30 - Cardiovascular Disease 3 Flashcards Preview

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Flashcards in 30 - Cardiovascular Disease 3 Deck (68):
1

Endocarditis is... + two types

inflammation of endocardium

prototypical lesion = vegetation on valves

infective and non-infective

2

Types of non=infective endocarditis

Nonbacterial thrombotic endocarditis
Endocarditis of SLE (Libman-Sacks disease)

3

Acute infective endocarditis

Highly virulent
Necrotising, ulcerative, destructive lesions
Difficult to cure and death occurs despite treatment

4

Sub-acute infective endocarditis

lower virulence
insidious infections of deformed valves
cured with antibiotics

5

Strep. bovis endocarditis indicates

Investigation into bowel cancer

6

Complications of infective endocarditis

immunologically mediated conditions e.g. glomerulonephritis

7

Clinical presentation of IE

splinter/subungual haemorrhages
Janeway lesions
Osler's nodes
Roth spots

8

Janeway lesions

erythematous or haemorrhagic non-tender lesions

9

Osler's nodes

Subcutaneous nodules in the pulp of the digits

10

Roth spots

Retinal haemorrhages in the eyes

11

FROM JANE

Fever
Roth spots
Oslers nodes
Murmurs

Janeway lesions
Anaemia
Nail - splinter haemorrhage
Emboli (septic)

12

Non-infective endocarditis abbreviation

NBTE

13

NBTE - who?

debilitated patients
those in hyper coagulable state
Trousseau syndrome
Endocardial trauma

14

Non-infective endocarditis libman-sacks endocarditis

associated with SLE usually asymptomatic

15

Rheumatic fever - what is it

acute, immunologically mediated multi-system inflammatory disease follow group A strep pharyngitis

16

Aschoff bodies

distinctive cardiac lesions
foci of T-cells, plasma cells and macrophages

17

Rheumatic fever - pathological features

Features of vegetations called veruccae
Mitral valve changes are classical - virtually ONLY cause of mitral stenosis
Leaflet thickening
Fibrous bridging of valvular commissures & calcification

18

Rheumatic fever - pathogenesis

antibodes against M proteins of Strep A cross react with self-antigens in the heart. CD4 cells specific for strep peptide react with proteins on heart.

Produce cytokines that activate macrophages e..g Aschoff bodies

19

Pericarditis - causes

inflammation of pericardial sac due to...

Coxsackie B, bacteria, TB, fungi, parasites

Rheumatic fever, SLE, scleroderma, post-cardiotomy
Late post-MI = dressler's, drug hypersensitivity

Misc. conditions = post MI, uraemia, cardiac surgery, neoplasia, trauma, radiation

20

Acute pericarditis -

serous
serofibrinous
purulent
haemorrhagic
caseous

21

Chronic pericarditis -

adhesive
adhesive mediastinopericarditis
constrictive pericarditis

22

Serous pericarditis -

inflammation causes clear serous fluid accumulation

caused, generally, by non-infectious aetiologies - most common, inflammation of adjacent structures. rarely by viral pericarditis (coxsackie B/ echovirus)

23

Serous pericarditis - causes

Rheumatic fever, SLE, scleroderma

Uraemia, neoplasia, radiation

24

Dressler's syndrome

2° pericarditis
aka - post-MI syndrome

Triad: fever, pleuritis chest pain, pericardial effusion

Autoimmune rxn to antigens released following myocardial infarction

Delay of weeks therefore not acute pericarditis

25

Pericarditis - clinical presentation

Exacerbated by: movement, respiration, laying flat
Relieved: sitting forward
Radiating: shoulders/neck
Differentials: angina, pleurisy

loudest pleural rub over diaphragm

fever, leucocytosis, pericardial effusion

26

Pericarditis - complications

pericardial effusion / cardiac tamponade

27

Types of cardiomyopathy

Dilated
Hypertrophic
Restrictive
Arrythmogenic right ventricular cardiomyopathy

28

Dilated cardiomyopathy - pathogenesis

progressive dilation -> contractile (systolic dysfunction)

heart enlarged heavy and flabby

29

Dilated cardiomyopathy - causes

genetic - AD
alcohol or chemo
SLE, scleroderma, thiamine def. , acromegaly, thyrotoxicosis, diabetes

30

Dilated cardiomyopathy - who?

