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Flashcards in XI - The Heart Deck (148):
1

The left ventricle is hypertrophied and dilated, with secondary left atrial dilation. The lungs are heavy and boggy, with perivascular and interstitial transudate, alveolar septal edema, and intra-alveolar edema. Hemosiderin-laden macrophages are present. SEE SLIDE 11.1.

Left-sided heart failure(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

2

Hemosiderin laden macrophages are also called _______

Heart failure cells. SEE SLIDE 11.1. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

3

Earliest and most significant complaint of patients with left-sided heart failure

Dyspnea(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

4

Most common cause of right sided HF.

Left-sided HF(TOPNOTCH)

5

This is a particularly dramatic form of breathlessness, awakening patients from sleep with attacks of extreme dyspnea bordering on suffocation.

Paroxysmal nocturnal dyspnea (PND) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

6

Isolated right sided HF occuring in patients with intrinsic lung disease that result in chronic pulmonary hypertension.

Cor Pulmonale(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

7

Long standing severe right-sided HF leads to fibrosis of centrilobular areas, creating this condition.

Cardiac cirrhosis(TOPNOTCH)

8

Term used when the liver has congested centrilobular areas (due to back up of blood) surrounded by paler peripheral regions. SEE SLIDE 11.2.

Nutmeg liver (CPC of the liver)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

9

Hallmark of right sided HF.

Pedal and pretibial edema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 382

10

Most congenital heart disease arises from faulty embryogenesis during what AOG?

3 - 8 weeks AOG(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 382

11

An abnormal communication between chambers of the heart or blood vessels.

Shunt(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 383

12

Smooth-walled defect near the foramen ovale, usually without associated cardiac abnormalities. It comprises 90% of ASDs.

Ostium secundum ASD(TOPNOTCH) Robbins Basic Pathology, 9th Ed., p 371

13

Chamber abnormalities seen in ASD.

Accompanied by right atrial and ventricular dilation, right ventricular hypertrophy, and dilation of the pulmonary artery-- reflecting chronic right-sided volume overload. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p 371

14

Reversal of blood flow through a prolonged left-to-right shunt due to pulmonary hypertension, yielding a right-to-left shunt. This causes unoxygenated blood to go into circulation, causing cyanosis.

Eisenmenger syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 383

15

These occur at the lowest part of the atrial septum and can extend to the mitral (anterior leaflet) and tricuspid valves (septal leaflet).

Ostium primum ASD. SEE SLIDE 11.3. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 384

16

Incomplete closure of the ventricular septum leading to left-to-right shunting. The right ventricle is hypertrophied and often dilated. Diameter of pulmonary artery is increased because of the increased volume by the right ventricle.

Ventricular Septal Defect(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

17

This arises from the left pulmonary artery and joins the aorta just distal to the origin of the left subclavian artery.

Ductus arteriosus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

18

The most common cause of cyanotic congenital heart disease. Heart is large and "boot-shaped" as a result of right ventricular hypertrophy.

Tetralogy of Fallot. SEE SLIDE 11.4. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

19

Components of Tetralogy of Fallot.

Pulmonary valve stenosis, Overriding of aorta, Right ventricular hypertrophy, Ventricular septal defect. SEE SLIDE 11.4. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 386

20

It is a discordant connection of the ventricles to their vascular outflow. The defect is an abnormal formation of the truncal and aortopulmonary septa.

Transposition of the Great Arteries. SEE 11.5 (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 386

21

Predominant manifestation of TGA?

Early cyanosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 387

22

Characterized by circumferential narrowing of the aortic segment between the LEFT SUBCLAVIAN ARTERY and the ductus arteriosus. DA is usually patent and is the main source of blood to the distal aorta. RV is hypertrophied and dilated, pulmonary trunk is also dilated.

