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Pathology > Week 8: Cardiovascular System Pathologies > Flashcards

Week 8: Cardiovascular System Pathologies Flashcards

1
Q

Congenital Heart Disease

A
  • general term used to describe many congenital heart defects
  • most common are left-to-right shunts (3 of them: atrial or ventricular septal defect, & patent ductus arteriosus) permit mixing of blood in systemic and pulmonary circulations
  • blood shunts from high-pressure systemic circulation to lower-pressure pulmonary circulation overloading the lungs with blood
  • increased load on the heart may cause enlargement (cardiomegaly) depending on location and size of shunt
  • need surgical intervention unless very small
  • ex: tetralogy of fallot, coarctation of aorta (both need surgical intervention)
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2
Q

Atrial Septal Defect/ 
Patent Foramen Ovale

A
  • free communication between both atria as a result of the lack of closure of the foramen ovale after birth
  • most common congenital cardiac defect
  • shunt overloads right ventricle
    -radiographic appearance: enlargement of right ventricle, atrium and pulmonary outflow tract
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3
Q

Patent Ductus Arteriosus

A
  • vessel shunts blood from the pulmonary artery into the systemic circulation during intrauterine life - does not close after birth
  • shunt causes an excess volume of blood returned to the left atrium & left ventricle
  • radiographic appearance: enlarged left atrium, left ventricle & pulmonary arteries, prominent aortic knob
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4
Q

Tetralogy of Fallot (TOF)

A
  • four abnormalities, cause right to left shunt which causes unoxygenated venous blood to enter the left ventricle and then to systemic circulation
    1. Ventricular septal defect
    2. Pulmonary stenosis (narrowing)
    3. Misplaced aorta (overriding of the aortic orifice above the ventricular defect)
    4. Right ventricular hypertrophy (thickened wall)
  • symptoms: cyanosis at birth, clubbing of fingers and toes, congestive heart failure (large VSD), only 10% of untreated patients live past 20 years
  • radiographic appearance: heart ascribed as looking like a book (coeur en sabot)
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5
Q

Coarctation of the Aorta

A
  • constriction of aorta usually beyond branching of blood vessels to head and arms
  • decreased blood flow to abdomen and legs leading to development of collateral circulation (enlargement of small vessels)
  • normal arm BP, low BP in legs
  • most common cause for hypertension in children
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6
Q

Coarctation of the Aorta Radiographic Appearance

A
  • rib notching due to pulsation of intercostal collateral vessels
  • 2 bulges in aortic knob = figure 3 sign
  • narrowing of vessel on angiography
  • CT chest sagittal arterial phase demonstrates length and location
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7
Q

Cardiomegaly

A
  • can be congenital or acquired
  • an increase in the size of the heart
  • many pathologies can cause it, such as hypertension, and especially with CAD (coronary artery disease)
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8
Q

Cardiomegaly Radiographic Appearance

A
  • PA projection preferred
  • Must be labelled if AP or supine
  • Label if different SID used
  • Due to image magnification, heart appears enlarged on these projections (AP or shorter SID)
  • Identifies abnormalities in the size and shape of the heart
  • Enlarged cardiac silhouette
  • Presence and extent of functional disorders best demonstrated in CT, CT Angiography and Doppler Echocardiography (US)
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9
Q

Coronary Artery Disease (CAD)

A
  • Narrowing of the coronary arteries
  • Causes oxygen deprivation of the myocardium & potentially ischemic heart disease, so heart cannot work
  • Narrowing attributable to atherosclerosis
  • Tissue beyond at risk
  • Collateral circulation may take over
  • If tissue dies then heart cannot pump properly, causes heart attack (myocardial infarction)
    Angioplasty for treatment
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10
Q

Coronary Artery Disease (CAD) Radiographic Appearance

A
  • CXR non-specific, but may show calcification of coronary artery
  • CT (with contrast) can be used to quantify calcium scoring, stenosis and cardiac function
  • CTA (uses contrast) needed for soft plaque
  • Coronary arteriography is a definitive diagnostic test
  • Blockage appears as gap or constriction in vasculature
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11
Q

Angina Pectoralis

A
  • also called angina or stable angina
  • often a symptom of CAD
    Recurring severe chest pain
  • may radiate to the neck, jaw, and left arm
  • often associated with the sensation of chest tightness or suffocation
  • often confused with indigestion
  • caused by temporary oxygen insufficiency to the myocardium
  • often occur after increased need for myocardial oxygen (exercise, stress)
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12
Q

Myocardial Infarction

A
  • heart attack
  • usually from atherosclerosis or coronary arteries
  • occlusion of a coronary artery from CAD deprives an area of myocardium of its blood supply leading to death of muscle cells
  • heart can’t pump
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13
Q

