Path: Heart

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1

what are the heart diseases broken up into

ischemic heart disease and everything else

2

what are the parts of the "everything else" of heart disease

congenital
hypertensive
valvular
cardiomyopathy
pericardium
tumors

3

what type of congenital heart defects are common

L to R shunt, R to L shunt, obstructive

4

what are the two types of heart pathologies

heart failure and heart disease

5

what are some ischemic issues possible with the heart

angina
infarction
chronic ischmia
sudden death

6

what are the varieties of hypertensive problems with the heart

left sided and right sided

7

what are the valvular issues associated with the yeart

AS
MVP
rheumatic
infective
non infective
carcinoid
artificial valves

8

what are the cardiomyopatheis

dilated
hypertrophic
restrictive
myocarditis

9

what are some issues that can happen in the pericardium

effusions
pericarditis

10

what are some tumors of the heart

primary and effects of other primaries

11

how much blood does the heart pump

6000 L/day

12

how much does the heart weigh

250-300 grams

13

what percentage of death is from heart disease

40%

14

what is wall thickness of the heart proportional to

pressure in the heart

15

how thick is the LV wall

1.5 cm

16

how thick is the RV wall

0.5 cm

17

how thick is the atrial wall

0.2 cm

18

what is starling's law in a nutshell

heart will pump out all blood that it is given

19

what is cardiomegaly

dilation of any chamber

or

hypertophy of anything

20

would there be a weight increase in dilation

nope just expanded

21

what is the action of ANP

vasodilator

22

where is ANP released fromand in response to waht

from atria in response to high BP

23

what does ANP look to do

reduce water sodium and adipose loads on circulatory system thereby reducing blood pressure

24

what is the contraction of a cardiac muscle like

ball

25

what are the slit like areas in cardiac muscle

capillaries

26

what would white background cells look like

fibroblasts

27

where are the intercalated disks

card image
28

what is the path of conduction

SA node to AV node to Bundle of His to Left and Right bundle

29

where do the Purkinje fibers run

subendocardially

30

which coronary artery is said to be dominant

the one that supplies the posterior interventricular septum (usually right sided)

31

a thrombosis of which coronary artery would usually result in sudden death

main left coronary artery

32

what is a good test of coronary artery and myocardial function

myocardial perfusion

33

what are the atrioventricular valves of the heart

tricuspid
mitral

34

what are the semilunar valves of the heart

pulmonic
aortic

35

how big are the tricuspid and mitral valves

tricuspid: 13 cm
mitral: 11 cm

36

how big are the pulomnic and aortic valves

pulmonic: 8 cm
aortic: 6 cm

37

what is a sign of cardiac aging in the chamgers

increased LA cavity size
decreased LV cavity size
sigmoid shaped ventricular septum

38

what is a sign of cardiac aging in epicardial coronary arteries

tortuosity
increased cross sectional luminal area
calcific deposits
atherosclerotic plaque

39

what is a sign of cardiac aging in the valves

aortic valve calcific deposits
fibrous thickening of leaflets
mitral valve annular calcific deposits
bukcling of mitral leaflets toward the LA

40

what is a sign of cardiac aging in the myocardium

increased mass
increased subepicardial fat
brown atrophy
lipofuschin deposition
basophilic degeneration
amyloid deposits

41

what do most people who don't die acutely die from

cardiac failure

42

what happens with the aorta in cardiac agingin

dilated ascending aorta with rightward shift
elongated thoracic aorta
sinotubular junction calcific deposits
elastic fragmentation and collagen accumulation
atherosclerotic plaque

43

what is the pigment that accumulates with age in the heart

lipofuschin (makes heart appear brown)

44

what is the brown atrophy of the heart

lipofuschin on opposite poles of the myocte nucleus

45

what does lipofuschin appear to be the product of

oxidation of unsaturated fatty acids

46

what are the pathologic pump possibilities for the heart

primary myocardial failure (myopathy)
obstruction to flow (valve)
regurgitant flow (valve)
conduction disorders (conduction)
failure to contain blood (wall integrity)

