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flashcards of path guide 2018 > histo cardio > Flashcards

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

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2
Q

stages of atherosclerosis

A
  1. 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
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3
Q

macroscopic description of a atherosclerotic plaque

A

raised lesion lipid core white fibrous cap

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4
Q

major RF for atherosclerosis

A

age gender genetics HTN hyperlipidaemia DM smoking

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5
Q

how does multiplicitive effect in atheroclerosis work

A

2RF- 4x risk 3RF-7x risk

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6
Q

murmer in mitral prolapse

A

late systolic murmer and mid systolic click

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7
Q

most significant independent RF in atherosclerosis

A

genetics

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8
Q

how does DM increase atherosclerosis risk

A

induces hypercholesterolaemia

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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

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10
Q

two complications of atheromatous plaque

A

rupture obstruction

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11
Q

at what point does stenosis cause symptoms

A

70% occlusion causes stable angina

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12
Q

changes seen in acute plaque change

A

erosion haemmorhage rupture

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13
Q

effect of a haemmorage into atheroscerotic plaque

A

increase in plaque size

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14
Q

effect of atherosclerotic plaque rupture

A

exposure of prothrombotic plaque contents

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15
Q

effect of atherosclerotic plaque erosiion

A

exposure of prothrombotic sub-endothelial basement membrane

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16
Q

characteristics of a avulnerable atherosclerotic plaque

A

thin cap many foam cells few smooth muscle cells many inflammatory cell clusters

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17
Q

how does vasoconstriction increase risk of plaque rupture

A

smaller lumen so greater local mechanical forces

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18
Q

factors increasing risk of plaque rupture by vasoconstriction

A

adrenergic agonists reduced endothelial relaxins platelet contents

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19
Q

what causes prinzmetal angina

A

coronary artery vasospasm

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20
Q

what is seen in the first 6 hours after an MI

A

no histological change

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21
Q

what is seen between 6 and 24 hours after MI

A

loss of nuclei homogeneous cytoplasm necrosis

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22
Q

what is seen 1-4 days after MI

A

invasion of polymorphs then macropahges

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23
Q

what is seen 5-10 days post MI

A

clearing up debris

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24
Q

what is seen 1-2 weeks post MI

A

granulation tissue restructuring new blood vessels, collagen synthesis

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25
Q

what is seen weeks and months after MI

A

decellularising the scar strengthening tissue

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26
Q

when may ST changes not be seen on ECG in an MI

A

subendocardial infarct

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27
Q

what happens in reperfusion injury

A

arrythmia

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28
Q

what causes reperfusion injury

A

ca overload oxiadative stress and inflammation

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29
Q

what is hibernating myocardium

A

chronic sub threshold ischaemia lower rate of metabolism in myocytes

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30
Q

how to reverse hibernating myocardium

A

revascularisation

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31
Q

complications of MI

A

Pericarditis (Dressler’s syndrome) mural thrombosis infarct expansion RV infarction ventricular aneurysm papilliary muscle rupture

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32
Q

definition of sudden cardiac death

A

“Unexpected death from cardiac causes in individuals without symptomatic heart disease or early (1hr) after onset of symptoms

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33
Q

symptoms of left sided heart failure

A

SOB pulmonary oedema

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34
Q

symptoms of right sided heart failure

A

peripheral oedema

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35
Q

CAUSES of heart failure

A

Ischaemic heart disease Valve disease Hypertension Myocarditis Cardiomyopathy Left sided heart failure (Right)

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36
Q

complications of heart failure

A

pulmonary emboli arrythmia sudden death

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37
Q

macroscopic findings of heart failure

A

dilated heart scarring and thinning of walls

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38
Q

microscopic findings of heart failure

A

fibrosis and replacment of ventricular myocardium

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39
Q

three types of cardiomyopathy

A

restrictive dilated hypertrophic

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40
Q

toxin driven causes of DCM

A

toxins: alcohol, iron, cobalt, chemo

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41
Q

infective causes of DCM

A

infection: viral myocarditis i

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42
Q

immunological causes of DCM

A

mmunological: myocarditis

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43
Q

hormonal causes of DCM

A

hormonal: diabetes, hyper/ hypothyroidism post partum

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44
Q

genetic causes of DCM

A

genetic Fabry’s, McArdles, haemochromotosis

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45
Q

pathology in HOCM

A

beta myosin heavy chain defect

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46
Q

inheritance of HOCM

A

autosomal dominant

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47
Q

consequences of HOCM

A

thickening of septum narrow left ventricular outflow

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48
Q

macroscopic findings on restrictive cardiomayopathy

A

large atria

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49
Q

causes of restrictive cardiomyopathy

A

secondary to myocardial disease such as amyloidosis or sarcoid

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50
Q

pathology of restrictive cardiomyopathy

A

reduced ventricular compliance

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51
Q

valves commonly affected by valvular disease

A

M>A>T>P

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52
Q

pathology of valvular disease

A

secondary to rheumatic fever thickening of valve leaflets fusuion of commisures

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53
Q

causes of aortic regurgitation

A

rigidity: rheumatic disease, degeneration destruction: microbial endocarditis marfan’s syphilitic aortitis ank spond dissecting aneurusm

