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Pathology Year 2 > 8. Heart & Blood Vessels – The Rest > Flashcards

8. Heart & Blood Vessels – The Rest Flashcards

1
Q

Introduction

A

Heart Disease (Cardiac Disease)
Blood Vessel Disease (Vascular Disease)
Disease present from birth (Congenital Cardiovascular
Disease)

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2
Q

Cardiac Disease

Vascular Disease

A 
Ischaemia and MI (previously covered)
Cardiac Failure
Valvular Heart Disease
Pericarditis and Myocarditis 
Unusual Cardiac Diseases

Congenital Cardiovascular disease

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3
Q

Vascular Disease

A 
Atherosclerosis (previously covered)
Aneurysms
Hypertension
Diabetic Vascular Disease   
Vein Diseases
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4
Q

Cardiac Failure

A

What is the normal function of the heart?
What is a syndrome?
Heart unable to pump blood at rate required for normal functioning

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5
Q

What happens when the heart does not pump as effectively as it should?

A

Oedema – pulmonary and peripheral

Tiredness

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6
Q

Many Causes

A 
Ischaemic Heart Disease
Hypertension
Valvular Heart Disease
Arrhythmias
Congenital Heart Disease
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7
Q

Cardiac Failure

A

Initially the heart ‘Compensates’

Leads to cardiac hypertrophy and/or dilatation, and eventual inability to maintain normal

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8
Q

Cardiac Failure

A 
Symptoms/Signs:
Shortness of breath (SOB) 
Fatigue 
Fluid in lungs (Pulmonary Oedema)
All-over, excessive, fluid-filled veins (Systemic Venous Congestion & Oedema)
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9
Q

Classification

A

Acute vs Chronic

Left vs Right Vs both sided (congestive)

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10
Q

Treatment

A

Treat the underlying cause

There are a range of medicines used to help control heart failure

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11
Q

What does a valve do?

A

A valve regulates flow in one direction only

Think how this works in the heart

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12
Q

Valvular Heart Disease - Mechanisms (1)

A

Stenosis - Failure to open completely, impeding forward flow

Incompetence/Regurgitation - Failure to close, allowing reverse flow

Vegetations – abnormal tissue growth on valve (fibrin, platelets & bacteria)

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13
Q

Valvular Heart Disease - Mechanisms (2)

A

Most common disease - stenoses of the aortic and mitral valves
Account for 2/3rds of all valve disease
Valvular stenosis mainly due to primary valve cusp abnormality, a chronic process
Valvular regurgitation may result from disease of cusps but also damage to supporting structures (tendinous cords, papillary muscles)
Vegetations can result from Infective Endocarditis & Rheumatic Fever

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14
Q

Valvular Heart Disease – Underlying Causes

A 
Infection – Endocarditis/Rheumatic disease 
Calcific aortic valve disease 
Age-related degeneration
Carcinoid Syndrome
Fibrosis & muscle rupture after MI
Heart failure
Hypertension
Congenital 
Prosthetic Heart Valves
Connective Tissue Disorders 
IV Drug use
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15
Q

Mitral Stenosis

A

Rheumatic Fever

Pulmonary hypertension
L atrial & R ventricular hypertrophy
Murmur

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16
Q

Mitral Incompetence

A

Rheumatic Fever
Dilatation of Mitral valve
Papillary muscle fibrosis & dysfunction
Degeneration of valve cusps

Variable Haemodynamic effect
Murmur

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17
Q

Aortic Stenosis

A

Calcific degeneration
Rheumatic fever

Murmur
L Ventricular hypertrophy
Angina, syncope, L ventricle failure or sudden death

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18
Q

Aortic Incompetence

A

Rheumatic Fever
Dilatation of aortic root
Rheumatological disorders

Murmur
Collapsing pulse
Angina
L Ventricular failure

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19
Q

Endocarditits (vegetations)

A 
Rheumatic Disease
Bacteria
Prosthetic Heart Valves
Calcific Valve Disease
IV Drug use

Malaise
Clubbing
Cardiac murmurs & failure
Arthralgia
Pyrexia
Skin lesions
Splenomegaly
Haematuria
Glomerulonephritis
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20
Q

Valvular Heart Disease

A 
Symptoms/Consequences of Valvular disease:
Differ with the site/type lesion
Stroke 
Arrythmias
Ventricular hypertrophy
Angina (Chest pain)
Syncope (Fainting)
Heart failure
Infarcts to kidneys and spleen
Poor prognosis once symptoms
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21
Q

Infective Endocarditis (1)

A

Endocardium is the inner lining of the heart and its valves.

