6. Cardiovascular System II Pathologies Flashcards
Hypercholesterolaemia
2/3 of UK have serum cholesterol greater than 5.2mmol/L.
Hypercholesterolaemia: Causes and Risks
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.
Hypercholesterolaemia: Signs
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
Hypercholesterolaemia: Treatment
• Statins (side effects: muscle aches, insomnia, dizziness, fatigue, headaches, liver damage, gastro-intestinal effects, cataracts). Induces a deficiency in CoQ10.
Arteriolsclerosis
• 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.
Atherosclerosis Pathophysiology
• 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.
Arteriolsclerosis: Cause and Risks
• 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.
Arteriolsclerosis: Signs and Symptoms
• Angina pectoris -ischaemic heart pain (from thrombosis & embolism). • Stroke (from thrombosis, embolism & haemorrhage).
Arteriolsclerosis: Complications
• Myocardial infarction & Stroke/TIA. • Aneurysm and haemorrhage. • Embolism–an embolus (mobile blood clot) travels through the blood and causes a blockage.
Arteriolsclerosis: Treatment
• Surgery –stents, statins, exercise.
Angina Pectoris
• 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.
Types of Angina
• Stable: Pain is precipitated by physical exercise. • Unstable: Occurs randomly.
Angina: Signs and Symptoms
• Heavy, constricting chest pain, radiating to the neck, left shoulder and jaw. Eases on rest. • Dyspnoea.
Angina: Treatment
• Acute relief: GTN (Glyceryl Trinitrate) sublingual (converted in the blood to nitric oxide vasodilation). • Long term drug therapy: anti-hypertensives.
Stroke
• 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.
Stroke: Causes
• Thrombus/embolus (80%) = ischaemic stroke. • Haemorrhagic stroke -blood vessel damage (i.e. following ruptured aneurysm).
Stroke: Signs and Symptoms
Sudden weakness, numbness/tingling, loss of speech, loss of vision, sudden severe headaches, confusion, unsteadiness.
Stroke: Diagnosis
CT scan, MRI scan
Stroke: Treatment/Support
• Hospital, O2 therapy, aspirin, thrombolytic treatment, surgery.
Transient Ischaemic Attack: “Mini Stroke”
• 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.
Transient Ischaemic Attack: Causes
Same as stroke
Transient Ischaemic Attack: Signs and Symptoms
• Transient impaired functions resolves with 24 hours. • Unilateral weakness, dysphasia (difficulty speaking), unilateral tingling. • Double vision, vertigo, confusion.
Aneurysm
• 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).
Deep Vein Thrombosis (DVT)
• Thrombus formation in the deep veins of the legs. • Clot may dislodge and cause a pulmonary embolism.
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.
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.
DVT: Treatment
Complete rest and heparin
Pulmonary Embolism: Symptoms
Dyspnoea, chest pain, cough, haemoptysis (coughing blood), tachycardia/tachypnoea, pleural rub
Varicose Veins
Incompetent valves cause pooling of the venous blood & chronically dilated veins.
Varicose Veins: Signs and Symptoms
Aching & fatigue of legs, distended blue veins.
Varicose Veins: Dianosis
Doppler and ultrasound.
Varicose Veins: Treatment
Compression, hydrotherapy, exercise, stripping,legs elevation.
Varicose Veins: Complications
Haemorrhage, venous ulcers. DVT following treatment.
Haemorrhoids: “Piles”
• Enlarged and often inflamed veins in the anal canal. • Some prolapse, other types do on straining and in fourth degree are permanent.
Haemorrhoids: Causes
• Chronic constipation, chronic cough. • Hypertension (portal hypertension). • Obesity, Pregnancy.
Haemorrhoids: Signs and Symptoms
• Painless unless they become strangulated. • Bright, red blood on faeces/toilet paper. • Protruding haemorrhoids causing pain & itching.
Oesophageal Varices
• Varicose veins of the Oesophagus, tending to affect the distal oesophagus.