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Path - Histopath > cardiovascular histology > Flashcards

cardiovascular histology Flashcards

1
Q

define atherosclerosis?

A

an arteriosclerosis

atheromatous deposits &
fibrosis

of inner layer of arteries

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2
Q

where do atheroma plaques form?

A

intima then protude into lumen

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3
Q

describe the process of atherosclerosis?

A

smooth endothelium damage

platelets stick to damaged endothelium

endothelium proliferates

fibrous cap fomrs on top of endothelium

choleserol deposits in core of lesion

plaque enlarges, blocking lumen of vessel

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4
Q

which study looked at risk factors of atherosclerosis ?

A

Framingham Heart Study

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5
Q

Risk factors have a what type of effect on risk of atherosclerosis?

A

MULTIPLICATIVE EFFECT

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6
Q

list Constitutional Risk Factors (impossible/hard to control) in atheroslcerosis?

A

age

gender - W: protected premenopause, risk increased post menopause

Genetics - most significant independent risk factor

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7
Q

what is the MOA of statins?

A

inhibit HMG-CoA reductase rate limiting enzyme in liver cholesterol synthesis

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8
Q

HTN alone increases risk of IHD by __%

DM increases risk of IHD by __%

Prolonged cigarret smoking increases risk of IHD by __%

A

60%

double

double

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9
Q

ihd is a group of conditions resulting from ….?

A

from myocardial ischaemia

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10
Q

what is the order of extent of injury?

A

loss of cell function

cell death

microscopic changes

gross changes

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11
Q

what are the 4 stages of presentation of ihd?

A

Angina pectoris
Myocardial infarction
Disease with heart failure
Sudden cardiac death.

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12
Q

pathogensis of ihd?

A

Predominant cause is

insufficient coronary perfusion to suffice myocardial demand

due to chronic progressive atherosclerotic narrowing of epicardial coronary arteries

and variable degrees of superimposed plaque change, thrombosis and vasospasm

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13
Q

what are the componesnt of a vulnerable plaque?

A

Lots foam cells or extracellular lipid
Thin fibrous cap
Few smooth muscle cells
Clusters inflammatory cells

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14
Q

why does emotional stress inc risk of sudden death?

A

Adrenalin increases blood pressure & causes vasoconstriction
Increases physical stress on plaque

Hence emotional stress increases risk of sudden death
Circadian periodicity to sudden death (6am-noon)

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15
Q

what level of stenosis is required to see symptoms?

A

75% stenosis or more generally needed to cause symptoms precipitated by exercise

Vasodilation cannot compensate above this level of stenosis

90% stenosis can lead to pain at rest

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16
Q

where do plaques tend to form in the epicardial coronary arteries?

A

Plaques mainly in first few cm of LAD or LCX

Entire length RCA

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17
Q

what are the 3 acute coronary syndromes?

A

STEMI

NSTEMI

Unstable angina

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18
Q

what is the pathophysiology of ACS?

A

Stable plaque becomes unstable
Due to rupture, erosion, haemorrhage etc

Generally leads to superimposed thrombus which increases occlusion

no plaque disruption in stbale angina though

19
Q

which angina is caused by artery spasm?

A

prinzmetal

aka variant angina

20
Q

what is a Warning of impending infarction?

A

unstable angina

21
Q

what is the myocardial response to a sudden disruption to its blood supply?

A

Myocardial blood supply compromised leading to ischaemia
Loss of contractility within 60 seconds
Therefore heart failure can precede myocyte death
Potentially reversible
Irreversible after 20-30 minutes

22
Q

most common arteries of infarct?

A

LAD – 50%, ant wall LV, ant septum, apex

RCA - 40%, post wall LV, post septum, post RV

LCx - 20%, lat LV not apex

23
Q

after an mi, which cells are first to repond in order?

