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1
Q

What is arteriosclerosis?

A

Hardening of arteries characterized by wall thickening and loss of elasticity

Arteriosclerosis has three patterns: arteriolosclerosis, Monckeberg medial sclerosis, and atherosclerosis.

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2
Q

What is arteriolosclerosis?

A

Affects small arteries and arterioles

Associated with diabetes and hypertension.

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3
Q

What are the two variants of arteriolosclerosis?

A
  • Hyaline
  • Hyperplastic

Hyaline is seen in elderly, diabetes, and hypertension, while hyperplastic is a response to malignant hypertension.

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4
Q

What is Monckeberg medial sclerosis?

A

Calcification of muscular arteries wall media, usually the internal elastic membrane

Typically occurs in those over 50 years old and is not clinically significant.

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5
Q

What is atherosclerosis?

A

A form of arteriosclerosis characterized by atheromatous plaques in the intima of medium and large arteries

It represents a chronic inflammatory and healing response to endothelial cell injury.

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6
Q

What are the non-modifiable risk factors for atherosclerosis?

A
  • Genetics (family history)
  • Age (40-60 years)
  • Gender (males and postmenopausal females)

These factors significantly increase the risk of developing atherosclerosis.

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7
Q

What are some modifiable risk factors for atherosclerosis?

A
  • Hyperlipidemia
  • Hypertension
  • Smoking
  • Diabetes
  • Inflammation (CRP)
  • Homocystinemia
  • Metabolic syndrome
  • Lipoprotein a

Modifying these factors can help reduce the risk of atherosclerosis.

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8
Q

What are the components of atherosclerotic plaques?

A
  • Smooth muscle cells
  • Macrophages
  • T cells
  • ECM (collagen, elastic fibers)
  • Lipids

These components contribute to the formation and stability of the plaques.

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9
Q

What is a ‘vulnerable’ plaque?

A

A plaque characterized by a thin cap, large lipid core, and numerous inflammatory cells

Vulnerable plaques are more prone to rupture.

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10
Q

What can result from atherosclerosis stenosis?

A

Critical stenosis (>70%) can result in angina and peripheral vascular disease

Symptoms typically arise when stenosis reaches 70%.

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11
Q

What is the definition of an aneurysm?

A

Localized abnormal dilatation of the heart or blood vessels

A true aneurysm involves all layers of the vessel wall, while a false aneurysm is a defect leading to an extravascular hematoma.

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12
Q

What are common risk factors for abdominal aortic aneurysm (AAA)?

A
  • Atherosclerosis
  • Hypertension
  • Smoking

AAAs are more commonly found in males over 50 years old.

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13
Q

What can cause aneurysms?

A
  • Atherosclerosis
  • Hypertension
  • Cystic medial degeneration
  • Inherited connective tissue defects (e.g., Marfan syndrome)
  • Trauma
  • Vasculitis

Each of these factors compromises the vessel wall structure.

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14
Q

What is the classification of aortic dissections?

A
  • DeBakey:
    • Type I – ascending and descending aorta
    • Type II – ascending aorta only
    • Type III – descending aorta only
  • Stanford:
    • Type A – involving ascending aorta
    • Type B – distal to left subclavian artery

These classifications help determine treatment approaches.

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15
Q

What is the classic presentation of aortic dissection?

A

Sudden onset of chest or abdominal pain radiating to the back

Patients may also show differential blood pressure in arms.

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16
Q

What is vasculitis?

A

Vessel wall inflammation with specific vascular size predilections

Can be infectious or non-infectious.

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17
Q

What is Polyarteritis nodosa?

A

Transmural necrotizing vasculitis with fibrinoid necrosis affecting medium and small-sized arteries

Commonly associated with chronic Hepatitis B.

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18
Q

What is Wegener granulomatosis?

A

Granulomatosis with polyangiitis affecting kidneys and upper airway tracts

Classic triad includes necrotizing vasculitis, granulomas, and crescentic glomerulonephritis.

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19
Q

What are the four overlapping syndromes of ischemic heart disease?

A
  • Angina pectoris
  • Myocardial infarction
  • Chronic ischemic heart disease
  • Sudden cardiac death

Each syndrome represents a different clinical manifestation of ischemic heart disease.

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20
Q

What is the definition of myocardial infarction?

A

Acute coronary syndrome resulting from interruption of coronary blood flow causing ischemia and cell death

It is a significant cause of morbidity and mortality worldwide.

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21
Q

What are the types of myocardial infarction?

