Path Lecture: Cardiac 4

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1

where do you find toxoplasmosis gondi

house cats/cattle

2

what diseases does toxoplasmosis gondi lead to

seizures and heart problems

3

what are the new world trypanosomes carried by

reduvid bug (chagas)

4

what does chagas disease infect

esophagus/heart

5

what will be edematous in chagas

periorbital

6

what happened when people took fen fen

got carcinoid in heart: R heart

7

why was the left heart spared in vasoactive fen phen

vasoactive amines metabolized by lungs

8

what is carcinoid

tumor in small bowel (paneth cells or appendix)

9

can the carcinoid be malignant

yes

10

what hormones does carcinoid produce

serotonin/bradykinin

11

what do you worry about in pancreatic cancer

DVT and PE

12

what does anyone with adenocarcinoma/glandular carcinoma have a great risk of

thrombotic events

13

when do you give antibiotics prophylactically

patient has valve damage before dental procedures

14

is a valve ever totally competent

no

15

what happens when there is a contusion of the heart

increased epi release and small vessel constriction

16

what keep leaflets of valves from prolapsing during systole

papillary muscles and chordae tendinae

17

what is a midsystolic click from

MVP

18

in a ventricular aneurysm, where would a mural thrombus form

trabeculae carnae

19

what is a way that the heart structure can block the outflow tract

IV septum hypertrophy

20

how will CHF lead to lousy heart strength

poor coronary flow

21

what are the stages of edema in CHF

interstitial then alveolar

22

what can CHF be due to

athero or long standing HTN

23

what is nutmeg liver

chronic passive congetsion

24

what dies in nutmeg liver

central lobular necrosis

25

what will dilated LV lead to in terms of mitral valve

MR/incompetence

26

what will MR/incompetence lead to in the lungs

increased pulmonary pressure

27

my notes

...

28

what is pretty much guaranteed if you smoke

advanced atherosclerosis

29

how does the heart contract

wrings itself out, not just simple collapse

30

when do the coronary arteries get most of their blood flow

diastole

31

when can limitation of valve motion play into coronary artery movement

if coronary arteries are on the valve too much, they will be narrowed if the valve can't move

32

where are the coronary arteries usually

aortic valve's exterior

33

which coroonary artery is dominant

whichever one supplies the posterior IV septum

34

are most people RCA or LCA dominant

RCA

35

what are valves an extension of

ENDOCARDIUM

36

how does the myocardium contract

pulls against itself and intercalated discs

37

why dont we have to innervate every heart cell

intercalated discs

38

in addition to being ion channels how else do intercalated discs function

tendons

39

how is the syncitium of myocardial muscle arranged

pretty linearly

40

what is the fibroconnective tissue of the heart like

just like perivascular tissue and joints

41

in the otherwise healthy adult, what are the relevant categroies of presentation in the heart

leaks in circulatory system that allow blood to escape, reducing filling and diminishing blood volume

conduction system abnormalities leading to lousy pumping coordination

obstruction to blood flow

incompetent valves

failure of pump itself

42

how do you check if there is a volume problem going on in a pinch

JVD

43

what danger can disrythmias lead to

clots in LA

44

what will happen to the aortic valve that won't allow it to close

scarring

45

what type of lesions will be present in the hypertrophic heart

fibrotic white lesions

46

if you have developing cardiac tamponade in a crashing BP patient who is unconscious what do you need to do

CHECK JVD

47

what is "toward failure" in the heart

contractile/systolic failure

48

what is "backward failure" in the heart

ventricular filling problem

49

what are two common things associated with backward failure of the heart

amyloid buildup (light chian antibody) and RCM)

50

what are ventricular filling problems related to (generally)

external problems like trapping by a scarred pericardium

myocardial problem

51

how do we group congenetal heart disaeses

cyanosis: late/tardive, early/cyanotic, noncyanotic

52

what do 90% of heart defects come from? genetics?

