Cardiovascular Pathology

Question 1

What are the chambers of the heart separated by ?

Answer 1

A fibromuscular septum

Question 2

What is the protective liquid which surrounds the heart muscle and tissue?

Answer 2

Pericardium

Question 3

What are the three layers of the heart?

Answer 3

• epicardium (squamous)
• myocardium (muscle)
• endocardium (smooth thin layer of endothelial cells that line the chambers and valves)

Question 4

What is an aneurysm?

Answer 4

It is a localized permanent dilation of an artery.

Question 5

What are the two main types of aneurysms?

Answer 5

• atherosclerotic abdominal aortic aneurysm (impair flow to the lower limbs)
• brain aneurysm in the Circle of Willis in the brain (subarachnoid haemorrhage)

Question 6

What are the four major initiating factors for aneurysms?

Answer 6

• atherosclerosis
• High BP
• head injury
• family history of heart conditions.

Question 7

What can a ruptured aneurysm lead to ?

Answer 7

• bleeding, hypovolemic shock and death

Question 8

Atherosclerosis can lead to?

Answer 8

Coronary artery disease

Question 9

Describe the 4 steps of the atherosclerotic process?

Answer 9

1. Damage
2. Entry of LDLs
3. LDLs taken up by macrophage
4. Cytokines, fibrosis and collagen

Question 10

What is atherosclerosis?

Answer 10

Deposits of fatty acids laid down in the artery wall, normally either the aorta or the coronary arteries (atheroma)

Question 11

What are the 5 major risk factors of developing atherosclerosis?

Answer 11

• hypertension
• hypercholesterolemia
• smoking
• family history
• diabetes mellitus

Question 12

What is an aneurysm?

Answer 12

It is an abnormal dilation of a blood vessel

Question 13

Coronary artery disease can be caused by severe atheroma in these arteries due to limiting the blood supply to the heart, what are the clinical manifestations of the coronary artery disease?

Answer 13

• angina
• myocardial infarction
• cardiac death
• CAD with heart failure

Question 14

What are the three diseases of the heart?

Answer 14

• heart failure
• myocardial infarction
• valvular heart disease

Question 15

What are the two views of heart failure?

Answer 15

Right heart failure - heart cannot pump out what is coming in
Left heart failure - heart cannot pump out enough blood to meet the metabolic requirements

Question 16

What does incomplete emptying lead to a rise in pressure of?

Answer 16

Incomplete emptying leads to a rise in pressure in preceding chamber.

Question 17

What are the main causes of left heart failure?

Answer 17

• CAD
• myocardial infarction
• hypertension
• valve disease

Question 18

In right heart failure, what can often be seen in the liver?

Answer 18

A swollen, enlarged liver.
Possible peripheral swelling

Question 19

What is the main cause of right heart failure?

Answer 19

Chronic obstructive pulmonary disease

Question 20

Why does the heart fail?

Answer 20

CAD
Valve disease
Arrhythmias
Hypertension
Lung disease
Congestive heart failure (left and right)

Question 21

A myocardial infarct is caused by what?

Answer 21

An area of necrosis of heart muscle resulting from a sudden, absolute or relative reduction in the coronary blood supply.

Question 22

What is the commonest cause of a myocardial infarct?

Answer 22

Atherosclerosis or thrombosis blocking coronary arteries.

Question 23

What is necrosis followed by?

Answer 23

Inflammatory infiltration and fibrous repair

Question 24

As cells die, different enzymes are released and can be identified serologically, what are these three enzymes in order of their release peak?

Answer 24

Creatinine kinase (0-6)
Troponin (0-14)
Lactate Dehydrogenase (0-14)

Question 25

10% of heart failure cases are caused by what?

Answer 25

Valvular heart disease

Question 26

What is the normal role of valves in the heart?

Answer 26

To prevent retrograde blood flow

Question 27

Blood flow through the heart is caused by a synchronous series of events?

Answer 27

Contraction (systole) Relaxation (diastole)

Question 28

What is valvular stenosis?

Answer 28

This is the thickening/calcification of the valves leading to the obstruction of the normal flow of blood into a chamber or vessel.

Question 29

Valvular stenosis can be caused by which type of disease?

Answer 29

Rheumatic fever

Question 30

Infective endocarditis/vegetations of the valve can lead to what to develop on heart valves?

Answer 30

Valve leaflets which either develop infective or thrombotic nodules that impair valve function.

Question 31

What is the major risk of infective endocarditis?

Answer 31

That the valve leaflets could fragment or embolise.

Question 32

In valvular stenosis, obstruction to blood flow leads to what?

Answer 32

Myocardial hypertrophy --> increased risk of sudden death and eventual heart failure.

Question 33

Rheumatic fever develops as a result of which infection?

Answer 33

2-3 weeks after streptococcal upper respiratory tract infection

Question 34

Infective endocarditis if a less aggressive infections may result in what type of illness?

Answer 34

May result in a prolonged illness with embolic phenomena caused by the embolization of the vegetations

Question 35

What is the focal area of abnormality on the endocardium of a valve leaflet?

Answer 35

Tiny deposits of platelets and fibrin - the beginnings of a thrombus