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CVS Flashcards

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1
Q

What is rheumatic fever

A

Autoimmune collagen disease

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2
Q

What is the etiology of rheumatic fever

A

URTI with beta hemolytic streptococcus group A

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3
Q

What are the predisposing factors of rheumatic fever

A
  • low immunity
  • crowding
  • genetic factor
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4
Q

What is the pathogenesis of rheumatic fever

A
  • Elevation of ASO antibody in blood to attach the bacteria
  • cross reaction as the antibody attack the heart&raquo_space;>complement activation»> activation of macrophages
  • CD4 attack the heart»> cytokine mediated inflammation»»> fibrinoid necrosis
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5
Q

What is the pathogenetic lesion of RH rheumatic fever

A

The aschoff nodule

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6
Q

Sites of aschoff nodule

A

Heart
Skin
Joints
CNS basal ganglia

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7
Q

Gross picture of aschoff nodule

A

Small
Rounded
Pale grey
Firm

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8
Q

Microscopic picture of aschoff nodule

A 
Early
- fibrinoid necrosis surrounded by inflammatory cells ( macrophages and lymphocytes)
- fibroblasts
- aniskow cells
- aschoff giant cells
Chronic
- fibrosis and calcification
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9
Q

What is pan carditis

A

Myocarditis + endocarditis + pericarditis

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10
Q

What is the common site of acute rheumatic heart disease

A

The posterior wall of left atrium

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11
Q

Explain myocarditis of acute rheumatic heart disease

A

Multiple aschoff nodules

No complications

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12
Q

Explain pericarditis of acute rheumatic heart disease

A 
Sero fibrinous inflammation
( Bread and butter )
Fate:- 
Resolution or 
organization
        ↓                                                             By fibrosis >>> adhesion                                         ( milky patches )
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13
Q

Explain endocarditis of acute rheumatic heart disease

A
  • Mural endocarditis
    • early > aschoff nodules
    • late > Mc Callum patch ( fibrised endothelium) > mural thrombosis > may embolism
  • Valvular endocarditis
    Early > swollen valve > endothelial damage > vegetations
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14
Q

Gross picture of vegetations of valvular endocarditis of acute rheumatic heart disease

A

Small
Pale
Along the line of closure
Adherent

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15
Q

Microscopic picture of vegetations of valvular endocarditis of acute rheumatic heart disease

A

Platelets and fibrin

Subendothelial aschoff nodules

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16
Q

Chronic rheumatic heart disease

A
  • aschoff nodules >fibrosis
  • valve > fibrosis > white thick and deformed
  • double valve lesion ( stenosis and incompetence)
    Thick and short cordae tendenae > funnel shaped valve
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17
Q

Complications of chronic rheumatic heart disease

A 
A F S H
arrhythmia
Fibrosis
Subacute bacterial endocarditis
Heart failure
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18
Q

