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38 Cards in this Set

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What is rheumatic heart disease?
it's secondary rheumatic fever which is acute, recurrent inflamm. disease that develops 1-5 weeks after group A strep infection.

need 2 major jones or 1 major and 2 minors plus evidence of strep.
the major criteria
-erhythema marginatum
-sydenham chorea
-carditis
-subcutaneous nodules
-migratory large joint polyarthritis
the minor criteria
-fever
-arthralgia

-upper acute phase reactants
-c reactive
-cerulaplasmin
-alpha 1 antitrypsin
-C 3 complement
-prolonged PR interval
When do you most likely have chronic RHD?
most likely when 1st attack is early in childhood

1st bout of rheumatic fever is severe

you have recurrent attacks
Physical changes are...
secondary to mitral stenosis. this includes LAH and enlargement, chronic congestive changes in lungs, RVH, and CHF
what do you see in chronic RHD
fibrous thickening of leaflets

bridging fibrosis across commissures

thickened, fused and shortened mitral valve chordae
Name the three types of acute pericarditis
1. Serous
2. Fibrinous & Serofibrinous
3. Purulent
serous pericarditis
slowly accumulating fluid secondary to nonbacterial involvements. not sure how it starts.
Fibrinous & Serofibrinous
MOST COMMON

seen with MI and produces the friction rub. usually completely resolves without problem
Purulent
secondary to bacterial, fungal, parasitic infectoin which has reached the pericardium by direct extension
most common causative agents of purulent pericarditis?
gram + stap, strep and pneumococci
describe hemorrhagic pericarditis
most often follows cardiac surgery or ass'd with TB or malignancy.

has fibrin and hemorrhage.
describe caseous pericarditis
secondary to TB and usually direct extension from lymph nodes. leads to fibrocalcific constrictive pericarditis
Chronic pericarditis.
may heal without problem at all. maybe just some plaque.
Describe Adhesive Mediastinopericarditis
the pericardial sac is obliterated and the parietal surface is tethered to mediastinal tissue. Results in hypertrophy and dilation.
Whats the most common cause of constrictive (chronic) pericarditis?
TB is the most common cause. this is because of the thick, dense fibrous obliteration of the pericardial sac- often calcification- limits diastolic expansion and restricts output.
Hemangioma is
a benign lesion most commonly seen in kids. in skin or mucous membrane, goes away as kid grows (the 1-2 mm ones). they also may be on the viscera.
Which are the bigger hemangiomas?
cavernous- 1-2cm. common in the liver, CNS and other viscera.
Von Hippel-Lindau disease is
a cavernous h. of the cerebellum, brainstem, or eye grounds assd with cystic lesions in the pancreas, liver, kidney
Pyogenic granuloma is
ulcerated polypoid variant of capillary h. often secondary to trauma.
Glomus Tumor is
a benign tumor. Smooth muscle cell tumor from the glomus body. found in the distal fingers, beneath nailbeds. very small.
Vascular Ectasia is
abnormally prominent capillaries, venules and arterioles in skin or mucous membranes
Nevus Flammeus
birth mark. port wine stain on face/neck.
Spider Telangiectasis
subq arterioles like a web. often above waist and from hyper estrogenic states in pregenancy and cirrhosis.
Bacillary Angiomatosis is
potentially fatal infectious disease secondary to ricketts bacteria. people with immunocomprises like AIDS.
Simple Lymphangioma is
not a big issue. just lymph pushing out of a lesion
Cystic Hygroma
often large in kids. on neck or axilla. need to remove them, but some come back. poor margins and hard to deal with.
What is hemangioendothelioma?
it's an intermediate grade tumor, most often cured by excision. some recur. looks like metastatic carcinoma, melanoma, sarcoma.
4 types of Kaposi Sarcoma (intermediate)
1. chronic/classic/europe- purple plaque
2. lyphadenopathic/african- lymph nodes
3. transplant- immunocompromised b/c of docs
4. AIDS-associated
Name a malignant tumor
1. angiosarcoma
2. hemangiopericytoma
Describe angiosarcomas
hemangio- or lymphangio-

most aggressive of vascular tumors, often fatal.

seen in older folks that worked with pesticides. sites are skin, soft tissue, breast, and spleen.

may arise in areas of lymphedema.
Hemangiopericytoma
is rare. metastasize quickly and goes to lung, bone and liver.
Are tumors of the heart rare?
yeah.

metastatic lesions are more frequent.
What is the most common primary tumor of the heart in adults?
Myxomas. most often in the fossa ovale of the atria. this damages the valve in a wrecking ball manner from the peripheral embolization fragments. the biggest problem is the obstruction of the valve.
Lipomas
circumscribed by poorly encapsulated
papillary fibroelastomas
may emboli.
the most common primary heart tumor in kids is
rhabdomyomas. they infiltrate the ventricle.
most common malignant
angiosarcoma