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Systemic Pathology 500 > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

Primary hypertension

A

Idiopathic

95% of cases

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2
Q

Secondary hypertension

A

Secondary to: renal disease, vascular disease, endocrine disorders, adrenal disorders, alcohol intake, hyperthyroidism, coarctation of aorta etc etc

5% of cases

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3
Q

Blood pressure results from:

A

Cardiac output (CO) + peripheral vascular resistance (TPR)

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4
Q

What predicts cardiovascular events better, systolic or diastolic BP?

A

Systolic BP (measures how hard heart is working)

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5
Q

What is a common consequence of inadequately treated hypertension?

A

Stroke

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6
Q

Relationship between artherosclerosis and BP

A

High bp accelerates development of atherosclerosis

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7
Q

Hypertension

A

Persistent elevation of diastolic (>90 mmHg) and/or systolic (>140 mmHg) blood pressure.

Measured twice, two weeks apart

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8
Q

Hypertensive vascular disease

A

Aka hypertension

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9
Q

Incidence

A

Rate of new cases; probability of occurrence

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10
Q

Prevalence

A

Proportion of cases in a population in a given time.

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11
Q

Congenital heart disorders develop

A

In utero during 1st trimester

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12
Q

Septal defects

A

Most common form of congenital heart disease (40%)

Defect in septum between left and right side of heart

Ventricular septal defect more common and more serious

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13
Q

Pathogenesis of Ventricular Septal Defect

A 
Higher left chamber pressure than right
Left-to-right shunt
Hypertrophy of right side of heart
Pulmonary hypertension
Narrowing of pulmonary artery
Increased pressure in right side
Right to left shunt
Deoxygenated blood leaving heart
Cyanosis
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14
Q

Left to right shunt

A

In VSD

Higher pressure in left chamber causes blood to flow from left to right through defect

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15
Q

Right to left shunt

A

In VSD

Pulmonary hypertension and narrowing of pulmonary artery causes increase in pressure in right chamber

Blood then flows from right to left through defect.

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16
Q

Tetralogy of Fallot

A
  1. Stenosis of pulmonary artery or valve
  2. Ventricular septal defect
  3. Dextroposition of aorta
  4. Hypertrophy of right ventricular.
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17
Q

Most common congenital heart defects

A

Septal defect

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18
Q

Most common cause of infant cyanosis

A

Tetralogy of Fallot

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19
Q

Patent ductus arteriosis

A

Failure to form ligamentum arteriosum

Ductus arteriosis between pulmonary trunk and aorta remains open.

Usually occurs in preterm infants.

Aortic blood flows into pulmonary trunk, increasing pulmonary BP and overworking both ventricles.

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20
Q

Coarctation of the aorta

A

Local congenital malformation.

Decreased flow of oxygenated blood, left ventrical works harder, hypertension develops.

Hypertrophic of left ventricle.

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21
Q

Rheumatic Fever and heart disease

A

Systemic, immunologically mediated disease related to streptococcal infection

Usually two weeks after strep throat
10% cases result in scarring a deformity of heart valves (pancarditis)

Can manifest with: chorea, poly arthritis, SOB, cough, rash …

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22
Q

Endocarditis

A

Inflammation of endocardium. Usually includes valvular defects.

From bacterial infection, especially staphylococcal and streptococcal.

Men 2x women

Variable manifestation. Difficult to diagnose. Heart murmurs, failure.

Poor prognosis. Untreated always fatal.

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23
Q

Myocarditis

A

Inflammation of myocardium. Often viral (but also bacterial and parasitic). Can also result from sarcoidosis, SLE, drugs, radiation.

HIV, rheumatic fever, Chagas disease
Common.

Vague symptoms: chest pain, mild fever, SOB and other signs of heart failure.
Can include arrhythmia, cardiac conduction problems

Chronic – can lead to cardiomyopathy

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24
Q

Pericarditis

A

Inflammation of pericardium
May be isolated by most often associated with other infections of the heart. Primary or secondary

RHD, LSE, uremia, radiation, trauma

Thickened layers of pericardium (parietal and visceral, aka epicardium) rub against each other and the heart.

