Pathoma - Endocarditis, Cardiomyopathies And Cardiac Tumors - Fundamentals Of Pathology

Front 1

What is endocarditis?

Back 1

Inflammation of endocardium, predominantly of the lining of the cardiac valves.

Front 2

Endocarditis is usually due to __________________.

Back 2

bacterial infection

Front 3

Most common overall cause of endocarditis?

Back 3

Streptococcus viridans

Front 4

The virulence of S. viridans is _________ (high/low).

Back 4

low, therefore it can only infect previously damaged valves

Front 5

S. viridans infects ______________ (intact/previously damaged) valves.

Back 5

previously damaged (low-virulence)

Front 6

What is the result of a S. viridans infection of the valves, what happens to the valve?

Back 6

Small vegetations that do not destroy valve (low virulence)

Front 7

Infection with S. viridans of previously damaged cardiac valves is also called ___________________.

Back 7

subacute endocarditis

Front 8

Pathogenesis of endocarditis?

Back 8

(1) Damaged endocardial surface (exposes tissue factor and collagen) develops thrombotic vegetations (PLTs and fibrin)
(2) Transient bacteremia leads to trapping of bacteria in vegetations.

Front 9

A person is undergoing a dental procedure. Why is this sometimes important when talking about IE?

Back 9

Can force bacteria into blood (transient bacteremia) that can be trapped in the thrombotic vegetations created by the previously damaged heart valve.

Front 10

What is the MCC of IE in IV-drug users?

Back 10

S. aureus

Front 11

The virulence of S. aureus is _________ (high/low) and it infects ____________ (healthy/previously dmged valves).

Back 11

high; healthy

Front 12

An heroin addict has endocarditis. What valve is usually involved?

Back 12

Tricuspid (they travel by veins)

Front 13

What is the result of S. aureus infective endocarditis?

Back 13

Results in large vegetations that destroy the valve (acute endocarditis)

Front 14

What organism causes endocarditis of prostatic valves?

Back 14

S. epidermidis

Front 15

A patient with colorectal cancer is known to have infectious endocarditis. What organism is most likely involved?

Back 15

S. bovis

Front 16

A patient presents with infectious endocarditis. The organism is S. bovis, what should you check for?

Back 16

Colorectal carcinoma

Front 17

An endocarditis blood culture comes back negative. What organisms could you suspect?

Back 17

HACEK organisms

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Front 18

Clinical features of infective endocarditis?

Back 18

(1) Fever
(2) Murmur (vegetations disrupt flow)
- Can get septic embolization of vegetations
(3) Janeway lesions (consequence of septic embolization)
- Erythematous non-tender lesions on palms & soles
(4) Osler nodes (painful lesions on fingers and toes)
- Due to septic emboli
(5) Splinter hemorrhages of the nail bed
- Due to septic emboli

Front 19

Which one is a painful lesion, Janeway lesions or Osler nodes?

Back 19

Osler nodes ("Ouch Ouch Osler")

Front 20

Infectious endocarditis is associated with what hematologic disease?

Back 20

Anemia of chronic disease

Front 21

Laboratory findings in infectious endocarditis?

Back 21

(1) Generally positive blood culture
(2) Anemia of chronic disease (high ferritin, TIBC low)

Front 22

What can be done to detect lesions on valves?

Back 22

Transesophageal echocardiography (TEE)

Front 23

What is nonbacterial thrombotic endocarditis?

Back 23

Sterile vegetations that arise with hypercoagulable state or underlying adenocarcinoma. Vegetations arise on mitral valve along lines of closure and results in regurgitation.

Front 24

This endocarditis is seen in systemic lupus erythematosus. Describe it.

Back 24

Libman-Sacks endocarditis.

(1) Sterile vegetations associated with SLE
(2) Vegetations present on surface and undersurface (both sides) of mitral valve
(3) Result in mitral regurgitation.

Front 25

Libman-Sacks endocarditis is highly characteristic of having ______________.

Back 25

Sterile vegetations on both sides of leaflets

Front 26

What is a cardiomyopathy?

Back 26

Myocardial diseases that lead to cardiac dysfunction

Front 27

What is the MC form of cardiomyopathy?

Back 27

Dilated cardiomyopathy

Front 28

What parts of the heart are dilated in dilated cardiomyopathy?

Back 28

All four chambers

Front 29

What is the physiologic problem in dilated cardiomyopathy?

Back 29

It's gonna result in a systolic dysfunction leading to biventricular CHF.

