Cardiovascular Disease 3 (Cardiovascular Pathology) Flashcards
What is Endocarditis?
Inflammation of the endocardium of the heart.
*Identifies by vegetation on valves
What are the 2 main forms of Endocarditis?
1) Infective Endocarditis
2) Non Infective Endocarditis
Describe Infective Endocarditis?
Infective Endocarditis is caused by the colonisation / invasion of the heart valves / chamber by a pathogen.
What are the features of acute infective endocarditis?
- caused by highly virulent organisms.
- Necrotizing, ulcerative and destructive lesions.
- Hard to cure (requires surgery)
How is sub-acute infective endocarditis treated?
Antibiotics
What are the risk factors and causes of Infective Endocarditis?
- Rheumatic Heart disease
- Mitral Valve Prolaps
- Valvular Stenosis
- Artificial Valves
- Congenital defects
- Bicuspid Aortic valve
How does infection get to the heart? give examples of bacteria.
Bacteria via blood stream e.g.dental abnormalities. bowel lesions
- Streptococcus Viridans (from mouth)
- Staphylococcus Aureus
What are the charcteristics of the vegetations of acute Infective endocarditis?
- Friable, bulky, destructive
- Often more than one valve
What are the symptoms of Infective Endocarditis?
1) FEVER
2) Flu like
3) Murmurs
What are the signs / symptoms of infective Endocarditis?
- Janeway Lesions (lesions on palms / soles)
- Osler’s nodes (nodules on digits)
- Roth Spots (haemorrhage in eyes)
- Spliner Haemorrhages (nails)
What is the pneumonic used to remember signs and symptoms of Infective Endocarditis?
FROM JANE Fever Roth spots Osler's nodes Murmurs
Janeway lesions
Anaemia
Nail splinter/ haemorrhage
Emboli
Who is usually affected by non bacterial thrombotic endocarditis (NBTE)?
Debilitated patients
(cancer or sepsis)
It is associated with a hypercoagulable state e.g DVT, PE.
What are the vegatations of Non Bacterial Thrombotic Endocarditis like?
- small
- not invasive / inflammatory
- 1 or many
- In a line on the cusps
What is (Non Infective) Libman Sacks endocarditis?
What are the warts like?
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.
What is rheumatic fever?
Rheumatic fever is an acute, IMMUNOLOGICALLY MEDIATED, Inflammatory disease following Group A Streptococcal Pharyngitis.
What causes rheumatic fever?
Group A Streptococcal Pharyngitis
What are the characteristic features of Rheumatic fever?
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»_space;> (fishmouth stenoses)
What is the aetiology of Rheumatic fever?
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.
What is Pericarditis?
Inflammation of the pericardial sac
What are the causes of pericarditis?
Give examples of infective, immunological and miscellaneous causes.
1) Infection
- Virus (Coxsackie B)
- Bacterial, TB, fungi, parasites.
2) Immunologically mediated process
- Rheumatic fever,
- SLE,
- Sclerodema,
3) Miscellaneous
- ureamia
- cardiac surgery
What is serous pericarditis? And what causes it?
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.
What is serofibrinous / fibrinous pericarditis?
Serofibrinous or Fibrinous pericarditis is inflammation of the pericardium that has serous fluid and / or fibrinous exudate in the pericardial sac.
What is Dessler’s Syndrome?
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
What is the appearance of dry fibrinous pericarditis?
-dry, granular, roughened surface.
What is the appearance of purulent / suppurative pericarditis?
-Red, granular exudate
What is mediastino-pericarditis caused by?
purulent/suppurative pericarditis
What is haemorrhagic pericarditis?
BLOOD mixed with serous (watery) or suppurative (pus) effusion.
What are the causes of haemorrhagic pericarditis?
- Neoplasia (maligant cells in effusion)
- Infections (e.g. TB)
- Following cardiac surgery
What is adhesive pericarditis?
Adhesive Pericarditis is chronic inflammation of the pericardium with FIBROSIS / STRINGY ADHESIONS that obliterate the pericardial cavity.
What is adhesive mediastinopericarditis?
Obliterates the pericardial cavity WITH ADHERENCE TO SURROUNDING STRUCTURES
It causes cardiac hypertophy and cardiac dilation.
What are the clinical features of pericarditis?
- Sharp central chest pain
- Pericardial friction rub
- fever
- (pericardial effusion, cardiac temponade)
What is cardiomyopathy and what are the 4 main types?