Preductal "infantile" coarctation of the aorta. SEE SLIDE 11.6. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 387

23

Aorta is sharply constricted by a ridge of tissue at or just distal to the NONPATENT ligamentum arteriosum. Constricted segment is made of smooth muscle and elastic fibers that are continuous with the aortic media, and lined by thickened intima. Ductus arteriosus is closed. Proximally, the aortic arch and its vessels are dilated, LV is hypertrophic.

Postductal "adult" coarctation of the aorta. SEE SLIDE 11.6. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 387

24

There is upper extremity hypertension, due to poor perfusion of the kidneys, but weak pulses and low blood pressure in the lower extremities. Claudication and coldness of the lower extremities also present. Enlarged intercostal and internal mammary arteries due to collateral circulation, seen as rib "notching" on xray.

Postductal coarctation of the aorta (without a PDA). SEE SLIDE 11.6. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

25

Left-to-right or Right-to-Left shunt?Atrial septal defect

Left-to-right(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

26

Left-to-right or Right-to-Left shunt?TOF

Right-to-Left(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

27

Left-to-right or Right-to-Left shunt?VSD

Left-to-right(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

28

Left-to-right or Right-to-Left shunt?Eisenmenger syndrome

Right-to-Left (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

29

Left-to-right or Right-to-Left shunt?Transposition of great arteries

Right-to-Left(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

30

A condition wherein ischemia causes pain but is insufficient to lead to death of myocardium.

Angina pectoris(TOPNOTCH)

31

A condition wherein ischemia causes pain but is insufficient to lead to death of myocardium.

Angina pectoris(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

32

A condition wherein the severity or duration of ischemia is enough to cause cardiac muscle death.

Acute Myocardial Infarction(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

33

This refers to progressive cardiac decompensation (heart failure) following myocardial infarction.

Chronic Ischemic Heart Disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

34

This can result from a lethal arrythmia following myocardial ischemia.

Sudden Cardiac Death(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

35

How many percent should the lumen of a blood vessel be obstructed for it to be symptomatic, in the setting of increased demand?

More than 70% (critical stenosis)(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 375

36

How many percent should the lumen of a blood vessel be obstructed for it to be symptomatic at rest (unstable angina)?

90%(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 375

37

Episodic chest pain associated with exertion or some other form of increased myocardial oxygen demand. Pain described as crushing or squeezing substernal sensation which can radiate to left arm. Relieved by rest or vasodilators.

Stable angina(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 390

38

Increasing frequency of pain, precipitated by progressively less exertion, episodes tend to be more intense and longer lasting.

Unstable angina(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 390

39

Angina occuring at rest due to coronary artery spasm.

Variant or Prinzmetal angina(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 390

40

Infarct involving >= 50% of the myocardial wall thickness.

Transmural infarcts(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 391

41

Most common blood vessel involved in myocardial infarction?

Left anterior descending artery (40-50%)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 392

42

Electron microscope findings 30 minutes after an ischemic event.

Microfibril relaxation, glycogen loss and mitochondrial swelling(TOPNOTCH)

43

An infarct can be readily identified by a reddish blue discoloration after how many hours after MI?

12-24 hours(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 393

44

Coagulation necrosis ensues how many hours after MI?

4-12 hrs after an irreversible injury(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 394

45

Injury to infarcts mediated in part by oxygen free radicals generated by increased number of infiltrating leukocytes facilitated by reperfusion.

Reperfusion injury(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 394

46

Cardiac enzymes that become detectable 2-4 hours post-infarct peaks at 48 hours and remains elevated for 7-10 days.

Troponin I and Troponin T(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 395

47

This cardiac enzyme is detectable in the blood within 2-4 hrs of MI, peaks at 24-48 hrs and returns to normal within approximately 72 hrs.

CKMB(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 395

48

Myocardial rupture may occur how many days after MI?

3-7 days after infarction(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 397

49

This occurs within 2-3 days of a transmural infarct and typically resolves within time. It is the epicardial manifestation of the underlying myocardial inflammation.

Pericarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 397

50

A late complication of MI, most commonly results from a large transmural anteroseptal infarct that heals with formation of a thin scar tissue.

Ventricular aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 397

51

This type of hypertrophy develops in pressure-overloaded ventricles, with an increase in wall thickness, and reduced cavity diameter.

Concentric hypertrophy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 399

52

Type of hypertrophybthat develops in patients with volume overload such as aortic valve insufficiency. Characterized by hypertrophy associated with ventricular dilation.

Eccentric hypertrophy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 399

53

Normal weight of heart and normal LV wall thickness

320-360 grams, 1.2-1.4 cm (TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 387

54

In this disease, the left ventricle may exceed 2.0 cm in thickness and the heart may weigh >500 grams (Left ventricular hypertrophy). Microscopically, myocyte diameter increases, associated with irregular nuclear enlargement and hyperchromasia ("box-car nuclei"), and increased interstitial fibrosis.

Sytemic Hypertensive heart disease(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 387

55

It is the failure of a valve to open completely, obstructing forward flow.

Stenosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 401

56

This results from failure of a valve to close completely, thereby allowing reversed flow.

Insufficiency(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 401

57

The hallmark of this disease is heaped-up calcified masses on the outflow side of the cusps, which protrude intonthe sinuses of Valsalva and mechanically impede valve opening. Cusps may become secondarily fibrosed and thickened.

Calcific aortic stenosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 401

58

This is characterized by ballooning or hooding of the mitral leaflets. Affected leaflets are enlarged, redundant, thick and rubbery. The tendinous cords are elongated, thinned and occasionally ruptured. Histologically, there is thinning of the fibrosa layer of the valve, accompanied by expansion of the middle spongiosa layer with increased deposition of mucoid material.

Myxomatous degeneration of the mitral valve(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 402

59

Patients with this disease may complain of palpitations, dyspnea or atypical chest pain. Auscultation shows a midsystolic click associated with a regurgitant murmur.

Mitral valve prolapse(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 402

60

Pathognomonic sign for rheumatic fever-- myocardial inflammatory lesions composed of plump activated macrophages (Anitschkow cells), plasma cells, and lymphocytes. SEE SLIDE 11.7.

Aschoff bodies(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 402

61

TRUE or FALSE: Aschoff bodies are rarely seen in chronic rheumatic heart disease

TRUE. They are replaced by a fibrous scar. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. p.391

62

These cells have abundant cytoplasm and central nuclei with chromatin arrayed in a slender, wavy ribbon (caterpillar cells) which can be found in all three layers of the heart in rheumatic fever. A component of Aschoff bodies. SEE SLIDE 11.8.

Anitschkow cells(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 403

63

Characterized by organization and subsequent scarring, as a sequelae of rheumatic fever. The mitral (or tricuspid) valve is involved, with leaflet thickening, commisural fission and shortening, thickening and fusiong of the chordae tendinae. Fibrous bridging across valvular commisures create "fishmouth" or " buttonhole" deformity. SEE SLIDE 11.9.

Chronic Rheumatic Heart Disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 403

64

Most common valve involved in RHD.

Mitral valve (upto 70% of cases with RHD)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 405

65

Major components Jones Criteria for RF.

CarditisMigratory polyarthritisSubcutaneous nodulesErythema marginatumSyndenham chorea(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

66

Minor components Jones criteria for RF

FeverArthralgiaElevated acute phase reactants (e.g. CRP)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

67

How many major and/or minor manifestations are needed to diagnose RF?

Remember: 20122 major 0 minor or1 major 2 minor(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

68

Endocarditis of previously normal valves, the most common causative agent is S. aureus.

Acute bacterial endocarditis(TOPNOTCH)

69

Serious infection characterized by microbial invasion of heart valves or mural endocardium, often with destruction of the underlying cardiac tissues. The heart valves are friable, bulky and potentially destructive.