Chest pain.
Fibrous exudate.

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25
Q

Two predisposing factors required for endocarditis

A
  1. Predisposing abnormality of endocardium

2. Microorganisms in the bloodstream

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26
Q

Pathogenesis of endocarditis

A

Bacteria damages surface of valves
Inflammation
Fibrin and platelet thrombi form and create nidus for more thrombogenic material
Grow into wartlike structures (verrucous endocarditis)
Inflammation and scarring cause deformities and/or ulcerations

Valves may rupture and create septic emboli (kidney, brain, extremities)

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27
Q

Nidis

A

“Nest” of bacteria, parasites, and other agents of disease.

Seen in endocarditis

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28
Q

“Vegetation”

A

Abnormal growth (seen in endocarditis)

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29
Q

Excrescence

A

Distinct outgrowth on a body, especially one that results in disease or abnormality

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30
Q

Acute bacterial endocarditis: presentation

A

May present as an acute febrile illness

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31
Q

Subacute bacterial endocarditis: presentation

A

Mild temperature that waxes and wanes

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32
Q

Pathogenesis of Myocarditis

A

Involves three stages (1. active 2. healing 3.healed) that are characterized by inflammatory cell infiltrates leading to intersitial edema, focal necrosis and fibrosis.

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33
Q

Pericardial effusion

A

Exudation of fluid into pericardial sac. Associated with pericarditis

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34
Q

Cardiomyopathy

A

Group of conditions impairing contraction of and relations between cardiac muscle fibres.

Can be primary or secondary.

Dilated, hypertrophic, restrictive

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35
Q

Dilated cardiomyopathy

A

Occurs most commonly in middle aged black men
Idiopathic or secondary
Fatigue, weakness, chest pain.

Risk factors: obesity, alcohol, hypertension, smoking, infections, pregnancy

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36
Q

Hypertrophic cardiomyopathy

A

Appears to be an autosomal dominant condition
Frequently asymptomatic
Most common cause of sudden cardiac death in young athletes

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37
Q

Restrictive cardiomyopathy

A

Occurs as a result of myocardial fibrosis
amyloidosis, sarcoidosis, etc.

Rigid, noncompliant cardiovascular tissue

Exercise intolerance, SOB, fatigue, edema, ascites

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38
Q

Amyloidosis

A

Rare condition involving buildup of amyloid (inappropriately folded proteins).

Can cause restrictive cardiomyopathy

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39
Q

Sarcoidosis

A

Collection of inflammatory cells in nodules, within tissues

Can cause restrictive cardiomyopathy

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40
Q

Mitral Regurgitation

A

Incompetency of the mitral valve.

Back flow from left ventricle to left atrium

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41
Q

Mitral Stenosis

A

Narrowing of mitral valve impeding blood flow from left atrium to left ventricle

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42
Q

Aortic regurgitation

A

Incompetency of aortic valve

Backflow from aorta to left ventricle

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43
Q

Aortic stenosis

A

Narrowing of aortic valve obstructing blood flow from left ventricle to aorta.

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44
Q

Valvular disease

A

Stenosis or incompetency
Usually mitral or aortic valves.

RDH, endocarditis, congential valve disease, autoimmune disorders

Backflow –> overburdened chamber –> hypertrophy
Hypertension
Decreased blood flow

Variable manifestation: angine, dyspnea, heart failure, arrhythmia, palpations, heart murmur
… of asymptomatic

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45
Q

Arteriosclerosis

A

Hardening of the arteries

46
Q

Atherosclerosis

A

A form of arteriosclerosis in which fatty plaque deposits build up in arteries

47
Q

Ischemic Heart Disease

A

AKA coronary heart disease (CHD) or coronary artery disease (CAD)

Major disorder of myocardium due to insufficient blood supply

48
Q

Gradual ischemic heart disease can lead to

A

Hypofusion if myocardium and congestive heart failure

49
Q

Angina pectoralis

A

Chest pain, which may radiate (especially down left arm)and lasts 3-20 minutes.

