8. Heart & Blood Vessels – The Rest Flashcards Preview

Pathology Year 2 > 8. Heart & Blood Vessels – The Rest > Flashcards

Flashcards in 8. Heart & Blood Vessels – The Rest Deck (58)
1

Introduction

Heart Disease (Cardiac Disease)
Blood Vessel Disease (Vascular Disease)
Disease present from birth (Congenital Cardiovascular
Disease)

2

Cardiac Disease



Vascular Disease

Ischaemia and MI (previously covered)
Cardiac Failure
Valvular Heart Disease
Pericarditis and Myocarditis
Unusual Cardiac Diseases

Congenital Cardiovascular disease

3

Vascular Disease

Atherosclerosis (previously covered)
Aneurysms
Hypertension
Diabetic Vascular Disease
Vein Diseases

4

Cardiac Failure

What is the normal function of the heart?
What is a syndrome?
Heart unable to pump blood at rate required for normal functioning

5

What happens when the heart does not pump as effectively as it should?

Oedema – pulmonary and peripheral
Tiredness

6

Many Causes

Ischaemic Heart Disease
Hypertension
Valvular Heart Disease
Arrhythmias
Congenital Heart Disease

7

Cardiac Failure

Initially the heart ‘Compensates’
Leads to cardiac hypertrophy and/or dilatation, and eventual inability to maintain normal

8

Cardiac Failure

Symptoms/Signs:
Shortness of breath (SOB)
Fatigue
Fluid in lungs (Pulmonary Oedema)
All-over, excessive, fluid-filled veins (Systemic Venous Congestion & Oedema)

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Classification

Acute vs Chronic
Left vs Right Vs both sided (congestive)

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Treatment

Treat the underlying cause
There are a range of medicines used to help control heart failure

11

What does a valve do?

A valve regulates flow in one direction only

Think how this works in the heart

12

Valvular Heart Disease - Mechanisms (1)

Stenosis - Failure to open completely, impeding forward flow

Incompetence/Regurgitation - Failure to close, allowing reverse flow

Vegetations – abnormal tissue growth on valve (fibrin, platelets & bacteria)

13

Valvular Heart Disease - Mechanisms (2)

Most common disease - stenoses of the aortic and mitral valves
Account for 2/3rds of all valve disease
Valvular stenosis mainly due to primary valve cusp abnormality, a chronic process
Valvular regurgitation may result from disease of cusps but also damage to supporting structures (tendinous cords, papillary muscles)
Vegetations can result from Infective Endocarditis & Rheumatic Fever

14

Valvular Heart Disease – Underlying Causes

Infection – Endocarditis/Rheumatic disease
Calcific aortic valve disease
Age-related degeneration
Carcinoid Syndrome
Fibrosis & muscle rupture after MI
Heart failure
Hypertension
Congenital
Prosthetic Heart Valves
Connective Tissue Disorders
IV Drug use

15

Mitral Stenosis

Rheumatic Fever

Pulmonary hypertension
L atrial & R ventricular hypertrophy
Murmur

16

Mitral Incompetence

Rheumatic Fever
Dilatation of Mitral valve
Papillary muscle fibrosis & dysfunction
Degeneration of valve cusps

Variable Haemodynamic effect
Murmur

17

Aortic Stenosis

Calcific degeneration
Rheumatic fever

Murmur
L Ventricular hypertrophy
Angina, syncope, L ventricle failure or sudden death

18

Aortic Incompetence

Rheumatic Fever
Dilatation of aortic root
Rheumatological disorders

Murmur
Collapsing pulse
Angina
L Ventricular failure

19

Endocarditits (vegetations)

Rheumatic Disease
Bacteria
Prosthetic Heart Valves
Calcific Valve Disease
IV Drug use

Malaise
Clubbing
Cardiac murmurs & failure
Arthralgia
Pyrexia
Skin lesions
Splenomegaly
Haematuria
Glomerulonephritis

20

Valvular Heart Disease

Symptoms/Consequences of Valvular disease:
Differ with the site/type lesion
Stroke
Arrythmias
Ventricular hypertrophy
Angina (Chest pain)
Syncope (Fainting)
Heart failure
Infarcts to kidneys and spleen
Poor prognosis once symptoms

21

Infective Endocarditis (1)

Endocardium is the inner lining of the heart and its valves.

