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Flashcards in CVS Deck (121):
1

describe the presentation of the condition seen in the image

  • presentation = classic sudden death from arrhythmias (athlete that collapses and dies)
    • exertional dyspnea
    • diastolic dysfunction
    • decreased LVEDV and decreased stroke volume → normal EF

2

describe symptoms of the acute vs. subacute form of the condition seen in the image

  • acute:
    • high fever
    • splinter hemorrhages
    • no splenomegaly
    • no finger clubbing
    • no anemia
  • subacute
    • low-grade fever
    • splenomegaly
    • finger clubbing

3

describe what is seen in the image

4

describe the presentation of the condition seen in the image

  • presentation:
    • becomes apparent 6 months after birth (once fetal Hb decreases, since fetal Hb binds O2 with higher affinity)
    • tet spells (squatting) 
      • afterload increases to reverse the shunt (L → R) → cyanosis transiently improves
      • single S2 → no sound from pulmonic valve
      • large VSD → no murmur

5

describe the image

Wegener/GPA

lung from a patient with granulomatosis with polyangiitis, demonstrating large nodular cavitating lesions

6

describe what would be seen on x-ray in the condition seen in the image

x-ray:  widening of mediastinum since the blood collects in the media

7

describe the complications of the condition seen in the image

  • complications:
    • arrhythmias → HF

8

describe the treatment for the condition seen in the image

treatment = large aneurysms → surgically replaced by prosthetic grafts

9

describe what is seen in the image

10

describe the condition in the image and how & when it occurs

occurs 3-14 days post-MI

  • papillary muscle rupture: severe mitral regurg. → pulm. veins → pulm. edema
    • pan-systolic murmur loudest at apex (at the mitral valve)

11

describe the 2 types of the condition seen in the image

  • 2 types:
    • transmural: full thickness of ventricular wall; associated with plaque disruption & superimposed completely occlusive thrombosis
      • STEMI
    • subendocardial: inner 1/3 to 1/2 of ventricular wall;
      • commonly caused by hypovolemic shock due to a gunshot wound  
      • subendocardium is a watershed area and receives blood last → infarction alone tends to be due to ischemia rather than complete occlusion of an artery
      • NSTEMI

12

describe the presentation of the condition seen in the image

  • presentation: most commonly asymptomatic
    • incidental finding of a pulsatile and expansile abdominal mass or on ultrasound/CT

13

describe the organisms involved in the acute vs. subacute form of the condition seen in the image

  • acute
    • S. aureus in normal valves
      • most common among IVDU → tricuspid valve
    • Pseudomonas aeruginosa 2nd most common in IVDU
    • candida in IVDU
  • subacute
    • S. viridans in abnormal valves → good prognosis w/ antibiotics
    • S. bovis → tricuspid involvement + colon cancer
    • HACEK group

14

15

describe investigations for the condition seen in the image

  • investigation: ECG → will see unfused valve leaflets and LVH
    • systolic ejection click followed by crescendo-decrescendo murmur → radiates to carotids

16

describe what is seen in the image

17

describe the condition in the image and how & when it occurs

occurs after scar is fulled formed

  • left ventricular aneurysm after full formed scar
    • stasis → mural thrombus → arrhythmia + embolism → most common place is legs, brain

18

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • antero-superior displacement of the infundibular septum moves towards the RV → drags the aorta with it → overriding RV → creates large VSD

19

describe what is seen in the image

20

describe the type of hypertrophy seen in the image

  • HCM = concentric hypertrophy → impaired diastolic filling → LV-outflow obstruction → anterior leaflet of MV

21

list other risk factors for the condition seen in the image

  • other risk factors:
    • homocystinuria, lipoprotein a, increased PA-1 inhibitor, CRP, decreased estrogen

22

describe investigations for the condition seen in the image

  • investigations:
    • markedly elevated ESR (>100) → nonspecific marker of inflammation 
    • temporal artery biopsy: the disease is focal and skips so need to take a segmental biopsy 
      • elastic trichrome stain
      • negative biopsy does NOT rule out the disease

23

describe the most common form of the condition seen in the image and what it is associated with

membranous VSD is the most common VSD

  • L → R shunt but most close with age
  • associated with trisomy 21, 13, 18
  • incidental finding on ECG

