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Biomedicine I > 6. Cardiovascular System II Pathologies > Flashcards

6. Cardiovascular System II Pathologies Flashcards

1
Q

Hypercholesterolaemia

A

2/3 of UK have serum cholesterol greater than 5.2mmol/L.

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2
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Hypercholesterolaemia: Causes and Risks

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CAUSES / RISKS: • ‘Familial’(defect on chromosome 9, causing inability to remove LDL from blood). • Age related (risk increases with age). • Hypertension. • Diabetes mellitus. • Obesity. • Smoking. • Sedentary lifestyle. • Diet. • Excessive alcohol.

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3
Q

Hypercholesterolaemia: Signs

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Xanthelasma: a sharply demarcated yellowish deposit of cholesterol underneath the skin. It usually occurs on or around the eyelids Coreal Arcus: ring around the cornea

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4
Q

Hypercholesterolaemia: Treatment

A

• Statins (side effects: muscle aches, insomnia, dizziness, fatigue, headaches, liver damage, gastro-intestinal effects, cataracts). Induces a deficiency in CoQ10.

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5
Q

Arteriolsclerosis

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• Thickening & loss of elasticity of arterial walls. • Leads to the formation of atherosclerotic plaques in the walls of arteries which may disrupt blood flow to target organs. • Affects large and medium-sized arteries (coronary, carotid, and cerebral arteries, the aorta, and major arteries of the extremities). • It is the leading cause of morbidity and mortality in the US and in most developed countries.

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6
Q

Atherosclerosis Pathophysiology

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• Damage of the vascular endothelium occurs, creating inflammation. • LDLs deposit in the damaged tunica intima and are oxidised, subsequently attracting phagocytes. • Macrophages surround the fatty material in an attempt to destroy it and create foam cells. • There is a proliferation of vascular smooth muscle cells. • A cap is formed over the atherosclerotic plaque to wall off the plaque from the blood.

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7
Q

Arteriolsclerosis: Cause and Risks

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• Hereditary, male sex, age (men > 45, women > 55), ethnicity (South Asian and African or Caribbean background). • Hypercholesterolaemia/hyperlipidaemia, hypertension, diabetes, obesity, smoking, stress, sedentary lifestyle, excessive alcohol.

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8
Q

Arteriolsclerosis: Signs and Symptoms

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• Angina pectoris -ischaemic heart pain (from thrombosis & embolism). • Stroke (from thrombosis, embolism & haemorrhage).

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9
Q

Arteriolsclerosis: Complications

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• Myocardial infarction & Stroke/TIA. • Aneurysm and haemorrhage. • Embolism–an embolus (mobile blood clot) travels through the blood and causes a blockage.

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10
Q

Arteriolsclerosis: Treatment

A

• Surgery –stents, statins, exercise.

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11
Q

Angina Pectoris

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• Ischaemic heart disease due to obstruction or spasm of the coronary arteries. • The symptoms associated with angina result from the demands of the myocardium not being met by its blood supply e.g. due to atherosclerosis or vascular spasm. • Not a cardiac arrest or heart attack.

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12
Q

Types of Angina

A

• Stable: Pain is precipitated by physical exercise. • Unstable: Occurs randomly.

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13
Q

Angina: Signs and Symptoms

A

• Heavy, constricting chest pain, radiating to the neck, left shoulder and jaw. Eases on rest. • Dyspnoea.

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14
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Angina: Treatment

A

• Acute relief: GTN (Glyceryl Trinitrate) sublingual (converted in the blood to nitric oxide vasodilation). • Long term drug therapy: anti-hypertensives.

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15
Q

Stroke

A

• Also known as a ‘cerebrovascular accident’. • 50% affect cerebral cortex (affects contralateral body). • A disruption of blood supply to the brain. • 4 minutes of ischaemia causes irreversible cell damage. • Characterised by rapidly developing signs of cerebral function, lasting more than 24 hours.

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16
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Stroke: Causes

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• Thrombus/embolus (80%) = ischaemic stroke. • Haemorrhagic stroke -blood vessel damage (i.e. following ruptured aneurysm).

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17
Q

Stroke: Signs and Symptoms

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Sudden weakness, numbness/tingling, loss of speech, loss of vision, sudden severe headaches, confusion, unsteadiness.

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18
Q

Stroke: Diagnosis

A

CT scan, MRI scan

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19
Q

Stroke: Treatment/Support

A

• Hospital, O2 therapy, aspirin, thrombolytic treatment, surgery.

