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23 Cards in this Set
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Characterized by deposition of small masses of fibrin, platelets, and other blood components on cardiac valve leaflets No microorganisms Associated with malignancies and cachexia -Hypercoagulable states -Particularly mucinous adenocarcinomas of the ... Associated with endocardial ... -Swan-Ganz pulmonary artery catheter Associated with other debilitating conditions -Extensive burns, sepsis |
NON-BACTERIAL, THROMBOTIC (MARANTIC) ENDOCARDITIS
pancreas trauma |
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*Libman-Sacks Endocarditis*
Associated with ... -Only 4-5% of patients with ... get Libman-Sacks Endocarditis ... vegetations – non infections Primarily affects ... and ... valves Can result in serious valve deformity requiring surgery Gross: single or multiple 1-4 mm granular pink vegetations on either or both sides of the valve leaflets, may extend onto ..., papillary muscles, mural endocardium Histology: intense ..., fibrinoid necrosis, and subsequent fibrosis |
systemic lupus erythematosus (SLE)
SLE Sterile Mitral and Tricuspid chordae tendineae inflammation |
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look at slide 29 in lecture 42
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ok
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*... *
Most common valvular abnormality Most are due to age related degenerative calcification 6-7th decades (70 yrs old) for ...; 40-60 yrs old for calcified congenital ... aortic valve (1% of population) Symptoms: ischemic chest pain, fatigue, fainting, sudden death, shortness of breath, syncope |
Degenerative Calcific Aortic Valve Stenosis
tricuspid bicuspid |
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*Mitral Valve Prolapse (MVP)*
General Information -Most common cause of isolated mitral ... -Occurs in ~3-5% of adult population -Affects women ... men -Known pathologically as “... degeneration of the mitral valve” -Most cases are sporadic and the cause is unknown -Associated with ... syndrome and ... syndrome and a minority of MVP patients will have one of these syndromes -Mitral valve is “floppy” or incompetent |
regurgitation
> Myxomatous Marfan Ehler-Danlos |
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*Mitral Valve Prolapse*
Clinical -Most patients are ... -Minority have chest pain fatigue, dyspnea, psychiatric problems (depression, anxiety) -Midsystolic ... -Mid to late systolic ... -Confirmed on ... *Parasternal view with >=2 mm systolic displacement of the mitral valve leaflets (of one or both) into the left atrium superior to the mitral annulus |
asymptomatic
click murmur echocardiogram |
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*Morphology of ...*
Pancarditis (endocardium, myocardium, pericardium) Small, warty vegetations along the lines of closure of the valve leaflets. May affect all 4 valves -(... >... >TV>PV) Inflammation of valves leads to deformity - is self-perpetuating and leads to chronic valve deformity ...: distinctive inflammatory lesion seen in rheumatic fever -Focal fibrinoid necrosis of collagen alongside blood vessels surrounded by macrophages, lymphocytes (T cells), & plasma cells -See plump cardiac histiocytes (... cells) which are pathognomonic for RF (AKA ... cells) |
Rheumatic Carditis
MV AV Aschoff body Anitschkow caterpillar |
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look at slide 11 of lecture 43
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*... *
Organization of acute inflammation and fibrosis -Valve leaflet thickening -Commisural fusion -Shortening, thickening, fusion of the chordae tendineae -Aschoff bodies replaced by fibrous scar -Fibrous bridging and calcification leading to “fish mouth” or “button hole” stenoses By far the most frequent case of ... May result in CHF May require balloon valvotomy or valve replacement |
Chronic Rheumatic Heart Disease
mitral stenosis |
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*... *
Most common form of cardiomyopathy Progressive cardiac dilation and contractile dysfunction -All 4 chambers -Usually develop accompanying ... -Progressive CHF Etiology -... (most common) -Alcohol toxicity -Postpartum -Familial (genetic form) -Drug (adriamycin, cocaine) -Post Viral myocarditis -Parasitic infections (Chagas disease) |
Dilated Cardiomyopathy
hypertrophy Idiopathic |
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*Dilated Cardiomyopathy*
Presentation -Ages 20-50 -Progressive signs and symptoms of CHF Complications -Mural ... -Cardiac ... Poor prognosis – 5 yr. survival of ~25% Treatment – ... |
thrombi
arrhythmias Heart Transplant |
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*...*
Results in diastolic dysfunction Common cause of sudden death in young athletes Impetus for echocardiogram screening -http://www.stopsuddendeath.net/ |
Hypertrophic Cardiomyopathy (HCM)
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*Hypertrophic Cardiomyopathy (HCM)*
Gross -Massive myocardial hypertrophy without chamber ... -Classically is asymmetric with hypertrophy most prominent in the ..., particularly in the subaortic region of the septum -Ventricular outflow tract is often obstructed by the septal hypertrophy Histology -Extensive myocyte hypertrophy -Haphazard disarray of both individual and bundles of myocytes -Interstitial ... |
dilation
ventricular septum fibrosis |
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A 16 year old boy who has had no health problems begins having intermittent episodes of chest pain. He abruptly falls down during a basketball game and is pronounced dead at the scene. The autopsy examination of his heart will most likely reveal
1. Haphazard and hypertrophied septal myocytes 2. Extensive amyloid deposition 3. Extensive iron deposition 4. Mitral stenosis 5. Infective endocarditis |
1. Haphazard and hypertrophied septal myocytes
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A 32 year old medical student has recently noted abdominal enlargement. He regularly visits the UNC and Loose Caboose to partake in therapeutic alcohol consumption after reading articles describing the beneficial effects of alcohol on HDL levels. A chest X-ray shows cardiomegaly. A CT scan indicates that he has a cirrhotic liver. He is afebrile and normotensive. Which of the following conditions is he most likely to have?