24

describe the unstable form of the condition seen in the image

  • unstable = usually rupture → lefts off the cap and exposes core to lumen
    • moderately stenotic (50-75%) 
    • thinner fibrous cap
    • core rich in lipids, T cells and macrophages
    • less smooth muscle prolif
      • smooth muscle makes the collagen for the fibrous cap
    • eccentric 

25

describe the genetic etiology of the condition seen in the image

  • genetics:
    • most common → AD mutations affecting cytoskeletal proteins
    • less common = X-linked mutations → dystrophin gene

26

describe the condition seen in the image

27

describe the complications of the condition seen in the image

  • complications:
    • arrhythmias 
    • IE of mitral valve
    • LHF
    • RHF
    • mural thrombus due to stasis that can embolize and give stroke
    • infarcts of the septum → ischemia → angina or MI

28

describe the image seen

mitral valve prolapse

29

describe the heart sound associated with the condition in the image

harsh pansystolic murmur : loudest at left sternal border incidentally found on physic

30

describe the presentation of the condition seen in the image

  • presentation:
    • usually in patients over 60 yrs
    • congenital bicuspid valve (Turner's) - occurs in earlier in life (40 yrs)
    • SAD (syncope, angina, dyspnea) due to CHF/arrhythmia

31

describe the form of hypertrophy seen in the condition in the image

  • dilated = most common cardiomyopathy; eccentric hypertrophy
    • eccentric = sarcomeres added in series

32

describe the complications in the acute form of the condition seen in the image

  • acute IE complications:
    • sepsis → septic emboli → lungs → multiple lung abscesses
    • ring abscess in myocardium → arrhythmia 
    • abscesses form → liquefactive necrosis

33

describe the etiology and pathogenesis of the condition seen in the image

  • hyaline arteriosclerosis:
    • etiology: chronic benign hypertension → affects only afferent arteriole 
    • pathogenesis: endothelial damage → leakage of plasma proteins v exudate

34

describe the presentation of the condition seen in the image

  • presentation:
    • more common in males about 40 y/o
    • URT sx: naso-mucosal ulcerations, sinusitis
    • LRT: necrotizing pneumonia, granulomatous vasculitis that does NOT spare the lung → lung abscess
      • pneumonia does NOT get better with antibiotics (similar to adenocarcinoma in-situ)
    • affects kidneys → renal infarcts and affects glomeruli capillaries 
      • crescent shape → hematuria

35

describe investigations for the condition seen in the image

  • investigation:
    • c-ANCA in blood (PR3 antibodies)
    • don't see anything with immunofluorescence → pauci-immune
      • this is common among all ANCA-associated vasculitides 

36

describe what a rupture into the lumen would be called in the condition seen in the image

  • rupture into lumen = double-barreled aorta

37

describe how the condition in the image affects all layers of the heart

  • myocarditis: arrhythmia; Aschoff bodies around arteries (perivascular) and granuloma-like (combination of CD4+ lymphocytes & activated macrophages/Antischkow cells)
    • most common cause of death in the acute stage
  • pericarditis: fibrinous pericarditis (bread and butter) → friction rub
  • endocarditis: regurgitation of mitral valve → could cause pulm. edema
    • pansystolic murmur loudest at apex
    • sterile vegetations with fibrin b/c organism is no longer there

38

describe the treatment for the condition seen in the image

  • treat with IV steroids to prevent blindness/reduce inflammation on ophthalmic artery

39

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • inflammatory response starts in vaso vasorum which supplies the t. media → obliterative end arteritis (narrowing) → occlusion of vaso vasorum due to endothelial damage → necrosis of media → ischemia causes loss of elastic fibers → chronic inflammation → fibrosis → vessel becomes weakened → aneurysm 

40

describe what is seen in the image

41

describe the pathogenesis of the condition in the image

  • pathogenesis:
    • immune complex-mediated disease of medium vessels
      • type III HS
    • transmural and affects small to medium arteries but the LUNG IS SPARED
      • fibrinoid necrosis → heals with fibrosa → feels like nodes → nodosa
      • capillaries, venules and arterioles UNAFFECTED
      • string of pearls appearance on angiogram → rosary sign

42

describe what is seen in the image

43

describe the ascending form of the condition seen in the image

  • ascending = worse prognosis
    • rupture backward into the pericardial space → pericardial tamponade
    • rupture forward & compromise:
      • common carotid a. → stroke
      • coronary a. → MI
      • subclavian a. → unequal BP and pulse in upper ex.
      • anterior spinal a. → myelitis 
      • renal a. → renal failure

