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Clinical Pathology (RIP) > T9 - L1 Cardiovascular Pathology 1 > Flashcards

T9 - L1 Cardiovascular Pathology 1 Flashcards

1
Q

what is cardiovascular disease?

A

umbrellas term used to describe all conditions for the heart and
blood vessels, which can be acquired or congenital

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2
Q

what is ischaemic heart disease?

A
  • group of syndromes resulting from myocardial ischaemia

- An imbalance between demand and supply of oxygenated blood to the heart

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3
Q

what is the most common cause of ischaemic heart disease?

A

coronary artery atherosclerosis

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4
Q

what are the 4 categories of ischaemic heart disease syndromes?

A
  • myocardial infarction
  • angina pectoris
  • chronic IHD with heart failure
  • sudden cardiac death
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5
Q

what is the difference between stable and unstable angina?

A

Stable angina: increases with exertion

Unstable angina: unrelated to amount of exertion

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6
Q

what is Prinzmetal angina?

A
  • also known as variant angina

- due to vasospasm od coronary arteries

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7
Q

which type of angina is due to vasospasm rather than atherosclerosis?

A

Prinzmetal angina

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8
Q

acute coronary syndrome refers to which conditions?

A
  • myocardial infarction
  • unstable angina
  • sudden cardiac death
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9
Q

what are risk factors of Ischaemic heart disease?

A
  • hypertension
  • high blood cholesterol
  • diabetes
  • smoking
  • sedentary lifestyle/overweight
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10
Q

what therapeutic advances do we have to treat IHD in the early stages?

A
  • lipid lowering medicines
  • anti-hypertensive medicines
  • anti-platelet medicines
  • anti-diabetic medicine
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11
Q

what is the pathogenesis of myocardial inschemia?

A

]- reduced blood flow in coronary arteries

- due to a combination of fixed vessel narrowing and atherosclerosis

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12
Q

a fixed coronary obstruction typically leads to which IHD?

A

stable angina

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13
Q

a severe fixed coronary obstruction would lead to which IHD?

A

chronic ischaemic heart disease

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14
Q

what is a mural thrombus?

A

thrombi that adhere to the wall of a blood vessel and can restrict blood flow but usually do not block it entirely

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15
Q

what is an occlusive thrombus?

A

thrombosis within a vessel that leads to complete occlusion

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16
Q

what IHD can a mural thrombus with variable obstruction cause?

A

Unstable angina or acute subendocardial myocardial infarction or
sudden death

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17
Q

what IHD can a occlusive thrombus cause?

A

Acute transmural myocardial infarction or sudden death

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18
Q

what is the difference between a acute subendocardial myocardial infarction and a acute transmural myocardial infarction?

A

ischemia of the myocardium can extend to the endocardium, disrupting the inner lining of the heart (“transmural” infarction).

Less extensive infarctions are often “subendocardial” and do not affect the epicardium.

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19
Q

what is myocardial infarction?

A

death of cardiac muscle from prolonged ischaemia

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20
Q

what changes would you see in the myocardium 1-2 days after infarction?

A

Pale colour, oedema, myocyte necrosis, neutrophils

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21
Q

what changes would you see in the myocardium 3-4 days after infarction?

A

Yellow with haemorrhagic edge, myocyte necrosis, macrophages

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22
Q

what changes would you see in the myocardium 1-3 weeks after infarction?

A

pale colour, thin, granulation tissue then fibrosis

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23
Q

what changes would you see in the myocardium 3-6 weeks after infarction?

A

dense fibrous scar

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24
Q

what complications arise as a result of a MI?

A
  • impaired contractility (stroke due to embolism, cariogenic shock, congestive heart failure)
  • tisse necrosis (cardiac tamponade, congestive heart failure)
  • electrical instability (arrthymias)
  • pericardial inflammation (pericarditis)
25
Q

how can an arrhythmia result from a MI?

A

either directly or by limited perfusion to the conduction system structures (
SA node, etc)

26
Q

how can congestive cardiac failure result from a MI?

A
  • contractility dysfunction

- Mitral regurgitation

27
Q

how can a thromboembolism result from a MI?

A

Tissue is vulnerable to breaking off:

  • causing PE (if on right side)
  • Stroke/Infraction (if on left side of the heart).]
28
Q

how can pericarditis result from a MI?

A

[Inflammation through myocardium – can also extend to pericardium]

29
Q

how can a ventricular aneurysm result from a MI?

A
  • scars on ventricle = weaker ventricle wall

- weaker ventricle wall balloons out - aneurysm

30
Q

what is meant by a cardiac tamponade?

A
  • also known as pericardial tamponade

- is when fluid in the pericardium builds up, resulting in compression of the heart.

