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129 Cards in this Set
- Front
- Back
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Lipids |
C H O N Soluble in organic solvent Triglycerides Cholesterol Phospholipid Glycolipid |
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Triglycerides |
Emulsification in stomach Digestion in the duodenum Form micelles 2 monoglycerides and free fatty acids Chylomicrons secreted into lymphatic |
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Lipoprotein lipase |
ApoCll required Synthesis and secreation stimulated by insulin Synthesis mainly in adipose and muscle |
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Lipoprotein function |
Transport glycerides to site of utilization and storage Transport cholesterol between sites if absorption synthesis catabolism and excretion |
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LDL |
Main carrier of cholesterol in man Apoptotic B |
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High affinity receptors |
Recognize and bind apoB of LDL |
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Low affinity receptors (scavenger pathway) |
More important at high plasma LDL levels |
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HDL |
smallest heaviest of the lipoprotein and contain most protein Synthesis in liver and intestines Reverse transport of cholesterol from tissue to liver ApoA1 and phospholipid |
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Blood lipid concentration |
Cholesterol 200-240 Triglycerides 150-200 LDL-cholesterol 100-160 HDL- 40-60 |
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Familial hypercholesterolemia |
Mutation of LDL receptor gene Increase risk of coronary heart disease |
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Type 1 hyperchylomicronaemia |
Absence of ApoCll deficiency in LPL Increase TG, chylomicron Eruptive xanthomas |
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Type lla hyperbetalipoproteinemia |
Hypothyroidism Lack of or defective high affinity LDL receptor Increase cholesterol Ischemic heart disease |
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Hypercholesterolemia with hypertriglyceridemia |
Overproduction of VLDL and LDL Increase cholesterol and triglycerides Ischemic heart disease Insulin dependent Diabetes mellitus |
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Tupe lll Broad beta hyperlipoproteinemia |
Aproprotein E2 deficiency Palmar xantomas Increase cholesterol and TG |
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Endogenous hypertriglyceridemia |
Increase synthesis and decrease catabolism of VLDL alcohol ingestion Elevated TG Glucose intolerance Often obese |
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Hyperbetalipoproteinemia with hyperchlyomicronemia |
Increase VLDL synthesis Uncontrolled diabetes mellitus Increase triglycerides with chylomicron |
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Lipoprotein X |
Obstructive jaundice High levels of free cholesterol and phospholipid |
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Abetalipoproteinemia |
Absence of apoB No chylomicron VLDL or LDL in serum |
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Hypobetalipoproteinemia |
Low level o apoB |
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Analphalipoproteinemia (tangier's disease) |
HDL deficiency Accumulation of cholesterol esters in reticulo-endothelial tissues |
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Arthritis |
Most common feature Polyarthritis and migrating polyarthritis Painful migrating short duration Affect more than 5 joints Treatment NSAIDS |
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Carditis |
Most serious feature May lead to death High pulse rate Cardiomegaly Murmurs Mitral and aortic regurgitation Pericardial friction rubs Cardiac failure Treatment steroids |
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Sydenham's chorea |
Extrapyramidal disorder Purposless involuntary movements Difficulty writing walking and talking Usually benign Treatment haloperidol |
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Subcutaneous nodules |
Firm non tender or im clusters Last a few days only Associated with carditis |
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Erythema marginatum |
Cutaneous lesions Reddish pink border Pale center Round and irregular shape |
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Rheumatic fever |
A disease caused by group A streptococcus that causes multi systemic inflammation 6-15 yrs |
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Infective endocarditis |
A microbial infection of the endocardium surface of the heart |
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Causes of IE |
Poor dental hygiene HIV diabetes mellitus Long term hemodialysis 3 times as common in male as females |
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Subacute IE |
Affects abnormal valves Extracardiac manifestation are the result of arterial embolisation of fragments of vegetation Blindness retinal artery Coronary artery embolisation MI |
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Two types of RHD |
Acute endocarditis pericarditis myocarditis Chronic valve deformity |
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Rheumatic pericarditis |