44

describe the image 

HCM

histo demonstrating disarray, extreme hypertrophy, characteristic branching of myocytes as well as interstitial fibrosis

45

describe the pathogenesis of the condition in the image

  • pathogenesis: unknown
    • medium to large arteries affected
      • temporal, ophthalmic (blindness) and vertebral a.
    • giant cells and mononuclear cells
    • focal nodular, intimal thickening, fragmentation of IEL
    • NOT transmural (only affects intima and inner media)
    • granulomatous vasculitis = CD4 mediated

46

describe the 4 cardinal features seen in the condition in the image

  • 4 cardinal features = PROVe
    • Pulmonary stenosis (most important; determines severity of condition)
    • RVH
    • Overriding aorta
    • VSD

47

describe the image

DCM

the histologic picture shows myocyte hypertrophy and interstitial fibrosis (collagen is blue bc Masson-trichrome stained)

48

describe microscopic polyangiitis 

  • necrotizing vasculitis (similar to PAN) but:
    • smaller vessels (capillaries, small arterioles)
    • no granulomas
    • lung affected (pulm. capillaries → hemoptysis)
    • lesions are the same stage/age
      • unlike in PAN
    • MPO-ANCA/p-ANCA

49

describe Churg-Strauss syndrome

50

what other disease is the condition in the image associated with?

associated with Hep B

51

describe investigations for the condition seen in the image

  • investigations:
    • EKG: ST elevation for transmural due to occlusive infarct
      • ST depression (NSTEMI) for subendocardial infarct
    • troponin I/T = rise in 3-12 hours, peak at 48, persists 5-14 days
    • CK-MB = rise in 3-12 hours, peak at 24 hours, disappears in 3 days; use to check for reinfarction
    • LDH: rises in 24 hours, peaks at 3-6 days, returns to baseline in 8-12 days
    • myoglobin = first marker to rise (not specific, rarely used)

52

differentiate from rheumatic heart disease and calcified aortic stenosis

  • RHD affects mitral first, then aortic
  • in calcific aortic stenosis, valve is unfused, unlike RHD where there is commissural fusion 

53

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • direct damage by virus + CD8 mediated damage against infected myocytes → cytokine release → aggravation of myocardial dysfunction
    • inflammation (infiltration of lymphocytes) → necrosis (patchy) of myocytes

54

describe the image

55

describe the complications in the subacute form of the condition seen in the image

  • subacute IE complications:
    • sepsis → septic emboli → legs, brain
    • glomerulonephritis (type III HS with immune complex deposition)

56

describe what is seen in the image

view of the junction of the fibrous cap and core, showing scattered inflammatory cells, calcification (arrowheads) and neovascularization (arrows)

57

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • disruption of atheromatous plaque → subendothelial collagen and thrombogenic necrotic material are exposed → platelets adhere to the exposed material and eventually form an occlusive platelet thrombus with help of TxA2 and serotonin → complete occlusion of coronary artery

58

describe how the reversal of the condition in the image leads to complications

  • Eisenmenger's syndrome
    • pulm. HTN → reversal of shunt (R→L) → cyanosis
      • clubbing of fingers
      • polycythemia 
        • low O2 stimulates EPO from kidney

59

the condition seen in the image is the only vasculitis that eventually extends to ______

the condition seen in the image is the only vasculitis that eventually extends to veins and nerves (involves the entire neurovascular bundle)

60

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • repeated S. pyogenes pharyngitis = type II hypersensitivity
      • cross-reacting antibodies to M protein of S. pyogenes cross-reacting with antigens of valves and joins = molecular mimicry

61

describe the condition seen in the image

  • restrictive: least common type
    • stiff walls → loss of ventricular compliance → impaired ventricular filling during diastole → diastolic dysfunction → systolic dysfunction

62

list the modifiable vs. non-modifiable predisposing factors of the condition seen in the image

  • modifiable:
    • hypercholesterolemia 
    • hypertension
    • smoking
    • diabetes
  • non-modifiable
    • age 
    • gender
    • genetic predisposition 

63

describe the presentation of the condition seen in the image

  • presentation:
    • tree bark appearance due to intimal wrinkling
    • compresses central structures:
      • esophagus → dysphagia
      • left recurrent → hoarseness 
      • trachea → dyspnea
    • inflammation can spread to aortic roots where coronary a. originate → ischemia of myocardium → MI
    • can lead to aortic regurg./insuff./incompetency → getting blood from both LA AND aorta → volume overload → cor bovinum → LHF → pulm. edema → RHF
      • most common cause of death
    • stasis in heart causes mural thrombus
    • IE from dental work (superimposed infxn on damaged valves)

