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Pathology > CVS > Flashcards

CVS Flashcards

1
Q

2 main principles of vascular disease?

A

Stenosis or obstruction

Weakening of vessel wall

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2
Q

Risk Factors for Atherosclerosis?

A

Age, Male, hypercholesterolaemia, DM, HTN, smoking, familial history

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3
Q

3 stages of atherosclerosis?

A

Fatty Streaks, Fibro lipid plaques, complicated lesions

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4
Q

Consequences of Atherosclerosis?

A

Narrowing (stable angina), occlusion (MI), embolism (stroke), rupture of AAA

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5
Q

Define IHD

A

imbalance between blood and oxygen supply and demand in the heart

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6
Q

3 Acute Coronary Syndromes?

A

Unstable Angina, NSTEMI, STEMI

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7
Q

What causes and relieves stable angina?

A

Reversible narrowing of the lumen (70%)
Exercise and stress
Rest and vasodilators

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8
Q

What causes prinzmental/variant angina?

A

Vasospasm rather than stenosis

Rare

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9
Q

Characteristics of Unstable Angina?

A

Partial Occlusion of the lumen
Chest pain at increasingly less levels of exercise or at rest
No biochemical or ECG markers
Warning for MI

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10
Q

Definition of MI?

A

irreversible necrosis of cardiac myocytes

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11
Q

What time frame can limit damage with an MI?

A

3 hours

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12
Q

Who frequently suffers ‘silent MIs’?

A

Diabetics

Elderly

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13
Q

What can be seen 24-48 hours post-MI?

A

pale oedematous grossly

oedema, inflammatory cells, myocyte necrosis

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14
Q

What can be seen 3-4 days post-MI?

A

yellow centre with haemorrhagic border

necrosis, inflammation and early granulation tissue

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15
Q

What can be seen 1-3 weeks post-MI?

A

pale and thin tissue

granulation tissue

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16
Q

What can be seen 6 weeks post-MI?

A

Scar tissue

Dense fibrosis

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17
Q

Complication of MI within hours?

A

Death- Ventricular Fibrillation

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18
Q

Complication of MI 24-48 hours?

A

Arrhythmias

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19
Q

Complication of MI first few days?

A

Mitral incompetence due to papillary muscle dysfunction

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20
Q

Complication of MI 3-5 days?

A

Cardiac rupture -> cardiac tamponade

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21
Q

Complication of MI 1 week?

A

Mural thrombosis

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22
Q

Complications of MI that occur at various times?

A

Ventricular Aneurysm, Pericarditis, Heart Failure

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23
Q

What percentage of HTN is secondary?

A

Around 5%

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24
Q

Causes of secondary HTN?

A

Renal disease (CKD, Renal Artery Stenosis, Renin-producing tumours)
Endocrine (Pheochromocytoma, Cushing’s, Conn, adrenal hyperplasia)
CVS- Coarctation of aorta
Other- drugs (cocaine)

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25
Q

Malignant HTN measurements?

A

Systolic >200mmHg

Diastolic> 120mmHg

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26
Q

Aneurysm Definition?

A

localised abnormal permanent dilation of a blood vessel

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27
Q

Where is Berry aneurysm most common?

A

Circle of Willis

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28
Q

AAA risk factors?

A

Atherosclerosis, HTN, men, smokers

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29
Q

Site of AAA?

A

below the origin of renal arteries and above aortic bifurcation

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30
Q

Aortic Dissection Aetiology?

A

HTN, Marfan’s, Ehler’s Danlos

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31
Q

Types of aortic dissection?

A

ascending aorta

distal to subclavian artery

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32
Q

Diagnosis of dissecting aorta on CT?

A

Double-barrel aorta

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33
Q

Left Ventricular Failure Symptoms?

A

orthopnoea, dyspnoea, cough, PND, pre-renal renal failure, alveolar haemorrhage- rusty sputum

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34
Q

Rusty Sputum indicates?

A

Alveolar haemorrhage- LVF

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35
Q

Most common cause of RVF?

A

LVF

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36
Q

Cor Pulmonale Definition?

A

RHF due to pulmonary hypertension

37
Q

Clinical Features of RHF?

A

raised JVP, peripheral oedema, systemic and hepatic congestion, ascites, hepatosplenomegaly

38
Q

Gold standard for diagnosing heart failure?

A

Echo

39
Q

Biochemical Marker for Heart failure?

A

BNP

40
Q

Types of Cardiomyopathies?

A

Dilated, Hypertrophic, Arrhythmic Right Ventricular, Restrictive, SADS/channelopathies

41
Q

Cardiomyopathy that presents in early adulthood and causes sudden death in athletes?

A

HOCM

42
Q

Systemic causes of restrictive cardiomyopathy?

A

sarcoidosis, amyloidosis, scleroderma

43
Q

Max intensity ejection murmur in mid to late systole indicates?

A

Aortic Stenosis

44
Q

Water-hammer pulse indicates?

A

Aortic Regurgitation

45
Q

Causes of aortic regurgitation?

A

Dilation of aortic root (old age), valve disease

46
Q

Complications of aortic regurgitation?

A

LVH and LVF

47
Q

Pan-systolic murmur?

A

Mitral Regurgitation

48
Q

What murmur is heard in mitral regurgitation?

A

Pan-systolic murmur

49
Q

Mid-systolic click?