Dull heavy shaggy coat Bread and butter Aschoff body rarely seen |
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Rheumatic endocarditis |
Thickening of leaflets/cusps Vegetation of valve MV AV TV macCallums patch in posterior wall of LA |
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Rheumatic myocarditis |
Specific changes with aschoff bodies Non specific intestinal myocarditis Parenchymal damage |
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Aschoff bodies (nodules) |
Round oval Three phases Early exudative Intermediate gangulimatous Late fibrous |
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Pathology of chronic RHD |
Scaring thickening and regidity of leaflets and shortening chordae tendeneae Commissural fusion Superimposed calcification Fishmouth or buttonhole deformity with valve stenosis or insufficient |
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Main causes of death in chronic RHD |
Congestive cardiac failure Embolism Sudden death Infective endocarditis |
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Blood culture |
A culture of blood obtained from a single venipuncture wheater that blood is inoculated into 1 or multiple bottles |
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Symptoms of IE |
Splinter haemorrhage Osiers nodes painful Back pain Clubbing Roth spots Janeway lesion painless
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Procedure on IE |
Do not cover barcode automated system Disinfect top of bottle before inoculation them with blood Do not re palpate the vein after cleaning 3 sets of blood culture over 24hrs 1hr apart If BC negative draw blood 48hrs after antibiotic therapy stopped for 7days 20ml adult 5ml children |
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Shock |
A state of inadequate tissue perfusion due cardiac or non cardiac pathology |
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Hypovolaemic shock |
Commonest type Due to intra vascular depletion secondary to haemorrhage and other fluid loss Hypotension Sweating Tachycardia Cyanosis |
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Septic shock |
There is defect in O2 exchanger Cause Gram negative bacteria or endotoxin released Tachycardia Flushed face due to vasodilation |
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SIRS |
The body's response Elevated temperature and WBC |
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Cardiogenic shock |
Heart pump failure Decrease BP Enlarged liver Decrease preload afterload Increase contractility |
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Anaphylaxis shock |
IgE mediated Non IgE mediated Rash wheels erythema Hypotension Bronchospasm Epipen Anti histamine |
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Spinal shock |
Disruption of sympathetic NS outflow Vasodilation Patients warm Slow pulse Hypotension can affect breathing C3-C5 |
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Menstrual TSS |
Use of hyperabsorbable tampons |
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Nonmenstrual TSS |
Are associated with vaginal colonization of toxic secreation strain |
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Type of shock |
Hypovolaemic Septic Cardiogenic Anaphylaxis Spinal |
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Patent ductus arterioles |
Difference between aorta and pulmonary artery Faulty closure LV hypertrophy Mucus membrane pink Wide pulse pressure Infective endocarditis Pulmonary hypertension Decrease diastolic pressure |
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Opening and origination of the ductus arteriols |
Left 6th aortic arch Low oxygen production High prostaglandins |
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VSD |
LV hypertrophy,dilation and overloaded Pansystolic murmer Swiss cheese appearance Most common |
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ASD |
Right ventricular hypertrophy Atrial fibrillation Wide spread S2 Systolic murmurs |
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Coarctation of aorta |
Abnormal femoral pulse LV hypertrophy Change in systolic pressure |
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Tetralogy of fallot |
Most common R to L shunt Hypoxic Squatting Blue spell Pulmonary stenosis Single S2 |
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Arteriosclerosis |
A generic term for 3 patterns of vascular disease which cause thickening and inelasticity of artery |
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Artherosclerosis |
Degeneration and necrosis of the media Major cause of aneurysm |
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Theory of atherosclerosis as a respond to injury |
Endothelial injury | Dysfunction of lipoprotein | Adhesion of monocytes to endothelium | Migration of monocytes to the intema | Adhesion of platelets to intema | Migration of smooth muscle from media to intema | Proliferation of smooth muscle with extracellular matrix | Accumulation of lipids
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Double barrel aorta |
Rupture externally into pericardium Pleural cavity or retroperitoneum Re-enter aortic lumen |
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Classification of aortic dissection |
Debakey type 1- involve ascending and descending aorta Type 2- involving ascending aorta Type 3- involving descending aorta Stanford type A- bother type 1 and 2 debakey Type B- type 3 debakey |
