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Cardiovascular > Non Ischaemic CV disease > Flashcards

Non Ischaemic CV disease Flashcards

1
Q

what is cardiomyopathy?

A

any disease of the cardiac muscle

often results in changes in the size of the heart chambers and thickness of the heart

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2
Q

describe the classification of cardiomyopathy

A

dilated
hypertrophic
restrictive
arrhythmogenic right ventricular dysplasia

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3
Q

what is dilated cardiomyopathy?

A

a big heart
heart is flabby and floppy
histology features are non specific

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4
Q

what causes dilated cardiomyopathy?

A 
genetics (50%)
AD, AR, X-linked, mitochondrial 
genes that encode heart muscle proteins 
desmin, dystrophin
toxins 
alcohol 
doxorubicin- chemotherapy agents 
rare causes- cardiac infection and pregnancy
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5
Q

what are the clinical features of dilated myopathy?

A

general picture of heart failure
SoB, poor exercise tolerance
low ejection fraction = low CO

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6
Q

what is hypertrophic cardiomyopathy?

A

big solid hearts
hypertrophic and strong contraction
diastolic dysfunction only which eventually causes outflow obstruction

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7
Q

what are the causes of hypertrophic cardiomyopathy?

A

mostly genetic
beta myosin heavy chain
myosin binding protein C
alpha tropomyosin

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8
Q

what happens to the myofibrils in HCM?

A

they are disorganised creating swirls

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9
Q

what is restrictive cardiomyopathy?

A

stiff heart which causes a lack of compliance
doesn’t fill well so diastolic dysfunction
can look normal
biatrial dilation as a result of back pressure

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10
Q

what are the causes of restrictive cardiomyopathy?

A

deposition of something into the myocardium
metabolic byproducts- iron
amyloid
sarcoid- multi system granulomatous disorder
tumours
fibrosis.. following radiation

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11
Q

what is amyloid?

A

abnormal deposition of an abnormal protein
tendency to form beta pleated sheets
body cant get rid of them

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12
Q

describe the classifications of amyloids

A 
AA
AL
haemodialysis associated
familial forms
diabetes
alzheimers
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13
Q

what are AA amyloids?

A

they relate to chronic diseases like rheumatoid

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14
Q

what are AL amyloids?

A

light chains, abnormal immunoglobulin

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15
Q

what are haemodialysis associated amyloids?

A

beta 2 microglobulin

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16
Q

what is a familial form of amyloid?

A

transthyretin

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17
Q

describe the histology of amyloid

A

waxy pink material
stains positively for ‘congo red’
exhibits green birefringence

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18
Q

what is arrhythmogenic right ventricular dysplasia?

A

a genetic disease- autosomal dominant with low penetrance
syncope and funny turns
arrhythmia
can cause sudden death
non specific features so difficult to diagnose

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19
Q

what happens in ARVD?

A

right ventricles becomes largely replaced by fat

big and floppy

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20
Q

what is myocarditis?

A

inflammation of the heart

can be infectious or non infectious but is normally infectious

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21
Q

what are the infectious causes of myocarditis?

A 
viral
bacterial 
fungal
protozoal
helminthic
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22
Q

what are the viral causes of myocarditis?

A 
coxsackie A and B 
ECHO virus 
Chaga's disease 
borrelia burgdorferi- lyme's disease
HIV
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23
Q

what is the pathology of infectious myocarditis?

A

thickened beefy myocardium

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24
Q

what causes non infectious myocarditis?

A

immune mediated hypersensitivity reactions
hypersensitivity to infection
hypersensitivity to drugs
systemic lupus erythematosus

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25
Q

what happens in rheumatic fever?

A

mitral stenosis with thickening and fusion of valves leaflets
short thick chordae tendinae
myocardium also patchily inflamed

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26
Q

what is pericarditis?

A

inflammation of the pericardial layers

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27
Q

what are the causes of pericarditis?

A 
infection
immune mediated 
idiopathic 
uraemic 
post MI 
connective tissue disease
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28
Q

what are the infectious causes of pericarditis?

A

viruses
bacteria
fungi
TB

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29
Q

describe viral pericarditis

A

viruses especially ECHO produce serious effusions

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30
Q

describe bacterial pericarditis

A

extension from elsewhere
pneumonia
produce purulent effusions

31
Q

describe fungi pericarditis

A

immunosupressed patients
post transplant
produce purulent effusions

32
Q

describe TB pericarditis

A

caseous material in sac

33
Q

describe pericarditis post MI

A

dressler’s syndrome
many weeks post
assumed to be immune mediated
damaged heart muscle releases previously un-encountered material that stimulates an immune response

34
Q

what are the complications of pericarditis?

A 
pericardial effusion
tamponade
constrictive pericarditis
cardiac failure
death
35
Q

what is endocarditis?

A

affects heart lining but generally refers to inflammation of the valves
may be infectious or non infecious

36
Q

what causes infectious endocarditis?

A

can occur on normal valves
usually requires a very virulent organism may be bacterial or fungal
IV drug abuse and septicaemia

37
Q

which patient groups are predisposed to infectious endocarditis?

