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Questions and Answers
What is the most common cyanotic congenital heart disease?
What is the most common cyanotic congenital heart disease?
What clinical feature is most associated with Tetralogy of Fallot?
What clinical feature is most associated with Tetralogy of Fallot?
Which distinguishing feature is characteristic of Transposition of the Great Arteries?
Which distinguishing feature is characteristic of Transposition of the Great Arteries?
What primary effect does coarctation of the aorta have on the body, particularly in adults?
What primary effect does coarctation of the aorta have on the body, particularly in adults?
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What is the primary clinical finding in patients with congenital heart disease characterized by right-to-left shunts?
What is the primary clinical finding in patients with congenital heart disease characterized by right-to-left shunts?
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Which clinical condition is associated with hypoplasia of the aortic arch proximal to the PDA?
Which clinical condition is associated with hypoplasia of the aortic arch proximal to the PDA?
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Which of the following is a common cause that contributes to congenital heart disease?
Which of the following is a common cause that contributes to congenital heart disease?
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What kind of cardiac chamber overload occurs due to aortic stenosis?
What kind of cardiac chamber overload occurs due to aortic stenosis?
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What is the phenomenon called that describes greater local damage due to late restoration of blood flow in ischemic tissues?
What is the phenomenon called that describes greater local damage due to late restoration of blood flow in ischemic tissues?
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Which factor contributes to increased intracellular calcium during reperfusion injury?
Which factor contributes to increased intracellular calcium during reperfusion injury?
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What is considered the best biomarker for acute myocardial infarction?
What is considered the best biomarker for acute myocardial infarction?
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Which condition can lead to occlusion of the microvasculature during reperfusion injury?
Which condition can lead to occlusion of the microvasculature during reperfusion injury?
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What is a common clinical manifestation of myocardial infarction?
What is a common clinical manifestation of myocardial infarction?
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What is the expected time frame for CK-MB levels to peak after myocardial infarction?
What is the expected time frame for CK-MB levels to peak after myocardial infarction?
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Which group is more likely to experience silent infarcts?
Which group is more likely to experience silent infarcts?
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What is a potential consequence of a large myocardial infarction?
What is a potential consequence of a large myocardial infarction?
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Which type of non-ischemic cardiomyopathy is characterized by progressive cardiac dilation and contractile dysfunction?
Which type of non-ischemic cardiomyopathy is characterized by progressive cardiac dilation and contractile dysfunction?
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What is a common symptom of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?
What is a common symptom of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?
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What percentage of patients with Hypertrophic Cardiomyopathy have the obstructive type?
What percentage of patients with Hypertrophic Cardiomyopathy have the obstructive type?
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Which of the following is NOT an etiology of Dilated Cardiomyopathy?
Which of the following is NOT an etiology of Dilated Cardiomyopathy?
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What test uses an ultrasound beam to examine the heart's functioning?
What test uses an ultrasound beam to examine the heart's functioning?
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Which of the following is a symptom of Hypertrophic Cardiomyopathy?
Which of the following is a symptom of Hypertrophic Cardiomyopathy?
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Which non-ischemic cardiomyopathy involves replacement of normal heart muscle with fatty fibrous tissue?
Which non-ischemic cardiomyopathy involves replacement of normal heart muscle with fatty fibrous tissue?
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What is a common cause of peripartum cardiomyopathy?
What is a common cause of peripartum cardiomyopathy?
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What is a common source of bacteremia leading to infective endocarditis?
What is a common source of bacteremia leading to infective endocarditis?
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Which heart valves are most commonly affected by infective endocarditis?
Which heart valves are most commonly affected by infective endocarditis?
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What clinical feature is most consistently associated with infective endocarditis?
What clinical feature is most consistently associated with infective endocarditis?
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What is characteristic of the vegetations seen in acute endocarditis?
What is characteristic of the vegetations seen in acute endocarditis?
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Which of the following statements about subacute endocarditis is true?
Which of the following statements about subacute endocarditis is true?
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What complication may arise from the shedding of emboli in infective endocarditis?
What complication may arise from the shedding of emboli in infective endocarditis?
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Which type of tissue is often found at the base of vegetations in subacute endocarditis?
Which type of tissue is often found at the base of vegetations in subacute endocarditis?
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What may be present in 90% of patients with left-sided lesions in infective endocarditis?
What may be present in 90% of patients with left-sided lesions in infective endocarditis?
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What is one of the clinical features associated with septicemia in untreated infective endocarditis?
