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CP30 - Cardiovascular 3 Flashcards

1
Q

what is endocarditis?

A

inflammation of the endocardium of the heart

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2
Q

what are the 2 main form of endocarditis?

A

infective endocarditis & non-infective endocarditis

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3
Q

what can endocarditis cause?

A

vegetations of the heart valves ie stenosis

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4
Q

which one out of acute and subacute infective endocarditis is more nasty

A

acute infective endocarditis

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5
Q

what is acute infective endocarditis caused by ?

A

highly virulent organisms (in comparison to subacute infective endocarditis which is caused by lower virulence)

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6
Q

what are some features for acute infective endocarditis?

A

Necrotizing, ulcerative, destructive lesions

Difficult to cure with antibiotics and usually require surgery

Death frequent days to weeks despite treatment

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7
Q

what are the risk factors for acute/subacute infective endocarditis?

A

cardiac/valvular abnormalities eg MVP, valvular stenosis, artifical valves, unrepaired adn repaired congenital defects

rheumatic heart disease

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8
Q

what is the major route of spread for infective endocarditis?

A

haemotagenous

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9
Q

what are some causative organisms for infective endocarditis?

A

streptococcus viridans (from mouth)

S. aureus - from skins

coagulase -ve staphylococci (common infect prosthetic heart valves

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10
Q

what can acute infective endocarditis cause to the heart valves?

A

destructive lesions - AV, MV, right heart

Can erode - myocardium - abscess (ring abscess)

emboli contain large no. of virulent organisms

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11
Q

what are some clinical symptoms for infective endocarditis?

A

fever, non-specific symptoms, murmurs

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12
Q

what are some complications for IE?

A

immunologically mediated conditions eg glomerulonephritis

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13
Q

what are some clinical presentation of IE?

A

splinter/subungual haemorrhages

Janeway lesions - erythematous or haemorrhagic non-tender lesions on the palms or soles

osler’s nodes - subcutanouse nodules in the pulp of the digits

Roth spots - retinal haemorrhages in the eyes

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14
Q

what is non-bacterial thrombotic endocarditis?

A

non-infective endocarditis

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15
Q

who often gets non-infective thrombotic endocarditis

A

patients in debilitated state (weakened state) eg cancer/sepsis

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16
Q

what is non-bacterial thrombotic endocarditis associate with?

A

hypercoagulable state ie DVT, PE etc

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17
Q

what is non-bacterial thrombotic endocarditis part of?

A

part of the trousseau syndrome of migratory thrombophlebitis

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18
Q

what is the risk factor for non-bacterial thrombotic endocarditis ?

A

endocardial trauma/indwelling cather eg central line

SLE (systemic lupus erythematosis)

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19
Q

what are the vegetations of the NBTE like?

A

small sterile thrombi on valve leaflets, minimal local effect

systemic emboli - infarct in brain and heart

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20
Q

which organism cause the episode of rheumatic fever?

A

group A streptococcal pharyngitis - then the aftermath of this organism cause the inflammation etc

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21
Q

what is the only infection causes mitral valve stenosis?

A

mitral valve

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22
Q

what is the pathogenesis of rheumatic fever?

A

immune responses to group A strep

Antibodies directed against the M proteins of streptococci
Cross-react with self antigens in the heart

CD4+ T cells specific for streptococcal peptides
React with self proteins in the heart
Produce cytokines that activate macrophages (e.g. Aschoff bodies)

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23
Q

what is the most common infective organisms for pericarditis?

A

viruses (Coxsackie B), TB

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24
Q

what are some of the other causes for pericarditis?

