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Pathology by week > W25 - CVD > Flashcards

W25 - CVD Flashcards

1
Q

atherosclerosis - what is it?

A

an arteriosclerosis characterized by atheromatous deposits in and fibrosis of the inner layer of the arteries

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2
Q

Name 7 major risk factors for development of ischaemic heart disease/atherosclerosis?

A
  1. Old age
  2. Gender (premenopausal women protected, postmenopausal risk increases)
  3. Genetics
  4. Hyperlipidaemia
  5. Hypertension
  6. Smoking
  7. Diabetes Mellitus

NB: Risk factors have a MULTIPLICATIVE EFFECT

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3
Q

Which of the following is NOT a major risk factor for ischaemic heart disease?

A) Age

B) Male gender

C) High alcohol consumption

D) Hypertension

E) Smoking

A

C) High alcohol consumption

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4
Q

Describe the pathogenesis behind atherosclerotic changes in a blood vessel

A
  1. Endothelial injury
  2. LDL accumulation
  3. monocyte adhesion to endothelium
  4. Monocyte migration into intima => macrophage + foam cells
  5. Platelet aggregation
  6. SM cell recruitment
  7. Lipid accumulation - extra & intracellular, macrophages, SM cells
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5
Q

In atherosclerotic changes, one of the earliest lesions seen is a ____ _____

A

In atherosclerotic changes, one of the earliest lesions seen is a fatty streak

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6
Q

Fatty streak:

  • affect on blood flow?
  • in which age category is it always seen?
  • relationship to plaques?
A

Fatty streak:

  • no flow disturbance
  • in virtually all children >10yrs
  • relationship to plaques uncertain
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7
Q

What is the arrow showing in this blood vessel specimen?

A

Fatty streak

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9
Q

At which sites does atherosclerosis usually occur?

A

Vulnerable sites of arteries = bifurcations and curvatures (where we likely have turbulent flow)

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10
Q

Athermoatous plaque can ____ or _____

A

Athermoatous plaque can obstruct or rupture

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11
Q

Consequences of atheroma - critical stenosis occurd as _____% occlusion

A

Consequences of atheroma - critical stenosis occurd as 70% occlusion

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12
Q

Consequences of atheroma - name 3 acute plaque changes

A

3 acute plaque changes:

  1. rupture
  2. erosion
  3. haemorrhage into plaque
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13
Q

In terms of atheromatic plaques, what 4 features make the plaque vulnerable?

A
  • Lots foam cells or extracellular lipid
  • Thin fibrous cap
  • Few smooth muscle cells
  • Clusters inflammatory cells
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14
Q

What do you see here?

A

complete occlusion of LAD (left anterior descending) *most commonly occluded coronary artery*

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15
Q

Why is atheromatic vessel changes considered to be the silent killer?

A

B/c it progresses without any symptoms, and when symptoms develop it’s usually due to reduced blood flow causing myocardial ischaemia

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17
Q

Ischaemic heart disease could present in different ways based on severity and disease advancement. Name 4 presentations

A
  1. Angina pectoris
  2. MI
  3. Chronic IHD with HF
  4. Sudden cardiac death
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18
Q

IHD pathogenesis?

A

Predominant cause is insufficient coronary perfusion relative to myocardial demand due to chronic progressive atherosclerotic narrowing of coronary arteries and variable degrees of superimposed plaque change, thrombosis and vasospasm

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19
Q

IHD:

  • at what % of stenosis does a patient typically get stable angina (pain on exertion)?
  • at what % of stenosis does a patient typically get unstable angina (pain at rest)?
A

IHD:

  • at what % of stenosis does a patient typically get stable angina (pain on exertion) = 75%
  • at what % of stenosis does a patient typically get unstable angina (pain at rest) = 90%
20
Q

IHD: where are the plaques usually found?

  • LAD
  • LCX
  • RCA
A

IHD: where are the plaques usually found?

  • LAD = 1st few cms (most common)
  • LCX = 1st few cms
  • RCA = entire length
21
Q

Name 3 more common and 8 less common MI complications

A
  1. Contractile dysfunction
  2. Arrhythmia
  3. Myocardial rupture
  4. Pericarditis (Dressler Syndrome)
  5. RV infarction
  6. Infarct extension
  7. Infarct expnsion
  8. Mural thrombus
  9. Ventricular aneurysm
  10. Papillary muscle rupture
  11. Chronic IHD => HF
22
Q

MI

  • total mortality in 1st year
  • mortality per year after 1st
A

MI

  • total mortality in 1st year = 30%
  • mortality per year after 1st = 3-4%
23
Q

Sudden cardiac death:

  • what is it?
  • aetiology?
A

Sudden cardiac death:

  • what is it = Unexpected death from cardiac causes in individuals without symptomatic heart disease or early (1hr) after onset of symptoms
  • aetiology = most commonly due to ischaemia-induced electrical instability (arrythmias)*

* other conditions also associated: aortic atenosis, mitral valve prolpase, pulmonary hypertension

24
Q

The major cause of ischaemic heart disease is…

A) Reduced blood flow due to atherosclerosis

B) Increased cardiac demand for oxygen

C) Increased compliment fixation

D) Pump failure leading to hypoperfusion

E) Uncoupling of Na/K channels

A

A) Reduced blood flow due to atherosclerosis

25
Q

Cardiac failure - 3 types

A
  • Congestive Heart Failure (L&R)
  • Left sided (-> SOB, pulmonary oedema)
  • Right sided (-> peripheral oedema)
26
Q

Cardiac failure - causes (6)

A

–Ischaemic heart disease (IHD)

–Valve disease

–Hypertension

–Myocarditis

–Cardiomyopathy

– Left sided heart failure (Right)

27
Q

Complications of cardiac failure (4)

A

Sudden Death
Arrhythmias
Systemic emboli
Pulmonary oedema (with superimposed infection)

28
Q

Cardiac failure pathology?

A

Dilated heart, Scarring & thinning of the walls

•Microscopy: fibrosis and replacement of ventricular myocardium

29
Q

Cardiomyopathy - 3 types

A

Too thin, too thick, too stiff

  1. dilated cardiomyopathy,
  2. hypertrophic cardiomyopathy,
  3. restrictive cardiomyopathy
30
Q

Dilated cardiomyopathy - definition + causes (6)

A

Dilated cardiomyopathy due to progressive loss of myocytes

•Causes:

  1. Idiopathic
  2. Infective – viral myocarditis
  3. Toxic: alcohol, chemotherapy
  4. Hormonal – hyper-, hypo- thyroid, diabetes, peri-partum
  5. Genetic – haemochromatosis, Fabry’s, McArdle’s
  6. Immunological – myocarditis incl. viral
31
Q

Hypertrophic cardiomyopathy (HCM) - definition + causes (1)

A

Hypertrophic cardiomyopathy (HCM) - left ventricular hypertrophy of myocytes

causes:

50% of cases are familial (autosomal dominant, variable penetrance)

32
Q

pathophysiology of HCM

A

mutations in gene encoding beta myosin heavy chain, leading to thickening of septum and narrowing left ventricular outflow tract

33
Q

Restrictive cardiomyopathy - definition and causes (3)

A

Restrictive cardiomyopathy = impaired ventricular compliance

Causes:

  • idiopathic
  • 2ndary to other diseases (amyloid, sarcoidosis)
34
Q

In chronic rheumatic valvular disease, list the cardiac valves in order of most to leave affected

A

Mitral > Aortic > Tricuspid > Pulmonic

Left sided valves predominantly affected

mitral alone 48%, mitral + aortic 42%

35
Q
  1. Which valve is this?
  2. Which is normal? Which is abnormal?
A
  1. Which valve is this = aortic valve
  2. Which is normal? Which is abnormal = left is normal. Right is calcified (AS)
36
Q

What is chronic rheumatic valvular disease?

A

Sequelae of earlier rheumtic fever, causing:

1) thickening of valve leaflet
2) fusion of commissures
3) thickening, shortening and suion of chordae tendinae

37
Q

Aortic stenosis

  • commonest cause?
  • pathophsyiology?
A

Aortic stenosis

  • commonest cause = calcification
  • pathophsyiology = In elderly, calcium deposits outflow side cusp, impairing opening of valve, and causing outflow tract obstruction
39
Q

Aortic regurgitation - causes (3)

A

Aortic regurgitation - causes:

  1. Rigidity - rheumatic, degenerative
  2. Destruction - microbial endocarditis
  3. Disease of aortic valve ring => dilatation => valve insufficient to cover increased area (i.e. in Marfan’s syndrome, dissecting aneurysm, syphilic aortitis, etc)
40
Q

Endocarditis - drug related usually results in vegetations on which side?

A

R sided valves

41
Q

True vs false aneurysms

A

True - all layers of wall

False – extravascular haematoma

42
Q

A common cause of aneurysm is…

A) Ulcerative colitis

B) Liver failure

C) Charcot disease

D) Hypertension

E) Fat embolus

A

D) Hypertension (damages the wall)

43
Q

Causes (3) of aneurysm

and the pathophysiology

A
  1. Congenital conditions i.e. Marfan’s
  2. Atherosclerosis
  3. Hypertension

… all led to weakening of wall

Pathology by week (70 decks)

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