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20
Q

Transient Ischaemic Attack: “Mini Stroke”

A

• Temporary inadequacy of circulation to part of the brain. • Gives similar clinical picture to stroke but lasts no longer than 24 hours. • Can be warning sign for a full stroke.

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21
Q

Transient Ischaemic Attack: Causes

A

Same as stroke

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22
Q

Transient Ischaemic Attack: Signs and Symptoms

A

• Transient impaired functions resolves with 24 hours. • Unilateral weakness, dysphasia (difficulty speaking), unilateral tingling. • Double vision, vertigo, confusion.

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23
Q

Aneurysm

A

• Abnormal local dilations of arteries due to weakness of the vessel wall. • Often secondary to atherosclerosis. Common examples of aneurysms include: Abdominal Aortic Aneurysm (AAA): • Asymptomatic until bursts (80% are fatal). • Pulsatile abdominal mass and “tearing” lower back pain. Berry Aneurysm: • Occurs in the centre of the cerebrum, causing a sub-arachnoid haemorrhage (presents as a severe headache).

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24
Q

Deep Vein Thrombosis (DVT)

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• Thrombus formation in the deep veins of the legs. • Clot may dislodge and cause a pulmonary embolism.

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25
DVT: Risks
• Reduced blood flow(immobility, pressure on vein by tumour, shock, long-haul flights). • Changes in blood (dehydration, polycythaemia, sticky platelets, oral contraceptive pill). • Damage to blood vessel wall.
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DVT: Signs and Symptoms
• Limb pain, calf swelling, tenderness along vein, distension of superficial veins, increased skin temperature and local redness (erythema). • Positive Homan’s sign.
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DVT: Treatment
Complete rest and heparin
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Pulmonary Embolism: Symptoms
Dyspnoea, chest pain, cough, haemoptysis (coughing blood), tachycardia/tachypnoea, pleural rub
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Varicose Veins
Incompetent valves cause pooling of the venous blood & chronically dilated veins.
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Varicose Veins: Signs and Symptoms
Aching & fatigue of legs, distended blue veins.
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Varicose Veins: Dianosis
Doppler and ultrasound.
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Varicose Veins: Treatment
Compression, hydrotherapy, exercise, stripping,legs elevation.
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Varicose Veins: Complications
Haemorrhage, venous ulcers. DVT following treatment.
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Haemorrhoids: "Piles"
• Enlarged and often inflamed veins in the anal canal. • Some prolapse, other types do on straining and in fourth degree are permanent.
35
Haemorrhoids: Causes
• Chronic constipation, chronic cough. • Hypertension (portal hypertension). • Obesity, Pregnancy.
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Haemorrhoids: Signs and Symptoms
• Painless unless they become strangulated. • Bright, red blood on faeces/toilet paper. • Protruding haemorrhoids causing pain & itching.
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Oesophageal Varices
• Varicose veins of the Oesophagus, tending to affect the distal oesophagus.
38
Oesophageal Varices: Causes
• Portal hypertension (e.g. secondary to liver cirrhosis). • Right sided heart failure.
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Oesophageal Varices: Signs and Symptoms
• Bleeding:Haematemesis, melaena. • Anaemia -iron deficiency.
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Oesophageal Varices: Treatment
Treat the cause Drugs to stop bleeding (vasoconstrict)
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Oesophageal Varices: Complications
Rupture and bleeding
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Raynaud’s Syndrome
• Intermittent attacks of ischaemia in extremities. • Most common in women 30-40 years old.
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Raynaud’s Syndrome: Causes
• Extreme temperature, emotional stimuli • Rheumatological diseases e.g. RA.
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Raynaud's Syndrome: Signs and Symptoms
• Vasospasm followed by hyperaemia. • Pallor, cyanosis, redness. Pain.
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Raynaud's Syndrome: Treatment
• Minimise stress, exercise regularly, keep warm, stop smoking. Topical nitrates.
46
Oedema
• Excess fluid accumulation in interstitial spaces. • Usually ‘pitting’ oedema. • If non-pitting usually lymphoedema or hypothyroidism. • Volume of fluid kept in interstitial spaces is normally kept at 20% of body weight. A number of processes can disturb this.
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Oedema: Causes
Heart failure, renal disease, hepatic disease, drugs (long term steroids, NSAIDs),DVT (late complication).
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Oedema: Treatment
TREATMENT: • Treat the cause. • Diuretics (encourages body water loss, but doesn’t address cause. Causes loss of minerals). • Exercise, lose weight (if overweight). • Raise legs, avoid prolonged standing • Lymphatic drainage and massage. • Herbs (nettle root, dandelion leaf).
