Cardiovascular disease 3 Flashcards by Rob Mackenzie

What is endocarditis and what is its clinical features?

Inflammation of heart endocardium. Prototypical lesion = vegetation on valves

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What are the two types of endocarditis?

Infective - clinically important!!

Non-infective

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What is infective endocarditis?

Colonisation/invasion of heart valves/chamber endocardium by microbes

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What is vegetation?

Thrombotic debris/organism which destroys/invades underlying cardiac tissue

Can invade prosthetic valves too!

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What are most endocarditis infections caused by?

Bacterial

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What is the difference between acute vs subacute?

Acute

nastyyyy
high virulent
necrotising, ulcerative and destructive
difficult to cure with antibiotics - surgery

Subacute

less virulent
Less destructive - insidious infection
Cured with antibiotics

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How is endocarditis caused?

Can occur in healthy heart but mainly with valvular/cardiac abnormalities…

rheumatic fever
MV prolapse
Valvular stenosis
congenital defects
prosthetic valves

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What are the three main bacteria that cause endocarditis?

S viridans (from mouth)** in native but damaged/abnormal valves

S Areus (from skin) esp IVDU

Staph epidermis commonly infect prosthetic valves

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What are the clinical features of infective endocarditis?

Fever (most consistent)
Unspecific - flu/weight loss
Murmur - 90% left sided IE

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What are the clinical signs of IE?

F - fever
R - Roth spots
O - Oslers Nodes
M - Murmurs

J - Janeway lesions
A - anaemia
N - nail (splinter) haemorrhage
E - Emboli

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What predisposes individuals to non-infective endocarditis?

Debilitation e.g. cancer patient
Hyper coagulated state
Endocardium trauma e.g. indwelling catheter/central line

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What are the characteristics of the vegetation in non bacterial thrombotic endocarditis (NBTE)

Small (1-5mm)
Not destructive
Sterile
Non-invasive/inflammatory
Systemic emboli

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What disease is non-infective endocarditis associated with?

SLE (lupus)

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What valves are affected by non-infective ‘Libman Sacks endocarditis’?

Tricuspid and mitral

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What is the characteristics of the vegetation of infective endocarditis?

Friable, bulky, destructive, more than one valve (virulent organisms)

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What are the characteristics of the vegetation of non bacterial thrombotic endocarditis?

Small, sit on cusps of valves only, not invasive/inflammatory

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What are the characteristics of the vegetation of non infective endocarditis Libman-sacks?

Small, AV valves on chordae, valvular endocardium or mural endocardium

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What is Rheumatic fever and what organism is it caused by?

Acute immunological mediated multistage disease (AUTOIMMUNE DISEASE)
- following group A strep pharyngitis

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What is a distinctive feature of Rheumatic fever?

Aschoff bodies

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What is it called when an infection infects all 3 layers?

Pancarditis

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What are the vegetations of rheumatic fever called?

Veruccae

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What valve is classically infected by rheumatic fever? What type of stenosis does it this called?

Mitral valve -Virtually ONLY cause of mitral stenosis

Fish mouth

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What type of condition is RF?

Autoimmune condition

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What happens with RF (the steps)

Antibodies produced against Strep A pharyngitis cross link with self antigens of the heart

CD4 cell against strep A pharyngitis react with proteins of heart - produce cytokines - macrophages - aschoff bodies

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How is rheumatic fever diagnosed?

Jones criteria

What can rheumatic fever cause in the long term?

- Left atrial dilatation - Right ventricular hypertrophy - Mitral thrombi - embolism?

What is pericarditis?

Inflammation of outside layer of heart, pericardium

What are the causes of pericarditis?

Infection - virus (COXSACKIE B - if in doubt..), bacteria, fungi, parasites Immunological - SLE, RF, Dresslers syndrome (late post MI), post-cariotomy Others - trauma, radiation, post MI (early)

What is the difference between acute and chronic pericarditis?

Acute - inflammatory Chronic - adhesive

What are the characteristics of serous pericarditis and what usually causes it?

Inflammation with serous fluid accumulation Usually non infective aetiology but can be caused by.. Virus (coxsackie) rare Immunological Other

What is serofibrous pericarditis and what is it usually caused by?

Inflammation with serous and/or fibrinous exudate -fibrinous = without fluid - dry, granular, roughened Caused mainly by acute MI or Dressler's syndrome

What is dressers syndrome and what are the 3 main characteristics?

