Cardiac Pathology

Front 1

Congestive Heart Failure
physical exam

Back 1

-tachycardia
-S3
-fine rales at lung bases
-lower exremity edema
-hepatojugular reflux
-cardiomegaly

Front 2

Case:
72 yo man with a past medical history of HTN and coronary artery disease status post CABG complains of breathlessness

Back 2

Congestive Heart Failure

Front 3

Congestive Heart Failure

Back 3

-multisystem derangement that occurs when the heart is not longer able to eject blood delivered to it by the venous system

Front 4

What is forward failure?

Back 4

inadequate cardiac output

Front 5

What is backward failure?

Back 5

increased congestion of the venous circulation

Front 6

What are the neurohumoral reactions of CHF?

Back 6

catecholamines (NEPI- inc. heart rate and contractility)

Front 7

What are the morphological changes of CHF?

Back 7

concentric hypertrophy and eccentric hypertorphy

Front 8

Concentric hypertrophy

Back 8

ventricular wall thickness inc. w/o an inc. in the chamber size

Front 9

Eccentric Hypertrophy

Back 9

ventricular wall thickness and chamber size inc.

Front 10

Dilatation

Back 10

chamber enlargment

Front 11

Compensated Heart Failure

Back 11

dilated ventricle that is able to maintain CO at a level that meets the needs of the body

Front 12

Decompensated heart failure

Back 12

failing myocardium in no longer able to maintain a CO that meets the needs of the body

Front 13

What are the common causes of left-sided heart failure?

Back 13

1. systemic HTN
2. ischemic heart disease
3. miral or aortic valve disease
4. primary disease of the mycardium

Front 14

What does left-sided heart failure lead to?

Back 14

1. pulm. congestion
2. pulm. edema
3. small alveolar space hemorrhage

Front 15

What are the common causes of right-sided heart failure?

Back 15

1. left-sided heart failure
2. pulm. disease
3. congenital abnormalities

Front 16

What does right-sided heart failure lead to?

Back 16

-congestion of abdominal viscera
-soft tissue edema
-pleural effusions
-pericardial effusions
-ascites

Front 17

What is nutmeg liver?

Back 17

from right-sided heart failure caused by congestion of abdominal viscera

Front 18

How common is heart failure

Back 18

-common
-5 million in US each yr
-1 million hospital
-300,000 deaths

Front 19

Case:
65yo man with diabetes, HTN and hypercholesterolemia with crushing chest pain that radiates to the jaw

Back 19

Ischemic Heart Disease

Front 20

Ischemic Heart Disease physical exam

Back 20

-tachycardia, diaphoretic
-EKG with abnormal Q-wave
-elevated troponin I and CK-MB

Front 21

What is ischemic heart disease caused by?

Back 21

narrowing of the lumina of the coronary arteries by atherosclerosis

Front 22

What results from ischemic heart disease?

Back 22

1. angina pectoris
2. acute MI
3. sudden cardiac death
4. chronic ischemic heart disease with congestive heart failure

Front 23

What is the incidence of ischemic heart disease?

Back 23

men > 60
women > 70

Front 24

What are risk factors for ischemic heart disease?

Back 24

1. HTN
2. diabetes
3. smoking
4. high levels of LDL cholesterol

Front 25

critical stenosis

Back 25

75% or greater reduction in the lumen of one or more coronary arteries

Front 26

What is the pathology of Ischemic Heart Disease?

Back 26

-severe atherosclerosis of the coronary arteries
-acute plaque changes
-coronary artery vasospasm

Front 27

Angina Pectoris

Back 27

intermittent chest pain caused by transient, reversible myocardial ischemia

Front 28

Typical or stable angina

Back 28

fixed critical stenosis

Front 29

Prinzmetal or variant angina

Back 29

coronary artery spasm

Front 30

unstable angina pectoris
(preinfarction angina)

Back 30

acute plaque change

Front 31

Myocardial Infarction

Back 31

-development of an area of myocardial necrosis caused by local ischemia
-1.5 mil/yr -500,000 deaths
-M>F until after 80yo

Front 32

What causes an MI?

