Flashcards in Cardiovascular Diseases 3 Deck (99):
Inflammation of the endocardium of the heart 'vegetations on valves'
2 main types of endocarditis
Describe the vegetations of infective endocarditis
mixture of thrombotic debris and organisms
destroy underlying cardiac tissue
What are the 2 types of infective endocarditis?
Acute and subacute
Which is caused by more virulent organisms, subacute or acute infective endocarditis?
Describe the vegetations of acute infective endocarditis
Friable, bulky, potentially destructive vegetations. Ring abscess
Which is more easily treatable with antibiotics; acute or subacute endocarditis?
Risk factors for infective endocarditis
Unrepaired congenital defects
Causative organisms of infective endocaridits
Coagulase -ve staphylococci
Which organisms can cause endocarditis, from prosthetic heart valves
Coagulase -ve staphylococci
Which organims can cause infective endocarditis from the mouth?
Clinical features of IE
Erythematous or haemorrhagic non tender lesions on the palms or soles
Subcutaneous nodules in the pulp of the digits
Retinal haemorrhages in the eyes
Complications of IE
Immunologically mediated conditions e.g. glomerulonephritis
2 types of non infective endocarditis
Non bacterial thrombotic endocarditis (NBTE)
Libman Sacks endocarditis
In which patients do you get NBTE
cancer or sepsis.
a hypercoagulable state (DVT, PE and mucinous adenocarcinomas)
indwelling catheter lines
NBTE is part of what syndrome?
Trousseau syndrome of migratory thrombophlebitis
Describe the vegetations if NBTE
Small, sterile thrombi on valve leaflets. Single or multiple on line of closure of leaflets or cusps.
What are the effects of NBTE
non invasive/no inflammatory reaction>minimal local effect
Systemic emboli infarcts in the brain, heart etc
What type of endocarditis is associated with SLE
What valves are affected in libman sacks endocarditis?
Mitral and tricuspid valves
What are the effects of libman sacks endocarditis?
Usually asymptomatic, rarely cardiac failure or systemic emboli
Describe the vegetations of libman sacks endocarditis
Small (1-4mm), sterile, pink warty vegetations. Single or multiple
Rheumatic fever is an acute, immunologically mediated, multi-system inflammatory disease following what infection?
Group A steptococcal pharyngitis- causes scarlet's fever
What are the distinctive cardiac lesions, made up of T-cells, plasma cells and macrophages found in rheumatic fever?
What are the vegetations called in rheumatic fever?
Pathological features of rheumatic fever
Mitral valve changes
Fish mouth or buttonhole stenoses- fibrous bridging of valvular commissures and calcification
Causes of rheumatic fever
Immune responses to group A strep (pharyngitis)
What criteria is used to diagnose rheumatic fever?
Clinical features of rheumatic fever
chorea (neurological condition causing jerky movements)
Inflammation fo the pericardial sac
Causes of pericarditis
Infections e.g. viruses (cocksackie B), bacteria, fungi etc
Immunologically mediated processes- rheumatic fever, SLE, scleroderma, post MI (Dressler's)
5 Types of acute pericarditis
3 types of chronic pericarditis
A type of pericarditis involving inflammation which causes serous fluid accumulations
Causes of serous pericarditis
Inflammation in adjacent structures
Viral pericarditis (cocksackie B/echinovirus)
Immunologically mediated processes- rheumatic fever, SLE, scleroderma
Misc. conditions- uraemia, neoplasia, radiation
Most common form of pericaridits
A type of pericarditis; serous fluid and/or fibrinous exudate in pericardiat sac
Common causes of serofibrinous pericarditis
Acute MI, Dressler's syndrome
Uraemia, radiation, rheumatic fever, SLE, trauma, surgery
Features of serofibrinous pericarditis
Dry, granular, roughened surface
Causes of purulent/suppurative pericarditis
Features of purulent/suppurative pericardiits
Red, granular, exudate i.e. pus
Complications of purulent/suppurative pericarditis (rare)
Restrictive pericarditis- serious
A type of pericarditis where blood is mixed with serous (water) or suppurative (pus) effusion
Causes of haemorrhagic pericarditis
Infections e.g. TB
Following cardiac surgery - cardiac tamponade
Causes of caseous pericarditis
TB or fungal
Type of pericarditis with fibrinous/stringy adhesions obliterating pericardial cavity
Type of pericarditis which obliterates pericardial cavity with adherence to surrounding structures. Causes cardiac hypertrophy/dilation
A type of pericarditis where the heart is encased in a fibrous scar- limit cardiac function and only treatment is surgery
Dressler's syndrome occurs post MI and is clinical triad of what 3 features?
