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Year 2 Clinical Pathology > Cardiovascular diseases 2 > Flashcards

Cardiovascular diseases 2 Flashcards

1
Q

What 5 things characterize the hypertrophy and/or dilation of the heart in left sided heart failure?

A

1) Increased heart size and mass
2) Increased protein synthesis
3) Abnormal proteins
4) Fibrosis
5) Inadequate vasculature

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2
Q

What 3 things is the cardiac dysfunction in left sided heart failure characterised by?

A

1) heart failure (systolic/diastolic)
2) Arrhythmias
3) Neurohumoral stimulation

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3
Q

What are the 6 main steps in the pathogenesis of left sided heart failure?

A

1) Increased cardiac work
2) Increased wall stretch
3) Cell stretch
4) Hypertrophy and/or dilation
5) Cardiac dysfunction

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4
Q

What 3 things can lead to increased cardiac work (leading to left sided heart failure)?

A

1) Hypertension - pressure overload
2) Valvular disease - pressure and/or volume overload
3) MI - regional dysfunction with volume overload

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5
Q

Left sided heart failure (low output) affects what 3 organs particularly?

A

1) Kidneys
2) Brain
3) Lungs

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6
Q

What effects does left sided heart failure have on the kidneys? 2

A

1) Pre-renal azotemia - It is an excess of nitrogen compounds in your blood stream due to a lack of blood flow to each kidney
2) Salt and fluid retention - RAAS activation, natriuretic peptides

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7
Q

What effect does left sided heart failure, thus low output, have on the brain? 3

A

1) Irritability
2) Decreased attention
3) Stupor (state of near-consciousness) -> coma

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8
Q

What effect does left sided heart failure have on the lungs?

A

Pulmonary congestion and edema

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9
Q

What are the 6 possible pulmonary symptoms of left sided heart failure?

A

1) Dyspnea
2) Orthopnea
3) PND (paroxysmal nocturnal dyspnea)
4) Blood tinged sputum
5) Cyanosis
6) Elevated pulmonary WEDGE pressure (pressure measured by wedging a catheter in pulmonary artery)

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10
Q

What are the 2 main causes of right sided heart failure?

A

1) Left sided heart failure

2) Cor pulmonale - abnormal enlargement of right side of heart due to disease of the lungs or pulmonary blood vessels

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11
Q

In which 5 organs can the signs and symptoms of right sided heart failure be seen?

A

1) Liver
2) Spleen
3) Kidneys
4) Pleura/pericardium
5) Peripheral tissues

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12
Q

What are the symptoms or signs seen in the liver/spleen in right sided heart failure? 3

A

1) Passive congestion/ nutmeg liver - liver dysfunction due to venous congestion
2) Congestive splenomegaly
3) Ascites

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13
Q

What 2 signs can be seen in the pleura/pericardium in right sided heart failure?

A

1) Pleural and pericardial effusions

2) Transudates (extravascular fluid with low protein content)

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14
Q

What are the 3 main autopsy findings in congestive heart failure?

A

1) Cardiomegaly
2) Chamber dilatation
3) Hypertrophy of myocardial fibres - BOXCAR nuclei

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15
Q

What is valvular heart disease?

A

Opening problems - stenosis

and Closing problems (incompetency or insufficiency) - regurgitation

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16
Q

70% of all valvular heart disease is attributable to which 2 conditions?

A

1) Aortic stenosis - calcification of deformed valve

2) Mitral stenosis

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17
Q

What are the 2 main causes of aortic stenosis?

A

1) ‘Senile’ calcific aortic stenosis

2) Rheumatic heart disease

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18
Q

What is the main cause of mitral stenosis?

A

Rheumatic heart disease

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19
Q

What is rheumatic heart disease?

A

Follows a group A strep pharyngitis - get pancarditis (endocarditis + myocarditis + pericarditis)

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20
Q

What are the 5 signs of acute rheumatic heart disease?

A

1) Inflammation
2) Aschoff bodies
3) Anitschkow cells
4) Pancarditis
5) Vegetations on chordae tendinae at leaflet junction

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21
Q

What are the 3 signs of chronic rheumatic heart disease?

A

1) Thickened valves
2) Commisural fusion
3) Thick, short chordae tendinae

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22
Q

What changes in the heart does aortic stenosis initially lead to?

A

1) Left ventricular hypertrophy (but no hypertension)

2) Ischemia

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23
Q

Which 2 conditions does aortic stenosis lead to?

