Cardiovascular Pathology 3 Flashcards
What is peripheral vascular disease?
Atherosclerosis of arteries supplying legs (or arms) leading to narrowing of the vessel lumen and restriction of blood flow
Who is peripheral vascular disease typically seen in?
- Age >40
- Obese people
- Smokers
- Family history
- Men (or post-menopausal women)
- Those with a PMH including:
- Diabetes
- Hypercholesterolaemia
- Hypertension
Peripheral vascular disease can either be chronic or acute. What is the aetiology of both?
- Chronic: gradual atherosclerosis –> narrows lumen –> reduced blood flow –> ischaemia –> tissue damage/death
- Acute: plaque rupture or thrombus formation –> narrows lumen –> reduced blood flow –> ischaemia –> tissue damage/death
What are the clinical features of acute peripheral vascular disease? (6 P’s!)
- Pale
- Pulseless
- Painful
- Paralysed
- Paraesthetic
- Perishingly Cold
Why are the clinical features of chronic PVD different? (Why do you not get the 6 Ps)?
Do NOT get 6 Ps as collateral vessels form but instead symptoms according to increasing severity
Clinical features of chronic PVD?
- Asymptomatic; found during a physical exam (ABI) i.e. reduced pulses
- Intermittent claudication; complaint of pain upon exertion (in leg)
- Critical limb ischaemia; rest pain and tissue loss
What is an ABI?
The ankle-brachial pressure index (ABPI) or ankle-brachial index (ABI) is the ratio of the blood pressure at the ankle to the blood pressure in the upper arm. Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease.
What is giant cell arteritis (temporal arteritis)?
A type of vasculitis typically affecting the large arteries in the head. Considered a medical emergency as it can lead to blindness.
Aetiology of giant cell arteritis? What type of hypersensitivity is it?
Autoimmune blood vessel damage; this is type IV hypersensitivity as it is T cell-mediated
What PMH is typically linked to giant cell arteritis?
polymyalgia rheumatica
Pathogenesis of giant cell arteritis?
- 1) Chronic granulomatous inflammation
- 2) Thickens wall of artery
- 3) Narrows lumen
- 4) Reduced blood flow
- 5) Ischaemia
- 6) Tissue damage/death
Clinical features of giant cell arteritis?
- Flu-like symptoms;
- Fatigue
- weight loss
- Fever
- Pain;
- Tender superficial temporal artery/ scalp
- Jaw claudication (when eating)
- Vision problems;
- Blurred vision
- Blindness (can be permanent)
- Stroke
What is infective endocarditis?
Infection and inflammation of the endocardium (lining of the heart), mainly involving the valves (when a valve is affected by endocarditis, it tends to be become regurgitative instead of stenotic)
Infective endocarditis typically occurs in patients with structurally abnormal valves. What can cause structurally abnormal valves?
Rheumatic heart disease, congenital heart disease, age-related valve calcification
Who is infective endocarditis typically seen in?
- Structurally abnormal valves (rheumatic heart disease, congenital heart disease, age-related valve calcification)
- Foreign material in the heart (ICD, prosthetic valves)
- Immunosuppression (HIV)
-
Bacteraemia
- IVDU
- Long term IV catheter (dialysis pts)
- Colorectal cancer
- Dental procedures (“Prophylaxis not recommended routinely”)
Infective endocarditis can also occur in healthy patients with normal hearts after infection with what?
Virulent organisms (e.g. S. aureus)
What group of organisms is infective endocarditis typically caused by?
Bacteria
What 2 major groups of bacteria typically cause infective endocarditis? Which specific organisms?
- Streptococcus
- viridans
- bovis
- Staphylococcus
- aureus
- epidermis
What are these organisms causing infective endocarditis associated with?
a) S. viridans
b) S. bovis
c) S. aureus
d) S. epidermis
a) dental procedures
b) colorectal cancer
c) normal hearts of healthy patients
d) prosthetic valves
Which organisms causing infective endocarditis is associated with dental procedures?
Streptococcus viridans
Which organisms causing infective endocarditis is associated with colorectal cancer?
Streptococcus bovis
Which organisms causing infective endocarditis is associated with prosthetic valves?
Staphyococcus epidermis
2 types of fungi can also cause infective endocarditis (although rarely). What are these?
- Candida
- Aspergillus
Pathogenesis of infective endocarditis:
After valvular vegetations form in infective endocarditis, what 4 things can then happen?
- Vegetations damage valves
- Bacteria in vegetations form local abscess
- Bits of vegetations break off (emboli)
- Immune response to infection
What is the danger of bacteria in valvular vegetations forming local abscesses?
Can lead to AV block
What are Roth spots?
A haemorrhage in the retina
What are Osler nodes?
Osler’s nodes are painful, red, raised lesions found on the hands and feet; associated with infective endocarditis
What are Janeway lesions?
Janeway lesions are rare, non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler’s nodes.
Janeway –> palms, non-tender
Osler’s –> tips, tender
What are splinter haemorrhages?
Splinter hemorrhages are tiny blood spots that appear underneath the nail.