Cardiovascular Pathology Flashcards Preview

DMD2 sem 2 > Cardiovascular Pathology > Flashcards

Flashcards in Cardiovascular Pathology Deck (32)
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1
Q

What does the tunica intima consist of?

A

Single layer of endothelial cells

Basement membrane

Thin layer of ECM

2
Q

How is vascular pathology different between blockage and rupture?

A

Blockage is preceded by narrowing

Rupture is preceded by weakening

3
Q

What are the steps to vascular narrowing in response to vascular wall injury?

A

Endothelial activation

Smooth muscles develop and remodelling occurs

Intimal thickening occurs

4
Q

What are the BP values and their associated danger zones?

A

Normal = <120 systolic + <80 diastolic

Elevated = 120 - 129 systolic + <80 diastolic

High BP (hypertension) stage 1 = 130 - 139 systolic OR 80 -89 diastolic

High BP stage 2 = 140 systolic or higher OR 90+ diastolic

Hypertensive crisis = >180 systolic and/or >120 diastolic

5
Q

What is BP a function of?

A

CO x TPR

6
Q

Why should BP be controlled?

A

Increased risk of atherosclerosis

Aortic dissection

Cardiac hypertrophy

Multi-infarct dementia

Heart failure

Renal failure

7
Q

What causes hypertensive vascular disease?

A

Idiopathic or primary 90 - 95% of cases

Secondary 5 - 10%

8
Q

Why must hypertension be treated?

A

If left untreated 50% of patients may die of ischaemic heart disease

Lowering diastolic BP by 5mmHg leads to 34% reduction in stroke risk and 21% reduction in risk of ischaemic heart disease

9
Q

What is arteriolosclerosis?

A

Hardening of the arteries.

It is a generic term for arterial wall thickening and loss of elasticity

10
Q

What are the patterns of arteriolosclerosis?

A

Arteriolosclerosis of small arteries and arterioles. May cause downstream ischaemic injury

Monckeberg medial sclerosis (calcification of the wall of arteries)

Atherosclerosis (the most important)

11
Q

What determines the likelihood of atherosclerosis?

A

Acquired (Cholesterol, smoking, HTN)

Inherited (LDL, receptor gene mutations)

12
Q

What happens in the early stages of atherosclerosis?

A

Atheroma forms or atheromatous/atherosclerotic plaque. Raised lesion, soft grumous core of lipid and fibrous cap.

13
Q

What are the consequences of atherosclerosis?

A

Mechanical obstruction of blood flow

May rupture and lead to thrombosis

14
Q

What determines the risk factors for atherosclerosis?

A

Age 40 - 60

Gender (Males and females post menopause)

Genetic (rarely mendelian and often polygenic)

Hyperlipidaemia (Hypercholesterolaemia)

Hypertension

Cigarette smoking

Diabetes mellitus

15
Q

What is the myocardium composed of?

A

The left ventricle more organized spiral myocytes that contract with a coordinated wave of contraction. Right ventricle is less structured.

Atria are more haphazardly arranged and generate weaker contractile.

16
Q

What causes acute haemodynamic stress?

A

Fluid overload

Abrupt valvular dysfunction

Myocardial infarction

17
Q

Why does heart failure occur?

A

Failure of adaptive mechanisms to keep up with demands due to things like myocyte apoptosis

Intracellular cytoskeletal alterations

ECM deposition

18
Q

What is the difference between systolic and diastoic dysfunction?

A

Systolic is progressive deterioration of myocardial contractile function. (ischamic injury, inadequate adaptation to pressure or
volume overload due to hypertension or valvular
disease, or ventricular dilation)

Diastolic is due to inability of heart chamber to expand and fill sufficiently during diastole (Left ventricular hypertrophy, myocardial fibrosis, constrictive pericarditis, or amyloid deposition)

19
Q

How does right sided heart failure happen?

A

In patients with left sided heart failure

Isolated in patients with lung disorders hence the name cor pulmonale

20
Q

What lung disorders can lead to right sided heart failure?

A

Primary parenchymal lung diseases and secondary conditions affecting pulmonary vasculature (primary pulmonary hypertension and recurrent pulmonary thromboembolism)

Pulmonary vasoconstriction (obstructive sleep apnea and altitude sickness)

21
Q

What are the patterns of MI?

A

Transmural

Subendocardial

multifocal

22
Q

How quick do the following return to normal after MI:

Troponin I

CK-MB

cTNT

A

Troponin I = 5 - 10 days hours

CK-MB = 48 - 72 hours

cTnT = 5 to 14 days

23
Q

What are the types of angina pectoris?

A

Stable = relieved by rest

Prinzmetal variant = Anginal attacks unrelated to physical activity

Unstable = Caused by disruption of an atherosclerotic plaque with superimposed partial thrombosis and possibly embolization or vasospasm

24
Q

What is the difference between valvular stenosis and insufficiency?

A

Stenosis = failure of valve to open completely

Insufficiency = failure of valve to close completely

25
Q

What causes aortic stenosis?

A

Calcification and sclerosis anatomically normal or congenitally bicuspid aortic valves

26
Q

What causes aortic insufficiency?

A

Dilation of ascending aorta, often secondary to hypertension and/or aging

27
Q

What causes mitral stenosis?

A

Rheumatic heart disease

28
Q

What causes mitral insufficiency?

A

Myxomatous degeneration

29
Q

Which conditions need antibiotic prophylaxis following dental procedures?

A

History of infective endocarditis

Prosthetic cardiac valve or prosthetic material used for cardiac valve repair

Cardiac transplant that develops cardial valvulopathy

Unrepaired cyanotic congenital heart disease

Completely repaired congenital heart defect with prosthetic material or device

Any repaired congenital defect with residual defect at the site or adjacent to the site

30
Q

Which dental procedures need antibiotic prophylaxis?

A

Manipulation of the periapical region of the teeth

Manipulation of gingival tissue

Perforation of the oral mucosa

31
Q

Do not need prophylaxis:

A

Routine anesthetic injections through non-infected
tissue
• Taking dental radiographs
• Placement of removable prosthodontic appliances
• Placement of removable orthodontic appliances
• Adjustment of orthodontic appliances
• Placement of orthodontic brackets
• Shedding of deciduous teeth
• Bleeding from trauma to the lips or oral mucosa.

32
Q

What should be provided to IE patients before their appointment?

A

Oral: Amoxicillin 2g for adults 50mg/kg for children

no oral: IM or IV 2g ampicillin or 1g cefazolin or ceftriaxone

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