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Flashcards in cardiovascular disease 3 Deck (102):
1

define endocarditis

Inflammation of the endocardium of the heart.

2

2 main forms of endocarditis

– Infective endocarditis (Clinically important).
– Non-infective endocarditis
(Nonbacterial thrombotic endocarditis (NBTE)), Endocarditis of SLE (Libman-Sacks Disease)

3

what is contained within vegetations of infective endocarditis

– Mixture of thrombotic debris and organisms

4

where do vegetations of endocarditis occur

Aorta, aneurysmal sacs, blood vessels, prosthetic valves

5

what type of pathogen causes most endocarditis- bacterial,viral or fungal.

bacterial, although some can be fungal.

6

acute endocarditis is caused by

highly virulent organisms

7

lesions produced by acute endocarditis are typically

– Necrotizing, ulcerative, destructive

8

what is the prognosis of acute endocarditis

poor.

9

subacute endocarditis

low virulence organism

10

lesions produced by chronic endocarditis are typically

less destructive

11

what is the prognosis of subacute endocardditis

cured with antibiotics

12

risk factors of endocarditis

most common causes- mitral valve prolapse, valvular stenosis, prosthetic valves, unprepared congenital defects, bicuspid AV.
cardiac, valvular problems, rheumatic heart disease.

13

how does infection get to the heart and cause endocarditis

Dental abnormalities, IVDU, wounds, bowel cancer.
streptococcus viridans from mouth
S aurues from skin
coagulase negative staphylococci- from prosthetic valves
Strep. bovis- endocarditis should prompt investigations for bowel cancer.

14

vegetation from acute infective endocarditis have what features

• Friable (soft), bulky, potentially destructive.
• Single, multiple and often more than one valve.
• Can erode--- myocardium ------abscess (ring abscess).
• Emboli contain large numbers of virulent organisms

15

clinical features of infective endocarditis

fever- rapidly developing, fever, chills and weakness.
weight loss
murmus- common in left sided endocarditis

16

complications of infective endocarditis

– Immunologically mediated conditions e.g. glomerulonephritis.
(micro-thromboemboli)
– Splinter(in nails) / subungual hemorrhages
– Janeway lesions- • Erythematous or haemorrhagic non-tender lesions on the palms or soles.
– Osler’s nodes- Subcutaneous nodules in the pulp of the digits
– Roth spots- Retinal haemorrhages in the eyes

17

what does the pneumonic FROMJANE stand for in terms of the clinical presentation of infective endocarditis.

• F – Fever
• R – Roth spots
• O – Osler’s nodes
• M – Murmurs
• J – Janeway Lesions
• A – Anaemia
• N – Nail (splinter) haemorrhage
• E – Emboli (septic)

18

what are the 2 types of non-infective endocarditis

NBTE- non bacterial thrombolytic endocarditis

Libman sacks endocarditis

19

what is non bacterial thrombolytic endocarditis aka

marantic endocarditis

20

what group of patients is non bacterial thrombolytics endocarditis prevelanent in

chronically ill
people who are hypercoaguable

21

characteristics of vegetations in non-bacterial, thrombolytic endocarditis

small, non destructive, sterol thrombi on valve leaflets
single or multiple.
not invasive/no inflammatory reaction reaction- minimal local effect.
systemic emboli (infects into brain and heart)

22

what structures do non-bacterial, thrombolytic endocarditis affect

AV valves, chordae, valvular endocardium or mural endocardium of atria and ventricles.

23

what mediates rheumatic heart disease

immune system following group streptococcal infection.

24

what presentation is a diagnostic factor if rheumatic fever

Aschoff bodies- diagnostic of RHD.
distinctive cardiac leisons
foci- T cells, plasma cells and macrophages.
Can be found in all 3 cardiac layers-pancarditis

25

name of vegetations in rheumatic heart disease

veruccae.

26

which valve is typically affected in rheumatic heart disease and how is it affected

mitral valve stenosis
leaflet thickening
virtually always involved in chronic disease.

27

what name if given to the type of stenosis which occurs in rheumatic heart disease

fish mouth, buttonhole.

28

what is the aetiology of rheumatic fever/RHD

hypersensitivity reaction combines antibody and t cell mediated response.
– Antibodies directed against the M proteins of streptococci
– Cross-react with self antigens in the heart
– CD4+ T cells specific for streptococcal peptides
– Produce cytokines that activate macrophages (e.g. Aschoff bodies)

29

what criteria is used to diagnose a patient with rheumatic heart disease

Jones criteria.
Required criteria for diagnosis- 2 major
Required criteria- 1 major and 2 minor.