Front 30

Complications of dilated cardiomyopathy?

Back 30

(1) Mitral & tricuspid regurgitation
(2) Arrhythmia

Both are due to stretching.

Front 31

Most commonly the cause of dilated cardiomyopathy is __________.

Back 31

idiopathic

Front 32

What causes are there of dilated cardiomyopathy?

Back 32

(1) Idiopathic
(2) Genetic mutations (AD is MC, cytoskeletal prot. are affected)
(3) Myocarditis (Coxsackievirus B)
(4) Alcohol abuse
(5) Drugs (doxorubicin, daunorubicin)
(6) Pregnancy (late third trimester or within 6 months postpartum)

Front 33

Treatment of dilated cardiomyopathy?

Back 33

Transplant

Front 34

What is hypertrophic cardiomyopathy?

Back 34

Massive hypertrophy of the left ventricle

Front 35

Hypertrophyic cardiomyopathy is due to what?

Back 35

AD genetic mutations in sarcomere proteins (e.g., myosin heavy chain gene)

Front 36

What is the MCC of sudden death in young individuals?

Back 36

Hypertrophic cardiomyopathy

Front 37

How are patients with hypertrophic cardiomyopathy going to present?

Back 37

(1) Decreased cardiac output (heart can't fill)
(2) Sudden death due to ventricular arrhythmias; common cause of sudden death in young athletes
(3) Syncope with exercise

Front 38

Why do we see syncope with exercise in people with hypertrophic cardiomyopathy?

Back 38

Because of the preferential involvement of the interventricular septum close to the aortic valve (relative block, like aortic stenosis).

Front 39

On biopsy of a person with hypertrophic cardiomyopathy you would see what?

Back 39

Myocytes should normally be lined up nicely in parallel. However, on this biopsy they are in a disarray (going in every single direction). This is what we see in this heart disease.

Front 40

What is restrictive cardiomyopathy?

Back 40

Decreased compliance of ventricular endomyocardium. It restricts filling during diastole.

Front 41

Causes of restrictive cardiomyopathy? (7)

Back 41

(1) Amyloidosis
(2) Sarcoidosis
(3) Hemachromatosis
(4) Endocardial fibroelastosis (children)
(5) Loeffler syndrome
(6) After open-heart surgery
(7) Systemic sclerosis

Front 42

What is Loeffler syndrome?

Back 42

There is peripheral eosinophilia with increase in toxic products (esp. MBP) --> Endomyocardial necrosis --> Scarring --> Thrombi covers area and gets organized

Front 43

Endocardial fibroelastosis is seen in the first ______ years of life.

Back 43

2

Front 44

Patients with restrictive cardiomyopathy will present with?

Back 44

CHF (blood backs up)

Front 45

A classic finding in EKG in restrictive cardiomyopathy?

Back 45

Low-voltage EKG with diminished QRS amplitudes.

Front 46

What is a cardiac myxoma?

Back 46

Cardiac tumor. Benign mesenchymal proliferation with a gelatinous appearance.

Front 47

What would a cardiac myxoma show on histology?

Back 47

Abundant ground substance on histology.

Front 48

What is the MC primary cardiac tumor in adults?

Back 48

Cardiac myxoma

Front 49

How and where does a cardiac myxoma grow?

Back 49

Pedunculated mass in the left atrium.

Front 50

Cardiac myxomas can cause what?

Back 50

Syncope due to obstruction of mitral valve.

Front 51

What is a rhabdomyoma?

Back 51

Benign hamartoma of skeletal muscle.

Front 52

What is the most common primary cardiac tumor in children?

Back 52

Rhabdomyoma

Front 53

What heart tumor is associated with tuberous sclerosis?

Back 53

Rhabdomyoma

Front 54

In tuberous sclerosis we see multisystem _____________.

Back 54

hamartomas

Front 55

Tuberous sclerosis is an _______ (AR/AD) disease.

Back 55

AD

Front 56

Rhabdomyomas usually arise in what part of the heart?

Back 56

Ventricle

Front 57

What is more common, metastasis or primary tumors of the heart?

Back 57

Metastasis

Front 58

Common metastasis to the heart include?

Back 58

(1) Breast carcinoma
(2) Lung carcinoma
(3) Melanoma
(4) Lymphoma

Front 59

A melanoma metastasizes to the heart. Where would it typically go?

Back 59

Pericardium. It results in a pericardial effusion.