64

describe complications of the condition seen in the image

  • complications:
    • DVT (paradoxical embolism → bypasses pulm. circulation and goes to systemic circulation)
    • jet lesions (R → L ventricle → lands on endocardial surface and damages it → dental work → IE)

65

describe the morphology of the subacute form of the condition seen in the image

  • subacute IE morphology:
    • small vegetations, granulation tissue, fibrosis, plasma cells, macrophages, fibroblasts
    • dystrophic calcification

66

describe the etiology, pathogenesis, and signs/symptoms of the condition seen in the image

  • hyperplastic = chronic malignant HTN
    • concentric, laminated thickening of the walls → "onion-skin" → hyperplasia
  • signs:
    • hematuria, oliguria
    • malignant nephrosclerosis → flea-bitten appearance
  • fibrinoid necrosis: due to sudden malignant HTN → necrotizing arteriolitis
    • seen in pheochromocytoma, pre-eclampsia 
    • complications:
      • aortic dissection, hemorrhagic stroke, papilledema 

67

describe the condition in the image and how it can be non-immune related as well as immune-related

  • fibrinous pericarditis (bread and butter pericarditis) 
    • occurs 1-3 days post-MI
    • extension of myocardial inflammation into the pericardium
  • Dresslers autoimmune pericarditis at least 2 weeks to several months after MI
    • immune-mediated
    • fever, leukocytosis, high ESR

68

describe the presentation of the condition seen in the image

  • presentation:
    • young (<35), male smokers of Japanese, Indian or Jewish descent
    • initially intermittent claudication
    • Reynaud's phenomenon 
      • vasospasm → white → blue (cyanotic) → blood returns → red
    • superficial nodule phlebitis 
      • tender nodules over course of vein
    • auto-amputation of digits
    • chronic ulceration of the skin → gangrene 

69

describe the condition in the image and how & why it occurs

​​occurs 3-14 days post-MI

  • IV septum rupture (L to R shunt) = VSD, pulm. edema
    • pan-systolic murmur loudest in left lower sternal border
    • only time that right ventricle has O2 blood
      • can differentiate from mitral regurgitation by measuring O2 sat. 

70

describe the morphology of the acute form of the condition seen in the image

  • acute IE morphology:
    • large vegetations w/ minimal neutrophils (because valves are avascular)

71

describe the image

viral myocarditis

lymphocytic myocarditis with edema and associated myocyte injury

72

describe the complications of the condition seen in the image

  • LVH → increased protein synthesis or decreased protein degradation
  • LHF = pulm. edmea → pulm. HTN → RHF
    • transudate until 2 weeks in the lungs
    • >2 weeks = fibrosis and hemosiderin-laden macrophages in lungs
  • decreased SV and decreased CO
    • less supply, increased demand
    • ischemia and infarction of myocardium → MI
  • mural thrombus + arrhythmia → embolic stroke
  • aortic valve is damaged → infective subacute endocarditis (S. viridans)

73

describe what is seen in the image

aorta with fatty streak

  • fatty streaks begin as minute yellow, flat macules that coalesce into elongated lesions
  • composed of lipid-filled foamy macrophages but are only minimally raised and do not cause any sig. flow disturbances
  • coronary fatty streaks form during adolescence at the same anatomic sites that are prone to plaques later in life

74

describe the presentation of the condition in the image

  • renal artery thrombosis (but doesn't cause glomerular nephritis so no hematuria) → ischemia → hypoxia → acute tubular necrosis → renal failure
    • hypertension because it stimulates JG cells due to hypoxia
  • coronary artery → MI
  • liver infarcts
  • GI → red infarct
  • vaso navorum → common fibular nerve vessel → foot drop
  • skin: nodules, palpable purpura

75

describe the acquired etiology of the condition seen in the image

DCM

  • BADD PICCC
  • B = beri beri (thiamine def.)
  • A = alcohol
  • D = dystrophin
  • D = doxorubicin (chemotherapy drug)
  • P = peripartum
  • I = iron overload (hemochromatosis)
  • CCC = Coxsackie, Chagas, cocaine

76

describe the distribution of the lesions in descending order of the condition in the image

  • distribution of lesions in descending order:
    • kidney > heart > liver > GI

77

describe the pain associated with the condition in the image

pain radiates to the back (felt between the scapulae) and moving down as the dissection progresses

