histo cardio Flashcards
1
Q
atherosclerosis definition
A
an srteriosclerosis characterised by atheromatous deposits and fibrosis in the inner lining of arteries tunica intima but protrude into vessel lumen
2
Q
stages of atherosclerosis
A
- damage to endothelium 2. platelet deposition on damaged tissue 3. endothelial proliferation 4. fibrous cap 5. cholesterol deposits in core 6. plaque enlarges blocking artery
3
Q
macroscopic description of a atherosclerotic plaque
A
raised lesion lipid core white fibrous cap
4
Q
major RF for atherosclerosis
A
age gender genetics HTN hyperlipidaemia DM smoking
5
Q
how does multiplicitive effect in atheroclerosis work
A
2RF- 4x risk 3RF-7x risk
6
Q
murmer in mitral prolapse
A
late systolic murmer and mid systolic click
7
Q
most significant independent RF in atherosclerosis
A
genetics
8
Q
how does DM increase atherosclerosis risk
A
induces hypercholesterolaemia
9
Q
injury hypothesis of atherosclerosis
A
Endothelial injury Lipoprotien accumulation (LDL) Monocyte adhesion to endothelium Monocyte migration into intima -> macrophages & foam cells Platelet adhesion Factor release Smooth muscle cell recruitment Lipid accumulation -> extra & intracellular, macrophages & smooth muscle cells chronic inflammation and atherosclerosis e.g. metabolic stress
10
Q
two complications of atheromatous plaque
A
rupture obstruction
11
Q
at what point does stenosis cause symptoms
A
70% occlusion causes stable angina
12
Q
changes seen in acute plaque change
A
erosion haemmorhage rupture
13
Q
effect of a haemmorage into atheroscerotic plaque
A
increase in plaque size
14
Q
effect of atherosclerotic plaque rupture
A
exposure of prothrombotic plaque contents
15
Q
effect of atherosclerotic plaque erosiion
A
exposure of prothrombotic sub-endothelial basement membrane
16
Q
characteristics of a avulnerable atherosclerotic plaque
A
thin cap many foam cells few smooth muscle cells many inflammatory cell clusters
17
Q
how does vasoconstriction increase risk of plaque rupture
A
smaller lumen so greater local mechanical forces
18
Q
factors increasing risk of plaque rupture by vasoconstriction
A
adrenergic agonists reduced endothelial relaxins platelet contents
19
Q
what causes prinzmetal angina
A
coronary artery vasospasm
20
Q
what is seen in the first 6 hours after an MI
A
no histological change
21
Q
what is seen between 6 and 24 hours after MI
A
loss of nuclei homogeneous cytoplasm necrosis
22
Q
what is seen 1-4 days after MI
A
invasion of polymorphs then macropahges
23
Q
what is seen 5-10 days post MI
A
clearing up debris
24
Q
what is seen 1-2 weeks post MI
A
granulation tissue restructuring new blood vessels, collagen synthesis
25
what is seen weeks and months after MI
decellularising the scar strengthening tissue
26
when may ST changes not be seen on ECG in an MI
subendocardial infarct
27
what happens in reperfusion injury
arrythmia
28
what causes reperfusion injury
ca overload oxiadative stress and inflammation
29
what is hibernating myocardium
chronic sub threshold ischaemia lower rate of metabolism in myocytes
30
how to reverse hibernating myocardium
revascularisation
31
complications of MI
Pericarditis (Dressler's syndrome) mural thrombosis infarct expansion RV infarction ventricular aneurysm papilliary muscle rupture
32
definition of sudden cardiac death
“Unexpected death from cardiac causes in individuals without symptomatic heart disease or early (1hr) after onset of symptoms
33
symptoms of left sided heart failure
SOB pulmonary oedema
34
symptoms of right sided heart failure
peripheral oedema
35
CAUSES of heart failure
Ischaemic heart disease Valve disease Hypertension Myocarditis Cardiomyopathy Left sided heart failure (Right)
36
complications of heart failure
pulmonary emboli arrythmia sudden death
37
macroscopic findings of heart failure
dilated heart scarring and thinning of walls
38
microscopic findings of heart failure
fibrosis and replacment of ventricular myocardium
39
three types of cardiomyopathy
restrictive dilated hypertrophic
40
toxin driven causes of DCM
toxins: alcohol, iron, cobalt, chemo
41
infective causes of DCM
infection: viral myocarditis i
42
immunological causes of DCM
