Pericarditis & Atherosclerosis

Question 1

list the cause of serous fluid seen in pericardial effusion

Answer 1

• CHF
• hypoalbuminemia

Question 2

list the cause of serosanguineous fluid seen in pericardial effusion

Answer 2

• trauma
• malignancy

Question 3

list the cause of chylous fluid seen in pericardial effusion

Answer 3

• mediastinal lymphatic obstruction

Question 4

list the cause of blood (hemopericardium) fluid seen in pericardial effusion

Answer 4

• cardiac tamponade:
  
  • rupture aortic dissection or MI or penetrating traumatic injury

Question 5

primary pericarditis is usually ___ in origin and caused by ____

Answer 5

primary pericarditis is usually infectious in origin and caused by viruses

Question 6

____ is the most common systemic disorder associated with pericarditis

Answer 6

uremia is the most common systemic disorder associated with pericarditis

Question 7

list causes of secondary pericarditis

Answer 7

• uremia = most common systemic disorder associated with pericarditis
• MI, cardiac surgery
• radiation induced
• rheumatic fever
• SLE
• malignancies

Question 8

fibrinous pericarditis is seen in ____

Answer 8

fibrous pericarditis = bread and butter - irregular shaggy

fibrinous pericarditis is seen in:

• RHD
• uremia
• post-MI
• post-viral

Question 9

fibrinous and hemorrhagic pericarditis is seen in ____

Answer 9

fibrinous and hemorrhagic pericarditis is seen in malignancy

Question 10

fibrinopurulent (suppurative) pericarditis is seen in ____

Answer 10

fibrinopurulent (suppurative) pericarditis is seen in bacterial pericarditis

Question 11

caseous pericarditis is seen in ____

Answer 11

caseous pericarditis is seen in TB

Question 12

list the outcomes of acute pericarditis

Answer 12

1. resolution without clinical sequelae
2. cause immediate hemodynamic complications if elicit large effusion
3. progress to a chronic fibrosing process
   
   • usually following caseous and suppurative pericarditis but can be idiopathic
   • chronic constrictive pericarditis

Question 13

describe the morphology of chronic pericarditis

Answer 13

• delicate adhesions to dense, fibrotic scars that obliterate the pericardial space
• extreme cases = heart is completely encase with dense scar tissue –> can’t expand –> constrictive pericarditis

Question 14

list the top 4 modifiable risk factors for atherosclerosis

Answer 14

• modifiable:
  
  • hyperlipidemia
  • HTN
  • cigarette smoking
  • DM

Question 15

describe hyperlipidemia

Answer 15

• increased levels of LDL = bad cholesterol
• diabetes, nephrotic syndrome and hypothyroidism –> premature and severe atherosclerosis

Question 16

low ___ and ____ intake can cause high ___ levels which can lead to atherosclerosis

Answer 16

low folate and B12 intake can cause high homocysteine levels which can lead to atherosclerosis

Question 17

in hyperlipidemia, lipoproteins accumulate within the ___ which generate ____ lipids that have atherogenic properties

explain this

Answer 17

in hyperlipidemia, lipoproteins accumulate within the intima which generate oxidized lipids that have atherogenic properties

• ingested by macrophages –> foam cells
• stimulate release of cytokines –> chemotactic for circulating monocytes
• inhibits the motility of macrophages already in the lesion

Question 18

macrophages release cytokines such as ___ and growth factors such as _____

Answer 18

macrophages release cytokines such as IL-1, TNF and growth factors such as SMC proliferation

Question 19

smooth muscle proliferation converts fatty streaks into ____

Answer 19

smooth muscle proliferation converts fatty streaks into fibrofatty atheroma

Question 20

____ are the precursor lesion of atherosclerotic plaques

Answer 20

fatty streaks are the precursor lesion of atherosclerotic plaques and is seen in all children older than 10

Question 21

the key feature of atherosclerotic plaque is ___ thickening and ___ accumulation

Answer 21

the key feature of atherosclerotic plaque is intimal thickening and lipid accumulation

Question 22

name the 3 principal components of atherosclerotic plaques

Answer 22

1. cells = smooth muscle cells, macrophages, T-cells
2. ECM = collagen, elastic fibers, proteoglycans
3. intracellular and extracellular lipid deposits