47

what does ANP work to do

reduces water, sodium, and adipose loads on circulatory system reducing the blood pressure

48

what is the "triad" of CHF

tachycardia
dyspnea
edema

49

what is ultimately CHF afailure of

Starling mechanism

50

what are the humoral factors of CHF

catecholamines
renin, angiotensin, aldosterone
ANP

51

what happens to the heart in CHF

hypertrophy and dilation

52

why do people get dyspnea in CHF

due to a backup of blood; must oxygenate more

53

how can the heart undergo hypertrophy

pressure overload (concentric)
volume overload (CHF)

54

what will the heart experience if it is 2x its normal weight

ischemia

55

if it's 3x its normal weight what will the heart experience

HTN

56

what will happen if the heart is over 3x its normal weight

myopathy and aortic regurgitation

57

how can you distinguish cardiomyopathy from LV hypertrophy

when thickening is just limited to LV it is just hypertrophy

58

what are some CHF autopsy findings

cardiomegaly
chamber dilation
hypertrophy of myocardial fibers and boxcar nuclei

59
card image

what is apparent from these nuclei

boxcar nuclei because they are squared off

60

what is the result (overall) of left sided failure

low output vs congestion

61

what happens in the lungs in left sided heart failure

pulmonary congestion and edema

accumulation of heart failure cells

62

what happens in the kidneys with left sided failure

pre-renal azotemia
salt and fluid retention (RAA and ANP activation)

63

what happens in the brain in left sided failure

irritability, decreased attention, stupor, coma

64

what are the main left heart failure symptoms

dyspnea on exertion and rest

orthopnea

paroxysmal nocturnal dyspnea

blood tinged sputum

cyanosis

elevated pulmonary wedge pressure

65

what is orthopnea

redistribution of peripheral edema fluid

66

how is orthopnea graded

by number of pillows needed

67

how does someone get right sided heart failure

left heart failure

cor pulmonale

68

what are the liver and spleen spymptoms and signs of righ sided heart failure

passive congestion (nutmeg liver)
congestive splenomegaly
ascites

69

what are the pleural and paricardial signs of right sided heart failure

pleural and pericardial effusions and transudates

70

where will congestion of liver be in right heart failure

central vein

71

what are the symptoms of right heart failure

fatigue
dependent edema
jugular venous distention
hepatomegaly
ascites, pleural effusion
GI
cyanosis
incrased peripheral venous pressure

72
card image

what is present in the top right

a lot of blood cells with pigment: chronic heart failure

if acute: would have more acual blood

73

where is the classic place to test for pitting edema

foot

74
card image

what is this and what are all the red dots

nutmeg liver

central veins are all the red dots due to vena cava and hepatic veins pressure buildup

75

where do you get necrosis first in the liver

central portion of the lobule (furthest from hepatic artery)

76

can you have cirrhosis secondary to heart failure

yep

77

what are the types of heart diseas

congenital
ischemic
hypertensive
valvular
myopathic

78

what are congenital heart defects due to

faulty embryogenesis

79

are congenital heart defects usually monomorphic or polymorephic

monomorphic (ASD, VSD, hypo RV, hypo LV)

80

when might congenital heart defects not be evident until

adult live

81

what is the overall incidence of congenital heart defecst

1% of US births

82

what happens in the cyanotic heart defects

right to left shunt

83

what happens in the acyanotic heart defecst

left to right shunt

84

besides the shunts what is the main congenital heart diseas

stenosis of aorta or pulmonary artery

85

how many people who have congenital heart diseases have gene abnormalities

10%

86

what are the trisomies in congenital ehart defects

21. 13. 15, 18, XO

87

what does the mtuation of the TBX5 gene lead to

ASD
VSD

88

what does the mutation of the NKX2.5 gene lead to

ASD

89

what region of chromosome 22 is improtant in heart development

22q11.2

(deletion to conotruncus, branchial arch,face)