54
Q

difference between a true and false aneurysm

A

true aneurysm: involves all layer of vessel wall false: extravascular haematoma

55
Q

causes of aneurysm

A

marfans atherosclerosis HTN

56
Q

causes of DCM

A

idiopathic alcohol, peripartum sarcoidosis, amyloidosis

57
Q

how does DCM cause heart failure

A

systolic dysfunction

58
Q

how does hypertrophic cardiac myopathy cause heart failure

A

diastolic dysfunction

59
Q

how does restrictive cardiomyopathy cause heart failure

A

diastolic dysfunction

60
Q

causes of restrictive cardiomyopathy

A

amyloidosism sarcoidosis, radiation induced fibrosis

61
Q

genetic defect in HCM

A

autosomal dominant inheritance of mutated betaMHC gene 403arg-glycine

62
Q

histological appearance of HCM

A

myocyte disarray

63
Q

mutations in HCM

A

bMHC troponin T (Sudden death) MYBP-C

64
Q

what is ARVC

A

arrythmyogenic righ ventricular cardiomyopathy replacement of myocytes with fibrofatty tissue in the right ventricle

65
Q

organism responsible for acute rheumatic fever

A

group A beta haemolytic strep

66
Q

symptoms of rheumatic fever

A

skin: erythema marginatum, subcutaneous nodules heart: endocarditis, myocarditis, pericarditis joint: arthritis, synovitis cns: encephalitis, sydenhams chorea

67
Q

what are the major jones criteria for rheumatic heart disease

A

Carditis Arthritis Sydenham’s chorea Erythema marginatum Subcutaneous nodules

68
Q

what are minor jones criteria for rheumatic heart disease

A

fever raised ESR/ CRP prolonged PR interval tachycardia migratory arthralgia malaise previous rheumatic fever

69
Q

how to diagnoses rheumatic heart disease

A

group A beta haemolytic strep infection + 1 major criterion 1 major and 2 minor criteria

70
Q

which valve does rheumatic heart disease tend to affect and what is the consequence

A

mitral valve and MR/ MS due to scarring

71
Q

what valve is affected in 25% of cases of rheumatic heart disease

A

aortic

72
Q

causes of aneurysm

A

marfans atherosclerosis HTN

73
Q

causes of DCM

A

idiopathic alcohol, peripartum sarcoidosis, amyloidosis

74
Q

how does DCM cause heart failure

A

systolic dysfunction

75
Q

how does hypertrophic cardiac myopathy cause heart failure

A

diastolic dysfunction

76
Q

how does restrictive cardiomyopathy cause heart failure

A

diastolic dysfunction

77
Q

causes of restrictive cardiomyopathy

A

amyloidosism sarcoidosis, radiation induced fibrosis

78
Q

genetic defect in HCM

A

autosomal dominant inheritance of mutated betaMHC gene 403arg-glycine

79
Q

histological appearance of HCM

A

myocyte disarray

80
Q

mutations in HCM

A

bMHC troponin T (Sudden death) MYBP-C

81
Q

what is ARVC

A

arrythmyogenic righ ventricular cardiomyopathy replacement of myocytes with fibrofatty tissue in the right ventricle

82
Q

organism responsible for acute rheumatic fever

A

group A beta haemolytic strep

83
Q

symptoms of rheumatic fever

A

skin: erythema marginatum, subcutaneous nodules heart: endocarditis, myocarditis, pericarditis joint: arthritis, synovitis cns: encephalitis, sydenhams chorea

84
Q

what are the major jones criteria for rheumatic heart disease

A

Carditis Arthritis Sydenham’s chorea Erythema marginatum Subcutaneous nodules

85
Q

what are minor jones criteria for rheumatic heart disease

A

fever raised ESR/ CRP prolonged PR interval tachycardia migratory arthralgia malaise previous rheumatic fever

86
Q

how to diagnoses rheumatic heart disease

A

group A beta haemolytic strep infection + 1 major criterion 1 major and 2 minor criteria

87
Q

which valve does rheumatic heart disease tend to affect and what is the consequence

