T2 Cardiology Pathology Flashcards
What does the fibrous cap of the atheroma covering contain?
- smooth muscle cells
- macrophages
- foam cells
- lymphocytes
- collagen
- elastin
What does the necrotic centre of the atheroma covering contain?
- cell debris
- cholesterol crystals
- foam cells
- Ca
According to the response-to-injury hypothesis, what molecules take place in the progressive interactions following the endothelial injury?
- modified lipoproteins
- myocyte-driven macrophages
- T-lymphocytes
- a. wall constituents
What is the morphological evolution of the fatty streak? Do they always result in atherosclerosis?
- lesion –> fatty-filled foamy macrophages –> multiple flat yellow spots –> fatty streak
- no
What is the morphological evolution of an atherosclerotic plaque?
intimal thickening –> lipid accumulation –> white yellow –> red superimposed thrombus on plaque –> vessel lumen impingement
What is the main composition of an a thrombus vs a v thrombus?
a –> platelets; v –> fibrin
Give an example of an anti-platelet agent used to treat a thrombosis
clopidogrel
Give an example of an anti-coagulant agent used to treat v thrombosis
heparin
warfarin
What factors can cause endothelial damage? (Virchow’s triad)
- endothelial dysfunction: smoking, hypertension
- endothelial damage: surgery, catheter, trauma
What hereditry factors can cause hypercoagulability? (Virchow’s triad)
- Factor V Leiden
- Prothrombin
- Protein S&S deficiency
What acquitred factors can cause hypercoagulability? (Virchow’s triad)
- cancer
- chemo
- OCR/HRT
- pregnancy
- obesity
- HIT
What endothelila injury causing factors contribute to stasis? (Virchow’s triad)
- immobility
- polycythemia
What is the sequelae of thrombosis?
- occlusion of vessel
- dissolution
- incorporation into vessel wall
- recanalisation
- embolisation
What are the causes of systemic emboli?
- sequelae of MI
- AF
- infective carditis
Difference does stable plaque differ to unsabel one?
- small lipid core
- thick fibrous cap
- low macrophage content
- low microvessel density
- no intraplaque haemorhage
- no cap rupture
- no superimposed thrombus
What is the detailed mechanism of IH injury?
- no OP –> less ATP
- anaerobic –> more lactate, glycogen stores depleted
- Na pump fails –> Na accumulation
- memb damage –> intracellularprotein leakage –> enzymes digest cell
- Ca pump fail –> Ca influx
- less protein synthesis
What intercellular proteins are produced by cardiac muscle damage?
- creatine kinase
- troponins
What intercellular proteins are produced by liver damage?
- transaminases
- AK phosphate
Whata are the causes of ischaemia?
- vascular occlusion
- vasospasm
- vascular damage
- extrinsic compression
- mechanical interruption
- hypoperfusion
What organs have end arterial circulations, and would thus be severly affected by ischaemia?
- kidneys
- spleen
- testies
In a rapid restoration of blood flow, what therapeutic measures are used for 1) ischamia and 2) strokes?
- PCI
- thrombolysis
Why is an infarction less dangerous when the rate of occlusion is slow?
more time for collateral supplies to form
How long does it take before the following tissues are irreversibly damaged due to ischaemia? neurone, myocyte damage, cardiac fibroblast
- 3-4 mins
- 20-30 mins
- hrs
What is the cause and pathophysiology of coagulative necrosis?
- denaturation
- enzyme unable to break down structure –> basic outline preserved (eusinophilic) –> tissue remain firm
What is the cause and pathophysiology of liquefactive necrosis?
- enzyme digestion
- cyst formed
What infarcts are red?
- dual blood upply
- venous infarcts
Morphology of MI
Look up diagram
How does unsuccessful therapeutic intervention of ishcaemia lead to reperfusion injury?
- +++ reactive O2 species
- cytokines recruitment
- complementary pathway activated
What is the aetiology of hypovolaemic shock?
- IVF —
- venous return, pre-load —
- SV —
- CO —
What is the compensation for hypovolaemic shock?
- vasoconstriction –> +++ TPR
- tachycardia
What is the compensation in cardiogenic shock?
- vasoconstriction –> +++ TPR
What are the four causes of cardiogenic shock?
- myopathic
- arrhythmia
- mechanical
- extra-cardiac
(for specific examples for each one visit notes)
What is the cause of disruptive shock?
- SVR —
- severe vasodilation
What is the compensation in disruptive shock?
- +++ SV
- +++ CO
What are the subtypes of disruptive shock?
- anaphylactic
- septic
- toxic shock synfrome
- neurogenic
what is the disruptive component of septic shock?
- inflam. & non-inflam. cascade
- vascular permeability
- vasodilation
what is the hypovolaemic component of septic shock?
- — oral intake
- vomiting
- diarrhoea
what is the cardiogenic component of septic shock?
sepsis-related M dysfunction
