30 - Cardiovascular Disease 3 Flashcards by David Thomas

Endocarditis is… + two types

inflammation of endocardium

prototypical lesion = vegetation on valves

infective and non-infective

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Types of non=infective endocarditis

Nonbacterial thrombotic endocarditis

Endocarditis of SLE (Libman-Sacks disease)

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Acute infective endocarditis

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

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Sub-acute infective endocarditis

lower virulence
insidious infections of deformed valves
cured with antibiotics

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Strep. bovis endocarditis indicates

Investigation into bowel cancer

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Complications of infective endocarditis

immunologically mediated conditions e.g. glomerulonephritis

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Clinical presentation of IE

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

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Janeway lesions

erythematous or haemorrhagic non-tender lesions

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Osler’s nodes

Subcutaneous nodules in the pulp of the digits

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Roth spots

Retinal haemorrhages in the eyes

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FROM JANE

Fever
Roth spots
Oslers nodes
Murmurs

Janeway lesions
Anaemia
Nail - splinter haemorrhage
Emboli (septic)

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Non-infective endocarditis abbreviation

NBTE

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NBTE - who?

debilitated patients
those in hyper coagulable state
Trousseau syndrome
Endocardial trauma

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Non-infective endocarditis libman-sacks endocarditis

associated with SLE usually asymptomatic

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Rheumatic fever - what is it

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

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Aschoff bodies

distinctive cardiac lesions

foci of T-cells, plasma cells and macrophages

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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

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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

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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

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Acute pericarditis -

serous 
serofibrinous
purulent
haemorrhagic 
caseous

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Chronic pericarditis -

adhesive
adhesive mediastinopericarditis
constrictive pericarditis

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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)

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Serous pericarditis - causes

Rheumatic fever, SLE, scleroderma

Uraemia, neoplasia, radiation

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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

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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

Pericarditis - complications

pericardial effusion / cardiac tamponade

Types of cardiomyopathy

Dilated Hypertrophic Restrictive Arrythmogenic right ventricular cardiomyopathy

Dilated cardiomyopathy - pathogenesis

progressive dilation -> contractile (systolic dysfunction) heart enlarged heavy and flabby

Dilated cardiomyopathy - causes

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

Dilated cardiomyopathy - who?

20-50 | slow progressive signs

Dilated cardiomyopathy - 5 yr survival

25% | death due to CCF, arrythmia / embolism

Dilated cardiomyopathy - treatment

cardiac transplantation | long-term ventricular assist

Hypertrophic cardiomyopathy -

stiff LV myocardium | diastolic dysfunction with preserved systolic function

Hypertrophic cardiomyopathy - causes

100% genetic

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

Hypertrophic cardiomyopathy - complication

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

Hypertrophic cardiomyopathy - treatment

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

Restrictive cardiomyopathy -

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

Restrictive cardiomyopathy - idiopathic or 2°

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

Restrictive cardiomyopathy - morphology

ventricles normal size but with slightly enlarged chambers. myocardium is firm and non-compliant

Arrythmogenic right ventricular cardiomyopathy -

aka arrhythmogenic RV dysplasia | AD - 1in5k

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

Arrythmogenic right ventricular cardiomyopathy - clinical presentation

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

Myocarditis - cause

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

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

maybe steal slide 57 of 82

for causes of myocarditis

Vasculitis -

inflammation of vessel walls | any organ and any vessel

GCA stands for

giant cell arteritis

GCA - who?

elderly in west

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

GCA - morphology

intimal thickening med. granulomatous inflammation -> elastic lamina fragmentation multinucleated giant cells

GCA - clinical presentation

Rare

GCA - diagnosis

biopsy

GCA - treatment

corticosteroids | anti-TNF therapy in refractory cases

Aneurysms -

localised, permanent, abnormal dilatations of a blood vessel

Aneurysms - aetiology

``` atherosclerotic dissecting berry microaneurysms syphilitic mycotic false ```

What is a dissecting aneurysm?

Tear in the wall | blood tracks between intimal and medial layers

Dissecting symptoms

Tearing pain in chest radiating to upper left shoulder

Most common dissecting aneurysm

thoracic aorta 2° to systemic hypertension. progressive vascular occlusion and haemopericardium. High mortality w/o treatment

Dissecting aneurysm

Aim to reduce arterial pressure / surgery

Berry aneurysm -

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

Berry aneurysm - who?

young hypertensive patients

Berry aneurysm - what does rupture cause?

subarachnoid haemorrhage (SAH)

Charcot-Bouchard aneurysms -

occur in intracerebral capillaries in hypertensive disease, causing intracerebral haemorrhage retinal microaneurysms can develop in diabetes

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

What is a false aneurysm?

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

False aneurysm morphology

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

6 Ps

``` Pale Pulseless Painful Paralysed Paraesthetic Perishing cold ```

30 - Cardiovascular Disease 3 Flashcards

(68 cards)