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Ischaemic heart disease |
Structural and functional abnormality of the heart as a consequence of ischaemic heart disease |
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Clinical syndromes of IHD |
Angina pectoris MI Sudden death Chronic ischaemic heart disease |
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Angina pectoris |
Substernal chest pain resulting from transient ischemia |
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Myocardial infarction |
Necrosis of cardiac muscles |
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Morphology of MI |
Transmural Subendocardial |
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Transmural infarction |
Occurs in the LV Extend from the subendocardium to the subepicardium Uniform infarction |
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Subendocardial infarction |
Affects inner portion of the myocardium Mulifocal |
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Macroscopic changes of MI |
<12- no gross examination 12-24 hr- red blue appearance 3-4 days- boarder more distinct 7-10 days- bright yellow area 3 weeks- thinning of the myocardium fibrosis 6-8 weeks- scar tissue appearance white |
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Histology of MI |
Necrotic myocytes Attract acute inflammatory respond- neutrophils Increase macrophages Granulation tissue Fibrous tissue |
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Stable angina |
Associated with exertion Relieved by rest Threshold lowered by cold smoking ingestion of meal |
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Variant angina |
Angina seconday to coronary artery Spasm causes obstructive symptoms |
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Unstable angina |
Worse Angina at rest |
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Grading of angina |
Class 1- angina with strenuous exercise Class 2- slight limitation on vigorous activity Class 3- marked limitation of daily activity Class 4- inability to perform daily activity |
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Diagnosis of angina pectoris |
ST segment depressed or elevated Inverted T wave Elevated CK troponin |
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Investigation of angina pectoris |
ECG Stress test echocardiogram Coronary angiography |
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Most common site of artherosclerosis |
Superficial femoral artery goes through Hunter's canal |
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Claudation |
Calf pain brought on by exercise and relieved by rest. |
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Treatment for cladation |
Burgers exercise |
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Burguer's exercise |
Exercise done to maintain circulation in limbs |
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Fem pop bypass |
Most common bypass surgery |
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Benign nephrosclerosis |
Gross- mild decrease in size Fine granulation of cortex Cortical narrowing Histological hyalin artheriolosclerosis Tubular atrophy Interstitial fibrosis Glomerular changes |
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Malignant nephrosclerosis |
Histology fibrinoid necrosis Hyperplastic artheiolosclerosis Necrotizing glomerulitis |
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Hypertensive intracerebral haemorrhage |
Supratentorial> brainstem= cerebellum Gross hypertrophy of the affected hemisphere Rupture in ventricle Increase intracranial pressure |
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Hypertensive vascular disease |
Hyalin artheriolosclerosis Hperplastic arterioilosclorsis Aortic dissection |
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Pulmonary hypertensive heart disease |
RV enlargement Disease affecting the structure and function of the lungs |
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Causes of heart failure |
Prrssure overload Volume overload Intrinsic pump failure |
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Heart failure |
Where the output of the heart is insufficient to meet the demands of the tissue |
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Cardiomyopathy |
Disease of the muscle of the heart |
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Different type of cardiomyopathy |
Dilated Hypertrophy Restrictive |
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Dilated cardiomyopathy |
Most common Systolic dysfunction Low cardiac output Increase end diastolic volume Congestive heart failure Vascular incompetence Arrhythmias Embolism Gross dialatation of chambers Myocardium flabby Mural thrombosis |
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Hypertrophic cardiomyopathy |
LV hypertrophy Diastolic dysfunction Increase diastolic filling Angina pectoris Palpitations Syncope Due to mutations in genes coding for sacromere proteins |
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Restrictive cardiomyopathy |
LV muscle abnormally rigid and rubbery Decrease diastolic relaxation L atrium hypertrophy Diastolic dysfunction Increase ventricular pressure Abnormal color of ventricle |
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Cardiac amyloidosis |