20-50
slow progressive signs

31

Dilated cardiomyopathy - 5 yr survival

25%
death due to CCF, arrythmia / embolism

32

Dilated cardiomyopathy - treatment

cardiac transplantation
long-term ventricular assist

33

Hypertrophic cardiomyopathy -

stiff LV myocardium
diastolic dysfunction with preserved systolic function

34

Hypertrophic cardiomyopathy - causes

100% genetic

35

Hypertrophic cardiomyopathy - clinical features

low stroke volume due to impaired diastolic filling
obstruction to LV outflow in 25% of patients
exertional dyspnoea
systolic ejection murmur

36

Hypertrophic cardiomyopathy - complication

AF
mural thrombus formation
cardiac failure
ventricular arrythmias
sudden death in some familes and sudden death in athletes

37

Hypertrophic cardiomyopathy - treatment

decreased heart rate and contractility - B-adrenergic blockers
reduction of the mass of the septum

38

Restrictive cardiomyopathy -

1° decrease in ventricular compliance due to impaired vent filling during diastole

39

Restrictive cardiomyopathy - idiopathic or 2°

fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites

40

Restrictive cardiomyopathy - morphology

ventricles normal size but with slightly enlarged chambers.

myocardium is firm and non-compliant

41

Arrythmogenic right ventricular cardiomyopathy -

aka arrhythmogenic RV dysplasia
AD - 1in5k

42

Arrythmogenic right ventricular cardiomyopathy - morphology

RV dilation / myocardial thinning
Fibrofatty replacement of RV
Disorder of cell-cell desmosomes
Exercise causes cells to detach and die

43

Arrythmogenic right ventricular cardiomyopathy - clinical presentation

silent, syncope, chest pain, palpitations, sudden cardiac death in the young during exercise

44

Myocarditis - cause

infections (most) - Coxsackie A&B viruses; Chagas disease (Trypanosoma cruzi - protozoa)

45

Myocarditis - clinical features

asymptomatic
heart failure, arrhythmias and sudden death
non-specific - fatigue, dyspnoea, palpitations, precordial discomfort and fever
can mimic acute MI
DCM can develop

46

maybe steal slide 57 of 82

for causes of myocarditis

47

Vasculitis -

inflammation of vessel walls
any organ and any vessel

48

GCA stands for

giant cell arteritis

49

GCA - who?

elderly in west

50

GCA - pathology

chronic granulomatous inflammation
large -> med arteries
esp. head art. e.g. temporal also vertebral and ophthalmic arteries

aorta = giant cell aortitis

ophthalmic arterial involvement: permanent blindness

MEDICAL EMERGENCY

51

GCA - morphology

intimal thickening

med. granulomatous inflammation -> elastic lamina fragmentation

multinucleated giant cells

52

GCA - clinical presentation

Rare

53

GCA - diagnosis

biopsy

54

GCA - treatment

corticosteroids
anti-TNF therapy in refractory cases

55

Aneurysms -

localised, permanent, abnormal dilatations of a blood vessel

56

Aneurysms - aetiology

atherosclerotic
dissecting
berry
microaneurysms
syphilitic
mycotic
false

57

What is a dissecting aneurysm?

Tear in the wall
blood tracks between intimal and medial layers

58

Dissecting symptoms

Tearing pain in chest radiating to upper left shoulder

59

Most common dissecting aneurysm

thoracic aorta 2° to systemic hypertension.

progressive vascular occlusion and haemopericardium. High mortality w/o treatment

60

Dissecting aneurysm

Aim to reduce arterial pressure / surgery

61

Berry aneurysm -

small, saccular lesions that develop in the circle of willis
develop at sites of medial weakness at arterial bifurcations

62

Berry aneurysm - who?

young hypertensive patients

63

Berry aneurysm - what does rupture cause?

subarachnoid haemorrhage (SAH)

64

Charcot-Bouchard aneurysms -

occur in intracerebral capillaries in hypertensive disease, causing intracerebral haemorrhage

retinal microaneurysms can develop in diabetes

65

Mycotic aneurysms -

rare
weakening of arterial wall 2° to bacterial/fungal infection
organisms enter media from the vasa vasorum
SBE is the most common underlying infection
often in cerebral arteries
infections of AAAs -> risk rupture

66

What is a false aneurysm?

Blood filled space around a vessel, usually following traumatic rupture or perforating injury

67

False aneurysm morphology

adventitial fibrous tissue contains the haematoma
commonly seen following femoral artery puncture during angiography/plasty

68

6 Ps

Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishing cold

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