Pathology Flashcards
What is the leading cause of mitral stenosis and what are some clinical features?
Cause: Rheumatic fever
Features: AF due to thrombi, haemoptysis, pulmonary congestion and HTN, RV hypertrophy
What are the causes of and clinical features present with aortic stenosis?
Causes: degenerative calcification, old age, rheumatic aortic valve disease
Features: small pulse, LV hypertrophy, angina, syncope, LV failure, death
What type of murmur does mitral stenosis and aortic stenosis produce?
Mitral - rumbling diastolic
Aortic - ejection systolic murmur
What is infective endocarditis?
Infection of heart valves or mural endocardium by a microbe with formation of vegetations
What are the clinical forms of infective endocarditis?
(1) Acute endocarditis - caused by virulent organisms, large vegetations, valvular destruction (staph aureus)
(2) Subacute endocarditis - less virulent organisms, grow slowly on damaged valves (more common) - strep viridian’s
What are some of the pathological features of dilated cardiomyopathy?
Hypertrophy and dilatation of all 4 chambers, with bowing of the iV septum to the right side
What are the pathological features of hypertrophic cardiomyopathy?
Myocardial hypertrophy and abnormal diastolic filling due to increased wall thickness
What are the pathological features of restrictive cardiomyopathy?
Ventricles are normal sized, cavities not dilated, but the myocardium is firm and non-compliant
What is myocarditis?
Inflammation of the myocardium with lymphocytic infiltration
What are the infectious causes and immune mediated causes of myocarditis?
Infectious - virus, bacteria, protozoa, rickettsial, fungal
Immune mediated - post viral, post strep, SLE, RF, Polymyositis, drug
What is the most common tumour of the heart and where is it found?
Myxoma - commonly found in the atria in the fossa ovalis
What anatomical location is affected by chronic bronchitis? and is the pathology, etiology, symptoms?
Bronchus - mucous gland hyperplasia and hyper secretion
cause - smoke, pollutants
signs - cough, sputum
What is the anatomical location of emphysema and what are the pathological changes, ethology and signs?
Acinus - airspace enlargement, wall destruction due to tobacco smoke
- dyspnea, barely chest, wheeze, cough
What types of emphysema are there?
Centriacinar - upper lobes, proximal portion of acinus
Panacinar - all lung fields, particularly bases
What is the pathogenesis of emphysema?
Imbalance between enzymes being produced - smoking inhibits the anti-proteases found in normal bronchial mucous
What is bronchiectasis and what are the clinical and pathological features?
Permanent dilation of the bronchi/bronchioles as a result of obstruction or infection.
Features: constant cough, smelly sputum, finger clubbing
Pathology: dilatation, purulent material, inflamed and ulcerated, fibrosis and lymphoid folicle formation
What is the pathogenesis of asthma?
Various stimuli/allergens resulting in reversible bronchoconstriction.
Also mucous plugging, focal necrosis, deem of bronchiole walls, hypertrophy of mucous glands and smooth muscle
What are some obstructive lung diseases?
- Chronic bronchitis
- Bronchiectasis
- Asthma
- Emphysema
- Small airway/bronchiolitis
What are the 4 stages of the acute inflammatory response in bacterial pneumonia?
(1) Congestion
(2) Red hepatisation
(3) Grey hepatisation
(4) Resolution
What are the common causative organisms of bacterial community acquired acute pneumonia?
o Streptococcus pneumoniae o Haem. Influenza o Moraxella catarrhalis o Staph aureus o Klebsiella pneumoniae o Pseudomonas aeruginosa o Legionella pneumophilia
What are the community acquired atypical pneumonias mostly caused by?
Viral (influenza, adenovirus) and mycoplasma
What are the common organisms causing pneumonia in the immunocompromised host?
o Bacterial – pseudomonas aeruginosa, mycobacterium, legionella listeria monocytogenes
o Viruses – CMV, Herpes
o Fungi
What are some clinical manifestations of heart failure?
Abdominal and cerebral symptoms, peripheral deem, dyspnoea, fatigue and weakness, cachexia
What does ‘forward failure’ and ‘backward failure’ in heart failure mean?
FF - diminished cardiac output, reduced tissue perfusion
BF - Pooling of blood in venous system + edema
In hypertensive heart disease, which side of the heart is affected by systemic HTN and pulmonary HTN?