no, teratogens like alcohol and rubella

53

is there a greatly increased incidence of congenital abnormality among affected siblings

yes

54

what will be the case of a tardive cyanotic kid

not blue, but doesn't have normal stamina of kids his age

55

what is the really bad thing about tardive cyanotic diseases

left to right shunt at first, but then becomes right to left due to increased pulmonary vascular pressures and reaction of pulmonary vessels

56

what is eisenmengers reaction

hyperplasia of pulmonary artery which leads eventually to reversal of flow: VERY BAD

57

what is very common with eisenmenger's after you get pulmonary hyperplasia

RHF

58

what type of ASD is low in the heart

primum type

59

what is the problem dealing with in primum ASD

endocardial cushion

60

what can also be associated with ASD primum type

cleft anterior mitral leaflet and tricuspid valve

61

what is the most common type of ASD

secundum

62

if the secundum ASD is really big what do you have

single atrium!

63

what is the ASD that is high in the septum called

sinus venosus defect

64

will VSD or ASD evolve problems more quickly

VSD

65

where is the VSD worse: membranous or muscular septum

muscular

66

what do you give to kids to close the PDA and why

endomethicin/aspirin to drop PGE2 to close the PDA

67

what is a reason someone might have pure right sided heart failure

increased vascular proliferation from HSV-1

68

what are some things that cause clubbing of the fingers

hypertrophic osteoarthropathy
soft tiss ane periosteal bone (something)
emphysema
lung cancer
heart defects
see with CYANOTIC disease

69

which member of tetrology of fallot is the compensatory one

RVH

70

which member of the tetralogy of fallot is the causative agent of the compensatory one

pulmonic stenosis

71

what could keep kid from dying in TGA

PDA or ASD

72

why can't you just whack off the vessels and switch them in TGA?

CORONARY ARTERIES

73

what is MAPVR like

many small BVs coalesce into pulmonary vein to deposit into the LA, but every once in a while you get a rebel pulmonary venule or something that retuns blood to the RA or somewere else

74

what would a MAPVR act like (another heart defect) if it were big enough to be detectable

VSD!

75

where do aortic coarctations often happen

proximal to ductus arteriosus

76

do aortic coarctation symptoms manifest sooner when you have them proximal to the ductus arteriosus or after

SOONER

77

what will you have if you have aortic coarctation proximal to the ductus arteriosus

HYPOPLASTIC AORTIC ARCH

78

who gets aortic coarctations most commonly

males and girls iwth turner's

79

what will ANP be like in people with aortic coarctation

really low: atria don't get any blood flow

80

what is the renal perfusion like in coarctation

very low

81

what will be a result of the low renal perfusion and low ANP of coarctation

huge vascular volume to increase P, and LV still beating itself to death

82

what is IHSS

idiopathic hypertrophic subaortic stenosis

83

what is iHSS due to

congenital malformation of muscular wall obstructing the outflow tract

84

IHSS a valvular problem

nope, it's just an actual obstruction of the OUTFLOW TRACT

85

what is CHF in its purest sense

mechanical pump failure

86

will a chf heart have a thicker wall? hypertrophy?

no probably not a thicker wall but it WILL HAVE HYPERTROPHY

87

what types of people are doubly screwed with CHF

well if thye have CHF that's one bad thing, but if they are ALCOHOLICS that is even worse: adding toxins to the heart

88

what is systolic failure

loss of heart's contractile function

89

what is diastolic fucntion

chambers of heart CANNOT expand during diastole due to constriciton or restriction of herat!

90

what is an important curve in systolic failure

STARLING's CURVE

91

why does a super dilated LV in CHF lead to incompetent mitral valve

jsut because it does not grow with the ventricle

92

what part of the mitral valve in particular is going to be your source of backup

mitral valve distention due to ANNULUS distending

93

what should you be thinking with unilateral pulmonary edema

CANCER

94

are heart defects going to be wedge shaped

no obviously not

95

what days after an MI do you get autolysis to get the dead stuff out

days 1-3 and 3-7

96

why does hypertensive heart disease lead to fatal arrythmias

papillary muscles don't coordinate with systolic contraction!

