Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

September lectures yr 3 (2018) > Other cardiovascular pathology > Flashcards

Other cardiovascular pathology Flashcards

1
Q

What are the three main forms of valvular heart disease?

A

pure or mixed
affect single or multiple valves

1) stenosis = valve is too narrow and fails to open completely, impeding blood flow forwards
2) incompetence (regurgitation) = failure of the valve to close completely, reverse flow of blood
3) functional regurgitation = valve becomes incompetent due to dilatation of a ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What factors are important to consider in terms of the clinical consequences of a valvular disorder?

A

dependent upon:

  • which valve is impaired
  • degree of impairment
  • rate of disease development (rate and quality of compensatory mechanisms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the severity of valvular heart disease vary?

A

range from physiologically unimportant (rheumatic mitral stenosis) to severe and rapidly fatal (acute aortic incompetence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can valvular incompetence arise?

A

due to intrinsic disease of the valve cusps, or damage to/distortion of supporting structures (aorta, papillary muscles and tendinous cords)
Can be superimposed on underlying valve abnormality
Acute or chronic condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the usual underlying cause of valvular stenosis including examples?

A

Valvular stenosis almost always has an underlying valve abnormality (chronic)

  • valvular calcification = form of stenosis that affects aortic and mitral valves
    e. g. mitral annular calcification, calcific aortic stenosis (common with age) and calcification of a congenitally bicuspid aortic valve (normally 3 cusps)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the mechanism causing valvular stenosis?

A

heart valves subject to high repetitive mechanical stress, especially at the hinge points of the cusps therefore cumulative damage is further complicated by dystrophic calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is mitral incompetence?

A

myxomatous degeneration and mitral valve prolapse
- very common
often both mitral valves will become enlarged, hooded and redundant causing them to prolapse back into the left atrium during systole
- very rarely it can lead to sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a common cause of mitral stenosis?

A

rheumatic fever - due to acute immunologically mediated inflammatory disease that follows infection with group A beta-hemolytic strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Other than mitral stenosis what are the other associated symptoms caused by rheumatic fever?

A

migratory polyarthritis of large joints, carditis, subcutaneous nodules, skin rash, and sydenham chorea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can happen to the heart in acute rheumatic heart disease?

A

pancarditis

  • endocardium will form vegetations
  • myocardium will form inflammatory foci with aschoff bodies
  • pericardium will be inflamed

this damage can accumulate with repeated infections leading to chronic rheumatic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is chronic rheumatic heart disease characterized by?

A

deforming fibrotic valvular disease (fish mouth) with leaflet thickening
commissural fusion and shortening
thickening and fusion of the tendinous cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is infective endocarditis?

A

serious (usually bacterial) infection that colonise the heart valves = results in the formation of friable bulky vegetations with underlying tissue destruction
- acute and subacute forms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the characteristics of acute infective endocarditis ? (virulence, valve, presentation, outcome, lesion, organisms)

A 
virulence= high 
valve= previously normal
presentation= acute onset
outcome = 50% mortality in days-weeks
lesion= necrotising, ulcerative, invasive 
organisms= staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the characteristics of subacute infective endocarditis ? (virulence, valve, presentation, outcome, lesion, organisms)

A 
virulence= low 
valve= usually abnormal
presentation= insidious onset
outcome = recover in weeks-months
lesion= less destructive 
organisms= alpha hemolytic strep, mouth commensals, staph epidermis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What factors predispose you to infective endocarditis?

A 
abnormal valves 
immunosuppression 
diabetes
alcoholism 
IV drug use 
e.g. anything that can lead to bacteraemia - dental procedures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which valves are most commonly affected by endocarditis?

A

aortic and mitral valves are most commonly affected - however tricuspid is often affected with IV drug use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What endocarditis in the tricuspid valve due to IV drug use lead to ?

A 
formation of vegetations
myocardial abscess
valve rupture
systemic emboli 
septic emboli 
immune complex formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does non-bacterial thrombotic endocarditis involve?

A

deposition of fibrin and platelet thrombi on valve leaflets - can be on either side of the heart and will affect previously normal valves
As it is sterile it is a non-destructive process but can cause emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When does non-bacterial thrombotic endocarditis typically occur?

A

hypercoaguable states such as DIC, cancer and sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 2 main forms of artificial valves?

A

mechanical and bioprothesis (often porcine xenografts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the complications of artificial valves?

A

thromboembolic hence long term anticoagulants must be taken
increase susceptibility to infective endocarditis and
structure deteriorates through age

22
Q

What is cardiomyopathy?

A

heart disease resulting from a primary abnormality in the myocardium
caused by: inflammation, immunological disease, systemic metabolic disorders, muscular dystrophies and genetic myocyte abnormalities or it can be idiopathic

23
Q

What are the 3 main clinical pictures of cardiomyopathy?

A

1) dilated cardiomyopathy
2) hypertrophic cardiomyopathy
3) restrictive cardiomyopathy
- each has a spectrum of severity and there can be overlap between them

24
Q

How are cardiomyopathies diagnosed?

A

endomyocardial biopsy of the right ventricle

25
Q

What are the characteristics of dilated cardiomyopathy?

A

progressive hypertrophy
dilation
contractile dysfunction
leads to congestive cardiac failure

26
Q

What are the causes of dilated cardiomyopathy?

