Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CLINICAL PATHOLOGY > Cardiovascular diseases 3 > Flashcards

Cardiovascular diseases 3 Flashcards

1
Q

What is endocarditis?

A

Inflammation of the endocardium of the heart with prototypical lesions/vegetations on heart valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 main types of endocarditis?

A

1) Infective endocarditis

2) Non-infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is infective endocarditis?

A

Colonization or invasion of heart valves or heart chamber endocardium but a microbe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The vegetation of infective endocarditis are made up of what?

A

Mixture of thrombotic debris and organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What harmful effect do the vegetations found in infective endocarditis have?

A

They destroy the underlying cardiac tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Other than the heart valves or endocardium what other structures can become infected in infective endocarditis?

A

1) Aorta
2) Aneurysmal sacs
3) Blood vessels
4) Prosthetic valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most cases of infective endocarditis are caused by what kind of organism?

A

Mostly bacteria, fungi and other classes can however be a cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 types of infective endocarditis, how do they differ in severity?

A

1) Acute endocarditis - severe, medical emergency

2) Sub-acute endocarditis - less severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the main differences between acute and sub acute infective endocarditis? 4

A

1) Acute can occur with infection of a previously normal heart valve whereas sub-acute tends to be insidious infections of deformed valves
2) Acute is caused by highly virulent organisms compared to the organisms of lower virulence in sub-acute
3) In acute get necrotizing, ulcerative, destructive lesions, sub acute is much less destructive
4) Sub-acute has a wax and wane course (flare ups)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the differences between acute and sub acute endocarditis in terms of treatment and prognosis?

A

Treatment - acute is difficult to cure with Abx and usually requires surgery, sub-acute is cured with Abx
Prognosis - in acute death is frequent within days to weeks despite treatment, subacute is cured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Infective endocarditis can occur in a normal heart but what are the 2 main risk factors?

A

1) Cardiac/valvular abnormalities

2) Rheumatic heart disease was a major cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What 5 valvular abnormalities predispose to infective endocarditis?

A

1) MV prolapse
2) Valvular stenosis (calcification etc.)
3) Prosthetic valves
4) Unrepaired and repaired congenital defects
5) Biscuspid AV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Strep bovis infective endocarditis should prompt investigation for what?

A

Bowel cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Any route of bacteria into the bloodstream can lead to infection in the heart, name 4 routes into the blood stream?

A

1) Dental work abnormalities
2) IVDU
3) Wounds
4) Bowel cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which bacteria from the mouth causes 50-60% of cases of infective endocarditis and what kind of valves does it infect?

A

Streptococcus viridans

Causes endocarditis in native but damaged or abnormal valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which bacteria from the skin causes 10-20% of cases of infective endocarditis, in which groups is it most common?

A

Staph aureus

Most common in IVDUs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which bacteria commonly infects prosthetic heart valves?

A

Coagulase negative staphylococci (eg. staph epidermis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is culture negative endocarditis? What percentage of cases does it account for and how should it be treated?

A

Presents as infective endocarditis but no organism can be cultures
Accounts for 10-15% of cases
Treated as if infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name 7 risk factors for infective endocarditis?

A

1) Dental disease or procedures
2) Prolonged indwelling vascular catheters
3) IVDU
4) Underlying genitourinary disease or procedures
5) Bowel malignancy
6) Prosthetic valves
7) Soft tissue infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How would the vegetation in infective endocarditis be described?

A

Friable, bulky, potentially destructive (less destructive in sub acute IE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where do the vegetations tend to reside in infective endocarditis?

A

AV, MV, right heart (especially in IVDUs)

Can be single or multiple and often more than one valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can vegetations lead to abscesses?

A

Vegetations can erode the myocardium and produce ring abscesses
Emboli of vegetations can also break off which contain large numbers of virulent organsims and create abscesses at the sites where the emboli lodge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What 2 things can emboli of vegetations in infective endocarditis lead to?

A

1) Septic infracts

2) Mycotic aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 3 main possible clinical features of IE?