Typically precipitated by effort

Relieved by rest and nitroglycerin

Most common in men over 65

50
Q

Causes of angina pectoralis

A

Anything that alters blood supply to myocardium, or blood requirements of myocardium

51
Q

Categories of angina

A
  1. Chronic stable
  2. New-onset
  3. Nocturnal
  4. Postinfarction
  5. Preinfarction
  6. Prinzmetal’s
  7. Decubitus
52
Q

Chronic stable angina

A

Classic exertional angina

Predictable and constant

53
Q

New-onset angina

A

Unstable. Developed within the lasts two weeks.

54
Q

Prinzmetal’s angina

A

Symptoms similar to typical
Caused by coronary artery spasm (not blockage)

Occurs early in morning, so not exercise related

55
Q

Decubitus angina

A

Atypical
More common in women
Occurs at rest

Relieved by sitting or standing

56
Q

Myocardial infarction

A

Development of ischemia with resultant necrosis of myocardial tissue

Heart attack.

Due to sudden occlusion of a coronary artery (anterior descending branch of LCA most common)

57
Q

Congestive heart failure

A

Heart unable to pump sufficient blood

Predominantly the failure is on left.

Blood flow slows
Blood returning to heart backs up in veins
Edema in tissues, lungs
Decreased blood to kidneys leads to Na and H2O retention, which increases load on heart
Heart has to work harder –> LV hypertrophy

Poor prognosis. Not really reversible

58
Q

Cor pulmonale

A

Right ventricle enlargement secondary to lung disorder.

COPD (chronic)
Pulmonary embolism (acute)
59
Q

Pulmonary embolism

A

Occlusion of one or more pulmonary arteries by thrombi

Cause DVT in 50% of cases

60
Q

Atelectasis

A

Total or partial collapse of lung

Possible consequence of pulmonary embolism

61
Q

Rales

A

Crackly, rattling lung sounds

Possible sign of pulmonary embolism

62
Q

Dysthymia

A

Disturbance in rate or rhythm of heartbeat

63
Q

Atrial fibrillation

A

Most common chronic arrhythmia
Inefficient pumping, Usually secondary to heart disease

Ventricles don’t fill properly, so heart races but blood flow diminishes

64
Q

Fibrillation

A

Rapid uncoordinated heart beats

65
Q

Ventrical fibrillation

A

Electrical problem
Involuntary uncoordinated contractions
Frequent cause of cardiac arrest

“Clear!”

66
Q

Heart block

A

AV block
Dysrrhythmia caused by interruption in cardiac conduction

1st, 2nd and 3rd degree blocks.

Can be caused by meds or disease
Treated with meds or pacemaker

67
Q

Ectopic beats

A

Electrical activation of heart that originates outside SA node

68
Q

Paroxysmal tachycardia

A

Abnormal rapid heart rate that begins and ends suddenly

69
Q

Arteriosclerosis

A

Group of disorder characterized by thickening and loss of elasticity in the arterial walls.

Hardening of the arteries.

70
Q

Three types of arteriosclerosis

A
  1. Athlerosclerosis
  2. Monckeberg’s artiosclerosis
  3. Artiolosclerosis
71
Q

Athlerosclerosis

A

Plaques/fatty deposits form in the intima of arteries, blocking lumen

Athero=gruel (lipids, macrophages, T cells, smooth muscle cells, ECM, calcium, necrotic debris).
Simultaneous hardening and softening.

72
Q

Monckeberg’s Arteriosclerosis

A

Age-related (senile) arteriosclerosis

Destruction of muscle and elastic fibres in middle layer of endothelial wall (tunica media), and formation of calcium deposits.