Autoimmune condition occurring weeks/months after MI - FEVER - PLEURETIC CHEST PAIN - PERICARDIAL EFFUSION

What is purulent/supprative pericarditis caused by?

Infection (bacterial) - red, granular exudate i.e. pus complete resolution = rare - cause restrictive pericarditis

What is haemorrhage pericarditis and hat is it comply caused by?

Blood mixed with serous/supprative effusion Mainly caused by TRAUMA, neoplasia, cardiac surgery

What its chronic pericarditis characterised by?

Adhesion - fibrous/stringy adhesions

What is constrictive pericarditis?

Heart encased in fibrous shell (scar) - cardiac function limited and has to be treated surgically to correct

What are the clinical features of pericarditis?

Pleuritic chest pain - central chest pain Pericardial rub

What are the clinical complications of pericarditis?

**Pericardial effusion** | Cardiac Tamponade

What is cardiomyopathy and what are the 4 types?

Disease of the heart - dilated - restrictive - hypertrophic - Arrythrogenic right ventricular cardiomyopathy

What are the characteristics of Dilatation cardiomyopathy?

Dilatation with cardiac dysfunction - flabby, heavy, enlargement - Myocyte hypertrophy with fibrosis

What are the causes of dilation cardiomyopathy?

Genetic - mainly autosomal dominant - cytoskeleton protein gene mutation Alcohol/toxins

What is hypertrophic cardiomyopathy and what is its characteristics?

Myocardial hypertrophy WITHOUT hypertrophy - stiff/noncompliant left ventricular myocardium - diastolic dysfunction but systolic preserved - thick, heavy, hyper contractile - Main cause of LVH

What is the cause of hypertrophic cardiomyopathy?

100% genetic

What are the clinical features of hypertrophy cardiomyopathy?

- Reduced SV due to impaired diastole, reduced compliance and reduced chamber size - Left ventricular outflow obstruction - Exertional dysponea - Systolic heart murmur with LV outflow obstruction

What are the main complications of hypertrophic cardiomyopathy?

- AF - Mural thrombosis - arythmias - sudden death - most common cause!

What is the main treatment for hypertrophic cardiomyopathy?

Beta blockers

What is restrictive cardiomyopathy and what is its clinical features?

- Reduced ventricular compliance - Impaired ventricular diastole - Slight enlargement of chambers/hypertrophy - myocardium - reduced compliance

What happens with right arrythmogenic right ventricular cardiomyopathy and what are its clinical features?

- Genetic disease - RV dilatation and myocardial thinning - fibrofatty replacement of RV and disordered desmosomes - Exercise cause cell detachment and cell death - syncope, chest pain, palpitations, sudden death

What is myocarditis and what is the major cause?

Infective, inflammatory process of the myocrdiaim | - caused by infection - COXSACKIE A and B

What is vasculitis?

Inflammation of vessel walls - can affect any organ and any vessel - symptoms/signs dependent on vessel location/size

What is the classification of vasculitis based on?

Vessel size - large, medium, small

What is the most common form of vasculitis and what is its clinical features?

Giant cell vasculitis (aka temporal artiritis - affect large- medium vessels - Chronic granulamtous inflammation - especially in head (temporal artery)

When is giant cell vasculitis considered a medical emergency?

When it involves ophthalmic arteries - permanent blindness

What is the morphology of giant cell artiritis?

Intimal thickening (reduced luminal diameter) Granulomatous inflammation Multi-nucleated Giant cell

What are the clinical features of giant cell artiritis?

Headache Facial pain Jaw claudication (pain when chewing)

How to treat giant cell artiritis?

Corticosteroids

What are the most common type of aneurysm?

Atherosclerotic aneurysm (e.g. AAA)

What is the biggest risk factor for atherosclerotic aneurysm?

Size of aneurysm

What is a dissecting aneurysm? Where does it usually occur?

Tear in wall Blood tracks between intimal and medial layers - thoracic wall

What are the classical symptoms of dissecting aneurysm?

Tearing chest pain which radiates to upper left shoulder

What are Berry aneurysms?

small ,saccular lesions that develop in circle of Willis - bifurcations

What is the classical symptom of berry aneurysms rupture?

Thunderclap headache

What are mycotic aneurysms?

Rare; weakening of atrial wall by bacterial/fungal infection

What is a false aneurysm?

Blood filled space caused by trauma or perforating injury

what are the 6 Ps of acute ischaemia?

``` Pulseless Pale Painful Paralysed Parenthetic Perishingly cold ```