Pathology(heart)*
Terms
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- Right vent. hypertrophy and/or dilatation due to lung dse. or primary dse. of pulm. vasculature(primary pulm. HPN,emphysema);charact. by pulm. art. HPN(most common characteristic)
- Cor pulmonale
- Stage in the progression of MI in w/c Arrythmia is most likely to occur
- 0-6 hours
- Most common cause of left vent. hypertrophy
- HPN & aortic or mitral valvular dse.
- Cause of most deaths occuring during the early stages of acute rheumatic fever
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Myocarditis
-lead to cardiac failure - Noninflammatory dse. of the pericardium charact. by serous transudate in the pericardial space often caused by CHF or edematous conditions due to hypoproteinemia(nephrotic synd.,chronic liver dse.)
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Hydropericardium
-may result from any condition causing systemic edema - Stage in the progression of MI w/ the 1st appearance of neutrophils in viable tissue adjacent to the lesion
- After 12hours
- Stage in the progression of MI w/ the replacement of neutrophils by macrophage & phagocytosis of debris begins;yellow color of infarct
- By 3rd day
- Stage in the progression of MI w/ the beginning of growth of young fibroblast & newly formed vessels into the lesion;risk for myocardial rupture
- From 7days
- Stage in the progression of MI w/ well developed gay white scar;mature fibrous tissue replaces area of infarction
- Within 3-6months
- Multisystem infl. dse. w/ major cardiac manifestations affecting often children ages 5-15yrs.;charact. by transient mild migratory polyarthritis;occurs 1-4wks after infection of group A B-hemolytic streptococci
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Rheumatic Fever
-elevated titer of antistreptolysin O(ASO) is evidence of recent infection - Area of focal interstitial myocardial infl. charact. by fragmented collagen & fibrinoid material by large cells(Anitschkow myocytes) & multinucleated giant cells(Aschoff cells)
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Aschoff body
-classic lesion of rheumatic fever - Episodic chest pain caused by inadequate oxygenation of the myocardium
- Angina pectoris
- Most common form of angina precipitated by exertion & relieved by rest or vasodilators(nitroglycerin); results from sever narrowing of atherosclerotic coronary vessels
- Stable Angina
- Intermittent chest pain at rest caused by vasospasm
- Prinzmetal Angina
- Most imp. cause of morbidity from ischemic heart dse. charact. by myocardial coagulative necrosis caused by coronary art. occlusion;has 2 patterns of necrosis
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Myocardial Infarct
-separated into transmural infarct(traverses the entire vent. wall from the endocardium to epicardium) & subendocardial infarct(inf. 1/3 of the left vent. wall) - Complications of MI
- Arrythmia(most common cause of death in 1st few hours),Myocardial pump failure(lead to CHF or shock),Myocardial rupture(usually occurs w/ in 4-7 days;result in death from cardiac tamponade),Rupture of papillary muscle,Mural thrombosis, Vent. aneurysm
- Accumulation of bld. in the pericardial sac caused by traumatic perforation of the heart or aorta or by myocardial rupture assoc. w/ acute MI
- Hemopericardium
- Acute pericarditis charact. by a fibrin rich exudate caused by uremia, myocardial infarction, or acute rheumatic fever
- Fibrinous(serofibrinous)pericarditis
- Acute pericarditis commonly caused by bact. infection & charact. by purulent inflammatory exudate
- Purulent(suppurative)pericarditis
- Type of acute pericarditis assoc. w/ SLE,RHF, & a variety of viral infections charact. by production of clear,straw colored,protein rich exudate containing small #'s of inflammatory cells
- Serous Pericarditis
- Most common form of cardiomyopathy of unknown origin charact. by 4 chamber hypertrophy & dilataion w/ both right & left sided intractable heart failure
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Congestive(dilated)cardiomyopathy
-assoc. w/ alcoholism(alcohol cardiomyopathy),thiamine def(beriberi heart), or prior myocarditis - Cardiomyopathy caused by infiltrative process w/in the myocardium~stiffening of heart muscle w/c interferes w/ pumping action;cardiac amylodosis resulting in right&left sided heart failure