73
Q

Arteriolosclerosis

A

Arteriolar sclerosis

Thickening of walls of small arteries

Hypertension related
Not atheroma-related.

74
Q

Atheroma

A

Accumulation of degenerative material in the tunica interna.

Mostly macrophage cells containing lipids, calcium, and fibrous connective tissue.

Occur in atherosclerosis.

75
Q

Pathogenesis of atherosclerosis

A

Normal endothelium: smooth and non-reactive.

But endothelium gets damaged – often from LDLs that get corrupted by free radicals (from booze and ciggies), or by bacteria, or wear and tear from high blood pressure.

Damage allows macromolecules (esp cholesterol) to slip through to underlying muscle.

Collagen, platelets, proliferation, obstruction.

76
Q

Three categories of atherosclerosis

A
  1. Coronary artery disease
  2. Peripheral vascular disease
  3. Cerebrovascular disease
77
Q

Peripheral Vascular Disease

A

Any disease of the circulatory system outside the brain or the heart.

Lower extremities more commonly affected than upper extremities

Most commonly a result of atherosclerosis

Symptoms include intermittent claudication, pain, cyanosis, fatigue, gangrene, cold

78
Q

Vasculitis

A

A form of peripheral vascular disease.

Inflammation of a blood vessel, affecting either an organ or a system

79
Q

Arteritis

A

A vasculitis; Inflammation of an artery

80
Q

Infective arteritis

A

Arteritis due to infection

81
Q

Rheumatoid arteritis

A

Arteritis associated with Rheumatoid Heart Disease

82
Q

Giant Cell Arteritis (GCA)

A

A form of Arteritis
AKA cranial or temporal arteritis
Vasculitis primarily involving multiple sites of temporal and cranial arteries, sometimes aortic arch

More often in older women

Left untreated, may lead to stroke, blindness, aortic dissection

83
Q

Symptoms of Giant Cell Arteritis

A

Severe, continuous, unilateral, throbbing headache and temporal pain.

May also include: flu-like symptoms, visual disturbance, radiating pain, blindness, shoulder paralysis, claudication of the arm with cold hands, absent radial pulse.

84
Q

Claudication

A

Angina of the legs/jaw/arm

85
Q

Thromboangiitis Obliterans

A

Buerger’s Disease

A vasculitis affecting peripheral blood vessels, primarily in extremities (hands and feet).
Inflammatory lesions in peripheral blood vessels, accompanied by thrombus formation and vasospasm.
Small and medium blood vessels occluded and obliterated.

More common in men who smoke

86
Q

Symptoms of Thromboangiitis Obliterans

A

Episodic and segmental pain

Plantar, tibial and digital vessels most commonly affected

87
Q

Polyarteritis Nodosa

A

Multiple sites of inflammatory and digestive lesions in the arterial system.

Often comorbid with Hep B; frequently found in IV drug users

Affects small and medium sized vessels.

Good prognosis with treatment

88
Q

Which systems are more often involved with polyarteritis nods?

A 
Kidneys
Heart
Liver
GI tract
Muscles
Testes
89
Q

Aneurysm

A

Stretching of blood vessel wall at least 50% beyond its normal diameter.

90
Q

Aortic aneurysm

A

Most common site for an arterial aneurysm
Thoracic (ascending, transverse, first part of descending)
Abdominal (usually between renal and iliac arteries)

91
Q

Mycotic aneurysm

A

Bacterial or fungal infection, most often salmonella or syphillis

92
Q

Artherosclerotic aneurysm

A

Build up of fatty deposits on the inner wall of the arteries

Plaque formation erodes wall –> stretching –> inflammation –> fibrosis –> rupture

93
Q

Telangiectasia

A

Spider veins

Dilation of a small group of blood vessels

94
Q

Frostbite

A

Tissue damage caused by exposure to extreme cold (0-2 degrees or colder)

Vasoconstriction –> ice crystals form in tissues and expand –> cell membranes rupture –> digestive enzymes released

