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Flashcards in Exam 2 heart part II gomez Deck (92):
1

what can infective endocardtitis lead to

bulky friable vegetations
destruction of underlying structures (valves)
risk of systemic microemboli
usually L valves

2

What organisms are most common to cause infective endocarditis

S viridans> S aureus> HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

3

What valve is affected in IV drug abusres

the right

4

what organism is the #1 culprit for infective endocarditis with an artifical valve

S epidermidis

5

Describe Acute bacterial endocarditis

rapildy progressive destruction
highly virulent vacteria
50% die in days or weeks with onset Sx

6

Describe subacture bacterial endocarditis

insidious onset and protracted clinical course
involved valve usually deformed or abnormal
low virulence bacteria like S viridans
most recover with antibiotic Tx

7

What are the major clinical criteria for Dx infective endocarditis

3 blood cultures in 24 hours (has to be +)
echocardiographic findings like mass or absecess
new murmur from regurgitation

8

What is the combination of Clinical criteria to Dx infective endocarditis

2 major, 1 major +3 minor or 5 minor

9

what are the minor findings of infective endocarditis

predisposing heart lesion or IV drug use
fever
vascular lesions
immunologic phenomena
microbiologic evidence
echocardiographic findings not Dx of endocarditis

10

What is nonbacterial thrombotic endocarditis NBTE

valvular lesions that have no microorganisms

11

what is the major risk factor of NBTE nonbacterial thrombotic endocarditis

hypercoagulable state (debilitated patients with malignancy, DIC or sepsis)

12

what could occur because of NBTE

fragment and produce systemic emboli which could obstruct coronary aa or brain vasculature

13

what is marantic endocarditis

another name for NBTE in debilitated patients

14

What is Libman Sacks disease

Endocarditis of SLE
1-4 mm steril vegetaions on any surface
usually mitral and tricuspid

15

What SLE patients are at risk for libman sachs disease

with lupus anticoagulant (antiphospholipid Ab syndrome)

16

how do you differentiate NBTE and SLE endocarditis

SLE associated will be in many places in heart
NBTE is on sides of valve leaflets

17

How do you differentiate acute rheumatic heart disease endocarditis and infective endocarditis

acute rheumatic heart disease is marked by small warty verrucae along lines of closure of valve leaflets
infective endocarditis shows large irregular masses on valve cusps that can extend to chordae

18

What is carcinoid syndrome caused by

metastatic carcinoid tumor producing serotonins 5HT, kallikrein, bradykinin, histamine, PG

19

what does carcidnoid syndromer esult in

diarrhea, flushing, skin rash, bronchoconstriction and fibrous thickening of endocardial surfaces or right herat

20

where does the endocardial thickening tend to take place in carcinoid heart disease

right ventricle, tricuspid and pulmonic valves

21

what are the cons about mechanical prosthetic heart valces

require anticoagulation and cause mechanical hemolysis

22

what are complications of cardiac valve prostheses

thrombosis/thromboembolism
anticoagulant-related hemorrhage
prosthetic valve endocarditis
structural deterioration
in adequate or excessive healing

23

majority of cardiomyopathies are primary or seconday?

primary or idiopathic
not secondary

24

What are the 3 groups of cardiomyopathies

dilated (90%)
hypertrophic
restrictive

25

what is restrictive cardiomyopathy

mild increase in cardiac mass without increase in volume of left ventricle

26

hwo do you differentiate idiopathic dilated cardiomyopathy from myocarditis secondary to virus

endomyocardial biopsy

27

what are toxins associated with heart muscle disease

alcohol, cobalt, catecholamines, CO, lithium, hydrocarbons, arsenic, cyclophosphamide
doxorubicin

28

what metabolic conditions are associated wtih hear muscle disease

hyperthyroidism
hypothyroidism
hyper and hypo kalemia
nutritional deficiencies
hemochromatosis