90

what types of environmental things can cause congenital heart defects

rubella
teratogens

91

so what do L to R shunts all have in their names

Ds

92

what do R to L shunts all have in their names

Ts

93

to L to Rs cause cyanosis

no

94

what do L to R shunts cause

pulonary hypertension

95

what do R to L shunts have

cyanosis
venous embolii becaome systemic

96

what obstructions are common in congenital heart disease

aorta or pulmonary artery

97

what is the msot feared consequence of L to R shunt

irreversible pulmonary hypertension

98

what are the L to R shunts

ASD
VSD
ASVD
PDA

99

is ASD from patent foramen ovale

no

100

are ASDs symptomatic right away

asymptomatic until adulthood

101

what ia ASD From primum secoundum

defective fossa ovalis

102

what % of ASDs are from foramen secundum

90%

103

what % of ASDs are primum

5%

104

what cleft is ASD from primum

next to AV valves, mitral cleft

105

what % of ASDs is sinus venousus

5%

106

where is sinus venosus ASD

next to SVC with anomalous pulmonary veins draining to SVC or RA

107

what is the most common CHD defect

VSD

108

how many VSDs are isolated

30%

109

how many VSDs involve the membranous septum

90%

110

what will happen if a musuclar septum is involved in VSD

multiple holes

111

can small VSDs clsoe spontaneously

yep

112

what do large VSDs progress to

pulmonary hypertension

113

how many patent ductus arteriosuses are isolated

90%

114

what is the murmur of PDA like

harsh, machinery like

115

what is the shunt like in PDA

left to right, right to left as pulmonary hypertension approaches systemic pressure

116

what is interesting about PDAs

closing it or keeping it open may be life-saving

117

what would you give to keep PDA open

prostaglandin E1

118

what is AVSD associated with

defective, inadequate AV valves

119

what would a complete AVSD be like

all 4 chamberstotal freely communicate

120

what are the right to left shunts

tetralogy of fallot
transposition of great arteries
truncus arteriosus
total anomalous pulmonary venous connection
tricuspid atresia

121

waht is the most common right to left shunt

tetralogy for fallot

122

what happens in tetralogy of fallot

large VSD
obstruction to RV flow
aorta overrides VSD
RVH

123

what does survival depend on in tetralogy of fallot

severity of subpulmonic stenosis

124

when would someone have a "pink" tetralogy of fallot

if just a small pulmonic obstrcution

125

what would transposition of greate arteries need for survival

shunt of some sort

126

what are some shuts that keep people alive in transposition of great arteriesi

PDA or PFO (65%)
VSD (35%)

127

what is considered a stable shunt in transposition of great arteries

VSD

128

what is considered an unstable shunt in transpotiion of great arteris

PDA or PFO

129

in the transpotiion of great arteries, what ventricle is thicker

RV

130

what is done with transpotiion of great arteries

surgical switching

131

what does the truncus arteriosus divide

pulmonary trunk and aorta

132

what is hyperplastic in tricuspid atresia and what shunts could it have

RV

needs a shunt, ASD, VSD, or PDA

133

is there low mortality for triscpid atresia

nope

134

what happens in total anomalous pulmonary venous connection

pulmonary veins do not goin into LA but into L. innominate v. or coronary sinus

135

what does TAPVC need for survival

PFO or VSD

136

what will be hypoplastic in TAPVC

Left atrium

137

what are the potential causes of obstructive CHD

coarctation of aorta
pulmonary stenosis/atresia
aortic stenosis/atresia

138

does the coarctation of the aorta happen more in males or females

males

139

what genotypic sex frequently has coarctation of aorta

XO

140

is the infantile form of coarctatino of aorta proximal to PDA serious

yes

141

is there a PDA in the adult for of aorta coarctation

nope

142

how much of th etime does the coarctation of the arota have a bicuspid aortic valve