Endocarditis is when this lining becomes infected/inflammed

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22
Q

Infective Endocarditis (2)

A

Infection occurs on the edge of heart valves
Vegetation is a mass of bacteria, fibrin, platelets
Right-sided in IV drug use
Left-sided in others

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23
Q

Infective Endocarditis (3)

A

Colonization of the heart valves or mural endocardium usually by bacteria
Streptococci (α haemolytic) affects abnormal valves usually after dental extraction / cleaning / bronchoscopy / tonsillectomy

Staph aureus affects previously normal valves, usually IV drug abusers

PROPHYLAXIS - Imperative to give antibiotics to those at risk of developing endocarditis prior to any procedure that may produce a bacteraemia

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24
Q

Clinical Presentation

A

Sepsis
Heart Failure
New murmur

25
Pericarditis & Myocarditis (1)
Inflammatory Reaction involving the Heart Sac or Heart Muscle Many Causes: Viral, Bacterial, Parasitic, TB, Uraemia (urine products in blood) Carcinoma, MI, Post surgery, Drugs, Connective tissue disease, Unknown, Radiation
26
Pericarditis & Myocarditis (2)
Types: Acute Chronic Symptoms and Signs: Chest Pain Cardiac Failure Treatment: Anti-inflammatory Drugs Surgical Excision of the Pericardium
27
Unusual Cardiac Diseases
``` Cardiomyopathy Multisystem Diseases – like Sarcoidosis & Amyloidosis Thyrotoxicosis Myxoedema Alcoholism Pregnancy Iatrogenic (drug-induced) disease ```
28
Cardiomyopathy
Disease of heart muscle
29
Dilated
Idiopathic, alcohol, peripartum, genetic, myocarditis, sarcoid
30
Hypertrophic
Genetic, idiopathic, storage disease
31
Restrictive
Idiopathic, amyloidosis, radiation induced, chemotherapy related
32
Cardiac Dilatation | process of expansion/stretching
Dilation of chambers | Heart large and flabby
33
Hypertrophic Cardiomyopathy
Heavy, muscular, hypercontracting Abnormal diastolic filling 1/3 have intermittent left ventricular outflow obstruction End stage dilatation can occur Myocardial hypertrophy, disarray
34
Clinical Features of HCM
SOB, chest pain, palpitations, black-out Sudden death Atrial fibrillation 50% Familial, autosomal dominant with variable expression Genetic defect in 1 of 4 genes that encode cardiac contractile elements
35
Aneurysms
Localised, permanent, abnormal dilatation of a blood vessel Causes: Age, Atherosclerosis, Ischaemia, Hypertension, Inflammation, Diabetes, Autoimmune diseases, Bacteria, Bacterial Endocarditis, Fungus, Marfan’s Syndrome, Syphilis Treatment: Stents, Surgery, reducing arterial pressure
36
Atherosclerotic
``` Site: Lower abdominal Aorta & Iliac arteries Clinical Effects: Pulsatile abdominal mass Lower limb ischaemia Rupture, massive haemorrhage ```
37
Aortic Dissection
``` Site: Aorta & major branches Clinical Effects: Loss of peripheral pulses Haemopericardium External rupture – Haemorrhage Double-barrelled Aorta ```
38
Berry
Site: Circle of Willis | Clinical Effects: Subarachnoid Haemorrhage
39
Micro-Aneurysms
Site: Intracerebral capillaries | Clinical Effects: Intracerebral Haemorrhage, associated Hypertension
40
Syphilitic
Site: Ascending & arch of Aorta | Clinical Effects: Aortic Incompetence
41
Mycotic (infective)
Site: Root of Aorta & any vessel | Clinical Effects: Thrombosis or Rupture, causing Cerebral infarction or Haemorrhage
42
Hypertension (1)