A

1) Fever - most consistent sign, get a rapidly developing fever, chills and weakness, can be slight or absent particularly in the elderly
2) Non specific symptoms - may be the only presentation, loss of weight/flu-like syndrome
3) Murmurs - 90% of patients with left sided IE get this, this could also be a new valvular defect or represent a pre-existing abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the main complications of infective endocarditis?
Immunologically mediated conditions eg. glomerulonephritis
26
What are the clinical manifestations of infective endocarditis (caused by micro-thromboemboli)?
1) Splinter/ subungual haemorrhages 2) Janeway lesions - erythematous or haemorrhagic non tender lesions on the palms or soles 3) Osler's nodes - subcutaneous nodules in the pulp of the digits 4) Roth spots - retinal haemorrhages in the eyes
27
What is the pneumonic for remembering the clinical presentation of infective endocarditis?
``` FROM JANE Fever Roth spots Osler's nodes Murmurs Janeway lesions Anaemia Nail (splinter) haemorrhages Emboli (Septic) ```
28
Name the 2 kinds of non-infective endocarditis?
1) Non bacterial thrombotic endocarditis (NBTE) | 2) Libman-Sacks endocarditis
29
Non bacterial thrombotic endocarditis (NBTE) occurs in which patients and associated with what state?
Occurs in debilitated patients (Eg. cancer or sepsis) - AKA marantic endocarditis Associated with a hypercoagulable state - hence DVT, PE and mucinous adenomas are associated with it, pro-coagulant effects of tumour-derived mucin or tissue factor
30
What is trousseau syndrome?
Syndrome associated with malignancy, involving episodes of thrombophlebitis which appear in different locations over time (migratory thrombophlebitis)
31
NBTE is part of what syndrome associated with malignancy?
Trousseau's syndrome
32
Which 2 things predispose to NBTE?
1) Endocardial trauma | 2) Indwelling catheter
33
What kind of vegetations occur in NBTE?
- Small (1-5mm) sterile thrombi on valve leaflets | - Singly or multiple on line of closure of leaflets or cusps
34
How do the vegetations in NBTE potentially cause damage?
They are non invasive and don't illicit and inflammatory reaction so have minimal local effects but can create systemic emboli which can cause infracts in the brain/heart etc.
35
Libman-sacks endocarditis is associated with what disease?
Systemic Lupus Erythematosis (SLE)
36
What are the symptoms/complications of Libman-sacks endocarditis?
- Usually asymptomatic (other than the symptoms of SLE) | - Rarely cause cardiac failure or systemic emboli
37
Which valves tend to be affected in libman-sacks endocarditis, what is nature of the vegetations and where exactly do they commonly occur?
``` Mitral and tricuspid (AV) valves affected Get small (1-4mm) sterile pink warty vegetations, which can be single or multiple Often occur on the AV valves under surfaces and on the chordae, valvular endocardium or mural endocardium of atria or ventricles ```
38
What is rheumatic fever?
Acute, immunologically mediated (auto-immune) multi system inflammatory disease following group A streptococcal pharyngitis
39
Why has rheumatic fever reduced in incidence, where is it most prevelant?
Rarer because of improved diagnosis/treatment | Commoner in developing countries or poor western populations
40
What microscopic signs in the heart are diagnostic of rheumatic fever?
Aschoff bodies - distinctive cardiac lesions
41
What are aschoff bodies and where can they be found?
Foci of T cells, plasma cells and macrophages | Can be found in all 3 cardiac layers
42
What is the term for inflammation in all 3 layers in the heart?
Pancarditis
43
What are the vegetations found in rheumatic fever called?
Veruccae
44
Other than verrucae and aschoff bodies, what are the 2 other main pathological features of rheumatic fever?
1) Mitral valve changes - virtually the only cause of mitral valve stenosis, leaflet thickening, virtually always involved in chronic rheumatic heart disease 2) Fibrous bridging of valvular commissures and calcification - fish mouth or buttonhole stenoses
45
What is the aetiological process of rheumatic fever?
1) Hypersensitivity reaction - combined Ab and T cell mediated response 2) Immune response to group A strep pharyngitis 3) Ab directed against the M proteins of streptococci cross react with self Ags in the heart 4) CD4+ cells specific for streptococcal peptides react with self proteins in the heart and produce cytokine which activate macrophages (hence aschoff body formation)
