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Clinical Pathology > Cardiovascular Disease 3 (Cardiovascular Pathology) > Flashcards

Cardiovascular Disease 3 (Cardiovascular Pathology) Flashcards

1
Q

What is Endocarditis?

A

Inflammation of the endocardium of the heart.

*Identifies by vegetation on valves

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2
Q

What are the 2 main forms of Endocarditis?

A

1) Infective Endocarditis

2) Non Infective Endocarditis

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3
Q

Describe Infective Endocarditis?

A

Infective Endocarditis is caused by the colonisation / invasion of the heart valves / chamber by a pathogen.

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4
Q

What are the features of acute infective endocarditis?

A
  • caused by highly virulent organisms.
  • Necrotizing, ulcerative and destructive lesions.
  • Hard to cure (requires surgery)
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5
Q

How is sub-acute infective endocarditis treated?

A

Antibiotics

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6
Q

What are the risk factors and causes of Infective Endocarditis?

A
  • Rheumatic Heart disease
  • Mitral Valve Prolaps
  • Valvular Stenosis
  • Artificial Valves
  • Congenital defects
  • Bicuspid Aortic valve
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7
Q

How does infection get to the heart? give examples of bacteria.

A

Bacteria via blood stream e.g.dental abnormalities. bowel lesions

  • Streptococcus Viridans (from mouth)
  • Staphylococcus Aureus
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8
Q

What are the charcteristics of the vegetations of acute Infective endocarditis?

A
  • Friable, bulky, destructive

- Often more than one valve

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9
Q

What are the symptoms of Infective Endocarditis?

A

1) FEVER
2) Flu like
3) Murmurs

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10
Q

What are the signs / symptoms of infective Endocarditis?

A
  • Janeway Lesions (lesions on palms / soles)
  • Osler’s nodes (nodules on digits)
  • Roth Spots (haemorrhage in eyes)
  • Spliner Haemorrhages (nails)
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11
Q

What is the pneumonic used to remember signs and symptoms of Infective Endocarditis?

A 
FROM JANE
Fever
Roth spots
Osler's nodes
Murmurs

Janeway lesions
Anaemia
Nail splinter/ haemorrhage
Emboli

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12
Q

Who is usually affected by non bacterial thrombotic endocarditis (NBTE)?

A

Debilitated patients
(cancer or sepsis)

It is associated with a hypercoagulable state e.g DVT, PE.

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13
Q

What are the vegatations of Non Bacterial Thrombotic Endocarditis like?

A
  • small
  • not invasive / inflammatory
  • 1 or many
  • In a line on the cusps
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14
Q

What is (Non Infective) Libman Sacks endocarditis?

What are the warts like?

A

Libman Sacks Endocarditis is associated with Systemic Lupus Erythematosis (SLE).

The MITRAL and TRICUSPID atrio-ventricular valves are affected.

With small warty vegetations on the AV valves and chordae tendinae.

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15
Q

What is rheumatic fever?

A

Rheumatic fever is an acute, IMMUNOLOGICALLY MEDIATED, Inflammatory disease following Group A Streptococcal Pharyngitis.

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16
Q

What causes rheumatic fever?

A

Group A Streptococcal Pharyngitis

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17
Q

What are the characteristic features of Rheumatic fever?

A

1) ASCHOFF BODIES are nodules that can be found in all 3 cardiac layers of the heart.
2) vegetations called VERUCCAE
3) MITRAL Stenosis
4) Fibrous bridging and calcification of valves&raquo_space;> (fishmouth stenoses)

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18
Q

What is the aetiology of Rheumatic fever?

A

1) An Immune response to group A streptococcal pharyngitis.
2) Antibodies directed against streptococci react with self antigens of the heart.
3) CD4+ T cells specific for streptococci react with the heart and produce cytokines that active macrophages which cause Aschoff bodies.

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19
Q

What is Pericarditis?

A

Inflammation of the pericardial sac

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20
Q

What are the causes of pericarditis?

Give examples of infective, immunological and miscellaneous causes.