Pleuritic chest pain
Autoimmune reaction to antigens released following MI
3 clinical features of pericarditis
Sharp,central chest pain
Pericardial friction rub
Fever, leucocytosis, lymphocytosis, pericardial effusion
How is chest pain in pericarditis relieved?
Chest pain in pericarditis radiates where?
Complications of pericarditis?
Cardiac tamponade/pericardial effusion
Disorders of the myocardium
4 types of cardiomyopathies
Arrythmogenic right ventricular cardiomyopathy
Describe the features of the heart in dilated cardiomyopahty
Flabby- heart enlarged and heavy
Myocyte hypertrophy with fibrosis
Causes of dilated cardiomyopahty
Genetic- AD mainly, affects cytoskeleton proteins
Alcohol and other toxins e.g. chemotherapy
Others-SLE, scleroderma, thiamine def, acromegaly, thyrotoxicosis, diabetes etc
Clinical features of cardiomyopathy
Present in 20s-50s with
Shortness of breath
Poor exertional capacity
Treatment for dilated cardiomyopathy
Long term ventricular assist
Most common cause of sudden death in athletes
Type of cardiomyopathy- poorly compliant mycocardium, 'stiff' LV
In hypertrophic cardiomyopathy, is diasolic or systolic function abnormal?
Diastolic, systolic function is preserved
Causes of hypertrophic cardiomyopathy
100% genetic. Mutations in sarcomeric proteins- myofibre disarray
3 clinical features of hypertrophic cardiomyopathy
Decreased stroke volume- impaired diastolic filling
Obstruction to left ventricular outflow
Systolic ejection murmur
4 Complications of DCM/HCM
Treatment for HCM
Decrease heart rate and contractility- beta adrenergic blockers
Causes of restrictive cardiomyopahty
Primary decrease in ventricular complicance (impared function during diastole)
Secondary (infiltration)- fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites
Genetic disease that results in RV dilation and myocardial thinning- fibrofatty replacement of RV
Arrythmogenic RB cardiomyopathy
When do you get sudden cardiac death with arrythmogenic right ventricular cardiomyopathy?
Fibrofatty replacement of RB due to disorder of cell-cell desmosomes. With excercise, cells detach and die.
Infective or inflammatory process resulting in myocardial injury
Clinical features of myocarditis
Heart failure, arrythmias and sudden death
Can mimic acute MI
Infectious causes of myocarditis
Viruses (cocksackie A&B, influenza, HIV, CMV)
Immune mediated causes of myocarditis
post streptococcal (RF)
Other causes of myocarditis
Giant cell myocarditis
Inflammation of vessel walls, any organ, any vessel size
The name of the nomenclature for vasculitis, based on affected vessel size
Most common form of vasculitis (medial emergency)
Giant cell arteritis
Describe the pathology of giant cell arterieis
Chronic granulomatous inflammation- large>medium sized arteries
Common arteries affected by GCA?
Opthalmic arteris- permanent blindness
Symptoms of GCA
Vague symptoms e.g. fatigue, weith loss, facial pain or headache- painful to palpate superficial temporal artery, jaw claudication
Treatment for GCA
Localised, permanent, abnormal dilatations of a blood vessel
Name 7 aneuryms based on their aetiology
Name 2 aneurysms based on shape
Most common aneurysm
Type of aneurysm- tear in the wall, blood tracks between intimal and medial layers
Symptoms of a dissecting aneurysm
Tearing pain in chest radiating to upper left shoulder, usually thoracic aorta, secondary to systemic hypertension.
Type of aneurysm- small,saccular lesions that develop in the circle of willis. Develop at sites of medial weakness at arterial bifurcations.
Ruptures of berry aneurysm can have what effect?
Charcot-Bouchard and Retinal are what type of aneuryms
Micro and syphilitis
A type of micro and syphility aneurysm that occurs in intracerebral capillaries in hypertensive disease, can cause strokes
A type of rare aneurysm- weakening of arterial wall secondary to bacterial infection e.g. subaute bacterial endocarditis. Often in cerebal arteries
A type of aneurysm; blood filled space around a vessel, usually following traumatic fupture or perforating injury
Where is the haematoma in false aneurysms?
In the adventitial fibrous tissue