Cardiovascular Diseases 3 Flashcards
Inflammation of the endocardium of the heart ‘vegetations on valves’
Endocarditis
2 main types of endocarditis
Infective
Non-infective
Describe the vegetations of infective endocarditis
mixture of thrombotic debris and organisms
destroy underlying cardiac tissue
What are the 2 types of infective endocarditis?
Acute and subacute
Which is caused by more virulent organisms, subacute or acute infective endocarditis?
Acute
Describe the vegetations of acute infective endocarditis
Friable, bulky, potentially destructive vegetations. Ring abscess
Which is more easily treatable with antibiotics; acute or subacute endocarditis?
Sub-acute
Risk factors for infective endocarditis
Cardiac/valvular abnormalities MV prolapse Valvular stenosis Artificial valves Unrepaired congenital defects Bicuspid AV
Causative organisms of infective endocaridits
Streptococcus viridans
Staph A.
Coagulase -ve staphylococci
Which organisms can cause endocarditis, from prosthetic heart valves
Coagulase -ve staphylococci
Which organims can cause infective endocarditis from the mouth?
Streptococcus viridans
Clinical features of IE
Fever Murmurs Splinter haemorrhages Janeway lesions Oslers's nodes Roth Spots
Erythematous or haemorrhagic non tender lesions on the palms or soles
Janeway lesions
Subcutaneous nodules in the pulp of the digits
Osler’s nodes
Retinal haemorrhages in the eyes
Roth spots
Complications of IE
Immunologically mediated conditions e.g. glomerulonephritis
2 types of non infective endocarditis
Non bacterial thrombotic endocarditis (NBTE)
Libman Sacks endocarditis
In which patients do you get NBTE
cancer or sepsis.
a hypercoagulable state (DVT, PE and mucinous adenocarcinomas)
indwelling catheter lines
NBTE is part of what syndrome?
Trousseau syndrome of migratory thrombophlebitis
Describe the vegetations if NBTE
Small, sterile thrombi on valve leaflets. Single or multiple on line of closure of leaflets or cusps.
What are the effects of NBTE
non invasive/no inflammatory reaction>minimal local effect
Systemic emboli infarcts in the brain, heart etc
What type of endocarditis is associated with SLE
Libman Sacks
What valves are affected in libman sacks endocarditis?
Mitral and tricuspid valves
What are the effects of libman sacks endocarditis?
Usually asymptomatic, rarely cardiac failure or systemic emboli
Describe the vegetations of libman sacks endocarditis
Small (1-4mm), sterile, pink warty vegetations. Single or multiple
Rheumatic fever is an acute, immunologically mediated, multi-system inflammatory disease following what infection?
Group A steptococcal pharyngitis- causes scarlet’s fever
What are the distinctive cardiac lesions, made up of T-cells, plasma cells and macrophages found in rheumatic fever?
Aschoff bodies
What are the vegetations called in rheumatic fever?
Venuccae
Pathological features of rheumatic fever
Vegtations (venuccae)
Mitral valve changes
Fish mouth or buttonhole stenoses- fibrous bridging of valvular commissures and calcification
Causes of rheumatic fever
Hypersensitivity reaction
Immune responses to group A strep (pharyngitis)
What criteria is used to diagnose rheumatic fever?
Jone’s criteria
Clinical features of rheumatic fever
Carditis polyarthritis chorea (neurological condition causing jerky movements) erythema margination subcutaneous nodules fever arthralgia
Inflammation fo the pericardial sac
Pericarditis
Causes of pericarditis
Infections e.g. viruses (cocksackie B), bacteria, fungi etc
Immunologically mediated processes- rheumatic fever, SLE, scleroderma, post MI (Dressler’s)
5 Types of acute pericarditis
Serous Serofibrinous/fibrinous Purulent/suppurative Haemorrhagic Caseous
3 types of chronic pericarditis
Adhesive
Adhesive mediastinopericarditis
Constricive pericarditis
A type of pericarditis involving inflammation which causes serous fluid accumulations
Serous pericarditis
Causes of serous pericarditis
Inflammation in adjacent structures
Viral pericarditis (cocksackie B/echinovirus)
Immunologically mediated processes- rheumatic fever, SLE, scleroderma
Misc. conditions- uraemia, neoplasia, radiation
Most common form of pericaridits
Serofibrinous pericarditis
A type of pericarditis; serous fluid and/or fibrinous exudate in pericardiat sac
Serofibrinous pericarditis
Common causes of serofibrinous pericarditis
Acute MI, Dressler’s syndrome
Uraemia, radiation, rheumatic fever, SLE, trauma, surgery
Features of serofibrinous pericarditis
Dry, granular, roughened surface
Causes of purulent/suppurative pericarditis
Infections
Features of purulent/suppurative pericardiits
Red, granular, exudate i.e. pus
Complications of purulent/suppurative pericarditis (rare)
Mediastino-pericarditis
Restrictive pericarditis- serious
A type of pericarditis where blood is mixed with serous (water) or suppurative (pus) effusion
Haemorrhagic pericarditis
Causes of haemorrhagic pericarditis
Neoplasia
Infections e.g. TB
Following cardiac surgery - cardiac tamponade
Causes of caseous pericarditis
TB or fungal
Type of pericarditis with fibrinous/stringy adhesions obliterating pericardial cavity
Adhesive pericarditis
Type of pericarditis which obliterates pericardial cavity with adherence to surrounding structures. Causes cardiac hypertrophy/dilation
Adhesive mediastinopericarditis
A type of pericarditis where the heart is encased in a fibrous scar- limit cardiac function and only treatment is surgery
Constrictive pericarditis
Dressler’s syndrome occurs post MI and is clinical triad of what 3 features?
