What are the 3 main things you see in RHD?
How is the diagnosis of rheumatic heart disease made?
Using the Jones criteria
What are the major criteria (Jones) to diagnose RHD?
In most cases of myocarditis, the heart tends to be ___________________, and there are presence of ____________________, which consist of ___________________
Aggregates of lymphocytes and macrophages
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
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)
What is the end result of having aortic stenosis?
Impedes flow from LV into aorta
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
What is the prenatal structure which forms the ligamentum teres after birth?
What are the 2 valves most affected in RHD?
Mitral and aortic valves
What is the cause of a primum type atrial septal defect?
Endocardial cushion defect
How does transposition of the great vessels affect blood flow?
Right to left shunting of blood
What condition does congenitally bicuspid valves most commonly cause?
Calcific aortic stenosis
Most cases of calcific aortic stenosis are in what age group?
What is the morphology of calcific aortic stenosis?
Masses of calcium within sinuses of valve
Which group of people are more predisposed to get calcific aortic stenosis earlier in life?
Those with congenitally bicuspid aortic valve
How does the heart change with aortic stenosis?
LV pressure rises and wall gets thicker (hypertrophy)
How is aortic stenosis treated?
Repair of valve or replacement
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
Which population does myxomatous degeneration of the mitral valve affect the most?
Mitral valve prolapse is a common feature of which condition?
How does a mitral valve prolapse present clinically?
Patients usually asymptomatic
Mid-systolic click on exam
What are the findings in chronic RHD?
Valvular stenosis and regurgitation
What are the clinical findings on infective endocarditis?
Describe the vegetations on heart valves in acute infective endocarditis
Prone to embolization
Contain virulent organisms
What is the most common organism causing subacute (chronic) infective endocarditis?
Describe the vegetations on heart valves in subacute infective endocarditis
Less valvular destruction
What are the most common agents causing myocarditis?
Coxsackie A and B (virus)
Trypanosoma cruzi (nonviral)
What is the gross morphology of myocarditis?
Normal or dilated
Flabby ventricles (advanced stage)
What is the microscopic morphology of myocarditis?
Interstitial inflammatory infiltrate
Vegetations can be a source of systemic _____________________ and cause ___________________
Noninfected vegetations appear for which conditions?
Nonbacterial thrombotic endocarditis
Which patients are more prone to getting noninfected vegetations?
Patients with cancer or sepsis
What kind of fluid is found in pericardial effusions?
How does disease progression change in slow pericardial effusion vs rapid pericardial effusion?
: gives pericardium time to expand so does not disrupt cardiac function
: causes hemopericardium
________________________ is blood mixed with fibrinous or suppurative effusion and often follows cardiac surgery
What are the most frequent 2 types of pericarditis?
Fibrinous and serofibrinous pericarditis
What do you hear with a fibrinous pericarditis?
Loud pericardial friction rub
__________________ is TB until proven otherwise
What are the three types of cardiomyopathies?
Dilated cardiomyopathy (most common)
What is dilated cardiomyopathy?
Dilation of ventricle (usually left) in the absence of other conditions that can cause dilation
What is the usual age group for dilated cardiomyopathy?
20-50 year old
What is the most common cause for hypertrophic cardiomyopathy?
Mutation in genes that encode sarcomeric proteins in cardiac muscle
What is the gross morphology of a heart with dilated cardiomyopathy?
Enlarged heart with ventricular hypertrophy
Dilation of all chambers
No valve alterations
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)
What are the microscopic findings in hypertrophic cardiomyopathy?
Restrictive cardiomyopathy results in impaired…
Ventricular filling during diastole
What is a disease associated with restrictive cardiomyopathy?
What is the microscopic morphology of amyloidosis?
Amyloid deposits viewed using Congo red (looks green under light)
What are the different types of amyloidosis affecting the heart?
Amyloidosis restricted to heart
What is the most common primary cardiac tumor?
Where does a cardiac myxoma grow in the heart?
Fossa ovalis in atrial septum
What is the gross morphology of a cardiac myxoma?
Sessile or pedunculated (can move)
What can happen with a pedunculated cardiac myxoma?
Can move during systole into the AV valve
“ball valve” obstruction that can embolize
What is the microscopic morphology of a cardiac myxoma?
Myxoma cells in extracellular matrix
What is the most common primary tumor of a pediatric heart?
What mutations are associated with rhabdomyoma?
TSC1 or TSC2
What is the gross morphology of rhabdomyomas?
Gray-white myocardial masses that involves multiple ventricles