31
Q

how can cariogenic shock result from a MI?

A

hypotension = ↓ coronary perfusion = ↑ ischaemia

32
Q

how can a cardiac tamponade result from a MI?

A

[Ventricular wall rupture → blood in the pericardium puts pressure on the heart
causing dysfunction of the heart to pump.]

33
Q

A patient has an MI which results in electrical instability, what will this cause?

A

arrhythmias

34
Q

A patient has an MI which results in pericardial inflammation, what will this cause?

A

pericarditis

35
Q

A patient has an MI which results in tissue necrosis, what will this cause?

A

congestive heart failure

cardiac tamponade

36
Q

A patient has an MI which results in impaired contractility, what will this cause?

A

stroke (embolism)

cariogenic shock

congestive heart failure

37
Q

what blood markers would you test for for IHD?

A
  • troponins T and I
  • creatine kinase MB
  • myoglobin
  • Lactate dehydrogenase isoenzyme 1
  • Aspartate transaminase
38
Q

what blood pressure range is considered hypertensive?

A

A sustained diastolic pressure greater than 90mmHg or sustained systolic pressure greater
than 140mmHg.

39
Q

does the vulnerability of hypertension increase or decrease with age?

A

increase

40
Q

how do you work out blood pressure?

A

BP = cardiac output x peripheral resistance

41
Q

what affect does renin have in the Renin-Angiotensin-Aldosterone System?

A

renin acts on angiotensinogen (which is released from the liver) to form angiotensin I.

42
Q

what does the ACE (angiotensin-converting enzyme) do in the Renin-Angiotensin-Aldosterone System?

A
  • ACE released from lungs

- converts angiotensin I to angiotensin II.

43
Q

what physiological effect does angiotensin II have on the body?

A
  1. acts on the adrenal gland to stimulate aldosterone (which stimulates the reabsorption of salt (NaCl) and water (H20) in the kidneys.
  2. acts directly on blood vessels stimulating vasoconstriction
  3. Stimulates the release ofvasopressin(antidiuretic hormone, ADH) from the posterior
    pituitary, which increases fluid retention by the kidneys
  4. Stimulates thirst centers within the brain
  5. Facilitatesnorepinephrinerelease fromsympathetic nerveendings and inhibits
    norepinephrine re-uptake by nerve endings, thereby enhancing sympathetic adrenergic
    function
  6. Stimulatescardiac hypertrophyand vascular hypertrophy
44
Q

what physiological effect does aldosterone have on the body?

A

(released from the adrenal glands)

  • acts on the kidneys to stimulate the reabsorption of salt (NaCl) and water (H20)
45
Q

angiotensin binds to which receptor to constrict resistance vessels, thereby increasingsystemic vascular
resistanceandarterial pressure?

A

viaAII [AT1] receptors

46
Q

what is Cor Pulmonale?

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

  • Pulmonary (right sided) hypertensive heart disease
47
Q

what is an aneurysm?

A

A localised abnormal dilation of a blood vessel or the wall of the heart.

48
Q

what is a true aneurysm?

A

A true aneurysm is one that involves all three layers of the wall of an artery (intima, media and adventitia).

49
Q

what is a False aneurysm – (pseudoaneurysm)?

A

A false aneurysm, or pseudoaneurysm, is a collection of blood leaking completely out of an artery or vein, but confined next to the vessel by the surrounding tissue. This blood-filled cavity will eventually either thrombose (clot) enough to seal the leak, or rupture out of the surrounding tissue.

50
Q

what is meant by an arterial dissection?

A

An arterial dissection arises when blood enters the wall of an artery, as a hematoma
dissecting between its layers

51
Q

what is a type A aortic dissection?

A

a proximal lesion involving the ascending aorta

NB: More common, more serious and potentially damaging

52
Q

what is a type B aortic dissection?

A

Type B is the descending aorta alone.

53
Q

what type of aortic dissection results in a “true” and “false” lumen?

A

Double barrelled aortic dissection

54
Q

what causes aneurysms?

A
  • atherosclerosis
  • Cystic medial degeneration
  • trauma
  • congenital defects
  • infections (mycotic aneurysms)
55
Q

what is the most common cause of a AAA?

A

atherosclerosis

56
Q

what is a mycotic aneurysms?

A

a dilation of an artery due to damage of the vessel wall by an infection

57
Q

when is surgical repair of a AAA indicated?

A

AAA >5.5 cm in diameter or any size AAA with rapid growth

58
Q

what are some risk factors of an AAA?

A
  • advanced age
  • male gender
  • smoking
  • hypertension

Clinical Pathology (RIP) (49 decks)

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