46
What is the name of the diagnostic criteria for rheumatic fever?
Jones criteria
47
What are 2 cardiac complications of rheumatic heart disease?
1) Left atrium dilatation (mural thrombi can form and embolise) 2) Right ventricular hypertrophy
48
What is pericarditis?
Inflammation of the pericardial sac
49
What are the 3 types of causes of pericarditis?
1) infections - viruses (Coxsackie B), bacteria, TB, fungi, parasites 2) Immunologically mediated processes 3) Miscellaneous conditions
50
What virus is commonly associated with infections of the heart?
Coxsackie B virus
51
Immunologically mediated processes associated with what 6 conditions?
1) Rheumatic fever 2) SLE 3) Scleroderma 4) Post-cardiotomy (surgical incision of the heart) 5) Late post MI = Dressler's 6) Drug hypersensitivity
52
Name 6 non infective and non immunologically mediated conditions which can lead to pericarditis?
1) Post MI (Early) 2) Uraemia 3) Cardiac surgery 4) Neoplasia 5) Trauma 6) Radiation
53
What are the 5 forms of acute pericarditis?
1) Serous 2) Serofibrinous/fibrinous 3) Purulent/suppurative 4) Haemorrhagic 5) Caseous
54
What are the 3 forms of chronic pericarditis?
1) Adhesive 2) Adhesive mediastinopericarditis 3) Constrictive pericarditis
55
What is the main difference between acute and chronic pericarditis?
Acute - inflamed | Chronic - pericardial sack is stuck down
56
What is serous pericarditis?
Inflammation causes clear 'serous' fluid accumulation
57
What aetiologies in serous pericarditis caused by?
Non infectious aetiologies - Although inflammation in adjacent structures can cause a pericardial reaction, rarely caused by viruses
58
Name 6 specific aetiologies causing serous pericarditis?
``` Immunologically mediated processes 1) Rheumatic fever 2) SLE 3) Scleroderma Miscellaneous conditions 4) Uraemia 5) Neoplasia 6) Radiation ```
59
What is Dressler's syndrome, what clinical triad is it made up of?
Secondary pericarditis - AKA post MI syndrome Clinical triad of: 1) Fever 2) Pleuritic chest pain - worse on inspiration 3) Pericardial effusion
60
What is the aetiology of Dressler's syndrome?
Autoimmune reaction to antigens released following an MI - it is not the same as acute pericarditis as there is a delay of weeks
61
What causes a purulent/suppurative pericarditis?
Infections
62
What are the main features of purulent or suppurative pericarditis?
Red, granular exudate - ie pus | Inflammation can extend causing mediastinopericarditis
63
What is the most common outcome of suppurative pericarditis?
- Complete resolution is rare | - Get organisation by scarring which can lead to restrictive pericarditis which is v serious
64
What is haemorrhagic pericarditis?
Blood mixed with serous (watery) or suppurative (pus) effusion
65
What are the 3 common causes of haemorrhagic pericarditis?
1) Neoplasia (see malignant cells in effusion) 2) Infections (inc TB) 3) Following cardiac surgery - get cardiac tamponade
66
What are the 2 main causes of caseous pericarditis?
1) TB infection | 2) Fungal infection
67
What is constrictive pericarditis and how is it treated?
Heart encased in a fibrous scar which limits cardiac function Treated by surgery to remove 'shell' around heart
68
What is adhesive pericarditis?
Fibrosis/stringy adhesion obliterates the pericardial cavity
69
Adhesive mediastinopericarditis commonly follows what?
Pericarditis caused by infection, surgery or radiation
70
What is adhesive mediastinopericarditis and what heart abnormalities does it cause?
Obliterated pericardial cavity with adherence to surrounding structures Causes cardiac hypertrophy/cardiac dilation
71
How are pericardial effusion and pericarditis related?
Pericardial effusion can be a complication of pericarditis
72
What are the 6 clinical features of pericarditis?
1) Sharp central chest pain 2) Pericardial friction rub- parietal and visceral layers of pericardium rub together 3) Fever 4) Leucocytosis 5) Lymphocytosis 6) Pericardial effusion
73
What are the 2 main possible complications of pericarditis?
1) Pericardial effusion | 2) Cardiac tamponade
74
What is the classical pain in pericarditis?
Sharp central chest pain 1) Exacerbated by movement, respiration, lying flat 2) Relieved by sitting forwards 3) Radiating to the shoulders and neck
75
What is a cardiomyopathy?
Disorder of the myocardium
