AKT Cardiovascular Flashcards
Name two goals of cardiac rehabilitation
- Preserve or resume optimal functioning
2. Slow of reverse progression of disease
For which patients is cardiac rehabilitation most indicated? (4)
Post MI
Post CABG
Stable CAD
Chronic heart failure
What are some of the benefits of cardiac rehabilitation?
Reduced mortality Reduced adverse cardiac events (eg MI) Reduced re-hospitalisations Improved functional status Lower BP and lipids Better diabetic control Higher smoking cessation rates Weight reduction
Cardiac rehabilitation is _________ _______ better health outcomes
associated with
Name the six core components of the British Association for CV Prevention and Rehabilitation
- Health behaviour change and EDUCATION
- Lifestyle risk factor management
- physical activity and EXERCISE
- healthy EATING and body composition
- TOBACCO CESSATION and relapse prevention
- Psychosocial health
- Medical risk management
- Long-term strategies
- Audit and evaluation
Name four specialists that are typically involved in a cardiac rehab MDT
- Nurse specialist
- Physiotherapist
- Exercise specialist
- Dietician
On the Borg scale of perceived exertion, what rate of perceived exertion should cardiac rehab patients be aiming to achieve with exercise?
Borg level of 4-6 (moderate activity)
What is the target BMI for cardiac rehabilitation patients?
20-25 kg/m2
What is the reason for most patients who do not take part in cardiac rehab fail to do so?
Because of issues with service organisation
Which parts of the country are performing very well in their key performance indicators (in cardiac rehabilitation)
The West of the country- Devon and Cornwall
Which part of the country is only meeting 3/7 of the key performance indicators for cardiac rehabilitation?
The Northeast of the country. This might reflect service disparity and health inequality across the UK.
This is a measure of the overall direction of the cardiac electrical impulse in the body
QRS axis
What can cause ST elevation on an ECG?
MI or pericarditis
What are the two main determinants of arterial BP?
Cardiac output and systemic vascular resistance
Contraindications for Beta blockers?
Do not use Beta blockers in severe asthma or in diabetics with recurrent hypoglycaemia
What is the most common form of primary hyperlipidemia?
Type 2b- combined hyperlipidemia (characterised by high levels of both cholesterol and triglyceride)
High LDL and high VLDL
Lipoprotein abnormality- apo B100
Which familial dyslipidaemia is associated with palmar xanthomas?
Familial dysbetalipoproteinemia
Which are the three most common types of familial dyslipidemia?
2b: Combined hyperlipidemia (high LDL & VLDL)
4: Hypertriglyceridemia (high VLDL)
2a: Hypercholesterolemia (high LDL)
Which of the familial dyslipidemias has a lipoprotein abnormality in the LDL receptors?
Type 2a: Hypercholesterolemia
Which type of familial dyslipidemias results in extremely high levels of triglycerides, and blood samples appear “creamy?”
Type 1: Hyperchylomicronemia
TREAT WITH FIBRATES
What is the therapeutic goal for LDL reduction after starting Statins?
LDL reduction of >40%
What are the QRisk and JBS3 scores used for?
Identifies patients who are at significant risk of adverse cardiac events.
What drugs are recommended for primary prevention of cardiac events based on estimated risk scores?
Statins
What are the BEHAVIOURAL risk factors contributing to the highest proportion of deaths in 2013?
Poor diet and smoking
According to the WHO, what percentage of illnesses and causes of death are correlated with lifestyle (ie preventable by changing our behaviour)?
60%
People living in the most _________ areas of England are almost 4x as likely to die prematurely of CVD
Deprived
What lifestyle changes could reduce premature death, cancers, and vascular dementias?
smoking cessation
improving diet
increased physical activity
What is the WHO’s current recommendation for weekly amounts of moderate physical activity?
150 minutes per week
What is the correlation between deprivation, motherhood, and obesity?
Poor mothers tend to prioritise their childrens’ nutrition over their own. Will skip meals so their kids can eat, and later fill up on high calorie, low nutrition foods.
What behaviour change might be suggested to pregnant women who are still smoking?
It is now advisable to encourage pregnant women to cut back on smoking rather than just quit cold turkey, as that advice hasn’t been very effective in helping women quit.
What condition is considered the “entry” to acute coronary syndromes?
Unstable angina
A major occlusion of a coronary vessel leads to what type of infarct?
ST elevation MI
Which blood test is most specific for diagnosing an MI?
Troponin (T&I)
What type of creatine kinase is specific to cardiac muscle?
CK MB
Acute management for acute coronary syndromes?
Aspirin
LMW Heparin (Enoxaparin)
Nitrates
Revascularisation
If ischaemia is untreated, after many minutes will cardiac myocyte death begin to occur?
15 minutes
Myocardium can be salvaged up to ________ hours after coronary occlusion
12
What does “thrombolysis” invovle?
Streptokinase and aspirin
Where should patients presenting with MI symptoms be taken?
If transfer for PCI can be achieved in <2 hours this is the optimum strategy
List the four medications indicated for secondary preventative treatment post-MI
DAPT
Ace-inhibitors
Beta blockers
Stains
What is the most common cause of sudden cardiac death in patients over 30 years old?
