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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
Q

Pericarditis & Myocarditis (1)

A

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
Q

Pericarditis & Myocarditis (2)

A

Types: Acute
Chronic
Symptoms and Signs: Chest Pain
Cardiac Failure
Treatment: Anti-inflammatory Drugs
Surgical Excision of the Pericardium

27
Q

Unusual Cardiac Diseases

A 
Cardiomyopathy
Multisystem Diseases – like Sarcoidosis & Amyloidosis
Thyrotoxicosis
Myxoedema
Alcoholism
Pregnancy
Iatrogenic (drug-induced) disease
28
Q

Cardiomyopathy

A

Disease of heart muscle

29
Q

Dilated

A

Idiopathic, alcohol, peripartum, genetic, myocarditis, sarcoid

30
Q

Hypertrophic

A

Genetic, idiopathic, storage disease

31
Q

Restrictive

A

Idiopathic, amyloidosis, radiation induced, chemotherapy related

32
Q

Cardiac Dilatation

process of expansion/stretching

A

Dilation of chambers

Heart large and flabby

33
Q

Hypertrophic Cardiomyopathy

A

Heavy, muscular, hypercontracting
Abnormal diastolic filling
1/3 have intermittent left ventricular outflow obstruction
End stage dilatation can occur

Myocardial hypertrophy, disarray

34
Q

Clinical Features of HCM

A

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
Q

Aneurysms

A

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
Q

Atherosclerotic

A 
Site: Lower abdominal Aorta & Iliac arteries
Clinical Effects:
Pulsatile abdominal mass
Lower limb ischaemia
Rupture, massive haemorrhage
37
Q

Aortic Dissection

A 
Site: Aorta & major branches
Clinical Effects: 
Loss of peripheral pulses
Haemopericardium
External rupture – Haemorrhage
Double-barrelled Aorta
38
Q

Berry

A

Site: Circle of Willis

Clinical Effects: Subarachnoid Haemorrhage

39
Q

Micro-Aneurysms

A

Site: Intracerebral capillaries

Clinical Effects: Intracerebral Haemorrhage, associated Hypertension

40
Q

Syphilitic

A

Site: Ascending & arch of Aorta

Clinical Effects: Aortic Incompetence

41
Q

Mycotic (infective)

A

Site: Root of Aorta & any vessel

Clinical Effects: Thrombosis or Rupture, causing Cerebral infarction or Haemorrhage

42
Q

Hypertension (1)

A

(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
Q

Hypertension Diagnosis

A

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
Q

Hypertension (2)

A

Classified into causes:
Primary (essential) hypertension 95%
Secondary hypertension 5-10%

Further classified Clinically:
Benign hypertension
Malignant hypertension

45
Q

Risk Factors for Essential Hypertension

A

None Modifiable:
Genetics- family history

Modifiable: 
Diet-  high intake of sodium
Lifestyle-  stress & physical inactivity
Weight-   obesity
Alcohol & Smoking - usage
46
Q

Secondary Hypertension Causes

A

Renal eg Polycystic Kidney Disease

Endocrine eg Thyrotoxicosis

Vascular eg Raised intravascular volume

Neurogenic eg Acute stress (surgery)

47
Q

Clinical Classification of Hypertension

A

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
Q

Complications of Hypertension

A 
Organs Affected:
Blood vessels
Heart
Kidney
Eyes (Retina)
Brain
49
Q

Complications of Hypertension: Blood Vessels

A

Large Blood Vessel disease (Macroangiopathy)
Atherosclerosis

Small Blood Vessel disease (Microangiopathy)
Arteriolosclerosis

Increased risk of rupture
and dissection, & MI

50
Q

Complications of Hypertension: Heart

A

Heart disease:
Left ventricular hypertrophy
Cardiac Failure
Myocardial Infarction

51
Q

Complications of Hypertension: Kidney

A

Benign nephrosclerosis

Renal failure

52
Q

Complications of Hypertension: Eyes (Retina)

A 
Hypertensive retinopathy 
Retinopathy Grades:
Grade I   Thickening of arterioles
Grade II   Arteriolar spasms
Grade III  Hemorrhages 
Grade IV  Papilloedema (seen in Malignant Hypertension)
53
Q

Complications of Hypertension: Brain

A

Cerebral haemorrhage

Cerebral infarction

54
Q

Factors Indicating Adverse Prognosis in Hypertension

A 
Male
Young
Black Ethnicity
Smoker
Persistent  diastolic BP > 115 mm Hg
Diabetes  
Hypercholesterolemia 
Obesity 
Excess  alcohol 
Organ  damage:  
	Heart
	Kidney
        Eyes
	Brain
55
Q

Diabetic Vascular Disease

A

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
Q 
Specifically Vein Diseases
Venous Thrombosis (eg DVT)
A 
When normal venous return is impeded, predisposes to Thrombosis
Causes: 
Immobility
Malignancy 
Pregnancy & Childbirth 
Oestrogens 
Haematological disorders 
IV cannulas

Danger of PE!

57
Q

Specifically Vein Diseases

Varicosities

A 
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
Q

Congenital Cardiovascular Disease – Commonest Types

A

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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