95
Q

Diabetic microangiopathy

A

Caused by long term, poorly controlled hyperglycemia

Increased inflammation, increased scar tissue, decreased blood supply

Compounded by the immune dysfunction caused by hyperglycemia

Most common manifestations:

  1. retinopathy
  2. neuropathy
  3. nephropathy
96
Q

Diabetic retinopathy

A

Most common cause of adult blindness in USA

Retinal capillary microaneurysms –> macular edema –> neovascularization

97
Q

Diabetic neuropathy

A

Results from

  1. nerve ischemia from microvascular disease
  2. direct effects of hyperglycemia on neurons
  3. intracellular metabolic changes that impair nerve function

Starts with stocking/glove presentation

98
Q

Diabetic nephropathy

A

Glomerular sclerosis and fibrosis caused by metabolic and hemodynamic changes.

Number one cause of renal failure in US

99
Q

Decompression Sickness

A

Caisson disease, “the bends”, diver’s disease

Rapid pressure reduction causes gases to form bubbles in blood vessels. Bubbles block vessels, rupture or compress tissue, or activate clotting and inflammatory cascades.

Henry’s Law

80% recover completley

100
Q

Type 1 Decompression Sickness

A

Progressive worsening in joints, back and muscles.
Pain worse with movement; deep and boring
Lymphadenopathy, skin mottling, itching, rash

101
Q

Type 2 Decompression Sickness

A

Neurologic and maybe respiratory symptoms
Paresis, numbness, tingling, difficulty urinating, loss of bladder and bowel control
Seizures, slurred speech, vision loss, confusion, coma, death.

102
Q

Varicose Veins

A

AKA varicosisties
Abnormal dilation of veins leading to tortuosisty of vessel, incompetence of valves, and propensity to thrombosis

Women more than men (70% of women 60-70)

May lead to ulcers, thrombosis, phlebitis

103
Q

Common sites for varicose veins

A 
Lower extremities
Saphenous veins
Rectum and anal canal
Scrotum (variocele)
Esophagus
104
Q

Venous Thrombosis

A

Partial or full occlusion of a vein by a clot

Trauma to endothelium makes it stickier for platelets and clotting factors –> thrombosis

105
Q

Thrombophlebitis

A

Partial or full occlusion of a vein by a thrombus with a secondary inflammatory reaction in the wall of a vein.

Thrombus –> inflammation

106
Q

Phlebothrombitis

A

Inflammation of a vein, which predisposes a person to clot formation

Inflammation –> thrombus

107
Q

Deep Vein Thrombosis

A

3rd most common CV disease

Usually in calf.
Often clinically silent and benign, but can lead to pulmonary emboli (especially popliteal, femoral or inferior vena cava)

108
Q

Possible fates of thrombi

A

Recanalization (blood carves new pathway)
Dissolution
Organization (new tissue grows in and around it)
Persist as thrombus
Embolus

109
Q

Chronic Venous Insufficency

A

AKA postphlebitis syndrome, venous stasis

Inadequate venous return over a long period of time
Follows most sever cases of DVT, but can also be secondary to varicose veins, leg trauma or neoplasm

Damaged valves –> decreased venous return –> increased venous pressure –> venous stasis
–> superficial veins and capillaries dilate –> edema and reddish brown pigmentation

Inadequate oxygenation and waste removal –> cell death —> necrotic tissue –> venous stasis ulcers

Thin, shiny, dry skin. Cellulitis, dermititis

110
Q

Raynaud’s

A

Intermittent episodes of small artery or arteriole constriction of the extremities
More common in women
Usually triggered by cold, stress,
Pallor, cyanosis

Can be associated with Buerger’s or CT disorders, or neoplasms, occlusive arterial disease, TOS, frostbite etc.

111
Q

Raynaud’s phenomenon

A

secondary Raynaud’s

112
Q

Raynaud’s disease

A

primary Raynaud’s, Primary Vasospastic Disorder

Idiopathic

Systemic Pathology 500 (3 decks)

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