50% of the time

143

if there is pulmonic stenosis or atresia 100%, what else will be present

RV with ASD

144

what can atresia be thought of anatomically

severe stenosis

145

what type of aortic stenosis/atresia are there

valvular
subvalvular
supravalvular

146

if there is a valvular aortic stenosis and hypoplastic LV what will happen to the patient

fatality

147

where is the aortic wall going to be thick in subvalvular (subaortic) stenosis

below the cusps

148

where is the aortic wall thickened in supravalvular aortic stenosis/atresia

above cusps

149

what are the syndromes of ischemic heart disease

angina pectoris
myocardial infaarction
chronic IHD
sudden cardiac death
acute coronary syndromes

150

what types of angina pectoris exist

stable and unstable

151

what are the acute coronary syndromes

unstable angina
acute MI
sudden cardiac death

152

what does "acute" mean in terms of heart diseass

plaques are disrupted

153

what is IHD risk related to

number of plaques
distrubution of plaques
size and structure of plaques

AND disruption of plaques

154

what is acute coronary syndrome frequently initiated by

unpredictable and abrupt conversion of stable atherosclerotis plaque to unstable and potentially life-threatening atherothrombostic lesion through superficial erosion, ulceration, fissuring, rupture, or deep hemorrhage, usually with superimposed thrombosis

155

how many die per year of ischemic heart disease in the USA

1/2 million

156

how has deat due to acute coronary syndrome gone down since 1963

prevention of controllable risk factors
earlier, better diagnostic methods
PTCA, CABG, arrythmia control

157

what percentage of patients with IHD have atherosclerosis

90%

158

what is the most important factor in acute coronary syndrome

acute plaque change

159

what are the minor factors in acute coronary syndrome

inflammation
thrombus
vasoconstriction

160

what is associated with acute plaque change

rupture/refissuring
erosion/ulceration, exposing ECM
acute hemorrhage

161

do plaques have to be severely stenotic to cause acute changes

nope

162

so what is a acute coronary syndrome caused by

chronic plaque plus acute thrombosis

163

what is endothlial response to inflammation

CAMs, selectins are released

164

what is T cell release in inflammation

TNF, IL6, IFN gamma stimulate and activate endothelial cells and MPs

165

what predicts the probability of damage in angina patients

CRP (alpha-2 globulin)

166

what types of thrombus can there be

total occlusion
partial
embolization

167

what causes vasoconstriction

circulating adrenergic agonists (alpha)
platelet release products (ADP)
endothelially released factors like endothelin

168

what is the stenoses % for stable angina

over 75%

169

is there plaque disruption in stable angina

no

170

what is the coronary artery pathology in ischemic heart disesa

stable angina
unstable angina
transmural MI
subundocardial MI
sudden death

171

what are some characteristics of angina pectoris

paroxysmal (sudden)
recurrent
can go from 15 seconds to 15 minutes

172

what is angina pectoris from

reduced perfusion but no infarction

173

what are the three types of angina pectoris

stable
prinzmetal
unstable

174

what relieves stable angina

rest or nitro

175

what is the mein feature of Prinzmetal angina pectoris

spasm

176

what does prinzmetal angina pectoris respond to

nitro

177

what will the ECG show for prinzmetal angina pectoris

STE

178

what types of people get prinzmetal angina pectoris

often younger people wihtout much atherosclerotic narrowing

179

what is synonymous with unstable angina

crescendo, pre infarction, Q wave angina

180

what are some factors that coudl be present in unstable angina and what are some factors that are presetn

