Cardiovascular pathology 3 Flashcards
Peripheral Vascular Disease definition
Narrowing of blood vessels (usually arteries) = restricts blood flow. Mostly in the legs.
Peripheral Vascular Disease aetiology
Agents that can damage the endothelium
- Oxidative stress – smoking, hypertension, diabetes, hypercholesterolaemia, obesity
Peripheral Vascular Disease pathogenesis
- Chronic or acute – gradual atherosclerosis or plaque rupture/thrombus formation.
- Narrow artery = ischaemic = cell damage/death
Peripheral Vascular Disease clinical features
- Acute Ischaemia: 6 Ps pale, pulseless, painful, paralysed, paraesthetic, perishing cold
- Chronic peripheral vascular disease: start as intermittent claudication then get coagulative necrosis
Vasculitis: Giant Cell Arteritis definition
Chronic granulomatous inflammation of large to small sized arteries, principally in head (temporal arteritis). Considered a medical emergency as it can lead to blindness
Vasculitis: Giant Cell Arteritis epidemiology
- Most common form of vasculitis
- Older individuals >50
- F > M
- PMH of polymyalgia rheumatica
Vasculitis: Giant Cell Arteritis Pathogenesis
Chronic granulomatous inflammation = narrows artery = ischaemia = cell damage
Vasculitis: Giant Cell Arteritis clinical features
- Flu-like symptoms = fatigue, weight loss, fever
- Pain = tender superficial temporal artery/scalp, jaw claudication
- Vision problems = blurred vision, blindness
- Stroke
Claudication =
Pain and/or cramping in the muscles due to inadequate blood flow to the muscles
Infective Endocarditis definition
- Infection and inflammation of endocardium; lining of heart/mainly valves
Infective Endocarditis epidemiology
- Structurally abnormal valves
- Foreign material in heart
- Immunosuppressed
- Bacteraemia
Infective Endocarditis Aetiology
- Infection enters heart via any route of bacteria in blood stream
- Streptococcus Viridans/Bovis
- Staphylococcus Aureus/Epidermis
Infective Endocarditis pathogenesis
- Hear failure due to valve regurgitation
- Fibrin is deposited over the damaged valves and circulating bacteria colonise the fibrin - This leads to vegetations forming
Infective Endocarditis clinical features
- Fever
- Murmurs - 90% = left sided IE
- “FROM JANE” – Fever, Roth, Osler’s, Murmurs, Janeway, Anaemia, Nail Haemorrhage, Emboli
Pericarditis definition
- Definition = inflammation of pericardial sac
- Acute (< 6/12): serofibrinous, caseous, haemorrhagic & purulent
- Chronic (>6/12): constrictive
Pericarditis aetiology
- Infections - viruses (Coxsackie B)
- Autoimmune - Rheumatic fever, SLE
- Uraemia, cardiac surgery, neoplasia
Pericarditis pathogenesis
Serous: inflammation caused clear fluid accumulation - caused by non-infectious
- Serofibrinous: Serous fluid and/or fibrinous exudate in pericardial sac
Pericarditis clinical features
- Pericardial friction rub Sharp central chest pain: - Exacerbated by: movement, respiration, lying flat. - Relieved: sitting forwards. - Radiating: shoulders/neck. - Differentials: angina, pleurisy.
Rheumatic Fever definition
- Acute, immunologically mediated, multi-system inflammatory disease following group A streptococcal pharyngitis
Rheumatic Fever epidemiology
- Rare in developed world but typically, children 5-15yrs and history of sore throat
Rheumatic Fever pathogenesis
- Combined antibody and T cell mediated response to self-antigens in the heart
- Antibodies made for Strep attack cells in the heart as they have same antigen
Rheumatic Fever Clinical features
- Heart = pancarditis
- Endocarditis
- Mitral valve stenosis
- Vegetations “verrucae”
- Myocarditis
- Pericarditis
- arthritis
- CNS = Sydenhams chorea
4 types of cardiomyopathy
- Dilated
- Hypertrophic
- Restrictive
- Arrhythmogenic right ventricular cardiomyopathy (dysplasia)
Pathogenesis of cardiomyopathy’s
- Heart Failure (abnormal muscle cannot cope with workload)
- Emboli (Virchow’s Triad)
- Arrhythmias (disruption of electrical conduction pathways)
Clinical features of Dilated Cardiomyopathy
- Thin walled ventricular chambers = weak pump
- Can cause heart failure
- Heart enlarged, heavy, flabby
- Thrombus +/- emboli
- Arrhythmias and sudden death
Clinical features of Hypertrophic Cardiomyopathy
- Impaired ventricular filling +/- left ventricular outflow obstruction
- Relative ischaemia
- Mural thrombus formation
- Heart failure
Clinical features of Restrictive Cardiomyopathy
- Causes impaired ventricular filling
- Can lead to heart failure, arrhythmias, mural thrombi
- Often secondary to fibrosis and errors of metabolism
Clinical features of Arrhythmogenic RV Cardiomyopathy
- Young males/athletes
- Genetic disease – autosomal dominant
- Mutation in desmosome proteins = cells detach = fibrofatty tissue forms, interferes with contraction and conduction
- RV dilation and impaired filling
Myocarditis definition
inflammation of myocardium
Myocarditis aetiology
- Caused by infection
- Viruses - Coxsackie etc
- Bacteria - Dipth + meningococcus
- Fungi - Candida
- Protozoa
- Helminths
Myocarditis pathogenesis
Inflammation of myocardium = dysfunctional myocardium = electrical dysfunction = arrhythmias/ sudden death or mechanical dysfunction = heart failure