What is one of the clinical features associated with septicemia in untreated infective endocarditis?
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Which statement accurately describes the prognosis of infective endocarditis?
Which statement accurately describes the prognosis of infective endocarditis?
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Which type of endocarditis is characterized by sterile thrombi on cardiac valves?
Which type of endocarditis is characterized by sterile thrombi on cardiac valves?
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Which organism is associated with the lowest cure rates in infective endocarditis?
Which organism is associated with the lowest cure rates in infective endocarditis?
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What condition is NOT typically associated with nonbacterial thrombotic endocarditis?
What condition is NOT typically associated with nonbacterial thrombotic endocarditis?
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What is the typical size of vegetations in nonbacterial thrombotic endocarditis?
What is the typical size of vegetations in nonbacterial thrombotic endocarditis?
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What complication can arise from infective endocarditis due to glomerular trapping?
What complication can arise from infective endocarditis due to glomerular trapping?
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Which of the following is NOT a common clinical feature of infective endocarditis?
Which of the following is NOT a common clinical feature of infective endocarditis?
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What is the primary cause of ischemic heart disease (IHD) in 90-95% of cases?
What is the primary cause of ischemic heart disease (IHD) in 90-95% of cases?
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Which of the following is a characteristic of stable angina?
Which of the following is a characteristic of stable angina?
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What occurs with prolonged ischemia of myocardial tissue?
What occurs with prolonged ischemia of myocardial tissue?
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Which syndrome is NOT classified under acute coronary syndrome (ACS)?
Which syndrome is NOT classified under acute coronary syndrome (ACS)?
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What is one effect of reduced nitric oxide in endothelial dysfunction?
What is one effect of reduced nitric oxide in endothelial dysfunction?
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What feature is NOT characteristic of vulnerable plaques?
What feature is NOT characteristic of vulnerable plaques?
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Which risk factor is associated with an increased chance of myocardial infarction?
Which risk factor is associated with an increased chance of myocardial infarction?
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What is the earliest detectable feature of myocyte necrosis during myocardial infarction?
What is the earliest detectable feature of myocyte necrosis during myocardial infarction?
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Which mechanism can attribute to reduced coronary blood flow besides atheromatous plaques?
Which mechanism can attribute to reduced coronary blood flow besides atheromatous plaques?
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In the gross morphology of myocardial infarction, which artery is most commonly involved?
In the gross morphology of myocardial infarction, which artery is most commonly involved?
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What is a defining feature of complicated atherosclerotic lesions?
What is a defining feature of complicated atherosclerotic lesions?
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What is the function of activated platelets during the formation of a thrombus?
What is the function of activated platelets during the formation of a thrombus?
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Which histological feature indicates an increase in chronic ischemic heart disease?
Which histological feature indicates an increase in chronic ischemic heart disease?
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What is the role of tissue factor in the process of myocardial infarction?
What is the role of tissue factor in the process of myocardial infarction?
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Study Notes
Pathology of the Cardiovascular System
- This presentation outlines the pathology of the heart and blood vessels.
I. Pathology of the Heart
- Ischemic Heart Disease (IHD): a broad term encompassing several syndromes caused by myocardial ischemia (imbalance between cardiac blood supply and myocardial oxygen/nutritional needs). It accounts for 80-90% of heart disease mortality. Common causes include atherosclerosis (90-95%), vasospasm, thrombosis, stenosis, and inflammatory arteritis.
- Ischemia: refers to reduction in blood supply to an organ. If ischemia is reversed quickly, there is no permanent damage. Prolonged ischemia can cause necrosis, which is called an infarct.
- Symptoms (IHD): Symptoms range from asymptomatic with exertion to pain levels increasing with less exertion or even at rest.
- Syndromes under IHD: Angina Pectoris (reversible), Stable/Typical Angina, Prinzmetal/Variant Angina, Unstable/Crescendo Angina, Myocardial Infarction
- Myocardial Infarction (MI): Myocardial infarction, where ischemia causes frank cardiac necrosis. Angina pectoris describes chest pain. Chronic IHD with heart failure, and sudden cardiac death (SCD).
- Acute Coronary Syndrome (ACS): A catastrophic form of IHD. Includes MI, where ischemia causes necrosis and angina pectoris.
II. Pathology of the Blood Vessels
- Arterial Disorders: This section covers conditions affecting the arteries.
- Venous Disorders: This section covers conditions affecting the veins.
