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MED4 ACP > CVS Pathology > Flashcards

CVS Pathology Flashcards

(50 cards)

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1
Q

Definition of hypertension and malignant hypertension

A

Hypertension: sustained SBP > 140mmHg / DBP > 90 mmHg
Malignant hypertension: rapid BP rise, sustained SBP > 200 mmHg / DBP > 120 mmHg

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2
Q

How much % of hypertension is primary / essential?

A

95%

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3
Q

Secondary hypertension causes (3+5+3)

A

Renal: RAS, renal parenchymal disease, chronic renal disease

Endocrine: Primary hyperaldosteronism, Cushing syndrome, Acromegaly, Hyper- / Hypo-thyroidism, Phaeochromocytoma

Neurologic: ↑ ICP, OSA, acute stress

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4
Q

Risk factors for atherosclerosis (4+10)

A

Non-modifiable: male / post-menopausal female, elderly, familial hypercholesterolaemia, homocystinuria

Modifiable: hypercholesterolaemia, smoking, DM, HT, ↑ CRP, lipoprotein (a), physical inactivity, obesity, stress, infection

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5
Q

3 stages of atherosclerosis

A
  1. Fatty streaks
  2. Atheromatous plaque
  3. Complicated atheroma
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6
Q

Which histological layer is fatty streak deposited within? What is the cell that can be found in fatty streak?

A

tunica intima
lipid-filled foamy macrophages

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7
Q

2 parts of atheromatous plaque

A

fibrous cap + necrotic core

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8
Q

Difference between unstable atheroma and stable atheroma histologically (4)

A

thinner fibrous cap, larger lipid core, fewer SMC, ↑ inflammation

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9
Q

Pathogenesis of atherosclerosis

A

endotheilal injury + turbulent blood flow –> accumulation of lipoproteins –> monocytes and platelets adhere to endothelium –> monocytes migrate into intima –> differentiate into macrophages and foam cells

release cytokines and growth factors by platelets, macrophages, vascular wall cells –> SMC proliferate and migrate to intima

SMC, macrophages release cytokines –> produce ECM

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10
Q

Complications of complicated atheroma (3) (explain)

A

Acute plaque change
a. rupture: exposed necrotic core –> thrombus formation
b. haemorrhage into plaque –> volume expansion

Atheroembolism
- ruptured plaques –> discharge debris into blood –> microemboli

Aneurysm

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11
Q

In aneurysm, which layer of the blood vessel is weakened?

A

tunica media

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12
Q

Pathogenesis of aneurysm (3)

A
  1. inadequate / abnormal connective tissue synthesis
  2. excessive connective tissue degradation
    (e.g. proteolytic enzymes by macrophages in atherosclerotic plaque)
  3. loss of SMCs
    a. atherosclerosis –> ↑ diffusion distance –> ischaemia of inner media
    b. systemic hypertension –> luminal narrowing of vasa vasorum –> ischaemia of outer media
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13
Q

Pathology of aneurysm

A

cystic medial degeneration

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14
Q

Complications of AAA (4)

A
  1. occlusion of vessel branching off the aorta –> ischaemia of organs
  2. impingement on adjacent structures (e.g. ureter, vertebrae)
  3. Thromboembolism
  4. rupture –> fatal haemorrhage
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15
Q

Relationship of diameter and annual rupture risk of AAA

A

<4cm: almost never
4~5cm: 1%
5~6cm: 10%
>6cm: 25%

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16
Q

What is aortic dissection?

A

tear in tunica intima –> blood dissects into tunica media

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17
Q

Which type of aortic dissection has a higher mortality? How much?

A

Type A
70%

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18
Q

Immune-mediated vasculitis (2+4+3)

A

Giant cell arteritis
Takayasu arteritis

Polyarteritis nodosa
Kawasaki disease
Wegener’s granulomatosis
Churg-Strauss syndrome

Microscopic polyangiitis
Buerger disease
Behcet disease

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19
Q

Which vasculitis involves granuloma formation? (4)

A

giant cell arteritis, Takayasu arteritis, Wegener’s granulomatosis, Churg-Strauss syndrome

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20
Q

Which vasculitis is related to ANCA?

A

c-ANCA: Wegener’s granulomatosis
p-ANCA: Churg-Strauss syndrome, microscopic polyangiitis

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21
Q

Which vasculitis is related to viral Ag IC deposition? (Which virus most common?)

