JCU MB4 Term 1 Week 1 (RHD)

1

11yo boy, leg pain on running. BP 165/90, radial pulse 4+, dorsalis pedis pulse 1+.

2

A 42-year-old woman with progressive lower extremity oedema is found also to have a prominent midsystolic flow murmur over the pulmonary area, jugular venous distention, and increased hepatic span. Her chest x-ray shows a prominent right heart border. An example of her cardiac lesion is shown. What is the diagnosis?

ASD

3

A 54-year-old man with hypertension and a 60-pack-year smoking history has prolonged chest pain radiating to his neck. He abruptly develops severe dyspnoea 3 days later. Examination revelas hypotension and tachycardia, with diffuse rales and a high-pitched holosystolic murmur radiating to the axilla. He dies in florid pulmonary oedema. A picture of his heart at autopsy is shown. What is the cause of pulmonary oedema?

Mitral valve papillary muscle rupture

4

13-year-old female, fever, joint pain. Heart specimen shown. What gross feature is shown?

Fibrinous pericarditis

5

22-year-old male, SOB 5y. Picture shows mitral valve. What is the diagnosis?

Chronic RHD - Mitral Valve

6

12-year-old female, fever 2 weeks, knee pain. Picture shows mitral valve. What is the diagnosis?

ARF - Mitral valve vegetations

7

26-year-old female, SOB. Picture shows the mitral valve, viewed from the left atrium. What is the diagnosis?

Chronic RHD - Mitral stenosis

8

10-year-old girl, 2 weeks following URTI develops skin nodules over elbow, friction rub, knee and hip joint pain. She is tired and weak. Which of the following serum findings is most characterist of this condition?

9

A 40-year-old woman with congential bicuspid valve receives an aortic valve bioprosthesis. Four months later, she develops a 3-week history of low-grade fever and malaise. She dies of an embolic cerebrovascular infarct. The bioprosthetic valve at autopsy is shown. What organism do you expect on blood cultures?

Bioprosthetic valve - endocarditis

10

16-year-old female, SOB. Picture shows the mitral valve. What complication is not shown?

ARF - Mitral Valve

11

A 13-year-old boy has been cyanotic since birth with a complex set of cardiac murmurs. Despite surgical shunts, he eventually requires cardiac transplantation; his explanted heart is shown. What congenital heart disease is present?

Fallot's Tetralogy

12

10-year-old female, chest tightness, SOB, pulmonary hyperflow. The patient is stable, afebrile and acyanotic. Pulse 88 BPM, sinus rhythm, ECG shows right axis deviation at V1, notched R-wave. Image shows appearance at surgery. What is the likely diagnosis?

Atrial Septal Defect

13

18-year-old female, fever, joint pain. Heart microscopy shown. What is the circled feature?

Aschoff body

14

18-year-old female, fever, joint pain. Heart microscopy shown. What is the feature indicated by arrow A?

ARF microscopy with marked features

15

A 13-year-old girl develops malaise and fever, an irregular circular rash, and forearm subcutanous nodules 3 weeks after a painful pharyngitis. A new heart murmur and friction rub are heard. Her mitral valve anterior leaflet would appear as shown. What is the diagnosis?

ARF with vegetations

16

A 48-year-old woman with a 5-year history of worsening orthpnoea is found on examination to have atrial fibrillation and a rumbling diastolic murmur with opening snap. The gross appearance of her heart at surgical valve replacement is shown. What are the possible complications?

Mitral Valve Stenosis

17

A 45-year-old man with a 6-year history of progressive exertional dyspnoea is found by echocardiography to have an ejection fraction 28% (normal is 50-60%) with systolic dysfunction and mitral regurgitation. His native heart after cardiac transplantation is shown. What is the diagnosis?

Dilated Cardiomyopathy

18

An infant girlwith a late systolic murmur has upper extremity pulses and blood pressures greater than in her lower extremities. She also has a webbed neck and short fourth metacarpals. If an autospy were performed at this point, we might see a heart and great vessels as shown. What is the cardiovascular lession?

Coarctation of the aorta

19

One year after a myocardial infarction, a 65-year-old woman has congestive heart failure with an ejection fraction of 25% (normal is 50-75%). She has a sudden embolic stroke and dies; her heart is shown at autopsy. Explain the diminished cardiac output.

MI with long term complications

20

52-year-old female with T2DM, presented with fever for 2 weeks and SOB. Her mitral valve is shown in the images. What is the cause of her presentation?

Mitral valve - bacterial destruction

21

38-year-old male, died 7 days following sudden sever chest pain in the hospital. The image shows his heart at autopsy. What is the diagnosis?

Cardiac tamponade

22

A 30-year-old intravenous drug user with a 2-day history of fever is found to have coard systolic and diastolic murmurs, splenomegaly, and nail bed splinter haemorrhages. His CK-MB is elevated. He experiences sudden cardiac arrest. His aortic valve at autopsy is shown. Why did he die?

Endocardial infective vegetations