Infective endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

70

Endocarditis affecting previously damaged or abnormal valves, commonly caused by viridans Streptococci.

Subacute bacterial endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

71

Most consistent sign of infective endocarditis.

Fever(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 407

72

Characterized by deposition of sterile, non-inflammatory, nondestructive and small (1mm) masses of fibrin, platelets and other blood components on cardiac valves, along the line of closure of leaflets or cusps.

Nonbacterial thrombotic endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 407

73

Sterile vegetations thatvcan develop on the valves of patients with SLE. These are small, granular, pinkish vegetations 1-4mm in diameter and can be located on the undersurface of AV valves, on the cords or endocardium. SEE SLIDE 11.10.

Libman-Sacks endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 408

74

The lesions of this disease are distinctive, glistening white intimal thickenings on the endocardial surfaces of the cardiac chambers and valve leaflets. The lesions are composed of smooth muscle cells and sparse collagen fibers embedded in an acid mucopolysaccharide-rich matrix. Usually right-sided (causing tricuspid insufficiency and pulmonic stenosis).

Carcinoid heart disease. Of note, lesions that occur in fenfluramine and ergot alkaloid-induced valvulopathy look similar to this. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 395

75

Cardiomyopathy which is characterized by progressive cardiac dilation and contractile dysfunction. The heart is characteristically enlarged and flabby, with dilation of all chambers,the ventricular thickness may be less than, equal to or greater than normal.

Dilated cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 411

76

Alcohol, myocarditis, doxorubicin, and hemochromatosis are some of the causes of this cardiomyopathy.

Dilated cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 411

77

Characterized by myocardial hypertrophy, abnormal diastolic filling and ventricular outflow obstruction. The heart is thick-walled, heavy and hypercontracting. There is an assymetrical septal hypertrophy described as "banana-like". Histologically, there is severe myocyte hypertrophy and DISARRAY with interstitial fibrosis. SEE SLIDE 11.11.

Hypertrophic cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 412

78

Mechanism of heart failure in hypertrophic cardiomyopathy.

Diastolic dysfunction (impaired compliance)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 412

79

A common cause of sudden death in young athlethes.

Hypertrophic cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 412

80

The ventricles are of approximately normal size or slightly enlarged, the cavities not dilated, and the myocardium is firm. Biatrial dilation is common. Microscopically, there is interstitial fibrosis, varying from minimal to patchy to extensive and diffuse.

Restrictive cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 413

81

Mechanism of heart failure in restrictive cardiomyopathy.

Diastolic dysfunction or impaired compliance(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 413

82

Inflammation of the myocardium.

Myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

83

Most common type of myocarditis wherein lymphocytes infiltrate the interstitium. This may resolve or heal by progressive fibrosis.

Lymphocytic myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

84

Myocarditis that has interstitial and perivascular infiltrates composed of lymphocytes, macrophages and a high proportion of eosinophils.

Hypersensitivity myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

85

Myocarditis characterized by widespread inflammatory infiltrates containing multinucleated giant cells interspresed with lymphocytes, eosinophils and plasma cells. Poor prognosis.

Giant-cell myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

86

Myocarditis distinctive by virtue of parasitization of scattered myofibers by trypanosomes accompanied by an inflammatory infiltrate of neutrophils, lymphocytes, macrophages and occasional eosinophils.

Chagas myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

87

Viruses which account for most cases of myocarditis.

Coxsackie A and B(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

88

Type of pericarditis found in patients with uremia or viral infection. The exudate imparts an irregular apperance to the pericardial surface (bread and butter pericarditis).

Fibrinous pericarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 416

89

Bacterial pericarditis manifests with this type of exudate.

Fibrinopurulent (suppurative)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 416

90

Heart is completely encased by dense fibrosis that it cannot expand normally during diastole.

Constrictive pericarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 416

91

Normal amount of pericardial fluid in pericardial sac.

