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Cardiology > Cardiovascular Pathology > Flashcards

Cardiovascular Pathology Flashcards

1
Q

What is cardiomyopathy?

A

Changes in the size of the heart and changes in the thickness of chambers of the heart

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2
Q

What are the five main types of cardiomyopathy?

A

Dilated
Restrictive
Hypertrophic
Arrhythmogenic right ventricular dysplasia
Amyyloidosis

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3
Q

What is dilated cardiomyopathy

A

Heart 2-3x normal (450g)
Hypertrophic changes but soft - flabby and floppy
Down microscope - features non-specific, some hypertrophy (not very helpful in making diagnosis)

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4
Q

Causes of dilated cardiomyopathy

A

Genetics - about 50% of all
-AD,AR, X-linked, mitrochondrial
-These mutations are in the genes that encode for heart muscle proteins

Toxins related e.g alcohol

Doxorubicin - chemotherapy agents (must asses heart before starting chemotherapy)

Childbirth - late in pregnancy or post partum

Cardiac Infections e.g. Myocarditis

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5
Q

Clinical features of dilated cardiomyopathy

A

General size/‘picture’ of the heart
SOB, poor exercise tolerance etc
Low ejection fraction (low Cardiac Output)

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6
Q

What is hypertrophic cardiomyopathy

A

Big solid hearts
Hypertrophic and string contraction (but not like DCM)
Diastolic dysfunction (problem with filling)- systolic contraction is fine
Eventually outflow obstruction

Assoc. with sudden death - athletes

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7
Q

What is the causes of hypertrophic myopathy

A

Genetics (mutations of lots of different genes)

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8
Q

What is restrictive cardiomyopathy?

A

A lot of resistance/lack of compliance of heart - stiff
Diastolic dysfunction - doesnt fill well
Can look normal (unlike DCM or HOCM)
Biatrial dilatation as a result of back pressure from ventricles (no give in ventricles)

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9
Q

What is the causes of restrictive cardiomyopathy?

A

Something in heart muscle wall stopping it pumping well e.g metabolic byproducts like iron
Amyloid
Sarcoid - multi system granulomatous disorder
Tumours (very rare)
Radiation fibrosis (very rare)

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10
Q

What is Arrhythmogenic right ventricular dysplasia?

A

A genetic disease - autosomal dominant but with a low penetrance (may inherit disease but dont always get)
It is where the right ventricle muscle is largely replaced by fat = big and floppy
Trouble with this is that the right ventricle always looks a bit fatty

Very difficult to diagnose

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11
Q

How can Arrhythmogenic right ventricular dysplasia present itself?

A

Underlying Arrhythmias - so patients present with syncope and funny turns
Sudden death may occur

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12
Q

What is myocarditis?

A

Inflammation of the heart - usually infectious

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13
Q

What is the most common cause of infectious myocarditis

A

Infection: viral, bacterial, fungal, protozoal and helminthic

Most is viral - coxsackie A and B, ECHO virus most common
There is other ones as well - chagas disease, HIV and lyme’s disease

(Lymes disease can cause sudden death as it block AV node)

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14
Q

What is the most common cause of non-infectious myocarditis

A

Usually immune mediated hypersensitivity reactions e.g to drugs
Hypersensitivity to infection - poststreptococcal and rheumatic fever
Systemic lupus erythematosus (SLE) - hypersensitivity
Aschoff bodies (microscopic - another form of rheumatic granuloma) - be aware of for paediatrics

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15
Q

What is amyloid?

A

Generally resembles a type of restrictive cardiomyopathy’s
Multisystem disease (probs not a single system that will cover it well)
Abnormal deposition of any protein - abnormal proteins deposited throughout body (lots of diff types as lots of diff proteins)
Tendency to form beta pleated sheets - this means its more difficult for body to get rid of so debri builds up and impaire function of where these proteins are deposited

Is a cause of arrhythmogenic sudden death
At autopsy - often effects conduction pathway of heart

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16
Q

What are the different types of amyloid?

A

AA - related to chronic diseases e.g chronic autoimmune diseases like rheymatoid arthritis - abnormal antibodies
AL - light chains, abnormal immunoglobin - in the presence of haematological neoplasia and cancer
Haemodialysis associated amyloidosis - will be given beta 2 microglobulin deposition (dont look for other diseases in this situation)
Familial forms:
-Diabetes
-Alzheimer’s

17
Q

What does amyloid look like/how to identify?