could be: thrombosis, non transmural necrosis, embolization

DISRUPTION OF PLAQUE is there

181

what are the types of MI

transmural and subendocardial

182

what is the subendocardium

inner 1/3 of heart

183

what are MI risk factors the same as

atherosclerosis

184

are most MIs transmural and caused by coronary artery occlusion

yep

185

in the 10% of transmural MIs not associated with athero, what causes them

vasospasm
emboli
unexplained

186

is the subendocarium or the transmural coronary arteries perfused better

transmural

187

when does ATP depletion start in the heart

seconds

188

when does contractliity get lost in the heart

under 2 minutes

189

when is ATP reduced to 50% of normal in MI

10 minutes

190

when is ATP reduced to 10% of normal in MI

40 min

191

when does irreversible clel injury happen in MI

20-40 min

192

when does microvascular injury start in MI

over an hour

193

why does necrosis go from pericardium to subendocardium

because normally the subendocardium is least wel perfused

194

what is the apex of the myocardium like in terms of a human being

like the foot of a human being, likely to receive the brunt of the ischemic and infarctive phenomena

195

can you see ischemia grossly

no

196
card image

what is the progression top left to right, then left to right, then down

1. pynosis (waviness) 1 day
2. neutrophils in 3-4 days
3. MPs in 7 days
4. organization in weeks
5. fibrosis in months

197

what does coagulative necrosis look like early

pale or purple

198

why after a week is necrossi yellow

MPs come in and chew up the dead tissue

199

when does necrosis get red and soft again

organization and neovascularization

200

when does necrotic tissue get white and firm

fibrosis, months after

201

how is MI tissue reperfused

thrombolysis
PTCA
CABG

202

can reperfusion restore necrotic or dead fibers

no, only reversibly injured ones and prevent further necrosis

203

what are reperfusion injuries from

free radicals and interleukins

204

what are you oxygenating in reperfusion

dead mylcardial cells and inflammatory processes

205

what are the parts of AMI diagnosis

symptoms
EKGn (Q wave, T wave inversion, STE)
diaphoresis
10% silent with Q waves
CKMB best enzyme
troponin T then tropoinin I

206

what predicts risk of AMI in angina patients

CRP

207

where is CRP made

by liver in response to inflammation

208

what is the physiologic role of CRP

bind to PC on surface of dead/dying cells in order to activate the complement system

209

what are some complications of MIs

wall motion abnormalities
arrythmias
rupture
pericarditis
RV infarction
mural thrombus
ventricular aneurysm
papillary muscle dysfunction (regurg)
CHF

210

when is a cardiac rupture msot likely

4-5 days

211

what does a disrupted endocardium set up

mural thrombus (left side of heart sometimes aorta with 80/20 frequency)

212

what is regurgitation more likely to be from: acute myocardial diseases or something else

acute myocardial disease

213

what is CIHD

ischemic cardiomyopathy

214

what does CIHD progress to with no pathlogic or clinical evidence of localized infarction

CIHD

215

what is present in CIHD

extensive athero
no infarct
hypertrophy and dilation

216

why is there hypertrophy in people who have hadMIs

to make up for infarcted tissue

217

how many get sudden cardiac death per year from athero

350,000

218

what does non atherosclerotic sudden cardiac death include

congenital coronary artery disaese
aortic stenosis
mitral valve prolapse
myocarditis
cardiomyopathy

other: pulmonary HTN, conduciton defects, other HTN

219

how many SCD people at autopsy have narrowing in 1-3 vessels

75%

220

how many people in SCD autopsy have healed infarcts

40%

221

what is the wastebasket diagnosis when nothing else seems apparent

arrythmia

222

what is left sided HTN

hypertrophic adaptive response of the heart which can progress

223

how thick is a chamber wall

only as thick as it needs to be

224

does LVH cause hypertension

NO it is the adaptive reaction to it

225

does CHF cause HTN

yep

226

does HTN cause CHF

yep

227

what is needed to diagnose HTN

LVH>2 and/or heart>500 gm
HTN over 140/90

228

what % of people in the US have HTN

25%

229

how thick should the LV be

1.5 cm

230

what will LVH show histopathologically

increased fiber (myocte) thickness
increased nuclear sieze with increased blockiness