Back 32

MIs are caused by coronary artery thrombosis

Front 33

Where do most MIs originate?

Back 33

in the subendocardium

Front 34

Transmural Infarcts

Back 34

involve most of the ventricular wall thickness

Front 35

Subendocardial infarcts

Back 35

involve the inner one third of the myocardium

Front 36

What are the complications from a MI? (6)

Back 36

1. papillary muscle dysfunction
2. external rupture of infarct
3. mural thrombi
4. acute pericarditis
5. ventricular aneurysm
6. cardiac arrhythmias
*most common cause of death from MI

Front 37

Chronic Ischemic Heart Disease

Back 37

development of progressive congestive heart failure as a consequence of long term ischemic myocardial injury

Front 38

Case:
55yo man w/ poor controlled HTN complains of headache and breathlessness at night w/ high BP and lt. vent. enlargement

Back 38

Hypertensive Heart Disease

Front 39

What abnormality is observed in a heart with a history of HTN?

Back 39

-left ventricular hypertrophy
->450g
-vent. wall thicknes >2cm

Front 40

Cor Pulmonale

Back 40

Disease of right sided heart chambers caused by pulmonary HTN resulting from pulmonary parenchymal or vascular disease

Front 41

Acute Cor Pulmonale

Back 41

-usually caused by pulmonary embolism (>50% vascular obstruction)
-rt. vent. dilation

Front 42

Chronic Cor Pulmonale

Back 42

progressive rt. vent. hypertrophy then dilation

Front 43

Valvular Heart Disease

Back 43

deformed valves may cause disease by two mechanisms:
1. impose a major hemodynamic burden on the cardiac chambers by causing obstruction (stenosis) or regurgitation (incompetence)
2. are more susceptible to infection

Front 44

Case:
13yo boy tired and short of breath and had sore throat two weeks prior. Presents w/ tachycardia, pericardial rub and faint heart sounds, erythematous rash on extremities and trunk

Back 44

rheumatic fever

Front 45

Rheumatic Fever

Back 45

an acute, immunologically mediated, multisystem inflammatory disease that follows an episode of group A streptococcal pharyngitis in 3% of patients after an interval of a few weeks

Front 46

What is the peak incidence of rheumatic fever?

Back 46

5-15yo

Front 47

Aschoff bodies

Back 47

central focus of fibrinoid necrosis surrounded by a chronic mononuclear inflammatory infiltrate and occassional Anitschkow cells

Front 48

Anitschkow cells

Back 48

large macrophages w/ vesicular nuclei and abundant basophilic cytoplasm (pathognomonic for RF)

Front 49

Acute Rheumatic Carditis

Back 49

inflammatroy changes in all three layer of the heart:
1. pericardium- fibrinous pericarditis; effusions
2. myocardium- heart failure
3. endocardium- valvular damage

Front 50

Verrucous Endocarditis

Back 50

-resolve w/o sequalae
-irreversible deformity of one or more valves
1. mitral valve- most commonly affected, stenosis and/or regurgitation, predisposition for infective endocarditis
2. aortic valve- stenosis and/or regurgitation, predisposition for infective endocarditis, fusion of aortic valve commissures

Front 51

Calcific Aortic Stenosis

Back 51

-irregular calcium deposits behind valve cusps
-congenitally bicuspid valves
-normal valves as an age-related degenerative change

Front 52

What is the most common cause of aortic stenosis?

Back 52

calcific aortic stenosis

Front 53

Case:
27yo woman presents for routine physical and has systolic murmur with a midsystolic click

Back 53

mitral valve prolapse

Front 54

What is the most frequent valvular lesion? (7%)

Back 54

mitral valve prolapse

Front 55

Mitral Valve Prolapse

Back 55

-in young women
-stretching of post. mitral valve leaflet (systolic murmur w/ midsystolic click)
-can result in mitral insufficiency
-predisposes to infective endocarditis

Front 56

Nonbacterial Thrombotic Endocarditis

Back 56

-deposisiton of sterile small masses of fibrin, platelets, and other blood components on the leaflets of the cardiac valves
-can embolize
-usually resolve spontaneously
-infective endocarditis as a complication

Front 57

What is the most common place for nonbacterial thrombotic endocarditis?