30 - 50 mL of thin, straw-colored fluid(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

92

Serous pericardial effusion can be caused by _________

CHF, hypoalbuminemia(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

93

Chylous pericardial fluid can be caused by _______

Mediastinal lymphatic obstruction(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

94

Rapidly developing collections of fluid within the pericardial sac can restrict diastolic cardiac filling producing this fatal sequelae.

Cardiac tamponade(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

95

The most common tumor of the heart.

Metastatic tumor(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

96

Most common primary tumor of the adult heart.

Myxoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

97

Major clinical manifestations of this cardiac tumor are due to valvular "ball-valve" obstruction, embolization or a syndrome of constitutional symptoms.

Myxoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 418

98

The most frequent primary tumor of the heart in infants and children. These are generally small gray-white myocardial masses composed of a mixed population of cells, the most characteristic of which are large, rounded or polygonal cells containing numerous glycogen-laden vacuoles separated by strands of cytoplasm, so-called spider cells.

Rhabdomyomas(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 418

99

Serosanguinous pericardial effusion can be caused by ________

Blunt chest trauma, malignancy, ruptured MI, aortic dissection(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 418

100

The most severe pulmonary changes in congestive heart failure

Accumulation of edema fluid in the alveolar spaces (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 529

101

Morphologic finding/telltale signs of previous episodes of pulmonary edema

Hemosiderin-laden macrophages (Heart failure cells) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 529

102

Most common underlying etiology of diastolic failure

Hypertension (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 529

103

Group of congenital heart disease characterized by increase pulmonary blood flow but are not initially associated with cyanosis

Left-to-right shunts (ASD, VSD, PDA) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 533

104

Most common genetic cause of congenital heart disease

Trisomy 21 (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 533

105

A 24 y/o female complained of shortness of breath and orthopnea lasting several days. The patient reported having diagnosed since childhood as having "hole in the heart." Physical exam revealed holosystolic murmur most audible in the left parasternal area accompanied by thrill. Rales were heared in the bilateral lower lung field. The most likely cause of her condition:

VSD (TOPNOTCH)

106

Most common cause of myocardial ischemia

Obstructive atherosclerotic lesions in the epicardial coronary arteries (TOPNOTCH) Robbins Basic Patholgoy, 9th ed., p. 538

107

The cause of sudden cardiac death in myocardial infarction

Ventricular arrythmia (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 539

108

Irreversible cell injury in MI occur in how many minutes?

20-40 minutes (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 541

109

Irreversible injury of ischemic myocytes in MI occurs first in what zone in the heart?

Subendocardial zone (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 541

110

What blood vessel supply the posterior third of the ventricular septum in majority of the individuals?

Right coronary artery (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 541

111

Pattern of infarction caused by occlusion of an epicardial vessel

Transmural infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

112

Pattern of infarction caused by plaque disruption or hypotension, causing circumferential myocardial damage

Subendocardial infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

113

Pattern of infarct also referred to as an "ST elevation myocardial infarct"

Transmural infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

114

Pattern of infarct also referred to as a "non-ST elevation infarct"

Subendocardial infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

115

The typical changes of coagulative necrosis becomes detectable in how many hours of injury?

First 6-12 hours(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 545

116

Microscopic findings in irreversibly injured myocytes characterized by intensely eosinophilic intracellular stripes composed of closely packed sarcomeres. SEE SLIDE 11.12.

Contraction bands(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 546

117

A 62 y/o obese male had sudden onset of heaviness in the chest, associated with diaphoresis and dyspnea which started 3 hours prior to consult at the ER. The biomarkers that are most sensitive and specific of myocardial damage that you will request:

Troponins I and T (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 547

118

A 72 y/o female experienced chest pain and hypotension. A posterior transmural infarct was suspected. Most common complications in this type of infarct

Conduction blocks, right ventricular involvement, or both (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 549

119

Free wall rupture, expansion, mural thrombi, and aneurysm are common in what type/location of infarct?