Fever
Pleuritic chest pain
Pericardial effusion
Autoimmune reaction to antigens released following MI
Dressler’s syndrome
3 clinical features of pericarditis
Sharp,central chest pain
Pericardial friction rub
Fever, leucocytosis, lymphocytosis, pericardial effusion
How is chest pain in pericarditis relieved?
Sitting forwards
Chest pain in pericarditis radiates where?
Shoulders/neck
Complications of pericarditis?
Cardiac tamponade/pericardial effusion
Disorders of the myocardium
Cardiomyopathies
4 types of cardiomyopathies
Dilated
Hypertrophic
Restrictive
Arrythmogenic right ventricular cardiomyopathy
Describe the features of the heart in dilated cardiomyopahty
Flabby- heart enlarged and heavy
Myocyte hypertrophy with fibrosis
Causes of dilated cardiomyopahty
Genetic- AD mainly, affects cytoskeleton proteins
Alcohol and other toxins e.g. chemotherapy
Others-SLE, scleroderma, thiamine def, acromegaly, thyrotoxicosis, diabetes etc
Clinical features of cardiomyopathy
Present in 20s-50s with
Shortness of breath
Fatigue
Poor exertional capacity
Treatment for dilated cardiomyopathy
Cardiac transplantation
Long term ventricular assist
Most common cause of sudden death in athletes
Hypertrophic cardiomyopathy
Type of cardiomyopathy- poorly compliant mycocardium, ‘stiff’ LV
Hypertrophic cardiomyopahty
In hypertrophic cardiomyopathy, is diasolic or systolic function abnormal?
Diastolic, systolic function is preserved
Causes of hypertrophic cardiomyopathy
100% genetic. Mutations in sarcomeric proteins- myofibre disarray
3 clinical features of hypertrophic cardiomyopathy
Decreased stroke volume- impaired diastolic filling
Obstruction to left ventricular outflow
Systolic ejection murmur
4 Complications of DCM/HCM
Heart failure
Sudden death
Atrial fibrillation
Stroke
Treatment for HCM
Decrease heart rate and contractility- beta adrenergic blockers
Causes of restrictive cardiomyopahty
Primary decrease in ventricular complicance (impared function during diastole)
Secondary (infiltration)- fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites
Genetic disease that results in RV dilation and myocardial thinning- fibrofatty replacement of RV
Arrythmogenic RB cardiomyopathy
When do you get sudden cardiac death with arrythmogenic right ventricular cardiomyopathy?
Fibrofatty replacement of RB due to disorder of cell-cell desmosomes. With excercise, cells detach and die.
Infective or inflammatory process resulting in myocardial injury
Myocarditis
Clinical features of myocarditis
Asymptomatic
Heart failure, arrythmias and sudden death
Non-specific symptoms
Can mimic acute MI
Infectious causes of myocarditis
Viruses (cocksackie A&B, influenza, HIV, CMV) Bacteria Fungi Protozoe-tryponosoma cruzi Helminths
Immune mediated causes of myocarditis
Post viral post streptococcal (RF) SLE Drugs Transplant rejection
Other causes of myocarditis
Sarcoidosis
Giant cell myocarditis
Inflammation of vessel walls, any organ, any vessel size
Vasculitis
The name of the nomenclature for vasculitis, based on affected vessel size
Chapel Hill
Most common form of vasculitis (medial emergency)
Giant cell arteritis
Describe the pathology of giant cell arterieis
Chronic granulomatous inflammation- large>medium sized arteries
Segmental disease
Common arteries affected by GCA?
Temporal arteries
Opthalmic arteris- permanent blindness
Symptoms of GCA
Vague symptoms e.g. fatigue, weith loss, facial pain or headache- painful to palpate superficial temporal artery, jaw claudication
Treatment for GCA
Corticosteroids
Anti-TNF
Localised, permanent, abnormal dilatations of a blood vessel
Aneurysms
Name 7 aneuryms based on their aetiology
Atherosclerotic Dissecting Berry Microaneurysm Syphilitis Mycotic False
Name 2 aneurysms based on shape
Saccular
Fusiform
Most common aneurysm
Atherosclerotic
Type of aneurysm- tear in the wall, blood tracks between intimal and medial layers
Dissecting aneurysm
Symptoms of a dissecting aneurysm
Tearing pain in chest radiating to upper left shoulder, usually thoracic aorta, secondary to systemic hypertension.
Type of aneurysm- small,saccular lesions that develop in the circle of willis. Develop at sites of medial weakness at arterial bifurcations.
Berry aneurysms
Ruptures of berry aneurysm can have what effect?
Subarachnoid haemorrhage
Charcot-Bouchard and Retinal are what type of aneuryms
Micro and syphilitis
A type of micro and syphility aneurysm that occurs in intracerebral capillaries in hypertensive disease, can cause strokes
Charcot-Bouchard aneurysms
A type of rare aneurysm- weakening of arterial wall secondary to bacterial infection e.g. subaute bacterial endocarditis. Often in cerebal arteries
Mycotic aneurysm
A type of aneurysm; blood filled space around a vessel, usually following traumatic fupture or perforating injury
False
Where is the haematoma in false aneurysms?
In the adventitial fibrous tissue
What are the 6ps of acute ischaemia
Pale Puseless Painful Perishingly cold Parasthtic Paralysed
