Cardiovascular disease

Question 1

2 things that cause inadequate supply to the myocardium

Answer 1

Reduced coronary blood flow

Myocardial hypertrophy

Question 2

4 IHD syndromes

Answer 2

Anigna pectoris
Acute coronary syndrome
Sudden cardiac death
Chronic ischaemic heart disease

Question 3

3 types angina

Answer 3

Stable- predictable relationship with exertion, due to fixed obstruction
Unstable- plaque disruption, red flag
Varient/prinzmetal- coronary artery spasm

Question 4

2 ways a subendocardial MI might occur without any acute coronary occlusion?

Answer 4

1. Stable athromatous occlusion

2. acute hypotensive episode

Question 5

Main blood marker of cardiac myocyte damage?

Answer 5

Troponins T and I

Question 6

When is troponin peaked?

Answer 6

12hrs post MI

Question 7

What else is troponin raised in?

Answer 7

PE, HF, myocarditis

Question 8

4 other blood markers of cardiac myocyte damage?

Answer 8

Creatinine kinase MB
Myoglobin
Lactate dehydrogenase
Aspartate transaminase

Question 9

What is Dressler’s syndrome?

Answer 9

Complication of MI- autoimmune pericarditis.

Question 10

Appearance of heart tissue following MI:
Less than 24 hours
1-2 days
3-4 days
1-3 weeks
More than 3 weeks

Answer 10

Less than 24 hours normal/dark
1-2 days pale, oedema
3-4 days yellow with haemorrhagic edges (macrophages)
1-3 weeks red/grey, pale, thin, granulation tissue then fibrosis
More than 3 weeks dense fibrous scar

Question 11

What is chronic ischaemic heart disease?

Answer 11

Atheroma = relative ischaemia and angina. Risk of sudden death, MI, unstable/variant angina

Question 12

2 most common mutations in familial hypercholesterolaemia

Answer 12

Low density lipoprotein receptor gene

Apolipoprotein B

Question 13

How do heterozygotes with familial hypercholesterolaemia present?

Answer 13

Xanthomas

Early atherosclerosis

Question 14

What BP is definted as HTN

Answer 14

140/90

Question 15

What do all primary/essential HTN causes have in common?

Answer 15

Positive sodium balance

Question 16

How does sodium increase BP?

Answer 16

Increases stroke vol as more water in blood, cardiac output is therefore increased, so vasoconstriction occurs to reduce the blood flow as is above metabolic demand, however this increases SVR so BP (SVRxCO) increases.

Question 17

4 systems that if diseased might cause secondary HTN?

Answer 17

Renal
Endocrine
Cardio
Neuro

Question 18

4 effects of hypertension

Answer 18

Renal failure
Hypertensive crisis
Acute hypertensive encephalopathy
Pulmonary HTN

Question 19

What BP is a HTNve crisis?

Answer 19

180/120

Question 20

Symptoms of acute hypertensive encephalopathy

Answer 20

Confusion, vomiting, convulsions, coma, death

Question 21

Framingham study was on what?

Answer 21

Risk factors for heart disease

Question 22

Describe RAAS?

Answer 22

angiotensin produced in afferent arterioles of kidney
Renin converts angiotensin to angiotensin I
Angiotensin I to angiotensin II
Ang 2 = vasoconstriction and stimulates adrenals to produce aldosterone
Aldosterone inhibits sodium and water loss to increase blood volume.

Question 23

What is Conn’s syndrome

Answer 23

Excess aldosterone secretion usually due to adrenocortical adenoma
HTN
elevated aldosterone, low renin
Potassium loss- muscle weaknessm arrhythmias, parasthaesia, metabolic alkalosis

Question 24

What is phaeochromocytoma

Answer 24

Tumour of adrenal medulla, secretes vasoconstrictive catecholamines (adrenaline and noradrenaline)
Presents with pallor, headache, sweating, nervousness, HTN

Question 25

Difference between Cushing’s disease and syndrome

Answer 25

Disease= pituitary lesion or neoplasm in adrenals that results in overproduction of glucocorticoids
Syndrome = excess glucocorticoids from any source

Question 26

What is the action of cortisol?

Answer 26

Sympathetic NS activation

Acts on the kidneys to = HTN

Question 27

3 causes of Cushing’s

Answer 27

Adrenocortical adenoma (or other neoplasm)
Pituitary adenoma
Paraneoplastic effect of other neoplasms (particularly small cell lung carcinoma) producing adrenocorticotrophic hormone that stimulates adrenals to produce cortisol