A

1) Infection
- Virus (Coxsackie B)
- Bacterial, TB, fungi, parasites.

2) Immunologically mediated process
- Rheumatic fever,
- SLE,
- Sclerodema,

3) Miscellaneous
- ureamia
- cardiac surgery

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21
Q

What is serous pericarditis? And what causes it?

A

Serous Pericarditis is an acute inflammation of the pericardium that causes clear serous fluid accumulation.

Causes:

  • usually caused by non-infectious aetiologies.
  • inflammation in nearby structures can cause a pericardial reaction.
  • Immunological causes e.g. Rheumatic fever, SLE, scleroderma.
  • Miscellaneous e.g.uraemia, neoplasia.
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22
Q

What is serofibrinous / fibrinous pericarditis?

A

Serofibrinous or Fibrinous pericarditis is inflammation of the pericardium that has serous fluid and / or fibrinous exudate in the pericardial sac.

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23
Q

What is Dessler’s Syndrome?

A

Dessler’s Syndrome is secondary pericarditis that occurs as an autoimmune reaction weeks after an MI.

There are 3 factors:

1) Fever
2) Pleuritic chest pain
3) Pericardial effusion

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24
Q

What is the appearance of dry fibrinous pericarditis?

A

-dry, granular, roughened surface.

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25
Q

What is the appearance of purulent / suppurative pericarditis?

A

-Red, granular exudate

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26
Q

What is mediastino-pericarditis caused by?

A

purulent/suppurative pericarditis

27
Q

What is haemorrhagic pericarditis?

A

BLOOD mixed with serous (watery) or suppurative (pus) effusion.

28
Q

What are the causes of haemorrhagic pericarditis?

A
  • Neoplasia (maligant cells in effusion)
  • Infections (e.g. TB)
  • Following cardiac surgery
29
Q

What is adhesive pericarditis?

A

Adhesive Pericarditis is chronic inflammation of the pericardium with FIBROSIS / STRINGY ADHESIONS that obliterate the pericardial cavity.

30
Q

What is adhesive mediastinopericarditis?

A

Obliterates the pericardial cavity WITH ADHERENCE TO SURROUNDING STRUCTURES

It causes cardiac hypertophy and cardiac dilation.

31
Q

What are the clinical features of pericarditis?

A
  • Sharp central chest pain
  • Pericardial friction rub
  • fever
  • (pericardial effusion, cardiac temponade)
32
Q

What is cardiomyopathy and what are the 4 main types?

A

Cardiomyopathy is a disorder of the heart muscle aka myocardium.

4 main types:

1) Dilated
2) Hypertrophic
3) Restrictive
4) Arrythmogenic right ventricular cardiomyopathy.

33
Q

What is dilated cardiomyopathy?

A

Progressive dilation of the heart leads to contractile (systolic) dysfunction.

34
Q

What are the characteristics of dilated cardiomyopathy?

A

-Flabby, dilated heart with fibrosis

35
Q

What are the causes of dilated cardiomyopathy?

A

1) Genetic:
2) Alcohol
3) SLE, scleroderma, thiamine deficiency, acromegaly

36
Q

At what age does dilated cardiomyopathy develop and what are the signs and symptoms?

A

Age 20 - 50.

-decrease in ejection fraction

-Shortness of Breath
-Fatigue
-

37
Q

What is the treatment for dilated cardiomyopathy?

A

Cardiac transplantation,

38
Q

What is hypertrophic cardiomyopathy and what are the characteristic featurtes?

A

Hypertophy of the left ventricular myocardium in the absence of hypertension.

Characterised by thick, stiff and hypercontracting LV.

39
Q

What is the cause of hypertrophic cardiomyopathy?

A

Genetic (most)

can be sporadic

40
Q

What are the clinical signs of hypertophic cardiomyopathy?

A
  • Decreased STROKE VOLUME (due to decreased chamber size / compliance of LV)
  • Obstruction to left ventricular outflow.
  • Dyspnoea (SoB)
  • Systolic ejection MURMUR
41
Q

What are the complications of Hypertrophic cardiomyopathy?