A
  • Type I – spontaneous MI due to primary coronary event
  • Type II – secondary MI due to supply-and-demand mismatch
  • Type III – MI resulting in sudden cardiac death
  • Type IV – iatrogenic
  • Type V – MI associated with coronary artery bypass surgery

These classifications help in understanding the underlying causes of the infarction.

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22
Q

What is the pathogenesis of myocardial infarction?

A

Occlusion leads to ischemia, dysfunction, and myocyte death

Irreversible injury typically occurs after 20-30 minutes of ischemia.

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23
Q

What is in-stent thrombosis?

A

Type V: MI associated with coronary artery bypass surgery.

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24
Q

What is the pathogenesis of myocardial response to occlusion?

A

Occlusion -> ischaemia -> dysfunction -> myocyte death

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25
What is the outcome of myocardial injury if flow deprivation lasts more than 20-30 minutes?
Irreversible myocardial injury.
26
What does the phrase 'time is myocardium' refer to in the context of PCI?
Severe compromise (but no complete blockage) for 2-4 hours can cause irreversible injury.
27
What happens after 6 hours of severe ischaemia?
Necrosis is usually complete.
28
What are the patterns of infarction dependent on?
Vessel involved, collaterals, severity and extent of ischaemia.
29
What type of infarction is characterized by involvement of a single vascular territory?
Transmural infarction.
30
What is the most common cause of anterior wall LV infarction?
LAD artery occlusion (40-50%).
31
What percentage of inferior/posterior wall LV infarction is caused by RCA occlusion?
30-40%.
32
What percentage of lateral wall infarction is caused by L Cx occlusion?
15-20%.
33
What characterizes non-transmural infarction?
<1/3 inner ventricle; may involve more than 1 territory.
34
What is NSTEMI associated with?
Thrombolysis before transmural infarct.
35
What can multifocal microinfarcts be caused by?
* Small vessel microembolisation * Vasculitis * Vascular spasm (cocaine)
36
What is Takotsubo cardiomyopathy associated with?
Vasospasm + psychological duress.
37
What is the clinical feature of an MI?
Chest pain – radiation down left arm, SOB, diaphoretic.
38
What ECG changes are indicative of an MI?
ST elevation, troponins.
39
What are common complications within the first day of an MI?
* Arrhythmias * Sudden cardiac death
40
What is the mortality rate for cardiogenic shock after an MI?
70% mortality rate.
41
What is the most common type of rupture after an MI?
Rupture of the free wall.
42
What is Dressler syndrome?
Possible autoimmune pathology after MI.
43
What does MONA stand for in MI treatment?
* Morphine * O2 * GTN * Aspirin
44
What are the two types of valvular heart disease?
* Congenital * Acquired (native vs prosthetic)
45
What is the most common cause of aortic stenosis?
Calcific valvular degeneration.
46
What is the epidemiology of senile calcific aortic stenosis?
Common degenerative age-related lesion, typically manifesting in pts > 70 yo.
47
What is a common complication of mitral valve prolapse?
Mitral regurgitation.
48
What are Aschoff bodies associated with?
Rheumatic fever.
49
What is the primary treatment for acute rheumatic fever?
Secondary penicillin prophylaxis using IM benzathine penicillin.
50
What are the major criteria for diagnosing infective endocarditis?
* Positive echo with vegetations * 2 separate positive blood cultures with typical micro-organism
51
What is the causative organism most common in IV drug users for infective endocarditis?
S. aureus.
52
What are the two classifications of infective endocarditis?
* Acute IE * Subacute IE
53
What is the definition of nonbacterial thrombotic endocarditis (NBTE)?
Sterile thrombi on leaflets of cardiac valves without inflammation.
54
What are Osler’s nodes?
Painful nodules on the fingers and toes associated with infective endocarditis ## Footnote Osler's nodes are a result of immune complex deposition and are a classic sign in infective endocarditis.
55
What are Roth’s spots?
Retinal hemorrhages with white centers seen in conditions like infective endocarditis ## Footnote Roth's spots indicate embolic events and are found on retinal examination.
56
What is the management for acute endocarditis?
Appropriate antibiotics; may require surgery ## Footnote Surgical intervention is often needed in acute cases due to severe damage or complications.
57
What defines nonbacterial thrombotic endocarditis (NBTE)?
Sterile thrombi on cardiac valve leaflets, typically 1-5 mm in size, loosely attached ## Footnote NBTE is associated with hypercoagulable states and malignancies.
58
What is the clinical significance of NBTE?
Embolic propensity ## Footnote The small thrombi can lead to embolic events, despite being sterile.
59
What are the common aetiologies of NBTE?