- Restrictive Cardiomyopathy
- Autosomal dominant cardiomyopathy charact. by hypertrophy of all chamber walls,especially the vent. septum(asymmetric septal hypertrophy), disoriented,tangled,& hypertrophied myocardial fibers
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Hypertrophic Cardiomyopathy
-results in left vent. outflow obstruction~syncope & sudden death w/c often occurs in young athletes - Dse. of the myocardiium presenting as biventricular heart failure in young people who do not have valvular,rheumatic,or congenital heart dse.charact. by diffuse myocardial degeneration & necrosis w/ an inflamatory infiltrate
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Myocarditis
-caused often by viral(coxsackievirus) infection - Acute pericarditis resulting from tumor invasion of the pericardium, tuberculosis or other bact. infxn. & charact. by bloody inflammatory exudate
- Hemorrhagic Pericarditis
- Pericarditis charact. by thickening & scarring of the pericardium~loss of elasticity~interferes w/ cardiac action & venous return~mimicking signs & symptoms of right sided heart failure
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Chronic(constrictive)pericarditis
-caused by tuberculous & pyogenic staphylococcal infxn. & marked by proliferation of fibrous tissue w/ occasional small foci of calcification - Refers to dse. of heart muscle that are noninflammatory,not assoc. w/ HPN, congenital heart dse.,valvular dse, coronary dse;charact. by unexplained vent. dysfunction(heart failure unresponsive to digitalis,vent. enlargement,vent. arrythmias)
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Cardiomyopathy
-classified into congenita(dilated), restrictive, & hypertrophic cardiomyopathy - Viral infxn. affecting preg. women in 1st trimester~congenital heart dse.(patent ductus arteriosus,aortic stenosis,vent.septal defect,pulmonary infundibular or valvular stenosis) along w/ microcephaly w/ mental retardation,deafness,cataracts, & growt
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Rubella(german measles)infxn.
-presence of IgM antibodies(indicates recent promary infxn) & IgG(indicates recent primary infxn,past infxn,& reinfection - Congenital heart dse. w/c present w/o cyanosis
- (Aortic stenosis,coarctation of the aorta)-no shunts;(Patent ductus arteriosus,atrial & vent. septal defect)-left to right shunts
- Congenital heart dse. w/c present w/ cyanosis
- Transposition of great vessels(survival depends on left-right shunt);Tetralogy of Fallot-right to left shunt;Left to Right shunts w/c reverse to right-left shunts due to inc. pulmonary art. press.(late cyanosis,cyanosis tardive)
- Most frequently occuring cardiac tumor found most often in adults
- Myxoma of the left atrium
- Most frequently occuring cardiac tumor in infants & young children notable for its assoc. w/ tuberous sclerosis
- Rhabdomyoma
- Atrial septal defect assoc. w/ mitral stenosis w/c is often of rheumatic origin
- Lutembacher synd.
- Congenotal heart dse. characterized by narrowing of the aorta(usaully distal to origin of subclavian art.) & development of collateral ciculation w/ dilataion of intercostal art.
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Coarctation of Aorta
-presents w/ HPN limited to upper extremities & cerebral vessels, notching of the ribs on x-ray;assoc. w/ Turner synd. - Congeniotal heart dse. due to failure of closure of the fetal ductus arteriousus;patent during fetal life due to low O2 & prostaglandin synthesis;can be closed sugically or pharma.(indomethacin)
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Patent Ductus Arteriosus
-if not closed~pulmonary HPN,right vent. hypertrophy,reversal of blood flow,late cyanosis;assoc. w/ living in high altitudes & rubella infxn - Chromosomal abnormality involving endocardial cushion defects~atrial & vent. septal defects w/ atrioventricular valve deformities
- Down Synd.(trisomy 21)
- Endocarditis resulting in thickened endocardial plaques involving the mural endocardium or valvular cusps of the right side of the heart
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Endocarditis of the carcinoid synd.