A

immunologically mediated - rheumatic fever, SLE. scleroderma, post-cardiotomy

miscelaneous conditions - post MI, uraemia, cardiac surgery, neoplasia

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25
what are the different from of pericarditis
acute and chronic
26
what are the different types of acute pericarditis?
mostly inflamed serous, serofibrinous/fibrinous, purulent/suppurative, haemorrhagic, casesous
27
what the different types of chronic pericarditis
mostly adhesive adhesive, adhesive mediastinopericarditis, constrictive pericarditis
28
what is serous pericarditis?
Inflammation causes clear ‘serous’ fluid accumulation
29
what causes serous pericarditis?
non-infectious -inflammation in adjacent structures can cause pericardial reactions rarely by viral pericarditis can also be stimulated by immunological & miscellaneous conditions
30
what is the common form of pericarditis?
serious fluid and/or fibrinous exudate in pericardial sac
31
what are the common causes of pericarditis?
acute MI, uraemia, radiation, rheumatic fever, SLE, trauma, surgery
32
what causes purulent/suppurative pericarditis
?
33
what are some clinical features for purulent/suppurative pericarditis?
red, granular, exudate(pus)
34
what are the outcome of purulent pericarditis?
complete resolution is rare oganisation by scarring - restrictive pericarditis (serious)
35
what is haemorrhagic pericarditis
pericarditis with blood mixed with serous or suppurative effusion
36
what are some of the common causes for haemorrhagic pericarditis
neoplasia (malignant cells in effusion) infection eg TB post-op - cardiac tamponade (compression of the heart tissue by an accumulation of fluid in the pericardial sac.)
37
what causes caseous pericarditis
TB or fungal
38
what is adhesive pericarditis?
Fibrosis / stringy adhesions obliterates pericardial cavity
39
what is adhesive mediastinopericarditis
follows pericarditis caused by infections,/surgery/radiations Obliterated pericardial cavity with adherence to surrounding structures Causes cardiac hypertrophy / cardiac dilation
40
what are constrictive pericarditis?
heart encased in fibrous scar - limits cardiac function
41
what is pericarditis?
it is inflammation of visceral and/or pericardial layers of mediostenium
42
what are some characterisitics for pericarditis?
sharp central chest pain, pericardial friction rub, fever, leuocytosis, lymphocytosis, pericardial effusion
43
what are some complications for pericarditis?
pericardial effusion/cardiac tamponade
44
what is cardiomyopathy
heart muscle disease ie disorder of myocardium
45
what are the 4 main types of cardiomyopathy
dilated, hypertrophic, restrictive, arrythmogenic right ventricular cardiomyopathy
46
what is dilated cardiomyopathy?
Heart enlarged, heavy, flabby (dilation of chambers) Myocyte hypertrophy with fibrosis Progressive dilation contractile dysfunction
47
what are some causes for dilated cardiomyopathy
genetic - cytoskeletal proteins gene mutations alcohol & other toxins - chemo others - SLE, scleroderma etc
48
what are some clinical presentation of dilated cardiomyopathy?
slow progressive signs - SoB, fatigue and ppor exertional capacity
49
what is the treatment of dilated cardiomyopathy
Cardiac transplantation | Long-term ventricular assist (can induce regression)
50
what is hypertrophic cardiomyopathy
myocardial hypertrophy
51
what are some features for hypertrophic cardiomyopathy
mainly in left ventricule Diastolic dysfunction with preserved systolic function Intermittent ventricular outflow obstruction
52
what is the aetiology for hypertrophic cardiomyopathy
100% genetics
53
what are some clinical features for hypertrophic cardiomyopathy
decreased stroke volume - Impaired diastolic filling - reduced chamber size / compliance of hypertrophied left ventricle Obstruction to the left ventricular outflow in 25% of patients Exertional dyspnoea due to above Systolic ejection murmur
54
what are some complication for hypertrophic cardiomyopathy?
Atrial fibrillation Mural thrombus formation embolization / stroke Cardiac failure Ventricular arrhythmias Sudden death, especially in some affected families Most common causes of sudden death in athletes