78

name complications for the condition seen in the image

  • complications:
    • critical size = > 5cm; has high risk for rupture → hypovolemic shock
    • mural thrombus due to stasis → downstream ischemia
    • compress vertebrae → back pain
    • compress ureter → hydronephrosis
    • if due to mycotic aneurysm → secondary infxn by salmonella possible

79

describe complications of the condition seen in the image

  • complications:
    • rupture of chordae tendinae → mitral regurg. → LHF → pulm. edema
      • pansystolic murmur at apex → mid-systolic click followed by decrescendo murmur
    • regurgitation of mitral valve → CHF
    • IE
    • ventricular arrhythmias → SCD
    • thrombo-emboli → stroke → Berry aneurysm

80

name a common cause for the condition seen in the image

  • common cause = tertiary syphilis → T. pallidum (G-ve spirochete)

81

describe the heart sounds heard in the condition in the image

DCM

  • hear S3 sound (gallop rhythm)
  • displaced apex beat (due to dilation of heart)

82

describe the image 

83

describe the morphological progression of the condition seen in the image

  • progression:
    • fatty dots with macrophage foam cells → fatty streaks with lipid-laden macrophages → cholesterol plaques (asymptomatic) → can embolize during vascular procedure (e.g. angiogram)

84

describe what is seen in the image

Chagas myocarditis; a myofiber distended with trypanosomes (arrow) is present along with mononuclear inflammation and myofiber necrosis

85

name predisposing factors for the condition seen in the image

  • predisposing factors:
    • atherosclerosis
    • HTN
    • trauma
    • vasculitis
    • congenital defects
    • infections (mycotic aneurysms)

86

the condition in the image is a (true/false) aneurysm because it involves ______

the condition in the image is a (true/false) aneurysm because it involves all 3 layers of the vessel wall

87

Wegener/GPA

vasculitis of a small artery with adjacent granulomatous inflammation including giant cells (arrows)

88

describe the murmur heard in the condition seen in the image

midsystolic click that corresponds with sudden tensing of the involved mitral leaflet or chordae tendinae as the leaflet is forced back towards the LA

89

describe the most common outcome and complications of the condition seen in the image

  • outcome: COMPLETE RESOLUTION (most commonly)
  • complications:
    • acute heart failure
    • arrhythmias → ventricular are most dangerous → SCD
    • viral myocarditis → DCM → chronic CHF

90

describe the genetic etiology of the condition seen in the image

  • familial AD due to point mutation in any of the following genes coding for sarcomere proteins:
    • Beta-myosin heavy chain = most common
    • myosin binding protein C
    • cardiac troponin T

91

name other causes of the condition seen in the image

  • parasitic:
    • Trichinella
      • eosinophils predominant
    • Tryapanosoma cruzi (Chagas disease)
      • South America
      • parasitization of scattered myofibers by trypanosomes
    • Toxoplasmosis 
      • household cats most common vector
      • causes myocarditis in immunocompromised

92

describe the image

93

___ are the most common cause of the condition seen in the image

Viruses (specifically Coxsackie A & B) is the most common cause of the condition seen in the image

94

describe what is seen in the image

95

describe the etiology of the condition seen in the image

  • etiology:
    • endomyocardial fibrosis 
      • hemochromatosis
      • amyloidosis
      • sarcoidosis
      • Loffler's (eosinophilia)

96

describe the order of likelihood that the condition in the image will occur in certain organ

in descending order of severity:

infrarenal abdominal aorta > coronary arteries > popliteal arteries > internal carotid arteries > vessels of the circle of Willis

97

describe investigations of the condition seen in the image

  • investigations:
    • cardiac catheterization or ECG
    • boot shaped heart 

98

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • accumulation of GAGs in spongiosa layer (myxoid degeneration of valve)

99

describe what is seen in the image

100

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • intimal tear (from HTN) + defective media (HTN leads to narrowing of vasa vasorum; Marfan's syndrome = fibrillin gene on chr. 15; Ehler's Danlos)

101

describe the stable form of the condition seen in the image

  • stable: intima has thickened (fibrous cap and lipid core)
    • 3 main factors make it stable:
      • thick fibrous cap 
        • pluripotent smooth muscles that travel from media to intima to deposit collagen)
      • less lipid core
      • less inflammatory cells (foam cells)