Anterior transmural infarct(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 549

120

Most common cause of rhythm disorder

Ischemic injury(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 550

121

A 24 y/o female presents with history of recurrent fever and joint pains accompanied by ECG changes and increased ASO titer in the past 2 years. Physical examination reveals cardiac murmur. What is the clinical impression?

Rheumatic heart disease (TOPNOTCH)

122

Characteristic anatomic change in MVP

Interchordal ballooning of mitral leaflets (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 556

123

Most frequent mechanism of SCD

Lethal arrythmia (asystole, ventricular fibrillation) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 552

124

Earliest microscopic change in systemic hypertensive heart disease

increase in transverse diameter of myocytes (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 552

125

Most common type of VSD

Membranous (Interventricular septum) VSD(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 535

126

The common feature of pulmonary thromboembolism, obstructive sleep apnea, altitude disease, and parenchymal lung disease

Pulmonary hypertension. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 530

127

A 5 wk old infant presents with tachypnea, diaphoresis, and difficulty feeding. A harsh, continuous, machinery-like murmur was noted upon auscultation. What is the most likely diagnosis?

Patent ductus arteriosus(TOPNOTCH)

128

Presents with hypertension in the upper extremities, and manifestations of arterial insufficiency such as claudication and coldness. Produce a radiographical visible erosion (notching) of the undersurfaces of the ribs.

Coarctation of the aorta (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 537

129

Major cause of infective endocarditis among intravenous drug abusers

Staphylococcus aureus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

130

Most common cause of endocarditis of native but previously damaged or otherwise abnormal valves

Streptococcus viridans (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

131

Predominant manifestations of RF

Carditis and arthritis(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

132

A 72 year old hypertensive female last seen apparently well 3 days ago, is found dead in her bathroom with rigor mortis and no signs of foul play. At autopsy, her heart showed left ventricular hypertrophy and a pale tan area at the anteroseptal wall. There are no thrombi in the heart chambers. The valves are unremarkable. Microscopic examination of the pale area showed well-established granulation tissue with new blood vessels and collagen deposition. Neutrophils are rare. She died of (A) an MI that occured 1 hour prior to demise (B) an MI 12 hours prior to demise (C) an MI 2 days prior to demise (D) something else entirely

something else entirely (evolution of morphologic changes in myocardial infarction) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 393

133

In hypertensive heart disease, there is concentric thickening of the left ventricular wall. A concomitant left atrial dilatation may also be seen due to (A) volume overload from a ventricle with narrowed lumen (B) pressure overload from a ventricle with narrowed lumen (C) cytokines secreted by hypertrophic ventricular myocytes cause atrophy of atrial myocytes (D) cytokines secreted by hypertrophic ventricular myocytes cause metaplasia of atrial myocytes

volume overload from a ventricle with narrowed lumen (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 399

134

What feature in a stenotic aortic valve suggests rheumatic valvular disease, rather than calcific aortic stenosis? (A) bicuspid valve (B) masses of calcium on the outflow side of cusps (C) fibrotic cusps (D) fusion of the commmissures

fusion of the commisures (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P402

135

A 20 year old asymptomatic female is found to have a midsystolic click on her preemployment physical examination. A 2D echo showed mitral valve prolapse. The involved leaflet would show (A) numerous fibroblasts with and dense collagen deposition (B) thinning of the fibrosa layer and myxoid expansion of the spongiosa layer (C) deposition of amorphous material that shows apple-green birefringence when stained with Congo red (D) fibrous stroma with gland-like structures secreting mucin

thinning of fibrosa layer and myxoid espansion of the spongiosa layer (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P402