Study These Flashcards
A

Polyarteritis nodosa
HBV

22
Q

Which vasculitis is found in kids and is associated with coronary artery aneurysm?

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A

Kawasaki disease

23
Q

Which vasculitis is also called pulseless disease and is commonly found in aorta?

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A

Takayasu arteritis

24
Q

Which vasculitis is related to asthma?

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A

Churg-Strauss syndrome

25
Which vasculitis is associated with young smokers and peripheral vascular disease?
Buerger disease
26
Which vasculitis is associated with orogenital ulcers?
Behcet's disease
27
Which vasculitis is commonly found on temporal artery and ophthalmic artery?
Giant cell arteritis
28
Which vasculitis is almost always spared from pulmonary circulation?
Polyarteritis nodosa
29
Morphology change in myocardial infarction
Gross: pallor --> mottling --> yellow centre with hyperaemic border --> grey fibrous scar LM: coagulative necrosis, oedema, wavy fibres --> hypereosionophilic myocytes --> loss of nuclei & striations, neutrophil infiltrate, microscopic haemorrhage --> infiltration of lymphocytes, fibroblasts, macrophages --> organising granulatous tissue —> fibrosis
30
What is Dressler syndrome?
postmyocardial infarction pericarditis
31
Complications of MI (8)
Arrhythmia --> SCD CHF Ventricular aneurysm Pericarditis Mural thrombosis MR Left-to-right shunt Cardiac tamponade
32
Pathogenesis of reperfusion injury (2)
- reoxygenation --> ROS --> sarcolemmal injury --> ↑ Ca2+ --> myocyte hypercontration --> cell death - ↑ WBCs --> capillary occlusions
33
Diagnosis of systemic hypertensive heart disease
LVH + evidence of HT in other organs
34
MC cardiomyopathy
dilated cardiomyopathy
35
Aetiology of dilated cardiomyopathy (5)
- genetics / idiopathic - previous myocarditis - pregnancy - haemochromatosis (secondary) - toxin (alcohol, cocaine, catecholamines...)
36
MC cause of death in young athletes (What is the aetiology?)
hypertrophic cardiomyopathy (genetic mutation)
37
What is Loeffler endomyocarditis? (Treatment)
restrictive cardiomyopathy caused by parasitic infection, mostly found in Africa Treatment: TKI
38
MC cause of restrictive cardiomyopathy
amyloidosis
39
What is the cardiomyopathy caused by defected desmosomal proteins?
Arrhythmogenic RV cardiomyopathy
40
Causes of aortic regurgitation
organic: - IE - degeneration - chronic RHD - subacute IE functional: - aortic dissection - aortic root dilatation
41
Causes of aortic root dilatation
aortitis (syphilis, Takayasu arteritis, ankylosing spondylitis, psoriasis...) Marfan's syndrome hypertension, atherosclerosis
42
Causes of aortic stenosis
[<60y] Chronic RHD, congenital [60~75y] Bicuspid aortic valve [>75y] Degenerative calcification
43
Causes of mitral regurgitation
Organic: - IE - MVP - chronic RHD - subacute IE Functional: - MI, trauma - LV dilatation (e.g. myocarditis, DCM)
44
Causes of mitral stenosis
chronic RHD congenital stenosis
45
Causes of tricuspid regurgitation
- pulmonary HT - L. ventricular disease - IE - chronic RHD - complication of pacemaker insertion - carcinoid syndrome
46
Diagnosis of acute rheumatic fever
Jones' criteria - migratory polyarthritis - pancarditis - subcutaneous nodules - erythema mariginatum - chorea (2 out of 5)
47
Diagnosis of infective endocarditis
Duke criteria (BE TIMER) (2 or 1+3 or 0+5) Major: - blood culture (typical organisms from 2 separate blood cultures) - echocardiogram findings Minor: - temperature (fever) - immunologic phenomena - microbiological evidence - embolic phenomena - risk factor (predisposing conditions)
48
Usual precursor of non-bacterial thrombotic endocarditis
hypercoagulable state
49
What is the Libman-Sacks endocarditis?
endocarditis in SLE
50
Aetiology of pericarditis (4)
Infection, post-MI, uraemia, drugs

MED4 ACP (13 decks)

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