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MED4 ACP > CVS Pathology > Flashcards

CVS Pathology Flashcards

1
Q

Definition of hypertension and malignant hypertension

A

Hypertension: sustained SBP > 140mmHg / DBP > 90 mmHg
Malignant hypertension: rapid BP rise, sustained SBP > 200 mmHg / DBP > 120 mmHg

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2
Q

How much % of hypertension is primary / essential?

A

95%

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3
Q

Secondary hypertension causes (3+5+3)

A

Renal: RAS, renal parenchymal disease, chronic renal disease

Endocrine: Primary hyperaldosteronism, Cushing syndrome, Acromegaly, Hyper- / Hypo-thyroidism, Phaeochromocytoma

Neurologic: ↑ ICP, OSA, acute stress

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4
Q

Risk factors for atherosclerosis (4+10)

A

Non-modifiable: male / post-menopausal female, elderly, familial hypercholesterolaemia, homocystinuria

Modifiable: hypercholesterolaemia, smoking, DM, HT, ↑ CRP, lipoprotein (a), physical inactivity, obesity, stress, infection

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5
Q

3 stages of atherosclerosis

A
  1. Fatty streaks
  2. Atheromatous plaque
  3. Complicated atheroma
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6
Q

Which histological layer is fatty streak deposited within? What is the cell that can be found in fatty streak?

A

tunica intima
lipid-filled foamy macrophages

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7
Q

2 parts of atheromatous plaque

A

fibrous cap + necrotic core

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8
Q

Difference between unstable atheroma and stable atheroma histologically (4)

A

thinner fibrous cap, larger lipid core, fewer SMC, ↑ inflammation

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9
Q

Pathogenesis of atherosclerosis

A

endotheilal injury + turbulent blood flow –> accumulation of lipoproteins –> monocytes and platelets adhere to endothelium –> monocytes migrate into intima –> differentiate into macrophages and foam cells

release cytokines and growth factors by platelets, macrophages, vascular wall cells –> SMC proliferate and migrate to intima

SMC, macrophages release cytokines –> produce ECM

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10
Q

Complications of complicated atheroma (3) (explain)

A

Acute plaque change
a. rupture: exposed necrotic core –> thrombus formation
b. haemorrhage into plaque –> volume expansion

Atheroembolism
- ruptured plaques –> discharge debris into blood –> microemboli

Aneurysm

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11
Q

In aneurysm, which layer of the blood vessel is weakened?

A

tunica media

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12
Q

Pathogenesis of aneurysm (3)

A
  1. inadequate / abnormal connective tissue synthesis
  2. excessive connective tissue degradation
    (e.g. proteolytic enzymes by macrophages in atherosclerotic plaque)
  3. loss of SMCs
    a. atherosclerosis –> ↑ diffusion distance –> ischaemia of inner media
    b. systemic hypertension –> luminal narrowing of vasa vasorum –> ischaemia of outer media
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13
Q

Pathology of aneurysm

A

cystic medial degeneration

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14
Q

Complications of AAA (4)

A
  1. occlusion of vessel branching off the aorta –> ischaemia of organs
  2. impingement on adjacent structures (e.g. ureter, vertebrae)
  3. Thromboembolism
  4. rupture –> fatal haemorrhage
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15
Q

Relationship of diameter and annual rupture risk of AAA

A

<4cm: almost never
4~5cm: 1%
5~6cm: 10%
>6cm: 25%

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16
Q

What is aortic dissection?

A

tear in tunica intima –> blood dissects into tunica media

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17
Q

Which type of aortic dissection has a higher mortality? How much?

A

Type A
70%

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18
Q

Immune-mediated vasculitis (2+4+3)

A

Giant cell arteritis
Takayasu arteritis

Polyarteritis nodosa
Kawasaki disease
Wegener’s granulomatosis
Churg-Strauss syndrome

Microscopic polyangiitis
Buerger disease
Behcet disease

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19
Q

Which vasculitis involves granuloma formation? (4)

A

giant cell arteritis, Takayasu arteritis, Wegener’s granulomatosis, Churg-Strauss syndrome

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20
Q

Which vasculitis is related to ANCA?

A

c-ANCA: Wegener’s granulomatosis
p-ANCA: Churg-Strauss syndrome, microscopic polyangiitis

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21
Q

Which vasculitis is related to viral Ag IC deposition? (Which virus most common?)

A

Polyarteritis nodosa
HBV

22
Q

Which vasculitis is found in kids and is associated with coronary artery aneurysm?