76
What are the 4 main types of cardiomyopathy?
1) Dilated 2) Hypertrophic 3) Restrictive 4) Arrythmogenic right ventricular cardiomyopathy
77
What happens to the heart in dilated cardiomyopathy?
1) Progressive dilation leading to contractile (systolic) dysfunction 2) Heart enlarged, heavy and flabby (dilation of chambers) 3) Get myocyte hypertrophy with fibrosis
78
Do you get diastolic or systolic dysfunction in dilated cardiomyopathy?
Systolic dysfunction
79
What are the 2 main causes of dilated cardiomyopathy?
1) Genetic - autosomal dominant (mainly), cytoskeletal proteins gene mutation 2) Alcohol and other toxins eg. chemotherapy
80
When does dilated cardiomyopathy commonly present?
Commonly 20-50
81
What are the signs/symptoms of dilated cardiomyopathy?
``` Slow progressive signs Symptoms of congestive cardiac failure: - SoB -Fatigue - Poor exertional capacity ```
82
What is the 5 year survival rate of dilated cardiomyopathy, what are the most common causes of death?
5 year survival = 25% | Death due to CCF, arrhythmia/embolism (intra-cardiac thrombus)
83
What are the 2 main treatments for dilated cardiomyopathy?
1) Cardiac transplantation | 2) Long-term ventricular assist
84
How is hypertrophic cardiomyopathy defined?
Myocardial hypertrophy in the absence of an obvious cause eg. hypertension
85
What happens to the heart in hypertrophic cardiomyopathy?
Poorly compliant left ventricular myocardium - thick walled, heavy and hypercontracting, with myocyte hypertrophy and disarray Diastolic dysfunction with preserved systolic function Intermittent ventricular outflow obstruction occurs in 1/3 cases
86
What is the main cause of unexplained LV hypertrophy?
Hypertrophic cardiomyopathy
87
Do you get diastolic or systolic dysfunction in hypertrophic cardiomyopathy?
Diastolic dysfunction
88
What is the cause of hypertrophic cardiomyopathy?
100% genetic - mutations in sarcomeric proteins, can be sporadic
89
What are the 4 main clinical features of hypertrophic cardiomyopathy?
1) Reduced stroke volume 2) Obstruction to LV outflow 3) Exertional dyspnoea due to the above 4) Systolic ejection murmur - ventricular outflow obstruction, anterior mitral leaflet moves towards the ventricular septum during systole
90
What are the 5 main complication of hypertrophic cardiomyopathy?
1) AF 2) Mural thrombus formation - stroke 3) Cardiac failure 4) Ventricular arrhythmias 5) Sudden death especially in some affected families- most common cause of sudden death in athletes
91
What are the 2 main treatments for hypertrophic cardiomyopathy?
1) Decrease heart rate and contractility - B-adrenergic blockers 2) Reduction of the mass of the septum which relieves the outflow tract obstruction
92
Which 2 genes are commonly mutated in cardiomyopathies?
1) HCM 2) DCM Can be both
93
What is restrictive cardiomyopathy?
A primary decrease in ventricular compliance | Impaired ventricular filling during diastole
94
What are the causes of restrictive cardiomyopathy?
1) Idiopathic | 2) Secondary (infiltration) - fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites (IEMs)
95
What is the morphology of the heart in restrictive cardiomyopathy?
1) Ventricles normal size/ slightly enlarged | 2) Myocardium is firm and non compliant
96
What is arrhythmogenic right ventricular cardiomyopathy?
- Also called arrythmogenic RV dysplasia - AD genetic disorder of the cell-cell desmosomes - During exercise the cells detach and die - Get RV dilation/ myocardial thinning - Get fibrofatty replacement of RV
97
What are the 4 main clinical features and the major complication of arrthmogenic RV cardiomyopathy?
Clinical features: Silent, syncope, chest pain palpitations Can cause sudden cardiac death in young people, particularly athletes
98
What is myocarditis?
Infective or inflammatory process leading to myocardial injury
99
Infections are the main causes of myocarditis, which 2 infectious agents are most common?
1) Coxsackie A&B viruses - most common in west | 2) Chagas disease (trypanosome cruzi) protozoa - endemic in south america
100
What are the 5 v broad clinical features of myocarditis?
1) Can be asymptomatic 2) Can lead to heart failure, arrhythmias and sudden death 3) Can produce non specific symptoms - fatigue, dyspnoea, palpitations, precordial discomfort and fever 4) Can mimic acute MI 5) DCM can develop
101
There are various infectious causes of myocarditis, what are the 5 immune mediated causes?
