CVS Pathology Flashcards
Definition of hypertension and malignant hypertension
Hypertension: sustained SBP > 140mmHg / DBP > 90 mmHg
Malignant hypertension: rapid BP rise, sustained SBP > 200 mmHg / DBP > 120 mmHg
How much % of hypertension is primary / essential?
95%
Secondary hypertension causes (3+5+3)
Renal: RAS, renal parenchymal disease, chronic renal disease
Endocrine: Primary hyperaldosteronism, Cushing syndrome, Acromegaly, Hyper- / Hypo-thyroidism, Phaeochromocytoma
Neurologic: ↑ ICP, OSA, acute stress
Risk factors for atherosclerosis (4+10)
Non-modifiable: male / post-menopausal female, elderly, familial hypercholesterolaemia, homocystinuria
Modifiable: hypercholesterolaemia, smoking, DM, HT, ↑ CRP, lipoprotein (a), physical inactivity, obesity, stress, infection
3 stages of atherosclerosis
- Fatty streaks
- Atheromatous plaque
- Complicated atheroma
Which histological layer is fatty streak deposited within? What is the cell that can be found in fatty streak?
tunica intima
lipid-filled foamy macrophages
2 parts of atheromatous plaque
fibrous cap + necrotic core
Difference between unstable atheroma and stable atheroma histologically (4)
thinner fibrous cap, larger lipid core, fewer SMC, ↑ inflammation
Pathogenesis of atherosclerosis
endotheilal injury + turbulent blood flow –> accumulation of lipoproteins –> monocytes and platelets adhere to endothelium –> monocytes migrate into intima –> differentiate into macrophages and foam cells
release cytokines and growth factors by platelets, macrophages, vascular wall cells –> SMC proliferate and migrate to intima
SMC, macrophages release cytokines –> produce ECM
Complications of complicated atheroma (3) (explain)
Acute plaque change
a. rupture: exposed necrotic core –> thrombus formation
b. haemorrhage into plaque –> volume expansion
Atheroembolism
- ruptured plaques –> discharge debris into blood –> microemboli
Aneurysm
In aneurysm, which layer of the blood vessel is weakened?
tunica media
Pathogenesis of aneurysm (3)
- inadequate / abnormal connective tissue synthesis
- excessive connective tissue degradation
(e.g. proteolytic enzymes by macrophages in atherosclerotic plaque) - loss of SMCs
a. atherosclerosis –> ↑ diffusion distance –> ischaemia of inner media
b. systemic hypertension –> luminal narrowing of vasa vasorum –> ischaemia of outer media
Pathology of aneurysm
cystic medial degeneration
Complications of AAA (4)
- occlusion of vessel branching off the aorta –> ischaemia of organs
- impingement on adjacent structures (e.g. ureter, vertebrae)
- Thromboembolism
- rupture –> fatal haemorrhage
Relationship of diameter and annual rupture risk of AAA
<4cm: almost never
4~5cm: 1%
5~6cm: 10%
>6cm: 25%
What is aortic dissection?
tear in tunica intima –> blood dissects into tunica media
Which type of aortic dissection has a higher mortality? How much?
Type A
70%
Immune-mediated vasculitis (2+4+3)
Giant cell arteritis
Takayasu arteritis
Polyarteritis nodosa
Kawasaki disease
Wegener’s granulomatosis
Churg-Strauss syndrome
Microscopic polyangiitis
Buerger disease
Behcet disease
Which vasculitis involves granuloma formation? (4)
giant cell arteritis, Takayasu arteritis, Wegener’s granulomatosis, Churg-Strauss syndrome
Which vasculitis is related to ANCA?
c-ANCA: Wegener’s granulomatosis
p-ANCA: Churg-Strauss syndrome, microscopic polyangiitis
Which vasculitis is related to viral Ag IC deposition? (Which virus most common?)
Polyarteritis nodosa
HBV
Which vasculitis is found in kids and is associated with coronary artery aneurysm?