29

what are the major causes of myocarditis in US

coxsackieviruses A and B
lyme disease
HS eosinophlic
trichinosis

30

What is the major cause of myocarditis in south america

Chagas disease (trypanosoma cruzi)
Brazil it is more common than ischemic heart disease

31

what type of cardiomyopathies have an impairement in compliance, "diastolic dysfunction"

hypertrophic and restrictive

32

what can cause restrictive cardiomyopathy

amyloidosis, radiation induced fibrosis

33

what are janeway lesions

small erythematous or hemorrhagic nontender lsesions on palms and soles from septic emboli events
endocarditis

34

what are osler nodes

small tendet subcutansoue nodules in pulp of digits or more proximally on fingers and persist for hours to days
endocarditis

35

what are roth spots

oval retinal hemorrhages with pale centers
endocarditis

36

what viruses can cause dilated cardiomyopathy

coxsackie B and other enteroviruses

37

What are some etiologic associations with dilated cardiomyopathy

alcohol, peripartum cardiomyopathy
iron overload
familial(genetic)

38

describe inheritance of familial dilated cardiomyopathy

presents in children in autosomal dominant pattern

39

what are clinical features of dilated cardiomyopathy

symptomatic CHF
SOB DOE
atrial and ventricular arrhythmias

40

what is the most common indication for cardiac transplantation

when dilated cardiomyopathy responds poorly to traditional CHF treatments
left ejection fraction is <25% normal

41

what do dilated cardiomyopathic hearts look like

increased size 2-3x
large flabby
dilation of all chambers
ventricular wall thickness decreased or mildy increased
mural thrombi common
normal valves and coronary arteries are normal lumen size

42

drugs that stimulate serotonina re used to treat what and can lead to what

treat migraines
can lead to carcinoid heart disease

43

what mutation is associated with arrhthmogenic right ventricular cardiomyopathy

autosomal dominant mutations:
plakoglobin on chrom 17 and desmoplakin on chr 6 (desmosomes)

44

What is Naxos syndrome

palmoplantar keratoderma with arrhythmogenic right ventricular mardiomyopathy and woolly hair (recessive plakoglobin mutation)

45

what is Carvajal syndrome

palmoplantar keratoderma with left ventricular cardiomyopathy and woolly hair (recessive desmoplakin mutation)

46

what are characteristics of arrythmogenic right ventricular cardiomyopathy

right sided heart failure and rhythm disturbances
replacement of myocytes with adipocytes and interstitial fibrous tissue

47

what are other names for hypertrophic cardiomyopathy

idiopathic hypertrophic subaortic stenosis
hypertrophic obstructive cardiomyopathy

48

what are features of hypertrophic cardiomyopathy

myocardial hypertrophy
abnormal diastolic filling
intermittent ventricular outflow obstruction (1/3 cases)

49

what mutations are associated with hypertrophic CM

dominant mutations with proteins of the sarcomere
B myosin heavy chain on Chr 14

50

what is the main clinical limitation with HCM

exertional dyspnea

51

what are the risks involved with HCM

10-20% a fib with risk mural thrombus formation
sudden cardiac death, usually younger individulas

52

describe gross structure of HCM

massic hypertrophy without ventricular dilation
disproportionate thickening of L ventricula septum compated to LV free wall
L ventricular chamber dec in size
hypertrophic septum is prominent in subaortic region where could cause obstruction to LV outlflow

53

describe histo path of HCM

marked myocyte hypertrophy 40 microns (normal 15 microns)
haphazard myofiber disarray
interstitial and replacement fibrosis in myocardium

54

is HCM a diastolic or systolic dysfunction? dilated CM?

HCM diastolic
DCM systolic

55

what type of proteins are mutated in HCM? DCM?