1) Post viral 2) Post streptococcal (RF) 3) SLE 4) Drugs 5) Transplant rejection
102
Other than the infectious and immune mediated causes of myocarditis, what are the 2 other causes?
1) Sarcoidosis | 2) Giant cell myocarditis
103
In what basic what can vasculitis be recognised histologically?
By blue dots in a blood vessel
104
What is vasculitis?
Inflammation of vessel wall (20 Subtypes) - can affect any organ or any vessel
105
How can the type of vasculitis be classified?
According to vessel size and then other features following that
106
What is the most common form of vasculitis?
Giant cell arteritis
107
What is the pathology of giant cell arteritis?
Chronic granulomatous inflammation In large to medium sized arteries
108
What arteries does giant cell arteritis commonly occur in?
Common in head - esp. temporal arteries- temporal arteritis | Also in vertebral and ophthalmic arteries
109
What is the term for giant cell arteritis in the aorta?
Giant-cell aortitis
110
What does giant cell arteritis in the ophthalmic artery lead to?
Permanent blindness - medical emergency requiring prompt recognition and treatment
111
What are the 3 key features of the morphology of giant cell arteritis?
1) Intimal thickening - reduced luminal diameter 2) Granulomatous inflammation - elastic lamina fragmentation 3) Multinucleated giant cells
112
What are the main clinical features of giant cell arteritis?
Vague symptoms such as fatigue and weight loss
113
What are the 2 main symptoms in temporal arteritis?
1) Superficial temporal artery is painful on palpation | 2) Jaw claudication
114
How is diagnosis of giant cell arteritis carried out? 2
1) Biopsy - segmental disease (skip lesions) so 2-3cm needed | 2) Histological examination
115
What is the treatment for giant cell arteritis? 2
1) Corticosteroids are generally effective | 2) Anti-TNF therapy in resistance cases
116
What is an aneurysm?
Localised, permanent, abnormal dilatations of a blood vessel
117
In which 2 ways can aneurysms be classified?
1) Shape | 2) Aetiology
118
What is the difference between a secular aneurysm and a fusiform aneurysm?
Sacular aneurysm - like a berry aneurysm | Fusiform aneurysm - whole thing dilated along one bit of length
119
What is the main risk factor for rupture of AAA?
Size of aneurysm
120
What is the most common type of aneurysm (classified by aetiology)?
Atherosclerotic aneurysm
121
How is AAA detected?
Using US
122
What are the 2 possible complications of AAA?
1) Rupture causing retroperitoneal haemorrhage | 2) Embolisation causing ischaemia
123
What is a dissecting aneurysm?
Tear in the wall - blood tracks between intimal and medial layers
124
What is the classical symptoms of a dissecting aneurysm?
Tearing pain in chest radiating to upper left shoulder
125
In which vessel does a dissecting aneurysm most commonly occur, what can it lead to?
Usually the thoracic aorta secondary to systemic hypertension Leads to progressive vascular occlusion and haemopericardium (mortality without treatment)
126
What are berry aneurysms?
Small saccular lesions which develop in the Circle of Willis - they develop at sites of medial weakness at arterial bifurcations
127
In which patients are berry aneurysms commonly found and what does rupture lead to?
Commonly found in young hypertensive patients | Rupture leads to SAH
128
Where and when do Charcot-Bouchard aneurysms (type of microaneurysm) occur, what do they cause?
Occur in intracerebral capillaries in hypertensive disease | Cause intracerebral haemorrhage (ie stroke)
129
In which patients do retinal microaneurysms occur, what do they cause?
Can develop in diabetic patients | Cause diabetic retinopathy
130
What are mycotic aneurysms?
Rare - weakening of arterial wall secondary to bacterial/fungal unfection Organisms enter media from vasa vasorum (network of small vessels that supply large vessels)
131
What is the most common underlying infection in mycotic aneurysms, which arteries are commonly affected?
Sub acute Bacterial endocarditis | Often in cerebral arteries
132
What is a false aneurysm?
Blood filled space around a vessel usually following traumatic rupture or perforating injury The adventitial tissue contains the haematoma
133
When are false aneurysms commonly seen?
Commonly seen following femoral artery puncture during angiography/ angioplasty

CLINICAL PATHOLOGY (56 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions