Pathology Heart Week

Front 1

name the epidemic cardiovascular diseases

Back 1

atherosclerosis
hyperlipoproteinemia
systemic hypertension

Front 2

8 characteristics of atherosclerosis

Back 2

1. inflammatory disease involving formation of lipid plaques in arterial walls and subsequent scarring
2. begins with fatty streak lesions and progresses to raised lesions, and finally results in complicated plaques
3. plaques have a fibrous cap and contain foam cells, lymphocytes, and cholesterol in the middle
4. advanced lesions can involve thrombosis, calcification, ulceration, and structural weakening of the vessel
5. may be caused by endothelial injury, lipid infiltration, infectious agents, or an inflammatory process
6. increased plasma LDL levels increase risk for atherosclerosis
7. disease progression may lead to gradual or sudden occlusion of blood vessels or hemorrhage
8. high-risk groups include older individuals, males, Caucasians, people with diabetes or hypertension, smokers, or people with elevated homocysteine levels

Front 3

4 characteristics of hyperlipoproteinemia

Back 3

1. serum triglycerides and cholesterol are carried by chylomicrons, VLDL, LDL, and HDL
2. apolipoproteins are required for synthesis, secretion, and stabilization of lipoproteins
3. primary hyperlipidemia is a genetic disease, and secondary hyperlipidemia is non-familial
4. defects in the LDL receptor lead to increased production of LDL in familial hypercholesterolemia

Front 4

5 characteristics of systemic hypertension

Back 4

1. most frequently affects blacks and males
2. primary, or essential, hypertension, is idiopathic
3. secondary hypertension may be caused by renal disease, endocrine disease, coarctation of the aorta, or other factors
4. vascular changes include hypertrophy of vascular muscle and intimal proliferation, with an increase in elastic tissue
5. severe hypertension accelerates atherosclerosis and may cause organ damage

Front 5

7 congenital heart diseases

Back 5

atrial septal defect
ventricular septal defect
atrioventricular septal defect
truncus arteriosus
hypoplastic left heart syndrome
transposition of great vessels
tetralogy of fallot

Front 6

atrial septal defect

Back 6

1. defects of the ostium secundum, or fossa ovalis, are most common
2. may also involve defects in the ostium primum, sinus venosus, or coronary sinus
3. left-to-right shunt may cause pulmonary hypertension and eventual reversal of the shunt
4. may also cause paradoxical embolization

Front 7

ventricular septal defect

Back 7

1. defects commonly involve the membranous septum or possibly the muscular septum
2. left-to-right shunt increased pulmonary pressure
3. Eisenmenger’s complex involves arterial oxygen unsaturation due to blood flow in both directions through the defect
4. results in a loud holosystolic murmur at the fourth interspace

Front 8

Atrioventricular Septal Defect

Back 8

1. defect involves a common opening between mitral and tricuspid orifices with one complex valve
2. causes a left-to-right shunt with regurgitation and volume overload
3. often leads to early death by heart failure or pneumonia

Front 9

4 characteristics of truncus arteriosus

Back 9

1. one great vessel leaves the heart through a semilunar valve
2. classified into one of several types, depending where the pulmonary arteries arise
3. involves an obligatory ventricular septal defect
4. entails a poor prognosis due to cyanosis or volume overload

Front 10

4 characteristics of hypoplastic left heart syndrome

Back 10

1. most severe form involves aortic valve atresia with mitral valve defects, combined with endocardial fibroelastosis in the left ventricle
2. other forms involve mitral valve atresia, mitral valve stenosis, hypoplasia of the aortic arch, or atresia of the aortic arch
3. manifested by cyanosis and inadequate systemic output
4. cardiac transplantation is the only reliable treatment

Front 11

3 characteristics of transposition of the great vessels

Back 11

1. must include a pulmonary-systemic communication via a patent ductus arteriosus or septal defect
2. clinical features include cyanosis, cardiac failure, and respiratory failure
3. may be corrected by an atrial switch or arterial switch operation

Front 12

3 characteristics of tetralogy of fallot

Back 12

1. components are a ventricular septal defect, right ventricular outflow obstruction, right ventricular hypertrophy, and a dextro-positioned aorta
2. leads to cyanosis and a poor prognosis if uncorrected
3. may be corrected by a Blalock-Taussig shunt or other procedures

Front 13

4 ischemic heart diseases

Back 13

angina pectoris
myocardial infarction
sudden cardiac death
chronic ischemic heart disease

Front 14

3 angina pectoris characteristics

Back 14

1. involves chest pain due to ischemia without infarction
2. often occurs in association with increased oxygen demand
3. classified as stable angina, Prinzmetal’s (variant) angina, or unstable or crescendo angina