55
what are the treatment for hypertrophic cardiomyopathy
Decrease heart rate and contractility - β-adrenergic blockers. Reduction of the mass of the septum, which relieves the outflow tract obstruction
56
what are some causes for restrictive cardiomyopathy
primary disease in ventricular compliance - Impaired ventricular filling during diastole idiopathic/secondary - fibrosis, amyloidosis, sarcoidosis, metastatic tumors or deposition of metabolites (inborn errors of metabolism)
57
what is the morphology of restrictive cardiomyopathy?
normal size/slightly dilated ventricles myocardium is firm and noncompliant
58
what is arrythmogenic right ventricle cardiomyopathy caused by
AKA arrhythmogenic R.V. dysplasia genetic
59
what happens in arrythmogenic right ventricle cardiomyopathy
RV dilation/myocardial thinning - cell to cell desosome problem fibrofatty replace RV Exercise - cells detach and die
60
what is the common causative agent for infective myocarditis
coxsackie A&B viruses
61
what is the clinical features for infective myocarditis
Asymptomatic Heart failure, arrhythmias and sudden death Non-specific symptoms - fatigue, dyspnea, palpitations, precordial discomfort, and fever Can mimic acute MI DCM can develop
62
what are some of the common causes for myocarditis
¥ Virus: coxsackie, HIV ¥ Chlamydiae ¥ Rickettsiae ¥ Bacteria: C diphtheriae, N meningococcus Immune mediated reactions: Post viral, SLE, transplant rejection
63
what is vasculitis
inflammation of the vessel wall
64
how is vasculitis classified
Classification based on affected vessel size!
65
what is the most common type of vasculitis
Giant cell arteritis
66
what is the pathology of giant cell arteritis
Chronic granulomatous inflammation Large to medium-sized arteries
67
what are some examples for giant cell arteritis
in the head - temporal arteries Also vertebral and ophthalmic arteries Ophthalmic arterial involvement Permanent blindness Giant-cell arteritis is a medical emergency requiring prompt recognition and treatment – early recognition is VITAL!
68
what is the histological features for giant cell arteritis
intimal thickening - reduce lumen size Med. granulomatous inflammation - elastic lamina fragmentation multinucleated giant cell
69
what are some clinical features for giant cell arteritis
Facial pain or headache Superficial temporal artery (painful to palpation) Jaw claudication Rare
70
what is the diagnosis test for giant cell arteritis
biopsy and histology
71
what is the treatment for giant cell arteritis
corticosteriods
72
definition for aneurysms
Localised, permanent, abnormal dilatations of a blood vessel
73
what are the different types of aneurysms
shape aetiology - ``` Atherosclerotic Dissecting Berry Microaneurysms Syphilitic Mycotic False ```
74
an example for atherosclerotic aneurysms
AAA - as atherosclerotic aneurysms are mainly in the abdomenal
75
what are some complication for atherosclerotic aneurysm
risk of rupture causing retroperitoneal haemorrhage or thrombosis/lower limb thromboemboli
76
what is dissecting aneurysms
usually in thoracic aorta; dissection along media causes vascular occlusion and haemopericardium (tear in inner layer of aorta causing blood to accumulate between inner and outer layer of aorta).
77
what is pathogenesis of dissecting aneurysm
it occurs when blood is forced through a tear in the the aortic intia creating a blood filled space in aortic media
78
what is capillary microaneurysms
usually occur in cerebrum causing cerebral haemorrhage
79
what is an example for microaneurysm?
Charcot-Bouchard aneurysms occur in intracerebral capillaries in hypertensive disease Causes intracerebral haemorrhage (i.e. stroke)
80
what is the cause of mycotic aneurysms
Weakening of arterial wall secondary to bacterial / fungal infection
81
what is a false aneurysm?
Blood filled space around a vessel, usually following traumatic rupture or perforating injury
82
what are the causes of acute arterial occlusion
embolus, thrombosis, trauma

Cardiovascular Pathology (3 decks)

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