231
card image

what is going on here

LVhypertrophy

232

what will the ECG LVH criteria look like

R-I+S-III>25 mm
S-V1+R-V5>35mm
ST-T dep in L lead
R wave in L lead>11mm
LAE+other criteria

possible criteria: 1 possible 2 probable 3 definite

233

why would there be atrial fibrillation in LVH

due to left atrial enlargment; when you dilate atrium you dilate the subendocardial region where the conduction system arises as well

234

what are the bad things that will also happen in LVH

CHF
cardiac dilation
pulmonary venous congestion
dilation

235
card image

is this LV hypertrophic or dilated

hypertrophic: chamber voleume has not increased with mural increase

236

what is the LVH course

normal longevity
progressive IHD
progressive renal damage, hemorrhagic CVA (lenticulostriate)
CHF

237

what arteries are most susceptible to hypertensive CVA

lenticulostriate in basal ganglia

238

what is HHD on the right side also called

cor pulmonale

239

what happens in acute HHD

massive PE (no RVH)

240

what happens in chronic HHD

COPD, CRPD, pulmonary artery disease, chest wall motion impairment

241

what happens as alveoli expand in COPD

arterioles narrow

242

what type of cor pulomnale will there be No RVH

acute

243

what are the two types of valvular heart diseases

opening: stenosis
closing: regurg

244

why do both stenosis and regurg cause hyeprtrophy of the chamber proximal to the valve

stenosis: chronic calcific diseas
regurg: more associated with acute disease

245

what is coronary insuficiency

inadequate one-way flow

246

what does valvular insufficiceny deal with

possible backflow

247

what makes up 70% of all valvular heart disease

aortic stenosis
mitral stenosis

248

what is aortic stenosis caused by

calcification of deformed valve
senile calcific aortic stenosis
rhematic heart disease

249

are there more valvular heart diseases on the right or left side

left

250

are there more stenosis issues or regurg inssues

stenosis

251

would a stenosis be more likely than a regurg to be chronic

yes

252

what is a reflex knee jerk conclusion to aortic stenosis

LVH

253

what usually causes aortic stenosis

2x gradient pressure
LVH and ischemia
cardiac decompensation, angina, CHF

254

how many people die in 5 years if angina is present with aortic stenosis

50%

255

hwo many people die in 2 years if CHF is present with aortic stenossi

50%

256
card image

what is apparent here

calcification of the mitral skeleton

257

is there usually dysfunction with the mitral annular calcification

no

258

what is there sometimes with mitral annular calcification

regurg usually but stenosis posible

259

do more men or women get mitral annular calcification

females

260

what are the common regurgitations

aortic
mitral

261

what can cause aortic regurg

rheumatic
infectious
aortic dilations: aortic aneurysm: syphillis, rheumatoid, marfan

262

what can cause mitral regurg

mitral valve prolapse unrelated to athero
infectious
fen-phen
papillary muscles, chordae tendinae, calcification of mitral ring

263

what is a mitral valve prolapse

myxomatous degeneratino of the mitral valve

264

what is mitral valve prolapse associted with

CT disorders

265

what is a slang term for mitral valve prolapse

floppy valve

266

what is the incidence of mitral valve prolapse

3%

267

can MVP see on echo

yep

268

do more women or men get mitral valve prolapses

women

269

is MVP usually symptomatic

nope

270

what do you hear in MVP

midsystolic click and holosystolic murmur if regurg present

271

what are some symptoms of MVP

occaisional chest pain, dyspnea

272

what % of people with MVP has no untoward effects

97%

273

what do the other 3% of people with MVP get

infective endocarditis
mitral insuff
arrythmias
sudden death

274

what is myxomatous degeneration like

parachute
general color: mucinous/cartilaginous/ground substance

275
card image

whats going on here

mVP myxomatous degeneration

276

what type of infection does rheumatic heart disease follow

gropu A strep a few weeks after

277

is rheumatic diseases decreased in developed countries

yes

278

what is pancarditis

endocarditis
myocarditis
pericarditis

279

what will acute carditis show

inflammation
aschoff bodies
anitskow cells
pancarditis
vegetations on chordae tendinae at leaflet junction

280

what will chronic carditis show

thickened valves
commissural fusion
thick, short chordae tendinae

281

what is aschoff body/anitschkow cell

giant cell like granulmoa!

