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Clinical Pathology > Cardiovascular Diseases 3 > Flashcards

Cardiovascular Diseases 3 Flashcards

1
Q

Inflammation of the endocardium of the heart ‘vegetations on valves’

A

Endocarditis

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2
Q

2 main types of endocarditis

A

Infective

Non-infective

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3
Q

Describe the vegetations of infective endocarditis

A

mixture of thrombotic debris and organisms

destroy underlying cardiac tissue

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4
Q

What are the 2 types of infective endocarditis?

A

Acute and subacute

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5
Q

Which is caused by more virulent organisms, subacute or acute infective endocarditis?

A

Acute

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6
Q

Describe the vegetations of acute infective endocarditis

A

Friable, bulky, potentially destructive vegetations. Ring abscess

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7
Q

Which is more easily treatable with antibiotics; acute or subacute endocarditis?

A

Sub-acute

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8
Q

Risk factors for infective endocarditis

A 
Cardiac/valvular abnormalities
MV prolapse
Valvular stenosis
Artificial valves
Unrepaired congenital defects
Bicuspid AV
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9
Q

Causative organisms of infective endocaridits

A

Streptococcus viridans
Staph A.
Coagulase -ve staphylococci

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10
Q

Which organisms can cause endocarditis, from prosthetic heart valves

A

Coagulase -ve staphylococci

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11
Q

Which organims can cause infective endocarditis from the mouth?

A

Streptococcus viridans

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12
Q

Clinical features of IE

A 
Fever
Murmurs
Splinter haemorrhages
Janeway lesions
Oslers's nodes
Roth Spots
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13
Q

Erythematous or haemorrhagic non tender lesions on the palms or soles

A

Janeway lesions

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14
Q

Subcutaneous nodules in the pulp of the digits

A

Osler’s nodes

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15
Q

Retinal haemorrhages in the eyes

A

Roth spots

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16
Q

Complications of IE

A

Immunologically mediated conditions e.g. glomerulonephritis

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17
Q

2 types of non infective endocarditis

A

Non bacterial thrombotic endocarditis (NBTE)

Libman Sacks endocarditis

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18
Q

In which patients do you get NBTE

A

cancer or sepsis.
a hypercoagulable state (DVT, PE and mucinous adenocarcinomas)
indwelling catheter lines

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19
Q

NBTE is part of what syndrome?

A

Trousseau syndrome of migratory thrombophlebitis

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20
Q

Describe the vegetations if NBTE

A

Small, sterile thrombi on valve leaflets. Single or multiple on line of closure of leaflets or cusps.

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21
Q

What are the effects of NBTE

A

non invasive/no inflammatory reaction>minimal local effect

Systemic emboli infarcts in the brain, heart etc

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22
Q

What type of endocarditis is associated with SLE

A

Libman Sacks

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23
Q

What valves are affected in libman sacks endocarditis?

A

Mitral and tricuspid valves

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24
Q

What are the effects of libman sacks endocarditis?

A

Usually asymptomatic, rarely cardiac failure or systemic emboli

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25
Q

Describe the vegetations of libman sacks endocarditis

A

Small (1-4mm), sterile, pink warty vegetations. Single or multiple

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26
Q

Rheumatic fever is an acute, immunologically mediated, multi-system inflammatory disease following what infection?

A

Group A steptococcal pharyngitis- causes scarlet’s fever

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27
Q

What are the distinctive cardiac lesions, made up of T-cells, plasma cells and macrophages found in rheumatic fever?

A

Aschoff bodies

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28
Q

What are the vegetations called in rheumatic fever?

A

Venuccae

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29
Q

Pathological features of rheumatic fever

A

Vegtations (venuccae)
Mitral valve changes
Fish mouth or buttonhole stenoses- fibrous bridging of valvular commissures and calcification

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30
Q

Causes of rheumatic fever

A

Hypersensitivity reaction

Immune responses to group A strep (pharyngitis)

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31
Q

What criteria is used to diagnose rheumatic fever?