(High Blood Pressure) But what is BP? BP is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats) Measured in millimeters of mercury - mmHg eg 120/80 mm Hg 120/80mmHg or lower is classed as normal BP
43
Hypertension Diagnosis
No universal definition of what exactly is high BP 140/90 offered 24hr ambulatory monitoring Categories: Mild: diastolic 95 – 104mmHg Moderate: 105 – 114mmHg Severe: >115mmHg
44
Hypertension (2)
Classified into causes: Primary (essential) hypertension 95% Secondary hypertension 5-10% Further classified Clinically: Benign hypertension Malignant hypertension
45
Risk Factors for Essential Hypertension
None Modifiable: Genetics- family history ``` Modifiable: Diet- high intake of sodium Lifestyle- stress & physical inactivity Weight- obesity Alcohol & Smoking - usage ```
46
Secondary Hypertension Causes
Renal eg Polycystic Kidney Disease Endocrine eg Thyrotoxicosis Vascular eg Raised intravascular volume Neurogenic eg Acute stress (surgery)
47
Clinical Classification of Hypertension
Benign Hypertension - Most remain stable over many years live a relatively normal life until/unless complications arise Malignant Hypertension - Accelerated Hypertensive disease 5% of cases Rapidly rising blood pressure 90% die in the first year!
48
Complications of Hypertension
``` Organs Affected: Blood vessels Heart Kidney Eyes (Retina) Brain ```
49
Complications of Hypertension: Blood Vessels
Large Blood Vessel disease (Macroangiopathy) Atherosclerosis Small Blood Vessel disease (Microangiopathy) Arteriolosclerosis Increased risk of rupture and dissection, & MI
50
Complications of Hypertension: Heart
Heart disease: Left ventricular hypertrophy Cardiac Failure Myocardial Infarction
51
Complications of Hypertension: Kidney
Benign nephrosclerosis | Renal failure
52
Complications of Hypertension: Eyes (Retina)
``` Hypertensive retinopathy Retinopathy Grades: Grade I Thickening of arterioles Grade II Arteriolar spasms Grade III Hemorrhages Grade IV Papilloedema (seen in Malignant Hypertension) ```
53
Complications of Hypertension: Brain
Cerebral haemorrhage | Cerebral infarction
54
Factors Indicating Adverse Prognosis in Hypertension
``` Male Young Black Ethnicity Smoker Persistent diastolic BP > 115 mm Hg Diabetes Hypercholesterolemia Obesity Excess alcohol ``` ``` Organ damage: Heart Kidney Eyes Brain ```
55
Diabetic Vascular Disease
Damage to Vessels Generally - Atherosclerosis Damage to Kidneys Damage to Nerves Damage to Retinas Complications such as: Gangrene Renal failure Blindness Effective control of Diabetes reduces disease!
56
``` Specifically Vein Diseases Venous Thrombosis (eg DVT) ```
``` When normal venous return is impeded, predisposes to Thrombosis Causes: Immobility Malignancy Pregnancy & Childbirth Oestrogens Haematological disorders IV cannulas ``` Danger of PE!
57
Specifically Vein Diseases | Varicosities
``` Common Problem Tortuous and Distended veins Cause Incompetent valves in legs Impaired venous return stasis oedema fibrin deposits around veins Often associated Ulceration – ankles and lower legs ```
58
Congenital Cardiovascular Disease – Commonest Types
Septal defects - Atrial or Ventricular Failure of blood vessel closure at birth - Patent Ductus Arteriosus Narrowed Aorta - Coarctation of the Aorta Valvular Abnormalities Vessels the wrong-way round - Transposition of the great vessels Coronary artery defects Multiple defects - Fallot’s Tetralogy

Pathology Year 2 (22 decks)

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