1 - Pathology Flashcards
For Myocardial Infarction, describe:
1) Definition
2) Epidemiology
3) Etiology
4) Pathogenesis
5) Clinical Features
6) Pathological Features
7) Complications
1) myocardial cell death due to vascular occlusion
2) risk increasing with age, 10% athreloscerotic plaque erosion, hemorrhage, or rupture; ~10% due to vasospasm, embolism or small vessel obstruction (vasculitis, amyloidosis, sickle cell, etc)
4) ischemia –> ATP depletion –> loss of contractility (60sec); continued complete ischemia for 20-30 min = irreversible injury, but partial occlusion can be sustained for 2-4hrs before injury; necrosis is typically complete by 6hrs of severe ischemia
5) angina, dyspnea, nausea, diaphoresis, ECG changes (elevated ST), serum markers (CK-MB, Troponin I/C)
6) 6-12hrs = intercellular edema, little gross change; 18-24hrs= infarct becomes pale, coagulative necrosis w/ neutrophils; ~1wk=soft, yellow tissue, macrophages; 7-10d=granulation tissue at edges (red); 1-2mn=white fibrous tissue (scar)
7) depends on size and location of injury; loss of contractility, at times (15%) leading to cardiogenic shock; arrythmias; ventricular rupture (<10days), fibrous pericarditis (2-3d); embolism; aneurysm; extension
What are the elements of Virchow’s Triad?
1) Stasis
2) Endovascular Injury
3) Hypercoagulability
What are the common risk factors for a venous thromboemolism?
1) Stasis: immobility, acute illnes, spinal cord injury, long/cramped travel,
2) Endovascular injury: surgery, trauma
3) Hypercoagulable: Malignancy, estrogen/pregnant, DIC, Genetic (ATIII, SLE, Factor V Leiden)
What are the common signs and symptoms of venous thromboembolism?
DVT and PE could be asymptomatic
DVT - pain, swelling, redness
- asymmetric edema, erythema, Homan’s sign, phelgmasia cerulea dolm
ens, phlemasa alba dolens
PE - dyspnea, angina, hemoptysis,
- tachycardia, tachypnea, decreased breath sounds, pleuritic rub, JVD, tricuspid regurg
What are the principle means of diagnosis of venous thromboembolism?
History –> Wells(Canada) rules
Lab –> PaO2, platelet, D-Dimer, Troponin, BNP
Imagining –> ultrasound, ventilation-perfusion lung scan, CT angiography, MRI angiography, pulmonary angiogram, X-Ray
What are the main treatment options for venous thromboembolism?
Anticoagulation!
Short term - prevent embolization, promote fibrinolytic system,
Long term - prevent recurrance, prevent post-thrombotic syndrome and thromboembolic pulmonary hypertension
For Essential Hypertension, describe:
1) Definition
2) Risk factors
3) Diagnosis
4) Tx
5) Complications
1) sustained systolic pressure >160mmHg and/or diastolic pressure >90mmHg
2)African American>Caucasian>Asian; obesity; diabetes; age; oral contraceptive use; family history; excessive alcohol; cigarettes
3) requires three separate readings BP >140/90mmHg, or any single reading >170/110 mmHG –> essential HPTN is a diagnosis of exclusion
4) Therapeutic lifestyle modifications, diuretics, B blocker, ACE inhibitors, ARB, Ca Ch blocker, a-adrenergic antagonist
5) atherosclerosis, stroke, chronic kidney disease, LV hypertrophy, heart failure, retinopathy, dissection, IHD
4)
Describe the difference in presentation and tx of secondary vs essential hypertension.
Essential HPTN is idiopathic (92-94%), where secondary is caused by another disease. Most common are:
Renal disease - polycystic disease, chronic renal failure, atherosclerosis
Adrenocortical hyperfunction - adrenal tumors
Pheochromocytoma
Thyroid disfunction
CV disease - coarctation of aorta, polyarteritis nodosa
Pregnancy - eclampsia
Meds - glucocorticoids, cyclosporin
Tx is based on the underlying disease
Define malignant HPTN.
rapid increase in BP >240/120mmHG associated with organ damage
This presents in young AA males most often with LV hypertrophy, retinal hemorrhages, angina, dyspnea, headaches
For Arteriosclerosis, describe:
1) Definition
2) Risk factors
3) Pathogenesis
4) Tx
5) Complications
1) arterial wall thickening and loss of elasticity due to intimal thickening in med-large arteries
2)Major: hyperlipidemia, HPTN, smoking, diabetes, obesity
Minor: male, oral contraceptives, age, sedentary life style, stress, family history, infections
3)Endothelial injury -> macrophage/platelet aggregation -> smooth muscle hyperplasia/migration to intima -> macs form foam cells -> fibrous cap develops -> cap calcifies and ulcerates/ruptures -> platelets aggregate -> thrombosis
4) therapeutic lifestyle mod, stent, angioplasty, B blocker, ACE inhibitors, vessel grfts
5) MI, thromboembolism(PE, stoke, solid organ necrosis), coronary artery disease
For Infectious Endocarditis, describe:
1) Definition
2) Risk factors
3) Diagnosis
4) Tx
5) Complications
1) inflammation of the lining of the heart and valves
2) IE of normal hearts - acute - IV drug use and/or S. Aureus infection
IE of damaged hearts - subacute - bacteremia from oral surgery or poor dentition, surgery, prosthetic valve replacement,
3) present with constitutional symptoms, janeway lesions, Osler nodes, splinter hemorrhages, valve involvement – at least three positive blood cultures for same organism
4) IV antibiotics specific to the organism - S. Aureus, S. Epidydimis, Strep. Virridans, Strep Faeculum/Enterococcus, HACEK
5) CV disease, septic emboli,
For Dilated Cardiomyopathy, describe:
1) Definition
2) Presentation
3) Diagnosis
4) Tx
1) pathologic hypertrophy of all four hear chambers
2) alcohol abuse, thiamine def, coxsackie B virus, HIV, cocaine - presents with right or left heart failure –> decreased EF, JVD, edema, orthopnea, hepatomegaly, cardiomegaly
3) radiography indicates cardiomegaly and pulmonary congestion, Echocardiogram
4) digitalis, B-blockers, ACE inhibitors, ARB, diuretics, vasodilators
For Hypertrophic Cardiomyopathy, describe:
1) Definition
2) Presentation
3) Diagnosis
4) Tx
1) autosomal dominant with asymmetrical septal LV hypertrophy
2) syncope, dyspnea, S4 gallop, cardiomegaly, mitral regurg, ** pain relieved by squatting and exacerbated by exercise
3) radiograph - dilated LV, echo - asymmetrical hypertrophy, MR
4) B-Blocker/Ca Ch Blocker (lower HR), ICD installed for high risk patients,
For Restrictive Cardiomyopathy, describe:
1) Definition
2) Presentation
3) Diagnosis
4) Tx
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