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Flashcards in Cardiovascular Diseases 3 Deck (99):
1

Inflammation of the endocardium of the heart 'vegetations on valves'

Endocarditis

2

2 main types of endocarditis

Infective
Non-infective

3

Describe the vegetations of infective endocarditis

mixture of thrombotic debris and organisms
destroy underlying cardiac tissue

4

What are the 2 types of infective endocarditis?

Acute and subacute

5

Which is caused by more virulent organisms, subacute or acute infective endocarditis?

Acute

6

Describe the vegetations of acute infective endocarditis

Friable, bulky, potentially destructive vegetations. Ring abscess

7

Which is more easily treatable with antibiotics; acute or subacute endocarditis?

Sub-acute

8

Risk factors for infective endocarditis

Cardiac/valvular abnormalities
MV prolapse
Valvular stenosis
Artificial valves
Unrepaired congenital defects
Bicuspid AV

9

Causative organisms of infective endocaridits

Streptococcus viridans
Staph A.
Coagulase -ve staphylococci

10

Which organisms can cause endocarditis, from prosthetic heart valves

Coagulase -ve staphylococci

11

Which organims can cause infective endocarditis from the mouth?

Streptococcus viridans

12

Clinical features of IE

Fever
Murmurs
Splinter haemorrhages
Janeway lesions
Oslers's nodes
Roth Spots

13

Erythematous or haemorrhagic non tender lesions on the palms or soles

Janeway lesions

14

Subcutaneous nodules in the pulp of the digits

Osler's nodes

15

Retinal haemorrhages in the eyes

Roth spots

16

Complications of IE

Immunologically mediated conditions e.g. glomerulonephritis

17

2 types of non infective endocarditis

Non bacterial thrombotic endocarditis (NBTE)
Libman Sacks endocarditis

18

In which patients do you get NBTE

cancer or sepsis.
a hypercoagulable state (DVT, PE and mucinous adenocarcinomas)
indwelling catheter lines

19

NBTE is part of what syndrome?

Trousseau syndrome of migratory thrombophlebitis

20

Describe the vegetations if NBTE

Small, sterile thrombi on valve leaflets. Single or multiple on line of closure of leaflets or cusps.

21

What are the effects of NBTE

non invasive/no inflammatory reaction>minimal local effect
Systemic emboli infarcts in the brain, heart etc

22

What type of endocarditis is associated with SLE

Libman Sacks

23

What valves are affected in libman sacks endocarditis?

Mitral and tricuspid valves

24

What are the effects of libman sacks endocarditis?

Usually asymptomatic, rarely cardiac failure or systemic emboli

25

Describe the vegetations of libman sacks endocarditis

Small (1-4mm), sterile, pink warty vegetations. Single or multiple

26

Rheumatic fever is an acute, immunologically mediated, multi-system inflammatory disease following what infection?

Group A steptococcal pharyngitis- causes scarlet's fever

27

What are the distinctive cardiac lesions, made up of T-cells, plasma cells and macrophages found in rheumatic fever?

Aschoff bodies

28

What are the vegetations called in rheumatic fever?

Venuccae

29

Pathological features of rheumatic fever

Vegtations (venuccae)
Mitral valve changes
Fish mouth or buttonhole stenoses- fibrous bridging of valvular commissures and calcification

30

Causes of rheumatic fever

Hypersensitivity reaction
Immune responses to group A strep (pharyngitis)

31

What criteria is used to diagnose rheumatic fever?

Jone's criteria

32

Clinical features of rheumatic fever

Carditis
polyarthritis
chorea (neurological condition causing jerky movements)
erythema margination
subcutaneous nodules
fever
arthralgia

33

Inflammation fo the pericardial sac

Pericarditis

34

Causes of pericarditis

Infections e.g. viruses (cocksackie B), bacteria, fungi etc
Immunologically mediated processes- rheumatic fever, SLE, scleroderma, post MI (Dressler's)

35

5 Types of acute pericarditis

Serous
Serofibrinous/fibrinous
Purulent/suppurative
Haemorrhagic
Caseous

36

3 types of chronic pericarditis

Adhesive
Adhesive mediastinopericarditis
Constricive pericarditis

37

A type of pericarditis involving inflammation which causes serous fluid accumulations

Serous pericarditis

38

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

39

Most common form of pericaridits

Serofibrinous pericarditis

40

A type of pericarditis; serous fluid and/or fibrinous exudate in pericardiat sac

Serofibrinous pericarditis

41

Common causes of serofibrinous pericarditis

Acute MI, Dressler's syndrome
Uraemia, radiation, rheumatic fever, SLE, trauma, surgery

42

Features of serofibrinous pericarditis

Dry, granular, roughened surface

43

Causes of purulent/suppurative pericarditis

Infections

44

Features of purulent/suppurative pericardiits

Red, granular, exudate i.e. pus

45

Complications of purulent/suppurative pericarditis (rare)

Mediastino-pericarditis
Restrictive pericarditis- serious

46

A type of pericarditis where blood is mixed with serous (water) or suppurative (pus) effusion

Haemorrhagic pericarditis

47

Causes of haemorrhagic pericarditis

Neoplasia
Infections e.g. TB
Following cardiac surgery - cardiac tamponade

48

Causes of caseous pericarditis

TB or fungal

49

Type of pericarditis with fibrinous/stringy adhesions obliterating pericardial cavity

Adhesive pericarditis

50

Type of pericarditis which obliterates pericardial cavity with adherence to surrounding structures. Causes cardiac hypertrophy/dilation

Adhesive mediastinopericarditis

51

A type of pericarditis where the heart is encased in a fibrous scar- limit cardiac function and only treatment is surgery

Constrictive pericarditis

52

Dressler's syndrome occurs post MI and is clinical triad of what 3 features?