A 
prosthetic valves
congenital defects
bicuspid valves
MV prolapse
calcific disease
38
Q

describe the microbiology of endocarditis

A 
HACEK
haemophilus
actinobacillus
cardiobacteria
eikenella
kingella
39
Q

describe the microbiology of endocarditis in IV drug users

A

candida
staph aureus
right sided vales

40
Q

describe the microbiology of endocarditis in people with prostehtic valves

A

s. epidermis

41
Q

describe the pathology of infectious endocarditis

A

aggregates of organisms on heart valves called vegetations
bacteria excite acute inflammation and bacterial and inflammatory cell products digest the valve leaflets
vegetations are also friable and can cause emboli

42
Q

describe the complications of endocarditis

A

acute vavular incompetence
high output cardiac failure
abscess, fistula, pericarditis

43
Q

describe the systemic manifestations of endocarditis

A 
oslers nodes
janeway lesions
roth spots
splinter haemorrhages
septicaemia
systemic septic emboli
mycotic aneurysms
44
Q

what causes non infectious endocarditis

A

rheumatic fever
SLE
non bacterial thrombotic endocarditis
carcinoid heart disease

45
Q

describe non-bacterial thrombotic endocarditis

A 
non invasive 
doesnt destroy valves
small and multiple vegetations 
can cause embolic disease 
assoc. with cancer
frequently assoc. with mucinous adnocarsinomas 
hypercoaguable states
46
Q

describe lupus endocarditis

A

small sterile emboli
often undersurfaces of the valves or on chords
range of changes- often small asymptomatic deposits or significant valvulitis

47
Q

what is carcinoid heart disease?

A

causes carcinoid tumours which you can see in the mucosa
neuroendocrine component- released hormone
produces right sides cardiac valve disease

48
Q

what are carcinoid tumours?

A

neoplasms of neuroendocrine cells

49
Q

what causes carcinoid heart disease?

A

excess 5HIAA, serotonin, histamine, bradykinin etc by tumour

50
Q

what are the symptoms of carcinoid heart disease?

A

flushing of skin
nausea
vomiting
diarrhoea

51
Q

describe tumours of the heart

A

primary tumours are rare
atrial myxoma is the commonest
secondary tumours may occur; metastatic malignant melanoma, direct invasion of carcinoma of lung, oesophagus

52
Q

describe atrial myxoma

A

can cause ball/ valve obstruction
may cause tumour emboli
may develop endocarditis
associated with systemic fever and malaise

53
Q

what are the pros of exercise testing?

A

cheap
reproducible
risk stratification

54
Q

what are the cons of exercise testing?

A

poor diagnostic accuracy in important sub-groups

submaximal tests

55
Q

what are the pros of perfusion imaging?

A

non invasive
pharmacological stress in less mobile patients
more precision than ETT
risk stratification

56
Q

what are the cons of perfusion imaging?

A

radiation

false positives and negatives

57
Q

what are the pros of CT angiographys?

A

non invasive

anatomical data and risk stratification

58
Q

what are the cons of CT angiography?

A

radiation
less precise than angiography, particularly when calcium present
cost

59
Q

what happens during an angiography?

A

sheath inserted into artery
catheter advanced from wrist/ groin to coronary ostium
xray contrast agent injected to outline coronaries
video fluoroscopy recorded images in multiple views

60
Q

what are the pros of angiography?

A

‘gold standard’
anatomical and risk stratification
follow on angioplasty

61
Q

what are the cons of angiography?

A

risk of death from stroke
radiation
contrast: renal dysfunction, rash, nausea

62
Q

what theorem is used to determine how likely a patient is to have IHD?

A

reverend bayes theorem

63
Q

describe the surgical technique of coronary artery bypass

A 
median sernotomy
long saphenous vein
internal mammary artery 
cardio-pulmonary bypass
cardioplegia
64
Q

what are the complications of CABG?

A 
death
stroke
MI
atrial fibrillation
infection
cognitive impairment 
sternal malunion
renal failure 
failure to recover
65
Q

what are the complications of PCI?

A 
death
stroke
MI
renal failure
bleeding
vascular complications
stent thrombosis
stent restenosis
66
Q

describe the PCI teachnique

A 
vascular access
anti-platelet drugs, anticoagulation
catheter to ostium of coronary 
guide wire down vessel
balloons threaded over wire
stent(s) implanted
balloon, catheter, wires removed
67
Q

what are the indications for angiography?

A

severe symptoms

high risk

68
Q

what is the suitability for revascularisation?

A

multi-vessel diease, diffuse or focal
left main disease
diabetes
co-morbidities

69
Q

describe radial artery access pros

A

dual supply to hand
superficial
compressible
no adjacent nerve/vein

70
Q

describe radial artery access cons

A

smaller
prone to spasm
asymptomatic occlusion can occur

71
Q

what is the treatment for a STEMI?

A

primary PCI

72
Q

what is the treatment for acute coronary syndrome?

A

angiography with a view to revascularisation

73
Q

what is the treatment for chronic stable angina?

A

revascularisation for severe symptoms or high risk

CABG vs PCI should be determined by discussion

Cardiovascular (31 decks)

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