A

mitral valve and MR/ MS due to scarring

88
Q

what valve is affected in 25% of cases of rheumatic heart disease

A

aortic

89
Q

what is the eponymous name of the organism responsible for rheumatic heart disease

A

lancefield group A strep

90
Q

what is the pathology of rheumatic heart disease

A

antigen mimcry, cell mediated immunity to strep antigens where antibodies cross react with myocardial antigens

91
Q

3 histological findings of rheumatic heart disease

A

Aschoff bodies beady fibrous vegetations Anitschkov myocytes

92
Q

what are aschoff bodies

A

small giant cell granulomas

93
Q

what are anitschkov myocytes

A

regenerating myocytes

94
Q

what is the term for the fibrous vegetations in rheumatic heart diease

A

verrucae

95
Q

treatment of rheumatic heart disease

A

benzylpenicillin or erythromycin if allergic

96
Q

appearance of verrucae of rheumatic heart disease

A

small warty vegetations along the lines of closure of the valve leaflet

97
Q

pathology of infective endocarditis

A

colonisation of heart valve/ mural endocardium with microbe

98
Q

appearance of infective endocarditis vegetations

A

large irregular mass on valve cusps that extends into the chordae

99
Q

vegetations seen in non-bacterial thrombotic endocarditis

A

small bland vegetations formed of thrombi along the lines of closure

100
Q

what is libman-sacks endocarditis associated with

A

SLE anti-phopholipid syndorme

101
Q

appearance of libman sacks endocarditis vegetaions

A

sterile platelet rich vegetations up to 2mm

102
Q

organisims causing acute infective endocarditis

A

staph aureaus strep pyogenes

103
Q

organisms causing subacute infective endocarditis

A

strep viridans staph epidermis HACEK coxiella mycoplsma candida

104
Q

HACEK organisms

A

gram negative bacteria haemophilus aggregatibacter cardiobacterium eikenella kingella

105
Q

difference in location of masses between acute and subacute IE

A

acute: large masses on aorta subacute: small friable masses on chordae

106
Q

features of IE

A

immune: oslers nodes, roth spots, haematuria due to glomerulonephritis thrombotic: janeway lesions, splinter haemmorgages, splenomegaly, microemboli and septic abscesses

107
Q

which valves are affected in IE

A

mitral/ aortic unless IVDU when RHS valves

108
Q

criteria for IE

A

Dukes criteria

109
Q

major dukes criteria

A

culture of a typical IE causing organism 2 positive cultures taken 12 hours apart evidence of vegetation on echo/ new murmur

110
Q

minor dukes criteria

A

risk factor e.g. prothestic valve fever >38 immune phenomena thrombotic phenomena positive blood cultures not meeting major criteria

111
Q

what dukes criteria is diagnostic of IE

A

2 major 1 major and 3 minor 5 minor

112
Q

treatment of MSSA IE

A

flucloxacillin

113
Q

treatment of MRSA IE

A

vancomycin + gentamicin + rifampicin

114
Q

treatmetn of subacute IE

A

benzylpenicillin + gentamicin for 4 weeks /vancomycin for 4 weeks

115
Q

causes of aortic stenosis

A

age congenital bicuspid valve

116
Q

pathology of aortic stenosis

A

high velocitity high pressure flow

117
Q

murmer for aortic stenosis

A

mid systolic ejection murmer over aortic area

118
Q

murmer for aortic regurgitation

A

diastolic descrendo murmer

119
Q

causes of aortic regurgitation

A

IE LV dilation, dissecting aortic aneurysm marfans, ank spond

120
Q

mitral stenosis murmer

A

diastolic descrescendo murmer with opening snap

121
Q

pathology of mitral stenosis

A

backpressure into left atrium high pressure flow through narrowed mitral valve

122
Q

cause of mitral stenosis

A

rheumatic fever

123
Q

cause of mitral regurgitaion

A

IE, connective tissue disease post MI, LV dilatation

124
Q

mitral regurgitation murmer

A

pansystolic murmer

125
Q

what is chronic rheumatic heart disease

A

thickening along the commisures/ lines of closure of valve leaflets usually left sides/ mitral valve

126
Q

causes of pericarditis

A

uraemia, viral, TB

127
Q

5 types of pericarditis

A

fibrous granulomatous- TB haemorrhagic- TB, uraemia purulent- staph fibrinous- MI, uraemia

128
Q

what is pericardial effusion

A

serous fluid in pericardial sac

129
Q

cause of pericardial effusion

A

chronic heart failure

130
Q

what is haemopericardium

A

myocardial rupture due to trauma or infarction

flashcards of path guide 2018 (15 decks)

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