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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
what happens in rheumatic fever?
mitral stenosis with thickening and fusion of valves leaflets short thick chordae tendinae myocardium also patchily inflamed
26
what is pericarditis?
inflammation of the pericardial layers
27
what are the causes of pericarditis?
``` infection immune mediated idiopathic uraemic post MI connective tissue disease ```
28
what are the infectious causes of pericarditis?
viruses bacteria fungi TB
29
describe viral pericarditis
viruses especially ECHO produce serious effusions
30
describe bacterial pericarditis
extension from elsewhere pneumonia produce purulent effusions
31
describe fungi pericarditis
immunosupressed patients post transplant produce purulent effusions
32
describe TB pericarditis
caseous material in sac
33
describe pericarditis post MI
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
what are the complications of pericarditis?
``` pericardial effusion tamponade constrictive pericarditis cardiac failure death ```
35
what is endocarditis?
affects heart lining but generally refers to inflammation of the valves may be infectious or non infecious
36
what causes infectious endocarditis?
can occur on normal valves usually requires a very virulent organism may be bacterial or fungal IV drug abuse and septicaemia
37
which patient groups are predisposed to infectious endocarditis?
``` prosthetic valves congenital defects bicuspid valves MV prolapse calcific disease ```
38
describe the microbiology of endocarditis
``` HACEK haemophilus actinobacillus cardiobacteria eikenella kingella ```
39
describe the microbiology of endocarditis in IV drug users
candida staph aureus right sided vales
40
describe the microbiology of endocarditis in people with prostehtic valves
s. epidermis
41
describe the pathology of infectious endocarditis
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
describe the complications of endocarditis
acute vavular incompetence high output cardiac failure abscess, fistula, pericarditis
43
describe the systemic manifestations of endocarditis
``` oslers nodes janeway lesions roth spots splinter haemorrhages septicaemia systemic septic emboli mycotic aneurysms ```
44
what causes non infectious endocarditis
rheumatic fever SLE non bacterial thrombotic endocarditis carcinoid heart disease
45
describe non-bacterial thrombotic endocarditis
``` non invasive doesnt destroy valves small and multiple vegetations can cause embolic disease assoc. with cancer frequently assoc. with mucinous adnocarsinomas hypercoaguable states ```
46
describe lupus endocarditis
small sterile emboli often undersurfaces of the valves or on chords range of changes- often small asymptomatic deposits or significant valvulitis
47
what is carcinoid heart disease?
causes carcinoid tumours which you can see in the mucosa neuroendocrine component- released hormone produces right sides cardiac valve disease
48
what are carcinoid tumours?
neoplasms of neuroendocrine cells
49
what causes carcinoid heart disease?
excess 5HIAA, serotonin, histamine, bradykinin etc by tumour
50
what are the symptoms of carcinoid heart disease?
flushing of skin nausea vomiting diarrhoea
51
describe tumours of the heart
primary tumours are rare atrial myxoma is the commonest secondary tumours may occur; metastatic malignant melanoma, direct invasion of carcinoma of lung, oesophagus
52
describe atrial myxoma
can cause ball/ valve obstruction may cause tumour emboli may develop endocarditis associated with systemic fever and malaise
53
what are the pros of exercise testing?
cheap reproducible risk stratification
54
what are the cons of exercise testing?
poor diagnostic accuracy in important sub-groups | submaximal tests
55
what are the pros of perfusion imaging?
non invasive pharmacological stress in less mobile patients more precision than ETT risk stratification
56
what are the cons of perfusion imaging?
radiation | false positives and negatives
57
what are the pros of CT angiographys?
non invasive | anatomical data and risk stratification
58
what are the cons of CT angiography?
radiation less precise than angiography, particularly when calcium present cost
59
what happens during an angiography?
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
what are the pros of angiography?
'gold standard' anatomical and risk stratification follow on angioplasty
61
what are the cons of angiography?
risk of death from stroke radiation contrast: renal dysfunction, rash, nausea
62
what theorem is used to determine how likely a patient is to have IHD?
reverend bayes theorem
63
describe the surgical technique of coronary artery bypass
``` median sernotomy long saphenous vein internal mammary artery cardio-pulmonary bypass cardioplegia ```
64
what are the complications of CABG?
``` death stroke MI atrial fibrillation infection cognitive impairment sternal malunion renal failure failure to recover ```
65
what are the complications of PCI?
``` death stroke MI renal failure bleeding vascular complications stent thrombosis stent restenosis ```
66
describe the PCI teachnique
``` 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
what are the indications for angiography?
severe symptoms | high risk
68
what is the suitability for revascularisation?
multi-vessel diease, diffuse or focal left main disease diabetes co-morbidities
69
describe radial artery access pros
dual supply to hand superficial compressible no adjacent nerve/vein
70
describe radial artery access cons
smaller prone to spasm asymptomatic occlusion can occur
71
what is the treatment for a STEMI?
primary PCI
72
what is the treatment for acute coronary syndrome?
angiography with a view to revascularisation
73
what is the treatment for chronic stable angina?
revascularisation for severe symptoms or high risk | CABG vs PCI should be determined by discussion

Cardiovascular (31 decks)

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