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Ascites
An excessive accumulation of fluid in the peritoneum.
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Ascites: Causes
• Liver cirrhosis (80%) –due to portal hypertension. • Malignancy of stomach, colon, pancreas, ovary. • Heart failure. • Constrictive pericarditis (fibrotic pericardium).
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Ascites: Signs and Symptoms
• Abdominal distensionand later discomfort. • Nausea and supressed appetite. • Dyspnoea.
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Ascites: Treatment
Diuretics may be implicated. Surgery (hepatic shunt).
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Shifting Dullness
• Shifting dullness is a test that can be used to identify the presence of ‘ascites’. •When turning the patient onto their side from a supine position, the excess peritoneal fluid will fall to the side the patient is lay on. •This can be identified by percussing the patients abdomen to note the change in transition of ‘resonance’ after changing position.
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Hypertension
• High blood pressure (UK) –140/90mmHg or higher. • Hypertension is a major risk factor for cardiovascular disease and cerebrovascular events.# • Often symptomless
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Hypertension: Types
• Primary (95%): Generally no identifiable cause, however several risk factors including family history, obesity, age, smoking, lack of exercise, stress. • Secondary (5%): Secondary to another identifiable cause. E.g. Renal disease.
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Hypertension: Treatment
• NICE guidelines: Begin with ACE-Inhibitors, then diuretics, then beta blockers. • Diet, exercise & lifestyle are essential. Weight loss (if appropriate), avoid salt, avoid caffeine, reduce stress and alcohol.
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Hypertension: Complications
• Cardiovascular events, heart failure, aneurysm. • Chronic Kidney Disease (CKD). • Stroke. • Cognitive decline and cerebral oedema. • Premature death. • Retinal bleeding.
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Hypotension
• Low blood pressure -\< 90/60mmHg. • Leads to inadequate blood supply to the brain.
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Hypotension: Causes
Shock MI Blood loss Long-term adrenal fatigue Anti-hypertensives
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Hypotension: Signs and Symptoms
• Unsteadiness, dizziness, light-headedness or fainting.
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Heart Failure
• Failure of the hearts mechanism as a pump. • A clinical syndrome characterised by breathlessness, fatigue, ankle oedema, tachycardia, tachypnoea, cardiomegaly. • Classified as acute (sudden decrease in cardiac output) or chronic (gradually develops).
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Heart Failure: Causes
• Coronary heart disease and hypertensionare the most common causes. • Valve diseases causes 10% cases e.g. aortic stenosis. • Often secondary to a myocardial infarction.
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Right-sided Heart Failure: Cause
•Increased vascular resistance in the lungs (lung disease). •Back pressure from the left side of the heart (e.g. valve problems). •Previous heart attack
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Right-sided Heart Failure: Signs and Symptoms
•Systemic oedema. •Ascites. •Portal hypertension (oesophageal varices, haemorrhoids).
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Left-sided Heart Failure: Cause
•High blood pressure. •Myocardial weakness. •Valve problems.
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Left-sided Heart Failure: Signs and Symptoms
•Pulmonary oedema. •Congestion bronchitis. •Cardiac asthma (often most severe at night)
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Acute Heart Failure: Signs and Symptoms
Chest pain, pain radiating into the jaw, neck and left arm. Shortness of breath, weakness, dizziness, overwhelming anxiety(medical emergency).
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Chronic Heart Failure: Signs and Symptoms
May be asymptomatic. Dyspnoea, fatigue, oedema, fluid retention, cardiomegaly, cyanosis (due to poor circulation of oxygen in blood).
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Valve Stenosis
•Fibrosis,thickening and calcification of valve. •Obstruction to blood flow through heart chambers (valve opening narrows). •To compensate the myocardiumhypertrophies (enlarges) -\>heart failure. Causes: •Congenital. •Rheumatic disease.
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Valve Regurgitation
• Inadequatevalve closure causing leakage. • The heart hypertrophiesand dilates to accommodate more blood -\> heart failure. Causes: •Congenital. •Rheumatic disease. •Infective endocarditis.
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Myocardial Infarction
• Necrosis (death) of myocardial tissue due to ischaemia. • Usually due to blockage of a coronary artery by a thrombus. • Coronary heart disease is the most common cause of death in the UK.
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Myocardial Infarction: Signs and Symptoms
• Severe chest pain (central, radiating to the left arm, neck or jaw) “Pressure, sharp”. • \>20 minutes which does notimprove on rest. • Sweating, nausea, pale and clammy skin. • ‘Sense of impending doom’. Diagnosis by ECG
