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Clinical Pathology > CP8-3 cardiovascular pathology 3 > Flashcards

CP8-3 cardiovascular pathology 3 Flashcards

1
Q

What is peripheral vascular disease?

A

Atherosclerosis of arteries supplying the legs (sometimes arms) leading to narrowing of the lumen and restriction of blood flow

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2
Q

What is the epidemiology of peripheral vascular disease?

A

Age >40
Obese people
Smokers
Men or post menopausal women (as oestrogen a protective factor)
People with family history
PMH of diabetes +/- hypercholestroaemia +/- hypertension

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3
Q

What is the aetiology of peripheral vascular disease?

A

Endothelial dysfunction due to oxidative stress —> fatty streak formation —> stable (fibrous) plaque forms —> plaque can become unstable —> narrows lumen —> reduces blood flow —> ischaemia —> tissue damage

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4
Q

What are the 6Ps of acute peripheral vascular disease symptoms?

A

Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishingly cold
… feet/limb

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5
Q

How does chronic peripheral vascular disease present?

A

With reduced pulse in ABI otherwise a symptom
With intermittent claudication with pain in limb upon exertion
With rest pain
With tissue loss
(Top to bottom, least to most severe)

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6
Q

What causes chronic peripheral vascular disease?

A

Gradual atherosclerosis

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7
Q

What causes acute peripheral vascular disease?

A

Plaque rupture or thrombus formation

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8
Q

What type of necrosis occurs in peripheral vascular disease?

A

Coagulative necrosis

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9
Q

What is giant cell arteritis aka temporal arteritis?

A

Type of vasculitis affecting the large arteries in the head.

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10
Q

Why is giant cell arteritis a medical emergency?

A

As it can lead to blindness

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11
Q

What is the aetiology of giant cell arteritis?

A

T cell mediated autoimmune damage of blood vessels via a type 4 hypersensitive reaction

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12
Q

What is the epidemiology of giant cell arteritis?

A

Older individuals (rarely found in patients under 50)
In US and Europe
Women > men
People with PMH of polymyalgia rheumatica

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13
Q

What is the pathogenesis of giant cell arteritis?

A

Cytokines releases in type 4 hypersensitivity reaction recruits macrophages and other inflammatory cells leading to chronic granulomatous inflammation. This thickens the arterial wall, narrowing the lumen, reducing blood flow and causing tissue damage due to ischemia

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14
Q

How do patients with giant cell arteritis preset?

A

Fatigue
Weight loss
Fever
Tender superficial temporal artery/ scalp
Jaw claudication when eating
Blurred vision
Blindness (can be permenant)
With a stroke

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15
Q

What is infective endocarditis?

A

Infection and inflammation of the endocardium mainly involving the valves

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16
Q

Who tends to get infective endocarditis?

A

People with…

…structurally abnormal valves e.g. due to congenital heart disease
…. Foreign material in heart e.g. prosthetic valves
…. Immunosuppression e.g. HIV
… bacteraemia due to IV drug use, long term IV catheter use, colorectal cancer and dental procedures
… normal healthy hearts but exposed to virulence organisms like s. Aureus

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17
Q

What bacteria can cause infective endoca?

A

Streptococcus e.g. viridans and bovis, and staphylococcus aureus or epidermis

Rarely fungi (usually in immunosuppressed) like candida and aspergillus

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18
Q

What is the pathogenesis of infective endocarditis?

A

Damage to endothelium up over valve causes fibrin deposition —> circulating bacteria colonise this fibrin —> vegetations form

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19
Q

What can infective endocarditis lead to and why?

A

Heart failure and murmurs due to vegetation damaging valves
AV block due to vegetations causing local abscesses
Jae way lesions, splinter haemorrhages, splenic infarct and kidney infarct due to emboli of vegetations
Fever and weight loss, and immune complex formation causing Roth spots, glomerulonephritis and oiler nodes due to san immune response to the infective endocarditis.

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20
Q

What is pericarditis?

A

Inflammation of the pericardial sac

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21
Q

What are the main classification of pericarditis?

A

Acute or chronic

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22
Q

What are the types of acute pericarditis?

A

Serofibrinous
Caseous
Haemorrhagic
Purulent

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23
Q

What is the main type of chronic pericarditis?

A

Constrictive

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24
Q

What is the aetiology of pericarditis?

A

Infections like Coxsackie B and TB
Autoimmune diseases like Dressler’s syndrome, SLE and rheumatic fever
Uraemia
Neoplasia

25
Q

What is the pathogenesis of pericarditis?

A

There is acute inflammation in the pericardium leading to leaky vessels, accumulation of fluid in the pericardial sac. When becomes chronic, extracellular matrix and collagen deposits causes fibrosis and thickening of the pericardium. This reduces filling of the heart which can lead to heart failure

26
Q

How does a patient with pericarditis present?

A

Central chest pain exacerbated lying down and laying flat
Pericardial friction rub heard on auscultation
Fever
Pericardial effusion which can lead to cardia tamponade
Heart failure

27
Q

What is found in the pericardial sac alongside fluid in serofibrinous pericarditis?