Kawasaki disease
Which vasculitis is also called pulseless disease and is commonly found in aorta?
Takayasu arteritis
Which vasculitis is related to asthma?
Churg-Strauss syndrome
Which vasculitis is associated with young smokers and peripheral vascular disease?
Buerger disease
Which vasculitis is associated with orogenital ulcers?
Behcet’s disease
Which vasculitis is commonly found on temporal artery and ophthalmic artery?
Giant cell arteritis
Which vasculitis is almost always spared from pulmonary circulation?
Polyarteritis nodosa
Morphology change in myocardial infarction
Gross: pallor –> mottling –> yellow centre with hyperaemic border –> grey fibrous scar
LM: coagulative necrosis, oedema, wavy fibres –> hypereosionophilic myocytes –> loss of nuclei & striations, neutrophil infiltrate, microscopic haemorrhage –> infiltration of lymphocytes, fibroblasts, macrophages –> organising granulatous tissue —> fibrosis
What is Dressler syndrome?
postmyocardial infarction pericarditis
Complications of MI (8)
Arrhythmia –> SCD
CHF
Ventricular aneurysm
Pericarditis
Mural thrombosis
MR
Left-to-right shunt
Cardiac tamponade
Pathogenesis of reperfusion injury (2)
- reoxygenation –> ROS –> sarcolemmal injury –> ↑ Ca2+ –> myocyte hypercontration –> cell death
- ↑ WBCs –> capillary occlusions
Diagnosis of systemic hypertensive heart disease
LVH + evidence of HT in other organs
MC cardiomyopathy
dilated cardiomyopathy
Aetiology of dilated cardiomyopathy (5)
- genetics / idiopathic
- previous myocarditis
- pregnancy
- haemochromatosis (secondary)
- toxin (alcohol, cocaine, catecholamines…)
MC cause of death in young athletes (What is the aetiology?)
hypertrophic cardiomyopathy (genetic mutation)
What is Loeffler endomyocarditis? (Treatment)
restrictive cardiomyopathy caused by parasitic infection, mostly found in Africa
Treatment: TKI
MC cause of restrictive cardiomyopathy
amyloidosis
What is the cardiomyopathy caused by defected desmosomal proteins?
Arrhythmogenic RV cardiomyopathy
Causes of aortic regurgitation
organic:
- IE
- degeneration
- chronic RHD
- subacute IE
functional:
- aortic dissection
- aortic root dilatation
Causes of aortic root dilatation
aortitis (syphilis, Takayasu arteritis, ankylosing spondylitis, psoriasis…)
Marfan’s syndrome
hypertension, atherosclerosis
Causes of aortic stenosis
[<60y] Chronic RHD, congenital
[60~75y] Bicuspid aortic valve
[>75y] Degenerative calcification
Causes of mitral regurgitation
Organic:
- IE
- MVP
- chronic RHD
- subacute IE
Functional:
- MI, trauma
- LV dilatation (e.g. myocarditis, DCM)
Causes of mitral stenosis
chronic RHD
congenital stenosis
Causes of tricuspid regurgitation
- pulmonary HT
- L. ventricular disease
- IE
- chronic RHD
- complication of pacemaker insertion
- carcinoid syndrome
Diagnosis of acute rheumatic fever
Jones’ criteria
- migratory polyarthritis
- pancarditis
- subcutaneous nodules
- erythema mariginatum
- chorea
(2 out of 5)
Diagnosis of infective endocarditis
Duke criteria
(BE TIMER)
(2 or 1+3 or 0+5)
Major:
- blood culture (typical organisms from 2 separate blood cultures)
- echocardiogram findings
Minor:
- temperature (fever)
- immunologic phenomena
- microbiological evidence
- embolic phenomena
- risk factor (predisposing conditions)
Usual precursor of non-bacterial thrombotic endocarditis
hypercoagulable state
What is the Libman-Sacks endocarditis?
endocarditis in SLE
Aetiology of pericarditis (4)
Infection, post-MI, uraemia, drugs