30

define pericarditis

inflammation of the pericardial sac

31

main causes of pericarditis

infections- coxscakie virus
bacterial- TB, fungi, parasites

Immunologically mediated processes- Rheumatic fever, SLE, scleroderma, post-cardiotomy, Late post-MI = Dressler’s, drug hypersensitivity

miscellaneous conditions
Post-MI (early), uraemia, cardiac surgery, neoplasia, Trauma, radiation

32

4 different forms of pericarditis

acute, chronic, serous, serofibrinous.

33

what are the typical components which define acute pericarditis

serous, serofibrinos/fibronous, purulent, haemorrhagic, caseous.

34

what are the typical components which define chronic pericarditis

adheisve
adhesive mediastinopericarditus.
constructive mediastinopericarditus.

35

what does serous pericarditis produce

inflammtion causes serous fluid accumulation.

36

what causes serous pericarditis

Caused by non-infectious aetiologies (generally)
– Inflammation in adjacent structures can cause pericardial reaction
– Rarely by viral pericarditis (Coxsackie B / echovirus)

Immunologically mediated processes
– Rheumatic fever, SLE, scleroderma

Miscellaneous conditions
– Uraemia, neoplasia, radiation

37

which is the most common type of pericarditis

Serofibrinous/ fibrinous pericarditis.

38

common causes of serofibrinous/ fibrinous pericarditis.

dresslers syndrome, acute MI, uraemia, radiation, rheumatic fever, SLE, trauma and surgey.

39

features of serofibrinous/ fibrinous pericarditis.

dry granular, roughend surface, intense inflammatory response.

40

define dressle's syndrome

secondary pericarditis

41

what clinical triad does dressler's syndrome involve.

fever, pleuritic chest pain, pericardial effusion.

42

what causes dresseler's syndrome

Autoimmune reaction to antigens released following myocardial infarction

43

how long post MI does dresser's syndrome develop

delay of weeks

44

causes of supparative pericarditis

infections.

45

Features of purulent / suppurative pericarditis

Red, granular, exudate i.e. pus (can be unto 500mls)

46

inflammation caused by supportive pericarditis can extend to where

mediastinal pericarditis.

47

what is a consequence of supportive pericarditis

restrictive pericarditis.

48

define haemorrhagic pericarditis

blood mixed with serous or supportive effusion

49

common causes of haemorrhagic pericariditis

Neoplasia (malignant cells in effusion)
Infections (inc TB)Following cardiac surgery ---- cardiac tamponade

50

common causes of caseous pericarditis

TB or fungal

51

3 main types of chronic pericadrditis.

adhesive pericarditis
adhesive mediastinopericarditis
constructive pericarditis.

52

what are the features of adhesive pericardiatis.

glued together
fibrosis/stringy adhesions obliterates the pericardial cavity

53

what are the features of adhesive mediastinopericarditis

obliterated pericardial activity with adherence to surrounding structures.

54

what are the features of constructive pericarditis

Heart encased in fibrous scar – limits cardiac function

55

clinical features of pericarditis

sharp central chest pain
percadial frictiona rub
Fever, leucocytosis, lymphocytosis, pericardial effusion

56

what factors exacerbate pericarditis chest pains

exacerbated by: movement, respiration, laying flat

57

what factors relieve pericarditis chest pains

sitting forwards

58

where does pericardial chest pain radiate to

shoulders and neck

59

2 complications of pericarditis

pleural effusion and cardiac tamponade

60

4 types of cardiomyopathy

dilated, hypertrophic, restrictive, arrythmogenic right ventricular cardiomyopathy.

61

pathogenesis of dilated cardiomyopathy

progressive dilation-contractile dysfunction, heart is enlarged, heavy flabby and cannot contract, myocyte hypertrophy.

62

causes of dilated cardiomyopathy

genetic- autosomal dominate
alcohol and other toxins- chemotherapy.
SLE, scleroderma, thiamine def., acromegaly, thyrotoxicosis, diabetes

63

clinical features of dilated cardiomyopathy

at any age
slow progressive signs
fatigue and poor exertional capacity

64

treatment for dilated cardiomyopathy

cardiac transplant
long -term ventricular assistance.

65

what defines hypertrophic cardiomyopathy

myocardial hypertrophy.

66

what causes a poorly compliant left ventricular myocardium.