A

Kawasaki disease

23
Q

Which vasculitis is also called pulseless disease and is commonly found in aorta?

A

Takayasu arteritis

24
Q

Which vasculitis is related to asthma?

A

Churg-Strauss syndrome

25
Q

Which vasculitis is associated with young smokers and peripheral vascular disease?

A

Buerger disease

26
Q

Which vasculitis is associated with orogenital ulcers?

A

Behcet’s disease

27
Q

Which vasculitis is commonly found on temporal artery and ophthalmic artery?

A

Giant cell arteritis

28
Q

Which vasculitis is almost always spared from pulmonary circulation?

A

Polyarteritis nodosa

29
Q

Morphology change in myocardial infarction

A

Gross: pallor –> mottling –> yellow centre with hyperaemic border –> grey fibrous scar

LM: coagulative necrosis, oedema, wavy fibres –> hypereosionophilic myocytes –> loss of nuclei & striations, neutrophil infiltrate, microscopic haemorrhage –> infiltration of lymphocytes, fibroblasts, macrophages –> organising granulatous tissue —> fibrosis

30
Q

What is Dressler syndrome?

A

postmyocardial infarction pericarditis

31
Q

Complications of MI (8)

A

Arrhythmia –> SCD
CHF
Ventricular aneurysm
Pericarditis
Mural thrombosis
MR
Left-to-right shunt
Cardiac tamponade

32
Q

Pathogenesis of reperfusion injury (2)

A
  • reoxygenation –> ROS –> sarcolemmal injury –> ↑ Ca2+ –> myocyte hypercontration –> cell death
  • ↑ WBCs –> capillary occlusions
33
Q

Diagnosis of systemic hypertensive heart disease

A

LVH + evidence of HT in other organs

34
Q

MC cardiomyopathy

A

dilated cardiomyopathy

35
Q

Aetiology of dilated cardiomyopathy (5)

A
  • genetics / idiopathic
  • previous myocarditis
  • pregnancy
  • haemochromatosis (secondary)
  • toxin (alcohol, cocaine, catecholamines…)
36
Q

MC cause of death in young athletes (What is the aetiology?)

A

hypertrophic cardiomyopathy (genetic mutation)

37
Q

What is Loeffler endomyocarditis? (Treatment)

A

restrictive cardiomyopathy caused by parasitic infection, mostly found in Africa
Treatment: TKI

38
Q

MC cause of restrictive cardiomyopathy

A

amyloidosis

39
Q

What is the cardiomyopathy caused by defected desmosomal proteins?

A

Arrhythmogenic RV cardiomyopathy

40
Q

Causes of aortic regurgitation

A

organic:
- IE
- degeneration
- chronic RHD
- subacute IE

functional:
- aortic dissection
- aortic root dilatation

41
Q

Causes of aortic root dilatation

A

aortitis (syphilis, Takayasu arteritis, ankylosing spondylitis, psoriasis…)
Marfan’s syndrome
hypertension, atherosclerosis

42
Q

Causes of aortic stenosis

A

[<60y] Chronic RHD, congenital
[60~75y] Bicuspid aortic valve
[>75y] Degenerative calcification

43
Q

Causes of mitral regurgitation

A

Organic:
- IE
- MVP
- chronic RHD
- subacute IE

Functional:
- MI, trauma
- LV dilatation (e.g. myocarditis, DCM)

44
Q

Causes of mitral stenosis

A

chronic RHD
congenital stenosis

45
Q

Causes of tricuspid regurgitation

A
  • pulmonary HT
  • L. ventricular disease
  • IE
  • chronic RHD
  • complication of pacemaker insertion
  • carcinoid syndrome
46
Q

Diagnosis of acute rheumatic fever

A

Jones’ criteria

  • migratory polyarthritis
  • pancarditis
  • subcutaneous nodules
  • erythema mariginatum
  • chorea
    (2 out of 5)
47
Q

Diagnosis of infective endocarditis

A

Duke criteria
(BE TIMER)
(2 or 1+3 or 0+5)
Major:
- blood culture (typical organisms from 2 separate blood cultures)
- echocardiogram findings
Minor:
- temperature (fever)
- immunologic phenomena
- microbiological evidence
- embolic phenomena
- risk factor (predisposing conditions)

48
Q

Usual precursor of non-bacterial thrombotic endocarditis

A

hypercoagulable state

49
Q

What is the Libman-Sacks endocarditis?

A

endocarditis in SLE

50
Q

Aetiology of pericarditis (4)

A

Infection, post-MI, uraemia, drugs

MED4 ACP (13 decks)

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