A
  • Atrial Fibrillation
  • Thrombus formation
  • Cardiac failur
  • Ventricular arrhythmias
  • sudden death
42
Q

What is the treatment of Hypertrophic cardiomyopathy?

A
  • Beta adrenergic blockers used to decrease heart rate and contractility.
  • Reduction of septum reduces outflow obstruction
43
Q

What is restrictive cardiomyopathy?

A
  • Decrease in ventricular compliance results in impaired ventricular filling during diastole.
  • Can be caused by fibrosis, tumour ect..
44
Q

What is arrythmogenic right ventricular cardiomyopathy?

A

it is a genetic disease. causing Right Ventricular dilation and myocardial thinning.

There is FIBROFATTY replacement of the right ventricle and disorder to the cell to cell desmosomes.

45
Q

What are the signs of Arryhtmogenic right ventricular cardiomyopathy?

A
  • syncope,
  • chest pain
  • palpitations
  • sudden cardiac death
46
Q

What is myocarditis?

A

Infection of the myocardium.

47
Q

What are the common causes of myocarditis?

Give one example for Viral, Bacterial, Protozoa,
Fungi and Immune

A

1) Viral:
- Coxsackie A&B viruses
- ECHO
- Infulenza
- HIV
- CMV

2) Bacterial
- C.Diptheriae
- N.Meningococcus
- Borrelia

3) Protozoa
- Chagas diasease

4) Fungi
- Candia
- histoplasma

5) Immune
- SLE

48
Q

What is vasculitis?

A

Inflammation of the vessel walls

49
Q

What is Giant Cell Arteritis and what is its pathology?

A

GCA is the most common form of vasculitis.

There is chronic granulomatous inflammation in the large to medium sized arteries,

50
Q

What arteries are particularly involved in Giant Cell arteritis?

A
  • Arteries in the head
  • Vertebral
  • Opthalmic (can cause permenant blindness)
51
Q

What is the morphology (charcterisics) of giant cell artertis?

A
  • Intimal thickening (reduces the lumenal diameter)
  • granulomatous inflammation
  • multinucleated giant cells
52
Q

What are the clinical signs / symptoms of Giant cell arteritis?

A

-Facial pain / headache

53
Q

What is an aneurysm?

A

Localised, permanent, abnormal DILATIONS OF BLOOD VESSEL

54
Q

What are the complications of Aortic Aneurysms?

A
  • Rupture causing retroperitoneal haemorrhage.

- Embolism causing limb ischaemia

55
Q

What is a dissecting aneurysm?

A
  • Tear in the wall

- Blood tracks between intimal and medial layers

56
Q

What are the classical symptoms of a dissecting aneurysm?

A

-tearing pain in chest radiating to upper left shoulder.

57
Q

What are berry aneurysms/

A
  • Small saccular lesions that develop in the circle of wilis.
  • develop at sites of weakness where arteries bifurcate.
58
Q

What type of brain haemorrhage can a rupture of a circle of willis berry aneurysm cause?

A

-Subarachnoid Haemorrhage

59
Q

Where do Charcot-Bouchard aneurysms occur? and what type of brain haemorrhage can occur on rupture?

A

Intracerebral capillaries in hypertensive disease.

Intracerebral haemorrage.

60
Q

What are mycotic aneurysms?

A

Weakening of the arterial wall secondary to a bacterial or fungal infection.

61
Q

What are the causes of arterial occlusion?

A 
Embolus from:
artial fibrillation
MI
Endocarditis
Valvular disease,

Thrombosis from:
Atherosclerosis

62
Q

What are the 6Ps that indicate acute ischaemia?

A

1) Pale
2) Pulseless
3) Painful
4) Paralysed
5) Parasthetic
6) Perishingly cold

63
Q

What are the clinical consequences of chronic peripheral vascular disease?

A

1) Intermittent Claudication

2) Critical Limb ischaemia (Rest pain and tissue loss)

Clinical Pathology (59 decks)

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