Cardio-vascular Pathology Flashcards
Define HF
Inability of the heart to pump blood at a rate required of metabolising tissues
Examples of systolic dysfunction
IHD
Cardiomyopathy
Pressure or volume overload = systemic hypertension or AS
Examples of diastolic dysfunction
(inability to relax/fill)
- amyloid
- myocardial fibrosis
- constrictive pericarditis
Frank-Starling Law
Stretching = increased contraction
Which mechanisms compensate dysfunction?
- Starling law
- hypertrophy = chamber dilatation
- neurohormonal systems (noradrenaline, RAS, ANP)
Consequence of pressure overload
concentric hypertrophy
Consequence of volume overload
Cavity dilatation
Without thickening?
Consequence of hypertrophy
Capillary decrease
Fibrous tissue increase
Increased metabolic needs
Vicious cycle = failure
Left Sided Failure Define
- due to peripheral pressure fall and pulmonary circulation damming
Symptoms of left sided failure
Lungs congested
Oedema
Dyspnoea, orthopnea, PND
Brain and kidneys affected if severe/hypoxia
Right Sided Failure Features
Secondary to LVF usually
Severe pulmonary HTN
Symptoms of right sided failure
Nutmeg liver = congested
Portal Vein pressure increase = splenomegaly, ascites
Kidneys and brain hypoxia
Peripheral oedema
Calculation for BP
CO x Peripheral Resistance
Renal causes of HTN
CKD Glomerulonephritis APKD RAS Vasculitis Renin tumour
Neurological causes of HTN
Stress
Psychogenic
Raised ICP
CV causes of HTN
Aortic coarctation
Systemic vasculitis
Increased intravascular volume or CO
Endocrine causes of HTN
Cushings Conns Exogenous hormones Phaeo Acromegaly Hyper/hypo thyroid Pregnancy
What affects cardiac output?
HR
Contractility
Sodium, mineralocorticoids, atriopeptin
Hormone Constrictors
Angiotensin II Catecholamines Thromboxane Leukotrienes Endothelin
Hormone Dilators
Prostaglandins
Kinins
NO
Neural constrictors
alpha-adrenergic
Neural dilators
beta-adrenergic
Local factors affecting peripheral resistance
Ions = pH, hypoxia
Autoregulation
How does HTN affect the heart?
LVH
How does HTN affect vessels?
Atheroma
Aortic dissection
Cerebrovascular haemorrhages
Degenerative changes = fibrointimal thickening
How does HTN affect small vessels?
Hyaline arteriosclerosis
Hyperplasic arteriolosclerosis
Fibrinoid necrosis
What is Cor pulmonale
Pulmonary HTN
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)
Features of cor pulmonale
Acute with massive PE Or chronic RV hypertrophy RA hypertrophy and dilatation Thickened R ventricle >0.5cm Tricuspid regurg
Vasculitis
inflammation of vessel walls
Infectious or non
Non are immune complex mediated = by ANCA, direct antibodies, cells, paraneoplastic or idiopathic
Anti GBM disease
Immune complex small vessel vasculitis
e.g = cryoglobinemia, IgA Henoch Schonlein, hypocomplementemic urticarial
ANCA Associated Small Vessel Vasculitis
Microscopic polyangiitis
Wegners = granulomatosis with polyangiitis
Churg Strauss = eosinophilic granulomatosis with polyangitis
Large vessel Vasculitis
Takayasu Arteritis
Giant Cell Arteritis
Medium Vessel Vascultiis
Polyarteritis Nodosa
Kawasaki Disease
Effects of vasculitis
Mural necrosis and haemorrhage
Secondary ischaemia of down stream tissue
May cause infarction
Localised/organ specific/ systemic
Polyarteritis Nodosa Features
Systemic vasculitis Arteries Often spares lungs At branching sites Segmental necrotising inflammation of arteries = renal, cardiac, GI tract
Effects of polyarteritis nodosa
Aneurysms, infarcts, haemorrhage
Transmural inflammation and fibrinoid necrosis (all 3 layers)
Thrombosis of vessel
Fibrosis becomes nodular
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
Therapy for polyarteritis nodosa
Steroids
Cyclophosphamide
Causes of polyarteritis nodosa
Hep B
Hep C
Cryoglobulins
ANCA related vasculitis features
Systemic or renal limitied
Flu like illness
Fever, arthralgia, myalgia, purpura, peripheral neuropathy, GI
Provoked by drugs = PPU, penciliiamine, hydralazine
Wegners granulomatosis geatures
URT/LRT Occular/ear Necrotising granulomas Vasculitis c-ANCA usually PR3
Presentation of Wegners granulomatosis
Sore eye Sore ear Stuffy nose Sore joints Gangrene Permanent kidney failure Destruction of face Lung cavities and bleeds
How to treat ANCA associated vasculitis
Cyclophosphamide
Steroids
Aggressive otherwise 1 year mortality if untreated
Define cardiomyopathy
Cardiac disease from primary intrinsic myocardial abnormality
Exclude ischaemia as a cause
3 main types of cardiomyopathy
Dilated - ventricles enlarge
Hypertophic - walls thickened
Restrictive - walls stiff but not necessarily thickened
Features of dilated cardiomyopathy
Contractile dysfunction
valves/arteries normal mostly
Thrombi
Myocardial hypertrophy/fibrosis
Causes of dilated cardiomyopathy
Idio Genetic Post myocarditis Alcohol/toxicity Pregnancy associated Haemochromatosis Sarcoidosis
Presentation of dilated cardiomyopathy
20-50yrs
LVF and RVF
Death from failure or sudden arrhythmia
How to treat dilated cardiomyopathy?
Transplantation
Hypertrophic Cardiomyopathy Effects
Poor diastolic filling
Outflow obstruction
Disproportionate thickening of septal myocardium
micro hypertrophy and fibrosis
Causes of hypertrophic cardiomyopathy
Beta myosin mutation (muscle protein)
Familial
Many different mutations
Treatment of hypertrophic cardiomyopathy
May need surgery
Restrictive cardiomyopathy causes
Idio
secondary to amyloidosis, sarcoidosis, tumour metastases
Features of restrictive cardiomyopathy
Dilated atria
Firm ventricles
Myocarditis define
inflammation causing myocardial injury and no response to it
Infections causing myocarditis
Enterovirus, HIV, chalmydia, rickettsiae, bacteria, fungi, protozoa
Immunological causes of myocarditis
SLE, drug reactions, transplant rejections
Other causes of myocarditis
Sarcoidosis, giant cell myocarditis
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
What can myocarditis lead to
Dilated cardiomyopathy