A 
most cases are idiopathic
alcohol 
peripartum 
genetic
myocarditis 
hemochromatosis 
chronic anaemia 
chemotherapy 
sarcoidosis
27
Q

What are the morphological changes seen in dilated cardiomyopathy?

A

2-3x heavier than normal with dilation of all chambers - may be mural thrombi as well as mitral and tricuspid regurgitation
coronary arteries will be normal

28
Q

Histologically, what can be seen in dilated cardiomyopathy?

A

fibres will be hypertrophied and attenuated

there will also be fibrosis

29
Q

What are the clinical features of dilated cardiomyopathy ?

A

slowly progressive congestive heart failure occur at any age
Ejection fraction can be as low as 25% leading to a high rate mortality from arrhythmia or heart failure
- treatment is cardiac transplant

30
Q

What are the characteristics of hypertrophic cardiomyopathy?

A

myocardial hypertrophy with abnormal diastolic filling - consists of heavy muscular hyper contracting heart

  • no ventricular dilation
  • asymmetrical septal hypertrophy
  • extensive myocyte hypertrophy and disarray with interstitial fibrosis
31
Q

What type of inheritance is hypertrophic cardiomyopathy?

A

usually autosomal dominant with variable penetrance there are many different mutations in four genes that encode sarcomeres

  • 1) beta myosin heavy chain
  • 2) cardiac troponin T
  • 3) alpha tropomyosin
  • 4) myosin binding protein C
32
Q

What are the clinical features of hypertrophic cardiomyopathy?

A

decreased chamber size coupled with poor compliance = decreased SV

33
Q

What clinical problems are associated with hypertrophic cardiomyopathy?

A 
angina 
atrial fibrillation 
cardiac failure 
ventricular arrhythmia 
sudden death
34
Q

What is restrictive cardiomyopathy due to?

A
35
Q

What can cause restrictive cardiomyopathy?

A

caused by radiation fibrosis, amyloidosis, sarcoidosis, metastatic tumor, inborn error in metabolism, endomyocardial fibrosis and endocardial fibroelasotosis

36
Q

What are the clinical features of restrictive cardiomyopathy?

A

heart ventricles and chambers will be normal sized

both atrial will be dilated and the myocardium will be fine

37
Q

What is myocarditis?

A

inflammatory process of the myocardium = injury to myocytes

38
Q

What can cause myocarditis?

A

viral infection
sarcoidosis
immune causes: post-viral, post-streptococcal, SLE, drug hypersensitivity and transplant rejection

39
Q

Clinically how can myocarditis present?

A

either be asymptomatic and later result in DCM
or
lead to arrthymia and acute heart failure with sudden death

40
Q

What is pericardial effusion?

A

fluid of a variety of compositions occupies the pericardial sac
- if the fluid is large enough and rapidly develops it can lead to cardiac tamponade

41
Q

What are the different compositions of fluid that can occur in pericardial effusion?

A
  • transudate = clear fluid forms against a pressure gradient
  • exudate = forms in inflammation and contains proteins
  • haemopericardium = fills the pericardium with blood and can be due to ventricular rupture
  • purulent pericarditis = thick pussy exudate
42
Q

What is pericarditis?

A

inflammation of the pericardium - can be secondary to cardiac disease, thoracic or systemic disorders or metastasis from a distant site

43
Q

What are the causes of pericarditis?

A

infections
immune mediated
miscellaneous

44
Q

What are the different types of pericarditis?

A 
serous 
fibrinous 
purulent 
hemorrhagic 
caseous
45
Q

What can happen to the fluid in pericarditis?

A

it can be reabsorbed, resolve itself or become organized and obliterate the pericardial space - this can lead to constrictive pericarditis if the heart becomes surrounded by dense fibrous tissue scar tissue

46
Q

What is the most common type of neoplasm of the heart?

A

primary are very rare but secondary are much more common

- most common primary tumor= benign atrial myxoma - attached to the endocardium and projects out into the heart lumen

47
Q

What can benign atrial myxoma cause?

A

ball-valve obstruction, injury to the valve and embolisation

48
Q

What are the 3 main categories of congenital heart disease?

A

1) R-L shunts
2) L-R shunts
3) Obstructive

49
Q

What are R-L shunts?

A

reduce oxygenation of the blood causing cyanosis
can be due to tetralogy of fallot, transposition of great vessels, persistent trunks arterioles, tricuspid atresia and total anomalous pulmonary venous connection

50
Q

What are L-R shunt?

A

lead to pulmonary hypertension by increasing pulmonary blood flow
with time shunt reverses
can lead to eisenmenger’s syndrome and late cyanosis = due to atrial and ventricular septal defects or patent ductus arteriosus

51
Q

What is obstructive congenital heart defects?

A

block flow due to an abnormal narrowing of a chamber, valve or blood vessel
eg. coarctation of the aorta

52
Q

What is vasculitis?

A

inflammation of the wall of a blood vessel

  • can be caused by infection, immune complex formation, ANCA antibodies, T-cell mediated destruction, inflammatory bowel disease or neoplasms
  • different patterns of disease occur, affecting specific sizes of vessels as well as causing rashes and affecting the kidneys

September lectures yr 3 (2018) (56 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions