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Clinical Pathology > 28 - Cardiovascular Disease 1 > Flashcards

28 - Cardiovascular Disease 1 Flashcards

(54 cards)

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1
Q

Ischaemic heart disease - definition

A

Inadequate blood supply to the myocardium via atheroma/ thrombus/ myocardial hypertropy

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2
Q

Ischaemic heart disease - pathogenesis

A

Acute & chronic

Autoregulation of coronary blood flow breaks down if

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3
Q

Ischaemic heart disease - syndromes

A

Angina pectoris
Acute coronary syndrome
Sudden cardiac death
Chronic ischaemic heart disease

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4
Q

Angina pectoris - types

A

Typical/stable - fixed obstructable, predictable on exertion
Variant/Prinzmetal - coronary artery spasm, unpredictable
Crescendo/unstable - red flag syndrome due to plaque disruption

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5
Q

Acute coronary syndrome

A 
Acute MI (+/- ECG ST elevation)
Crescendo/unstable angina
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6
Q

Acute ischaemia - causes and why

A

Atheroma + acute thrombosis / haemorrhage

Lipid rich plaques at most risk

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7
Q

Acute ischaemia - what is it?

A

Regional transmural myocardial infarction

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8
Q

Acute ischaemia - management

A

Thrombolysis

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9
Q

Acute ischaemia - Diagnosis

A

Clinical
ECG
Blood cardiac proteins

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10
Q

Subendocardial myocardial infarction - why is that region vulnerable?

A

subendocardial most vulnerable due to less blood going to it as capillaries run over endocardium

Can infarct without any acute coronary occlusion

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11
Q

Subendocardial myocardial infarction - ST elevation?

A

Rarely

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12
Q

Blood markers of cardiac myocyte damage - troponins T&I

A

Detectable 2-3hrs peaks at 12h detectable at 7 days.

Raised post-MI but also in PE, heart failure & myocarditis

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13
Q

Blood markers of cardiac myocyte damage - Creatine kinase

A

Detectable 2-3hrs, peaks at 10-24hrs, detectable to 3 days

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14
Q

Blood markers of cardiac myocyte damage - Myoglobin

A

peak at 2hrs but also released from damaged skeletal muscle

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15
Q

Blood markers of cardiac myocyte damage - lactate dehydrogenase isoenzyme 1

A

Peaks at 3 days, detectable to 14 days

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16
Q

Blood markers of cardiac myocyte damage - aspartate transaminase

A

Also present in liver so less useful as a marker of myocardial damage

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17
Q

Blood markers of cardiac myocyte damage - most useful/only one used?

A

Troponin

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18
Q

Blood markers of cardiac myocyte damage - creatine kinase subtypes

A

CK MM - muscle
CK BB - brain, lung
CK MB - cardiac, possibly muscle

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19
Q

Familial hypercholesterolaemia - commonest mutations

A 
Low density lipoprotein receptor gene (1in500)
Apolipoprotein B (1 in 1000)

Note homozygous more severe

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20
Q

Whats a xanthoma and egs.

A

Tendons
Periocular
Corneal arcus
Early atherosclerosis

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21
Q

Which is more common - primary hypertension or secondary?

A

Primary (95%)

Main secondary is hyperthyroidism

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22
Q

Renin cycle

Study These Flashcards
A

Synthesised, stored and release in juxtaglomerular apparatus in the wall of afferent renal arterioles.

Cleaves Angiotensinogen to Ang I
Ang I is converted to active Ang II in many tissues

23
Q

Ang II facts

Study These Flashcards
A

potent natural vasoconstrictor
V. short half life
Stimulates adrenal cortex to produce aldosterone

24
Q

Aldosterone facts

Study These Flashcards
A

Physiological mineralocorticoid
Renal action causes sodium and water retention
Circulating blood volume increases