A

1) Angina

2) CHF

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24
Q

What is the prognosis of aortic stenosis?

A

50% die in 5 years if angina is present

50% die in 2 years if CHF is present

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25
Q

What is mitral annular calcification, how does this affect the function of the mitral valve?

A
  • Calcification of the mitral skeleton
  • Usually no dysfunction
  • Regurgitation usually but stenosis is possible
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26
Q

Is mitral annular calfication more common in males or females?

A

Females

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27
Q

What are the 2 types of regurgitation?

A

1) Aortic regurgitations

2) Mitral regurgitations

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28
Q

What are the 3 main causes of aortic regurgitations?

A

1) Rheumatic
2) Infectious
3) Aortic dilatations (syphilis, rheumatoid arthritis, marfan)

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29
Q

What are the 5 main causes of mitral regurgitations?

A

1) Infectious
2) Fen-Phen (obesity drug)
3) Papillary muscles/ chordae tendinae dysfunction
4) Calcification of mitral ring (annulus)
5) Mitral valve prolapse

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30
Q

What is a mitral valve prolapse?

A

Myxomatous (pathological weakening of connective tissue) degeneration of mitral valve
Associated with connective tissue disorders
Floppy valve

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31
Q

What imaging technique can be used to see a mitral valve prolapse?

A

Echocardiogram

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32
Q

Is a mitral valve prolapse more common in males or females?

A

Females

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33
Q

What 4 possible complications is mitral valve prolapse associated with?

A

1) Infective endocarditis
2) Mitral insufficiency
3) Arrhythmias
4) Sudden death

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34
Q

Does mitral valve prolapse usually have any symptoms?

A

No, usually asymptomatic, 97% of sufferers have no untoward effects

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35
Q

What are the 4 possible symptoms of mitral valve prolapse?

A

1) Mid systolic click
2) Holosystolic murmur if regurgitation is present
3) Occasional chest pain
4) Dyspnea

36
Q

Congenital heart defects affect what percentage of the births?

A

1%

37
Q

Congenital heart defects are due to faulty embryogenesis when?

A

Weeks 3-8

38
Q

Which 4 congenital heart defects cause a left to right shunt?

A

1) Ventricular septal defect
2) Atrial septal defect
3) Patent ductus arteriosus
4) AV septum defect

39
Q

Name 3 congenital heart defects which cause no shunt?

A

1) Aortic stenosis
2) Pulmonary stenosis
3) Coarctation of the aorta

40
Q

Which 5 congenital heart defects cause a right to left shunt?

A

1) Tetralogy of Fallot
2) Transposition of great arteries
3) Truncus arteriosus (single blood vessel out of R&L ventricles)
4) Total anomalous pulmonary venous connection
5) Tricuspid atresia (complete absence of tricuspid valve - absent right ventricle)

41
Q

In what percentage of congenital heart defects are there gene abnormalities?

A

10%

42
Q

Which region of the genome is particularly important in heart development?

A

Region of Chr22 - 22q11.2

43
Q

What are the 2 most common genetic abnormalities in congenital heart disease?

A

Trisomies - 21, 13, 15, 18, XO

Mutations in genes encoding for transcription factors, TBX5, NKX2.5

44
Q

Which 2 environmental factors can lead to congenital heart defects?

A

1) Rubella

2) Tetratogens

45
Q

What is the function of the foramen ovale in the fetal period and what is it formed from?

A

Allow passage of blood from right atrium to left atrium as lungs have no function in oxygenating blood in fetal period
- Between the spetum primum and septum secundum - forming the interatrial septum

46
Q

What are the final stages in the formation of the pulmonary artery and the aorta in utero?

A

1) Septum divides the bulbus cordis and truncus of the primitive heart into 2 main arterial trunks - the aorta and pulmonary artery
2) It has a spiral path resulting in the normal anatomy of the vessels

47
Q

What are the signs of Left to right shunts? 2

A

1) No cyanosis

2) Pulmonary hypertension

48
Q

What are the 2 signs of right to left shunts? 2

A

1) Cyanosis

2) Venous emboli become systemic

49
Q

What is the most feared consequence of left to right shunts?

A

Irreversible pulmonary hypertension

50
Q

Are atrial septal defect and patent foramen ovale the same?

A

No

51
Q

When do symptoms of atrial septal defect usually become apparent?

A

Adulthood

52
Q

What percentage of ASDs are defects of the septum secundum?

