CP8-1 cardiovascular pathology 1

Question 1

What is the epidemiology of CVD?

Answer 1

7.6 million people have CVD
85 people per day die of an MI

Question 2

What is ischaemic heart disease?

Answer 2

the name for the group of coronary syndromes which are caused by myocardial ischaemia

Question 3

What is the aetiology of ischaemic heart disease?

Answer 3

almost always due to coronary artery atherosclerosis and sometimes due to hypertrophy

Question 4

What are the 4 syndromes classed as ischaemic heart diseases?

Answer 4

MI
Angina - stable/unstable/prinzmetal
Chronic ischaemic heart disease and heart failure
Sudden cardiac death related to coronary atherosclerosis

Question 5

What 3 diseases are classed as acute coronary syndrome?

Answer 5

MI
Unstable angina
Sudden cardiac death

Question 6

What is the epidemiology of IHD?

Answer 6

Prevalence highest in northern England and Scotland in the UK

Question 7

What are some medical risk factors for IHD?

Answer 7

High BP
High blood cholesterol
Diabetes

Question 8

What are some lifestyle risk factors for IHD?

Answer 8

smoking
overweight
lack of exercise

Question 9

What is the pathogenesis of IHD?

Answer 9

Fixed vessel narrowing and abnormal vascular tone due to atherosclerosis and endothelial dysfunction leads to imbalance between myocardial oxygen supply and demand

Question 10

What is an MI?

Answer 10

Death of cardiac muscle due to prolonged ischaemia

Question 11

What are the two types of MI?

Answer 11

Transmural
Subendocardial

Question 12

What is the pathophysiology of MI?

Answer 12

Acute plaque changes cause platelet aggregation causing thrombus formation leading to full/partial occlusion of coronary artery(s)

Question 13

What is the histology of the heart like 1-2 days after death?

Answer 13

pale with oedema, necrosis and high level of neutrophils

Question 14

What is the histology of the heart like 3-4 days after death?

Answer 14

yellow with haemorrhagic edge, necrosis and macrophages

Question 15

What is the histology of the heart like 1-3 weeks after death?

Answer 15

pale, thin with granulation tissue and then fibrosis

Question 16

What is the histology of the heart like 3-6 weeks after death?

Answer 16

a dense fibrous scar

Question 17

What are some complications of an MI?

Answer 17

Arrhythmias - if conduction system structures damaged e.g. SA node
Congestive cardiac failure - due to contractility dysfunction or papillary muscle infarct
Thromboembolism
Pericarditis
Cardiac tamponade
Cardiogenic shock

Question 18

What can impaired contractility as a result of an MI lead to?

Answer 18

Stroke due to embolism
Cardiogenic shock
Congestive heart failure

Question 19

What can tissue necrosis as a result of an MI lead to?

Answer 19

Congestive heart failure
Cardiac tamponade

Question 20

What can electrical instability due to an MI lead to?

Answer 20

arrhythmias

Question 21

What can pericardial inflammation as a result of an MI lead to?

Answer 21

pericarditis

Question 22

What are some detectable blood markers which indicated IHD?

Answer 22

troponins
creatine kinase
myoglobin
lactate dehydrogenase
aspartate transaminase

Question 23

What are the two types of hypertension?

Answer 23

Primary - idiopathic of essential
Secondary

Question 24

How is hypertension defined?

Answer 24

a sustained diastolic pressure greater than 90 mm Hg or sustained systolic pressure greater than 140 mm Hg

Question 25

What is the aetiology of primary hypertension?

Answer 25

Largely idiopathic but suspected multifactorial cause including genetic factors e.g. insulin resistance and environmental factors e.g. obesity and smoking

Question 26

What is the epidemiology of hypertension?

Answer 26

About 1 in 7 people globally Around a 1/3 of adults in England Africans affected more

Question 27

How is bp calculated?

Answer 27

Cardiac output x peripheral resistance

Question 28

What system is involved in maintaining BP?

Answer 28

Renin-angiotensin-aldosterone system

Question 29

How does the renin-angiotensin-aldosterone system work?