25
Conn's syndrome - causes and why
Caused by excess aldosterone secretion Why: adrenocortical adenoma, micronodular hyperplasia, renal sodium&water hypertension, elevated aldosterone w/ low renin, potassium loss (via muscle weakness.
26
Conn's syndrome - diagnosis
Diagnose by CT scan of adrenals in presence of metabolic abnormalities
27
Phaeochromocytoma - what is it? what causes the symptoms?
Tumour of adrenal medulla | Presents due to secretion of vasoconstrictive catecholamines - AD and NA
28
Phaeochromocytoma - clinical presentation
``` Pallor Headaches Sweating Nervousness Hypertension ```
29
Phaeochromocytoma - diagnosis
24hr urine collection for AD metabolites
30
Cushing's disease - what is it? + effects
Overproduction of cortisol by adrenal cortex Potentiating SNS and has mineralocorticoid (aldosterone-like) action of kidneys causing hypertension
31
Cushing's disease - causes
Adrenocortical neoplasm usually an adenoma A pituitary adenoma (80% cause) or paraneoplastic effect of other neoplasms (small lung cell carcinomas). The other neoplasms produce adrenocorticotrophic hormone that stimulates the zona fasciculata cells of the adrenal cortex to produce cortisol
32
Hypertension - effects
CV - hypertensive heart disease Renal failure Cerebrovascular incident
33
Hypertension - hypertensive heart disease
Systemic hypertension leads to increased LV blood pressure -> LV hypertrophy When pressure is too great LV fails to pump blood at normal rate and dilates
34
Hypertension - renal effects
Vascular changes: Arterial intimal fibroelastosis Hyaline arteriolosclerosis Slow deterioration in renal function leading to failure
35
Hypertensive cerebrovascular disease
Hypertensive encephalopathy Increased risk of rupture of abnormal arteries - atheromatous (intracerebral haemorrhage); berry aneurysm of the circle of Willis (subarachnoid haemorrhage)
36
Hypertension - hypertensive crisis
BP >180/120
37
Hypertension - hypertensive crisis clinical presentation
Acute hypertensive encephalopathy Renal failure Retinal haemorrhages Urgent treatment
38
Hypertension - acute hypertensive encephalopathy
Clincopathological syndrome Diffuse cerebral dysfunction - confusion, vomiting, convulsions, coma and death Rapid intervention required to reduce accompanying raised intracranial pressure
39
Pulmonary hypertension - caused by
Loss of pulm. vasculature 2* to LV failure Systemic to pulm. art. shunting Primary or idiopathic
40
Pulmonary hypertension - causes
Increased RV work to pump blood RV myocardium hypertrophy initially w/o dilation Later dilation and systemic venous congestion as RV failure develops
41
What is Framingham risk score?
Calculates an individual's risk of CVD based on multiple risk factors and algorithms
42
Other risk assessment systems
SCORE QRISK2 Joint British societies risk prediction charts
43
What is renin? Where is it made and released from?
Synthesised, stored in and released from juxtaglomerular apparatus in wall of afferent arteriole of kidney
44
What does renin do?
Cleaves angiotensinogen to angiotensin I
45
Where is Ang1 cleaved?
AngII in many tissues
46
What is AngII and what does it do?
Potent vasoconstrictor Very short half-life Stimulates adrenal cortex to produce aldosterone
47
What is aldosterone?
Physiological mineralocorticoid Causes sodium, and in turn, water retention Increases blood volume
48
What is Conn's syndrome?
Excess aldosterone secretion Adrenocortical adenoma Renal sodium and Na retention Elevated aldosterone and low renin Potassium loss
49
What does potassium loss cause?
Muscular weakness Cardiac arrhythmias Parasthaesesia Metabolic alkalosis
50
Phaeochromocytoma - what is it?
Tumour of adrenal medulla | Secretion of vasoconstrictive catecholamines - AD & NA
51
Phaeochromocytoma clinical presentation
``` Pallor Headaches Sweating Nervousness Hypertension ```
52
Phaeochromocytoma diagnosis
24hr urine collection of AD metabolites
53
Cushing's disease
Overproduction of cortisol by adrenal cortex Caused by: pituitary adenoma (80%) Adenocortical neoplasm - usually adenoma Paraneoplastic effect of neoplasms
54
How would another neoplasm cause cushing's disease?
Produce adrenocorticotrophic hormone that stimulates zona fasciculata cells of the adrenal cortex to produce cortisol

Clinical Pathology (65 decks)

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