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Clinical Pathology > 29 Cardiovascular disease 2 > Flashcards

29 Cardiovascular disease 2 Flashcards

1
Q

Explain the pathogenesis of left sided heart failure:

A

Hypertension, valvular disease and MI increase cardiac work.
Hypertrophy then dilation lead to cardiac dysfunction.

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2
Q

What are the effects of left sided heart failure on other organs?

A

Kidneys: pre-renal azotemia, salt and fluid retention (low flow confused for low volume).
Brain: irritability -> coma.
Lungs: congestion, oedema, dys/orthopnea, PND, cyanosis.

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3
Q

Aetiology of right sided heart failure: (2)

A

Left heart failure.

Cor pulmonale.

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4
Q

Effects of right sided heart failure on other organs: (4)

A

Liver congestion.
Congestive splenomegaly.
Ascites.
Pleural + pericardial effusions.

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5
Q

What are the autopsy findings of congestive heart failure? (4)

A

Cardiomegaly.
Chamber dilation.
Hypertrophy of fibres.
BOXCAR nuclei.

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6
Q

What is aortic and mitral stenosis commonly caused by?

A

Rheumatic heart disease.

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7
Q

What is rheumatic heart disease?

A

Weeks after a group A strep infection, antibodies turn against heart glycoproteins.

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8
Q

What are the acute effects of rheumatic heart disease on the heart? (5)
Chronic? (3)

A

Inflamm, aschoff bodies, anitschkow cells, pancarditis, vegetations on chordae tendinae.
Thickened valves, commissural fusion and shortened chord tendinae.

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9
Q

What does arotic stenosis result in?

A

2x gradient pressure.

LVH, ischaemia, angina, CHF.

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10
Q

Describe mitral annular calcification:
Effect:
Who:

A

Calcification in mitral valve.
Usually no dysfunction.
Regurgitation if so.
F»M.

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11
Q

What are the causes of atrial regurgitations? (5)

A

Rheumatic, infectious.

Aortic dilatations: syphilis, RA, marfan’s.

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12
Q

What are the causes of mitral regurgitation? (4)

A

Mitral valve prolapse.
Infectious.
Fen-Pen (old anti obesity drug).
Calcification of mitral ring.

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13
Q

What is a mitral valve prolapse?
Epidemiology?
Clinical features?

A

Myxomatous degeneration associated with connective tissue disorders.
F»M.
Asymptomatic. Mid-systolic click. Occasional chest pain/dyspnea.
3%-infective endocarditis, sudden death.

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14
Q

How do you easily distinguish between L-R shunts and R-L shunts?
Which causes cyanosis, paradoxical emboli, pulmonary hypertension.

A

L-R: word starts with D. Pulmonary hypertension.

R-L: name starts with T. Cyanosis and paradoxical emboli.

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15
Q

What does the gene TBX5 lead to?

A

ASD, VSD.

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16
Q

Which defects in the valve walls lead to physiological R to L shunt during foetal period? (2)

A

Foramen ovale in the septum secundum.

Ostium secundum in the septum premum.

17
Q

What does the aorticopulmonary septum do?

A

Divides bulbus cordis and trunks into 2 main arterial trunks: aorta and pulmonary artery.

18
Q

What are the causes of an atrial septal defect?

A

90%: Secundum: defective fossa ovalis.
Premum: Mitral cleft next to AV valves.
Sinus venosus.

19
Q

Describe the pathology of a ventricular septal defect.

A

Most common defect.
Associated with Tetralogy of Fallot.
Membranous septum. If muscular - multiple holes are present.
Large develops pulmonary hypertension.

20
Q

Describe the shunt in a patent ductus arteriosus:

Treatment:

A

L to R. R to L as pulmonary hypertension approaches systemic pressure.
If isolated - close.
If vessel are transposed - keep open using prostaglandin E1.

21
Q

What is atrial-ventricular septal defect associated with?

A

1/3rd have Down’s syndrome.

22
Q

What are the defects seen in tetralogy of fallot? (4)

A

VSD.
Obstruction to right ventricular outflow.
Overriding aorta.
Right ventricular hypertrophy.

23
Q

What is transposition of the great arteries?

What is needed for survival?

A

Abnormal formation of septa.
RV thicker than LV.
Fatal unless shunt present: PDA/PFO is unstable, VSD is stable.

24
Q

What is truncus arteriosus and what does it produce?

A

Failure of separation of trunks arteriosus.
Associated with ventricular septal defect.
Systemic cyanosis and increased pulmonary flow.

25
Q

What is tricuspid atresia?

A

Blocked tricuspid valve with hypoplastic right ventricle.

Needs a shunt.

26
Q

Describe a Total anomalous pulmonary venous connection:

What does it need to survive?

A

Pulmonary veins don’t go into LA, but connect to vena cava. Hypoplastic left atrium.
Needs PFO or VSD.

27
Q

What are the causes of obstructive coronary heart disease?

3

A

Coarctation of the aorta.
Pulmonary stenosis/atresia.
Aortic stenosis/atresia.

28
Q

Epidemiology of coarctation of the aorta:

A

M>F. 50% have bicuspid aortic valve.

29
Q

What happens in 100% atresia of pulmonary valve?

A

Hypoplastic right ventricle and atrial septal defect.

30
Q

What happens in 100% atresia of aortic valve?

A

Hypoplastic left ventricle.

Fatal.

31
Q

What does the gene NKX2.5 lead to?

A

ASD.

32
Q

What effect does 22q11.2 deletion have on the heart?

A

Conotruncus.

Clinical Pathology (66 decks)

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