Exam 2; Cardiovascular III Flashcards Preview

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Flashcards in Exam 2; Cardiovascular III Deck (53):
1

This is failure of a valve to open completely, obstructing forward flow and sometimes is caused by rheumatic fever and typically is always stenotic

mitral valve stenosis

2

Acute rheumatic fever is a systemic disease usually in children which follows which bacteria

Group A beta hemolytic; streptococcal pharyngitis

3

What are the clinical features of rheumatic fever

myocarditis
pericarditis
arthritis
erythema marginatum
subcutaenous nodules

4

What is characteristic of the pericarditis caused by rheumatic fever

fibrosis

5

What is characteristic of the endocarditis caused by rheumatic fever

sterile vegetations

6

What is characteristic of the myocarditis caused by rheumatic fever

Aschoff bodies; collections of mononuclear inflammatory cells and fibroblasts (granulomatous infection)

7

What is the longer term complication after recurrent bouts of acute rheumatic fever

chronic valvular disease with mitral valve stenosis (severe fibrosis and calcification)

8

How does rheumatic fever cause mitral valve stenosis

due to the production of antibodies against the streptococcal bacteria which cross react with various antigens in the heart, joints, and other sites

9

This is the insufficiency of a valve that fails to close completely, allowing back flow of blood

regurgitation

10

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

mitral valve prolapse

11

What occurs regarding floppy mitral valve (severe prolapse)

the valve cuss are large and microscopically show fragmentation, separation, and loss of collagen (myxomatous); may be isolated or part of Marfan's Syndrome

12

What are three complications of mitral valve regurgitation; develops in about 3% of affected patients

endocarditis
thromboemboli
sudden death (rare)

13

What are three causes of aortic valve stenosis

chronic rheumatic valvular disease
degenerative
congenital bicuspid valve

14

What is the onset of degenerative aortic valve stenosis compared to congenital bicuspid valve

degenerative is associated with advanced age (70s or 80s)
congenital bicuspid valvue is a much younger initial onset (40-50 years)

15

What three things can cause aortic valve regurgitation

valve cusp destruction (endocarditis)
weakened cusp valves (Marfans/myxomatous)
dilation of the aortic root

16

What usually causes infective endocarditis

bacterial infection in a heart valve, although it can also be caused by fungi or other infections

17

What are six predisposing factors of IE

intracardiac shunts
valvular disease
prosthetic valves (10-20% of all cases)
IV drug abuse
immune suppression
diabetes

18

What are the three factors that have been identified as having importance in the pathogenesis of IE

endocardial or endothelial injury dur to abnormalities in blood flow
fibrin thrombi
organisms in the blood

19

What are the clinical manifestations of infective endocarditis

fever
fatigue
anemia
myalgia/arthralgia
roth spots (retinal hemorrhages) and splinter hemorrhages (nail bed)**
heart murmur

20

What is the difference in duration between acute endocarditis and subacute endocarditis

acute - short
subacute - longer

21

What is the difference in the organism between acute endocarditis and subacute endocarditis**

acute - virulent organism (Staph. aureus)
subacute - low virulence organism (Strep. viridians)

22

What is the difference in the vegetations between acute endocarditis and subacute endocarditis

acute - large
subacute - small

23

What is the difference in tissue destruction between acute endocarditis and subacute endocarditis

acute - prominent tissue destruction
subacute - less tissue destruction

24

What is the difference in valve between acute endocarditis and subacute endocarditis

acute - previously normal
subacute - previously abnormal valve

25

What are five complications of infective endocarditis

valvular regurgitation/valvular dysfunction/CHF
rupture of the chord tendineae
contiguous spread of infection
thromboembolism with infarction
septic emboli with metastatic abscesses

26

What are the top two causes of vasculitis (inflammation of the BVs)

infection
immunologic mechanism (usually associated with other problems)

27

What is the etiology of giant cell (temporal) arteritis

unknown, but may be T cell mediated

28

What are the clinical features of giant cell (temporal) arteritis

rare before the age of 50
fever
weight loss
headache
visual disturbances
pain and tenderness over the temporal artery
caudication of the jaw (weakness when chewing due to decreased blood supply)
polymyalgia rheumatica

29

What is the pathology of giant cell (temporal) arteritis

granulomatous inflammation
intimal proliferation/fibrosis - narrowing of the lumen decreasing blood flow

30

What is the etiology of Takayasu Arteritis

unknown

31

What are the clinical manifestations of Takayasu Arteritis

thickening of the wall reduces blood flow in the major branches - reducing pulse
usually affects < 40 females
neurologic manifestations

32

What is the pathology of Takayasu arteritis

granulomatous inflammation with fibrosis affecting the aortic arch and arch branches

33

What is the etiology of polyarteritis nodsa

unknown in most cases, thought there was a link to HepB

34

What are the clinical manifestations of polyarteritis nodsa

It's acute-relapsing chronic; confusing due to multiple organ systems involved
RENAL FAILURE
fever
weight loss
hematuria
hypertension
abdominal pain
melena (blood in stool)

35

What is the pathology of polyarteritis nodsa

haphazard and segmental involvement of med/small muscular arteries
fibrinoid necrosis, thrombosis, neutrophils, aneurysms
with healing there is a lot of macrophages and PNMs

36

What are the usual sites of involvement involving polyarteritis nodsa

kidney (85)
heart (75)
liver (65)
GI tract (50)

37

What is the etiology of Kawasaki disease

suspected that a viral infection causes hypersensitivity reaction; anti-endothelial antibodies
"mucocutaneous lymph node syndrome"
medium vessels

38

What are the clinical manifestations of Kawasaki disease

typical in infants in young children
skin rash
mucous membrane lesions
servical lymphadenopathy
usually self limiting but 1-2% due with coronary artery vasculitis

39

What is the etiology of microscopic polyangiitis

antigen-antibody complexes

40

What are the clinical manifestations of microscopic polyangiitis

skin rash
joint swelling
pleural efffusion
pulmonary infiltrates
myocarditis
GI bleeding
renal failure

41

What may microscopic polyangiitis be precipitated by

drugs
microorganisms
foreign proteins or tumor proteins

42

There is a presence of this regarding microscopic polyangiitis

circulating anti-neutrophilic cytoplasmic antibodies (MPO-ANCA)

43

What is the pathology of microscopic polyangiitis

involves arterioles, capillaries, venules (microvasculature)
fibrinoid necrosis
karyorrhexis of neutrophils (leukocytoclastic vascilitis)

44

What is the etiology of Wegener granulomatosis

abnormal expression of proteinase 3 on endothelial cell surface followed by ANCA (anti-neurtophilic cytoplasmic antibodies) binding and neutrophil activation resulting in damage to the endothelium and vessel

45

What are the clinical manifestations of Wegener granulomatosis

sinusitis
pneumonitis
renal failure
glomerulonephritis

46

What is the pathology of Wegener granulomatosis

necrotizing granulomas with vasculitis

47

Which systems does Wegener granulomatosis affect

kidnes
upper and lower respiratory tract

48

What is the etiology of thromboangiitis obliterates (Buerger)

endothelial injury from substance in cigarette smoke

49

What are the clinical manifestations of thromboangiitis obliterates (Buerger)

pain of the extremities
ischemic ulcers
gangrene

50

What is the pathology of thromboangiitis obliterates (Buerger)

segmental acute and chronic vasculitis mainly in the extremities with thrombosis

51

This is a 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

dissecting aortic hematoma

52

What are the complications of a dissecting aortic hematoma

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

53

What are the predisposing factors of a dissecting aortic hematoma

hypertension
inherited connective tissue disorders (Marfan's)