Front 15

8 characteristics of myocardial infarction

Back 15

1. transmural infarctions are commonly caused by occlusion of a narrowed artery, leading to necrosis extending across the wall of the ventricle
2. subendocardial infarctions are due to severe coronary artery disease, preventing perfusion of the less vascular areas, causing a circumferential infarct
3. presents with severe, radiating chest pain, sweating, nausea, and shortness of breath
4. diagnosed by electrographic changes and enzymatic abnormalities
5. no changes visible at first, pallor and cyanosis become visible at 18-24 hours, infarct becomes yellow with a hyperemic border in the first week, and granulation tissue with collagen leads to scar formation in the following weeks and months
6. microscopic examination shows coagulative necrosis and neutrophil infiltration between days 1 and 3, dissolution of necrotic fibers is seen between days 3 and 7, granulation tissue is seen developing in the periphery between days 7 and 10, collagenization is seen by 2 weeks and finishes in 7 weeks
7. early complications include arrhythmias, pump failure, or infarct extension
8. later complications include rupture, mural thrombus, fibrinous pericarditis, or ventricular aneurysm

Front 16

3 characteristics of Sudden Cardiac Death

Back 16

1. unexpected death by cardiac causes within one hour of symptom onset
2. typically involves a lethal arrhythmia
3. may result from a conducting system anomaly, myocarditis, valvular disease, or most commonly ischemia

Front 17

3 characteristics of chronic ischemic heart disease

Back 17

1. condition of progressive congestive failure due to ischemic damage
2. involves severe coronary artery disease with patchy areas of fibrosis, healed infarction, and dilation of the ventricles
3. microscopic examination shows diffuse interstitial fibrosis and some areas of dense scarring, other areas of atrophy

Front 18

6 valvular heart diseases

Back 18

mitral stenosis
mitral regurgitation
aortic stenosis
aortic regurgitation
tricuspid stenosis
tricuspid regurgitation

Front 19

4 mitral stenosis characteristics

Back 19

1. generally results from rheumatic heart disease
2. presents with symptoms of left heart failure
3. antibodies to group A Streptococcus antigens cross-react with antigens present in the heart
4. may lead to inflammation, vegetation, and scarring on the valve

Front 20

3 mitral regurgitation characteristics

Back 20

1. may be caused by mitral valve prolapse as leaflets become floppy
2. frequently remains asymptomatic, may cause chest pain or heart failure
3. ischemia may cause necrosis and rupture of papillary muscles

Front 21

5 aortic stenosis characteristics

Back 21

1. may result from congenital or acquired bicuspid aortic value
2. also caused by idiopathic senile calcification of the value
3. leads to hypertrophy of the left ventricle
4. treated by valve replacement or commisurotomy
5. common symptoms are angina, syncope, and congestive heart failure

Front 22

2 aortic regurgitation characteristics

Back 22

1. caused by diseases of the aortic leaflets or aortic root
2. may result from endocarditis, vascular disease, or syphilis

Front 23

3 characteristics of tricuspid stenosis

Back 23

1. complication of carcinoid metastasis to the liver
2. may be caused by endothelial damage induced by serotonin
3. leads to endocardial fibrosis of valve cusps

Front 24

characteristic of tricuspid regurgitation

Back 24

1. rare disorder caused by endomyocardial fibrosis with eosinophilia

Front 25

4 endocarditis diseases

Back 25

acute bacterial endocarditis
subacute bacterial endocarditis
fungal endocarditis
non bacterial thrombic endocarditis

Front 26

4 characteristics of acute bacterial endocarditis

Back 26

1. often occurs in normal hearts or after cardiac surgery
2. drug addiction and chronic alcoholism are predisposing factors
3. commonly results from S. aureus or beta hemolytic Streptococci
4. sometimes involves right-sided valves, most frequently in IV drug abusers

Front 27

4 subacute bacterial endocarditis

Back 27

1. usually occurs in the context of underlying heart disease
2. frequently involves Streptococcus viridans
3. characterized by insidious onset
4. almost always involves the left-sided valves

Front 28

3 characteristics of fungal endocarditis

Back 28

1. organisms involved include Candida or Aspergillus
2. blood cultures are positive less frequently than in bacterial endocarditis
3. typically seen with prosthetic valves, IV drug abusers, or immunocompromised hosts

Front 29

3 characteristics of non-Bacterial Thrombotic Endocarditis

Back 29

1. can result from endothelial damage, resulting in masses of fibrin and platelets on valves
2. predisposing factors are hypercoagulability and trauma
3. may allow for attachment of organisms and infection

Front 30

4 myocarditis diseases

Back 30

lymphocytic myocarditis
giant cell myocarditis
hypersensitivity myocarditis
hypereosinophilic myocarditis

Front 31

5 lymphocytic myocarditis diseases

Back 31

1. inflammatory process resulting in chronic inflammation and necrosis of myocytes
2. possibly caused by enteroviral infection, or likely Chagas’ disease
3. pathogenesis involves viral cytotoxicity with immune-mediated damage
4. heart can become enlarged, soft, discolored, and dilated
5. generally asymptomatic, but may present with acute heart failure and arrhythmias

Front 32

4 characteristics of giant cell myocarditis

Back 32

1. rare disorder of young to middle-aged adults
2. generally becomes rapidly fatal
3. presents with congestive heart failure, arrhythmia, and heart block
4. myocyte necrosis is seen with lymphocytes and histiocytic giant cells