Myocardial Infarction Radiographic Appearance

A
  • CXR non-specific, but may show calcification of coronary artery
  • CXR can be used to check heart size and rule out CHF
  • CT (contrast) can be used to quantify calcium scoring, stenosis and cardiac function
  • CTA (uses contrast) needed for soft plaque
    *Cardiac MRI can be used too
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14
Q

Congestive Heart Failure (CHF)

A
  • Heart unable to pump blood at sufficient rate and volume to provide an adequate supply to body tissues
  • Due to heart abnormality, hypertension, obstruction
  • May need to increase mAs if pulmonary edema present
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15
Q

Congestive Heart Failure (CHF) Radiographic Appearance

A
  • Cardiac enlargement as heart strives to pump blood properly
  • Densities from interstitial edema
  • Densities from alveolar edema
    Pleural effusions
  • Redistribution of pulmonary venous blood flow (dilated pulmonary veins seen leaving hilum)
  • Widening of right superior mediastinum and dilated SVC
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16
Q

Hypertension

A
  • High blood pressure
  • The leading cause of strokes and CHF
  • Can also cause kidney damage
  • Blood pressure is a function of cardiac output (amount of blood pumped per minute by the heart) and peripheral resistance (condition of vessel walls)
  • Usually slow increase and long term (benign or idiopathic)
  • Prolonged can cause left ventricle to enlarge and fail (hypertensive heart disease)
  • May be sudden and increase quickly (called malignant)
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17
Q

Aneurysm

A
  • Weakness in vessel walls caused by atherosclerosis, infection, trauma or defect creating a bulge, or distention of an artery
  • Usually involves aorta, and abdominal aorta specifically
  • May rupture and cause immediate death depending on location
  • Saccular aneurysm = one side of vessel involved
  • Fusiform aneurysm = bulging throughout entire vessel circumference
  • Multiple small aneurysms = generalized arterial inflammation (arteritis)
17
Q

Radiographic Appearance Aneurysm

A
  • Aneurysms not seen on x-ray imaging, unless calcium present
  • Seen on US, angiography, CTA, MRA
  • CT with contrast – helical reformatting allows visualization of aneurysm in multiple planes and use of ROI (region of interest) can apply Hounsfield units to image to determine whether thrombus or rupture is fresh or old
18
Q

Berry Aneurysm

A
  • common in circle of Willis
  • surgically treated with clip or coil
19
Q

Traumatic Rupture of the Aorta

A
  • Occurs from closed chest trauma such as rapid deceleration, blast, or compression
  • Also called aortic transection
  • Near-complete tear through all the layers of the aorta
  • Needs immediate treatment
20
Q

Traumatic Rupture of the Aorta Radiographic Appearance

A
  • Hemorrhage into mediastinum causes it to widen
  • Displacement of nasogastric tube to right from displaced esophagus
  • Widened paratracheal stripe
  • Collection of blood over left lung apex (apical pleural cap sign)
  • Loss of aortic knob discrete shadow
20
Q

Aortic Dissection

A
  • Potentially life-threatening condition, needs immediate attention
  • Tear in the wall of the aorta (intima = inner layer) causes blood to flow between the layers of the wall of the aorta forcing layers apart
  • Makes a true and false lumen
  • False lumen may form aneurysm due to blood’s pressure
  • From arterial hypertension, trauma, congenital defect
20
Q

Aortic Dissection Radiographic Appearance

A
  • CXR - Widening of aortic shadow with irregular wavy border
  • Aortography for diagnosis
  • Or CT / MRI may demonstrate filling defect &/or 2 lumens
  • TEE can also be used = transesophageal echocardiography (US)
20
Q

Arteriosclerosis

A
  • Occurs when the arterial walls thicken, harden and lose elasticity
  • Often refers to calcification of small arteries
  • May be due to fat, cholesterol, calcium deposits in arteries
  • May be called hardening of the arteries
20
Q

Atherosclerosis

A
  • Atherosclerosis is a specific type or further development of arteriosclerosis (terms often used interchangeably)
  • Fat, cholesterol, or other deposits (like calcium) develop in the intima – called plaques
  • Causes narrowing/ occlusion/ luminal stenosis of large and medium sized arteries
  • Cholesterol (lipid or blood lipid) test is used to check levels of cholesterol in the blood and subsequent risk of plaque build up in vessels that can result in heart disease or stroke
  • Plaque formation in cerebral arteries can lead to occlusion and CVA (stroke)
  • Plaque formation in coronary arteries (CAD) can lead to occlusion and myocardial infarct (heart attack)
20
Q

Atherosclerosis Radiographic Appearance

A
  • Plaques often calcify and appear on plain radiographs and in CT
  • Seen as irregularly distributed densities along vessel track
21
Q

Peripheral Vascular Disease (PVD)

