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Path - Histo > CVD > Flashcards

CVD Flashcards

1
Q

What are the two main dangerous consequ3nces of atheromatous plaque

A

stenosis

rupture

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2
Q

What is a fatty streak made up of

A

lipid filled foamy macrophages

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3
Q

when does coronary artery stenosis cause angina

A

when demand > supply

over 70% occlusion

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4
Q

what are features of vulnerable plaques

A

lots of foam cells / lipids
thin fibrous cap
few smooth muscle cells
clusters of inflammarory cells

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5
Q

why can emotion cause sugdeen death

A

because adrenaline causes vasoconstriction> increased physical stress withhin the plaque > stenosis / rupture

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6
Q

Explain angina

A

Transient ischaemia that does NOT produce myocyte necrosis

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7
Q

Explain stable angina

A

comes on with exertion, relieved by rest

NO plaque disruption

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8
Q

Explain prinzmetal angina

A

due to coronary artery spams

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9
Q

explain unstable angina

A

more frequent, longer lasting pain
onset at rest / after less exertion
due to disruption of plaque

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10
Q

when do histologycal changes start to occur following MI

A

after 6h

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11
Q

what is the most common valve affected in rheumatic heart disease

A

mitral

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12
Q

what changes occur in rheumatic heart disease

A

thickened valve leaflets
valve commissures fuse
thickened, shortened chordae tendinae
valves look like BUTTONHOLES (thhick, tight, sclerosed)

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13
Q

what are the 3 key components of an athorsclerotic plaque

A

Cells (smooth muscle, macrophages, leukocytes)
ECM (incl collagen)
Fluid (intracell and extracellular)

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14
Q

Which part of the aorta is affected most from atherosclerosis

A

Abdominal aorta

more than thoracic aorta

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15
Q

Which locations of vessels are affected more by atherosclerosis and wgy

A 
Near origins (ostia) of major branches 
As turbulent blood flow has low / oscillatory shear stress, which is atherogenic

While high laminar flow is protectivew

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16
Q

List some modifiable RF for heart disease

A

T2DM
HTN
Hypercholesteraemia
Smoking

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17
Q

List some non-modifiable RF for atherosclerosis

A

gender (male)
increasing age
FH

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18
Q

What are some categories of complications of MI

A

Mechanical
Arrhythmia
Pericardial

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19
Q

What are mechanical complications of MI

A
  • loss of muscle > contractile dysfunction > cardiogenic shock
  • ventricular dysfunction > congestive HF
  • LV infarct > papillary muscle dysfunction/necrosis > mitral regurg
  • ruptureof ventricular wall, septum, papillary muscle
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20
Q

What does rupture of papillary muscle cause

A

Mitral regurg

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21
Q

What type of arrhythmia commonly develops post MI

A

VF (in the first 24hours) - sudden death

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22
Q

What can occur to the pericardium post MI

A

Pericarditis
Pericardial effusion
Dressler syndrome

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23
Q

Explain the evolution of MI - under 6h

A

Normal by histology, with CK-MB also normal

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24
Q

Explain the evolution of MI - 6h-24h

A

loss of nuclei, homogeneous cytoplasm, necrotic cell death

25
Explain the evolution of MI - 1-4 days
infiltration of polymorphs then macrophages (to clean up debris)
26
Explain the evolution of MI - 5-10 days
Removal of debris
27
Explain the evolution of MI - 1-2 weeks
granulation tissue new blood vessels myofibroblasts collagen synthesis
28
How does fluid overload occur from cardiac damage
Cardiac damage > decreased cardiac output > activation of RAS > salt and water retention (to maintain perfusion) > eventually overloaded
29
Explain LV failure presentation
pooling of blood into pulmonary circulaton > dyspnoea, orthoponeoa, PND, wheeze, fatigue
30
Explain why RV failure may occur
often secondary to LVF OR from chronic severe pulmonary HTN
31
Explain presentation of RV failure
engorgenment of systemic and venous system > peripheral oedema, ascites, fascial engorgement
32
explain hypertrophic cardiomyopathy
heart is thick walled, heavy, hypercontra cting
33
what is the inheritance of HCM
Autosomal DOMINANCE | common mutation in beta-MHC gene
34
what is hypertrophic obstructive cardiomyopathy
septal hypertrophy | causes outflow tract obstruction
35
what is a consequence of HOCM
DCM
36
what age does rheumatic fever peak at
5-15
37
what are symptoms of rheumatic fever
heart: pancardiitis Joints: arthritis, synovitis Skin: erythema marginatum, subcut nodules CNS: encepalopathy, Sydenham's chorea
38
What infection does RhF occur after
Strep throat (group A streP)
39
what do you need for diagnosis of RHF
group A strep infection + 2 major crit or 1major+2minor
40
What are Jones major criteria for RHF
``` CASES Carditis Arthritis Sydenham's chorea Erythema marginatum Subcut nodules ```
41
what are Jones minor criteria
``` fever raised ESR/CRP migratory arthralgia prolonged PR interval prior RhF Malaise tachycardiA ```
42
What do you see on histology of RhF
AVA ``` Aschoff bodies (small giant-cell granulomas) V - beady fibrous vegetations (verrucae) Anitschkov myocytes (regenerating myocytes) ```
43
How do you manage RhF
Benzylpen
44
What is the pathology behind cardiac damage in RhF
Antigenic outcry - cross reaction of anti-strep antibodies with heart tissue
45
describe the vegetations you see in RhF
small warty vegetations (verrucae)
46
describe the vegetations you see in IE
large, irregular masses on valve cusps, extending into the chordae
47
describe the vegetations you see in non-bacterial thrombotic endocarditis
small, bland vegetations attached to lines of closure | formed by thrombiu
48
describe the vegetations you see in Libman sacks
small warty vegetations | STERILE and platelet-rich
49
what are causative organisms for acute. IE
Staph aureus | Strep pyogenes
50
What are causative organisms for chronic IE
Strep viridans | Staph epidermis
51
What valves are usually involved in IE
mitral/aortic
52
what valves are involved in drug users IE
tricuspid
53
what criteria can you use for IE
Duke criteria
54
Explain how many Duke criteria you need for IE diagnosis
2 major 1 major+3minor 5 minor
55
what are the two major duke criteria
+ve culture (typical organisms) OR 2 positive cultures 12h apart vegetation/abscess on echo or new regurg murmur
56
what antibiotic do you give for subacure IE
benzylpen + gent
57
what antibiotic do you give for acute IE
fluclox for MSSA rifamèicin + vanc + gent for MRSA
58
What is the triad with Young's syndrome
BAR Bronchiectasis Azoospermia Rhinosinusitis
59
explain Dressler syndrome
autoimmune complication of MI occurs 4 weeks after the episode Features: chest pain, fever, pericardial rub

Path - Histo (19 decks)

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