atherosclerosis Flashcards
1
Q
define hypertension
A
high blood pressure
2
Q
aetiology of hypertension
A
genes
environment
3
Q
characteristic of hypertension
A
140/90 BP
4
Q
describe stage 1 treatment of hypertension
A
offer antihypertensive drug treatment to patients younger than 80
5
Q
describe stage 2 treatment of hypertension
A
antihypertensive drug treatment
6
Q
step 1 of treatment of hypertension for aged over 55
A
or black people of african/caribbean descent = calcium channel blocker or thiazide
7
Q
step 1 of treatment of hypertension for aged under 55
A
ACE inhibitor or ARB
8
Q
step 2 of treatment of hypertension
A
add thiazide type diuretic to step 1
9
Q
step 3 of treatment of hypertension
A
add CCB, ACEi and diuretic together
10
Q
step 4 of treatment of hypertension
A
resistant hypertension:
- unable to achieve target BP
11
Q
strengths of antihypertensive therapy
A
help many people lower their high blood pressure and keep their hearts from becoming overworked.
12
Q
weakness of antihypertensive therapy
A
- renal artery stenosis
- impaired renal function
- hyperkalaemia
13
Q
treatment of hypertension during pregnancy
A
V hydralazine, labetalol and oral nifedipine
14
Q
what is atherogenesis
A
formation of focal elevated lesions in intima of large and medium sized arteries
15
Q
describe atherogenesis
A
Atheromas formalong the inside lining of your arteries and interrupt blood flow through your body
16
Q
development of atheromatous plaques
A
- injury to endothelial lining of artery
- chronic inflammatory and healing response of vascular wall to agent causing injury
17
Q
what characterises early atheromatous plaque
A
smooth yellow patches in intima
18
Q
what characterises complicated atheroma
A
atheromatous plaque and haemorrhage into plaque
19
Q
what characterises a fully developed atheromatous plaque
A
form at arterial branching points
20
Q
risk factor of atheroma
A
hypercholesterolaemia
- lipids are involved in plaque formation and growth
21
Q
what are the signs of hyperlipidaemia
A
- familial/primary vs acquired/secondary
- LDL, HDL, total cholesterol, triglycerides
- corneal arcus
- tendon xanothmata
- xanthelasmata
22
Q
what is corneal arcus
A
white, blue or gray crescent shape (arc) made of lipid (fatty) deposits that curves around the outer edges of the cornea of the eye
23
Q
what is tendon xanthomata
A
slowly enlarging subcutaneous nodules usually found attached to the Achilles tendon or tendons over the knuckles
24
Q
what is xanthelasmata
A
a sharply demarcated yellowish deposit of cholesterol underneath the skin
25
describe ruptured atheromatous abdominal aortic aneurysm
media beneath atheromatous plaques gradually weakened - sudden rupture can cause massive haemorrhage
26
describe embolisation of distal arterial bed
detachment of small thrombus fragments from thrombosed atheromatous arteries
27
describe acute atherothrombotic occulsion
rupture of plaque can cause irreversible ischaemia and necrosis of tissues
28
what is thrombosis
the formation of a solid mass from the constituents of blood within the vascular system
29
pathogenesis of thrombosis
- atheromatous coronary artery
- turbulent blood flow
- loss of intimal cells
- collagen exposed
- platelets adhere
- RBC’s become trapped
- lines of Zahn
- propagation
- consequences
30
what are the factors causing thrombosis
- endothelial injury
- stasis or turbulent blood flow
- hypercoagulability of the blood
31
what is embolism
detached intravascular mass
32
factors causing embolism due to thrombus
mural thrombosis often associated with MI or left atrial dilation + AF)
33
factors causing embolism due to fat
after major fractures
34
factors causing embolism due to gas
decompression sickness - Na2 forms as bubbles which lodge in capillaries
35
factors causing embolism due to air embolus
head and neck wounds, surgery, CV lines
36
factors causing embolism due to trophoblast
pregnant women - lungs
37
define ischaemia
relative lack of blood supply to tissue/organ leading to inadequate O2 supply to meet the needs of the tissue/organ
38
describe hypoxic hypoxia
O2 level = low
inspired O2 = normal
PaO2 = low
39
describe anaemic hypoxia
inspired O2 = normal
blood = abnormal
40
describe stagnant hypoxia
inspired O2 = normal
O2 delivery = abnormal
41
describe cytotoxic hypoxia
inspired O2 = normal
tissue level = abnormal
42
describe cytotoxic hypoxia
inspired O2 = normal
tissue level = abnormal
43
what is infarction
ischaemic necrosis within a tissue/organ in living body produced by occlusion of either the arterial supply or venous drainage
44
relationship between atheroma and ischaemia
Most ischemic strokes are caused by atherosclerosis
45
describe biochemical consequences of ischaemia
reduced O2 leads to anaerobic metabolism which leads to cell death
46
describe the process of infarction
anaerobic metabolism leads to cell death leads to liberation of enzymes leads to breakdown of tissue
47
describe transmural infarction
ischaemic necrosis affects full thickness of the myocardium
48
describe subendocardial infarction
ischaemic necrosis mostly limited to a zone of myocardium under the endocardial lining of the heart
49
what is stable angina
a discomfort in the chest and/or adjacent areas associated with myocardial ischaemia but without myocardial necrosis
50
what causes stable angina
reduction in coronary artery blood flow to the myocardium
51
non-modifiable risks of stable angina
Age, gender, creed, family history & genetic factors.