A

Jone’s criteria

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32
Q

Clinical features of rheumatic fever

A 
Carditis
polyarthritis
chorea (neurological condition causing jerky movements)
erythema margination
subcutaneous nodules
fever
arthralgia
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33
Q

Inflammation fo the pericardial sac

A

Pericarditis

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34
Q

Causes of pericarditis

A

Infections e.g. viruses (cocksackie B), bacteria, fungi etc

Immunologically mediated processes- rheumatic fever, SLE, scleroderma, post MI (Dressler’s)

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35
Q

5 Types of acute pericarditis

A 
Serous
Serofibrinous/fibrinous
Purulent/suppurative
Haemorrhagic 
Caseous
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36
Q

3 types of chronic pericarditis

A

Adhesive
Adhesive mediastinopericarditis
Constricive pericarditis

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37
Q

A type of pericarditis involving inflammation which causes serous fluid accumulations

A

Serous pericarditis

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38
Q

Causes of serous pericarditis

A

Inflammation in adjacent structures
Viral pericarditis (cocksackie B/echinovirus)
Immunologically mediated processes- rheumatic fever, SLE, scleroderma
Misc. conditions- uraemia, neoplasia, radiation

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39
Q

Most common form of pericaridits

A

Serofibrinous pericarditis

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40
Q

A type of pericarditis; serous fluid and/or fibrinous exudate in pericardiat sac

A

Serofibrinous pericarditis

41
Q

Common causes of serofibrinous pericarditis

A

Acute MI, Dressler’s syndrome

Uraemia, radiation, rheumatic fever, SLE, trauma, surgery

42
Q

Features of serofibrinous pericarditis

A

Dry, granular, roughened surface

43
Q

Causes of purulent/suppurative pericarditis

A

Infections

44
Q

Features of purulent/suppurative pericardiits

A

Red, granular, exudate i.e. pus

45
Q

Complications of purulent/suppurative pericarditis (rare)

A

Mediastino-pericarditis

Restrictive pericarditis- serious

46
Q

A type of pericarditis where blood is mixed with serous (water) or suppurative (pus) effusion

A

Haemorrhagic pericarditis

47
Q

Causes of haemorrhagic pericarditis

A

Neoplasia
Infections e.g. TB
Following cardiac surgery - cardiac tamponade

48
Q

Causes of caseous pericarditis

A

TB or fungal

49
Q

Type of pericarditis with fibrinous/stringy adhesions obliterating pericardial cavity

A

Adhesive pericarditis

50
Q

Type of pericarditis which obliterates pericardial cavity with adherence to surrounding structures. Causes cardiac hypertrophy/dilation

A

Adhesive mediastinopericarditis

51
Q

A type of pericarditis where the heart is encased in a fibrous scar- limit cardiac function and only treatment is surgery

A

Constrictive pericarditis

52
Q

Dressler’s syndrome occurs post MI and is clinical triad of what 3 features?

A

Fever
Pleuritic chest pain
Pericardial effusion

53
Q

Autoimmune reaction to antigens released following MI

A

Dressler’s syndrome

54
Q

3 clinical features of pericarditis

A

Sharp,central chest pain
Pericardial friction rub
Fever, leucocytosis, lymphocytosis, pericardial effusion

55
Q

How is chest pain in pericarditis relieved?

A

Sitting forwards

56
Q

Chest pain in pericarditis radiates where?

A

Shoulders/neck

57
Q

Complications of pericarditis?

A

Cardiac tamponade/pericardial effusion

58
Q

Disorders of the myocardium

A

Cardiomyopathies

59
Q

4 types of cardiomyopathies

A

Dilated
Hypertrophic
Restrictive
Arrythmogenic right ventricular cardiomyopathy

60
Q

Describe the features of the heart in dilated cardiomyopahty

A

Flabby- heart enlarged and heavy

Myocyte hypertrophy with fibrosis

61
Q

Causes of dilated cardiomyopahty

A

Genetic- AD mainly, affects cytoskeleton proteins
Alcohol and other toxins e.g. chemotherapy
Others-SLE, scleroderma, thiamine def, acromegaly, thyrotoxicosis, diabetes etc

62
Q

Clinical features of cardiomyopathy

A

Present in 20s-50s with
Shortness of breath
Fatigue
Poor exertional capacity

63
Q

Treatment for dilated cardiomyopathy

A

Cardiac transplantation

Long term ventricular assist

64
Q

Most common cause of sudden death in athletes

A

Hypertrophic cardiomyopathy

65
Q

Type of cardiomyopathy- poorly compliant mycocardium, ‘stiff’ LV

A

Hypertrophic cardiomyopahty

66
Q

In hypertrophic cardiomyopathy, is diasolic or systolic function abnormal?

A

Diastolic, systolic function is preserved

67
Q

Causes of hypertrophic cardiomyopathy

A

100% genetic. Mutations in sarcomeric proteins- myofibre disarray

68
Q

3 clinical features of hypertrophic cardiomyopathy

A

Decreased stroke volume- impaired diastolic filling
Obstruction to left ventricular outflow
Systolic ejection murmur

69
Q

4 Complications of DCM/HCM

A

Heart failure
Sudden death
Atrial fibrillation
Stroke

70
Q

Treatment for HCM

A

Decrease heart rate and contractility- beta adrenergic blockers

71
Q

Causes of restrictive cardiomyopahty

A

Primary decrease in ventricular complicance (impared function during diastole)
Secondary (infiltration)- fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites

72
Q

Genetic disease that results in RV dilation and myocardial thinning- fibrofatty replacement of RV

A

Arrythmogenic RB cardiomyopathy

73
Q

When do you get sudden cardiac death with arrythmogenic right ventricular cardiomyopathy?

A

Fibrofatty replacement of RB due to disorder of cell-cell desmosomes. With excercise, cells detach and die.

74
Q

Infective or inflammatory process resulting in myocardial injury

A

Myocarditis

75
Q

Clinical features of myocarditis

A

Asymptomatic
Heart failure, arrythmias and sudden death
Non-specific symptoms
Can mimic acute MI

76
Q

Infectious causes of myocarditis

A 
Viruses (cocksackie A&B, influenza, HIV, CMV)
Bacteria
Fungi
Protozoe-tryponosoma cruzi
Helminths
77
Q

Immune mediated causes of myocarditis

A 
Post viral
post streptococcal (RF)
SLE
Drugs
Transplant rejection
78
Q

Other causes of myocarditis

A

Sarcoidosis

Giant cell myocarditis

79
Q

Inflammation of vessel walls, any organ, any vessel size

A

Vasculitis

80
Q

The name of the nomenclature for vasculitis, based on affected vessel size

A

Chapel Hill

81
Q

Most common form of vasculitis (medial emergency)

A

Giant cell arteritis

82
Q

Describe the pathology of giant cell arterieis

A

Chronic granulomatous inflammation- large>medium sized arteries
Segmental disease

83
Q

Common arteries affected by GCA?

A

Temporal arteries

Opthalmic arteris- permanent blindness

84
Q

Symptoms of GCA

A

Vague symptoms e.g. fatigue, weith loss, facial pain or headache- painful to palpate superficial temporal artery, jaw claudication

85
Q

Treatment for GCA

A

Corticosteroids

Anti-TNF

86
Q

Localised, permanent, abnormal dilatations of a blood vessel

A

Aneurysms

87
Q

Name 7 aneuryms based on their aetiology

A 
Atherosclerotic
Dissecting
Berry
Microaneurysm
Syphilitis
Mycotic
False
88
Q

Name 2 aneurysms based on shape

A

Saccular

Fusiform

89
Q

Most common aneurysm

A

Atherosclerotic

90
Q

Type of aneurysm- tear in the wall, blood tracks between intimal and medial layers

A

Dissecting aneurysm

91
Q

Symptoms of a dissecting aneurysm

A

Tearing pain in chest radiating to upper left shoulder, usually thoracic aorta, secondary to systemic hypertension.

92
Q

Type of aneurysm- small,saccular lesions that develop in the circle of willis. Develop at sites of medial weakness at arterial bifurcations.

A

Berry aneurysms

93
Q

Ruptures of berry aneurysm can have what effect?

A

Subarachnoid haemorrhage

94
Q

Charcot-Bouchard and Retinal are what type of aneuryms

A

Micro and syphilitis

95
Q

A type of micro and syphility aneurysm that occurs in intracerebral capillaries in hypertensive disease, can cause strokes

A

Charcot-Bouchard aneurysms

96
Q

A type of rare aneurysm- weakening of arterial wall secondary to bacterial infection e.g. subaute bacterial endocarditis. Often in cerebal arteries

A

Mycotic aneurysm

97
Q

A type of aneurysm; blood filled space around a vessel, usually following traumatic fupture or perforating injury

A

False

98
Q

Where is the haematoma in false aneurysms?

A

In the adventitial fibrous tissue

99
Q

What are the 6ps of acute ischaemia

A 
Pale
Puseless
Painful
Perishingly cold
Parasthtic
Paralysed

Clinical Pathology (53 decks)

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