97

where can mural thrombu occur very quickly in the heart and in what setting

trabeculae carnae in healed infarcts

98

why is cor pulmonale so devastating

when you lose tissue, you lose everthign: BVs, lungs, alveoli, etc too

99

how can smoking be a cause of R side HTN

lose lung tissue leading to hyperplasia

100

what happens when there is traumatic injury to the heart and people die

...

101

what is sympathetic pericarditis

due to epi release that also comes with eosinophilic infiltrate and arrythmia

102

can the heart aneurysm

yes

103

where would rheumatic heart disease probably have antibodies

mostly on CT with inflammatory mediators on outer part of valve

104

what is an aschoff nodule

monocytic infiltrate that tries to be a granuloma but can't and end up scarring down and heart can't go through a diastolic filling phase because of them

105

are achoff bodies sterile

YES

106

what will accompany the presence of aschoff nodules

changes in small BVs and subcutaneous lesions and joints

107

what are aschoff noodules associated with

ARF!!!!

108

how would a "fish mouth" mitral valve behave functionally

MS and MR!

109

what valves are most involved in ARF

mitral and aortic

110

ok so what are the ARF lesions that we should be looking for

carditis
syndehams
carditis
subcutaneous nodules
migratory polyarthritis

111

what valves are going to be markedly affected in marfan's

annulus of MVP!

112

what happens to suspensory ligaments in eyes of marfan's

subluxation

113

why is there an increased incidence of arrythmias due to BC aortic valve

increased demand of coronaries, and they are not in the rightplace

114

what will BC aortic valves look like

there is a frenulum where there is supposed to be a fissure

115

what type of damage is characteristic of MVP

myxomatous degeneration

116

what is the deformity characteristic of MVP

parachute deformity

117

what should you listen for in MVP

midsystolic click

118

what types of congenital valvular problems can arise

marfan's: MVP, dissecting aortic anurysms

BC AV: arrythmias

MVP (myxomatous)

Calcific aortic valvular stenosis

119

what will a calcific aortic valve present like

syncopal episode

120

what is similar between MV in DCM and calcific aortic stenosis

both STENOTIC and INSUFFICIENT

121

if you have a ton of backflow in MVP what will the atria look like

glistening and pearly

122

can VSDs get IE really easily? why?

VSD is a nonleafed valve so the low P side has bloow rush across it and blood in contact with the edge of the opening curls around in an eddy current and lifts endothelial cells and deposits platelets where bacteria can colonize and generate things like IE

123

what is interesting about an embolus from IE

it can carry bacteria with it to other places

124

why is it important to know who has valve disorders

prophylactically treat for dental workups, etc.

125

what is intersting about infective endocarditis bugs

some work quickly, others are chronic

126

what are we thinking with right sided endocarditis

IV drug user

127

what is an indication for colon cancer in IE

s. bovus

128

what else associates colon cancer and endocarditis besides a strep bovus infection

nonbacterial thrombotic endocarditis with medium sized focal lesions

129

what types of things are associated with MARANTIC/THROMBOTIC ENDOCARDITIS

various types of glandular/adenocarcinomas

130

where are the marantic endocarditis lseioons

valves and endothelium

131

when do we get libman sachs endocaritdis

when we start making Abs vs. all sorts of stuff in SLE, especially breakdown products and ribosomes to DS DNA and they are in the bloodstream all the time

132

what does a bjork scleley valve look like

toilet seat, leads to a lot of clots

133

what is a carcinoid

tumor that arises in the small bowel or appendix coming from paneth cells at base of crypts of leiberkuhn that are neural crest derivative cells

134

what do carcinoids actively secretion

hormones: SEROTONIN, BRADYKININ

135

are all carcinoids benign

NO

136

where can malignant carcinoids go

liver

137

what is the main problem in carcinoids

they make lots of SEROTONIN and lead to burning of the hear'ts right side

138

why is the left heart spared from the effects of carcinoid

because the lungs can metabolize the serotonin

139

what will a carcinoid damaged heart show

tremendous collagen deposition and thick endocardium

140

what diet pill will show similar effect to carcinoid

fen-phen

141

CM chart from lecture?

...