282

what will MVP show clinically

migratory polyarthritis
myocarditis
subcutaenous nodules
erythema marginatum
sydenham chorea

283

what usuallly causes infectious endocarditis

s. viridans

284

what often causes infectious endocarditis in IVD users

staph aureus

285

what are some assorted other bacterial causes of infectious endocarditis

enterococci
normal oral flora: HIB, actinobacillus, cardiobacterium, eikenella, kingela

other: fungi, rickettsiae, chlamydia

286

what is the mortality of acute infectious endocarditis

50% mortality

287

what is subacute infectious endocarditis' mortality

very low

288

how big are the vegetations on infective endocariditis

>5mm

289

how big are the non infective endocarditises vegetation

<5mm

290

what are the vegetatinos like in various infectious endocardtises

rheumatoid (chordae tendinae junction
infectious (big)
lupus (libman-saks)
NBTE (<5mm)

291

what are the major methods of endocarditis diagnossi

postitive blood cultures idicating characteristic organism or persistance of unusual organism

echocardiographic findings, including valve-related or implant-related mass or abscess or partial separation of artificial valve

new valvular regurgitation

292
card image

what are these

Janeway lesions

293
card image

what are these

Osler's Nodes

294
card image

what is this

splinter hemorrhages

295
card image

what is this

Roth's spots

296

do you think that for every skin lesion you see that there may be 10 visceral lesions that you don't see

yep

297

what size is indicative of noninfective vegetations of endocarditis

<5mm

298

what are some causes of non infective vegetations

PE
Trousseau syndrome (migratory thrombophlebitis with malignancies
Swan-Ganz
Libman-Saks with SLE (both sides of valve

299

which valves would you expect to see Swan-Ganz vegetations

right heart

300

what are the symptoms of carcinoid syndrome

episodic skin flushing
cramps
nausea and vomiting
increased serotonin and 5IAA in urine
fibrous intimal thickening (RV, tricuspid valve, pulmonic valve, similar to what fen-phen does on the left side)

301

what are most carcinoids from

GI tract

302

why are carcinoids nasty to the right heart intima

lungs break down serotonin

303

where do people get artifiical valves from

mechanical
xenografts

304

how many people have complications within 10 years of artificial valves

60%

305

what is myopathic heart disease

muscle failure of the heart

306

what are the 6 causes of cardiomyopathies

inflammatory
immunologic
metabolic
dystrophies
genetics
idiopathic
toxic

307

what are the 3 functional causes of cardiomyopathies

dilated cardiomyopathy (systolic dysfunction)
hypertrophic cardiomyopathy (diastolic dysfunction)
restrictive cardiomyopathy (diastolic dysfunction)

308

what is the number one toxin that causes cardiomyopathies

alcohol

309

what is a restrictive cardiomyopathy

wall that is not thickened or dilated necessarily but rigid in diastolic relaxation (loss of compliance)

smaller EDV

310

how is EF related to EDV

EF=1/EDV

311

what does a hypertrphic cardiomyopathy look like

small volume with a big wall

312

what does a dilated cardiomyopathy look like

heart just gets bigger, expanded wall, slightly thicker

313

what is LVEF=

LVEF=(EDV-ESV)/EDV

314

what does LVEF differentiate

hypertrophic from dilated cardiomyopathy

315

what are the characteristics of dilated cardiomyopathy

chamber thickness increased
progressively declning LVEF
LVEF is proportional to prognosis

316

how may people with dilated cardiomyopathy die in 2 years

50%

317

what are the 3 main causes of dilated cardiomyopathhy

myocarditis
EtOH
adriamycin

318

so what is the rule on DCM

4 chamber dilation
4 chamber hypertropy
interstitial fibrosis (increased collagen!)

