Vascular Pathology Flashcards

1
Q

What are the likely potential causes of sudden collapse and death in a young adult?

A
Fatal arrhythmia, related to hypertrophic cardiomyopathy
Myocarditis
Congenital coronary artery problem
Aortic root problem
Long QT syndrome
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2
Q

What are the possible causes of haemopericardium?

A
Ruptured MI
Ruptured ventricular aneurysm
Aortic dissection
Pericarditis
Trauma
Cardiac malignancies
Ruptured coronary artery aneurysm
Post thrombolysis
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3
Q

How does haemopericardium cause death?

A

Cardiac tamponade

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4
Q

What are the main risk factors for aortic dissection?

A
Hypertension
Marfans syndrome
Ehlers-Danlos syndrome
Hyperlipidaemia
Smoking
Big vessel vasculitis
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5
Q

What are the potential complications of aortic dissection?

A
Severe internal bleeding > death
Organ damage
Stroke
Aortic valve damage > aortic regurgitation
Haemopericardium
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6
Q

What is the typical phenotype of a person with Marfan syndrome?

A

Tall
Skinny
Abnormal heart sounds: aortic dilatation and regurgitation
Mitral valve prolapse

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7
Q

What are the genetic features of Marfan syndrome?

A

Autosomal dominant
Up to 30% of cases sporadic
Great variation in clinical expression

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8
Q

What do the cardiovascular manifestations of Marfan syndrome include?

A

Mitral valve prolapse
- Asymptomatic
- Mitral competence with/without ruptured chordae
- Arrhythmias and sudden death
- Predisposition to infective endocarditis
Cystic medionecrosis = cystic medial degeneration of aorta
- Aortic dissection
- Annuloaortic ectasia and aortic regurgitation

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9
Q

Which medication is a risk factor for subarachnoid haemorrhage?

A

OCP

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10
Q

Why should a CT head be done before a lumbar puncture?

A

If subarachnoid haemorrhage, lumbar puncture can cause coning due to sudden decrease in intracranial pressure

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11
Q

What are the causes of a subarachnoid haemorrhage?

A

Ruptured berry aneurysm

Ruptured arteriovenous aneurysm

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12
Q

What is the management for subarachnoid haemorrhage?

A

Transfer to neurosurgical facility
Blood pressure control
Analgesia
Find cause and definitive treatment

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13
Q

After a subarachnoid haemorrhage, what causes further brain damage, usually on day 5?

A

Ischaemia due to vasospasm of carotid arteries

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14
Q

What causes vasospasm post-subarachnoid haemorrhage?

A

Breakdown products of blood irritating vessels

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15
Q

What causes raised intracranial pressure after a post-subarachnoid haemorrhage vasospasm?

A

Oedema secondary to ischaemia

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16
Q

What are the risk factors for a subarachnoid haemorrhage?

A
Smoking
Alcohol misuse
Hypertension
Bleeding disorders
Mycotic aneurysm
17
Q

Where are the most common sites for berry aneurysms?

A

Junction of posterior communicating artery with internal carotid artery
Junction of anterior communicating with anterior cerebral artery
Bifurcation of middle cerebral artery

18
Q

What are the presenting clinical features of a subarachnoid haemorrhage?

A

Thunderclap headache
Vomiting
Collapse
Late: seizures and coma

19
Q

What are the complications of a subarachnoid haemorrhage?

A

Rebleeding
Cerebral ischaemia due to vasospasm > permanent CNS deficit
Hydrocephalus
Hyponatraemia

20
Q

What proportion of patients with a subarachnoid haemorrhage die?

21
Q

Name three other types of aneurysm that may occur in vessels supplying the CNS

A

Microaneurysm
Mycotic
Atherosclerotic

22
Q

What are the causes of thrombophilia?

A
ACP resistance
Factor V Leiden
Prothrombin gene mutation
Protein C and S deficiency
Antithrombin deficiency
Some OCPs
Antiphospholipid syndrome
23
Q

What sorts of tests can be done to investigate thrombophilia?

A
FBC
Blood film
Coagulation profile
- Prothrombin time (PT)
- Thrombin time
- APTT
- Fibrinogen
APC resistance test
Lupus anticoagulant Abs
Anticardiolipin Abs
Assays for
- Antithrombin deficiency
- Protein C and S deficiency
24
Q

What is vasculitis?

A

Inflammation of walls of blood vessels

25
What can vasculitis be associated with?
Fibrinoid necrosis Thrombosis Perivascular haemorrhage Leukocytoclasis
26
What vessels can vasculitis affect?
Almost any
27
What are the common constitutional symptoms of vasculitis?
``` Fever Weight loss Malaise Arthraligia Myalgia ```
28
What are the causes of vasculitis?
``` Immune - Deposition of circulating immune complexes - Seeding of Ag in vascular bed > in situ formation of immune complexes Infection - Direct invasion - Immune mediated Radiation Toxins and drugs ```
29
Which vessels are affected in large vessel vasculitides?
Aorta and major branches
30
Which vasculitides predominantly affect large vessels?
Giant cell arteritis | Takayasu arteritis
31
Which vessels are affected in medium vessel vasculitides?
Main visceral arteries
32
Which vasculitides predominantly affect medium vessels?
Polarteritis nodosa | Kawasaki disease
33
Which vessels are affected in small vessel vasculitides?
Small intraparenchymal arteries Arterioles Capillaries Venules
34
Which vasculitides are ANCA associated, and affect small vessels?
Microscopic polyangiitis Granulomatosis with polyangiitis (Wegener's) Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
35
Which vasculitides are associated with immune complexes, and affect small vessels?
Anti-GBM disease Cryoglobulinaemic vasculitis IgA vasculitis (Henoch-Schonlein) Hypocomplementemic urticarial vasculitis
36
What are some examples of variable vessel vasculitis?
Behcet's disease | Cogan's syndrome
37
What are some examples of single organ vasculitis?
Cutaneous leukocytoclastic angiitis Primary CNS vasculitis Isolated aortitis
38
What are some examples of vasculitis associated with systemic disease?
Lupus Rheumatoid Sarcoid