mmunological: myocarditis
43
hormonal causes of DCM
hormonal: diabetes, hyper/ hypothyroidism post partum
44
genetic causes of DCM
genetic Fabry's, McArdles, haemochromotosis
45
pathology in HOCM
beta myosin heavy chain defect
46
inheritance of HOCM
autosomal dominant
47
consequences of HOCM
thickening of septum narrow left ventricular outflow
48
macroscopic findings on restrictive cardiomayopathy
large atria
49
causes of restrictive cardiomyopathy
secondary to myocardial disease such as amyloidosis or sarcoid
50
pathology of restrictive cardiomyopathy
reduced ventricular compliance
51
valves commonly affected by valvular disease
M\>A\>T\>P
52
pathology of valvular disease
secondary to rheumatic fever thickening of valve leaflets fusuion of commisures
53
causes of aortic regurgitation
rigidity: rheumatic disease, degeneration destruction: microbial endocarditis marfan's syphilitic aortitis ank spond dissecting aneurusm
54
difference between a true and false aneurysm
true aneurysm: involves all layer of vessel wall false: extravascular haematoma
55
causes of aneurysm
marfans atherosclerosis HTN
56
causes of DCM
idiopathic alcohol, peripartum sarcoidosis, amyloidosis
57
how does DCM cause heart failure
systolic dysfunction
58
how does hypertrophic cardiac myopathy cause heart failure
diastolic dysfunction
59
how does restrictive cardiomyopathy cause heart failure
diastolic dysfunction
60
causes of restrictive cardiomyopathy
amyloidosism sarcoidosis, radiation induced fibrosis
61
genetic defect in HCM
autosomal dominant inheritance of mutated betaMHC gene 403arg-glycine
62
histological appearance of HCM
myocyte disarray
63
mutations in HCM
bMHC troponin T (Sudden death) MYBP-C
64
what is ARVC
arrythmyogenic righ ventricular cardiomyopathy replacement of myocytes with fibrofatty tissue in the right ventricle
65
organism responsible for acute rheumatic fever
group A beta haemolytic strep
66
symptoms of rheumatic fever
skin: erythema marginatum, subcutaneous nodules heart: endocarditis, myocarditis, pericarditis joint: arthritis, synovitis cns: encephalitis, sydenhams chorea
67
what are the major jones criteria for rheumatic heart disease
Carditis Arthritis Sydenham's chorea Erythema marginatum Subcutaneous nodules
68
what are minor jones criteria for rheumatic heart disease
fever raised ESR/ CRP prolonged PR interval tachycardia migratory arthralgia malaise previous rheumatic fever
69
how to diagnoses rheumatic heart disease
group A beta haemolytic strep infection + 1 major criterion 1 major and 2 minor criteria
70
which valve does rheumatic heart disease tend to affect and what is the consequence
mitral valve and MR/ MS due to scarring
71
what valve is affected in 25% of cases of rheumatic heart disease
aortic
72
causes of aneurysm
marfans atherosclerosis HTN
73
causes of DCM
idiopathic alcohol, peripartum sarcoidosis, amyloidosis
74
how does DCM cause heart failure
systolic dysfunction
75
how does hypertrophic cardiac myopathy cause heart failure
diastolic dysfunction
76
how does restrictive cardiomyopathy cause heart failure
diastolic dysfunction
77
causes of restrictive cardiomyopathy
amyloidosism sarcoidosis, radiation induced fibrosis
78
genetic defect in HCM
autosomal dominant inheritance of mutated betaMHC gene 403arg-glycine
79
histological appearance of HCM
myocyte disarray
80
mutations in HCM
bMHC troponin T (Sudden death) MYBP-C
81
what is ARVC
arrythmyogenic righ ventricular cardiomyopathy replacement of myocytes with fibrofatty tissue in the right ventricle
82
organism responsible for acute rheumatic fever
group A beta haemolytic strep
83
symptoms of rheumatic fever
skin: erythema marginatum, subcutaneous nodules heart: endocarditis, myocarditis, pericarditis joint: arthritis, synovitis cns: encephalitis, sydenhams chorea
84
what are the major jones criteria for rheumatic heart disease
Carditis Arthritis Sydenham's chorea Erythema marginatum Subcutaneous nodules
85
what are minor jones criteria for rheumatic heart disease
fever raised ESR/ CRP prolonged PR interval tachycardia migratory arthralgia malaise previous rheumatic fever
86
how to diagnoses rheumatic heart disease
