Valvular pathology

Question 1

Cardiomyopathy definition

Answer 1

heart disease resulting from abnormality in myocardium, excludes ischemic heart disease, valve related heart disease, hypertensive heart disease

Question 2

Dilated cardiomyopathy -Define the macroscopic appearance of the heart

Answer 2

enlarged ventricle +/- atria with thinning of the wall

Question 3

Name the mechanism of heart failure in dilated cardiomyopathy and myocardial pathological changes

Answer 3

Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific
Impaired contractility - systolic / contraction. Myocardial Pathologic Changes: Non-specific

Question 4

Name several examples of associated disease processes with dilated cardiomyopathy

Answer 4

Idiopathic, toxic (ethanol, adriamycin), metabolic (hemochromatosis), inflammatory (sarcoidosis), traumatic or degenerative (dystrophy)

Question 5

Hypertorphic cardiomyopathy -Define the macroscopic appearance of the heart and pathological changes

Answer 5

•Thickened interventricular septum bulges into the left ventricle outflow tract during early systole. outflow obstruction through aortic valve (~25%) / ejection murmur. Anterior leaflet of the mitral valve may also impinge on septal wall during systole. Pathologic Changes: Non-specific hypertrophy & disarray of fibers

Question 6

Name the mechanism of heart failure in hypertrophic cardiomyopathy

Answer 6

Impaired compliance - diastolic / relaxation

Question 7

Name several examples of associated disease processes with hyertrophic cardiomyopathy

Answer 7

Genetic: Degenerative (dystrophy); metabolic (glycogen storage disease); infants of diabetic mothers

Question 8

Define macroscopic appearance of heart in restrictive cardiomyopathy and pathologic changes and mechanism of failure

Answer 8

• Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
• Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
• Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy
• Mechanism: Impaired compliance - diastolic / relaxation (filling) +/- contractility - systolic. Pathologic Changes: Infiltrative process: amyloid; leukemia. Fibrosis: radiation-induced myopathy

Question 9

Name several examples of associated disease processes with restrictive cardiomyopathy

Answer 9

Idiopathic, Metabolic-Ischemic (amyloidosis); Traumatic (radiation); inflammatory (sarcoidosis)

Question 10

Describe the anatomic finding in myofibers in the setting of hypertrophy

Answer 10

Hypertrophy and disarray of fibers. Same number of myocytes but more sarcomeres

Question 11

Name the most common form of hypertension (~90%)

Answer 11

Essential (or primary) HTN is idiopathic and found in 90% of cases. Secondary HTN is related to renal disease, endocrine disease or cardiovascular disease

Question 12

Name several renal disease processes that manifest as systemic hypertension

Answer 12

Chronic renal disease (trauma), glomerulonephritis (inflam), vasculitis (inflam), renal artery stenosis (trauma), polycystic renal disease (developmental), neoplasm

Question 13

Name a developmental process involving the aorta that leads to hypertension

Answer 13

Coarctation of arota - developmental

Question 14

Name at least one hypertension-associated disease process in each of the following organs a. Pituitary b. Thyroid c. Adrenal

Answer 14

Pituitary- acromegaly (neoplasm). Thyroid: hyperthyroidism- thyrotoxicosis (inflam). Adrenal: adenoma- aldosterone (neooplasm) and pheochromocytoma (neoplasm)

Question 15

Complications of systemic HTN

Answer 15

1. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
2. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
3. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
4. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
5. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
6. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis
7. Atherosclerosis 2. Cerebral vascular disease: a. Ischemic: arteriolosclerosis, b. Hemorrhage
8. Kidney: Key cause of “chronic renal disease”; often along with diabetic renal disease: a. Arteriolosclerosis, b. Glomerulosclerosis

Question 16

Define the most common cause of right heart failure

Answer 16

left heart failure

Question 17

Define “cor pulmonale”

Answer 17

Pulmonary HTN due to pulmonary parenchyma disease, pulmonary vessel disease, or Chest movement alterations. Plus exclusion of left heart failure

Question 18

Name at least two diseases leading to pulmonary hypertension resulting from a. Pulmonary parenchymal disease

b. Pulmonary vascular diseases
c. Chest movement-associated diseasesName at least two diseases leading to pulmonary hypertension resulting from a. Pulmonary parenchymal disease
b. Pulmonary vascular diseases
c. Chest movement-associated diseasesName at least two diseases leading to pulmonary hypertension resulting from a. Pulmonary parenchymal disease
b. Pulmonary vascular diseases
c. Chest movement-associated diseases

Answer 18

pulmonary parenchyma disease: a. Emphysema b. Interstitial lung disease c. Bronchiectasis d. Pneumoconiosis. pulmonary vessel disease: a. Pulmonary Emboli b. Primary pulmonary hypertension c. Radiation d. Tumor in vessels. Chest movement alterations: obesity, muslce diseases, denervating diseases

Question 19

give examples of etiologies that can manifest with left heart failure

Answer 19

Ischemic cardiomyopathy, nonischemic cardiomyopathy, HTN, valve disease (aortic or mitral)

Question 20

Name complications of left heart failure

Answer 20

Right hear failure, edema, reduced kidney perfusion, hypoxic encephalopathy

Question 21

Recognize that congenital heart disease can manifest with right heart failure

Answer 21

OK

Question 22

Distinguish pulmonary causes of right heart failure

Answer 22

pulmonary parenchyma disease, pulmonary vessel disease, or Chest movement alterations.

