Heavy on neoplasia

Heart- myocarditis, myocardia infarction

Myocarditis
Biventriclar heart failure in yon with no valve, rhematic or congenital
heart disease
Diffuse myocardial degereation with necrosis
Often caused by viral and coxsackievirus is cause
Heart disease
Ischemic 80%
Atherosclerotic narrowing of coronary artery
Angina pectoris
Stable : exertion, nitroglycerin
Unstable: at rest, imminent infaction, embolism
Prinzmetal: intermitten chest pain ar rest/
MI
Improtant cause of morbidity from IHD
L anterior descending and Coronary artery occlusion= necrosis
Cells involved : neutrophil, macrophage and fibroblast
Two patterns
Transmural= entire vetnricular wall
Subendocardial= 1/3 interior wall of LV
Arrytmia = common cause of death in infarction
Chronic IHD
HTN
Cor plmonale
Pulomnary obstruction causing right heart failure -> cause nut meg liver
Valve disease
congenital
Ch 11 and 12 - from lecture

Aspiration pneumonitis- what happens with lung abcess - outcome

regurgitation while unconscious
neuromuscular disease
chemical & mixed infective damage
i.e. stomach contents
gastric acid can cause ARDS
food: foreign body reaction
organisms

Valve- mitral and aortic -> crucial

Valvular diesaese occur as late result of rheumatic fever
Strep. pyogenes)
Mitral valve=
Prolapse is frequent lesion
Myxoid degeneration=> mitral valve leaflet = floppy -> systolic mrmur
Predispose infective endocarditis
Aortic valve
Stenosis
Calcific aortic stenosis => degenerative calcific aortic stenosis

Liebman sacks= occur in systemic lpus erythematous, small vegetation on valve

leaflet, type 3 complex hypersensitivity

Aschoff body= rheumatic fever, myocardial inflammation

Are they vegetations? YES

 Use tempreature (afibrilie? -> old infection damage)
Infectio and high temperature => what would casue acute(high virulence =
staph) or subacute (Strep viridian = low virulence)
Mitral valve involed
MV with aortic valve
Tricspid
Possible vegetation = distal embolization => cause septic infacts
-> cocaine, heroin (foreign object) and IV drugs: can cause infective endocarditis

Heart tumor #1 = metastatic, myxoma of left atrium- most frequent cardiac

primary tumor (native?)
#1 in children= rhabdomyomas

Valve becomes fibrotic- fish eye/gullet?

Always look at nail bed -> cyanosis teralogy of fallot

Arrhythmia=> sudden cardiac death involving MI

Ischemic heart disease= what causes MI? Thrombosis => commonly Left coronary
Artery -widow maker

pericarditis:
Non inflammatory
Hydropericardium: serous transduate in percardial space = systemic
edema, CHF
Hemopericaridum= accumulation of blood from trauma in pericardial sac
Acute pericardidits
Seous= sle, rheumatic fever= protein rich exudate
Fibrinous or serofivrinous
Fibrin rich exudate
Caused by MI or acute rhematic fever
Purulent or suppurative- bacterial infection => inflammtory exdate
Hemorrhagic
Tumor invasion/ tuberculosis
Chronic pericarditis
Pyogenic staph or tuberculosis
Thickening and scarring of percardim - less elastic
Proliferation of fibrous tissue

how do you get the fluid out?

-> long gauge needle btw rib to get fluid
-> once heal= fibrotic => more pathology
friction rub

Environmental:
Niacin Deficiency: allegra -> 3 Ds 1) dementia 2) diarrhea 3) dermatitis
Thiamine: dri beriri=> polyneuropathy
Wet beri,beri-> edema
Riboflavin: cheilosis- cracked commisure
Seborrheic dermatosis: scaly skin
Glossitis: red tongue?
Vit A def = blindness
Vit C= scurvy
Vit d= Ca and P metabolism, ricketts and osteomalacia

Alcoholic: cirrotic-> exodontia (caput medusa) -> clotting factors 2,7,9 and 10
-=> vitamin K
Preventable causes of death, heart disease, obesity, life style change

How does lead enter=> ingestion, lead paint/toys

Asbestos- mesothelioma, coated with iron and calcium (ferroginous body

Radiation exposure= paradox-> chemotherapy oncogenic but used to treat
cancer (matter of degree)
-> causes thyroid and leukemia

Blood
=> lekemia = etiology unknown
Lesion of cell origin for lymphoid or hematopoetic
Myeloid
AML:
Adult
Poor response to therapy
Myeloblastic
CML
Philadelphia chromosme (9, 22)
Not aggressive until blast phase
Lymphoid
ALL
Children
Lymphoblast
Responsive to therapy
T cell receptor or B cell Ig gene
CLL
Prolifer from b cell
Older adult
Slow onset but rapid and fatal blast phase
=>myeloproliferative= erythrocytosis blood (myeloid) stem cell poly vera
make more RBC = Thicker blood => possible thrombosis
=> multiple myeloma = lesion in bone=> plasma cell malignancy, bone pain, M
protein spike= IgG and A

=> lymphoid
Hyperplasia: response to infection/inflammation
Hamartoma
Lymphood neoplasm- malignant
Hodgkin= reed sternburg + AWL Eyes => hodkins disease
Lymphoid predominance
Mixed cell
Lymp depleted
Nodular sclerosis: female, excellent prognosis
Non hodgkin
From native lympoid cells
Ann arbor: I - single node
I - single node
II- two roe more on same side of diaphragm
III bothe sides of diaphragm
IV- everywhere
Brkitts = starry sky, jaw of afican kid

=>hemophilia (well versed)

Several recessive bleeding disorders
Hemophilia A (Factor VIII) is more common
 Factor XIII, dz of hapsburg royal family, most common, x-linked
redessive= male, private mutant allele
Mild to severe bleeding - gingival, joints
TX by cryoprecipitated factor VIII, recombinate factor VIII
Hemophilia B (Factor IX, Christmas disease)
FActor IX/ x-linked/factor IX =longer half life
Usually associated with VWf= deficient or inhibition VWf release
Located in weibel-palade body of endothelial cell
Bind to platelet receptor-> promote platelet adhesion
Bleed in GI, nose, joint, muscle
Hemophilia C (Factor XI deficiency)

=> thelassemia (crucial!!!)

-> genetic disorder/ deficient kin alpha or beta chain of hemoblobin/
-> B-thalassemia: most common form/ classified as major intermediate and
minor
-> Major: anemia from decreased hemoglobin synthesis, shortened life of red
cell/
-> splenomegaly,
->Distortion of skull and facial bone: erythroid marrow expansion
-> microcytosis, hypochromia
Minor
-> from eterozgos inheritance
-> minimal hypochromic, microcytic anemia
-> iron deficiency
Alpha thalassemia
-> common in southeast asia
-> caused by deletion of one or more of the four alpha-globin gene
-> loss of 1 gene = silent carrier/ 2genes Alpha thal. Trait/ 3 genes,
hemoglobin H disesase/ 4 gene deletion= fatal
-> alpha thalassemia is less severe
Both sickle cell and thallassemia have 1) intact PDL, 2) coarse trabeculae 3)
thickened dipole of skull
Malaria= plasmonium ______