1. Non-bacterial thrombotic endocarditis 2. Infective endocarditis 3. Hypertrophic cardiomyopathy 4. Dilated cardiomyopathy 5. Restrictive cardiomyopathy |
4. Dilated cardiomyopathy
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Patrick Swayze has been undergoing treatment for pancreatic cancer. Assuming he has no history of previous cardiovascular disease or chronic health problems, which of the following cardiac problems is he most likely to develop?
1. Non-bacterial thrombotic endocarditis 2. Libman-Sacks endocarditis 3. Hypertrophic cardiomyopathy 4. Dilated cardiomyopathy 5. Restrictive cardiomyopathy |
1. Non-bacterial thrombotic endocarditis
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A previously 32 year old anesthesiology resident has developed a problem with intravenous drug use. She suddenly develops fever , chills, weakness, and a new heart murmur. Echocardiogram shows large vegetations on her native tricuspid valve. Blood cultures will most likely confirm infection with?
1. Trypansoma cruzi 2. Staphylococcus aureus 3. Streptococcus viridans 4. Cardiobacterium 5. Borrelia burgdorferi |
2. Staphylococcus aureus
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A 14 year old boy has a history of acute rheumatic fever. Which of the following valves is most likely to develop abnormalities:
1. Mitral 2. Aortic 3. Tricuspid 4. Pulmonic 5. ileocecal |
1. Mitral
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A 77-year-old man who has been previously healthy has started having syncopal episodes. He is afebrile and has no rash or skin lesions. A X-ray appears to show left ventricular enlargement with the other chambers appearing normal in size and there is some bilateral pulmonary edema. Which of the following is the most likely diagnosis?
1. Calcific aortic stenosis 2. Mitral stenosis 3. Rheumatic fever 4. Restrictive cardiomyopathy 5. Endocarditis |
1. Calcific aortic stenosis
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A 27-year old man with no significant past medical history presents to the ER with fever, chills, and pleuritic chest pain for the past 2 days. His temperature is 39oC. On exam he has pinpoint lesions between his toes and a new systolic heart murmur that is best heard at the lower left sternal border. He has multiple scars on his inner thighs and upper arms. A chest X-ray shows patchy infiltrates. What is the most likely cause of his condition?
1. Aortic valve prosthesis 2. Calcific aortic stenosis 3. Injection drug use 4. Rheumatic valvular disease 5. Ventricular septal defect |
3. Injection drug use
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A 44 year old woman is found dead at home. An autopsy reveals an enlarged left atrium with mural thrombus and deformities of her mitral valve. The most likely etiology of her death is?
1. Lupus 2. Dilated cardiomyopathy 3. Non-bacterial thrombotic endocarditis 4. Rheumatic fever 5. Hemochromatosis |
4. Rheumatic fever
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A 39 year old woman is found to have small and medium sized vegetations on both sides of her mitral valve leaflets. This pattern is most typically seen with
1. Rheumatic Heart Disease 2. Libman-Sacks Endocarditis 3. Infective Endocarditis 4. Non-bacterial Thrombotic Endocarditis 5. Mitral valve prolapse |
2. Libman-Sacks Endocarditis
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An 18 year old UT football man is noted to have mitral valve prolapse on a screening echocardiogram. Most patients with this condition will require mitral valve replacement?
1. True 2. False |
2. False
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