-caused by secretory products of tumors(serotonin,vasoactive peptides),rarely involves the left side bec. secretory products are detoxified in the lung - Charact. of rheumatic heart dse. in w/c the mitral & aortic valves often are affected by the form. of MacCallum plaque & warty,bead-like,rubbery vegetations(verrucae) along the lines of the closure of the valve leaflet
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Rheumatic Endocarditis
-verrucae are nonfriable,not a source of peripheral emboli;valves become thickened,deformed,fibrotic,calcified w/ fusion of valve cusps & thickening of the chordea tendineae - Noncardiac manifestations of acute rheumatic fever
- Fever,malaise,inc. erythrocyte sedimentation rate,arthralgia, arthritis,migratory polyarhtritis, skin lesions(subcutaneous nodules, erythema marginatum),Sydenham Chorea(involuntary,purposeless muscular movements,bizarre grimace,emotional lability)
- Bact.,rarely fungal,infxn. of the endocardium;involvement of valvular surface;charact. by large,oft,friable, easily detached vegetations; cmplicated by ulceration w/ perforation of valve cusps or rupture of one of the chordea tendineae
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Infective Endocarditis
-classified into Acute(caused by Staph. aureus-50%;2nd to infxn anywhere else in the body) & subacute(caused by Strep. virians-50%;occurs w/ congenital heart dse.,often rheumatic in origin) - Causes of right vent. hypertrophy
- Left vent. failure,chronic lung dse., mitral valve dse.,congenital heart dse w/ left to right shunt
- Complications of infective endocarditis
- Distal embolization(fragmented vegetation) resulting in septic infarcts in the brain & other organs; focal glomerulonephritis due to immune complex dse. or by septic emboli
- Nonbacterial thrombotic endocarditis(marantic endocarditis)
- Assoc. w/ debilitating disorders(metastatic cancer,wasting conditions resulting in peripheral embolization(sterile emboli);charact. by sterile fibrin deposits along the line of closure of valve leaflets
- Endocarditis w/c occurs in SLE charact. by small vegetations on either of both surfaces of the valve leaflets
- Libman-Sacks Endocarditis
- Causes & manifestations of left sided heart failure in CHF
- (Ischemic heart dse.,hypertension, aortic & mitral valvular dse., myocardial dse.)-cause;(dyspnea & orthopnea due to pulm. congestion & edema,pleural effusion w/ hydrothorax, dec. renal perfusion,cerebral anoxia)-manifestations
- Causes of right sided failure in CHF
- Left sided heart failure(most common),left sided lesion(mitral stenosis),pulmonary HPN due to chronic lung dse.(corpulmonale), cardiomyopathy,diffuse myocarditis, tricuspid or pulmonary valvular dse.
- Clinical manifestations of right sided heart failure
- Renal hypoxia~fluid retention, peripheral edema(pitting edema of ankles),pleural effusion,ascites, hydrothorax(also in left sided failure);enlarge & congested liver & spleen;distention of neck veins
- Most frequent valvular lesion,often in young women,charact. by myxoid degeneration of the ground substance of the valve(component of Marfan synd.)~stretching of post. mitral valve leaflet~floppy cusps(parachute def.) w/ prolapse into the atrium during sy
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Mitral Valve Prolapse
-benign,asymptomatic~mitral insufficiency;assoc w/ arrythmias & predisposes to infective endocarditis - Causes of mital valve insufficiency
- Rheumatic heart dse.,mitral valve prolapse,infective endocarditis,damage to pappilary muscle due to MI,due to left vent. dilatation w/ stretching of the mitral valve ring
- Causes of aortic valve stenosis
- Degenerative calcific aortic stenosis(most common cause >60yrs;used when valve is 3 cusps),Congenital bicuspid aortic valve,Rheumatic heart dse.(fusion of the valve commisures)
- Common causes of aortic valve insufficiency
- Nondissecting aortic aneurysm(cystic medial necrosis),Rheunatic heart dse.(assoc w/ mitral valve),Syphilitic aortitis(dilatation of aortic valve ring)
- Congenital heart dse. w/c may close spontaneously,lead to pulmonary hypertension~right sided heart failure;reversal of flow & late cyanosis
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Ventricular septal defects
-vary in size - Congenital heart dse. characterized by the aorta arizing from the right vent. & pulmonary art. from the left vent; patent ductus arteriosus necessary for survival
- Transposition of the great vessels
- Atrial septal defect w/c affects lower part of the septum;if large~assoc. w/ deformaties of atrioventricular valves
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Septum Primum
-presents in adult life w/ pulmonary HPN,reversal of flow~cyanosis;can lead to paradoxic embolism - 2 types of atrial septal defect w/c affects the fossa ovalis & one w/c affects the upper part of the septum near the entrance of the superior vena cava
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Septum secundum & Sinus venosus
-presents in adult life w/ pulmonary HPN & reversal of flow~cyanosis;can lead to paradoxic embolism