102

the most common location of the condition in the image is _____

the most common location of the condition in the image is the infrarenal abdominal aorta

103

describe the image

104

describe the presentation of the condition seen in the image

  • presentation:
    • varies from asymptomatic to sudden acute HF or arrhythmias 
    • but usually nonspecific flu-like symptoms
      • fatigue, dyspnea, palpitations, chest pain, fever
      • may mimic acute MI

105

describe the presentation of the condition seen in the image

  • presentation:
    • young women between 20-40 
    • fatigue or atypical chest pain
    • Marfan's syndrome
    • Ehlers Danlos syndrome
    • asymptomatic and incidental finding of mid systolic click → abrupt tension on leaflets and chordae tendinae when valve tries to close

106

describe what is seen in the image

107

describe the presentation of the condition seen in the image

  • presentation: 
    • combination of R and L HF (b/c both ventricles are dilated, like CHF)
    • hear S3 sound (gallop rhythm) → systolic (contractile) dysfunction
    • displaced apex beat (due to dilation at 5th intercostal space mid-clavicular line → pushed to mid-axillary line)
    • EF = <25% 

108

describe the presentation of the condition in the image

  • presentation: 
    • M/F > 50 years old
    • jaw claudication and facial pain
    • polymyalgia rheumatica (fever with muscle and joint pain)
    • ocular symptoms → diplopia, progressive hazy vision

109

describe the image and the components of it

Aschoff body in acute rheumatic carditis; there is central necrosis associated with a circumscribed collection of mononuclear inflammatory cells, including some activated macrophages with prominent nucleoli and central wavy (caterpillar) chromatin (Anitschkow cells)

110

describe the investigations for the condition seen in the image

  • investigations:
    • echocardiogram: dilated heart chambers with low EF due to systolic dysfunction
    • endomyocardial biopsy: hypertrophy of myocytes with interstitial fibrosis

111

describe the presentation of the condition seen in the image

  • presentation:
    • severe, crushing substernal pain >20 min. which can radiate to neck, jaw, epigastrium, shoulder or left arm
      • due to release of adenosine and lactate from necrotic cells on nerve endings
    • sympathetic response: accompanied by diaphoresis and dyspnea with rapid and weak pulse along with cold clammy hands
    • different than angina in that an MI can persist for days and isn't always relieved by rest and/or vasodilators

112

describe the shape of the LV in the condition seen in the image

banana-shaped LV →​ subaortic hypertrophy 

113

the condition seen in the image mainly affects the ____ and ___ arteries

the condition seen in the image mainly affects the tibial and radial arteries

  • 6Ps
    • paresthesia
    • pain
    • pallor
    • paralysis
    • poikilothermia
    • pulselessness

114

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • characterized by segmental, thrombosing, acute and chronic inflammation of small to medium arteries
    • granulomatous vasculitis with microabscesses → Type IV HS to tobacco
    • ONLY one that eventually extends to veins and nerves 
      • involves entire neurovascular bundle

115

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • ineffective myocyte contraction → triggers exuberant growth factor release → intense compensatory hypertrophy → myofiber disarray and fibroblast prolif. → myocardial hypertrophy → abnormal diastolic filling

116

describe investigations for the condition seen in the image

Antistreptolysin O (ASO) and DNAse B titer in blood

117

describe the phrase "displaced temporal heterogeneity" in relation to the condition in the image

displaced temporal heterogeneity = old (fibrosis) and new (neutrophils and fibrinoid necrosis) inflammatory changes

118

describe the most common cause of death by the condition in the image

  • can lead to aortic regurg./insufficiency/incompetency → blood to LV from LA AND aorta → volume overload → cor bovinum → LHF → pulm. edema → RHF from LHF
    • most common cause of death: LVH → CHF due to aortic regurgitation

119

describe complications of the condition seen in the image

  • complication:
    • arrhythmia + mural thrombus (due to stasis) → embolizes → lower limb or brain (stroke)

120

describe the pathogenesis of the condition seen in the image

  • pathogenesis:
    • abnormal blood → endothelial injury → focal deposits of platelet-fibrin
    • bacteremia → adherence (fibronectin and polysaccharides) → invasion of valvular defects

121

describe the classic triad seen in the condition in the image

  1. acute necrotizing granulomas of upper and lower resp. tract
  2. focal necrotizing or granulomatous vasculitis affecting small to medium-sized vessels
  3. renal disease in the form of focal, or necrotizing, often crescentic glomerulitis