of onset, and are usually secondary to a ___

Fatal arrhythmia

What are some more common complications of an MI?

``` Contractile dysfunction Fibrinous pericarditis Myocardial rupture Infarct expansion Ventricular aneurysm ```

___ precipitates sudden cardiac death in 80-90% of cases

Coronary artery disease

Sudden cardiac death is due to a __ most often arising from ischemia-induced myocardial irritability

Fatal arrhythmia

Left-sided hypertensive heart disease is usually due to ___ HTN Right-sided hypertensive heart disease is usually due to ___ HTN

Systemic Pulmonary

In left-sided heart disease, pressure overload results in LV hypertrophy (LV wall is concentrically thickened). What happens to the LA and what type of dysfunction and arrhythmia can result?

Diastolic dysfunction can result in LA enlargement Can lead to A fib

Acute cor pulmonale may arise from a large __

Pulmonary embolus

Chronic stenosis may cause ___ overload hypertrophy --> CHF Chronic insufficiency (regurgitation) may cause ___ overload hypertrophy --> CHF

Pressure Volume

___ is the most common valve abnormality. The prevalence increases with age (60-80 yrs), "wear and tear" is associated with chronic HTN, hyperlipidemia, inflammation. The bicuspid valves show an accelerated course and can get ossification of valves.

Calcification aortic stenosis

What type of "cells" can be found on affected valves in calcific aortic stenosis?

Osteoblast-like cell

Where do calcific deposits occur in mitral annular calcification?

Fibrous annulus (fibrous ring) Normally does not affect valve function

What gender and age group is more likely to have mitral annular calcification?

F > M | > 60 years

When do valve leaflets prolapse back into the LA with a mitral valve prolapse?

Systole --> Mid-systolic click

Who is more likely to have a mitral valve prolapse?

F : M --> 7:1 ratio

What is the buzzword associated with leaflets becoming thickened and rubbery d/t proteoglycans deposits in mitral valve prolapse?

Myxomatous degeneration

Rheumatic fever is a multisystem inflamm disorder following pharyngeal infx with ___

Group A streptococcus

The pathogenesis of rheumatic heart disease is an immune response to streptococcal ___ proteins that cross react with cardiac self-ags.

What are other common features of rheumatic fever?

``` J-Joints (migratory polyarthritis) O-O supposed to look like a heart for heart problems (pancarditis) N-Nodules (subQ nodules) E-Erythema marginatum (rash) S-Syndenham chorea ```

What is the morphologic feature associated with pancarditis in acute RF?

Aschoff bodies

In chronic RHD, mitral leaflet thickening, fusion and shortening of commisures, fusion and thickening of tendinitis cords will result in __

Mitral stenosis

what type of valvular disorder is mostly associated with RF?

Mitral stenosis

__ is a rapidly progressive, destructive infx of a previously normal valve. It requires surgery in addition to ABx

Acute infective endocarditis

__ is a slower-progressing infx of a previously deformed valve (such as in RHD). It can often be cured with ABx alone

Subacute infective endocarditis

What are some predisposing conditions for infective endocarditis?

Valvular abnormalities: RHD, prosthetic valves, MV prolapse, calcific stenosis, bicuspid AV Bacteremia: ANother site of infx, dental work/surgery, contaminated needles, compromised epithelium

Which valves are more commonly affected in infective endocarditis?

Left-sided valves more commonly affected Right-sided valves often involved in IV drug abusers

What is the classic feature of infective endocarditis?

Friable, bulky, destructive valvular vegetations Friability leads to septic emboli Vegetations are mixtures of fibrin, inflamm cells, and orgs

What type of symptoms do infective endocarditis pts usually present with?

Nonspecific symptoms --> fever, weight loss, fatigue Murmurs usually present with left-sided lesions

This org is often involved in infective endocarditis d/t dental work and valve abnormalities

Strep viridans

This org causes infective endocarditis of normal valves, abnormal valves, and IV drug abusers.