HCM sarcomere proteins
DCM cytoskeleton proteins

56

what are the heart findings in restrictive cardiomyopathy

ventricles are normal size
ventricular chambers are normal size
biatrial enlargement common

57

what disorders are associated with restrictive in cardiomyopathy

amyloidosis
endomyocardial fibrosis
loeffler endomyocarditis
endocardial fibroelastosis

58

what is loeffler endomyocarditis

endomyocardial fibrosis with large mural thrombi that occurs worldwide and is assoc with eosinophlic leukemia

59

what is endocardial fibroelastosis

multifactorial left ventricular endocardial fibrosis that usually occurs in first 2 years of life

60

what is systemic senile amyloidosis

amyloidosis of heart, in aged patients
localized to both ventricular and atrial myocardium or sometimes just atria

61

systemic senile amyloidosis is most common in what demographic

african americans with transthyretin mutation

62

what is amyloid composed of in senile form

transthyretin

63

what causes isolated atrial amyloidosis

ANP deposition

64

what is primary systemic amyloidosis

chronic disease that involves most visceral organs and almost always invovles interstitiu of myocardium

65

What is ayloid composed of in systemic form

Ig Light chain material

66

what does cardiac amyloidosis stain under polarized light

congo red stain shows apple green birefringence

67

eos have how many nuclear lobes

2

68

what are toxins that cause direct cardiac disease and mechanisms

adriamycin- lipid peroxidaiton of myocyte membrane
cyclophosphamide (cytoxan)- vascular lesion with myocardial hemorrhage
high dose catecholamines (vasopressors)- Ca overload or vasoconstriction and increased cardiac load
iron overload (hemochromatosis)- interferes with metal dependent enzyme systems

69

the giant cell myocarditis is what type cells

macrophages

70

what does chagas myocarditis look like on cross section

myofiber distended with trypanosomes with necrosis and not much inflammation

71

what is most common cause of cardiaac tumors

metastatic malignancies

72

what is second most common cause cardiac tumor

myxoma (fever and malaise via IL 6)

73

what is a carney complex

myxomas, pigmened skin lesions and overactivity of endocrine organs (null utation PRKAR1A Chr 17)

74

what is the #1 cardiac tumor in chldren

rhabdomyoma
50% assoc with tuberous sclerosis (TSC1 and 2 genes)

75

what are direct cardiac consequences of a noncardiac tumor

pericardial myocardial metastases
large vessel obstruction
pulmonary tumor emboli

76

what are the indirect cardiac consequences of noncardiac tumors

NBTE
carcinoid heart disease
pheochromocytoma associated
myeloma associated amyloidosis

77

what are causes of serous pericardial effusions

CHF and hypoalbuminemia

78

what are causes of serosanguinous pericardial effusions

malignancy, trauma, ruptured MI, aortic dissection

79

what are causes of sanguinous pericardial effusions

hemopericardium (aortic/cardiac rupture)

80

what are causes of purulent pericardial effusions

infection

81

what cause chylous pericardial effusion

lymphatic obstruction

82

cardiac tamponade can occur with what amount og fluid accumulation

250 ml

83

what is the #1 cause of pericarditis

viruses

84

what are causes of serous pericarditis

Rheumatoid fever, SLE, scleroderma, tumors, uremia, Dressler syndrome

85

what are causes of fibrinous and serofibrinous pericarditis

MI, Dressler syndrome, uremia, radiation RF, SLE, trauma, cardiac surgery

86

What are causes of purulent pericarditis

infections

87

what are causes of constrictive pericarditis

pericardium is rigid, thickend, scarred and less elastic than normal

88

what are causes of hemorrhagic pericarditis

neoplasia, bacteria, TB, bleeding diathesis, cardiac surgery

89

what are causes of casseous pericarditis

TB or fungus

90

what are causes of adhesive pericarditis

fibrous or fibroelastic scar, "concretio cordis" if severe

91

cardiac allograft rejection looks like what on cross section

lymphocytic infiltrate

92

what is allograft arteriopathy

after transplant, ahve severe diffuse concentric intinal thickening causing critical stenosis. 50% within 5 years, 100% within 10 years