Cardiovascular Pathology Flashcards
How many people live with CVD in the UK?
7 Million
The group of syndromes resulting from myocardial ischaemia are collectively known as
Ischaemic Heart Disease
What is IHD usually caused by?
coronary artery atherosclerosis
What makes up acute coronary syndrome?
MI
Unstable angina
How does prinzmetal angina differ from other types of angina?
It is caused by vasospasm rather than atherosclerosis
What are risk factors for IHD?
High BP
High HDL
Low TC:HDL ratio
In what layer does the atherosclerotic plaque develop?
Intima
What are the types of MI?
Transmural- across the full thickness of the wall
Subendocardial- across the inner 1/3rd that is least well perfused
What type of necrosis occurs in myocardium?
Coagulative
STEMIs are associated with which type of MI? Will there be cardiogenic shock?
Transmural
Yes
When will the following changes occur in the myocardium:
Yellow with haemorrhagic edge, myocyte necrosis and macrophages
Day 3-4
What are complications of an MI?
Heart failure Arrhythmia Pericarditis Cardiac tamponade Cardiogenic shock
What is Beck’s triad?
Hypotension
Distended JVD
Muffled heart sounds
What is Virchow’s Triad?
Hypercoagubility
Altered blood flow
Endothelial cell injury
Troponins T&I can be seen in what condition?
IHD
peak at 12 hours but can also be seen in PE, HF and myocarditis
Creatinine Kinase MB (CKMB) peaks when?
10-24 hours
It is also found in skeletal muscle
Myoglobin, Aspartate transaminase and Lactate dehydrogenase isoenzyme 1 are blood markers of what?
IHD
Lactate is detectable for up to 14 days after an MI
What group is affected more by hypertension?
Africans
BP=
Cardiac output x Peripheral resistance
What does the RAAS regulate?
blood volume and systemic vascular resistance
Where is renin produced?
Juxtaglomerular apparatus in the kidneys
Where can AII be formed?
Lungs (primarily)
Heart
Brain
What does aldosterone do?
Stimulates reabsorption of salt and water at the kidneys
What does AII to?
stimulates aldosterone release
causes vasoconstriction
stimulates release of ADH to increase fluid retention
facilitates noradenaline release
Renal artery stenosis, polyarteritis nodosa and aortic coarctation can
cause secondary hypertension
BP over 180/120 shows signs of
malignant hypertension
A ‘flea bitten’ kidney, SAH and lacunar infarcts are
complications of hypertension
In left sided hypertensive heart disease, what occurs
hypertrophy of LV in response to pressure overload
Cor pulmonlae refers to
right sided hypertensive heart disease that causes:
RV hypertrophy and HF secondary to pulmonary artery hypertension caused by disorders of the lung
What are diseases of the lung parenchyma that can cause Cor Pulmonale?
COPD, CF, Pneumoconiosis, Bronchiectasis, Pulmonary interstitial fibrosis
Kyphoscoliosis, Pickwickian syndrome and neuromuscular diseases are causes of
Cor pulmonale
A breach in the vascular wall leading to an extravascular haematoma that communicates with the intravascular space is known as
a false aneurysm
Dissecting aneurysms occur
between the walls of the artery
Which type of double barreled aorta is associated with the descending aorta alone?
Type B
What are the main causes of aneurysms?
Atherosclerosis
Cystic medial degeneration (associated with Marfan)
Insiduous HF is caused by
hypertension and valve diseases
HF is more common in
those over 40
males
postmenopausal women
Sudden HF is cause by
a large MI and fluid overload
What are other causes of HF?
Beriberi
anaemia
hyperthyroidism
Atrial natriuretic peptides are released in
cardiac dysfunction
Left sided HF is due to
pulmonary congestion
low CO and hypoperfusion of tissues
What are symptoms seen in left sided HF?
Increased hydrostatic pressure in pulmonary circulation Orthopnoea PND Blood tinged sputum 'Wedge' pressure
What causes left sided HF?
Cor pulmonale or left heart failure
A nutmeg liver is seen in what condition?
What is it caused by?
Right sided HF
Passive congestion
Hydrothorax and distention of the jugular veins are symptoms of which sided HF?
Right
Aortic stenosis occurs via
calcification of a congenitally bicuspid valve
calcification in those over 70
rheumatic heart disease
What is the only cause of mitral stenosis?
Rheumatic heart disease
What causes a ‘collapsing pulse’?
Aortic regurgitation
What can cause aortic regurgitation?
Rheumatological disorders
Syphilis
Marfan’s
MVP is the main cause of
Mitral regurgitation
Fen-phen (appetite suppressant) induces valvular fibrosis that causes
Mitral regurgitation
Problems with the chordae tendinae and papillary muscle can cause
mitral regurgitation
myxamatous degeneration of the mitral valve is also known as
mitral valve prolapse
MVP is associated with
Marfan syndrome
Which congenital heart diseases are associated with a L to R shunt?
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
AV septal defect
Which congenital heart diseases are associated with a R to L shunt?