* Hypercoagulable states * Cancer (especially mucinous adenocarcinoma) * Prolonged debilitating illness * Endocardial trauma ## Footnote These conditions lead to a hypercoagulable state, increasing the risk of thrombus formation.
60
What is associated with Libman-Sacks disease?
Endocarditis of systemic lupus erythematosus (SLE) ## Footnote This type of endocarditis typically involves small, sterile vegetations on either side of the valve leaflets.
61
What is the primary feature of carcinoid heart disease?
Affects right heart valves, occurs in 50% of patients with carcinoid syndrome ## Footnote Carcinoid syndrome results from bioactive compounds released by carcinoid tumors.
62
What are the types of cardiomyopathy?
* Dilated cardiomyopathy * Hypertrophic cardiomyopathy * Restrictive cardiomyopathy * Arrhythmogenic right ventricular cardiomyopathy * Specific cardiomyopathy * Non-classified cardiomyopathies ## Footnote These classifications help in diagnosing and understanding the underlying mechanisms of heart dysfunction.
63
What is the most common type of cardiomyopathy?
Dilated cardiomyopathy ## Footnote It accounts for 90% of cardiomyopathy cases.
64
What are the clinical presentations of dilated cardiomyopathy?
* Slowly progressive signs of congestive heart failure (CHF) * Dyspnea * Easy fatigability * Poor exertional capacity ## Footnote Patients may experience these symptoms as the condition worsens.
65
What is the characteristic pathology of dilated cardiomyopathy?
Dilated ventricles, hypertrophied muscle cells, and variable fibrosis ## Footnote The heart's ability to contract is significantly impaired in this condition.
66
What is the primary genetic inheritance pattern of hypertrophic cardiomyopathy (HCM)?
Autosomal dominant with incomplete penetrance ## Footnote The genetic basis often involves defects in cardiac sarcomere proteins.
67
What is the main clinical concern in hypertrophic cardiomyopathy?
Sudden cardiac death from arrhythmias ## Footnote HCM is a leading cause of sudden cardiac death in young athletes.
68
What are the common etiologies of restrictive cardiomyopathy?
* Idiopathic * Cardiac amyloidosis * Endomyocardial fibrosis * Cardiac sarcoidosis * Hemochromatosis * Scleroderma * Radiation therapy * Tumor invasion ## Footnote These conditions lead to impaired ventricular filling during diastole.
69
What is myocarditis?
Myocardial damage caused by inflammatory infiltrates secondary to infections or immune reactions ## Footnote Coxsackie viruses are common causative agents.
70
What is the most common primary heart tumor in adults?
Myxoma ## Footnote Myxomas are typically found in the left atrium and can cause obstruction or embolic events.
71
What is the most common pediatric primary heart tumor?
Rhabdomyoma ## Footnote Rhabdomyomas are often associated with tuberous sclerosis.
72
What is the classification of heart tumors?
* Neoplastic * Primary (e.g., myxoma, fibroma) * Secondary (metastatic) * Non-neoplastic (infection, thrombus) ## Footnote This classification helps in understanding the nature and management of heart tumors.
73
What is the primary treatment for heart tumors?
Surgical excision ## Footnote Most heart tumors, especially symptomatic ones, require surgical intervention.
74
What is a left to right shunt?
Abnormal blood flow from the left side of the heart to the right side, typically non-cyanotic ## Footnote Conditions like VSD, ASD, and PDA create these shunts.
75
What is Eisenmenger’s syndrome?
Reversal of blood flow due to increased pulmonary vascular resistance ## Footnote This occurs when right ventricular pressure exceeds systemic pressure in the context of a left-to-right shunt.
76
What characterizes transposition of the great vessels?
Ventriculoarterial discordance requiring shunting for survival ## Footnote Without shunting, this condition is usually incompatible with life.
77
What is truncus arteriosus?
Failure of the truncus to develop a septum, leading to a single vessel leaving the heart ## Footnote This congenital defect can lead to significant hemodynamic complications.
78
What is the most common cause of pulmonary artery interruption?
Hypoplastic pulmonary artery leading to collateral vessel formation ## Footnote This condition is often associated with congenital heart defects like TOF.
79
What is the significance of coronary artery aneurysm?
Atherosclerosis in adults and Kawasaki disease in children ## Footnote Aneurysms need to be less than 50% of vessel length and 1.5x width to be considered true aneurysms.
80
What is a bronchogenic cyst?
Ventral foregut malformation that can arise in the pulmonary parenchyma or mediastinum ## Footnote These cysts may become symptomatic if they lead to infection or compression of adjacent structures.
81
What is the typical location for ectopic parathyroid glands?
Inferior third arch and superior fourth arch ## Footnote Ectopic glands are more likely to be found in the mediastinal or tracheoesophageal groove.

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