06-10-22 – Effects of Systemic Disease on CVS Flashcards
Learning outcomes
- To appreciate how systemic disease affects the cardiovascular system
- To appreciate how systemic disease affects the cardiovascular system
- Specifically be able to comment briefly on:Diabetes mellitusHypertensionChronic obstructive pulmonary diseaseAmyloidosis Rheumatoid arthritis Vasculitides & SLEThyroid disease Sarcoidosis Nutrition Drugs
- Specifically be able to comment briefly on:Diabetes mellitusHypertensionChronic obstructive pulmonary diseaseAmyloidosis Rheumatoid arthritis Vasculitides & SLEThyroid disease Sarcoidosis Nutrition Drugs
What 10 systemic conditions/factors can affect the CVS?
- Systemic conditions/factors that can affect the CVS:
1) Diabetes mellitus
2) Hypertension
3) Chronic obstructive pulmonary disease
4) Amyloidosis
5) Rheumatoid arthritis
6) Vasculitis & SLE (systemic lupus erythematosus)
7) Thyroid disease
8) Sarcoidosis
9) Nutrition
10) Drugs
What is the dominant cause of mortality in diabetic patients?
What are 5 examples of diabetes associated metabolic disorders?
What are these conditions associated with?
- The dominant cause of mortality in diabetic patients is cardiovascular complications.
- Diabetes associated metabolic disorders:
1) Hyperglycaemia
2) Hypertriglyceridemia
3) Hypercholesterolemia
4) Hypoalphalipoproteinemia
5) Increased levels of advanced glycation of end products, glycated and oxidized lipoproteins - These disorders are associated with oxidative stress
What is glycation?
Why does glycation occur in diabetes?
What proteins can it occur in?
How can this lead to accelerated vascular damage?
How can this cause kidney disease?
How can glycation of haemoglobin be used to measure the effectiveness of diabetes treatment?
- Glycation is the covalent attachment of a sugar to a protein/lipid, which can lead to cross-linking of proteins
- Glycation occurs in diabetes due to hyperglycaemia (increased blood sugar)
- Glycation can affect haemoglobin in the blood
- Glycation of haemoglobin can lead to accelerated vascular damage
- This is because proteins are repelled away from cell membranes in the vessels by charge
- Glycation can alter the charge of proteins, meaning proteins can become trapped in the basement membrane, which can affect the integrity of the vessel walls and affect permeability
- If this occurs in the glomeruli of the kidneys, this can lead to kidney disease
- The life cycle of RBCs is 90 days
- We can measure the effectiveness of diabetes treatment by checking to see levels of glycation every 90 days, as if treatment is effective, the glycation rate should have decreased heavily
What is hyperlipidaemia?
What is familial hypercholesterolaemia (FH)?
What is it caused by?
How does it affect blood lipid levels?
How can this affect vessels?
What is a familial disease?
When might we suspect FH?
What 6 conditions can atherosclerosis cause?
- Hyperlipidaemia is above normal lipid (fat) levels in the blood, which include several types of lipids, including triglycerides
- Familial Hypercholesterolaemia (FH) is an inherited condition that is passed down through families and is caused by one or more faulty genes.
- It’s caused by a genetic mutation that means your liver is unable to remove excess ‘bad’ cholesterol, known as LDL.
- This leads to an increase in levels of LDL cholesterol in the blood (hypercholesterolaemia)
- An increase in lipids in the blood can lead to the accumulation of fatty deposits in the artery walls, which can lead to atherosclerosis
- ‘Familial’ disorders are those which appear to have a genetic component, affecting more family members than would be expected by chance alone.
- We may suspect FH when the patient is young, as it is less likely that the cause of hypercholesterolaemia is from diet
- Atherosclerosis can cause:
1) Hypertension
2) Heart attack
3) Stroke
4) Aneurysm
5) Blood clot - plaque may rupture. Platelets clump together to form clots at the site of the damage.
6) Emboli
What is COPD?
How is COPD and CVD disease related?
How can pulmonary hypertension affect the right side of the heart?
What is cor pulmonale
How does this affect the pumping of the right side of the heart?
What are 7 causes of pulmonary hypertension?
- Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties
- Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) frequently occur together and their coexistence is associated with worse outcomes than either condition alone.
- Potential complications of pulmonary hypertension include: Right-sided heart enlargement and heart failure (cor pulmonale).
- Cor pulmonale causes the right ventricle to enlarge and pump blood less effectively than it should.