Endocarditis is when this lining becomes infected/inflammed

22

Infective Endocarditis (2)

Infection occurs on the edge of heart valves
Vegetation is a mass of bacteria, fibrin, platelets
Right-sided in IV drug use
Left-sided in others

23

Infective Endocarditis (3)

Colonization of the heart valves or mural endocardium usually by bacteria
Streptococci (α haemolytic) affects abnormal valves usually after dental extraction / cleaning / bronchoscopy / tonsillectomy

Staph aureus affects previously normal valves, usually IV drug abusers

PROPHYLAXIS - Imperative to give antibiotics to those at risk of developing endocarditis prior to any procedure that may produce a bacteraemia

24

Clinical Presentation

Sepsis
Heart Failure
New murmur

25

Pericarditis & Myocarditis (1)

Inflammatory Reaction involving the Heart Sac or Heart Muscle Many Causes:
Viral, Bacterial, Parasitic, TB, Uraemia (urine products in blood)
Carcinoma, MI, Post surgery, Drugs, Connective tissue disease, Unknown, Radiation

26

Pericarditis & Myocarditis (2)

Types: Acute
Chronic
Symptoms and Signs: Chest Pain
Cardiac Failure
Treatment: Anti-inflammatory Drugs
Surgical Excision of the Pericardium

27

Unusual Cardiac Diseases

Cardiomyopathy
Multisystem Diseases – like Sarcoidosis & Amyloidosis
Thyrotoxicosis
Myxoedema
Alcoholism
Pregnancy
Iatrogenic (drug-induced) disease

28

Cardiomyopathy

Disease of heart muscle

29

Dilated

Idiopathic, alcohol, peripartum, genetic, myocarditis, sarcoid

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Hypertrophic

Genetic, idiopathic, storage disease

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Restrictive

Idiopathic, amyloidosis, radiation induced, chemotherapy related

32

Cardiac Dilatation
(process of expansion/stretching)

Dilation of chambers
Heart large and flabby

33

Hypertrophic Cardiomyopathy

Heavy, muscular, hypercontracting
Abnormal diastolic filling
1/3 have intermittent left ventricular outflow obstruction
End stage dilatation can occur

Myocardial hypertrophy, disarray

34

Clinical Features of HCM

SOB, chest pain, palpitations, black-out
Sudden death
Atrial fibrillation

50% Familial, autosomal dominant with variable expression
Genetic defect in 1 of 4 genes that encode cardiac contractile elements

35

Aneurysms

Localised, permanent, abnormal dilatation of a blood vessel

Causes: Age, Atherosclerosis, Ischaemia, Hypertension, Inflammation, Diabetes, Autoimmune diseases, Bacteria, Bacterial Endocarditis, Fungus, Marfan’s Syndrome, Syphilis

Treatment: Stents, Surgery, reducing arterial pressure

36

Atherosclerotic

Site: Lower abdominal Aorta & Iliac arteries
Clinical Effects:
Pulsatile abdominal mass
Lower limb ischaemia
Rupture, massive haemorrhage

37

Aortic Dissection

Site: Aorta & major branches
Clinical Effects:
Loss of peripheral pulses
Haemopericardium
External rupture – Haemorrhage
Double-barrelled Aorta

38

Berry

Site: Circle of Willis
Clinical Effects: Subarachnoid Haemorrhage

39

Micro-Aneurysms

Site: Intracerebral capillaries
Clinical Effects: Intracerebral Haemorrhage, associated Hypertension

40

Syphilitic

Site: Ascending & arch of Aorta
Clinical Effects: Aortic Incompetence

41

Mycotic (infective)

