CP8-1 cardiovascular pathology 1 Flashcards
What is the epidemiology of CVD?
7.6 million people have CVD
85 people per day die of an MI
What is ischaemic heart disease?
the name for the group of coronary syndromes which are caused by myocardial ischaemia
What is the aetiology of ischaemic heart disease?
almost always due to coronary artery atherosclerosis and sometimes due to hypertrophy
What are the 4 syndromes classed as ischaemic heart diseases?
MI
Angina - stable/unstable/prinzmetal
Chronic ischaemic heart disease and heart failure
Sudden cardiac death related to coronary atherosclerosis
What 3 diseases are classed as acute coronary syndrome?
MI
Unstable angina
Sudden cardiac death
What is the epidemiology of IHD?
Prevalence highest in northern England and Scotland in the UK
What are some medical risk factors for IHD?
High BP
High blood cholesterol
Diabetes
What are some lifestyle risk factors for IHD?
smoking
overweight
lack of exercise
What is the pathogenesis of IHD?
Fixed vessel narrowing and abnormal vascular tone due to atherosclerosis and endothelial dysfunction leads to imbalance between myocardial oxygen supply and demand
What is an MI?
Death of cardiac muscle due to prolonged ischaemia
What are the two types of MI?
Transmural
Subendocardial
What is the pathophysiology of MI?
Acute plaque changes cause platelet aggregation causing thrombus formation leading to full/partial occlusion of coronary artery(s)
What is the histology of the heart like 1-2 days after death?
pale with oedema, necrosis and high level of neutrophils
What is the histology of the heart like 3-4 days after death?
yellow with haemorrhagic edge, necrosis and macrophages
What is the histology of the heart like 1-3 weeks after death?
pale, thin with granulation tissue and then fibrosis
What is the histology of the heart like 3-6 weeks after death?
a dense fibrous scar
What are some complications of an MI?
Arrhythmias - if conduction system structures damaged e.g. SA node
Congestive cardiac failure - due to contractility dysfunction or papillary muscle infarct
Thromboembolism
Pericarditis
Cardiac tamponade
Cardiogenic shock
What can impaired contractility as a result of an MI lead to?
Stroke due to embolism
Cardiogenic shock
Congestive heart failure
What can tissue necrosis as a result of an MI lead to?
Congestive heart failure
Cardiac tamponade
What can electrical instability due to an MI lead to?
arrhythmias
What can pericardial inflammation as a result of an MI lead to?
pericarditis
What are some detectable blood markers which indicated IHD?
troponins
creatine kinase
myoglobin
lactate dehydrogenase
aspartate transaminase
What are the two types of hypertension?
Primary - idiopathic of essential
Secondary
How is hypertension defined?
a sustained diastolic pressure greater than 90 mm Hg or sustained systolic pressure greater than 140 mm Hg
What is the aetiology of primary hypertension?
Largely idiopathic but suspected multifactorial cause including genetic factors e.g. insulin resistance and environmental factors e.g. obesity and smoking
What is the epidemiology of hypertension?
About 1 in 7 people globally
Around a 1/3 of adults in England
Africans affected more
How is bp calculated?
Cardiac output x peripheral resistance
What system is involved in maintaining BP?
Renin-angiotensin-aldosterone system
How does the renin-angiotensin-aldosterone system work?
- When there is a drop in BP or fluid vol, the kidney releases renin.
- Renin acts on angiotensin from the liver to form angiotensin I
- ACE release from the lungs acts on angiotensin I to form angiotensin II
4a. Angiotensin II acts directly on blood vessels to stimulate vasoconstriction
4b. Angiotensin II acts on the adrenal gland to stimulate the release of aldosterone which acts on the kidney to stimulate reabsorption of salt and water.
What is an example of a drug which works on the renin-angiotensin-aldosterone system?
ACE inhibitors (suffix = pril e.g. ramipril)
What are the roles of angiotensin II?
- Increase systemic vascular resistance and arterial pressure via vasoconstriction
- Increases sodium and water retention by stimulating sodium reabsorption in the kidneys and aldosterone release by the adrenal cortex
- Also increases fluid retention by stimulating the release of ADH vasopressin
- Facilitates norepinephrine release from sympathetic nerve enhancing sympathetic adrenergic functions
- Stimulates cardiac and vascular hypertrophy
What are the subcategories of secondary hypertension?
Endocrine
Adrenal
Renal
CVS
Drugs
What are some endocrine causes of secondary hypertension?
cushing’s syndrome
acromegaly
thyroid disease
hyperparathyroid disease
What are some adrenal causes of secondary hypertension?
Conn’s disease
adrenal hyperplasia
pheochromocy toma
What are some renal causes of secondary hypertension?
What are some CVS causes of secondary hypertension?
aortic coarctation
renal artery stenosis
polyarteritis nodosa
What are some drugs which can cause secondary hypertension?
What is malignant hypertension?
What are some complications of hypertension?
Hypertensive renal disease
Hypertensive cerebrovascular disease e.g. strokes
Hypertensive heart disease
What is left sided hypertensive heart disease?
Hypertrophy of the heart as an adaptive response to hypertension leading to myocardial dilation, congestive heart failure and sudden death
What is the criteria for diagnosis hypertensive heart disease?
Left ventricular concentric hypertrophy alongside a history or pathological evidence of hypertension
What is cor pulmonale?
Right sided heart disease where there is hypertrophy, dilation and potentially heart failure secondary to pulmonary artery hypertension due to disorders of the lung or pulmonary vasculature
What causes of right ventricular hypertrophy mean cor pulmonale is not diagnosed?
if right sided hypertrophy is due to congenital causes or as a result of left sided hypertrophy
What are some diseases of the pulmonary parenchyma that lead to cor pulmonale?
What are some diseases of the pulmonary vessels that lead to cor pulmonale?
What are some disorders of chest movement that lead to cor pulmonale?
neuromuscular disease
Kyphoscoliosis
marked obesity (Pickwickian syndrome)
What are some disorders causing pulmonary arterial compression that lead to cor pulmonale?
What is an aneurysm?
What are the two types of aneurysm?
true aneurysm - when bounded by arterial wall components/attenuated wall of the heart
false aneurysm - a breach of the vascular wall leading to extravascular hematoma that freely communicates with the intravascular space aka pulsating haematoma
What is a true aneurysm?
What is a false aneurysm?
What is an arterial dissection?
What is a type of aortic dissection?
A double barrelled aorta
What is the aetiology of aneurysms?
What are some types of aneurysms?
AAA - abdominal aortic aneurysm
Berry aneurysms
Mycotic aneurysm
Syphilitic (leutic) aneurysms
At what size does an AAA require surgical repair?
> 5.5 cm
What are some risk factors for aneurysm?
Smoking
Hypertension
Advanced age
Being male
