Cardio Flashcards
Atherosclerosis is a primary cause of which three diseases
Heart attack, stroke and gangrene of the extremities
What affects the distribution of atherosclerotic plaques
Haemodynamics (flow and turbulence) cause media thinning and altered gene expression
Angina pectoris
Pain in the centre of the chest which is brought on by exercise and relieved by rest, may spread to the jaw and arms. Caused by increased myocardium oxygen demand and insufficient supply by the coronary arteries. Almost exclusively secondary to atherosclerosis
What is the response to injury hypothesis
Atherosclerosis is initiated by injury to endothelial cells leading to endothelial dysfunction, leukocyte accumulation and migration
What is ischaemia-reperfusion injury
Reintroduction of blood flow following ischaemia causes oxidative stress and neutrophils migrate causing inflammation and further damage to the tissue
Name some examples of good inflammation
Pathogens, parasites, tumours and wound healing
Name some examples of bad inflammation
Myocardial reperfusion injury, IHD, atherosclerosis, Rheumatoid arthritis and asthma
What are the two factors which ignite inflammation in the arterial wall
LDL and endothelial dysfunction
Which inflammatory cytokines are found in plaques
IL-1, IL-6, IL-8, INF-gamma, TGF-beta, MCP-1
What are foam cells
Lipid laden macrophages
What are the two types of coronary arteries
Epicardial (Run along surface of the heart, LAD, RCA, Cx) and small vessels (run within the cardium)
What are causes of angina
Atherosclerosis, anaemia, obstruction of vessels (ie from LV hypertrophy) increasing distal resistance
Name three other causes of angina besides atherosclerosis
Prinzmetals (coronary spasm), Syndrome X (microvascular resistance), Crescendo and unstable angina: ACS
What are the 3 factors needed for angina pain
heavy central tight radiates, exertion preciptitates, relieved by rest/GTN
Angina differential diagnosis
Pericarditis, PE, Chest infection, Aortic dissection, GI, MSK, psychological
Signs of complications on examination
Scars (midline sternonotomy, pacemaker, legs)
What is a sign unique to angina
Leivens sign, where they clutch hand across chest
What are the signs of angina on ECG and Echo
There are no direct signs. Can show IHD or previous infarcts
What are the signs of IHD and previous infarcts on ECG and Echo
Q waves, T wave inversion and BBB
What sign on an ECG during exertion indicates ischaemia
ST depression
Name two beta 1 specific beta blockers
Atenolol and bisoprolol
Beta blocker side effects
Tiredness, nightmares, bradycardia, cold hands and feet, erectile dysfunction
Beta blocker contraindications
Asthma, excess bradycardia, heart block, prinzmetal’s angina
How do nitrates treat angina
As venodilators they reduce the preload, work and oxygen demand of the heart. They also dilate the coronary arteries.