A

Mitral Valve Prolapse

50
Q

What murmur is heard in mitral valve prolapse?

A

mid systolic click and late systolic murmur

51
Q

Mitral Stenosis murmur?

A

Opening snap and diastolic murmur

52
Q

Main cause of mitral stenosis?

A

Rheumatic Heart Disease

53
Q

Complications of Mitral Stenosis?

A

Right-heart failure
A Fib
Thromboembolism

54
Q

Rheumatic fever bloods?

A

High anti-streptolysin O titre

55
Q

When does rheumatic fever occur?

A

Post-strep throat infection

56
Q

Infective Endocarditis Risk Factors?

A

Rheumatic valve disease, poor dental hygiene, IV drug use, valve replacement, pacemaker insertion, DM, sepsis, immunosuppression, surgery, IV catheter

57
Q

What causes non-infective endocarditis?

A

small thrombotic vegetations on valves

cancer (marantic)

58
Q

What causes Libman-Sachs endocarditis?

A

SLE

59
Q

Non-cyanotic Congenital Heart Diseases?

A

LtR
VSD
ASD
PDA

60
Q

What is Eisenmenger’s Syndrome?

A

LtR -> inc. pulmonary vascular resistance -> RtL

61
Q

ASD murmur?

A

Diastolic Rumbling Murmur

62
Q

VSD murmur?

A

loud pansystolic murmur and thrill

63
Q

PDA murmur?

A

machinery-like murmur, loudest at 2nd heart sound

64
Q

Treatment of PDA?

A

IV Indomethacin

65
Q

Cyanotic Congenital Heart Diseases?

A

Tetralogy of Fallot
Transposition of Great Arteries
Tricuspid Atresia

66
Q

4 steps to Tetralogy of Fallot?

A

1) Right Ventricular Obstruction
2) Right Ventricular Hypertrophy
3) VSD
4) Aorta overrides the VSD

67
Q

When is transposition of great arteries compatible with life?

A

If there is a ASD, VSD or PDA present to allow mixing of the blood

68
Q

What is transposition of the great arteries?

A

Pulmonary artery drains left side of the heart

Aorta drains right side of the heart

69
Q

Hypertension in upper body and hypotension in lower body indicates?

A

Coarctation of the aorta

70
Q

Bacterial colonisation of IV catheter?

A

Staph aureus

Staph epidermidis

71
Q

Two causes of bacterial endocarditis?

A

Bacteraemia (through the blood)

During cardiac valve surgery

72
Q

What is the most common cause of bacterial endocarditis?

A

Bacteraemia

73
Q

Routes to bacteraemia causing bacterial endocarditis?

A

Through the mouth- strep mutans

Through the skin- staph aureus, staph epidermidis

74
Q

Bacteria that causes bacteraemia and bacterial endocarditis through the mouth?

A

Strep mutans

75
Q

What is the single commonest cause of infective endocarditis in developed countries?

A

Staph aureus

76
Q

Abnormalities that predispose infective endocarditis?

A

Rheumatic fever
Degenerative valve disease
Mitral valve prolapse
Valve surgery/prosthesis

77
Q

Signs in the hands for infective endocarditis?

A

Splinter haemorrhages, Janeway lesions, Osler nodes

78
Q

Duke Categories for Infective Endocarditis?

A

Definite- 2 major, 1 major and 3 minor, 5 minor
Possible- 1 major and 1 minor, 3 minor
Rejected- alternative diagnosis, no evidence, resolution

79
Q

Major criteria for Duke Infective Endocarditis?

A

Typical organism in 2 separate blood cultures
Any organism in persistent blood cultures
Signs on ECHO
New valvular regurgitation

80
Q

Minor criteria for Duke Infective Endocarditis?

A 
Predisposing features
Fever
Vascular phenomena
Immunological phenomena
Suggestive microbiology
81
Q

Infective Endocarditis treatment?

A

IV antibiotics for minimum of 2 weeks

82
Q

Streptococcal endocarditis treatment?

A

Penicillin
Benzylpenicillin
+/- Gentamicin

83
Q

Enterococci endocarditis treatment?

A

Ampicillin
Amoxycillin
+ gentamycin if low level resistance
+ streptomycin if high level resistance

84
Q

Staphylococci endocarditis treatment?

A

If methicillin sensitive- flucloxacillin
If methicillin resistant- vancomycin
If prothesis present- add gentamycin

85
Q

Persistent fever after treatment of infective endocarditis?

A

Abscess at aortic root
Drug hypersensitivity
Infection in IV line

86
Q

Prophylaxis for Infective Endocarditis during dentistry?

A

Only in high risk patients
Only for procedures needing gingival manipulation
Only if oral mucosa perforated

87
Q

What patients are considered high risk for infective endocarditis?

A

Previous history
Prosthetic valve
Cyanotic Congenital Heart Disease
Any congenital heart disease repaired with prosthetic material (for 6 months after)

88
Q

Lipids as CVS risk factors?

A 
High LDL
Low HDL
High non HDL
High TG (weak)
TC:HDL (stronger than either alone)
apoB:apoA-1 (may be stronger again)
89
Q

Primary hyperlipidaemias?

A

Familial hypercholesterolaemia
‘Common’ polygenic hypercholesterolaemia
Familial dysbetalipoproteinaemia

Pathology (13 decks)

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