Cardiovascular Pathology Flashcards

Question

Long standing hypertension is a risk factor for the brain. How?

Answer 1

haemorrhagic stroke (long term stress, effects the tissue composition, where it branches is the weakest point) small vessel haemorrhages in the brain retinal changes – vision changes

Answer 2

Ischaemic heart disease (MI) Cardiomegaly / hypertrophy of cardiac muscles

Answer 3

Nephropathy – remodelling kidney changes due high BP, leads to kidney failure.

Answer 4

AAA – Abdominal Aortic Aneurysm Dissecting Aneurysm- high pressure blood shears between the two layers of the blood vessels (tunica / media) Peripheral Vascular Disease – significant atherosclerotic plaque – stops perfusion into the legs Carotid changes – atherosclerosis at bifurcation.

Answer 5

Accumulation of excess fluid in tissues is termed edema Under normal circumstances on a small amount of interstitial fluid leaks which is removed by lymphatic vessels. Excess fluid leaks from capillaries in 3 main circumstances: Increased hydrostatic pressure in vessels (heart failure) More fluid leaves capillaries with reduced plasma oncotic pressure (hypoproteinemia) More fluid leaves capillaries if vascular permeability is altered (allergic reaction liberating histamine, acute inflammation)

Answer 6

Increased hydrostatic pressure in the pulmonary vascular bed Due to left sided heart failure 2. Subcutaneous edema Increased hydrostatic pressure in the systemic venous system Due to right sided heart failure.

Answer 7

Hyperlipidaemia Hypertension Diabetes mellitus Cigarette smoking Family history

Answer 8

Fatty streak (small, intracellular fat , innocuous) Atheroma (raised, lipid centre, dangerous) Fibrous plaque (intimal scar, innocuous)

Answer 9

Almost all children older than 10 in developed countries have fatty streaks, with coronary fatty streaks beginning in adolescence. It consists of aggregates of foam cells, which are lipoprotein-loaded macrophages. Fatty streaks may also include T cells, aggregated platelets, and smooth muscle cells. It is the precursor lesion of atheromas.

Answer 10

Atheroma is an accumulation of degenerative material in the intima of an artery wall. The material consists of mostly macrophage cells, or debris, containing lipids, calcium and a variable amount of fibrous connective tissue. It develops in areas of turbulent flow due to increased hydrostatic pressure at that point, whereas it is not seen in low pressure systems such as the Pulmonary artery or vein

Answer 11

Change in the structure of the tunica media may result in loss of elasticity of the vessel wall. Major factor in the pathogenesis of aneurysm formation. Mainly occurs in large arteries affected by severe atherosclerosis, Abdominal aorta An aneurysm which continues to grow in size, will cause progressive weakening of the artery wall. The larger the aneurysm becomes, the greater the risk of rupture. This requires surgical intervention Prevention of a rupture is the most important goal in medical therapy

Answer 12

Fusiform bulges or balloons out on all sides of the blood vessel. usually due to atheroma often below renal arteries; may affect iliac arteries Saccular E.g. Berry Aneurysm in the circle of Willis. bulges / balloons out on one side Pseudoaneurysm aka False aneurysm Not an enlargement of any of the layers of the blood vessel. May be as a result of prior surgery. Blood fills between the layers of the blood vessel wall creating a pseudo aneurysm.

Answer 13

An aneurysm that occurs with a tear in the artery wall that separated the 3 layers of the wall (rather than ballooning out the entire wall)

Answer 14

Multifactorial reasons which lead to the breakdown of structural proteins in the artery walls which provide support and stability to the vessel wall. Atherosclerosis plays an important role in aneurysm formation risk factors associated with atherosclerosis e.g. male, genetics, hyperlipidemia, hypertension, smoking, diabetes, obesity.

Answer 15

Abdominal Aortic Aneurysm (AAA) Atherosclerosis Genetic Giant Cell Arteritis Cerebral Aneurysms Hypertension Atherosclerosis Head Trauma Iliac Artery Aneurysm Atherosclerosis Pregnancy Post lumbar / Hip surgery Femoral / Popliteal Aneurysm Atherosclerosis Trauma

Answer 16

acute inflammation of veins which triggers a thrombus Caused by: bacteria parasite physical / chemical stimuli Superficial thrombophlebitis – visible, localised swelling, erythema

Answer 17

Deep vein thrombosis – global swelling but no localised erythema visible due to thrombosis within muscle compartment