A

-Peripheral arteriosclerotic disease, so hardening/ narrowing/ occlusion of vessels of legs and less often arms
- Radiographic appearance: diffuse vascular narrowing, irregularity of the lumen or filling defects, seen on an arteriogram (CT MRI or US)

22
Q

Thrombosis

A
  • Thrombus = mass of coagulated blood or clot usually adhering to the vessel wall
  • Precipitating factors include trauma, bacterial infection, arteriosclerosis, prolonged bed rest, airplane travel, or thickened blood (polycythemia = increased RBC)
  • Usually vein not artery (veins lower pressure)
  • Thrombus could be reabsorbed, grow to occlude vessel, or break off and become embolus
23
Q

Thrombosis Radiographic Appearance

A
  • CT image may show partial or full occlusion of vessel (partial blockage or abrupt ending)/filling defect
  • Arteriography used for diagnosis
24
Q

Deep Venous Thrombosis (DVT)

A
  • Thrombus development in deep veins
  • Usually lower extremities
  • Due to trauma, bacterial infection, prolonged bed rest, air travel, oral contraception use
  • Leg are may be red, hot, swollen, painful
  • Blood clot may dislodge to the lungs (pulmonary emboli) which can be fatal
  • Dislodging can come from sudden movement
25
Q

Deep Venous Thrombosis (DVT) Radiographic Appearance:

A
  • Diagnose with CT venography or colour Doppler US
  • Show partial or full occlusion/filling defects
26
Q

Embolus

A
  • May be thrombus or plaque that has broken off/ come loose = most common sources
  • Can occur due to sudden thrombus movement of area
  • A fat embolus is a possible complication of bone trauma, an air bubble may be introduced into vasculature and act as embolus
  • Emboli circulate through the bloodstream and can become lodged in a vessel resulting in occlusion
  • Leg vein thrombus or fat emboli from leg trauma will likely lodge in pulmonary artery = pulmonary embolism
  • Cardiac, mitral valve and arterial thrombi may cause brain embolism
27
Q

Embolus Radiographic Appearance

A
  • Filling defect where embolus gets lodged
  • CT used to diagnose pulmonary embolism
28
Q

Aortic Stenosis

A
  • Obstruction of flow of blood exiting the heart (from the left ventricle)
  • Increases workload of left ventricle
  • May be caused by rheumatic heart disease, a congenital valvular deformity (especially bicuspid valve) or degenerative process of aging (idiopathic)
28
Q

Mitral Stenosis

A
  • Stenosis (narrowing) of mitral valve(bicuspid/ left AV valve) (separates left atrium and left ventricle)
  • Complication of rheumatic heart disease
  • Results from diffuse thickening of valve by fibrous tissue and/or calcific deposits
29
Q

Mitral Stenosis Radiographic Appearance

A
  • PA CXR – left atrium enlargement
  • Double contour as left atrium shadow seen over right atrium shadow
  • Posterior displacement of left mainstem bronchus
    Widening of tracheal bifurcation (carina)
30
Q

Aortic Stenosis Radiographic Appearance

A

PA CXR – enlargement of left ventricle, bulging ascending aorta, aortic valve calcification

31
Q

Pericardial Effusion

A
  • Accumulation of fluids within pericardial space surrounding the heart (within double layered pericardial sac)
  • From bacteria, viruses, or neoplastic involvement or idiopathic
  • If slow development, pericardium can expand and heart can continue to function as normal
  • If fast, called cardiac tamponade, heart compressed by pressure from fluid, function and cardiac output reduced
32
Q

Pericardial Effusion Radiographic Appearance

A
  • PA CXR – enlargement of cardiac silhouette
  • Water bottle sign
  • US – echocardiography
  • CT or MRI
33
Q

Arteriovenous Fistula/ 
Arteriovenous Malformation

A
  • AVF = abnormal connection between artery and vein
  • Congenital or acquired (injury, surgery for dialysis)
  • Can occur anywhere in body
  • AVM = usually refers to brain
  • Can cause blood clots or bleeds (if rupture)
  • Tissues beyond the fistula may not receive adequate oxygenation (capillaries missed during circulation)
  • Angiography, MRI or CT
  • radiographic appearance: filling defect, unusual vasculature
34
Q

Arrhythmias

A
  • Abnormal/ irregular heartbeat – too fast (tachycardia), too slow (bradycardia), irregular
  • From many causes including coronary artery disease and heart attack or scarring from previous one
  • From problem with electrical system of the heart muscle
  • Depending on cause and severity may remain untreated, treated with medication or electronic pacemaker
35
Q

Dextrocardia

A
  • Heart is located in the right side of the chest and points to the right
  • Other organs may also be reversed
  • Can be asymptomatic/ no problems if by itself; often occurs with other conditions that cause problems
  • radiographic appearance: heart on right side of body

Pathology (14 decks)

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