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Clinical Pathology > Theme 9: Cardiovascular Pathology III > Flashcards

Theme 9: Cardiovascular Pathology III Flashcards

1
Q

What is peripheral vascular disease?

A

atherosclerosis of arteries supplying legs (or arms), leading to narrowing of the vessel lumen and restriction of blood flow

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2
Q

Who gets peripheral vascular disease? (epidemiology)

A
  • age > 40
  • obesity
  • smokers
  • family history
  • men (or post-menopausal women)
  • dyslipidaemia
  • those with a PMH including: diabetes, hypercholesterolaemia, hypertension
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3
Q

Why is the prevalence of peripheral vascular disease higher in men?

A

oestrogen is a protective factor so it protects women until menopause

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4
Q

Explain the process of atherosclerosis (5 steps)

A
  1. Normal artery
  2. Endothelial dysfunction
  3. Fatty streak formation
  4. Stable (fibrous) plaque formation
  5. Unstable plaque formation
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5
Q

Explain the pathogenesis of peripheral vascular disease

A
  1. Gradual artherosclerosis (chronic) or plaque rupture/ thrombus formation (acute)
  2. Narrows lumen
  3. Reduced blood flow
  4. Ischaemia
  5. Tissue damage/ death
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6
Q

What are the clinical features of acute peripheral vascular disease?

A 
6 Ps:
Pale
Pulseless
Painful
Paralysed
Paraesthetic (pins and needles)
Perishingly cold
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7
Q

What are the clinical features of chronic peripheral vascular disease?

A

Asymptomatic: reduced pulses
Symptomatic: intermittent claudication
Critical limb ischaemia: rest pain and tissue loss

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8
Q

What is giant cell artertitis? (temporal arteritis)

A

A type of vasculitis affecting the large arteries in the head. Considered a medical emergency as it can lead to blindness

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9
Q

Who is at risk of giant cell arteritis?

A
  • older individuals, VERY rare if < 50 years old
  • US/europe
  • F > M
  • PMH of polymyalgia rheumatica
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10
Q

What causes giant cell arteritis?

A
  • autoimmune damage to blood vessels

- type IV hypersensitivity

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11
Q

Explain the pathogenesis of giant cell arteritis?

A
  1. Chronic granulomatous inflammation
  2. Thickens wall of artery
  3. Narrows lumen
  4. Reduced blood flow
  5. ischaemia
  6. tissue damage and death
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12
Q

What are the clinical features of giant cell arteritis?

A
  • fatigue
  • weight loss
  • fever
  • tender superficial temporal artery
  • jaw claudication (when eating)
  • blurred vision
  • blind ness
  • stroke
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13
Q

What is infective endocarditis?

A

infection and inflammation of the endocardium (lining of the heart), mainly involving valves

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14
Q

Who is at risk of IE?

A

Patients with:

  • structurally abnormal valves (rheumatic heart disease, congenital heart disease, age-related calcification)
  • foreign material in heart (ICD, prosthetic valves)
  • immunosuppression
  • bacteraemia - IVDU, long term IV catheters

but can occur in healthy patients with virulent organisms e.g S.aureus

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15
Q

What causes IE?

A
  1. Streptococcus - viridans / bovis
  2. Staphylococcus - aureus / epidermis
  3. Fungi - candida, aspergillus
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16
Q

How does IE make you ill?

A
  1. Damage to endothelium over valve
  2. Fibrin deposition
  3. Circulating bacteria colonise this fibrin
  4. Vegetations form
    then either
    -vegetations damage valves–> HR, murmur
    -bacteria in vegetations form local abscess –> AV block
    -bits of vegetations break off –> emboli/ infarction
    -immune response to infecction - fever, weight loss
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17
Q

What are the clinical features of IE?

A
  • splenic infarct
  • splinter haemorrhage
  • jane way lesions
  • osler’s nodes
  • roth spots (retinal haemorrhage)
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18
Q

What is pericarditis?

A

inflammation of the pericardial sac

19
Q

how are the different types of pericarditis classified?

A
  1. Acute (<6 months): then further classified based on the type of fluid surrounding the cells - serofibrinous, caseous, haemorrhagic and purulent
  2. Chronic (>6 months): constrictive
20
Q

What can cause pericarditis?

A
  1. Infections - viruses (coxsackie B), bacteria, TB, fungi, parasites
  2. Autoimmune- rheumatic fever, SLE, scleroderma, drug hypersensitivity, post-MI
  3. Miscellaneous - uraemia, radiation, neoplasia, trauma
21
Q

How does chronic pericarditis make you ill?

