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Cardiovascular Pathology > CP30 - Cardiovascular 3 > Flashcards

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
Q

what are the different from of pericarditis

A

acute and chronic

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26
Q

what are the different types of acute pericarditis?

A

mostly inflamed

serous, serofibrinous/fibrinous,
purulent/suppurative, haemorrhagic, casesous

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27
Q

what the different types of chronic pericarditis

A

mostly adhesive

adhesive, adhesive mediastinopericarditis, constrictive pericarditis

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28
Q

what is serous pericarditis?

A

Inflammation causes clear ‘serous’ fluid accumulation

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29
Q

what causes serous pericarditis?

A

non-infectious -inflammation in adjacent structures can cause pericardial reactions

rarely by viral pericarditis

can also be stimulated by immunological & miscellaneous conditions

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30
Q

what is the common form of pericarditis?

A

serious fluid and/or fibrinous exudate in pericardial sac

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31
Q

what are the common causes of pericarditis?

A

acute MI, uraemia, radiation, rheumatic fever, SLE, trauma, surgery

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32
Q

what causes purulent/suppurative pericarditis

A

?

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33
Q

what are some clinical features for purulent/suppurative pericarditis?

A

red, granular, exudate(pus)

34
Q

what are the outcome of purulent pericarditis?

A

complete resolution is rare

oganisation by scarring - restrictive pericarditis (serious)

35
Q

what is haemorrhagic pericarditis

A

pericarditis with blood mixed with serous or suppurative effusion

36
Q

what are some of the common causes for haemorrhagic pericarditis

A

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
Q

what causes caseous pericarditis

A

TB or fungal

38
Q

what is adhesive pericarditis?

A

Fibrosis / stringy adhesions obliterates pericardial cavity

39
Q

what is adhesive mediastinopericarditis

A

follows pericarditis caused by infections,/surgery/radiations
Obliterated pericardial cavity with adherence to surrounding structures
Causes cardiac hypertrophy / cardiac dilation

40
Q

what are constrictive pericarditis?

A

heart encased in fibrous scar - limits cardiac function

41
Q

what is pericarditis?

A

it is inflammation of visceral and/or pericardial layers of mediostenium

42
Q

what are some characterisitics for pericarditis?

A

sharp central chest pain, pericardial friction rub, fever, leuocytosis, lymphocytosis, pericardial effusion

43
Q

what are some complications for pericarditis?

A

pericardial effusion/cardiac tamponade

44
Q

what is cardiomyopathy

A

heart muscle disease ie disorder of myocardium

45
Q

what are the 4 main types of cardiomyopathy

A

dilated, hypertrophic, restrictive, arrythmogenic right ventricular cardiomyopathy

46
Q

what is dilated cardiomyopathy?

A

Heart enlarged, heavy, flabby (dilation of chambers)

Myocyte hypertrophy with fibrosis

Progressive dilation contractile dysfunction

47
Q

what are some causes for dilated cardiomyopathy

A

genetic - cytoskeletal proteins gene mutations

alcohol & other toxins - chemo

others - SLE, scleroderma etc

48
Q

what are some clinical presentation of dilated cardiomyopathy?

A

slow progressive signs - SoB, fatigue and ppor exertional capacity

49
Q

what is the treatment of dilated cardiomyopathy

A

Cardiac transplantation

Long-term ventricular assist (can induce regression)

50
Q

what is hypertrophic cardiomyopathy

A

myocardial hypertrophy

51
Q

what are some features for hypertrophic cardiomyopathy

A

mainly in left ventricule

Diastolic dysfunction with preserved systolic function

Intermittent ventricular outflow obstruction

52
Q

what is the aetiology for hypertrophic cardiomyopathy

A

100% genetics

53
Q

what are some clinical features for hypertrophic cardiomyopathy

A

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
Q

what are some complication for hypertrophic cardiomyopathy?

A

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
Q

what are the treatment for hypertrophic cardiomyopathy

A

Decrease heart rate and contractility - β-adrenergic blockers.

Reduction of the mass of the septum, which relieves the outflow tract obstruction

56
Q

what are some causes for restrictive cardiomyopathy

A

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
Q

what is the morphology of restrictive cardiomyopathy?

A

normal size/slightly dilated ventricles

myocardium is firm and noncompliant

58
Q

what is arrythmogenic right ventricle cardiomyopathy caused by

A

AKA arrhythmogenic R.V. dysplasia

genetic

59
Q

what happens in arrythmogenic right ventricle cardiomyopathy

A

RV dilation/myocardial thinning - cell to cell desosome problem

fibrofatty replace RV

Exercise - cells detach and die

60
Q

what is the common causative agent for infective myocarditis

A

coxsackie A&B viruses

61
Q

what is the clinical features for infective myocarditis

A

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
Q

what are some of the common causes for myocarditis

A

¥ Virus: coxsackie, HIV
¥ Chlamydiae
¥ Rickettsiae
¥ Bacteria: C diphtheriae, N meningococcus

Immune mediated reactions: Post viral, SLE, transplant rejection

63
Q

what is vasculitis

A

inflammation of the vessel wall

64
Q

how is vasculitis classified

A

Classification based on affected vessel size!

65
Q

what is the most common type of vasculitis

A

Giant cell arteritis

66
Q

what is the pathology of giant cell arteritis

A

Chronic granulomatous inflammation

Large to medium-sized arteries

67
Q

what are some examples for giant cell arteritis

A

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
Q

what is the histological features for giant cell arteritis

A

intimal thickening - reduce lumen size

Med. granulomatous inflammation - elastic lamina fragmentation

multinucleated giant cell

69
Q

what are some clinical features for giant cell arteritis

A

Facial pain or headache
Superficial temporal artery (painful to palpation)
Jaw claudication

Rare

70
Q

what is the diagnosis test for giant cell arteritis

A

biopsy and histology

71
Q

what is the treatment for giant cell arteritis

A

corticosteriods

72
Q

definition for aneurysms

A

Localised, permanent, abnormal dilatations of a blood vessel

73
Q

what are the different types of aneurysms

A

shape

aetiology -

Atherosclerotic
Dissecting
Berry
Microaneurysms
Syphilitic
Mycotic
False
74
Q

an example for atherosclerotic aneurysms

A

AAA - as atherosclerotic aneurysms are mainly in the abdomenal

75
Q

what are some complication for atherosclerotic aneurysm

A

risk of rupture causing retroperitoneal haemorrhage or thrombosis/lower limb thromboemboli

76
Q

what is dissecting aneurysms

A

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
Q

what is pathogenesis of dissecting aneurysm

A

it occurs when blood is forced through a tear in the the aortic intia creating a blood filled space in aortic media

78
Q

what is capillary microaneurysms

A

usually occur in cerebrum causing cerebral haemorrhage

79
Q

what is an example for microaneurysm?

A

Charcot-Bouchard aneurysms occur in intracerebral capillaries in hypertensive disease

Causes intracerebral haemorrhage (i.e. stroke)

80
Q

what is the cause of mycotic aneurysms

A

Weakening of arterial wall secondary to bacterial / fungal infection

81
Q

what is a false aneurysm?

A

Blood filled space around a vessel, usually following traumatic rupture or perforating injury

82
Q

what are the causes of acute arterial occlusion

A

embolus, thrombosis, trauma

Cardiovascular Pathology (3 decks)

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