319
card image

what is going on here

DCM

320

what is an uncommon dilated cardiomyopathy that mostly affects the right ventricle

arrhythmogenic RV cardiomyopathy

naxos syndrome

321
card image

what is this

arrhythmogenic RV CM or arrhythmogenic RV dysplasia

322

what is another name for hypertrophic CM

IHSS (idiopathic hypertrophic subaortic stenossis)

323

what do genetic IHSSes involve

beta myosin heavy chain
troponin T
alpha tropomyosin
myosin binding protein C

324

what happens in HCM

massive hypertrophy
asymmetric septum
disarray of myocytes
interstitial fibrosis

325

what clinically will be involved in HCM

decreased chamber volume
decreased SV
decreased diastolic filling

326

what causes RCM

generally idiopathic

327

what happens to ventricular compliance in RCM

decrased

328

what does RCM mainly affect

diastole
normal chamber size and wall thickness

329

what are the 3 disases of RCM (that affect the subendocardial areea)

endomyocardial fibrosis (african kids)
loeffler endomyocarditis (eosinophilic leukemia)
endocardial fibroelastosis (infants)

330

what is myocarditis

inflammation of the myocardium

331

what usually causes myocarditis

mostly microbial
(coxackie A and B, CMV, HIV)
trypanosoma cruzi (Chagas disaes
trichinosis
toxoplasmosis
Lyme disease
diptheria

post viral rheumatic, SLE, drug hypersensitivity, alpha methyl dopa, sulfas

332

when do people get immmune myocarditis

post-viral
rheumatic
SLE
drug hypersensitivity (alpha-methyl dopa, sulfas)

333

what is the usual pattern of all myocarditis

lymphocytic infiltrates

334

what are some other myocarditides

adriamycin
cyclophsophamide
catecholamines
amyloid: systemic or primary cardiac
- congo stain: gree with polarization
amyloid againg
hemocrhomatosis
hyper and hypothyroidism

335

what do catecholamines lead to in the heart

exhaustion smyocarditides

336

how much fluid is in the pericardium

normally 30-50 mL clear serous fluid

337

what is another name for the visceral pericardium

epicardium

338

what is another name for the parietal pericardium

fibrous pericardium

339

what do pericardial effusions lead to

tamponade

340

what do people get cardiac tamponade from

ruptured MI
traumatic perforation
ruptured aortic dissection

341

what are the types of pericarditis

serous
fibrinous
purulent
hemorrhagic
caseous
chornic

342

what causes serous pericarditis

rheumatic fever
SLE
scleroderma
tumors
uremia

343

what causes fibrinous pericarditis

uremia
radiation
RF
SLE
open heart surgery

344

what causes hemorrhagic pericarditis

malignancy, TB

345

what causes caseous pericarditis

TB

346

what is standard pericarditis caused by

uremia and pericardial infections

347

what is exudate

fibrin

348

how many tumors of the heart are benign

90%

349

what are the tumors of the heart

myxomas
fibromas
lipomas
fibroelastomas
rhabdomyomas
sarcomas

350

where is the most common myxoma

left atrium

351

what are the fibroelastomas from

valvular usually papillary

352

what is the most common cardiac tumor in children

rhabdomyoma

353
card image

what is this

fibroelastoma

354
card image

what is this

rhabdomyoma

355
card image

what is this

myxoma

356

where would a myxoma be

fixed on atrial wall

357

what are the direct effects of a non cardiac tumor

pericardial and myocardial mets
large vessel obstruction
pulmonary tumor emboli

358

what is the indirect consequences of a non cardiac tumor

nonbacterial thrombotic endocarditis (trousseau)
carcinoid heart disease
pheochromocytoma assd HD
myeloma assd amyloidosis

359

what are some effects of tumor therapy on the heart

chemotherapy
radiation therapy

360

how many people survive in 5 years from cardiac transplant

over 60%

361
card image

what do we have here

cardiac transplant pathology


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