Cardio

Question 1

atherosclerosis definition

Answer 1

atheromatous deposits in the intima of arteries and inner layer fibrosis

Question 2

characteristics of atherosclerosis

Answer 2

intimal thickening
narrowing of lumen
lipid accumulation

Question 3

3 components of athersoclerotic plaque

Answer 3

ECM - collagen, elastin, proteoglycans
cells - smooth muscle cells, macrophages, T lymphocytes
lipids - both intra and extracellular

Question 4

modifiable risk factors

Answer 4

t2dm, hypertension, smoking, hypercholesterol

Question 5

non-modifiable

Answer 5

age, sex, family history,

Question 6

factors that make a plaque VULNERABLE (4)

Answer 6

1. high amounts of lipid/foam cells
2. thin fibrous cap
3. decreased amount of smooth muscle cells
4. large clusters of inflamm cells

Question 7

most common sites of atherosclerosis

Answer 7

infrarenal abdominal aorta, abdo aorta&raquo_space;> thoracic.

coronarys, popliteal, circle of willis

Question 8

where along a blood vessel is atherosclerosis most likely to form?

Answer 8

ostia (origins) of major branches as there will be increased turbulent flow - oscillatory shear stress - atherogenic

Question 9

an occlusive intracoronoary thrombus overlying a disrupted atherosclerotic plaque, leading to myocardial ischaemia

Answer 9

MI

Question 10

pathogenesis of MI

Answer 10

atherosclerotic plaque rupture –> platelet activation –> thrombosis –> vasospasm

Question 11

how long must ischaemia last before irreversible damage?

Answer 11

20-40min

myocyte death

Question 12

mechanical complications of MI

Answer 12

1. contractile dysfunction - cardiogenic shock
2. ventricular dysfunction - cardiogenic shock
3. LV infarct and papillary muscle damage - mitral regurg
4. cardiac rupture - R>L shunts, haemopericardium

Question 13

> 4 weeks post MI with persistent ST elevation

Answer 13

ventricular aneurysm

Question 14

how many patients develop arrythmia post MI

Answer 14

90%

Question 15

arrythmia causing death in <24hr post MI

Answer 15

VF

Question 16

chest pain, fevers, and effusion weeks after MI

Answer 16

Dressler’s syndrome

Question 17

histological findings 6hrs post MI

Answer 17

normal

Question 18

Most commonly affected vessel in MI

Answer 18

LAD 50%
RCA 40%
LC 10-20%

Question 19

evolution of MI (cells)

Answer 19

no more atherogenic food

neutrophils, macrophages, angioblasts, fibroblasts

Question 20

6-12 hours post MI - histology

Answer 20

oedema and necrosis. homogenous

Question 21

1-4 days post MI

Answer 21

PMN infiltration

Question 22

5-10 days

Answer 22

macrophages - clear up debris

Question 23

1-2 weeks

Answer 23

granulation, angiogenesis, collagen deposition

Question 24

weeks-months

Answer 24

cellularising, scarring, strenthening. myofibroblasts

Question 25

Reperfusion injury in MI is caused by:

Answer 25

oxidative stress, CA overload and inflammation
can cause arrythmia and stunned myocardium
reversible

Question 26

complication of mural thrombus

Answer 26

can embolise

bowel ischaemia is common

Question 27

liver histology seen with Right sided heart failure

Answer 27

nutmeg liver - cirrhosis

Question 28

signs of RVH systemically

Answer 28

engorgement of systemic vasculature
peripheral oedema
ascites
facial engorgement

Question 29

signs of LVH

Answer 29

breathless, orthopnoea, PND, wheeze, fatigue, pulmonary oedema.

Question 30

common cause of RVH

Answer 30

2ry to LVH

can also be caused by chronic massive pulmonary hypertension

Question 31

histology of heart failure

Answer 31

replacement of myocardium with fibrotic tissue

Question 32

3 types of cardiomyopathy

Answer 32

1. too thick - hypertrophic
2. too thin - dilated
3. too stiff - restricted

Question 33

large heart with loss of myocytes

Answer 33

dilated cardiomyopathy

Question 34

normal sized heart with large atria

Answer 34

restrictive cardiomyopathy

Question 35

large hypertrophic left ventricle

Answer 35

hypertrophic cardiomyopathy

Question 36

main problem in restrictive cardiomyopathy

Answer 36

reduced ventricular compliance leading to restricted filling of the heart

Question 37

causes of restrictive CM

Answer 37

1. idiopathic

2. 2ry to myocardial disease - amyloid, sarcoid

Question 38

causes of HOCM

Answer 38

50% AD genetic disorder in B myosin chains

Question 39

causes of DCM

Answer 39

idiopathic, infective , toxic, hormonal, genetics

Question 40

which valve is usually implicated in Rheumatic fever

Answer 40

mitral

Question 41

causative organism of Rheumatic

Answer 41

Lancefield group a strep

Question 42

pathogenesis of rheumatic heart disease

Answer 42

antigenic mimicry leading to GAS-abs crossreacting with myosin protein on cardiac tissue

Question 43

Histological findings in Rheumatic fever heart disease

Answer 43

vegetations
Aschoff bodies (small giant cell granulomas)
Anitschkov myocytes (regenrating myocytes)

Question 44

Rx of RhF

Answer 44

BenPen

Question 45

large irregular masses on valve cusps, extending into chordae.

Answer 45

Infective endocarditis.

Question 46

small bland vegetations formed of thrombi. associated with DIC/hypercoagulable states

Answer 46

non-bacteral thrombotic endocarditis

Question 47

small, warty vegetations ‘verrucae’ along lines of valve closure leaflets

Answer 47

Rheumatic valve disease

Question 48

small, sterile warty vegetations which are platelet rich. associated with SLE and APL

Answer 48

Libman-Sacks