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YEAR 5: Histopathology > Histo: Vascular and Cardiac Pathology Pt.2 > Flashcards

Histo: Vascular and Cardiac Pathology Pt.2 Flashcards

1
Q

What is the 1-year mortality after an MI?

A

30%

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2
Q

What is chronic ischaemic heart disease?

A
  • Progressive heart failure due to ischaemic myocardial damage
  • Leads to hypertrophied, dilated LV
  • Usually due to long-standing atherosclerosis
  • Microscopic fibrosis

NOTE: there may be no prior infarction

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3
Q

What is sudden cardiac death?

A
  • Unexpected death from cardiac causes in individuals without symptomatic heart disease or early (1hr) after the onset of symptoms
  • Usually due to lethal arrhythmia
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4
Q

What are some underlying conditions that can cause sudden cardiac death?

A

IHD (90%)

  • Acute myocardial ischaemia the usual trigger
  • Leads to electrical instability of the conduction system
  • This usually occurs at sites of old MI scars

Non-atherosclerotic cause (10%) - e.g. long QT

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5
Q

List some causes of heart failure.

A
  • Ischaemic heart disease
  • Valve disease
  • Hypertension
  • Myocarditis
  • Cardiomyopathy
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6
Q

List some complications of heart failure.

A
  • Sudden death
  • Arrhythmias
  • Systemic emboli
  • Pulmonary oedema with superimposed infection
  • Hepatic cirrhosis (nutmeg liver)
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7
Q

Outline the histology of heart failure.

A
  • Dilated heart
  • Scarring and thinning of the walls
  • Fibrosis and replacement of ventricular myocardium
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8
Q

What are cardiomyopathies?

A

Intrinsic problems of the heart muscle

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9
Q

What is dilated cardiomyopathy?

A

Caused by progressive loss of myocytes leading to a dilated heart

Systolic dysfunction

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10
Q

List some causes of dilated cardiomyopathy.

A
  • Idiopathic
  • Genetic: familial, haemochromatosis
  • Infection: post-viral myocarditis
  • Toxins: alcohol, drugs (cocaine, doxorubicin)
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11
Q

What is hypertrophic cardiomyopathy?

A
  • Thickening of the heart muscle
  • Family history in 50% of cases
  • Leads to ventricular outflow obstruction and arrhythmia

Diastolic dysfunction

NOTE: some are associated with a specific abnormality in the beta-myosin heavy chain

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12
Q

What is restrictive cardiomyopathy?

A

Impaired ventricular compliance - diastolic dysfunction, near-normal systolic function

Causes:

  • Amyloidosis
  • Sarcoidosis
  • Haemochromatosis
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13
Q

What is chronic rheumatic heart disease caused by?

A

Antigenic mimicry
Caused by immune cross-reactivity of group A streptococcal antigens and cardiac valves

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14
Q

Which valve is most commonly affected in rheumatic heart disease?

A

Mitral valve

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15
Q

What is the most common cause of aortic stenosis?

A

Aortic valve sclerosis - calcification (age-related)

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16
Q

List some causes of aortic regurgitation.

A

Valvular defect

  • Congential bicuspid valve
  • Age-related degeneration
  • RHD
  • Endocarditis

Aortic dilatation

  • Dissection
  • Chronic hypertension
  • Connective tissue diease e.g. Marfan’s
  • Aortitis e.g. syphilis
17
Q

Which valves are most commonly affected by endocarditis?

A
  • Left-sided valves (mitral > aortic)
  • If IVDU, then tricuspid
18
Q

What are the two different types of true aneurysms?

A
  • Saccular
  • Fusiform
19
Q

Describe the histology of rheumatic heart disease

A
  • Beady fibrous vegetations (verrucae)
  • Aschoff bodies (small giant-cell granulomas)
  • Anitschkov myocytes (regenerating myocytes)
20
Q

Acute vs subacute endocarditis?

A

Causative organism:

  • Acute = staph aureus, strep pyogenes
  • Subacute = strep viridans

Virulence:

  • Acute = high
  • Subacute = low

Vegetation morphology:

  • Acute = larger and more localised
  • Subacute = friable, soft thrombi, few mm in size

Spread:

  • Acute = aorta
  • Subacute = chordae
21
Q

Treatment for infective endocarditis?

A

Acute:

  • MSSA - fluclox
  • MRSA - rifampicin + vancomycin + gentamicin

Subacute:

  • Benzylpenicillin + gentamicin, or vancomycin for 4wks
22
Q

What is the most common cause of constrictive pericarditis?

A

TB

23
Q

What is the most common cause of myocarditis?

A

Viral infection

24
Q

What is the most common primary tumour in the heart?

A

Myxoma

25
Q

What type of necrosis occurs in MI?

A

Coagulative necrosis

26
Q

What is the most common cause of mitral valve stenosis?

A

Rheumatic heart disease

YEAR 5: Histopathology (33 decks)

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