group A beta haemolytic strep infection + 1 major criterion 1 major and 2 minor criteria
87
which valve does rheumatic heart disease tend to affect and what is the consequence
mitral valve and MR/ MS due to scarring
88
what valve is affected in 25% of cases of rheumatic heart disease
aortic
89
what is the eponymous name of the organism responsible for rheumatic heart disease
lancefield group A strep
90
what is the pathology of rheumatic heart disease
antigen mimcry, cell mediated immunity to strep antigens where antibodies cross react with myocardial antigens
91
3 histological findings of rheumatic heart disease
Aschoff bodies beady fibrous vegetations Anitschkov myocytes
92
what are aschoff bodies
small giant cell granulomas
93
what are anitschkov myocytes
regenerating myocytes
94
what is the term for the fibrous vegetations in rheumatic heart diease
verrucae
95
treatment of rheumatic heart disease
benzylpenicillin or erythromycin if allergic
96
appearance of verrucae of rheumatic heart disease
small warty vegetations along the lines of closure of the valve leaflet
97
pathology of infective endocarditis
colonisation of heart valve/ mural endocardium with microbe
98
appearance of infective endocarditis vegetations
large irregular mass on valve cusps that extends into the chordae
99
vegetations seen in non-bacterial thrombotic endocarditis
small bland vegetations formed of thrombi along the lines of closure
100
what is libman-sacks endocarditis associated with
SLE anti-phopholipid syndorme
101
appearance of libman sacks endocarditis vegetaions
sterile platelet rich vegetations up to 2mm
102
organisims causing acute infective endocarditis
staph aureaus strep pyogenes
103
organisms causing subacute infective endocarditis
strep viridans staph epidermis HACEK coxiella mycoplsma candida
104
HACEK organisms
gram negative bacteria haemophilus aggregatibacter cardiobacterium eikenella kingella
105
difference in location of masses between acute and subacute IE
acute: large masses on aorta subacute: small friable masses on chordae
106
features of IE
immune: oslers nodes, roth spots, haematuria due to glomerulonephritis thrombotic: janeway lesions, splinter haemmorgages, splenomegaly, microemboli and septic abscesses
107
which valves are affected in IE
mitral/ aortic unless IVDU when RHS valves
108
criteria for IE
Dukes criteria
109
major dukes criteria
culture of a typical IE causing organism 2 positive cultures taken 12 hours apart evidence of vegetation on echo/ new murmur
110
minor dukes criteria
risk factor e.g. prothestic valve fever \>38 immune phenomena thrombotic phenomena positive blood cultures not meeting major criteria
111
what dukes criteria is diagnostic of IE
2 major 1 major and 3 minor 5 minor
112
treatment of MSSA IE
flucloxacillin
113
treatment of MRSA IE
vancomycin + gentamicin + rifampicin
114
treatmetn of subacute IE
benzylpenicillin + gentamicin for 4 weeks /vancomycin for 4 weeks
115
causes of aortic stenosis
age congenital bicuspid valve
116
pathology of aortic stenosis
high velocitity high pressure flow
117
murmer for aortic stenosis
mid systolic ejection murmer over aortic area
118
murmer for aortic regurgitation
diastolic descrendo murmer
119
causes of aortic regurgitation
IE LV dilation, dissecting aortic aneurysm marfans, ank spond
120
mitral stenosis murmer
diastolic descrescendo murmer with opening snap
121
pathology of mitral stenosis
backpressure into left atrium high pressure flow through narrowed mitral valve
122
cause of mitral stenosis
rheumatic fever
123
cause of mitral regurgitaion
IE, connective tissue disease post MI, LV dilatation
124
mitral regurgitation murmer
pansystolic murmer
125
what is chronic rheumatic heart disease
thickening along the commisures/ lines of closure of valve leaflets usually left sides/ mitral valve
126
causes of pericarditis
uraemia, viral, TB
127
5 types of pericarditis
fibrous granulomatous- TB haemorrhagic- TB, uraemia purulent- staph fibrinous- MI, uraemia
128
what is pericardial effusion
serous fluid in pericardial sac
129
cause of pericardial effusion
chronic heart failure
130
what is haemopericardium
myocardial rupture due to trauma or infarction
