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CR3 > Cardio-vascular Pathology > Flashcards

Cardio-vascular Pathology Flashcards

1
Q

Define HF

A

Inability of the heart to pump blood at a rate required of metabolising tissues

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2
Q

Examples of systolic dysfunction

A

IHD
Cardiomyopathy
Pressure or volume overload = systemic hypertension or AS

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3
Q

Examples of diastolic dysfunction

A

(inability to relax/fill)

  • amyloid
  • myocardial fibrosis
  • constrictive pericarditis
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4
Q

Frank-Starling Law

A

Stretching = increased contraction

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5
Q

Which mechanisms compensate dysfunction?

A
  • Starling law
  • hypertrophy = chamber dilatation
  • neurohormonal systems (noradrenaline, RAS, ANP)
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6
Q

Consequence of pressure overload

A

concentric hypertrophy

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7
Q

Consequence of volume overload

A

Cavity dilatation

Without thickening?

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8
Q

Consequence of hypertrophy

A

Capillary decrease
Fibrous tissue increase
Increased metabolic needs
Vicious cycle = failure

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9
Q

Left Sided Failure Define

A
  • due to peripheral pressure fall and pulmonary circulation damming
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10
Q

Symptoms of left sided failure

A

Lungs congested
Oedema
Dyspnoea, orthopnea, PND
Brain and kidneys affected if severe/hypoxia

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11
Q

Right Sided Failure Features

A

Secondary to LVF usually

Severe pulmonary HTN

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12
Q

Symptoms of right sided failure

A

Nutmeg liver = congested
Portal Vein pressure increase = splenomegaly, ascites
Kidneys and brain hypoxia
Peripheral oedema

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13
Q

Calculation for BP

A

CO x Peripheral Resistance

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14
Q

Renal causes of HTN

A 
CKD
Glomerulonephritis
APKD
RAS
Vasculitis
Renin tumour
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15
Q

Neurological causes of HTN

A

Stress
Psychogenic
Raised ICP

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16
Q

CV causes of HTN

A

Aortic coarctation
Systemic vasculitis
Increased intravascular volume or CO

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17
Q

Endocrine causes of HTN

A 
Cushings
Conns
Exogenous hormones
Phaeo
Acromegaly
Hyper/hypo thyroid
Pregnancy
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18
Q

What affects cardiac output?

A

HR
Contractility
Sodium, mineralocorticoids, atriopeptin

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19
Q

Hormone Constrictors

A 
Angiotensin II
Catecholamines
Thromboxane
Leukotrienes
Endothelin
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20
Q

Hormone Dilators

A

Prostaglandins
Kinins
NO

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21
Q

Neural constrictors

A

alpha-adrenergic

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22
Q

Neural dilators

A

beta-adrenergic

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23
Q

Local factors affecting peripheral resistance

A

Ions = pH, hypoxia

Autoregulation

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24
Q

How does HTN affect the heart?

