CP30 - Cardiovascular 3 Flashcards
what is endocarditis?
inflammation of the endocardium of the heart
what are the 2 main form of endocarditis?
infective endocarditis & non-infective endocarditis
what can endocarditis cause?
vegetations of the heart valves ie stenosis
which one out of acute and subacute infective endocarditis is more nasty
acute infective endocarditis
what is acute infective endocarditis caused by ?
highly virulent organisms (in comparison to subacute infective endocarditis which is caused by lower virulence)
what are some features for acute infective endocarditis?
Necrotizing, ulcerative, destructive lesions
Difficult to cure with antibiotics and usually require surgery
Death frequent days to weeks despite treatment
what are the risk factors for acute/subacute infective endocarditis?
cardiac/valvular abnormalities eg MVP, valvular stenosis, artifical valves, unrepaired adn repaired congenital defects
rheumatic heart disease
what is the major route of spread for infective endocarditis?
haemotagenous
what are some causative organisms for infective endocarditis?
streptococcus viridans (from mouth)
S. aureus - from skins
coagulase -ve staphylococci (common infect prosthetic heart valves
what can acute infective endocarditis cause to the heart valves?
destructive lesions - AV, MV, right heart
Can erode - myocardium - abscess (ring abscess)
emboli contain large no. of virulent organisms
what are some clinical symptoms for infective endocarditis?
fever, non-specific symptoms, murmurs
what are some complications for IE?
immunologically mediated conditions eg glomerulonephritis
what are some clinical presentation of IE?
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
what is non-bacterial thrombotic endocarditis?
non-infective endocarditis
who often gets non-infective thrombotic endocarditis
patients in debilitated state (weakened state) eg cancer/sepsis
what is non-bacterial thrombotic endocarditis associate with?
hypercoagulable state ie DVT, PE etc
what is non-bacterial thrombotic endocarditis part of?
part of the trousseau syndrome of migratory thrombophlebitis
what is the risk factor for non-bacterial thrombotic endocarditis ?
endocardial trauma/indwelling cather eg central line
SLE (systemic lupus erythematosis)
what are the vegetations of the NBTE like?
small sterile thrombi on valve leaflets, minimal local effect
systemic emboli - infarct in brain and heart
which organism cause the episode of rheumatic fever?
group A streptococcal pharyngitis - then the aftermath of this organism cause the inflammation etc
what is the only infection causes mitral valve stenosis?
mitral valve
what is the pathogenesis of rheumatic fever?
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)
what is the most common infective organisms for pericarditis?
viruses (Coxsackie B), TB
what are some of the other causes for pericarditis?
immunologically mediated - rheumatic fever, SLE. scleroderma, post-cardiotomy
miscelaneous conditions - post MI, uraemia, cardiac surgery, neoplasia
what are the different from of pericarditis
acute and chronic
what are the different types of acute pericarditis?
mostly inflamed
serous, serofibrinous/fibrinous,
purulent/suppurative, haemorrhagic, casesous
what the different types of chronic pericarditis
mostly adhesive
adhesive, adhesive mediastinopericarditis, constrictive pericarditis
what is serous pericarditis?
Inflammation causes clear ‘serous’ fluid accumulation
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
what is the common form of pericarditis?
serious fluid and/or fibrinous exudate in pericardial sac
what are the common causes of pericarditis?
acute MI, uraemia, radiation, rheumatic fever, SLE, trauma, surgery
what causes purulent/suppurative pericarditis
?
what are some clinical features for purulent/suppurative pericarditis?
red, granular, exudate(pus)
what are the outcome of purulent pericarditis?
complete resolution is rare
oganisation by scarring - restrictive pericarditis (serious)
what is haemorrhagic pericarditis
pericarditis with blood mixed with serous or suppurative effusion
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.)
what causes caseous pericarditis
TB or fungal
what is adhesive pericarditis?