Fever
Pleuritic chest pain
Pericardial effusion

53

Autoimmune reaction to antigens released following MI

Dressler's syndrome

54

3 clinical features of pericarditis

Sharp,central chest pain
Pericardial friction rub
Fever, leucocytosis, lymphocytosis, pericardial effusion

55

How is chest pain in pericarditis relieved?

Sitting forwards

56

Chest pain in pericarditis radiates where?

Shoulders/neck

57

Complications of pericarditis?

Cardiac tamponade/pericardial effusion

58

Disorders of the myocardium

Cardiomyopathies

59

4 types of cardiomyopathies

Dilated
Hypertrophic
Restrictive
Arrythmogenic right ventricular cardiomyopathy

60

Describe the features of the heart in dilated cardiomyopahty

Flabby- heart enlarged and heavy
Myocyte hypertrophy with fibrosis

61

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

62

Clinical features of cardiomyopathy

Present in 20s-50s with
Shortness of breath
Fatigue
Poor exertional capacity

63

Treatment for dilated cardiomyopathy

Cardiac transplantation
Long term ventricular assist

64

Most common cause of sudden death in athletes

Hypertrophic cardiomyopathy

65

Type of cardiomyopathy- poorly compliant mycocardium, 'stiff' LV

Hypertrophic cardiomyopahty

66

In hypertrophic cardiomyopathy, is diasolic or systolic function abnormal?

Diastolic, systolic function is preserved

67

Causes of hypertrophic cardiomyopathy

100% genetic. Mutations in sarcomeric proteins- myofibre disarray

68

3 clinical features of hypertrophic cardiomyopathy

Decreased stroke volume- impaired diastolic filling
Obstruction to left ventricular outflow
Systolic ejection murmur

69

4 Complications of DCM/HCM

Heart failure
Sudden death
Atrial fibrillation
Stroke

70

Treatment for HCM

Decrease heart rate and contractility- beta adrenergic blockers

71

Causes of restrictive cardiomyopahty

Primary decrease in ventricular complicance (impared function during diastole)
Secondary (infiltration)- fibrosis, amyloidosis, sarcoidosis, metastatic tumours or deposition of metabolites

72

Genetic disease that results in RV dilation and myocardial thinning- fibrofatty replacement of RV

Arrythmogenic RB cardiomyopathy

73

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.

74

Infective or inflammatory process resulting in myocardial injury

Myocarditis

75

Clinical features of myocarditis

Asymptomatic
Heart failure, arrythmias and sudden death
Non-specific symptoms
Can mimic acute MI

76

Infectious causes of myocarditis

Viruses (cocksackie A&B, influenza, HIV, CMV)
Bacteria
Fungi
Protozoe-tryponosoma cruzi
Helminths

77

Immune mediated causes of myocarditis

Post viral
post streptococcal (RF)
SLE
Drugs
Transplant rejection

78

Other causes of myocarditis

Sarcoidosis
Giant cell myocarditis

79

Inflammation of vessel walls, any organ, any vessel size

Vasculitis

80

The name of the nomenclature for vasculitis, based on affected vessel size

Chapel Hill

81

Most common form of vasculitis (medial emergency)

Giant cell arteritis

82

Describe the pathology of giant cell arterieis

Chronic granulomatous inflammation- large>medium sized arteries
Segmental disease

83

Common arteries affected by GCA?

Temporal arteries
Opthalmic arteris- permanent blindness

84

Symptoms of GCA

Vague symptoms e.g. fatigue, weith loss, facial pain or headache- painful to palpate superficial temporal artery, jaw claudication

85

Treatment for GCA

Corticosteroids
Anti-TNF

86

Localised, permanent, abnormal dilatations of a blood vessel

Aneurysms

87

Name 7 aneuryms based on their aetiology

Atherosclerotic
Dissecting
Berry
Microaneurysm
Syphilitis
Mycotic
False

88

Name 2 aneurysms based on shape

Saccular
Fusiform

89

Most common aneurysm

Atherosclerotic

90

Type of aneurysm- tear in the wall, blood tracks between intimal and medial layers

Dissecting aneurysm

91

Symptoms of a dissecting aneurysm

Tearing pain in chest radiating to upper left shoulder, usually thoracic aorta, secondary to systemic hypertension.

92

Type of aneurysm- small,saccular lesions that develop in the circle of willis. Develop at sites of medial weakness at arterial bifurcations.

Berry aneurysms

93

Ruptures of berry aneurysm can have what effect?

Subarachnoid haemorrhage

94

Charcot-Bouchard and Retinal are what type of aneuryms

Micro and syphilitis

95

A type of micro and syphility aneurysm that occurs in intracerebral capillaries in hypertensive disease, can cause strokes

Charcot-Bouchard aneurysms

96

A type of rare aneurysm- weakening of arterial wall secondary to bacterial infection e.g. subaute bacterial endocarditis. Often in cerebal arteries

Mycotic aneurysm

97

A type of aneurysm; blood filled space around a vessel, usually following traumatic fupture or perforating injury

False

98

Where is the haematoma in false aneurysms?

In the adventitial fibrous tissue

99

What are the 6ps of acute ischaemia

Pale
Puseless
Painful
Perishingly cold
Parasthtic
Paralysed