52
modifiable risks of stable angina
Smoking, Lifestyle- exercise & diet, Diabetes mellitus, Hypertension & Hyperlipidaemia
53
clinical presentation of stable angina
- Tar stains on fingers.
- Obesity (centripedal).
- Xanthalasma and corneal arcus (hypercholesterolaemia).
- Hypertension.
- Abdominal aortic aneurysm arterial bruits, absent or reduced peripheral pulses.
- Diabetic retinopathy, hypertensive retinopathy on fundoscopy
54
what investigation should higher risk patients with suspected stable angina undergo
coronary angiography
55
what medicines are used for relief of stable angina symptoms
B blockers
Ca channel blockers
Lk channel blockers
all to achieve resting heart rate of under 60 BPM
56
medicines used to manage stable angina
statins, ace inhibitors and aspirin
57
what causes myocardial infarction
thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable plaque
58
symptoms of myocardial infarction
- chest pain, which travels from left arm to neck,
- shortness of breath,
- sweating,
- nausea,
- vomiting,
abnormal heart beating
59
describe rate limiting drugs
for symptom relief
beta-adrenoreceptor antagonist
60
describe vasodilator drugs
for symptom relief
examples: nitrates, calcium channel blockers
61
describe sodium channel activator drugs
ranolazine
62
function of beta blockers
block the sympathetic system
63
example of beta blocker
bisoprolol
64
adverse effects of beta blockers
asthma, acute heart failure and bradycardia
65
benefits of beta blockers
reduces myocardial workload, reduces rate of ischaemic events and mortality
66
function of calcium channel blockers
Prevent calcium influx into myocytes and smooth muscle arteries/arterioles by blocking L-type Ca channel
67
examples of calcium channel blockers
amlodipine (DHP) verapamil (N-DHP)
68
function of vasodilators
Nitric Oxide mediated smooth muscle relaxation
69
examples of vasodilators
nitrates
70
describe the mechanism of action of thrombolytic therapy
- converting plasminogen to plasmin, an enzyme that breaks down fibrin, a protein that forms the backbone of blood clots.
- By breaking down fibrin, thrombolytics can dissolve blood clots and restore blood flow to the affected area
71
common complications of myocardial infarction
- ventricular septal defect (VSD),
- papillary muscle rupture or dysfunction,
- cardiac free wall rupture,
- ventricular aneurysm,
- dynamic left ventricular (LV)
- outflow tract (OT) obstruction
- right ventricular (RV) failure
72
what is the role of beta-blockers in angina
reducing myocardial oxygen demand by decreasing heart rate and myocardial contractility
73
what is the role of statins
preventing myocardial infarction = lowering cholesterol levels
74
what are the potential adverse drug reactions following treatment of ischaemic heart disease
bradycardia, dizziness, hypotension, hyperkalemia, cough, and renal impairment
75
what is stroke
neurological deficit of sudden onset due to a blocked (ischemic) or ruptured (hemorrhagic) blood vessel in the brain
76
causes of stroke
blockage with thrombus or clot, disease of vessel wall, disturbance of normal properties of blood, rupture
77
risk factors for stroke
- Age
- Hypertension
- Cardiac Disease (esp atrial fibrillation)
- Diabetes
- Smoking
- Family history
- Cholesterol
- Bleeding disorders
78
treatments for stroke
thrombolysis via atleplase
tissue plasminogen activator - within 3 hours of treatment
79
treatments for stroke
thrombolysis via atleplase
tissue plasminogen activator - within 3 hours of treatment
80
what is primary stroke prevention
Primary stroke prevention refers to the treatment of individuals with no history of stroke.