Fibrosis / stringy adhesions obliterates pericardial cavity
what is adhesive mediastinopericarditis
follows pericarditis caused by infections,/surgery/radiations
Obliterated pericardial cavity with adherence to surrounding structures
Causes cardiac hypertrophy / cardiac dilation
what are constrictive pericarditis?
heart encased in fibrous scar - limits cardiac function
what is pericarditis?
it is inflammation of visceral and/or pericardial layers of mediostenium
what are some characterisitics for pericarditis?
sharp central chest pain, pericardial friction rub, fever, leuocytosis, lymphocytosis, pericardial effusion
what are some complications for pericarditis?
pericardial effusion/cardiac tamponade
what is cardiomyopathy
heart muscle disease ie disorder of myocardium
what are the 4 main types of cardiomyopathy
dilated, hypertrophic, restrictive, arrythmogenic right ventricular cardiomyopathy
what is dilated cardiomyopathy?
Heart enlarged, heavy, flabby (dilation of chambers)
Myocyte hypertrophy with fibrosis
Progressive dilation contractile dysfunction
what are some causes for dilated cardiomyopathy
genetic - cytoskeletal proteins gene mutations
alcohol & other toxins - chemo
others - SLE, scleroderma etc
what are some clinical presentation of dilated cardiomyopathy?
slow progressive signs - SoB, fatigue and ppor exertional capacity
what is the treatment of dilated cardiomyopathy
Cardiac transplantation
Long-term ventricular assist (can induce regression)
what is hypertrophic cardiomyopathy
myocardial hypertrophy
what are some features for hypertrophic cardiomyopathy
mainly in left ventricule
Diastolic dysfunction with preserved systolic function
Intermittent ventricular outflow obstruction
what is the aetiology for hypertrophic cardiomyopathy
100% genetics
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
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
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
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)
what is the morphology of restrictive cardiomyopathy?
normal size/slightly dilated ventricles
myocardium is firm and noncompliant
what is arrythmogenic right ventricle cardiomyopathy caused by
AKA arrhythmogenic R.V. dysplasia
genetic
what happens in arrythmogenic right ventricle cardiomyopathy
RV dilation/myocardial thinning - cell to cell desosome problem
fibrofatty replace RV
Exercise - cells detach and die
what is the common causative agent for infective myocarditis
coxsackie A&B viruses
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
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
what is vasculitis
inflammation of the vessel wall
how is vasculitis classified
Classification based on affected vessel size!
what is the most common type of vasculitis
Giant cell arteritis
what is the pathology of giant cell arteritis
Chronic granulomatous inflammation
Large to medium-sized arteries
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!
what is the histological features for giant cell arteritis
intimal thickening - reduce lumen size
Med. granulomatous inflammation - elastic lamina fragmentation
multinucleated giant cell
what are some clinical features for giant cell arteritis
Facial pain or headache
Superficial temporal artery (painful to palpation)
Jaw claudication
Rare
what is the diagnosis test for giant cell arteritis
biopsy and histology
what is the treatment for giant cell arteritis
corticosteriods
definition for aneurysms
Localised, permanent, abnormal dilatations of a blood vessel
what are the different types of aneurysms
shape
aetiology -
Atherosclerotic Dissecting Berry Microaneurysms Syphilitic Mycotic False
an example for atherosclerotic aneurysms
AAA - as atherosclerotic aneurysms are mainly in the abdomenal
what are some complication for atherosclerotic aneurysm
risk of rupture causing retroperitoneal haemorrhage or thrombosis/lower limb thromboemboli
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).
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
what is capillary microaneurysms
usually occur in cerebrum causing cerebral haemorrhage
what is an example for microaneurysm?
Charcot-Bouchard aneurysms occur in intracerebral capillaries in hypertensive disease
Causes intracerebral haemorrhage (i.e. stroke)
what is the cause of mycotic aneurysms
Weakening of arterial wall secondary to bacterial / fungal infection
what is a false aneurysm?
Blood filled space around a vessel, usually following traumatic rupture or perforating injury
what are the causes of acute arterial occlusion
embolus, thrombosis, trauma