A

90% - tend to be defective fossa ovalis

53
Q

What percentage of ASDs are defects of the septum primum?

A

5% - tend to be next to AV valves, mitral valve cleft

54
Q

What is the 3rd type of atrial septal defect?

A

Sinus venosus atrial septal defect - accounts for 5%

55
Q

What is the most common congenital heart defect?

A

Ventricular septal defect

56
Q

What percentage of VSDs are isolated, what is it often associated with?

A

30% - often associated with tetralogy of fallot

57
Q

What part of the VS is most commonly affected in VSDs?

A

Membranous septum - 90%

58
Q

What is distinctive about VSDs of the muscular septum?

A

Often have multiple holes

59
Q

What is the difference in effect of small and large VSDs?

A

Small holes often close spontaneously

Large one progress to pulmonary hypertension (L ->R shunt)

60
Q

What percentage of patent ductus arteriosus are isolated?

A

90%

61
Q

What 4 other congenital heart defects is a patent ductus arteriosus associated with?

A

1) VSD
2) Coarctation of the aorta
3) Pulmonary stenosis
4) Aortic stenosis

62
Q

Does a patent ductus arteriosus cause a L->R or R->L shunt?

A

Left to right but can go right to left as pulmonary hypertension approaches systemic pressure

63
Q

What is the possible life saving treatment for a patent ductus arteriosus?

A

Closing the defect early in life

64
Q

In what situation could treating a patent ductus arteriosus with prostaglandins to keep it open be life saving?

A

In coarctation of the aorta (pre ductal coarctation)

65
Q

What heart sound is heard in a patent ductus arteriosus?

A

Continuous, harsh, machinery like murmur

66
Q

Atrioventricular septal defects are associated with what?

A

Defective, inadequate AV valves

67
Q

What syndrome are complete AVSDs associated with?

A

Down syndrome

68
Q

What are the 2 types of AVSD?

A

1) Partial

2) Complete - all chambers freely communicate

69
Q

What 4 things is tetralogy of fallot made up of?

A

1) VSD - large
2) Obstruction to RV outflow (pulmonary stenosis)
3) Aorta overrides the VSD
4) RV Hypertrophy

70
Q

What does survival in tetralogy of fallot depend on?

A

Severity of the pulmonary stenosis - this determines the extent of R -> L shunt

71
Q

What is ‘pink’ tetralogy of fallot?

A

When pulmonic obstruction is small,

72
Q

What is transposition of the great vessels?

A

Abnormal formation of truncal and aortopulmonary septa

73
Q

What is require for survival in transposition of the great vessels?

A

A shunt - but it is fatal in the first few months of life if not treated with surgical switching

74
Q

Other than the obvious abnormality, how is the structure of the heart abnormal in transposition of the great vessels?

A

Right ventricle is thicker than the left ventricle

75
Q

What is truncus arteriosus?

A

Developmental failure of separation of truncus arteriosus into 2 vessels

76
Q

What other defect is TA associated with?

A

VSD

77
Q

What are the 2 signs of TA?

A

1) Systemic cyanosis

2) Increased pulmonary blood flow

78
Q

What is tricuspid atresia, what must it be associated with for survival?

A

Hypoplastic RV - basically only have one ventricle

Must be associated with a shunt for survival - high mortality

79
Q

What is total anomalous pulmonary venous connection (TAPVC)

A

Pulmonary veins do not go into LA but go into innominate LV or coronary sinus, hypoplastic left atrium

80
Q

What does TAPVC need to be associated with for survival?

A

Patent foramen ovale or VSD

81
Q

What are the 3 obstructive congenital heart defects?

A

1) Coarctation of the aorta
2) Pulmonary stenosis/ atresia (pulmonary valve not formed properly)
2) Aortic stenosis/ atresia

82
Q

Is coarctation of the aorta more common in males or females?

A

Males

83
Q

Coarctation of the aorta is associated with what valvular abnormality in 50% of cases?

A

Bicuspid aortic valve

84
Q

What are the 2 forms of coarctation of the aorta?

A

1) Infantile form (proximal to PDA) - serious

2) Adult form (closed ductus arteriosis ie. no PDA)

85
Q

What are the 3 types of aortic stenosis?

A

1) Valvular - if severe with a hypoplastic LV = fatal
2) Sub valvular (sub aortic) - aortic wall thick below cusps
3) Supra-vavlular - aortic wall thick above cusps in ascending aorta

Year 2 Clinical Pathology (64 decks)

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