Cardiomyopathy is a disorder of the heart muscle aka myocardium.
4 main types:
1) Dilated
2) Hypertrophic
3) Restrictive
4) Arrythmogenic right ventricular cardiomyopathy.
What is dilated cardiomyopathy?
Progressive dilation of the heart leads to contractile (systolic) dysfunction.
What are the characteristics of dilated cardiomyopathy?
-Flabby, dilated heart with fibrosis
What are the causes of dilated cardiomyopathy?
1) Genetic:
2) Alcohol
3) SLE, scleroderma, thiamine deficiency, acromegaly
At what age does dilated cardiomyopathy develop and what are the signs and symptoms?
Age 20 - 50.
-decrease in ejection fraction
-Shortness of Breath
-Fatigue
-
What is the treatment for dilated cardiomyopathy?
Cardiac transplantation,
What is hypertrophic cardiomyopathy and what are the characteristic featurtes?
Hypertophy of the left ventricular myocardium in the absence of hypertension.
Characterised by thick, stiff and hypercontracting LV.
What is the cause of hypertrophic cardiomyopathy?
Genetic (most)
can be sporadic
What are the clinical signs of hypertophic cardiomyopathy?
- Decreased STROKE VOLUME (due to decreased chamber size / compliance of LV)
- Obstruction to left ventricular outflow.
- Dyspnoea (SoB)
- Systolic ejection MURMUR
What are the complications of Hypertrophic cardiomyopathy?
- Atrial Fibrillation
- Thrombus formation
- Cardiac failur
- Ventricular arrhythmias
- sudden death
What is the treatment of Hypertrophic cardiomyopathy?
- Beta adrenergic blockers used to decrease heart rate and contractility.
- Reduction of septum reduces outflow obstruction
What is restrictive cardiomyopathy?
- Decrease in ventricular compliance results in impaired ventricular filling during diastole.
- Can be caused by fibrosis, tumour ect..
What is arrythmogenic right ventricular cardiomyopathy?
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.
What are the signs of Arryhtmogenic right ventricular cardiomyopathy?
- syncope,
- chest pain
- palpitations
- sudden cardiac death
What is myocarditis?
Infection of the myocardium.
What are the common causes of myocarditis?
Give one example for Viral, Bacterial, Protozoa,
Fungi and Immune
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
What is vasculitis?
Inflammation of the vessel walls
What is Giant Cell Arteritis and what is its pathology?
GCA is the most common form of vasculitis.
There is chronic granulomatous inflammation in the large to medium sized arteries,
What arteries are particularly involved in Giant Cell arteritis?
- Arteries in the head
- Vertebral
- Opthalmic (can cause permenant blindness)
What is the morphology (charcterisics) of giant cell artertis?
- Intimal thickening (reduces the lumenal diameter)
- granulomatous inflammation
- multinucleated giant cells
What are the clinical signs / symptoms of Giant cell arteritis?
-Facial pain / headache
What is an aneurysm?
Localised, permanent, abnormal DILATIONS OF BLOOD VESSEL
What are the complications of Aortic Aneurysms?
- Rupture causing retroperitoneal haemorrhage.
- Embolism causing limb ischaemia
What is a dissecting aneurysm?
- Tear in the wall
- Blood tracks between intimal and medial layers
What are the classical symptoms of a dissecting aneurysm?
-tearing pain in chest radiating to upper left shoulder.
What are berry aneurysms/
- Small saccular lesions that develop in the circle of wilis.
- develop at sites of weakness where arteries bifurcate.
What type of brain haemorrhage can a rupture of a circle of willis berry aneurysm cause?
-Subarachnoid Haemorrhage
Where do Charcot-Bouchard aneurysms occur? and what type of brain haemorrhage can occur on rupture?
Intracerebral capillaries in hypertensive disease.
Intracerebral haemorrage.
What are mycotic aneurysms?
Weakening of the arterial wall secondary to a bacterial or fungal infection.
What are the causes of arterial occlusion?
Embolus from: artial fibrillation MI Endocarditis Valvular disease,
Thrombosis from:
Atherosclerosis
What are the 6Ps that indicate acute ischaemia?
1) Pale
2) Pulseless
3) Painful
4) Paralysed
5) Parasthetic
6) Perishingly cold
What are the clinical consequences of chronic peripheral vascular disease?
1) Intermittent Claudication
2) Critical Limb ischaemia (Rest pain and tissue loss)