Immunoglobulin type AL Heart firm and rubbery |
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Arthralgia |
Joint pain without swelling |
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Transposition of great artery |
The great vessels switch position so oxygenated blood fron the left ventricle is pumped to the lungs through the pulmonary artery and deoxygenated blood from the right ventricle is pumped to the bidy through the aorta Parallel circuit |
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Syphilitic aneurysm |
The third stage of syphilis manifest Occur in the chest |
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Mycotic aneurysm |
Due to infection Infection endocarditis |
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Shape of aneurysm |
Saccular Fusiform |
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Eccentric hypertrophy |
A type of hypertrophy where the walls and chamber of a hollow organ undergoes growth in which the overall size and volume are enlarged |
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Concentric hypertrophy |
Hypertrophic growth of a hollow organ without overall enlargement |
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Doppler ultrasound |
Detect and measure blood flow Detect blood pressure behind the knees and at the ankle |
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Duplex ultrasound |
A color indicator Can detect artery stenosis and measure the degree of obstruction |
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Major Jones critiriea for RF |
Carditis Arthritis Erythema marginatum Chorea Subcutaneous nodules |
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Minor criteria for RF |
Arthralgia Fever Increase ESR, C reactive protein Prolonged PR interval |
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Morphology of tetralogy of fallot |
VSD right ventricular hypertrophy Infundibular pulmonary stenosis Over riding of ventricular septum by aorta |
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Obstructive congenital heart disease |
Coarctation of the aorta Pulmonary stenosis Aortic stenosis |
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Features of I.E. |
Roth spots Janeway lesion painless Osler nodules painful Splinter hemorrhage |
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Morphology of Trafalgar of fallot |
VSD RV hypertrophy Over riding ventricular septum by aorta Infundibulun of pulmonary stenosis |
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Obstructive lesions of congenital heart disease |
Coarctation of aorta Pulmonary stenosis Aortic stenosis |
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Minor characteristics for RF |
Arthralgia Fever Increase ESR C protein Prolonged PR interval |
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Sudden cardiac death |
Occurs within 1hr of onset of symptoms |
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NSTEMI |
Partial occlusion of coronary vessels |
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STEMI |
Total occlusion of coronary vessels |
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Untreated hypertension leads to |
Stroke Renal failure coronary heat disease |
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Chronic occlusion peripheral vascular disease |
Cladation Rest pain Blister/ulceration Gangrene |
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Acute occlusion peripheral vascular disease |
Pain pallor Pulselessness Paralysis Perishingly cold Paraesthesia |
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Leriche syndrome |
Pain in the calf thigh buttocks |
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Doppler ultrasound |
Measure blood flow at the back of the knee and ankle |
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Duplex ultrasound |
Color assisted |
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Most common bypass |
Fem-pop bypass |
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Criteria for diagnosing hypertension |
Cardiomegaly History of hypertension |
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Cor pulmonale |
Right ventricle hypertrophy secondary to pulmonary hypertension abused by disease affecting the structure and function of the lungs |
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Disease of cor pulmonale |
Disease of through parenchyma Pulmonary vessels Chest movement Pulmonary arteriolar contriction |
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Right side heart failure |
Hepatomegaly Elevated venous pressure Peripheral Oedema |
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Dilated cardiomyopathy Gross pathology |
Globular cardiomegaly Dialatation of chambers myocardium floppy and pale Mural thrombosis Focal endocardial thickening |
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Dilated cardiomyopathy microscopy changes |
Myocytes hypertrophy Myocytes degeneration Interstitial fibrosis Interstitial lymphocytes |
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Decompensated heart failure |
Overcompensation of the heart |
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Concentric hypertrophy |
Thickness of Wall increase without increase in sixe of the chamber |
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Symptoms of hypertrophic cardiomyopathy |
Angina Syncope Dyspnoea Palpitations Sudden death |