Back 57

mitral valve then aortic valve

Front 58

Libman-Sacks Endocarditis

Back 58

sterile vegetations that develop on cardiac valves of patients with systemic lupus erythematosus

Front 59

Where do Libman-Sacks endocarditis vegetations occur?

Back 59

either surface of mitral and tricuspid valves

Front 60

Case:
29yo man w/ fever and shaking chills and venopuncture sites on arms and sclerotic veins and one necrotic toe on each foot
temp104 HR140 BP90/50

Back 60

Infective Endocarditis

Front 61

Infective Endocarditis

Back 61

-bacterial or fungal infectios of the endocardium particularly the valvular surfaces (mitral)
-soft friable vegetations composed of inflamm. cells and bacteria

Front 62

What are risk factors for infective endocarditis?

Back 62

1. preexisting cardiac abnormalities (alpha hemolytic strep)
2. prosthetic heart vlaves (coagulase neg. staph)
3. intravenous drug abuse (tricuspid- staph aureus)

Front 63

What are complications from infective endocarditis? (2)

Back 63

1. distal embolization
2. ring abscesses

Front 64

What are complications from prosthetic valves? (5)

Back 64

1. mechanical deterioration
2. thrombi
3. infective endocarditis
4. paravalvular leaks
5. hemolysis

Front 65

Myocarditis

Back 65

inflammation of the myocardium

Front 66

What causes myocarditis? (3)

Back 66

1. infection (virus, bacteria, fungi, parasites)
2. immune-mediated reactions (postviral, poststrep, SLE, drug, tx regection)
3. unknown (sarcoid, giant cell myocarditis)

Front 67

Cardiomyopathies

Back 67

primary abnormality of myocardium

Front 68

Dilated Cardiomyopathy

Back 68

*most common
progressive cardiac hypertrophy, dilation and contractile dysfunction

Front 69

Hypertrophic Cardiomyopathy

Back 69

-hypertrophy of vent. wall, particularly the septum w/ abnormal diastolic filling and lt. vent. outflow obstruction
-arrhythmias and sudden death (young athletes)

Front 70

Restictive Cardiomyopathy

Back 70

infiltrative process w/in the myocardium that results ina decrease in vent. compliance w/ impaired diastolic filling and cotractile dysfunction

Front 71

Congenital Heart Disease

Back 71

lt. to rt. shunts
rt. to lt. shunts
obstruction

Front 72

Left to Right Shunts

Back 72

-ASD
-VSD
-PDA

Front 73

Right to Left Shunts

Back 73

-tetralogy of fallot
-transposition of the great arteries

Front 74

Congenital Obstruction

Back 74

coarctation of the aorta

Front 75

Tetralogy of Fallot (4)

Back 75

1. VSD
2. dextraposed aortic root that overrides the VSD
3. RV outflow obstruction
4. RV hypertrophy

Front 76

Pericardial Diseases (3)

Back 76

1. pericarditis
2. pericardial effusions
3. hemopericardium

Front 77

Pericarditis

Back 77

-primary- viruses
-secondary- acute MI, cardiac surgery, uremia, acute rheumatic fever

Front 78

Pericardial Effusions

Back 78

-serous- heart failure
-serosanguinous- trauma, malignancy
-chylous

Front 79

Hemopericardium

Back 79

cardiac tamponade (usually trauma)

Front 80

Cardiac Tumors- Metastic Neoplasms

Back 80

lung and breast

Front 81

Cardiac Tumors- primary neoplasms

Back 81

1. myxomas *most common
2. cardiac rhabdomyomas