4 INFORMATION of rheumatic arthritis

A

Migratory
Self limiting
Serous inflammation
Large joints

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19
Q

2 INFORMATION of rheumatic skin lesion

A

_ erythema marginatum

_ subconscious nodules over bony prominences

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20
Q

1 INFORMATION of rheumatic chorea

A

Involuntary. Purposeless. Sudden movement

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21
Q

What is Jone’s chriteria

A

For diagnosis of rheumatic heart disease

2 major or 1 major and 2 minor

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22
Q

What are minor signs of rheumatic heart disease

A

Fever
↑ ASO
↑ESR
arthralgia

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23
Q

What is endocarditis

A

Inflammation of mural or valvular endocardium with formation of vegetations

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24
Q

Types of endocarditis=

A

Types of vegetations

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25
What are types of endocarditis
NON INFECTIVE (RAT ) - Rheumatic - atypical verrucous - thrombotic non bacterial - valve lesion ( truma or carcinoid syndrome) INFECTIVE - acute bacterial - subacute bacterial
26
What are the aetiology of acute infective endocarditis
Low immunity + highly virulent pyogenic bacteria>>>septicemia
27
Pathogenesis of acute infective endocarditis
Pyogenic bacteria >>> proliferation on health heart >>> suppurative inflammation >>>suppurative vegetations
28
Morphology of valve in acute infective endocarditis
Suppurative inflammation >>> ulceration >>> perforation
29
Morphology of vegetations of acute infective endocarditis
Large - bulky - friable Microscopic>> platelets+ bacteria+ pus
30
Cardiac complications of acute infective endocarditis
- Valve perforation >>> acute heart failure >>> sudden death - abscess of myocardium and pericardium
31
Extra cardiac complications of acute infective endocarditis
- emboli >>> pyemia >>> multiple abscess | - toxemia
32
Aetiology of subacute infective endocarditis
Low virulent bacteria as streptococcus veridance >>> bacteremia + Dental procedure or diseased valve or defective shunt or IV drug abuse
33
Pathogenesis of subacute infective endocarditis
Weak bacteria >>> proliferation inside vegetations of diseased valve >>> non suppurative inflammation
34
Cardiac complications of subacute infective endocarditis
Double valve lesion >>> heart failure
35
Extra cardiac complications of subacute infective endocarditis
* infarction As cardiac or cerebral Mycotic aneurysm * Allergic vasculitis - focal embolic GN ( flea bitten kidney ) - finger lesion as osler nodules or splinter hemorrhage - peticheal hemorrhage in skin and retina
36
Site of vegetations of rheumatic heart
Left valves ( mitral and aortic ) upper surface
37
Site of vegetations in ABE
Left valves ( mitral and aortic ) upper surface
38
Site of vegetations in SBE
Left valves ( mitral and aortic ) upper surface
39
Site of vegetations in atypical verrucous
Anywhere
40
Site of vegetations in non bacterial thrombotic
Any value upper surface
41
What is the etiology of atypical verrucous
SLE
42
What are the aetiology of non bacterial thrombotic
- DIC ( dissiminated intravascular coagulation) - debilitating disease - damaged valve by trauma
43
Causes of mitral stenosis
- rheumatic heart - SBE - congenital
44
Pathological effects of mitral stenosis
* left atrium >> dilatation and hypertrophy >> lung congestion >> pulmonary hypertension >> right ventricle dilatation and hypertrophy >> right side heart failure * All champers are dilated except left ventricle
45
Causes of mitral incompetence
- rheumatic heart - SBE - congenital ( Marfan or valve prolapse ) - ruptured papillae or chorda
46
Pathological effects of mitral incompetence
Left side dilatation and hypertrophy >> left side heart failure >> lung congestion >> pulmonary hypertension >> right ventricle dilatation and hypertrophy >> right side heart failure
47
Causes of aortic stenosis
- Rheumatic - SBE - congenital - senile due to atherosclerosis and calcification
48
Pathological effects of aortic stenosis
Left side heart failure >> cerebral and coronary insufficiency >>> Right side heart failure
49
Causes of aortic incompetence
- rheumatic heart - SBE - congenital - syphilitic aneurysm
50
Pathological effects of aortic incompetence
Left side dilatation and hypertrophy >> failure >>> right side heart failure
51
All valvular diseases are complicated with
- thrombosis - SBE - heart failure
52
What are the degenerative valve diseases
- calcified aortic stenosis | - myxomatous mitral valve prolapse
53
Causes of myxomatous mitral valve prolapse
Marfan or hemodynamic injury
54
Diseases of myocardium
- inflammation>>> myocarditis - ischemia >>> infarction - non neoplastic , non inflammatory , non ischemic>>> cardiomyopathy
55
Types of myocarditis
PIGS - parenchymatous - interstitial - granulomatous - suppurative
56
Causes of parenchymatous myocarditis
- Most common> parasitic infection ( trichinella ) | - toxins
57
Inflammatory cells in parenchymatous myocarditis
Eosinophils
58
Causes of interstitial myocarditis
Viral infection ( coxsackie )
59
Inflammatory cells in interstitial myocarditis
Lymphocytes
60
Causes of granulomatous myocarditis
- most >>Rheumatic - TB - sarcoidosis - syphilis
61