- The ventricle is then pushed to its limit and ultimately fails
- It has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries
- Cause of pulmonary hypertension:
1) Acute or chronic left ventricular failure
* Increase in ventricular pressure and backlog of blood in pulmonary circulation leads to pulmonary hypertension
2) Mitral stenosis
* Increase in atrial pressure and backlog of blood in pulmonary circulation leads to pulmonary hypertension
3) Chronic bronchitis and emphysema
* Chronic bronchitis and emphysema often occur together and make up COPD
* The inability to get enough oxygen into the blood raises the risk of developing hypoxia (low blood oxygen levels)
* Sustained hypoxia reinforces vasoconstriction, which cause pulmonary hypotension
4) Emphysema
* In people with emphysema, the air sacs in the lungs (alveoli) are damaged.
* Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones.
* We don’t perfuse tissues that don’t contribute to gaseous exchange, which leads to vasoconstriction to these damaged alveoli
* This will cause an increase in venous pressure
* Lack of capillaries due to damaged alveoli will lead to low levels of oxygen in the blood (hypoxia), which will also cause vasoconstriction and shortness of breath
* The main cause of emphysema is long-term exposure to airborne irritants, including: Tobacco smoke. Marijuana smoke. Air pollution
5) Recurrent pulmonary emboli
* Blocked blood vessel in lungs
* Causes hypertension
6) Primary pulmonary hypertension
* Cause of raised pulmonary pressure unknown
7) CHD shunts
What causes AL amyloidosis?
Where can these deposits be placed?
What are plasma neoplasms?
What are 2 causes of systemic amyloidosis? What are amyloid deposits?
What are they made from?
How do amyloid deposits affect organs?
What organs can it affect?
What is rheumatoid disease?
How is it caused?
How is rheumatoid disease linked the amyloidosis?
- AL Amyloidosis (immunoglobin amyloidosis) is caused by an abnormality in plasma cells found in the bone marrow
- The abnormal plasma cells produce abnormal forms of light chain proteins, which enter the bloodstream and can form amyloid deposits.
- These deposits can be placed between cells and in the basement membrane, which can cause the lumen of tubular structures to be narrower
- Plasma cell neoplasms are diseases in which abnormal plasma cells form tumours in the bones or soft tissues of the body
- Systemic amyloidosis may be due to a plasma cell neoplasm (e.g myeloma – marrow cancer) or to a chronic inflammatory disorder
- Amyloid deposits are an extracellular beta-pleaded sheet material made from:
1) Immunoglobulin light chains
2) Serum amyloid protein A
3) Peptide hormones
4) Prealbumin etc. - Amyloids deposits often impair the function of the organ in which they are deposited
- These effects can include:
1) Heat failure
2) Nephrotic syndrome
* Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine
* Caused by AA amyloid
3) Organ enlargement (e.g hepatomegaly – liver enlargement)
* Caused by AA amyloid
- Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body (systemic disease that mainly affects joints)
- Rheumatoid disease causes amyloidosis, meaning patients with rheumatoid disease have a higher instance of CV morbidity
- Some of it will be due to inability to move and exercise, but some of it is to do with the systemic effects of amyloidosis
What is vasculitis?
What is it associated with?
What 6 ways can it affect blood vessels?
How can this affect the heart?
What is the most common vasculitis that we are likely see?
- Vasculitis is inflammation of the vessels
- It is sometimes associated with infection, but in particular, it is an auto-immune disease
- Vasculitis can cause the vessel to become:
1) Thickened
2) Weakened
3) Narrowed (stenosis),
4) Blocked (occlusion),
5) Enlarged (aneurysm), or
6) Scarred - Vasculitis affecting the heart can cause congestive heart failure
- Vasculitis as part of systemic lupus erythematosus (SLE) is what we are most likely to see
- SLE is the most common form of lupus
- Lupus is a condition that affects the immune system.
- It can cause problems with your skin, joints, kidneys and other organs.
What is the link between thyroid function and heart failure?
- Studies suggest patients with overt and subclinical thyroid dysfunction are at increased risk of heart failure
What is sarcoidosis?
What does it cause to develop?
What are hypersensitive reactions?
What type of hypersensitivity reaction Is sarcoidosis?
What 3 structures does sarcoidosis often affect?
How does cardiac sarcoidosis affect the heart?
- Sarcoidosis is a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body.
- Hypersensitivity reactions are exaggerated or inappropriate immunologic responses occurring in response to an antigen or allergen
- Sarcoidosis is a type 4 hypersensitivity reaction
- It often affects the:
1) Lungs
2) Lymph nodes
3) Can also affect your skin. - In cardiac sarcoidosis, tiny collections of immune cells form granulomas (small areas of inflammation) and scarring in the heart tissue, which can interfere with normal functioning
How does famine affect chances of developing CVD?
- Compared with the nonexposed participants, those who had been exposed to famine in early life had a significantly increased risk of total CVD , myocardial infarction, stroke, and coronary heart disease.
What are 4 different types of drugs that can cause CVD?
- Different types of drugs that can cause CVD:
1) Anticancer
2) Immunosuppressive
3) Diabetogenic
4) Anti-inflammatory drugs
