Cardiovascular Pathology Heart Disease

Front 1

Define stable angina

Back 1

retrosternal chest pain with exertion, usually secondary to atherosclerosis

Front 2

Define Prinzmetal's variant angina

Back 2

occurs at rest secondary to coronary artery spasm

Front 3

Define unstable/crescendo angina

Back 3

worsening chest pain due to thrombosis without necrosis

Front 4

Red infarcts would normally be found in ___________________, while pale infarcts are normally found in ____________________.

Back 4

Loose tissues with collateral blood supply: liver, lung, intestine, or following reperfusion; Solid tissues with single blood supply: heart, kidney, spleen.

Front 5

Which coronary arteries are most often occluded?

Back 5

LAD > RCA > circumflex

Front 6

List the possible symptoms of myocardial infarction

Back 6

Diaphoresis, nausea, vomiting, severe retrosternal pain, pain in left arm and/or jaw, shortness of breath, fatigue, adrenergic symptoms

Front 7

When is the greatest risk of arrhythmia after a myocardial infarction?

Back 7

2 to 4 days

Front 8

When is the greatest risk of free wall rupture after a myocardial infarction?

Back 8

5-10 days

Front 9

When is the greatest risk of ventricular aneurysms after a myocardial infarction?

Back 9

7 weeks

Front 10

What light microscope changes are visible in the first 2-4 hours of a myocardial infarction?

Back 10

None

Front 11

What changes can be found 4 hours after a myocardial infarction?

Back 11

coagulative necrosis, contraction bands visible after 4 hours, beginning of neutrophil emigration

Front 12

What changes can be found 2-4 days after a myocardial infarction?

Back 12

acute inflammation in tissue surrounding infarct, hyperemia, neutrophils, coagulative necrosis

Front 13

What changes can be found 5-10 days after a myocardial infarction?

Back 13

ingrowth of granulation tissue in the outer zone, macrophages and neutrophils

Front 14

What changes can be found 7 weeks after a myocardial infarction?

Back 14

complete contracted scar

Front 15

What ECG changes can you expect to see during a myocardial infarction?

Back 15

ST elevation (transmural infarct), ST depression (subendocardial infarct), pathological Q waves (transmural infarct)

Front 16

List the profiles of cardiac troponin 1, CK-MB, and AST during myocardial infarction

Back 16

Cardiac troponin 1: elevated after 4 hours, remains elevated for 7-10 days; CK-MB: peaks at 1 day; AST: peaks at 1.5 days

Front 17

List the complications of myocardial infarction

Back 17

cardiac arrhythmia, LV failure and pulmonary edema, cardiogenic shock, ventricular free wall rupture, aneurysm, fibrinous pericarditis, Dressler's syndrome

Front 18

What are the causes of congestive cardiomyopathy?

Back 18

Alcohol abuse, Beriberi, Coxsackie B virus myocarditis, Chronic coccaine use, Chagas' disease, Doxorubicin toxicity, peripartum cardiomyopathy

Front 19

What does congestive cardiomyopathy cause?

Back 19

Systolic dysfunction and heart dilation

Front 20

What are the causes of hypertrophic cardiomyopathy?

Back 20

50% familial autosomal dominant

Front 21

Disease: loud S4, apical impulses, systolic murmur

Back 21

Hypertrophic cardiomyopathy

Front 22

What does hypertrophic cardiomyopathy cause?

Back 22

Sudden death in young athletes, diastolic dysfunction

Front 23

Tx: hypertrophic cardiomyopathy?

Back 23

beta-blocker or non-dihydropyridine calcium channel blocker (verapramil)

Front 24

What are the causes of restrictive/obliterative cardiomyopathy

Back 24

sarcoidosis, amyloidosis, Loffler's syndrome, hemochromatosis

Front 25

What does restrictive/obliterative cardiomyopathy cause?

Back 25

diastolic dysfunciton

Front 26

What are the complications of congestive heart failure?

Back 26

Dyspnea on exertion, cardiac dilation, pulmonary edema, paroxysmal nocturnal dyspnea, orthopnea, hepatomegaly, ankle/sacral edema, jugular venous destension; make sure you know the mechanisms

Front 27

What are the possible types of embolism?

Back 27

FAT BAT: Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor

Front 28

What is Virchow's triad?

Back 28

Predisposition to deep venous thrombosis: Stasis, Hypercoagulability, Endothelial damage

Front 29

Disease: fever, Roth's spots, Osler's nodes, murmur, Janeway lesions, splinter hemorrhages, emboli

Back 29

Bacterial endocarditis

Front 30

What causes acute endocarditis? Subacute endocarditis? Nonbacterial?

Back 30

Acute: Staphylococcus aureus - attacks normal valves; Subacute: Viridans streptococcus - attacks congenitally abnormal or damaged valves; Non-bacterial: malignancy or hypercoagulable state

Front 31

What are the complications of bacterial endocarditis?

Back 31

Chordae rupture, glomerulonephritis, suppurative pericarditis, emboli

Front 32

What are the most frequency affected valves in bacterial endocarditis?

Back 32

Mitral valve; IV drug use = Tricuspid

Front 33

Disease: mitral regurgitation, or less commonly, mitral stenosis, verrucous vegetations

Back 33

Libman-Sacks endocarditis, caused by systemic lupus erythematous

Front 34

Disease: fever, erythema marginatum, valvular damage, ESR, polyarthritis, subcutaneous nodules, St. vitus' dance (chorea)

Back 34

Rheumatic heart disease

Front 35

Disease: granuloma with giant cells; activated histiocytes; elevated ASO titres

Back 35

Rheumatic heart disease; Aschoff bodies, Anitschkow's cells

Front 36

What is the cause of rheumatic heart disease?

Back 36

beta-hemolytic streptococci --> antibody mediated type 2 hypersensitivity

Front 37

Which heart valves are most commonly affected?

Back 37

high-pressure valves: Mitral > Aortic >> Tricuspid

Front 38

Disease: hypotension, JVD, distant heart sounds, increased HR, pulsus paradoxus, electrical alternans on ECG

Back 38

Cardiac tamponade

Front 39

What can pulsus parodoxus indicate?

Back 39

severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup

Front 40

What are the effects of cardiac tamponade?

Back 40

decreased CO, equilibration of diastolic pressure in all 4 chambers

Front 41

Disease: pericardial pain, friction rub, pulsus paradoxus, distand heart sounds, diffuse ST-segment elevation

Back 41

Pericarditis

Front 42

What are the causes and types of pericarditis?

Back 42

Serous: SLE, rheumatoid arthritis, viral infection, uremia; Fibrinous: uremia, MI (Dressler's syndrome), rheumatic fever; Hemorrhagic: TB, malignancy (eg: melanoma)

Front 43

What can result from pericarditis?

Back 43

Resolution without scarring or chronic adhesive pericarditis or chronic constrictive pericarditis

Front 44

What is the mechanism and result of syphilitic heart disease?

Back 44

Tertiary syphilis disrupts the vasa vasorum or the aorta causing dilation or the aorta and valve ring; may find calcifications --> tree bark appearance; can result in aneurysm of the ascending aorta or aortic arch, and aortic valve incompetence

Front 45

What is Kussmaul's sign and what can it indicate?

Back 45

Elevation of JVP on inspiration; cardiac tumor

Front 46

What are the most common heart tumors?

Back 46

Metastases = most common (melanoma, lymphoma); myxomas = adults, LA is the most common location; rhabdomyomas = children (associated with tuberous sclerosis)