CV Pathology Flashcards
What is the difference between arteriosclerosis and atherosclerosis?
Atherosclerosis is a type of arteriosclerosis involving buildup of plaques inside arteries. Arteriosclerosis is a general term for hardening of arteries.
What is the most important risk factor for atherosclerosis?
hyperlipidaemia
What is formed during atherosclerosis?
atheroma (fatty plaque)
What are the non-modifiable risk factors of atherosclerosis?
- Age
- Gender
- Genes. Familial hypercholesterolaemia. (Mutation of LDL receptor gene.)
Which cells are LDL (low density lipoprotein) receptors found?
what do they do?
many cell types including smooth muscle cells, fibroblasts and adrenocortical cells.
help facilitate movement of LDL and allows for enzymatic breakdown
basal state vs activated state of endothelial cells?
Basal State
smooth blood flow and surface
growth factors production
non-adhesive (no clot)
no inflammation
Activated State
turbulent blood flow and surface
cell adhesion molecules
pro-adhesive
pro-inflammation
What are the two stages of atherosclerosis?
Chronic inflammation phase
Healing phase
What happens in the chronic inflammation phase?
Chronic inflammatory injury by lipoproteins. Endothelial cells change surface cell receptors. This attracts macrophages and t cells via change in cell adhesion molecules forming foam cells in vessels. Foam cells burst, lipid deposits from dead cells
What happens in the healing response phase?
Smooth muscle cells migrate and proliferate to form a fibrous cap over the lipid-rich necrotic core containing foam cells
Growth factors drive smooth muscle accumulation
Eventually the necrotic core can become calcified
What growth factors are produced during healing phase?
PLGF, FGF, TGF-α
What are the effects of atherosclerosis?
- Decreased blood supply to tissue/organ (ischemia)
- Complete occlusion of the blood vessel leads to infarction.
- Thrombosis ( rupture of plaque)
- Embolism (can cause obstruction elsewhere)
What are symptoms of peripheral vascular diseases?
- Ischemia
- Claudication
- Gangrene
- Coagulation necrosis+infection
What surgical intervention can be used to improve leg circulation?
stent
What is an aneyrusm?
abnormal dilation of blood vessels
Where can aneurysms occur?
Where is most common?
- Can occur in blood vessel or in the cardiac wall as well as other places in the body.
- AAAs (abdominal aortic aneurysms) are the commonest and results from atherosclerosis
What can aneurysms cause?
can rupture - blood loss
may cause pressure on surrounding organs
What are the 2 acute coronary conditions?
angina pectoris
myocardial infarction
What happens in a myocardial infarction?
what tissue is created when healing
- Infarction-loss of blood supply; oxygen; nutrients
- Coagulation necrosis of myocardial muscle
- Anaerobic respiration ineffective
- Healing is by granulation tissue affects heart function
What happens to cells in coagulation necrosis?
what immune cells arrive and what makes up the granulation tissue
- Cells retain shape
- Cytoplasm becomes darker
- Remains of nuclei
- Striations lost
- Neutrophils arrive first then macrophages and lymphocytes
- Granulation tissue is made of fibroblasts and proliferating blood vessels
What can cause congestive heart failure?
CAD
hypertension
valve heart disease
What is the pathophysiologic signs of congestive heart failure?
- Hypertrophy of myocyte (adaptation) (increased resistance in BF)
- Heart may reach 2-3 times weight of normal
- Increased metabolic demands ; ischemia.
- Injury to myocyte as a result of ischemia (eventual apoptosis)
What is a blood vessel hamartoma called?
where is it found mostly?
Haemangioma
60% in head and neck
What do haemangiomas leave behind?
regress over the first 10 years of life
and may leave a birthmark
What are the types of vascular malformations (haemangiomas)?
- capillary - superficial
- cavernous - deep (larger lumen)
- Sturge Weber Syndrome - mixed
What is the aetiology of kaposi sarcoma?
Herpes virus 8 (HHV-8)
almost all oral KS are in HIV-infected patients
What are examples of benign cardiac tumours?
myxoma
lipoma
What is an example of a malignant cardiac tumour?
angiosarcoma
How do diseases of the valves occur?
- Congenital or acquired
- Acquired may be a result of other cardiac diseases such as ventricular hypertrophy
What can pathology of the valaves result in?
- Stenosis (injury to valve); failure of valve to open completely
- Insufficiency (many causes); failure of valve to close completely
- Vegetations (lumps on cusps of valves)
What is calcific aortic stenosis?
- Commonest of all valvular conditions
- Dystrophic calcium deposits in vital tissue as a result of tissue inflammation, hyperlipidaemia.
- Narrowing of the valvular orifice
Why may valve replacement surgery be risky?
patient may be on anticoagulants
infective endocarditis
What is rheumatic heart disease?
- Results from rheumatic fever
- Immune reaction against Streptococcus A antigens that cross react with host proteins in various tissues (valve).
- Similar to autoimmune disease
- Damage caused by a combination of type 2 and 4 hypersensitivity reactions
What are aschoff bodies?
Aschoff bodies are tiny fibronoid nodules in the heart muscle with inflammatory cells (T-lymphocyte) and modified macrophages (Anitschkow cells)
They are a hallmark sign of rheumatic fever.
What is rheumatic valvulitis?
- Inflammation of endocardium and valves results in fibrinoid necrosis/vegatations/ thrombi/ calcification due to strep infection
What is infective endocarditis?
- Microbial infection of heart valves
- Damaged or prosthetic valves are particularly susceptible
- Oral pathogens may be implicated
- Streptococcus viridens; Staphylococci aureus
- Vegetations formed on cusps contain fibrin, inflammatory cells and infective pathogens
- Can cause infective emboli
What can antibiotics used against infective endocarditis cause?
huge amounts of antibiotics can cause anaphalytic shock
