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Clinical Pathology > Cardiovascular disease 3 > Flashcards

Cardiovascular disease 3 Flashcards

1
Q

What is endocarditis and what is its clinical features?

A

Inflammation of heart endocardium. Prototypical lesion = vegetation on valves

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2
Q

What are the two types of endocarditis?

A

Infective - clinically important!!

Non-infective

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3
Q

What is infective endocarditis?

A

Colonisation/invasion of heart valves/chamber endocardium by microbes

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4
Q

What is vegetation?

A

Thrombotic debris/organism which destroys/invades underlying cardiac tissue

Can invade prosthetic valves too!

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5
Q

What are most endocarditis infections caused by?

A

Bacterial

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6
Q

What is the difference between acute vs subacute?

A

Acute

  • nastyyyy
  • high virulent
  • necrotising, ulcerative and destructive
  • difficult to cure with antibiotics - surgery

Subacute

  • less virulent
  • Less destructive - insidious infection
  • Cured with antibiotics
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7
Q

How is endocarditis caused?

A

Can occur in healthy heart but mainly with valvular/cardiac abnormalities…

  • rheumatic fever
  • MV prolapse
  • Valvular stenosis
  • congenital defects
  • prosthetic valves
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8
Q

What are the three main bacteria that cause endocarditis?

A

S viridans (from mouth)** in native but damaged/abnormal valves

S Areus (from skin) esp IVDU

Staph epidermis commonly infect prosthetic valves

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9
Q

What are the clinical features of infective endocarditis?

A

Fever (most consistent)
Unspecific - flu/weight loss
Murmur - 90% left sided IE

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10
Q

What are the clinical signs of IE?

A

F - fever
R - Roth spots
O - Oslers Nodes
M - Murmurs

J - Janeway lesions
A - anaemia
N - nail (splinter) haemorrhage
E - Emboli

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11
Q

What predisposes individuals to non-infective endocarditis?

A
  • Debilitation e.g. cancer patient
  • Hyper coagulated state
  • Endocardium trauma e.g. indwelling catheter/central line
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12
Q

What are the characteristics of the vegetation in non bacterial thrombotic endocarditis (NBTE)

A
  • Small (1-5mm)
  • Not destructive
  • Sterile
  • Non-invasive/inflammatory
  • Systemic emboli
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13
Q

What disease is non-infective endocarditis associated with?

A

SLE (lupus)

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14
Q

What valves are affected by non-infective ‘Libman Sacks endocarditis’?

A

Tricuspid and mitral

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15
Q

What is the characteristics of the vegetation of infective endocarditis?

A

Friable, bulky, destructive, more than one valve (virulent organisms)

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16
Q

What are the characteristics of the vegetation of non bacterial thrombotic endocarditis?

A

Small, sit on cusps of valves only, not invasive/inflammatory

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17
Q

What are the characteristics of the vegetation of non infective endocarditis Libman-sacks?

A

Small, AV valves on chordae, valvular endocardium or mural endocardium

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18
Q

What is Rheumatic fever and what organism is it caused by?

A

Acute immunological mediated multistage disease (AUTOIMMUNE DISEASE)
- following group A strep pharyngitis

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19
Q

What is a distinctive feature of Rheumatic fever?

A

Aschoff bodies

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20
Q

What is it called when an infection infects all 3 layers?

A

Pancarditis

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21
Q

What are the vegetations of rheumatic fever called?

A

Veruccae

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22
Q

What valve is classically infected by rheumatic fever? What type of stenosis does it this called?

A

Mitral valve -Virtually ONLY cause of mitral stenosis

Fish mouth

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23
Q

What type of condition is RF?

A

Autoimmune condition

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24
Q

What happens with RF (the steps)

A

Antibodies produced against Strep A pharyngitis cross link with self antigens of the heart

CD4 cell against strep A pharyngitis react with proteins of heart - produce cytokines - macrophages - aschoff bodies

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25
Q

How is rheumatic fever diagnosed?

A

Jones criteria

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26
Q

What can rheumatic fever cause in the long term?

A
  • Left atrial dilatation
  • Right ventricular hypertrophy
  • Mitral thrombi - embolism?
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27
Q

What is pericarditis?

A

Inflammation of outside layer of heart, pericardium

28
Q

What are the causes of pericarditis?

A

Infection - virus (COXSACKIE B - if in doubt..), bacteria, fungi, parasites

Immunological - SLE, RF, Dresslers syndrome (late post MI), post-cariotomy

Others - trauma, radiation, post MI (early)

29
Q

What is the difference between acute and chronic pericarditis?

A

Acute - inflammatory

Chronic - adhesive

30
Q

What are the characteristics of serous pericarditis and what usually causes it?

A

Inflammation with serous fluid accumulation

Usually non infective aetiology but can be caused by..

Virus (coxsackie) rare
Immunological
Other

31
Q

What is serofibrous pericarditis and what is it usually caused by?

A

Inflammation with serous and/or fibrinous exudate

-fibrinous = without fluid - dry, granular, roughened

Caused mainly by acute MI or Dressler’s syndrome

32
Q

What is dressers syndrome and what are the 3 main characteristics?