Site: Root of Aorta & any vessel
Clinical Effects: Thrombosis or Rupture, causing Cerebral infarction or Haemorrhage

42

Hypertension (1)

(High Blood Pressure)

But what is BP?
BP is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats)
Measured in millimeters of mercury - mmHg
eg 120/80 mm Hg
120/80mmHg or lower is classed as normal BP

43

Hypertension Diagnosis

No universal definition of what exactly is high
BP 140/90 offered 24hr ambulatory monitoring
Categories:
Mild: diastolic 95 – 104mmHg
Moderate: 105 – 114mmHg
Severe: >115mmHg

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Hypertension (2)

Classified into causes:
Primary (essential) hypertension 95%
Secondary hypertension 5-10%

Further classified Clinically:
Benign hypertension
Malignant hypertension

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Risk Factors for Essential Hypertension

None Modifiable:
Genetics- family history

Modifiable:
Diet- high intake of sodium
Lifestyle- stress & physical inactivity
Weight- obesity
Alcohol & Smoking - usage

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Secondary Hypertension Causes

Renal eg Polycystic Kidney Disease

Endocrine eg Thyrotoxicosis

Vascular eg Raised intravascular volume

Neurogenic eg Acute stress (surgery)

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Clinical Classification of Hypertension

Benign Hypertension - Most remain stable over many years
live a relatively normal life
until/unless complications arise

Malignant Hypertension - Accelerated Hypertensive disease
5% of cases
Rapidly rising blood pressure
90% die in the first year!

48

Complications of Hypertension

Organs Affected:
Blood vessels
Heart
Kidney
Eyes (Retina)
Brain

49

Complications of Hypertension: Blood Vessels

Large Blood Vessel disease (Macroangiopathy)
Atherosclerosis

Small Blood Vessel disease (Microangiopathy)
Arteriolosclerosis

Increased risk of rupture
and dissection, & MI

50

Complications of Hypertension: Heart

Heart disease:
Left ventricular hypertrophy
Cardiac Failure
Myocardial Infarction

51

Complications of Hypertension: Kidney

Benign nephrosclerosis
Renal failure

52

Complications of Hypertension: Eyes (Retina)

Hypertensive retinopathy
Retinopathy Grades:
Grade I Thickening of arterioles
Grade II Arteriolar spasms
Grade III Hemorrhages
Grade IV Papilloedema (seen in Malignant Hypertension)

53

Complications of Hypertension: Brain

Cerebral haemorrhage
Cerebral infarction

54

Factors Indicating Adverse Prognosis in Hypertension

Male
Young
Black Ethnicity
Smoker
Persistent diastolic BP > 115 mm Hg
Diabetes
Hypercholesterolemia
Obesity
Excess alcohol

Organ damage:
Heart
Kidney
Eyes
Brain

55

Diabetic Vascular Disease

Damage to Vessels Generally - Atherosclerosis
Damage to Kidneys
Damage to Nerves
Damage to Retinas

Complications such as:
Gangrene
Renal failure
Blindness

Effective control of Diabetes reduces disease!

56

Specifically Vein Diseases
Venous Thrombosis (eg DVT)

When normal venous return is impeded, predisposes to Thrombosis
Causes:
Immobility
Malignancy
Pregnancy & Childbirth
Oestrogens
Haematological disorders
IV cannulas

Danger of PE!

57

Specifically Vein Diseases
Varicosities

Common Problem
Tortuous and Distended veins
Cause
Incompetent valves in legs
Impaired venous return
stasis
oedema
fibrin deposits around veins
Often associated Ulceration – ankles and lower legs

58

Congenital Cardiovascular Disease – Commonest Types

Septal defects - Atrial or Ventricular
Failure of blood vessel closure at birth - Patent Ductus Arteriosus
Narrowed Aorta - Coarctation of the Aorta
Valvular Abnormalities
Vessels the wrong-way round - Transposition of the great vessels
Coronary artery defects
Multiple defects - Fallot’s Tetralogy