A

LVH

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25
How does HTN affect vessels?
Atheroma Aortic dissection Cerebrovascular haemorrhages Degenerative changes = fibrointimal thickening
26
How does HTN affect small vessels?
Hyaline arteriosclerosis Hyperplasic arteriolosclerosis Fibrinoid necrosis
27
What is Cor pulmonale
Pulmonary HTN
28
Causes of cor pulmonale?
Disease of lung parenchyma (COPD, CF, DIF) Disease of pulmonary vessels (PEs, vasculitis, PH) Disorders of chest movement (neuromuscular disease, kyphoscoliosis) Disorders causing arterial constriction (chronic altitude sickness, hypoxaemia)
29
Features of cor pulmonale
``` Acute with massive PE Or chronic RV hypertrophy RA hypertrophy and dilatation Thickened R ventricle >0.5cm Tricuspid regurg ```
30
Vasculitis
inflammation of vessel walls Infectious or non Non are immune complex mediated = by ANCA, direct antibodies, cells, paraneoplastic or idiopathic
31
Anti GBM disease
Immune complex small vessel vasculitis | e.g = cryoglobinemia, IgA Henoch Schonlein, hypocomplementemic urticarial
32
ANCA Associated Small Vessel Vasculitis
Microscopic polyangiitis Wegners = granulomatosis with polyangiitis Churg Strauss = eosinophilic granulomatosis with polyangitis
33
Large vessel Vasculitis
Takayasu Arteritis | Giant Cell Arteritis
34
Medium Vessel Vascultiis
Polyarteritis Nodosa | Kawasaki Disease
35
Effects of vasculitis
Mural necrosis and haemorrhage Secondary ischaemia of down stream tissue May cause infarction Localised/organ specific/ systemic
36
Polyarteritis Nodosa Features
``` Systemic vasculitis Arteries Often spares lungs At branching sites Segmental necrotising inflammation of arteries = renal, cardiac, GI tract ```
37
Effects of polyarteritis nodosa
Aneurysms, infarcts, haemorrhage Transmural inflammation and fibrinoid necrosis (all 3 layers) Thrombosis of vessel Fibrosis becomes nodular
38
Polyarteritis Nodosa Presentation
``` Young Adults Episodic Fever, malaise, weight loss, HTN, abdo pain, melaena, muscular pain, renal involvement, peripheral neuritis Gangrene Migraine Liver infarcts No haematuria ```
39
Therapy for polyarteritis nodosa
Steroids | Cyclophosphamide
40
Causes of polyarteritis nodosa
Hep B Hep C Cryoglobulins
41
ANCA related vasculitis features
Systemic or renal limitied Flu like illness Fever, arthralgia, myalgia, purpura, peripheral neuropathy, GI Provoked by drugs = PPU, penciliiamine, hydralazine
42
Wegners granulomatosis geatures
``` URT/LRT Occular/ear Necrotising granulomas Vasculitis c-ANCA usually PR3 ```
43
Presentation of Wegners granulomatosis
``` Sore eye Sore ear Stuffy nose Sore joints Gangrene Permanent kidney failure Destruction of face Lung cavities and bleeds ```
44
How to treat ANCA associated vasculitis
Cyclophosphamide Steroids Aggressive otherwise 1 year mortality if untreated
45
Define cardiomyopathy
Cardiac disease from primary intrinsic myocardial abnormality Exclude ischaemia as a cause
46
3 main types of cardiomyopathy
Dilated - ventricles enlarge Hypertophic - walls thickened Restrictive - walls stiff but not necessarily thickened
47
Features of dilated cardiomyopathy
Contractile dysfunction valves/arteries normal mostly Thrombi Myocardial hypertrophy/fibrosis
48
Causes of dilated cardiomyopathy
``` Idio Genetic Post myocarditis Alcohol/toxicity Pregnancy associated Haemochromatosis Sarcoidosis ```
49
Presentation of dilated cardiomyopathy
20-50yrs LVF and RVF Death from failure or sudden arrhythmia
50
How to treat dilated cardiomyopathy?
Transplantation
51
Hypertrophic Cardiomyopathy Effects
Poor diastolic filling Outflow obstruction Disproportionate thickening of septal myocardium micro hypertrophy and fibrosis
52
Causes of hypertrophic cardiomyopathy
Beta myosin mutation (muscle protein) Familial Many different mutations
53
Treatment of hypertrophic cardiomyopathy
May need surgery
54
Restrictive cardiomyopathy causes
Idio | secondary to amyloidosis, sarcoidosis, tumour metastases
55
Features of restrictive cardiomyopathy
Dilated atria | Firm ventricles
56
Myocarditis define
inflammation causing myocardial injury and no response to it
57
Infections causing myocarditis
Enterovirus, HIV, chalmydia, rickettsiae, bacteria, fungi, protozoa
58
Immunological causes of myocarditis
SLE, drug reactions, transplant rejections
59
Other causes of myocarditis
Sarcoidosis, giant cell myocarditis
60
Features of myocarditis
Direct damage or T cell mediated to antigens of myocyte surface Inflammation Myocyte necrosis Fatigue, fever, chest discomfort, HF, arrhythmias, sudden death
61
What can myocarditis lead to
Dilated cardiomyopathy

CR3 (30 decks)

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