Answer 29

1. When there is a drop in BP or fluid vol, the kidney releases renin. 2. Renin acts on angiotensin from the liver to form angiotensin I 3. ACE release from the lungs acts on angiotensin I to form angiotensin II 4a. Angiotensin II acts directly on blood vessels to stimulate vasoconstriction 4b. Angiotensin II acts on the adrenal gland to stimulate the release of aldosterone which acts on the kidney to stimulate reabsorption of salt and water.

Question 30

What is an example of a drug which works on the renin-angiotensin-aldosterone system?

Answer 30

ACE inhibitors (suffix = pril e.g. ramipril)

Question 31

What are the roles of angiotensin II?

Answer 31

- Increase systemic vascular resistance and arterial pressure via vasoconstriction - Increases sodium and water retention by stimulating sodium reabsorption in the kidneys and aldosterone release by the adrenal cortex - Also increases fluid retention by stimulating the release of ADH vasopressin - Facilitates norepinephrine release from sympathetic nerve enhancing sympathetic adrenergic functions - Stimulates cardiac and vascular hypertrophy

Question 32

What are the subcategories of secondary hypertension?

Answer 32

Endocrine Adrenal Renal CVS Drugs

Question 33

What are some endocrine causes of secondary hypertension?

Answer 33

cushing's syndrome acromegaly thyroid disease hyperparathyroid disease

Question 34

What are some adrenal causes of secondary hypertension?

Answer 34

Conn's disease adrenal hyperplasia pheochromocy toma

Question 35

What are some renal causes of secondary hypertension?

Question 36

What are some CVS causes of secondary hypertension?

Answer 36

aortic coarctation renal artery stenosis polyarteritis nodosa

Question 37

What are some drugs which can cause secondary hypertension?

Question 38

What is malignant hypertension?

Question 39

What are some complications of hypertension?

Answer 39

Hypertensive renal disease Hypertensive cerebrovascular disease e.g. strokes Hypertensive heart disease

Question 40

What is left sided hypertensive heart disease?

Answer 40

Hypertrophy of the heart as an adaptive response to hypertension leading to myocardial dilation, congestive heart failure and sudden death

Question 41

What is the criteria for diagnosis hypertensive heart disease?

Answer 41

Left ventricular concentric hypertrophy alongside a history or pathological evidence of hypertension

Question 42

What is cor pulmonale?

Answer 42

Right sided heart disease where there is hypertrophy, dilation and potentially heart failure secondary to pulmonary artery hypertension due to disorders of the lung or pulmonary vasculature

Question 43

What causes of right ventricular hypertrophy mean cor pulmonale is not diagnosed?

Answer 43

if right sided hypertrophy is due to congenital causes or as a result of left sided hypertrophy

Question 44

What are some diseases of the pulmonary parenchyma that lead to cor pulmonale?

Question 45

What are some diseases of the pulmonary vessels that lead to cor pulmonale?

Question 46

What are some disorders of chest movement that lead to cor pulmonale?

Answer 46

neuromuscular disease Kyphoscoliosis marked obesity (Pickwickian syndrome)

Question 47

What are some disorders causing pulmonary arterial compression that lead to cor pulmonale?

Question 48

What is an aneurysm?

Question 49

What are the two types of aneurysm?

Answer 49

true aneurysm - when bounded by arterial wall components/attenuated wall of the heart false aneurysm - a breach of the vascular wall leading to extravascular hematoma that freely communicates with the intravascular space aka pulsating haematoma

Question 50

What is a true aneurysm?

Question 51

What is a false aneurysm?

Question 52

What is an arterial dissection?

Question 53

What is a type of aortic dissection?

Answer 53

A double barrelled aorta

Question 54

What is the aetiology of aneurysms?

Question 55

What are some types of aneurysms?

Answer 55

AAA - abdominal aortic aneurysm Berry aneurysms Mycotic aneurysm Syphilitic (leutic) aneurysms

Question 56

At what size does an AAA require surgical repair?

Answer 56

>5.5 cm

Question 57

What are some risk factors for aneurysm?

Answer 57

Smoking Hypertension Advanced age Being male