Pathology Flashcards
emryonic defect which results in tetralogy of fallot
anterosuperior displacement of the infundibular septum
exposure to what can cause ebstein anomaly
lithium exposure in utero
risk factors of persistent pulmonary hypertension in the newborn
aspiration of meconium-stained amniotic fluid
neonatal pnuemonia
neonate with diabetic mother may be at risk of what cardiac complications
transportation of great arteries
truncus arteriosus
tricuspid atresia
VSD
cardiac defect associated with williams syndromec
supravalvular aortic stenosis
cardiac defect associated with 22q11 deletion syndrome
truncus arteriosus, tetralogy of fallot
cardiac defects associated with downs syndrome
AVSD (endocardial cushion defect), ASD, VSD
cardiac defects associated with congenital rubella
PDA, pulmonary artery stenosis, septal defects
string of beads appearance of renal artery
fibromuscular displasia
most common cause of secondary HTN in females
2 main types of arteiolosclerosis
thickening of arteries and artioles
1. hyaline - vessel wall thickening due to leakage of protein into subendothelial due to diabetes and hypertension
- hyperplastic - ‘onion skinning’ in severe hypertension with proliferation of smooth muscle cells
stanford vs DeBakey classification of aortic dissection
stanford (2 syllables = 2 types)
type 1 - ascending +/- arch/descending
type 2 - descending only
DeBakey (3 syllables = 3 types)
type 1 - ascening + descening
type 2 - ascending only
type 3 - descending only
at what point does the asending become the descending aorta
becomes the descending aorta just below the left subclavian artery
subclavian steal syndrome pathophysiology
occlusion of the subclavian artery proximal to the vertebral artery = hypoperfusion distal to stenosis
causes reversed blood flow in the vertebral artery = reduced cerebral perfusion on exertion of affected arm
subclavian steal syndrome features
BP difference in L vs R arm
arm ischaemia, pain, paraesthesia
vertebrobasillar insufficiency = dizziness, vertigo
risk factors for coronary artery vasospams
tobacco (number 1 risk)
cocaine
amphetamines
alcohol
triptans
treatment for coronary artery vasospams
CCB
nitrates
smoking cessation
MI complication;
- acute mitral valve regurgitation –> cardiogenic shock, severe pulmonary oedema
papillary muscle rupture
MI complication;
- cardiac tamponade, sudden death
ventricular free wall rupture
pathophysiology of dresslers syndrome
autoimmune pericarditis which develops 2 weeks after MI
cardiac antigens released after injury -> deposition of immune complexes in pericardium -> inflammation
MI complication;
- chest pain, murmur, HF, embolus
pseudoaneurysm
what is more likely to rupture and why - ventricular pseudoaneurysm or true ventricular aneurysm
pseudoaneurysm as its not contained within endocardium or myocardium
most common gene in familial dilated cardiomyopathy
TTP gene encoding the sarcometric protein titin
type of hypertrophy found in dilated cardiomyopathy
eccentric hypertrophy (sarcomeres added in series)
mutations in genes encoding what are responsible for familial hypertrophic cardiomyopathy
mutations in genes encoding sarcometric proteins such as myosin binding protein C and beta-myosin heavy chain
what drugs are avoided in hypertrophic cardiomyopathy
nitrates
betablockers
diuretics
eosinophillic infiltrates in myocardium
loffler endocarditis (associated with eosinophillic syndrome)
causes of restrictive / infiltrative cardiomyopathy
PLEASe Help
postradiation fibrosis
loffler syndrome
endocardial fibroelastosis
amyloidosis
sarcoidosis
haemochromatosis
cardiomyopathy that causes diastolic dysfunction
hypertrophic cardiomyopathy
restrictive/infiltrative cardiomyopathy
cardiomyiipathy that causes systolic dysfunction
dilated cardiomyopathy
condition which causes ventricular concentric hypertrophy vs eccentric hypertrophy
concentric = hypertrophic CM
eccentric = dilated CM
primary disturbance driving each type of shock
hypovolaemic - decrease in PCWP
cardiogenic - decrease in CO
obstructive (PE, tamponade) - decrease in CO
distrubutive (sepsis, CNS) - decrease in SVR
pathophysiology of pulsus paradoxus
decrease in systolic bP > 10mmHg during inspiration
inspiration causes increase in venous return –> increase rv filling –> interventricular septum bows toward LV (due to decrease pericardial compliance ) –> reduced LV ejection = reduced BP
what conditions is pulsus paradoxus found in
constrictive Pericarditis
obstructive pulmonary disease (Croup, OSA, Asthma, copd)
cardiac Tamponade
(P COAT)
most common valve involved in endocarditis
mitral valve
most common valve involved in endocarditis in IVDU
tricuspid valve (dont tri drugs)
causative organism of endocarditis in prosthetic valves
staph epidermidis
causative organism of endocarditis in IVDU
staph aureus, pseudomonas, candida
causative organism of endocarditis colon cancer
s gallolyticus
causative organism of endocarditis in GI/GU procedures
enterococcus
causative gram negative organism of endocarditis
HACEK
haemophillus, aggregatibacter, cardiobacterium, eikenella, kingella