Answer 18

Not primarily inflammatory Abnormally dilated veins Sites for varicose Veins: Legs Osoephagus Testes, Vuvla, perianal (haemorrhoids)

Answer 19

Inflammation of the pericardium Causes: Infective – Bacterial or Viral immune-mediated Chest trauma e.g. RTA Ischaemic – e.g. following a trans-mural MI causing an inflammatory pericarditis +/- effusion Resolution may result in: Constrictive pericarditis - Fibrosis, Fusion + Occasionally calcification or Cardiac tamponade – too much fluid in the pericardial space Both conditions can lead to cardiac failure

Answer 20

Disease of the myocardium Inherited or acquired 3 main types: HOCM (Hypertrophic obstructive cardiomyopathy) – 1 in 500 DCM (Dilated cardiomyopathy) - 50% inheritance (inherited + acquired types) ARVC (Arrthymogenic right ventricular cardiomyopathy) - rare

Answer 21

Takosubo/Broken Heart Syndrome Follows acute physical or emotional stress in 85% of cases Can cause fatal arrthymias/heart rupture Myocarditis autoimmune or viral Ischaemic Endocrine Diabetic/hyperthyroidism Poisons chemotherapy, alcohol, drugs

Answer 22

An autoimmune response to an untreated Strep A infections Scarlet Fever, Strep Throat Causes an inflammatory disease which can involve: Heart, skin, joints and brain The disease typically develops 2 – 4 weeks after a streptococcal throat infection. the heart is involved in about half of cases Damage to the heart valves is known as rheumatic heart disease

Answer 23

Subsequent changes in the heart: Thickening of valve cusp, especially along lines of closure Fusion of commissures Result is aortic stenosis, insufficiency or often both Aortic stenosis> LV hypertrophy Aortic insufficiency> LV hypertrophy and dilatation Subsequent changes in the heart: Predominantly left-sided valves (almost always mitral) Mitral > Aortic > Tricuspid > Pulmonary Mitral alone 48%, Mitral + aortic 42%

Answer 24

Occlusion of a coronary artery leading myocardial hypoxia > cell death. usually due to thrombotic occlusion of a coronary vessel It is generally accepted that the cross sectional area of the coronary artery lumen must be reduced by > 75% to significantly affect perfusion. underlying coronary artery disease Coronary arteries are prone to atheroma due to their unique flow pattern of being empty during systole and filling in diastole. This spurt—flow pattern causes turbulence and arterial wall trauma. causes a rapid drop in systolic function Time from Onset Gross Morphologic Finding 18 - 24 Hours Pallor of myocardium 24 - 72 Hours Pallor with some hyperaemia 3 - 7 Days Hyperaemic border with central yellowing 10 - 21 Days Maximally yellow and soft with vascular margins 7 Weeks White fibrosis

Answer 25

Anti- coagulants Stents fitted

Answer 26

Angina Pectoris Characterised by paroxysmal attacks of exercise related chest pain Anterior chest pain usually Caused by myocardial ischaemia Stable Angina (typical) Increases on exertion Resolves completely with rest or vasodilators Unstable Angina Occurs at rest or minimal exertion and usually lasts more than 20 minutes. Severe and of recent onset (i.e. within 1 month). Occurs with a crescendo pattern (brought on by less activity, more severe, more prolonged or increased frequency than previously.

Answer 27

Cardiac function is insufficient to pump blood at the rate required by the tissues in the body Heart failure can also affect the kidney’s ability to dispose of Sodium & water > leading to edema. As glomerular filtration rate decreases Divided it into: Left sided heart Failure Right sided heart Failure

Answer 28

Systolic Failure aka Heart Failure with reduced ejection fraction the left ventricle loses its ability to contract normally, & so can’t push enough blood out into circulation. Diastolic Failure aka Heart Failure with preserved ejection fraction The left ventricle loses its ability to relax normally (because the muscle has stiffened) & therefore the heart is unable to properly fill with blood between each beat. If fluid collects in the lungs, it can cause shortness of breath – particularly when a person is lying down  this is known as pulmonary edema.

Answer 29

NB. Blood returns from the body to the heart via the right atrium > into the right ventricle. The right ventricle  then pumps back to the lungs. Can occur as a result of left sided heart failure When the left ventricle fails, increased fluid pressure is transferred back to the lungs – damaging the hearts right side. When the Right side loses power, the blood backs up into the body’s veins this causes swelling in the ankles and abdomen.