Question 23

Name examples of diseases of the lung that lead to increased right heart work

Answer 23

Pulmonary Parenchymal Disease, Pulmonary vessel disease

Question 24

Name complications of right heart failure

Answer 24

Organ congestion (liver, spleen, others), peripheral edema

Question 25

A. Name examples of disease that result in the following types of endocarditis: 1. Serous, 2. Fibrinous, 3. Purulent, 4. Hemorrhagic, 5. Caseating

Answer 25

Serous: Metabolic (uremia), inflammatory (SLE, rheumatic fever, sarcoid), infectious. Fibrinous: metabolic (uremia), inflammatory (SLE, rheumatic fever, RA), ischemic (dressler syndrome), truama. Purulent: infection. Caseous: TB infection. Hemorrhagic: neoplasm, trauma, infection

Question 26

Name a collagen vascular disease (CVD) / connective tissue disease (CTD) which can manifest with pericarditis

Answer 26

Rheumatoid arthritis

Question 27

Name variant of pericarditis most commonly seen in CVD / CTD

Answer 27

fibrinous

Question 28

Name infectious etiologies that can manifest with pericarditis

Answer 28

Bacteria (staph, Neisseria meningitidis, TB), viral (influenza, HIV, adenovirus), fungal

Question 29

How does Chronic renal failure / uremia (uremic pericarditis) affect pericardium

Answer 29

dont know

Question 30

Most common variant of pericarditis in chronic renal failure

Answer 30

Serous or fibrinous

Question 31

Recognize the implications of pericardium of trauma

Answer 31

Hemorrhagic pericarditis due to blunt force tauma. Fibrinous pericarditis from radiation

Question 32

Recognize the implications of pericardium of ischemic disease

Answer 32

Dressler syndrome: results in fibrinous pericarditis several weeks after MI

Question 33

Name the “syndrome” (possibly immune-related) that can manifest with pericarditis after a myocardial infarct

Answer 33

Dressler syndrome

Question 34

List examples of neoplasms that most commonly metastasize to the pericardium

Answer 34

breast carcinoma, lung, carcinoma, other carcinomas, lymphomas, leukemias

Question 35

Name the specific variant of pericarditis most commonly seen in neoplastic pericarditis

Answer 35

hemorrhagic

Question 36

Name the primary neoplastic disease arising from mesothelial cells

Answer 36

Mesothelioma

Question 37

Define cardiac tamponade

Answer 37

Pericardial sac accumulation of blood, fibrinopurulent exudate or effusion which reduces volume of expansion during diastole and results in inadequate blood volume circulating.

Question 38

List the name of the process where the parietal and visceral pericardium fuse

Answer 38

Adhesion of visceral and parietal pericardium results in constrictive pericarditis

Question 39

Name a complication of this fusion of the pericardial fusion

Answer 39

Reduced CO leads to hyptension, fatigue, elevated systemic venous pressure (hepatomegaly, ascites, peripheral edema, jugular venous distenstion)

Question 40

Name treatment for constrictive pericarditis

Answer 40

Pericardial window is cut to relieve constriction

Question 41

List the long-term implications of a bicuspid aortic valve

Answer 41

stenosis, calcification

Question 42

Complications of prolapse of mitral valve

Answer 42

Regurgitation, infective endocarditis

Question 43

Describe the dystrophic mineralization process, asymptomatic vs. symptomatic, that occurs in the setting of aortic stenosis in relation to aging, abnromal valves,

Answer 43

Aging (asymptomatic early; can serve as substrate for vegetations), Abnormal valve (e.g. bicuspid aortic valve)

Question 44

Describe the primary complications of stenosis of the aortic valve

Answer 44

LV outflow deficit and LV hypertrophy. Mycoardial oxygen demand is increased in hypertrophied ventricle, but blood supply is limited due to reduced outflow, this leads to angina. Also reduced flow to systemic circulation results in syncope and dizziness

Question 45

Describe the key features of rheumatic valvular disease with respect to the leaflets and chordae tendinae

Answer 45

Valve Leaflets and Cusps: fibrosis, fusion, calcification. Chordae Tendinea: fibrosis, fusion, and shortening

Question 46

List several complications of rheumatic valve disease

Answer 46

Valve stenosis / incompetence … can progress to heart failure. Susceptibility to infective endocarditis. Mural thrombus formation in atrium leads to thromboemboli

Question 47

Valves most commonly involved in rheumatic valve disease

Answer 47

Mitral is most common, followed by aortic valve

Question 48

Distinguish the two major classes of vegetations and their etiologies

Answer 48

Non-infectious vegetations (Non-Infectious endocarditis): - Marantic: solid neoplasms, or thrombus formation on valve. Caused by Libman-Sachs endocarditis from Lupus (CVD, or rheumatic heart disease. . Infectious vegetations = “Infectious endocarditis”

Question 49

List complications of vegetations

Answer 49

Obstruction of the coronary sinuses / embolism to heart, Embolize systemically (called septic emboli if from infectious vegetation), Destruction of valve integrity (infectious endocarditis)