causative culture negative organism of endocarditis
coxiella, bartonella
causative organisms of endocarditis; acute and sub onset
acute - staph aureus
subacute - viridans strep
libman sacks endocarditis
aseptic endocarditis found in SLE due to hypercoaguable state
tree bark appearance of aorta
tertiary syphyillis - calcification of aorta
consequences of syphillitic heart disease
aortic aneurysms
aortic insufficiency
causative organisms of rheumatic fever
group A beta haemolytic streptococci
heart valve most affected in rheumatic fever
mitral
what typ eof hypersenstivity is rheumatic fever
type II
diagnostic features of rheumatic fever
JONES (with a love heart for O)
Joint (migratory polyarthritis)
carditis
Nodules in skin
Erythema marginatum (evanscent rash with ring margin)
Sydenham chorea (involuntary irregular movements of limbs and face)
pathology and immunologic features associated with rheumatic fever
aschoff bodies
anti streptolysin O
anti-DNase B titres
what are aschoff bodies and what condition are they found in
rheumatic fever
granuloma with giant cells and anitschkow cells (enlarged oval wavy rodlike nucleus)
what condition might rhabdomyomas be associated with
tuberous sclerosis
where in the heart do myxomas typically occur
atria
what type of interleukin does myxomas produce
IL-6
histology - gelatinous material, cells immersed in glycosaminoglycans
myxoma
ST elevation in leads V4-V6 would be due to thrombus in what vessel
distal left anterior descending
ST elevation in lead V1-V4 would be due to thrombus in what vessel
proximal left anterior descending
ST elevation in lead V1-V6 would be due to thrombus in what vessel
main left anterior descending
what is the preferred medication to lower high triglyceride levels ? and their mechanism of action
fibrates
active PPAR alpha to decrease expression of 7-alpha-hydroxylase which is the rate limiting step of bile acid synthesis
side effect of fibrates
cholesterol gallstones
hereditary angioedema pathophsyiology
inherited disorder of dysfunctional or deficient C1 esterase inhibitor leading to increased levels of bradykinin or C1 complement pathway products which cause vasodilation and increased permeability
hereditary angiodema presentation
episodic oedema of arms, face, genitals etc
what medication should be avoided in patients with hereditary angiodema
ACE inhibitors
underlying mechanism of AF
autonomous bursts of electrical activity within pulmonary veins
underlying mechanism of sick sinus syndrome
age related degeneration of SA node
mechanism of carotid massage in SVT
massaging carotid sinus stimulates carotid baroreceptors which decreases HR via activation of parasympathetic nervous system (via glossopharyngeal nerve)
post MI - hypotension, tachycardia, respiratory distress
papillary muscle rupture
leads to mitral regurgitation and acute pulmonary oedema
post MI - enlarged heart sillohette, hypotension, muffled heart sounds
left ventricular free wall rupture
causes tamponade and sudden death
macophages with wavy nuclei
aschoff bodies found in rheumatic fever
pathological features of cardiac tissue hours after MI
eosiophil infiltration
large influx of Ca which results in hypercontraction of sarcomeres
JVC distention, bilateral upper limb swelling, facial swelling and skin blanching
SVC syndrome
severe complications of SVC syndrome
increased risk of aneurysm or rupture of intracranial arteries
pancoast tumour which causes horner syndrome is due to obstruction of what structure
stellate ganglion
arrythmias, dilated cardiomyopathy, megacolon, megaoesophagus
chagas disease (trypanosoma cruzi)
pathological features of HOCM
ventricular concentric hypertrophy (sarcomeres added parralel)
mitral regurgitation
asymmetric septal hypertrophy
systolic motion of anterior mitral valve
(ASK MR SAM)
pathology of HOCM
pathophysiology of rhuematic fever
cross-reactivity between bacterial antigen and host immune system at the mitral valve (molecular mimicry)
type II hypersensitivity reaction
what type of virus causes rubella
positive single-stranded RNA virus of the gene rubivirus
what type of bacterium is syphillis
a helically coiled spirochete
what type of heart failure would be found in amyloidosis
restrictive cardiomyopathy
causes of dilated cardiomyopathy
alcohol
beriberi
chagas disease
coxsachie B
cocaine
doxorubicin
mumur found in rhematic heart disease
mid-diastolic rumble with opening snap at the apex
mid-systolic murmur with wide, fixed S2
ASD
most common cause of sudden death shortly after MI and its mechanism
arrythmias
re-entrant circuits
what is the most common causative organism of infective endocarditis in a patient on haemodialysis
staph aureus
what type of bacteria is staph aureus
gram psitive, catalase positive, coagulase positive, cocci
pathophysiology of tertiary syphillis heart disease
endarteritis in the vasa vasorum which causes ischaemia of the aorta = aortic aneurysms and aortic insufficiency
why is betablockers contraindicated in patients with MI + cocaine use
unopposed vascular smooth muscle contraction via alpha 1 receptors