A

Autoimmune condition occurring weeks/months after MI

  • FEVER
  • PLEURETIC CHEST PAIN
  • PERICARDIAL EFFUSION
33
Q

What is purulent/supprative pericarditis caused by?

A

Infection (bacterial) - red, granular exudate i.e. pus

complete resolution = rare - cause restrictive pericarditis

34
Q

What is haemorrhage pericarditis and hat is it comply caused by?

A

Blood mixed with serous/supprative effusion

Mainly caused by TRAUMA, neoplasia, cardiac surgery

35
Q

What its chronic pericarditis characterised by?

A

Adhesion - fibrous/stringy adhesions

36
Q

What is constrictive pericarditis?

A

Heart encased in fibrous shell (scar) - cardiac function limited and has to be treated surgically to correct

37
Q

What are the clinical features of pericarditis?

A

Pleuritic chest pain - central chest pain

Pericardial rub

38
Q

What are the clinical complications of pericarditis?

A

Pericardial effusion

Cardiac Tamponade

39
Q

What is cardiomyopathy and what are the 4 types?

A

Disease of the heart

  • dilated
  • restrictive
  • hypertrophic
  • Arrythrogenic right ventricular cardiomyopathy
40
Q

What are the characteristics of Dilatation cardiomyopathy?

A

Dilatation with cardiac dysfunction

  • flabby, heavy, enlargement
  • Myocyte hypertrophy with fibrosis
41
Q

What are the causes of dilation cardiomyopathy?

A

Genetic - mainly autosomal dominant - cytoskeleton protein gene mutation

Alcohol/toxins

42
Q

What is hypertrophic cardiomyopathy and what is its characteristics?

A

Myocardial hypertrophy WITHOUT hypertrophy

  • stiff/noncompliant left ventricular myocardium
  • diastolic dysfunction but systolic preserved
  • thick, heavy, hyper contractile
  • Main cause of LVH
43
Q

What is the cause of hypertrophic cardiomyopathy?

A

100% genetic

44
Q

What are the clinical features of hypertrophy cardiomyopathy?

A
  • Reduced SV due to impaired diastole, reduced compliance and reduced chamber size
  • Left ventricular outflow obstruction
  • Exertional dysponea
  • Systolic heart murmur with LV outflow obstruction
45
Q

What are the main complications of hypertrophic cardiomyopathy?

A
  • AF
  • Mural thrombosis
  • arythmias
  • sudden death - most common cause!
46
Q

What is the main treatment for hypertrophic cardiomyopathy?

A

Beta blockers

47
Q

What is restrictive cardiomyopathy and what is its clinical features?

A
  • Reduced ventricular compliance
  • Impaired ventricular diastole
  • Slight enlargement of chambers/hypertrophy
  • myocardium - reduced compliance
48
Q

What happens with right arrythmogenic right ventricular cardiomyopathy and what are its clinical features?

A
  • Genetic disease
  • RV dilatation and myocardial thinning
  • fibrofatty replacement of RV and disordered desmosomes
  • Exercise cause cell detachment and cell death
  • syncope, chest pain, palpitations, sudden death
49
Q

What is myocarditis and what is the major cause?

A

Infective, inflammatory process of the myocrdiaim

- caused by infection - COXSACKIE A and B

50
Q

What is vasculitis?

A

Inflammation of vessel walls - can affect any organ and any vessel

  • symptoms/signs dependent on vessel location/size
51
Q

What is the classification of vasculitis based on?

A

Vessel size - large, medium, small

52
Q

What is the most common form of vasculitis and what is its clinical features?

A

Giant cell vasculitis (aka temporal artiritis

  • affect large- medium vessels
  • Chronic granulamtous inflammation
  • especially in head (temporal artery)
53
Q

When is giant cell vasculitis considered a medical emergency?

A

When it involves ophthalmic arteries - permanent blindness

54
Q

What is the morphology of giant cell artiritis?

A

Intimal thickening (reduced luminal diameter)
Granulomatous inflammation
Multi-nucleated Giant cell

55
Q

What are the clinical features of giant cell artiritis?

A

Headache
Facial pain
Jaw claudication (pain when chewing)

56
Q

How to treat giant cell artiritis?

A

Corticosteroids

57
Q

What are the most common type of aneurysm?

A

Atherosclerotic aneurysm (e.g. AAA)

58
Q

What is the biggest risk factor for atherosclerotic aneurysm?

A

Size of aneurysm

59
Q

What is a dissecting aneurysm? Where does it usually occur?

A

Tear in wall
Blood tracks between intimal and medial layers

  • thoracic wall
60
Q

What are the classical symptoms of dissecting aneurysm?

A

Tearing chest pain which radiates to upper left shoulder

61
Q

What are Berry aneurysms?

A

small ,saccular lesions that develop in circle of Willis - bifurcations

62
Q

What is the classical symptom of berry aneurysms rupture?

A

Thunderclap headache

63
Q

What are mycotic aneurysms?

A

Rare; weakening of atrial wall by bacterial/fungal infection

64
Q

What is a false aneurysm?

A

Blood filled space caused by trauma or perforating injury

65
Q

what are the 6 Ps of acute ischaemia?

A 
Pulseless
Pale
Painful
Paralysed
Parenthetic
Perishingly cold

Clinical Pathology (50 decks)

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