A
  • collagen deposition
  • fibrosis and thickening of pericardium
  • fibrosis reduces filling of heart
  • HF
22
Q

Acute pericarditis is further named based on what type of fluid surrounds the cells. What is it called if:

  1. Fibrin
  2. Neutrophils
  3. RBCs
  4. Caseous necrosis
A
  1. Serofibrinous
  2. Purulent
  3. haemorrhagic
  4. TB
23
Q

what are the clinical features of pericarditis?

A
  • central chest pain
  • pericardial friction rub
  • fever
  • pericardial effusion (may lead to tamponade)
  • HF
24
Q

What is myocarditis?

A

inflammation of the myocardium

25
Q

What are the possible causes of myocarditis?

A
  1. Infections
    viruses, bacteria, fungi, protozoa, helminths
  2. Immune mediated
    - post group A streptococcus
    - SLE
    - drugs
    - rejection of heart transplant

other: sarcoidosis

26
Q

Explain the pathogenesis of myocarditis

A
  • inflammation of myocardium
  • dysfunctional myocardium
  • electrical dysfunction = arrhythmias/ sudden death

mechanical dysfunction = heart failure

27
Q

What is the definition of rheumatic fever?

A

a rare complication of group A streptococcal pharyngitis that affects the heart (and other parts of the body)

28
Q

Who gets rheumatic fever?

A
  • children
  • developing countries (rare in UK now)
  • often have recent Hx of core throught
29
Q

What causes rheumatic fever?

A

untreated group A streptococcus infection (streptococcus pyogenes) + immune cross reactivity

30
Q

Explain the pathogenesis of rheumatic fever

A
  1. group A strep infection
  2. Antibodies made against M protein on the surface of the strep pyogenes bacteria
  3. Antibodies also recognise proteins on surface of cells (self antigens) in the heart, skin, joints and CNS

Type II hypersensitivity = antibody

31
Q

What are the clinical features of rheumatic fever

A

Heart – endocarditis, myocarditis, pericarditis (pancarditis when all together)

  • Endocarditis – mitral valve stenosis “fish mouth” most common valve lesion, vegetations “verrucae”
  • Skin – subcutaneous nodules, erythema marginatum
  • Joints – arthritis
  • CNS – sydenhams chorea
  • General symptoms – fever, malaise
32
Q

What is a cardiomyopathy and what are the 4 main types?

A

= heart muscle disease

  1. Dilated
  2. Hypertrophic
  3. Restrictive
  4. Arrythmogenic right ventricular cardiomyopathy
33
Q

What is the epidemiology and aetiology of hypertrophic cardiomyopathy?

A

Epidemiology: all ages and genders
Aetiology: Genetic

34
Q

Explain the pathogenesis of hypertrophic cardiomyopathy

A
  • impaired ventricular filling as wall of heart is v thick so chambers are small
  • +/- left ventricular outflow obstruction
  • relative ischaemia
35
Q

What are the clinical features of hypertrophic cardiomyopathy?

A
  • HR
  • arrhythmias and sudden death
  • mural thrombus formation +/- embolization
  • relative ischaemia –> coronary arteries are still same magnitude so cannot supply hypertrophic muscle
36
Q

What is the epidemiology and aetiology of dilated cardiomyopathy?

A 
Epidemiology: any age but commonly males aged 20-50
Aetiology: 
-often unknown
-AD genetic
-alcohol
-catecholamines
-pregnancy
-haemachromatosis
-infection
37
Q

How does dilated cardiomyopathy make you ill?

A

dilated and thin walled ventricular chambers –> impaired ventricular pumping i.e decreased LVEF

38
Q

What is the aetiology of restrictive cardiomyopathy?

A
  • idiopathic
  • secondary:
  • amyloidosis
  • sarcoidosis
  • metastatic tumours
  • deposition of metabolites
39
Q

How does restrictive cardiomyopathy make you ill?

A

impaired ventricular filling

40
Q

What is the epidemiology and aetiology of arrythmogenic RV cardiomyopathy?

A

Epidemiology: most common in young males

Aetiology: genetic AD 1 in 5000

41
Q

Explain the pathogenesis of arrythmogenic RV cardiomyopathy

A

-RV myocyte adhesion impaired due to mutation in desmosome proteins –> cells detach –> fibrofatty tissue forms in attempt to repair damage –> interferes with muscle contraction and electrical conduction

42
Q

What are the clinical features of RV Arrythmogenic cardiomyopathy??

A
  • palpitations
  • syncope
  • HR
  • thrombus
  • arrhythmias and sudden cardiac death
43
Q

Which valve does rheumatic fever tend to affect?

A

mitral valve –> and causes regurgitation more than stenosis

Clinical Pathology (57 decks)

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