136

A 5 year old male who had a sore throat 3 weeks ago develops fever and joint pains. Auscultation revealed a friction rub, and ASO titers are increased. Which of the following is expected in the patient? (A) friable vegetations on the mitral valve containing fibrin, neutrophils and gram-positive cocci (B) small vegetations on the mitral valve with abundant eosinophils (C) myocardium with circumscribed aggregates of mononuclear cells and macrophages with prominent nucleoli (D) myocardium with poorly-circumsccribed aggregates of multinucleated giant cells

myocardium with circumscribed aggregates of mononuclear cells and macrophages with prominent nucleoli (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 403-404

137

A 19 year old football player dies suddenly during one training session. At autopsy, his heart showed myocardial hypertrophy with disproportionate thickening of the septum, and a narrowed left ventricular lumen. Microscopic examination showed myocyte hypertrophy, myofiber disarray, and interestitial fibrosis. These findings are due to (A) a mutation in one of his genes encoding sarcomeric proteins (B) a silent Coxsackie virus B infection (C) an undisclosed 3 year history of alcohol intake (D) anabolic steroids he has been taking for 6 months

a mutation in one of his genes encoding sarcomeric proteins (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P. 412-413

138

A 34 year old female on routine checkup is found to have a diastolic murmur. 2D echo showed a pedunculated 3 cm mass in her left atrium attached to the atrial septum. She has no other known masses on workup. She undergoes heart surgery where the atrial mass is resected. Which of the following is its most likely histology? (A) stellate cells admixed with endothelial and fibroblastic cells embedded in an abundant extracellular matrix (B) sheets of large polygonal cells containing glycogen-containing vacuoles arranged around a central nucleus (C) fascicles of fibroblasts and interspersed collagen bundles (D) sheets of pleomorphic cells lining vascular spaces, some with intracytoplasmic lumens, with atypical mitoses and areas of necrosis

stellate cells admixed with endothelial and fibroblastic cells embedded in an abundant extracellular matrix. SEE SLIDE 11.13. (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp 417-418

139

Estimated time from myocardial infarction given this morphologic change: No change grossly, with variable waviness of fibers

30 minutes to 4 hours (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

140

Estimated time from myocardial infarction given this morphologic change: Dark mottling grossly with microscopic evidence of coagulation necrosis

4 to 24 hours. Myocardial infarcts less than 12 hours old usually are not grossly apparent. In 12 to 24 hours, there is dark mottling due to trapped blood. SEE SLIDE 11.14. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

141

Estimated time from myocardial infarction given this morphologic change: Mottling with yellow-tan infarct center, prominent interstitial infiltrate of neutrophils

1-3 days. SEE SLIDE 11.14 (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

142

Estimated time from myocardial infarction given this morphologic change: Hyperemic border with central yellow-tan softening grossly. On microscope, there is early phagocytosis of dead cells by macrophages at infarct border

3-7 days. SEE SLIDE 11.14. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

143

Estimated time from myocardial infarction given this morphologic change: Maximally yellow-tan and soft WITH depressed red-tan margins. There is formation of GRANULATION TISSUE at the margins

7-10 days (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

144

Estimated time from myocardial infarction given this morphologic change: Red-gray in color, granulation tisue is well established with new blood vessels and collagen deposition

10-14 days (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

145

Estimated time from myocardial infarction given this morphologic change: Progressive graying (or scarring) of the infarcted area witn increased collagen deposition and decreased cellularity

More than 2 weeks. By 2 months, scarring is complete with a dense collagenous scar. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 380

146

Differentiate the vegetations seen in RHD and in infective endocarditis.

RHD: Usually 1-2mm vegetations called verrucae, composed mostly of fibrin, along the lines of closure; IE: Highly friable and destructive, composed of inflammatory cells, fibrin, and microorganisms. They can embolize (causing septic infarcts) and even erode the underlying myocardium, forming a ring abscess. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 394

147

Serotonin metabolite that correlates with the severity of right-sided heart lesions seen in carcinoid syndrome.

5-hydroxyindoleacetic acid (5-HIAA) (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 395

148

Sarcomeric protein most frequently affected in hypertrophic cardiomyopathy.

Beta-myosin heavy chain. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P 400