A

neutrophils

macrophages

angioblasts

fibroblasts and collagen

24
Q

how soon after an mi do you see;

Coagulation necrosis, loss nuclei & striations, neutrophils +++

A

1-3 days

25
Q

how soon after an mi do you see;

granulation tissue, macrophages,
new blood vessels, myofibroblasts, collagen synthesis

A

10-14 days

26
Q

how soon after an mi do you see;

normal by histology (CK-MB also normal)

A

under 6 hours

27
Q

what are the worst prognostic factors in MI?

A

Age, female, DM, previous MI

-> worse prognosis

28
Q

how do you treat a hibernating myocardium?

A

revascularisation

29
Q

list 3 complications of MI?

A

Contractile dysfunction – 40% infarct-> cardiogenic shock with 70% mortality rate

Arrhythmia

Myocardial rupture

Pericarditis (Dressler syndrome) 2nd or 3rd day

Infarct extension/expansion causing;
Mural thrombus

and more

30
Q

Most common areas of myocardial rupture?

A

free wall most common,

septum less common,

papillary muscle least common

31
Q

mortality in MI?

A

Total mortality = 30% in one year

3-4% mortality per year after first

32
Q

describe the heart in chronic IHD vs heaert failure?

A 
C IHD:
Enlarged heavy heart, hypertrophied, dilated LV
Atherosclerosis
Maybe mural thrombi
Fibrosis (microscopic)

Heart failure:
Dilated heart, Scarring & thinning of the walls

33
Q

causes of sudden cardiac death?

A

Marked atherosclerosis (>75% stenosis) in one or more vessels usually >90%

10% non atherosclerotic cause (long QT etc)

½ have plaque rupture

34
Q

what is the presentation of left vs right sided hf?

A

Left sided (-> SOB, pulmonary oedema)

Right sided (-> peripheral oedema, hepatomegaly, raised jvp)

35
Q

aetiology of dilated cardiomyopathy?

describe the heart?

A

Progressive loss of myocytes
Dilated heart

Causes: 
Idiopathic
Infective – viral myocarditis
Toxic: alcohol, chemotherapy (adriamycin, daunorubicin), cobalt, iron
thyroid conditions

etc

36
Q

aetiology of hypertrophic cardiomyopathy?

describe the heart?

A

Left ventricular hypertrophy
Familial in 50% (autosomal dominant, variable penetrance)
Beta-myosin heavy chain
Thickening of septum narrows left ventricular outflow tract

37
Q

aetiology of restrictive cardiomyopathy?

describe the heart?

A

Impaired ventricular compliance
Idiopathic or secondary to myocardial disease eg amyloid, sarcoidosis
Normal size heart – big atria

38
Q

list effects of CHRONIC RHEUMATIC VALVULAR DISEASE on heart structures?

A

thickened valves;
Predominantly left-sided valves (almost always mitral)
Mitral > Aortic > Tricuspid > Pulmonic

Mitral alone 48%, Mitral + aortic 42%

Thickening, shortening and fusion of chordae tendineae

39
Q

name the Commonest cause of aortic stenosis?

aetiology?

A

Calcific aortic stenosis

70s or 80s
Calcium deposits outflow side cusp
Impairs opening
Orifice compromised
Outflow tract obstruction
40
Q

what are the different types of aneurysm?

A

True - all layers wall
False – extravascular haematoma

Causes: Weak wall

41
Q

list some causes of aneurysm?

A

Congenital eg Marfans
Atherosclerosis
Hypertension

42
Q

atherosclerotic aortic aneurysm typically occur where?

A

in the abdominal aorta portion (AAA) below the renal arteries

43
Q

list some causes of aortic regard?

A

Rigidity - rheumatic, degenerative
Destruction - microbial endocarditis

Disease of aortic valve ring
-> dilatation-> valve insufficient to cover increased area:

Marfan’s Syndrome
Dissecting aneurysm
Syphilitic aortitis
Ankylosing spondylitis

Path - Histopath (21 decks)

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