IHD (eg acute MI)
What is the most common cause of sudden cardiac death in patients less than 30 years old?
Hypertrophic cardiomyopathies
The citrate malate cycle involves the process of moving acetyl coA from the ___________ into the __________.
mitochondria, cytosol
What is the rate-limiting step of fatty acid synthesis?
The conversion of Acetyl CoA into Malonyl CoA via ACETYL CO-A CARBOXYLASE
Which 3-carbon intermediate is only found in fatty acid biosynthesis?
Malonyl CoA
Which hormone plays a role in the conversion of Acetyl CoA into Malonyl CoA?
Glucagon
What type of fatty acid chain is produced at the end of fatty acid synthesis?
A 16 carbon palmitate
In FA synthesis, citrate must first be converted into _______ in order to cross the mitochondrial membrane
pyruvate
If there is already a high amount of palmitate in circulation, which enzyme does this inhibit?
Acetyl CoA carboxylase
Which two hormones INACTIVATE acetyl coA carboxylase?
Glucagon and adrenaline
Remember, when the glucose is gone, you don’t want to create fat to store it, you want to break it down to use it!
Fatty acid synthesis occurs in the…
cytosol
Where is cholesterol mainly synthesized?
In the liver
What is the rate-limiting step of cholesterol biosynthesis?
HMG CoA reductase
HMG CoA reductase activity is regulated by which two hormones?
Insulin and glucagon
Acetyl CoA is converted into __________ via HMG CoA reductase
Mevalonate
Most bile acids are reabsorbed by the gut and returned to the _______ to be recycled.
liver
Which enzyme do Statin drugs target?
HMG CoA reductase
What two substances are feedback inhibitors in cholesterol biosynthesis?
Cholesterol and mevalonate
What three substances are produced during each cycle of beta oxidation?
Acetyl CoA
FADH2
NADH
Where does beta-oxidation of fatty acids occur?
In the mitochondria
What is the rate-limiting step of beta oxidation?
The transfer of aceyl groups across the mitochondrial membrane via the carnitine shuttle (CPT 1 to CPT2 via ACYLC CARNITINE TRANSLOCASE)
Mutations in which group of dehydrogenase enzymes can result in SIDS?
FADH2
In step 1 of beta oxidation, fatty acids are first activated by attachment to which co-enzyme?
CoEnzyme A
Briefly list the 3 steps of beta oxidation
- BETA OXIDATION: Long chains of FA’s are broken down into 2c bits of Acetyl CoA
- Oxidation of Acetyl CoA into CO2 in the citric acid cycle
- Transfer of elections to the mitochondrial respiratory chain
These are special proteins that carry lipids through the bloodstream
Lipoproteins
What is the key lipoprotein for LDL’s?
Apo-B 100
What is the key lipoprotein for HDL?
Apo E
The density of an IDL is between ______ and ______/
VLDL and LDL
Which lipoprotein carries cholesterol to the muscle, adrenal glands and ADIPOSE TISSUE?
LDL
Which lipoprotein returns cholesterol to the liver?
HDL
Which lipoprotein activates lipoprotein lipase?
Apo C-II
The exogenous pathway of lipid transport involves ________ giving up lipids to the tissues by the action of tissue-bound ________.
chylomicrons, lipases
In the exogenous pathway of lipid transport, the liver recognises remnants of chylomicron particles by their ________ content, and take them up by endocytosis.
Apo-E
What type of lipoprotein has “reverse” lipid transport?
HDL. Returns cholesterol to the liver
What type of lipoprotein has exogenous transport of lipids?
Chylomicrons (remember Apo E lipoprotein plays a role)
What two types of lipoproteins have endogenous lipid transport?
VLDL and LDL (transports lipids to muscle and adipose tissue)
Activation of which enzyme causes the release of FFA’s into the tissues?
Lipoprotein lipase
How does a particle of VLDL become an LDL?
By losing TG via lipoprotein lipase (remember that the liporoteins that have Apo-C II on their surface, chylomicrons and VLDL, is what activates lipoprotein lipase in the tissues
Reverse cholesterol transport- HDL particles bound by _________ receptor B1 mediates transfer of cholesterol into the cell.
scavenger (SR-B1)
Extra-hepatic tissues take up LDL particles via endocytosis by recognition of the _________ lipoprotein on the surface of the LDL.
Apo-B 100
What three types of extra-hepatic tissue has LDL receptors?
Adipose tissue, muscle, and adrenal glands
Re-entry is the mechanism for almost all cardiac ________ abnormalities
arrythmia
Which cardiac tissue (site of action) is Digoxin most effective in?
AV node
How helpful are medications for arrhythmias?
They can help control the heart rate and frequency of arrhythmias, but they do not improve prognosis
Epsilon waves are pathognomonic for what type of cardiomyopathy?
arrhythmogenic RV cardiomyopathy
What is the hallmark of AFib on ECG?
Hallmark is that heart rate is RAPID and irregular, gap between complexes are random