- Tumors of Blood Vessels: This section describes tumors that can arise in blood vessels.
- Vasculitides: This section covers various inflammatory diseases of blood vessels.
- Functional Vascular Disorders: This section covers various functional disorders
- Hypertension: Related to blood pressure disorders.
III. Introduction
- Cardiovascular dysfunction can be attributed to one or more of six principal mechanisms:
- Pump failure (weak myocardial contraction, inadequate output)
- Flow obstruction (lesions obstruct blood flow, e.g., atherosclerotic plaque)
- Regurgitant flow (portion of output flows backward through an incompetent valve)
- Shunted flow (blood diverted between heart chambers or blood vessels)
- Disorders of cardiac conduction (automaticity of the pacemakers, conduction defects, or arrhythmias)
- Rupture of the heart or major vessel.
IV. Ischemic Heart Disease (IHD)
- Broad term encompassing several syndromes caused by myocardial ischemia, an imbalance between cardiac blood supply (perfusion) and myocardial oxygen/nutritional requirements. A major cause of death in developed countries.
V. Rheumatic Fever & Infective Endocarditis
-
Rheumatic Fever: An inflammatory disease that can damage the heart. It's an immunologic disease, not infectious.
-
Streptococcal Pharyngitis: The cause of rheumatic fever. A throat infection.
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Molecular Mimicry: Pathogenesis of rheumatic fever where immune cells mistaken body tissues for foreign invaders and an immune response ensues.
-
Infective Endocarditis: A microbial infection of heart valves and mural endocardium, characterized by vegetations.
- Acute: Commonly caused by S. aureus, common in IV drug users. More pronounced tissue destruction.
- Subacute: Commonly caused by Viridans Streptococci and HACEK organisms. Seen in previously diseased valves. Less pronounced tissue destruction.
VI. Valvular Heart Disease
- Stenosis: Incomplete valve opening, impeding forward blood flow.
- Insufficiency (Regurgitation): Incomplete valve closing, permitting backflow.
- Aortic Stenosis: Often caused by calcification of normal valves.
- Aortic Insufficiency: Commonly caused by dilation of the ascending aorta, often secondary to hypertension and aging.
- Mitral Stenosis: Usually seen in Rheumatic Heart Disease and is relatively common in developed countries.
- Mitral Insufficiency: Seen in mitral valve prolapse.
VII. Congenital Heart Disease
- Diseases of heart and great vessels present at birth.
- Most arise at 3-8 weeks after conception (AOG).
- Most common genetic cause: Trisomy 21 (Down syndrome).
- Left-to-right shunts: Blood flows from higher pressure to lower pressure.
- Right-to-left shunts: Blood flows from lower pressure to higher pressure.
- Obstructive lesions: A common cause is a defect in the structure of the heart.
VIII. Myocardial Infarction (MI)
- Death of cardiac muscle due to prolonged ischemia.
- Loss of contractility: Occurs within 1-2 minutes of severe ischemia onset.
IX. Cardiac Arrhythmias
- Aberrant rhythms can originate from the SA node or individual myocytes.
- Myocardial Infarction associated arrhythmias:
- Tachycardia (fast heart rate)
- Bradycardia (slow heart rate)
- Ventricular fibrillation (chaotic depolarization w/o functional contraction)
- Asystole (no electrical activity)
X. Cardiac Tumors
- Metastatic Neoplasms: The most common heart malignancy.
- Primary Neoplasms: Uncommon compared to metastasis. Almost always benign. Common benign ones include myxomas, fibromas, lipomas, papillary fibroelastomas, rhabdomyomas. The most common malignant tumor is angiosarcoma.
XI. Cardiac Transplantation
- A surgical procedure for patients with end-stage heart failure or severe coronary artery disease when other treatments have failed. Common indications are dilated or ischemic cardiomyopathy, intractable angina, and/or malignant arrhythmias. Contraindications include age more than 65, active systemic infection or disease, active malignancy, history of substance abuse, and/or psychosocial instability.
XII. Pericardial Disease
- Pericardial effusion: Accumulation of fluid in the pericardium, often with inflammatory conditions.
- Pericarditis: Inflammation of the pericardium, often secondary to viral infections, MI, or cardiac surgery.
- Uremia: A systemic disorder, most common systemic cause of pericarditis, with fluid accumulation, and consequent shock. Chronic constrictive pericarditis is a more chronic form, presenting with symptoms similar to restrictive cardiomyopathy.
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