ToF Transposition of the great arteries Truncus arteriosus Tricuspid atresia Total anomalous pulmonary venous connection
What congenital heart defects are associated with DiGeorge syndrome?
conotruncus
mutations of the TBX5 gene leads to
ASD, VSD
mutations of the NKX2.5 and GATA4 genes leads to
ASD
Congenital rubella syndrome can cause
Congenital heart diseases
R to L shunts cause
cyanosis
L to R shunts cause
pulmonary hypertension
Eisenmenger syndrome is
where in a VSD, the L to R shunt is reversed to a R to L shunt with cyanosis
Patent foramen ovale does not cause a
Atrial septal defect
Secundum is the most common type of
ASD
VSDs are common in
ToF
A boot shaped heart is characteristic of
TOF
The common features of TOF are
VSD
Overriding aorta
RV hypertrophy
Pulmonary stenosis
What does survival with TOF depend on
the severity of the pulmonary stenosis
Tet spells are experienced by babies when they
feed/cry
Which direction is the shunt in TOF?
R to L
Coarctation of the aorta is common in what condition
Turners syndrome
In infants, what does coarctation of the aorta cause
cyanosis in lower half of the body (due to patent ductus arteriosus)
In adults, what does coarctation of the aorta cause
hypertension in UL
hypotension in LL
notching on undersurface of the ribs
claudication and coldness
What are the 6 Ps of acute ischaemia?
pallor pulseless painful paralysed perishing cold paraesthetic
Chronic granulolmatous inflammation of arteries is known as
giant cell arteritis
GCA is usually
immune mediated
temporal arteritis is a form of
GCA
GCA can be treated with
corticosteroids
anti-TNF therapy
vegetations on valves is indicative of
endocarditis
SLE and NBTE are causes of
non-infective endocarditis
subacute infective endocarditis is caused by
organisms of a lower virulence
When is S. viridans likely to cause infective endocarditis ?
late (60 days after surgery)
usually to damaged valves
IVDUs are likely to get infective endocarditis from what organism?
S. aureus
When are murmurs present in IE?
Left sided cases
What are clinical signs of IE?
Splinter haemorrhages
Janeway lesions
Oslers nodes
Roth spots
What causes rheumatic fever?
Group A streptococci
Veruccae and Aschoff bodies are typical of
rheumatic fever
‘Fish mouth’ and ‘buttonhole’ stenosis are seen in
on the mitral valve in rheumatic fever
Diagnosis of rheumatic fever requires
Jones criteria
Coxsackie B can cause what cardiovascular infection?
Pericarditis
What is Dressler’s?
secondary form of pericarditis and occurs post MI (years later) and it is an autoimmune response
What type of pericarditis is caused by non-infectious aetiologies?
Serous pericarditis
What is the most common form of pericarditis?
Serofibrinous pericarditis
Suppurative pericarditis can extend to cause
mediostino-pericarditis
In which type of pericarditis is complete resolution rare
Suppurative pericarditis
Neoplasia and cardiac tamponade can cause what type of pericarditis?
Haemorrhagic
The treatment for what type of pericarditis is to remove the ‘shell’ by surgery?
Chronic pericarditis
The pericardial sac becomes fibrosed and leads to limited cardiac function
What relieves pericarditis?
Sitting forwards
What type of cardiomyopathy is associated with cytoskeleton protein gene mutations?
Dilated cardiomyopathy
In what cardiomyopathy is there diastolic dysfunction with preserved systolic function?
Hypertrophic cardiomyopathy
What can be used to treat hypertrophic cardiomyopathy?
beta-adrenergic blockers
What is the rarest cardiomyopathy?
Restrictive
A disorder of cell-cell desmosomes causes
Arrhythmic RV cardiomyopathy
Chaga’s disease and Lyme disease can cause
myocarditis
an inflammatory process of leptomeninges and CSF is known as
meningitis
meningoencephalitis is
inflammation of the meninges and brain parenchyma
What are the three forms of meningitis?
acute pyogenic (bacterial)
aseptic (viral)
chronic (TB, neurosyphilis and cryptococcis neoformans)
chronic meningitis is where CSF remains abnormal for >4 weeks
Haematogenous spread of CNS infections is
the most common and usually via an arterial route (can also be retrograde)
Direct implantation of CNS infections is normally
traumatic
CNS infections can spread from local regions such as
the mastioid, frontal sinuses and infected teeth
Clinical feature of meningitis include
headache irritability photophobia fever rash
In the young, meningitis can be caused by
S. agalactiae Listeria monocytogenes Klebsiella Salmonella H. influenzae
What does the CSF look like in meningitis?
cloudy and turbid
100-2000 polymorphs
high protein
Viral meningitis can start as
respiratory or intestinal infections
What type of meningitis has an insidious onset and high frequency of complications?
Tubercular meningitis
What commonly causes encephalitis?
viruses, especially Herpes
What are the clinical features of encephalitis?
behavioural changes
Headache
seizures
focal neurological consciousness
What can cause severe haemorrhage encephalitis affecting the temporal lobe?
Herpes encephalitis
When is the rabies infection cycle complete?
When the virus replicates in the salivary glands
What are symptoms of the prodromal phase of rabies?
fever
nausea
fatigue
burning
what are symptoms of the furious phase of rabies?
agitation
disorientation
hydrophobia
seizures
What are the last two phases of the rabies infection?
Dumb phase and coma phase
What causes tabes dorsalis?
Neurosyphilis
Brain abscesses are often
polymicrobial
What pathogen commonly causes brain abscesses after trauma/surgery?
S. aureus
How is a brain abscess managed?
Drainage
small abscesses can be treated with Abx