What is fiedler myocarditis
``` A type of granulomatous myocarditis which # idiopathic # affects young adults # rheumatic or thymoma patients # chronic inflammatory cells and elongated giant cells ```
62
Types of pulmonary hypertension
* acute due to massive pulmonary embolism * Chronic due to ( lung fibrosis - lung emphysema - lung congestion )
63
What are degenerative heart diseases
They are reversible - brown atrophy - cloudy swelling - fatty change - amyloidosis - glycogen storage
64
What is Von Gierk's disease
Congenital glycogen storage
65
Morphological types of cardiomyopathy
* dilated * hypertrophic * Restrictive
66
Dilated cardiomyopathy
- most common - causes. ( ABCD ) > Alcohol > Beri beri > Congenital > Drugs as chemotherapy - all champers are dilated - systolic dysfunction
67
Hypertrophic cardiomyopathy
- congenital - asymmetrical hypertrophy of left ventricle and ventricular septum - banana shaped ventricle - diastolic dysfunction
68
Restrictive cardiomyopathy
- rare - amyloidosis - thickening of endocardium and myocardium by fibrosis ( endomyocardial fibrosis ) due to starvation or eosinophilia due to parasitic infection ( loffler )
69
Causes of ischemic heart diseases
- aortic insufficiency - coronary insufficiency - increased cardiac work - insufficient blood
70
Aortic insufficiency in IHD
- aortic aneurysm - aortic coarctation - aortic stenosis - aortic incompetence
71
Coronary insufficiency in IHD
- atherosclerosis - thrombosis or embolism - spasm - vasculitis
72
Increased cardiac work in IHD
- hypertrophy - hypertension - aortic stenosis
73
Insufficient blood in IHD
- hypoxia - hypotension - anemia - CO toxicity
74
Types of angina
``` 1- stable > induced by effort > 70% occlusion 2- prinzmetal > vasospasm > TTT > VDs 3- unstable ( crescendo ) > increasing pain > 90% occlusion ```
75
Chronic IHD
Progressive H.F due to old infarction healed by fibrosis
76
What is myocardial infarction
Coagulative necrosis due to ischemia
77
Most common site of myocardial infarction
Apex
78
From where Apex gets its blood supply
Anterior descending coronary of left coronary
79
From where anterior part of the septum gets its blood supply
Anterior descending coronary of left coronary
80
From where anterior wall of left ventricle gets its blood supply
Anterior descending coronary of left coronary
81
From where lateral Wall of left ventricle gets its blood supply
Lateral circumflex
82
Right coronary supplies
- right ventricle - posterior wall of left ventricle - posterior wall of septum
83
Pathogenesis of myocardial infarction
-Ischemia >>> hypoxia >>> lack ATP >>> lactic acid accumulation >>> angina >>> after 30 mins necrosis -
84
Biomarkers of myocardial infarction
- CK - LDH - Troponin 1
85
Patterns of myocardial infarction
- Subendothelial - transmural - microscopic
86
Sub endothelial pattern of myocardial infarction
1/3 of the thickness
87
Transmural pattern of myocardial infarction
Full thickness
88
Morphology of myocardial infarction 1/2 > 2 hours
GROSS: no MICRO: wavy fibers, glycogen loss, mitochondrial swollen
89
Morphology of myocardial infarction 4hours > 1st Day
GROSS: mottled MICRO: eosinophilic fibers, pyknosis, neutrophils
90
Morphology of myocardial infarction 1st day> 3rd day
GROSS: pale yellow MICRO: no striations, no nuclei, neutrophils, MQ
91
Morphology of myocardial infarction 1st > 3rd week
``` GROSS: pale yellow, red margins MICRO: granulation tissue:- - new capillaries - fibroblasts - collagen ```
92
Morphology of myocardial infarction 2nd week > 2nd month
GROSS: grayish white, firm MICRO: fibrosis
93
Complications of myocardial infarction
CHAAMP - congestive heart failure - hemopericardium > early > acute heart failure - aneurysm of heart > late > thrombosis - arrhythmia > early - myocardial rupture > early - late pericarditis > immunological
94
Tumors of the heart
Bengin > myxoma Malignant > angiosarcoma Metastasis > melanoma
95
What is heart failure
Insufficient cardiac output
96
Types of heart failure
Left side | Right side
97
Causes of left side heart failure
CAMPS - congenital ( right to left shunt ) - aortic diseases - mitral incompetence - myocardial infarction - pericardial diseases - systemic hypertension
98
Effects of left side heart failure
- lung congestion | - right side heart failure
99
Causes of right side heart failure
- congenital ( left to right shunt ) - pulmonary stenosis - pulmonary incompetence - mitral stenosis - pericardial diseases - pulmonary hypertension
100
Effects of right side heart failure
Chronic generalized venous congestion
101
Types of pericarditis
Acute and chronic
102
Types of acute pericarditis
Serous Fibrinous Suppurative
103
Causes of acute serous pericarditis
Any cause of inflammation
104
Fate of acute serous pericarditis
Resolution
105
Causes of acute fibrinous pericarditis
Rheumatic heart
106
Fate of acute fibrinous pericarditis
Organization and fibrosis>> adhesion
107
Types of chronic pericarditis
Adhesive >> mild fibrosis | Constrictive >> severe fibrosis
108
Causes of chronic constrictive pericarditis
TB
109
Effects of chronic constrictive pericarditis
May obliterate orifices of vena cava>> generalized congestion
110
What is pneumopericardium
Air in pericardiam
111
What is hemopericardium
Tamponade blood in pericardiam

Pathology (3 decks)

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