REVIEW 3 (cardiac) Flashcards

1
Q

Does the following describe the valvular lesions in RHD or the vegetations seen in Infective Endocarditis?

– larger vegetations along the lines of closure of the valve leaflets.

-No bacteria w/in the vegetations

-ongoing inflammation leads to destruction of valves–> scarring–> valve deformities

A

RHD

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2
Q

What is “Fish-Mouth Stenosis” and what dz is this seen in?

A
  • Seen in RHD
  • The chordae tendinae inserting into the mitral valve are typically shortened and thickened and becomes fused to one another. This fibrous adherence across the commissures of the valve produce a “Fish-Mouth Stenosis”.
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3
Q

Which dz?

Characterized by colonization or invasion of the heart valves, leading to formation of bulky, friable vegetations composed of thrombotic debris and bacterial organisms

A

Infective Endocarditis

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4
Q

Which disease?

Produces necrotizing, valvular lesions with chance of perforation of the valve

A

Acute Bacterial Endocarditis

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5
Q
A
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6
Q

Which condition is a murmur more common due to larger size of vegetations/leaflet destruction and therefore embolization is more likely to occur?

A

Infective Endocarditis

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7
Q

ABE (Acute bacterial endocarditis) or SBE(subacute bacterial endocarditis)?

______=fever is usually low-grade, along with fatigue and flu-like symptoms

______=quick onset along with chills, night sweats, and weakness.

A

___SBE___=fever is usually low-grade, along with fatigue and flu-like symptoms

__ABE____=quick onset along with chills, night sweats, and weakness.

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8
Q

ABE or SBE?

  • highly destructive infection of the valves.
  • Frequently of a previously normal heart valve.
  • Also seen in prosthetic heart valves.
  • Usually due to Staph aureus or the Gram negatives
  • can lead to death w/in days, despite antibiotics.
  • Develops in the course of intense bacteremia.
  • Produces necrotizing, valvular lesions with chance of perforation of the valve
A

ABE (Acute Bacterial Endocarditis)

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9
Q

ABE or SBE?

  • slower, less virulent disease
  • caused by organisms of less virulence (i.e. St. viridans)Can cause infection in previously abnormal heart valves.
  • longer course: weeks to months
  • most patients recover after appropriate abx therapy.
  • The lesions are less destructive and show evidence of healing.
A

SBE

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10
Q

Which is worse, ABE or SBE? Why?

A

ABE

  • Highly destructive
  • Can lead to death w/in days despite abx
  • Produces necrotizing, valvular lesions with chance of perforation of the valve
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11
Q

RHD causes ______, involving all 3 layers of the heart

  1. Pericarditis (fibrinous, “bread and butter”)
  2. Myocarditis (usually dilated, histology shows Aschoff bodies)
  3. Endocarditis (most prominent changes seen in valves of the L heart)
A

Pancarditis

(Per google: Pancarditis is the inflammation of the entire heart: the epicardium, the myocardium and the endocardium)

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12
Q

_________ is a neurologic disorder characterized by involuntary movements that are continuous, non-repetitive, purposeless, jerky movements of the limbs, trunk and face muscles.

Causes impaired speech and gait .

A

Sydenhams Chorea (extracardiac finding in RHD)

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13
Q

What characteristic lab finding in RHD provides concrete evidence that there has been a recent infection with St. pyogenes

A

Increasing titers of serum antibodies to Group A Strept antigens (ASO titer)

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14
Q

What disease is an increased ASO titer a characteristic lab finding of?

A

RHD

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15
Q

What is C-reactive protein (CRP) and what disease is it a characteristic laboratory finding of?

A

Indicative of an inflammation

Characteristic lab finding in RHD

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16
Q

Causes of what cardiomyopathy?

  1. Can be primary (idiopathic or genetic):
    * genetic: usually autosomal dominant (autosomal and sex linked recessive have also been seen )
A

Dilated cardiomyopathy

17
Q

Causes of which cardiomyopathy?

  1. Secondary causes:
  • Toxic w/ ethanol as most common in the U.S. followed by Adriamycin and Cytoxin (Anticancer drugs), long-standing Cocaine use and Cobalt exposure
  • Viral Myocarditis
  • Pregnancy
  • High Catecholamines (pheochromocytoma)
A

Secondary Dilated Cardiomyopathy

18
Q

What are the 3 types of cardiomyopathies?

A
  1. Dilated Cardiomyopathy
  2. Hypertrophic cardiomyopathy
  3. Restrictive cardiomyopathy
19
Q

Which cardiomyopathy?

  • progressive chamber dilation and systolic dysfunction
  • reduced ejection fraction of <25%.
  • most common of the 3 CMs
A

Dilated cardiomyopathy

20
Q

Which CM?

  • multiple secondary causes including alcohol induced, viral myocarditis, and anticancer drugs such as Adriamycin (cardiotoxic drug).
  • Morphology reveals a heavy heart which is large and flabby with dilation of all chambers
A

Dilated cardiomyopathy

21
Q

Which cardiomyopathy is most common?

A

Dilated Cardiomyopathy

22
Q

Gross and microscopic findings of which CM?

  • walls are thin, partially replaced by fibrous tissue
  • heart size is 2-3x normal
  • Coronary arteries usually normal
A

Dilated Cardiomyopathy

23
Q

Which CM?

  • extensive hypertrophy of the LV myocardium.
  • possible left ventricular outflow tract obstruction
  • usually asymmetrical thickening of the ventricular septum as compared to the left ventricular free wall

-“Banana shaped” septum

  • +/- endocardial thickening with mural plaque formation of the outflow tract.
A

Hypertrophic cardiomyopathy

24
Q

Which CM?

  • Decreased ventricular compliance–> results in impaired ventricular filling during diastole with normal systolic function.
  • cause can be idiopathic
  • can be associated with an abnormal infiltrate such as Amyloid, Sarcoidosis, or metastatic tumor.
  • Radiation fibrosis also a cause
A

Restrictive Cardiomyopathy

25
Q

Which CM?

Gross/microscopic findings:

  • ventricles normal in size or slightly enlarged
  • chambers usually not dilated
  • myocardium is firm.
  • Histologically: patchy or diffuse interstitial fibrosis.
A

Restrictive cardiomyopathy

26
Q
A
27
Q

Which CM is also known as IHSS (idiopathic hypertrophic subaortic stenosis) where the heart is enlarged, heavy and muscular, exceeding 1200 gms, with or without chamber dilation.

A

Hypertrophic cardiomyopathy

28
Q

Which CM is largest due to its pathophysiology?

A

Dilated cardiomyopathy-

heart size can be 2-3x normal size

29
Q

What is the diagnosis of myocarditis, cardiac tumors and cardiomyopathies?

A

Endomyocardial biopsy

30
Q

Description of what procedure:

performed by:

  1. inserting a catheter into the groin (femoral artery) or neck vein (jugular vein)
  2. propelling it through the aorta into the left ventricle or into the right side of the heart.
  3. 1-2 mm pieces of myocardium are removed for histologic examination (punch biopsies)
A

Endomyocardial biopsy

Used to dx cardiomyopathies (esp. for Adriamycin, a cause of dilated cardiomyopathy), cardiac tumors and myocarditis

31
Q

Infective Endocarditis: Where are the most common location that the vegetations can emboli?

A

Complications of the septic emboli:

retinal (blindness), coronary (MI), cerebral (strokes), splenic, pulmonary (from IVDA’s) and renal (from renal abscesses to glomerulonephritis) complications in the form of infarcts or abscesses