A

Waxy pink material (clue will get in exam)
Stains positively for “congo red”
Exhibits apple green birefringence

18
Q

Amyloid can be isolated to the heart. What is it called when amyloid is localised in the atrium?

A

Abnormal atrial natriuretic protein

19
Q

What is the desposition of normal transthyretin called?

A

Senile cardiac amyloidosis - ‘normal’ consequence of aging but also can be inherited

20
Q

What is pericarditis?

A

Inflamation of the pericardium

21
Q

What are the causes of pericarditis?

A

Main cases:
Infection:
-ECHO virus (coxaci A and B), extension from elsewhere, generally serous (discoloured but clear fluid), suppurative (bacterial - white pus, cheesy looking) -TB

Immune mediated
e.g. post MI - dresslers syndrome, uraemia - high serum urea levels occur and renal failure, connective tissue diseases (e.g. rheumatoid, lupus)

Weird causes

22
Q

What is Dressler’s syndrome?

A

Many weeks (6) after MI - late complications of MIs
Assumed to be immune mediated - damaged heart muscles release preciously un-encountered material that stimulates an immune response

23
Q

What is endocarditis?

A

Inflammation of the inside lining of the heart - generally refers to the valves
Mostly caused by infection - specifically bacteria

24
Q

How does infectious endocarditis work?

A

Colonies of bugs on valves (vegetations). They are loose on the valves and with turbulent blood flow can come off and spread throughout body - emboli

25
Q

What bacteria is the most common cause of infectious endocarditis?

A

Strep Viridians

HACEK - Haemophilus, Actinobacillus, Cardiobacteria, Eikenella, Kingella

Staph aureus
- IV drug users, right side of heart

Staph epidermidis
- prosthetic valves

26
Q

What are the common causes of infectious endocarditis?

A

Rheumatic valves, prosthetic valves (more likely to have vegetation’s forming on them), congenital defects, bicuspid valves, MV prolapse, calcification disease

Lupus
Non-bacterial - marantic
Carcinoid disease

Can also see on normal valves not that’s not common

27
Q

What are the clinical features of infectious endocarditis?

A

Olsers nodes
Janeway lesions
Roth spots
Splinter haemorrhages
Systemic septic emboli - brain, kidney, lungs etc

28
Q

What does libman-sacks endocarditis?

A

Libman - sacks is what you see in lupus
Small sterile emboli
Vegitations on the underside and on top of the valves or on chords
The changes range - small asymptomatic deposits or significant valvulitis

29
Q

What is non-bacterial thrombotic endocarditis (NBTE)?

A

Can cause emboli disease but tends not to destroy valves therefore doesn’t destroy heart as much - Non-invasive

Can form non-bacterial thrombosis on valves - sterile vegitations (marantic endocarditis) this is normally associated with malignancy in hypercoagulability states (e.g. frequently mucinous adenocarcinomas)

30
Q

What is carcinoid heart disease?

A

Carcinoid tumours are neoplasms of neuroendocrine cells
They are seen in any mucosa - most commonly in GI tract and lung
Associated with release of hormone (hence neuroendocrine)

Carcinoid syndrome occurs only when the heart is involved becuase there’s metastases of liver - cause of carcinoid heart disease (metastases of liver)

31
Q

What is the clinical presentation of carcinoid syndrome? And why?

A

Liver must be metastasised so releases 5HIAA, serotonin, histamine, bradykinin etc checked in urine
This causes:
Flushing of skin
Nausea, vomiting and diarrhea
Right sided cardiac valve disease which causes tricuspid and pulmonary insufficiency (mechanism unknown)

32
Q

What are the cardiac tumours?

A

Don’t really get cardiac tumours
Benign tumour of myocardium - rhabdomyomas
Tumours of blood vessels - angiomas, angiosarcomas (incredibly rare)
Myxoma - most common but still very rare

33
Q

What are (atrial) myxoma tumours?

A

Most common but still very rare
Almost always in atria (90%) and usually in the left atrium
This can cause a ball/valve obstruction and myxoid embolism

34
Q

What is carney’s syndrome? (This is nitty gritty so dw too much but will come across - possibly wait till everything else is more solidified)

A

Associated with atrial myxomas
Multiple myxomatosis on skin
Pigmented skin lesions
Neurofibromas
Rare calcifying Sertoli cell tumours of testicle
Pancreatic and thyroid tumours
PRKAR1A gene

Cardiology (20 decks)

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