81
what is secondary prevention of stroke
- Secondary stroke prevention refers to the treatment of individuals who have already had a stroke or transient ischemic attack
- Measures may include the use of platelet antiaggregants, antihypertensives, statins, and lifestyle interventions
82
layers of thoracic aorta
tunica intima
tunica media
tunica adventitia
83
what is tunica intima
inner layer - endothelial
84
what is tunica media
middle layer - smooth muscle
85
what is tunica adventitia
outer layer - thin connective tissue
86
what is an aneurysm
localised enlargement of an artery caused by a weakening of the vessel wall
87
describe a true aneurysm
weakness and dilation of wall involving all 3 layers
88
describe a false aneurysm
rupture of wall of aorta contained by adventitia or soft tissue
89
clinical presentation of acute thoracic aneurysm
can be asymptomatic
- Shortness of breath (associated aortic regurgitation)
- Dysphagia and hoarseness
- Back pain
- Symptoms of dissection - sharp chest pain radiating to back (between shoulder blades), hypotension
- Pulsatile mass
90
what is aortic disection
tear in inner wall of aorta
91
presenting symptoms of acute aortic disection
- Chest pain – severe, sharp, radiating to back (inter-scapular)
- Collapse (tamponade, acute AR, external rupture)
- Stroke (involvement of carotid arteries)
92
examined symptoms of acute aortic dissection
- Reduced or absent peripheral pulses
- Hypertension or hypotension
- BP mismatch between sides
- Soft early diastolic murmur (aortic regurgitation)
- Pulmonary oedema
- Signs of CVA
93
what is coarctation
aortic narrowing close to where ductus arteriosus inserts
94
signs of coarctation
- Cold legs
- Poor leg pulses
95
what is marfans syndrome
an inherited disorder that affects connective tissue (fibrillin 1 gene)
96
what are possible aortic manifestations
- aortic/mitral valve prolapse - regurgitation
- aneurysm and dissection
- vascular - aneurysm, disection
97
clinical presentation of arterial occlusive disease
"six Ps":
-pallor
- pain
- paresthesia
- paralysis
- pulselessness
- poikilothermia
98
clinical presentation of aneurysmal disease
abdominal or back pain with a pulsatile abdominal mass
99
what is carotid endarterectomy
surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery
100
benefits of carotid endarterectomy
- Reduces Risk of Additional Stroke
- Reduces Risk of First Time Stroke
- Safe Procedure
- The Procedure Has Durable Outcomes
101
complications of carotid endarterectomy
- surgical complications
- restenosis = plaque returning
- limited benefits for mild to moderate blockage
102
function of the venous system in the lower limbs
A system of muscular venous pumps and bicuspid valves ensure flow from superficial to deep and from caudal to cephalad within the lower extremity
103
what are the complications with venous incompetence
- Recruitment of veins
- DVT.
- Pulmonary embolism (PE)
- Venous ulceration.
- Secondary lymphedema.
104
symptoms of chronic venous insufficiency
- Swelling in your legs or ankles.
- Tight feeling in your calves or itchy, painful legs.
- Pain when walking that stops when you rest.
- Brown-colored skin, often near the ankles.
- Varicose veins.
- Leg ulcers that are sometimes hard to treat
105
clinical presentation of CLI
- Stage I: Asymptomatic, incomplete blood vessel obstruction
- Stage II: Mild claudication pain in limb
- Stage IIA: Claudication when walking a distance of greater than 200 meters
- Stage IIB: Claudication when walking a distance of less than 200 meters
- Stage III: Rest pain, mostly in the feet
- Stage IV: Necrosis and/or gangrene of the limb
106
clinical presentation of compartment syndrome
- Inflammation,
- oedema,
- venous obstruction
- tense, tender calf
107
what is balloon angioplasty
procedure in which your vascular surgeon inserts a balloon catheter into a narrowed portion of an artery to treat arterial occlusive disease
108
what is bypass grafting
surgical procedure to redirect blood flow around an area of blockage to treat arterial occlusive disease
