Path Review

  1. What are the 3 main things you see in RHD?
    • Vegetations
    • Aschoff bodies
    • Fibrous pericarditis
  2. How is the diagnosis of rheumatic heart disease made?
    Using the Jones criteria
  3. What are the major criteria (Jones) to diagnose RHD?
    • Pancarditis
    • Polyarthritis
    • Sydenhams chorea
    • Subcutaneous nodules
    • Erythema marginatum
  4. In most cases of myocarditis, the heart tends to be ___________________, and there are presence of ____________________, which consist of ___________________
    • Dilated
    • Aschoff bodies
    • Aggregates of lymphocytes and macrophages
  5. What are the characteristics of vegetations in RHD?
    • No bacteria in vegetations
    • Inflammation of valves leads to valve deformitites
    • Chordae tendinae in mitral valve thicken and fuse, causing fish-mouth stenosis
  6. What is the end result of having mitral stenosis?
    Stagnation of blood in LA leads to left atrial, pulmonary, and RV HTN, and ultimately Cor pulmonale (right heart failure)
  7. What is the end result of having aortic stenosis?
    Impedes flow from LV into aorta
  8. In an adult with coarctated aorta, which artery would you expect the blood flow to enter to reach the intercostal arteries from the subclavian artery?
    Internal mammary artery
  9. What is the prenatal structure which forms the ligamentum teres after birth?
    Umbilical vein
  10. What are the 2 valves most affected in RHD?
    Mitral and aortic valves
  11. What is the cause of a primum type atrial septal defect?
    Endocardial cushion defect
  12. How does transposition of the great vessels affect blood flow?
    Right to left shunting of blood
  13. What condition does congenitally bicuspid valves most commonly cause?
    Calcific aortic stenosis
  14. Most cases of calcific aortic stenosis are in what age group?
    Senile (70-80)
  15. What is the morphology of calcific aortic stenosis?
    Masses of calcium within sinuses of valve
  16. Which group of people are more predisposed to get calcific aortic stenosis earlier in life?
    Those with congenitally bicuspid aortic valve
  17. How does the heart change with aortic stenosis?
    LV pressure rises and wall gets thicker (hypertrophy)
  18. How is aortic stenosis treated?
    Repair of valve or replacement
  19. What is myxomatous degeneration of the mitral valve?
    • One or both valve leaflets are enlarged or floppy
    • Valve prolapses back into left atrium during systole
  20. Which population does myxomatous degeneration of the mitral valve affect the most?
    Young women
  21. Mitral valve prolapse is a common feature of which condition?
    Marfan’s syndrome
  22. How does a mitral valve prolapse present clinically?
    • Patients usually asymptomatic
    • Mid-systolic click on exam
  23. What are the findings in chronic RHD?
    Valvular stenosis and regurgitation
  24. What are the clinical findings on infective endocarditis?
    • Splinter/subungual hemorrhages
    • Janeway lesions
    • Osler nodes
    • Roth spots
  25. Describe the vegetations on heart valves in acute infective endocarditis
    • Easily breakable
    • Prone to embolization
    • Contain virulent organisms
  26. What is the most common organism causing subacute (chronic) infective endocarditis?
    Viridans streptococci
  27. Describe the vegetations on heart valves in subacute infective endocarditis
    • Less valvular destruction
    • Granulation tissue
  28. What are the most common agents causing myocarditis?
    • Coxsackie A and B (virus)
    • Enterovirus
    • Trypanosoma cruzi (nonviral)
  29. What is the gross morphology of myocarditis?
    • Normal or dilated
    • Flabby ventricles (advanced stage)
  30. What is the microscopic morphology of myocarditis?
    Interstitial inflammatory infiltrate
  31. Vegetations can be a source of systemic _____________________ and cause ___________________
    • Emboli
    • Stroke
  32. Noninfected vegetations appear for which conditions?
    • Nonbacterial thrombotic endocarditis
    • SLE
  33. Which patients are more prone to getting noninfected vegetations?
    Patients with cancer or sepsis
  34. What kind of fluid is found in pericardial effusions?
    • Serous fluid
    • Blood
    • Pus
  35. How does disease progression change in slow pericardial effusion vs rapid pericardial effusion?
    • Slow: gives pericardium time to expand so does not disrupt cardiac function
    • Rapid: causes hemopericardium
  36. ________________________ is blood mixed with fibrinous or suppurative effusion and often follows cardiac surgery
    Hemorrhagic pericarditis
  37. What are the most frequent 2 types of pericarditis?
    Fibrinous and serofibrinous pericarditis
  38. What do you hear with a fibrinous pericarditis?
    Loud pericardial friction rub
  39. __________________ is TB until proven otherwise
    Caseous pericarditis
  40. What are the three types of cardiomyopathies?
    • Dilated cardiomyopathy (most common)
    • Hypertrophic cardiomyopathy
    • Restrictive cardiomyopathy
  41. What is dilated cardiomyopathy?
    Dilation of ventricle (usually left) in the absence of other conditions that can cause dilation
  42. What is the usual age group for dilated cardiomyopathy?
    20-50 year old
  43. What is the most common cause for hypertrophic cardiomyopathy?
    Mutation in genes that encode sarcomeric proteins in cardiac muscle
  44. What is the gross morphology of a heart with dilated cardiomyopathy?
    • Enlarged heart with ventricular hypertrophy
    • Dilation of all chambers
    • Mural thrombi
    • No valve alterations
  45. What is the gross morphology of a heart with hypertrophic cardiomyopathy?
    • Myocardial hypertrophy WITHOUT ventricular dilation
    • Asymmetric septal hypertrophy
    • Banana like configuration (because LV compressed)
  46. What are the microscopic findings in hypertrophic cardiomyopathy?
    Myofiber disarray
  47. Restrictive cardiomyopathy results in impaired…
    Ventricular filling during diastole
  48. What is a disease associated with restrictive cardiomyopathy?
  49. What is the microscopic morphology of amyloidosis?
    Amyloid deposits viewed using Congo red (looks green under light)
  50. What are the different types of amyloidosis affecting the heart?
    • Systemic amyloidosis
    • Amyloidosis restricted to heart
  51. What is the most common primary cardiac tumor?
    Cardiac myxoma
  52. Where does a cardiac myxoma grow in the heart?
    Fossa ovalis in atrial septum
  53. What is the gross morphology of a cardiac myxoma?
    Sessile or pedunculated (can move)
  54. What can happen with a pedunculated cardiac myxoma?
    • Can move during systole into the AV valve
    • “ball valve” obstruction that can embolize
  55. What is the microscopic morphology of a cardiac myxoma?
    Myxoma cells in extracellular matrix
  56. What is the most common primary tumor of a pediatric heart?
  57. What mutations are associated with rhabdomyoma?
    TSC1 or TSC2
  58. What is the gross morphology of rhabdomyomas?
    Gray-white myocardial masses that involves multiple ventricles
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Path Review