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Pathology > L14-15 CVS > Flashcards

L14-15 CVS Flashcards

1
Q

Describe the formation of atheroma

A
  1. Chronic endothelial injury
  2. Endothelial dysfunction (due to increased permeability and adhesion of leukocytes and friends)
  3. Smooth muscle recruitment to intima
  4. Macrophage and smooth muscle engulf lipid
  5. Smooth muscle proliferation, collagen deposition –> formation of fibrous cap
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2
Q

Consequences of atherosclerosis

A
  1. Vessel thickening –> narrowed lumen –> impaired BF –> hypoxia –> may lead to infarction
  2. Loss of elasticity –> increased chances of aneurysm –> rupture –> haemmorhage
  3. Endothelial changes –> predisposition to thrombosis
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3
Q

What are the 4 classical patterns of ischaemic heart disease?

A
  1. Angina pectoris
  2. Myocardial infarction
  3. Chronic ischaemic heart disease with heart failure
  4. Sudden cardiac death
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4
Q

What are the clinical diagnosis of MI

A
  1. Symptoms: angina pectoris
  2. ECG changes –> elevated ST region
  3. Elevated cardiac enzymes (troponine and creatinine)
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5
Q

What are the 4 complications of MI

A
  1. Ventricles (LV –> congestive heart failure)
  2. Conduction system (arrythmias)
  3. Pericarditis
  4. Valves (rupture of papillary muscle)
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6
Q

4 adaptive mechanism of the heart in the case of heart failure

A
  1. Increase HR
  2. Increase contractility of the myocardium
  3. Hypertrophy of the myocardium (pressure and volumetric stress)
  4. Frank-Starling mechanism
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7
Q

6 causes of left heart failure

A
  1. Pressure overload –> systemic hypertension
  2. Volume overload –> regurgitation and anaemic
  3. Loss of contractility –> Poison, myocarditis
  4. Loss of muscle –> MI
  5. Restricted filling –> pericardial effusion
  6. Conduction problems –> arrythmia
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8
Q

What does backward failure entail in left heart failure?

A
  1. Dilation of left atrium
  2. Congestion of pulmonary circulation
  3. Pulmonary oedema
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9
Q

What does forward failure entail in left heart failure?

A
  1. Decreased BP
  2. Poor tissue perfusion
  3. Hypoxia of organs
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10
Q

Effect of left heart failure for the kidney

A

Activation of RAAS –> hypertension and pulmonary edema

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11
Q

Effect of left heart failure for the brain

A

Cerebral hypoxia

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12
Q

Clinical signs of left heart failure

A
  1. Exertional dyspnoea
  2. Difficulty breathing when lying down
  3. Paroxysmal nocturnal dyspnoea
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13
Q

Causes of right heart failure

A
  1. Left heart failure –> congestive heart failure
    - Pulmonary congestion
  2. Valvular disease (tricuspid regurgitation)
  3. Lung diseases
    - lung parynchemal disease (COPD, emphysema)
    - Interstitial lung disease
    - pulmonary embolism
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14
Q

Effects of right heart failure

A
  1. Sphenomegaly
  2. Hepatomegaly
  3. Generalised oedema
  4. Nocturia
  5. Peripheral effusion
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15
Q

Describe what is going on for the fist 20-30 minutes of MI

A
  1. Cessation of aerobic metabolism
  2. Increase in lactic acid production
  3. Reduced ATP synthesis
  4. Decreased contractility
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16
Q

Which part of the heart muscle is usually the least perfused?

A

Subendothelial myocytes

17
Q

When does permanent damage of the myocytes occur?

A

2-4 hours after hypoxic condition

18
Q

MOA of reperfusion injury (2)

A
  1. In hypoxic condition, a metabolite Xanthine is produced and upon exposure to oxygen, xanthine is oxidised into reactive oxidative species –> mitochondrial permeability and damage to cell membrane
  2. Leukocytes returning to the site of infarction may release inflammatory factors –> more damage to existing ones
19
Q

Morphologic changes at 12-24 hours mark post MI

A
  1. Cells lose their nuclei
  2. Cells appear eusinophilic
  3. Infarcted tissue appears pale and blotchy
20
Q

Morphologic changes at 24-72 hours mark post MI

A
  1. Tissue appears soft and a shade of pale yellow
  2. Neutrophilic infiltration is seen
21
Q

Morphologic changes at 3-10 days mark post MI

A
  1. Yellow tissue with hyperaemic border
  2. Granulation tissue with new vascular formation is seen under the microscope
22
Q

Morphologic changes at 6-8 weeks mark post MI

A

Fibrous scar

23
Q

Short term complications of MI

A
  1. Cardiac dysrhythmias
  2. Calcular disfunction
  3. Papillary muscle rupture
  4. Left ventricle failure
  5. Acute pericarditis
  6. Thrombus may form
24
Q

Long term complications of MI

A
  1. Recurrent MI
  2. Left ventricular failure
  3. Aneurysms
  4. Immune-mediated pericarditis
25
Q

Hypertension is when the patient’s BP is …

A

140/90 mmHg or above

26
Q

What is the cause of mitral stenosis?

A

Rheumatic heart disease

27
Q

What are the causes of aortic stenosis?

A
  1. Calcium deposition
  2. Rheumatic heart disease
  3. Infective endocarditis
  4. Congenital bicuspid valve
28
Q

What are the causes of mitral insufficiency?

A
  1. Floppy valve syndrome
  2. Rheumatic heart disease
29
Q

What are the causes of aortic insufficiency?

A
  1. Dilation of ascending aorta (hypertension and ageing)
  2. Rheumatic heart disease
  3. Infective endocarditis
  4. Dilation of valve ring (syphillis)
30
Q

What are the local complications of infective endocarditis?

A
  1. Valve rupture
  2. Myocardial ring abscess
  3. Suppurative pericarditis
31
Q

What are the distant complications of infective endocarditis?

A
  1. Embolic –> organ infarction and abscess formation
  2. Immune complex mediated –> vasculitis and glomerulonephritis
  3. Others: anaemia of chronic disease and splenomegaly
32
Q

What are the predisposing risk conditions of infective endocarditis?

A
  1. Rheumatic heart disease
  2. Prosthetic heart valve
33
Q

What is the pathogenesis of infective endocarditis?

A
  1. Derangement in BF
  2. Deposition of fibrin-platelet mass on heart valve / endocardium
  3. Invasion of the meshwork by infective pathogens
  4. Clumping of bacteria due to agglutination of antigens

Pathology (13 decks)

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