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CSIM 1: Pathology Strand > CSIM 1.65: Cardiovascular Disease 4 > Flashcards

CSIM 1.65: Cardiovascular Disease 4 Flashcards

1
Q

Define:

1) Hypertension
2) Mild hypertension
3) Moderate hypertension
4) Severe hypertension
5) Malignant hypertension

A

1) Sustained elevated pressure over 140/90mmHg (or 130/80mmHg with diabetes or renal disease)
2) Diastolic 90-105
3) Diastolic 105-115
4) Diastolic 115-130
5) Diastolic 130+

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2
Q

What possible mechanisms have been proposed to explain essential hypertension?

A
  • Abnormal renin-angiotensin-aldosterone system
    • Abnormal sodium homeostasis
    • Abnormal sensitivity to catecholamines (adrenaline, noradrenaline)
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3
Q

Which cells make up the juxtaglomerular apparatus?

A
  • Juxtaglomerular cells
    • Macula densa cells
    • Lacis agranular cells
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4
Q

Describe how ACE inhibitors work

A

Inhibit angiotensin-converting enzyme, thus inhibiting the conversion of angiotensin 1 to angiotensin 2

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5
Q

Describe how the release of renin is controlled

A

Juxtaglomerular cells release renin in response to:
• Reduced NaCl in the macular densa (DCT) due to lowered GFR
• Decrease in renal perfusion rate detected directly
• Stimulation of β1 adrenergic receptor

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6
Q

What are the most common causes of secondary hypertension?

A
  • Renal disease
    • Adrenal tumours (pheochromocytoma)
    • Coarctation of the aorta (narrow aorta)
    • Corticosteroid drug therapy
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7
Q

What are the functions of angiotensin 2?

A
  • Upregulate aldosterone in the zona glomerulosa of the adrenal cortex
    • Vasoconstricts
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8
Q

What is benign and malignant hypertension?

A 
Benign hypertension - Hypertension which results in chronic  organ changes:
HEART CHANGES
  •  Left ventricular hypertrophy
  •  Chronic heart failure
  •  Ventricular arrhythmia 
VASCULAR CHANGES
  •  Atherosclerosis
  •  Cerebral aneurysm and haemorrhage
Treatable with long-term drug therapy

Malignant hypertension - Acute, rapidly progressive hypertension >130mmHg
• Blurred vision from papilloedema
• Retinal haemorrhages
• Renal failure and haematuria
• Cerebral haemorrhage/severe headache
Medical emergency

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9
Q

Define an aneurysm

A

Localised permanent dilatation of a blood vessel

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10
Q

What is a false aneurysm?

A

A blood-filled space around a blood vessel
• Caused by trauma or atheroma making the artery leaky, resulting in a pulsatile mass
• Not a true aneurysm as the vessel itself is of a normal calibre

IMG 163

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11
Q

What are the types of aneurysm?

A
  • Atherosclerotic
    • Dissecting
    • Berry
    • Capillary micro-aneurysm
    • Syphilitic
    • Mycotic
    • Cardiac
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12
Q

What type of aneurysm is an abdominal aortic aneurysm an example of? What is the clinical course of this condition after presentation?

What are the possible complications from this?

A

An atherosclerotic aneurysm
• Pulsatile abdominal mass
• Ruptures into the retro-peritoneum and peritoneal cavity

Complications:
• Atheroembolism from associated atheroma
• Erosion of the adjacent vertebra
• Compression of the ureter

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13
Q

Describe a dissecting aneurysm

A
  • Intimal tear develops, allowing blood to track to the media
    • Blood proceeds along the media forming a dissection and degenerating the tunica media
    • As it proceeds, branchesof the aorta are blocked, causing acute ischaemic damage

IMG 161

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14
Q

How does a patient with a dissecting aneurysm often present?

A
  • Severe pain (usually back pain)

* Shock

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15
Q

What type of aneurysm is a thoracic aortic aneurysm an example of?

A

A dissecting aneurysm

IMG 162

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16
Q

Describe the heritability of dissecting aneurysms

A

Associated to a single DNA mutation (monogenic) which is autosomal dominant

17
Q

Where do berry aneurysms often occur?

A

Circle of Willis or other brain regions

18
Q

What are capillary microaneurysms also known as? How large are these?

A

Charcot Bouchard aneurysms

Smaller than 0.5mm

19
Q

Describe the pathogenesis of syhilitic aneurysm

A
  • Due to tertiary syphilis
    • Tunica media undergoes ischaemic damage due to inflammation and narrowing of vasa vasorum
    • This can cause aortic root dilatation and therefore aortic valve regurgitation
20
Q

Describe the pathogenesis of a mycotic aneurysm

A
  • A bacterial or fungal infection enters the vasa vasorum, most commonly cerebral arteries
    • Usually secondary to bacterial endocarditis
21
Q

Describe the pathogenesis of a cardiac aneurysm

What can this cause?

A
  • Scarring following an MI leads to weakening of the left ventricular wall
    • This wall dilates under the blood pressure inside the left ventricle
    • An aneurysm forms which can be the cause of cardiac failure

IMG 164

22
Q

What is heart failure?

A

Heart is unable to provide sufficient pumping action to maintain blood flow to meet the needs of the body

23
Q

What are the primary cases of heart failure?

A
  • Ischaemic heart disease
    • Hypertension/Cor pulmonale
    • Valvular heart disease
    • Congenital heart disease
24
Q

What tools are used to aid in a cardiac failure diagnosis?

A 
Investigations:
  •  Electrocardiography/Echocardiography
  •  BNP: B type natriuretic peptide
  •  Chest X-ray
Clinical skills: 
  •  History
  •  Cardiovascular examination
25
Q

What is BNP: B type natriuretic peptide

A

Hormone released into plasma by stressed monocytes in cardiac failure

26
Q

What are the effects of:

1) Left-sided heart failure
2) Right-sided heart failure

A 
1) 
Acute:
  •  Pulmonary oedema
  •  Frothy, blood-stained sputum
Chronic
  •  Dyspnoea on exertion
  •  Poor renal perfusion causing renin-angiotensin system activation

2)
• Peripheral oedema
• Raised JVP
• Hepatic congestion

27
Q

What is congestive heart failure?

A

Concurrent left and right sided heart failure

28
Q

Describe briefly the renin-aldosterone-angiotensin system

A
  • Renin is an enzyme which converts angiotensinogen in the blood into angiotensin 1
    • Angiotensin 1 is turned into angiotensin 2 by angiotensin converting enzyme (ACE)

CSIM 1: Pathology Strand (30 decks)

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