heart 2

Question 1

What are the large vessels type of vasculitis ?

Answer 1

Giant cell arteritis - old age

Takayasu - early age

Question 2

giant cell arteritis is a large vessel vasculitis charechterised by …

Answer 2

​chronic granulomatous reaction → granulomas in lumens of SEGMENTS of arteries in the Head such as temporal ,vertebral , ophthalmic →ischemia

-t-cell mediated response against vessel wall antigen

affects old ages - *take large biopsy*

Question 3

Takayasu large vessel vasculitis is charactarised by…

Answer 3

“Pulseless disease”-in asian noodle motherfuckers

• intimal hyperplasia and thickening of vessel wall
• collagenous scarring → reduced BP ,weaker pulse in upper extremities

-in early ages unlike giant cell arteritis

Question 4

the medium sized vasculitis include …

Answer 4

PAN

KAWASAKI

Question 5

Polyarteritis Nodoa (PAN) is charachterized by …

Answer 5

-affects **many vessels EXCEPT THE LUNG

-30%**
of patients hepatitis B as antigen

2 forms
acute - segmental transmural necrotizing inflammation → thrombosis/aneurysm/rupture

chronic - necrotizing inflammation → fibrosis → ischemia

kidney failure
MI
small skin hemorrhages

Question 6

Kawasaki is a medium sized vasculitis characterized by …

Answer 6

Acute, febrile, self‐limited disease in infant/children

antibodies against endothelial cells especially → coronary arteries → aneurysm/thrombus/rupture/**AMI

“CRASH”
C**
onjunctivits
Rash
Adenopathy
Strawberry tongue
Hands+feet edema+rash

Question 7

types of small vessels vasculitis include …

Answer 7

Microscopic Polyangiitis

wegner granulomatosis

Buerger disease

Question 8

Microscopic Polyangiitis aka “leukocytoclastic vasculitis” is characterized by PMNI infiltration with fragmented nuclei as well as …

Answer 8

Hypersensitivity reaction to antibiotics, microorganisms or tumor - affects small vessels.

• no granulomas , P-ANCA in 70% of cases

90% of patients have :

• necrotizing glomerulonephritis → hematuria,proteinuria
• ​ pulmonary capillaries→hemoptysis

Question 9

Wegener granulomatosis is characterized by …

Answer 9

C-ANCA

Granulomas and Vasculitis of small vessels in the lungs and upper respiratory tract → hemorrhage and hemoptysis.

Chronic sinusitis

Glomerulonephritis

Question 10

Buerger disease is characterized by …

Answer 10

develops before age 35.

Strongly associated with smoking tobacco which is toxic to endothel

small microabscesses in vessel wall may result in gangrene of the extremities.

Raynaud phenomenon

Question 11

infectious vasculitis is usually caused by bacteria and fungi , particulary … which can cause…

Answer 11

Aspergillus

can cause mycotic aneurysm→thrombosis→infarct

Question 12

Isolated pericardial disease is uncommon. thats meaning …

Answer 12

pericardial diseases are almost always associated with disease in other parts of the heart

Question 13

pericarditis can be caused by …

Answer 13

primary pericarditis → viral infection

secondary pericarditis →

• after AMI
• Uremia
• ​SLE , RF
• Surgery

Question 14

what are the fates of pericarditis ?

Answer 14

immediate hemodynamic sequences

resolve

progress to chronic fibrotic process

Question 15

morphology of pericarditis comes in 2 forms

Answer 15

Acute pericarditis

• Virus/Uremia →“Bread-Butter” fibrinous exudate
• ​Bacteria → fibrino-purulent exudate
• ​Malignancy → Bloody effusion

Chronic pericarditis

delicate adhesions →fibrotic scars →contrictive pericarditis

Question 16

normally , serous fluid in the pericardial sac measures for about 30-50 ml. pericardial effusions exceeding these volumes occur in the following forms …

Answer 16

Serous → CHF, hypoalbuminemia

Seroanguinous (serous+blood) → ruptured MI , Trauma , aortic dissection , malignancy

Chylous → lymphatic obstruction

Question 17

a patient previously diagnosed with pericarditis is complaining about atypical chest and dyspnea. his blood pressure was measured and was found to be low. atempts to stabilize his blood pressure with medications failed. this patient may have developed…

Answer 17

cardiac tamponade due to fluid accumulation

Question 18

aneurysm is a …

Answer 18

abnormal dilation of blood vessel

Question 19

aneurysm are classified as …

Answer 19

true aneurysm →involves all 3 layers

false/pseudo aneurysm →breach in vascular wall→hematoma

Question 20

aneurysm can come in two shapes , namely

Answer 20

saccular / fusiform

Question 21

name 3 types of aneurysms

Answer 21

1) Abdominal Aortic Aneurysm -“AAA”
2) Syphilitic aneurysm
3) Berry aneurysm

Question 22

what are the causes of AAA and where does it usually arise ?

Answer 22

Atherosclerosis →compress→necrosis→dilation

Genetic polymorphism in →MMP/ MMPi / inflammatory infiltration

arises between renal arteries above iliac bifurcation

Question 23

what are the 2 types of AAA and my be the consequences of such aneurysms ?

Answer 23

Mycotic →bacteria infects atherosclerotic lesions

inflammatory → periaortic fibrosis + inf.inf.

consequences :

thrombosis → ischemia
rupture
embolism
compression on ureter

Question 24

syphilitic aneurysms are caused by which type of spirochaete bacterium?

Answer 24

Treponema pallidum →syphillis STD

disease affects vasa vasorum → ischemia of aortic root media→ scaring →dilation

valvular insufficiency → L.V.H

Question 25

Berry aneurysms are most commonly found in the …and are due to …

Answer 25

branching points of arteries in circle of willis

develops due to

congenital malformation + hypertension

if ruptures →intracranial pressure increases

treatment clip it ! or insert spiral metal inside it !

Question 26

aortic dissection is a …

Answer 26

intimal tear allows blood to flow to space between intima and media so they separate.

Question 27

what are the causes of aortic dissection ?

Answer 27

1) hypertension →old ages
2) atherosclerosis
3) C.T. disorders →young ages → Marfan syndrome

Question 28

how are aortic dissections classified ? what are the consequences of such dissections ?

Answer 28

A
Type 1/2 → proximal in ascending aorta

• type 1 - extensive, ascending +descending
• ​type 2 - focal, in ascending

B

• type 3 → distal, in descending aorta

consequences :

1) narrow orifices of blood vessels
2) rupture and bleeding inside body cavities →cardiac tamponade

3) sometimes new channels are formed allowing
* *re-entry** of blood to lumen of aorta →chronic dissection