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Myocardial Infarction: Management
• Oxygen. • CPR. • Aspirin 300mg orally & GTN spray. • Angioplasty(unblocking of artery). • Thrombolytic therapy (“clot busters”) –forms plasmin which breaks cross links of fibrin molecules.
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Arrhythmias
BRADYCARDIA: • Rate below 60. • Physiological: athlete. • Pathological: often caused by diseases affecting the SA or AV node (eg. Myocardial infarction). TACHYCARDIA: • Rate over 100. FIBRILLATION: • Irregular rhythm and force leading to inadequate blood supply.
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Atrial Fibrillation
• The most common cardiac arrhythmia. • Irregularly irregular rhythm (uncoordinated, rapid, small, local atrial contractions). • Associated with stagnation of blood in the atria leading to thrombus formation and risk of embolism (stroke). • Palpate pulse to assess for irregularity. Patients may present with breathlessness, palpitations, dizziness, chest discomfort (or a stroke).
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Cardiac Arrest
• Conduction arrest(nota heart attack). • Approximately 70% occurs due to coronary heart disease. Other causes include cardiomyopathy, trauma, medication overdose, haemorrhage. • Occurs when the heart develops an arrhythmia causing it to stop.
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Cardiac Arrest: Treatment
• Cardiopulmonary Resuscitation (CPR )to provide circulatory support until availability of defibrillation (application of an electric current to reset the electrical impulses running through the autorhythmic cells).
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Endocarditis
• An inflammation of the endocardium and valves. • Infective (bacterial) cause(Staphylococcus aureus / Streptococci viridans).
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Endocarditis: Signs and Symptoms
• Non-Specific symptoms: Fever, fatigue, muscle &joint aching, loss of appetite (flu like symptoms). • Dyspnoea, blood in urine, persistent cough. • Signs: Osler’s nodes (red tender spots under skin of fingers), splinter haemorrhages (splinter appearance under nail bed), heart murmur.
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Endocarditis: Treatment
• Intravenous antibiotics. • Herbs & nutrition –antimicrobials, immune support.
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Pericarditis
• Acute inflammation of the pericardium. • Infiltration of pericardium with leukocytes.
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Pericarditis: Cause
• Normally viral infection (e.g. Flu, HIV, mumps, EBV) • Can be due to systemic inflammatory condition e.g. rheumatoid arthritis (RA), A.S.
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Pericarditis: Signs and Symptoms
• Chest pain: Radiating to the back and relieved by sitting up & forward. Worsened by lying down or breathing deeply. • Dyspnoea when reclining, low-grade fever, weakness, fatigue & feeling nauseous, dry cough, oedema (abdominal / leg). • Pericardial friction rub.
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Pericarditis: Treatment
• Rest, NSAIDs. Surgical drainage if severe
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Pericarditis: Complications
1. Constrictive pericarditis: Thickened and fibrotic pericardium. 2. Cardiac tamponade (pericardial effusion): Fluid collects in the pericardium, putting pressure on the heart & inhibiting it from filling completely.
86
Shock
• A reduction in circulating blood volume, blood pressure and cardiac output, resulting in hypoxia of the tissues. • Hypovolaemic Shock • Cariogenic Shock • Septic Shock • Neurogenic Shock • Anaphylactic Shock
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Hypovolaemic Shock
• Blood volume is reduced by 15-25%. • May be blood or fluid loss due to haemorrhage, severe burn (loss of serum), vomiting, diarrhoea (loss of water and electrolytes), organ perforation.
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Cardiogenic Shock
• Myocardium can’t maintain cardiac output -acute heart disease (e.g. MI).
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Septic Shock
• Infection causes an immune & inflammatory response causing vasodilatation & pooling of blood.
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Neurogenic Shock
• Loss of sympathetic control on blood vessels & increased parasympathetic stimulation of the heart –leads to dilation of blood vessels & bradycardia. This causes reduced cardiac output, blood pooling and fainting(e.g. spinal cord injury).
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Anaphylactic Shock
•Severe allergic response causing vasodilatation, bronchoconstriction, reduced cardiac output & tissue hypoxia.
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Shock: Signs and Symptoms
• Hypoxia–cold, clammy, cyanosis, faint, weak, confusion, anxiety, tachycardia, weak pulse, rapid breathing, hypotension
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Shock: Physiological Changes
• The body attempts to counteract shock by: vasoconstriction, increased heart rate, water retention. If these are insufficient the following occurs: anaerobic respiration, lactic acid build up, acidosis, cell death
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Biomedicine I (18 decks)

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