Staph aureus

This org is associated with infective endocarditis of prosthetic valves

Staph epidermidis

Aside from strep viridans, staph aureus, and staph epidermidis, what other orgs are associated with infective endocarditis?

``` H-Hemophilus A-Actinobacillus C-Cardiobacterium E-Eikenella K-Kingella ```

Describe what happens to the the following features of the myocardium and chambers as you age: LV chamber size: ___ Epicardial fat: ___ Myocardial changes: ___

Decreased LV size Increased epicardial fat Lipofuscin and basophilic degeneration, fewer monocytes, increased collagen fibers

Nonbacterial thombotic endocarditis is associated with ___

MALIGNANCIES (Esp. mucinous adenocarcinomas) Sepsis Catheter-induced endocardial trauma

What is the most common type of cardiomyopathy?

Dilated (90%)

What type of dysfunction is associated with dilated cardiomyopathy?

Systolic dysfunction Progressive cardiac dilation and systolic dysfunction, usually with dilated hypertrophy

Dilated cardiomyopathy is thought to be familial in 30-50% of cases and due to ___ mutations and is autosomal dominant (usually)

TITIN Alcohol strongly linked to DCM, so is myocarditis, cardiotoxic drugs/substances (Doxorubicin, cobalt Fe overload)

Describe the morphology of Dilated cardiomyopathy

Dilation of all chambers Mural thrombi common Functional regurgitation of valves

What is a classical presentation of Dilated cardiomyopathy?

Usually manifests between 20-50 yrs old Progressive CHF --> dyspnea, exertional fatigue, decreased ejection fraction Arrhythmias Embolism

___ is due to excess catecholamines following extreme emotional of psychological stress. It appears > 90% women ages 58-75, the symptoms and signs resemble an acute MI and there is apical ballooning of the LV with abnormal wall motion and contractile dysfunction.

Takotsubo cardiomyopathy BROKEN HEART SYNDROME

In Arrhythmogenic RV cardiomyopathy, RV failure and arrhythmias cause __ which can lead to sudden death

V tac and V fib It is familial (usually autosomal dominant)

Desmosome and intercalated dysfunctions are associated with this cardiomyopathy:

Arrhythmogenic RV cardiomyopathy

__ is a genetic disorder leading to myocardial hypertrophy and diastolic dysfunction, leading to decreased stroke volume and often ventricular outflow obstruction

Hypertrophic cardiomyopathy

In Hypertrophic cardiomyopathy, numerous mutations are known involving sarcomeric proteins, most commonly ___

B-myosin heavy chain

Describe the morphology of hypertrophic cardiomyopathy:

Massive myocardial hypertrophy, often with marked septal hypertrophy Microscopically, myocytes disarray

Consequences of extensive ___ can lead to foci of myocardial ischemia, LA dilation and mural thrombus, diminished CO and increased pulm congestion leading to exertional dyspnea, arrhythmias, and Sudden death

Hypertrophic cardiomyopathy

___ is due to decreased ventricular compliance (increased stiffness), leading to diastolic dysfunction. It may be secondary to depositio of material within the wall (amyloid) or increased fibrosis (radiation). The ventricles are usually normal size, but both atria can be enlarged

Restrictive cardiomyopathy

Amyloid is an EC deposition of proteins which form an insoluble B-pleated sheet. It may be systemic (due to myeloma) or restricted to the heart which is usually __

Transthyretin

When amyloid deposits in the interstitium of the myocardium of a ___ cardiomyopathy results

Restrictive

What is the most common causative agent/org responsible for myocarditis?

Coxsackie A and B viruses most common

What are some non-infectious causes of myocarditis?

Immune-mediated rxns, including RF, SLE, drug hypersensitivity

The single most common genetic cause of congenital heart disease is ___

Trisomy 21

What are the 3 left-to-right shunt congenital heart disorders (Galbraith slides)

ASD VSD PDA

___ is usually asymptomatic until adulthood. The L-->R shunting causes volume overload on the right side which may lead to pulmonary HTN, Right heart failure, paradoxical embolization, and may be closed surgically with normal survival

ASD

___ is the most common form of congenital heart disease. Many smaller defects close spontaneously but Large ones may cause significant shunting leading to RV hypertrophy, pulmonary HTN which can ultimately reverse flow through the shunt, leading to cyanosis

VSD

A ___ may fail to close when infants are hypoxic, and/or have defects associated with increased pulmonary vascular pressure (VSD). It produces a harsh, machinery-like murmur. Large shunt can increase pulm pressure and eventually shunt reversal and cyanosis

PDA

What type of murmur do you hear with a PDA?

Harsh, machinery-like murmur

What are the 3 R-->L shunts (Galbraith slides)?

Classic TOF Transposition of great arteries W/ VSD Transposition of great arteries W/O VSD

What are the 4 cardinal features of TOF?

VSD Obstruction of RV outflow tract Aorta overrides the VSD RV hypertrophy

What does the heart look like in TOF?

"BOOT-SHAPED"--> heart is enlarged d/t RV hypertrophy

The clinical severity of TOF depends on the degree of ___

Subpulmonary stenosis

Which form of coarctation of the aorta generally has a PDA?

Infantile

What are the characteristics of a coarctation of the aorta with a PDA that manifests at birth?

May produced cyanosis in lower half of body

What are the characteristics of a coarctation without PDA?

Usually asymptomatic HTN in UE's, Hypotension in LE's Claudication and cold LE's May eventually see concentric LV hypertrophy

What is the greatest determinant of cyanosis in TOF?

Degree of pulmonary stenosis

Ch 12-Cardiac Path-Galbraith PDF's Flashcards

(94 cards)