Pathology of the Heart II Flashcards Preview

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Flashcards in Pathology of the Heart II Deck (52):
1

congenital heart disease

between 3 and 8 weeks gestational age

2

most common cause of congenital defect

trisomy 21

if have this -work up heart

3

most common congenital cardiac malformation

bicuspid aortic valve - 2% of population

second - ventricular septal defect
third - atrial septal defect

4

atrial septal defect

first diagnosed as adults
-no problems in childhood
-pulmonary HTN in adults shows symptoms

5

ventricular septal defect

picked up in kids
-can close on its own

6

neural crest cells

form aorta and first branches

boundary - coarctation of aorta occurs here

7

atrial septal defect genotype

NKX2-5

sinus venosus type

8

holt-oram syndrome

TBX5 mutation
-ASD, VSD, conduction defects
-also limb and hand problems

9

digeorge syndrome

deletion 22q11.2 **
TBX1

CATCH-22

cardiac outflow tract defects

10

marfan syndrome

mutation in fibrillin

congenital heart disease
-aortic aneurysm, valve abnormalities

11

CATCH-22

digeorge

cardiac
abnormal facies
thymic aplasia
cleft palate
hypocalcemia
chromosome 22 deletion

12

cardiac defects from neural crest

5th brachial arch
3rd and 4th pharyngeal pouches

13

atresia

complete obstruction

14

left to right shunt

cause pulmonary volume overload

compensation - hypertrophy and vasc resistance

results in right to left shunt - eisenmenger syndrome

15

right to left shunt

hypoxia and tissue cyanosis
-bypass lungs

allow paradoxical emboli

finger and toe clubbing
-hypertrophic osteoarthropathy
-also polycytemia

16

causes of L > R shunts

ASD, VSD, PDA, AVSD
-baby pink usually

get pulmonary HTN - reversal (eisenmenger)
-reversal - needs transplant

17

eisenmenger

late cyanotic congenital heart disease
-with reversal of L > R shunt

18

VSD

ventricular septal defect

P hypertrophy RV
V hypertrophy LV

majority - membranous septum (upper)
minority - muscular septum (lower)

19

ASD

atrial septal defect

3 major types
-secundum (majority)
-primum
-sinus venosus

may be asymptomatic
-10% > pulmonary HTN

may have murmur

20

secundum ASD

majority
-involve fossa ovalis

21

primum ASD

adjacent to AV valve

22

sinus venosus ASD

near superior vena cava

23

PDA

patent ductus arterious

communication of aorta and pulmonary artery

usually closes:
-increased O2
-decreased pulmonary resistance
-decreased prostaglandin E2

continuous harsh machine like murmur

24

machine like murmur

patent ductus arteriosus

25

Tx for PDA

NSAID - decreased prostaglandin E2

first - look for other defects
-second - fix this

26

AVSD

atrioventricular septal defects

complete - all four chambers communicate

1/3 have down syndrome

27

majority of congenital heart disease in children with down syndrome

AVSD

40%

then VSD > ASD > PDA > tetralogy of fallot

28

right to left shunt causes

cyanotic congenital heat disease

get clubbing of tips of fingers and toes - hypertrophic osteoarthropathy
-polycythemia due to hypoxia
also can have paradoxical emboli

BLUE BABY

29

tetralogy of fallot

1 - VSD
2 - subpulmonic valve stenosis with obstruction of right ventricular outflow tract
3 - overridding aorta
4 - right ventricular hypertrophy

boot shaped heart

degree of stenosis gives degree of blue baby

30

boot shaped heart

tetralogy of fallot

31

overriding aorta

in tetralogy of fallot
-due to ability to look through VSD and see aorta instead of LV wall

32

pink tetralogy of fallot

mild subpulmonic stenosis
-lung perfused

33

transposition of great arteries

aorta and pulmonary artery switched
-separate circulations

only survive with VSD, PDA, or patent foramen ovale

to stop closure - infuse prostaglandin E and perform atrial septostomy

Tx - surgery

34

infantile coarctation of aorta

preductal
with PDA
-infant - blue bottom, pink top
-deox blood from pulmonary a to aorta
-pressure difference

35

adult coarctation of aorta

postductal
junction where ligamentum arteriosum is
-no color difference
-do see pressure difference

36

response to coarctation of aorta

dilated ascending aorta and major branches (proximal to coarctation)

collateral ciculations form - intercostal notching

also hear murmurs - pansystolic

adult form - can get renal HTN

37

pulmonic valvar stenosis

RVH and pulmonary a dilation

38

pulmonic subvalvar stenosis

RVH and NO pulmonary a dilation

39

aortic valvar stenosis

infants only survive with PDA

left ventricular underdevelopment
-hypoplastic left heart syndrome

40

subaortic stenosis

infective endocarditis, LVH, post-stenotic dilation
-sudden death

41

supravalvar aortic stenosis

aortic dysplasia - thick wall
-chromosome 7 deletion - williams beuren syndrome
-possible cause

42

IHD

ischemic heart disease

imbalance between supply and demand for heart O2

majority - atherosclerotic coronary aa - 90%

43

leading cause of death in US for both M and F

ischemic heart disease

higher males

premenopausal women - uncommon

44

75% obstruction

symptoms with exercise

45

90% obstruction

ischemia at rest

46

causes of IHD

atherosclerotic coronaries
thrombosis over disrupted plaque
local platelet aggregation
vasospasm

47

acute coronary syndrome

abrupt plaque change followed by thrombosis

large core and thin cap (young plaques)

48

plaque rupture

2/3 narrowed less than 50%

85% narrowed less than 70%

tend to involve entire RCA and proximal LAD / LCX

49

unstable angina

plaque is changing

50

transmural MI

full wall thickness

51

stable angina

stenosis >75%

no change in plaque

52

sudden death

often small platelet aggregates or thrombi and/or thromboemboli