A

Fibrin

28
Q

What is found in the pericardial sac alongside fluid in purulent pericarditis?

A

Neutrophils

29
Q

What is found in the pericardial sac alongside fluid in haemorrhagic pericarditis?

A

Red bloods cells

30
Q

What is found in the pericardial sac alongside fluid in caseous pericarditis?

A

Caseous necrosis due to TB

31
Q

What is myocarditis?

A

Inflammation of the myocardium (heart itself)

32
Q

What is the epidemiology of myocarditis?

A

Anyone depending on cause

33
Q

What is the aetiology of myocarditis?

A

Infection mainly viruses
Autoimmune conditions like SLE
Drugs
Sarcoidosis

34
Q

What drugs can cause myocarditis?

A

Methylodopa
Sulphonamides

35
Q

What is the pathogenesis of myocarditis?

A

Inflammation of myocardium leads to dysfunction including electrical dysfunction leading to arrhythmias +/- mechanical dysfunction like heart failure

36
Q

How might patients present with myocarditis?

A

Asymptomatic
With chest pain
Heart failure
Arrhythmias
Sudden death

37
Q

What is rheumatic fever?

A

A rare complication of a group A strep pharyngitis that affects other organs including the heart

38
Q

What is the epidemiology of rheumatic fever?

A

Rare in UK now but still found in developing countries
In children
Often have history of sore throat

39
Q

What is the aetiology of rheumatic fever?

A

Untreated group A strep infection e.g. strep pyogens with immune cross reactivity

40
Q

What is the pathogenesis of rheumatic fever?

A

Group A strep causes a type 2 hypersensitivity reaction where antibodies are made against M protein on the surface of strep pyogenes bacteria. However these antivodies also recognise proteins on surface of cells in the heart, skin, joints and CNS

41
Q

How do patients with rheumatic fever present?

A

With endocarditis (usually mitral stenosis), myocarditis or pericarditis
With subcutaneous nodules or erythema marginatum on the skin
Arthritis
Sydenham’s chorea
Fever
Malaise

42
Q

What is cardiomyopathy?

A

Heart muscle disease separated into dilated, hypertrophic, restrictive and arrythmogenic

43
Q

What is hypertrophic (obstructive) cardiomyopathy?

A

Cardiomyopathy where heart can’t fill or empty properly (left ventricle outflow obstruction) due to pump failure, relative ischaemia and electrical disruption

44
Q

What is the aetiology of hypertrophic cardiomyopathy?

A

Genetics

45
Q

Who gets hypertrophic cardiomyopathy?

A

Anyone can

46
Q

How do patients with hypertrophic cardiomyopathy present?

A

Heart failure
Chest pain due to ischaemia
Arrhythmias and sudden death
Mural thrombus formation +/- embolisation

47
Q

Why does hypertrophic cardiomyopathy contribute to intracardic thrombus formation?

A

As increased stasis of blood

48
Q

What is dilated cardiomyopathy?

A

Dilated and thin walled ventricle chambers lead to impaired ventricular pumping (decreases LVEF) causing pump failure where heart can’t empty

49
Q

What is the epidemiology of dilated cardiomyopathy?

A

Anyone but most common in males aged 20-50

50
Q

What is the aetiology of dilated cardiomyopathy?

A

Often unknown
Can be autosomal dominant inherited gene mutation
Alcohol
Takotsubo
Infection like Coxsackie B
Pregnancy
Haemochromatosis

51
Q

How do patients with dilated cardiomyopathy present?

A

Heart failure
Thrombus +/- emboli due to blood stasis
Arrhythmias and sudden death as electrical activity also affected

52
Q

What is restrictive cardiomyopathy?

A

Impaired ventricular filling due to pump failure usually secondary to another disease

53
Q

What is the aetiology of restrictive cardiomyopathy?

A

Idiopathic or secondary to amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites

54
Q

What is the epidemiology of restrictive cardiomyopathy?

A

Dependent on cause but can affect anyone

55
Q

How to patients with restrictive cardiomyopathy present?

A

Heart failure
Arrhythmias and sudden death
Mural thrombus formation +/- embolisation

56
Q

What is arrythmogenic cardiomyopathy?

A

Impaired cell adhesion causing cells to detach and fibrofatty tissue to form to repair damage. This interferes with muscle contraction and electrical conduction leading to pump failure and arrhythmias

57
Q

What is the epidemiology of arrythmogenic cardiomyopathy?

A

Most common in young males

58
Q

What is the aetiology of arrythmogenic cardiomyopathy?

A

Genetics - autosomal dominantly
Mutation in desmosome proteins which are involved in myocyte adhesion

59
Q

How to patients with arrhythmogenic cardiomyopathy present?

A

Palpitations
Syncope
Heart failure
Thrombus +/- emboli
Arrhythmias and sudden cardiac death which is often exercise induced.

Clinical Pathology (65 decks)

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