• Diastolic dysfunction with preserved systolic function
• Intermittent ventricular outflow obstruction (1/3 cases)

67

clinical features of hypertrophic cardiomyopathy

• ↓Stroke volume
– Impaired diastolic filling - reduced chamber size / compliance of hypertrophied left ventricle
• Obstruction to the left ventricular outflow
– 25% of patients
• Exertional dyspnoea due to above
• Systolic ejection murmur
– Ventricular outflow obstruction
– Anterior mitral leaflet moves toward the ventricular septum during systole.

68

complications of hypertophic cardiomyopathy

– Atrial fibrillation
– Mural thrombus formation which can embolization / stroke
– Cardiac failure
– Ventricular arrhythmias
– Sudden death, especially in some affected families
• Most common causes of sudden death in athletes

69

treatment for hypertophic cardiomyopathy

– Decrease heart rate and contractility - β-adrenergic blockers.
– Reduction of the mass of the septum, which relieves the outflow tract obstruction

70

in restrictive cardiomyopathy what is the primary cause.

decrease in ventricular compliance.
– Impaired ventricular filling during diastole- decreased ventricular compliance so it cannot fill

71

in restrictive cardiomyopathy what is the secondary cause.

– Fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites (inborn errors of metabolism)

72

define arrythmogenic right ventricular cardiomyopathy

defect in cell adhesion which falls apart when we exercise.

73

pathogenesis of arrythmogenic right ventricular cardiomyopathy

• RV dilation / myocardial thinning
• Fibrofatty replacement of RV
• Disorder of cell-cell desmosomes.
• Exercise causes the cells detach and die

74

symptoms of arrythmogenic right ventricular cardiomyopathy

• Silent, syncope, chest pain, palpitations

75

define myocarditis

• Infective (or inflammatory) process àmyocardial injury

76

causes of myocarditis

• Infections - most cases
– Coxsackie A&B viruses most common

77

primary cause of arrythmogenic right ventricular cardiomyopathy

genetics

78

clinical features of myocarditis

– Asymptomatic
– Heart failure, arrhythmias and sudden death
– Non-specific symptoms - fatigue, dyspnea, palpitations, precordial discomfort, and fever
– Can mimic acute MI

79

define vaculitis

• Inflammation of the vessel walls

80

what is the most common form of vasculitis

giant cell arteritis

81

pathology of giant cell arteritis

– Chronic granulomatous inflammation
– Large to medium-sized arteries
– Esp. in the head (e.g. temporal arteries – AKA temporal arteritis)
– Also vertebral and ophthalmic arteries

82

morphology of giant cell arteritis

• Intimal thickening
– reduces the lumenal diameter
– Med. granulomatous inflammation
– elastic lamina fragmentation
• Multinucleated giant cells
– 75% of adequately biopsied

83

clinical features of giant cell arteritis

• Rare

84

treatment of giant cell arteritis

– Corticosteroids is generally effective
– anti-TNF therapy in refractory cases
Aneurysms

85

define aneurysm

Localised, permanent, abnormal dilatations of a blood vessel

86

what classifies a anyrsysm

shape- saccular berry, fusiform

87

what are the different types of anyersyms.

atherosclerotic
dissecting
berry
microanyersym
syphilitic
mycotic and false

88

what is the most common for of anyersysm in the elderly

atherosclerotic

89

what are the pain complications of an anyersym

– Rupture causing retroperitoneal haemorrhage
– Embolisation causing limb ischaemia.

90

define dissecting aneurysms

tear in the wall, blood tracks between intimal and medial layers,

91

symptoms of a dissecting anyersysm

– Tearing pain in chest radiating to upper left shoulder

92

define berry anyersym

• Small, saccular lesions that develop in the Circle of Willis
• Develop at sites of medial weakness at arterial bifurcations

93

what does rupture of a berry anyeursym cause

subarachnoid haemorrhage

94

what does micro and syphilitic aneurysms cause

intracerebral haemorrhage
(stroke)

95

where do charcot-bouchard aneurysms occur

intracerebral capillaries in hypertensive disease.

96

define mycotic anyersyms

weakening of the arterial wall secondary to bacterial and fungal infections.

97

what infection is mostly likely going to cause mycotic anyersyms

sub acute endocarditis

98

which arteries are commonly affected in mycotic anyersym

AAA
cerebral arteries

99

define false anyeursym

Blood filled space around a vessel, usually following traumatic rupture or perforating injury

100

the puncture of which artery commonly presents with a false aneurysm

femoral artery

101

Peripheral vascular disease can lead to what major consequence

limb ischaemia.

102

what 6 P's define ischaemia

pale, pulseless, painful, paralysed, paraesethtic, perishingly cold.