Front 33

2 characteristics of hypersensitivity myocarditis

Back 33

1. associated with hypersensitivity to a number of drugs
2. involves interstitial inflammation without myocyte necrosis

Front 34

3 characteristics hypereosinophilic myocarditis

Back 34

1. involves persistent systemic eosinophilia
2. shows eosinophil infiltration of the endocardium and myocardium
3. extensive myocyte necrosis occurs, and mural thrombus may result

Front 35

2 types congestive heart failure

Back 35

left or right ventricular

Front 36

3 characteristics left ventricular heart failure

Back 36

1. caused by systemic hypertension, coronary artery disease, valvular heart disease, congenital defects, or cardiomyopathy
2. involves dilation of left atrium, pulmonary blood volume increase, pulmonary edema, and transfer of volume back to the right ventricle
3. commonly results in left ventricular hypertrophy, pulmonary edema, and decreased renal blood flow

Front 37

2 characteristics right ventricular heart failure

Back 37

1. most commonly caused by left heart failure or by cor pulmonale
2. manifested by edema, liver congestion, and right ventricular hypertrophy

Front 38

3 types cardiomyopathy

Back 38

dilated
hypertrophic
restrictive

Front 39

5 characteristics dilated cardiomyopathy

Back 39

1. characterized by dilation of the chambers, particularly the ventricles
2. can lead to reduced muscle contractility and some hypertrophy
3. progressively leads to congestive heart failure and possibly arrhythmias
4. associated with myocarditis, alcohol, diabetes, thiamine deficiency, and heavy metal toxicity
5. may be familial due to mutated dystrophin

Front 40

hypertrophic cardiomyopathy

Back 40

1. characterized by enlarged myofibers in disarray with boxcar nuclei
2. often occurs in young adults and causes sudden death in healthy victims
3. hypertrophied interventricular septum can occlude aortic outflow
4. leads to elevated diastolic pressure and diastolic dysfunction
5. may be treated with calcium channel blockers

Front 41

4 characteristics restrictive cardiomyopathy

Back 41

1. characterized by rigid ventricular walls and decreased diastolic filling
2. primary disease is caused by endomyocardial fibrosis or Loffler’s endocarditis parietalis fibroplastica
3. also caused by amyloidosis, idiopathic myocardial fibrosis, or ischemia
4. manifestations include dyspnea, increased pulmonary venous pressure, hepatomegaly, left heart failure, and pulmonary congestion

Front 42

6 types cardiac tumors

Back 42

myoma
fibroma
rhabdomyoma
papillary fibroelastoma
sarcoma
metastatic tumors

Front 43

4 characteristics myoma

Back 43

1. benign proliferation of primitive cells
2. variegated tumor attached by a stalk or pedicle
3. most commonly occurs in the left atrium
4. may cause constitutional symptoms and embolization

Front 44

2 characteristics fibroma

Back 44

1. most common pediatric cardiac tumor
2. can lead to heart failure, arrhythmias, chest pain, and sudden death

Front 45

3 characteristics rhabdomyoma

Back 45

1. hamartoma composed of altered cardiac myocytes
2. high association with tuberous sclerosis
3. may regress spontaneously

Front 46

4 characteristics papillary fibroelastoma

Back 46

1. benign tumor composed of avascular papillary excresences
2. characterized by fronds lined with endothelial cells
3. generally occurs in adults
4. frequently remains asymptomatic

Front 47

3 characteristics sarcoma

Back 47

1. all types of sarcomas may occur in the heart
2. often located in the left atrium
3. may present with dyspnea secondary to left ventricular inflow obstruction

Front 48

3 characteristics metastatic tumors of the heart

Back 48

1. lung carcinoma, lymphoma, breast carcinoma, leukemia, and melanoma may all involve the heart
2. symptoms are largely dependent upon the tumor location
3. may cause pericardial effusions with pericardial involvement, arrythmias, congestive heart failure, or syncope

Front 49

4 types cardiavascular interventions

Back 49

coronary artery bypass grafting
percutaneous coronary angioplasty
coronary artery stenting

Front 50

4 characteristics coronary artery bypass grafting

Back 50

1. segments from the saphenous vein or the internal mammary artery may be used
2. restenosis of the graft may occur due to damage during surgery, poor runoff, or twisting
3. fibrointimal proliferation or atherosclerosis may occur in the graft
4. grafts from the internal mammary artery usually remain patent for a long time

Front 51

2 characteristics coronary angioplasty

Back 51

1. catheters with balloons are passed into the coronary artery, and the balloon is inflated to dilate the arterial lumen
2. restenosis may occur acutely or over a longer period of time

Front 52

3 characteristics coronary artery stenting

Back 52

1. addresses the problem of restenosis following angioplasty
2. scaffolding holds the arterial wall open
3. inflammation and neointimal proliferation occur in reaction to the stent

Front 53

4 characteristics cardiac transplantation

Back 53

1. accepted treatment for treating end-stage heart disease
2. early pathology involves immediate failure, hyperacute rejection, or reperfusion injury
3. acute rejection typically occurs by cellular mechanisms
4. diffuse graft vasculopathy may be a long-term complicatio