Systemic - Left
Pulmonary - Right
What are the heart changes occurring in systemic hypertension?
Concentric LV hypertrophy with increased wall thickness
It impairs diastolic filling, leading to atrial enlargement
What is Cor Pulmonale?
Right ventricular enlargement due to pulmonary hypertension caused by disorders of the lungs or pulmonary vessels
What are the types of Angina pectoris?
- stable angina - induced by exercise, relieved by GTN or rest
- variant form - recurrent prolonged attacks of severe ischaemia caused by spasm of coronary artery
- unstable angina - pain at rest that persists
What is a transmural (STEMI) and a subendocardial (NSTEMI) MI?
STEMI - full thickness necrosis in area supplied by single coronary artery
NSTEMI - circumferential necrosis around inner 1/2-1/3 of V wall
What are complications of MI?
Sudden death
other: arrhythmia, cardiogenic shock, pericarditis, mural thrombus, PE, tamponade
Whats the difference between arteriosclerosis and atherosclerosis?
arterio - thickening/hardening of arteries for any reason
Athero - due to fatty material (atheroma/plaque)
What are the stages in the inflammatory response resulting in atherosclerosis?
(1) endothelial injury - LDL/cholesterol etc
(2) inflammation - monocytes, T cells, foam cells
(3) fibroproliferative response - smooth muscle cells migrate and produce CT elements
(4) plaque formation in tunica intima
What is a fibrous plaque?
A raised lesion with a soft lipid core, covered by a firm fibrous cap and usually involves a partial circumference of the wall
What are the 5 complications of atherosclerosis?
- calcification
- ulceration
- rupture
- haemorrhage
- aneurysmal dilatation
What are major consequence of atherosclerosis in the heart, brain, peripheral arteries and aorta?
heart - MI, Angina
brain - CVA, TIA
Peripheral - gangrene
Aorta - abdominal aortic aneurysm
What are the two types of small blood vessel disease?
- hyaline arteriosclerosis - due to endothelial damage = smooth muscle hypertrophy and fibrosis
- hyperplastic - occurs in HTN emergency patients - concentric prolif. of smooth muscle (onion skin)
How would a patient with pulmonary HTN present?
RH failure (peripheral edema, failure to oxygenate (anginal chest pain, SOB), arrhythmias
What are aneurysms and how can they be classified?
Abnormal localised dilatation of a vessel or part of the heart (media)
- Cause
- Morphology - saccular or fusiform
- Anatomical site
What are 3 main complications of aneurysms?
- rupture - rapidly fatal
- occlusion - disturbance in blood flow leads to thrombus
- mass effect - compress other structures
What is an intracranial berry aneurysm? clinical features and complications
Saccular cerebral aneurysm, form from defective smooth muscle in the artery.
Features - before rupture usually nothing, after = thunderclap headache, vomiting, collapse, seizure, death
What is an abdominal aortic aneurysm, features and complications?
Fusiform aneurysm
complications - rupture, peripheral thromboembolism
features - asymptomatic maybe back pain, then rupture = abdominal pain + pulsatile mass
What is an aortic dissection? complications and clinical features?
Blood enters wall of the aorta through a tear in the intimate, separating the media. (*marfans)
complications - rupture, extension to branches of aorta/occlusion (MI, stroke)
features - sudden onset chest pain/between shoulder blades, collapse, shock, death
What is Marfan’s syndrome?
Autosomal dominant genetic disorder with mutation of fibrillin gene (results in abnormal elastic tissue)
What is vasculitis?
Inflammation of the blood vessels leading to thickening (ischaemia via occlusion) or thinning (aneurysm)
What is temporal arteritis?
Inflammation of large and medium sized arteries - often branch of carotid
What is polyarteritis nodosa?
Multisystem necrotising vasculitis involving medium sized arteries
Fibrinoid necrosis, neutrophils, lymphocytes infiltrate, narrowing of lumen, thrombosis, ischaemia
Granulomatosis with polyangitis - Wegener’s?
Small vessel vasculitis affecting upper and lower resp tract + kidney
What are some factors that may increase the load on a persons heart?
- Anaemia
- Sepsis
- Thyroid disease
- Pregnancy
- Medications
- Renal/resp failure
