Cardio Pathology (AWAN) Flashcards
______ is the leading cause of death in all areas of the world.
CVD (cardiovascular disease)
Can you name all 10 risk factors for CVD?
- Genetics
- Age
- Gender
- Alcohol / Tobacco
- Diet and Physical activity (exercise)
- Pollutants / Mutations
- Socio-economic status
All of the following are Non-modifiable risk factors for CVD EXCEPT:
A. Genetics
B. Diabetes
C. Gender
D. Age
B. Diabetes
Non-modifiable risk factors for CVD: “GAG”
- Genetics
- Age
- Gender
Modifiable:
- High BP
- High cholesterol
- Diabetes
- you can modify them by treating them with medications
List the two principal mechanisms for the pathology of CVD:
- Narrowing (stenosis) or complete destruction of vessel lumens
- Weakening of vessel walls, leading to dilation or rupture
Atherosclerosis
A. means “hardening of the arteries”
B. characterized by intimal lesions called atheromas that protrude into vessel lumens
C. an atheromatous plaque consists of a raised lesion with a soft, yellow, grumous core of lipid covered by a white fibrous cap
D. All of the above
D. All of the above
Atherosclerotic plaques can do all of the following EXCEPT:
A. obstruct blood flow
B. rupture leading to thrombosis
C. recruit more atheromas to adhere
D. Weaken the underlying media leading to an aneurysm
C. recruit more atheromas to adhere
What are the 2 major components of a well developed atheromatous plaque:
- Fibrous cap: smooth muscle, macrophages, foam cells, collagen, lymphocytes
- Necotic Center: cell debris, cholesterol, foam cells and calcium
Discuss the timeline of Atheroscleorsis: (6)
- Foam cells (lipid-laden macrophage)
- Fatty streak
- Intermediate lesion (plaque)
- Atheroma (increasing plaque)
- Fibrous plaque (obstructive atherosclerotic plaque)
- Complicated lesion/rupture (results in thrombosis)
Discuss the process of atherosclerosis with emphysis on the formation of foam cells:
Atherosclerosis
- Monocyte enters the lumen of the artery and becomes a macrophage
- The macrophage begins eating all the cholesterol (LDL)
- The macrophage dies and becomes a foam cells
- Foam cells accumulate
- T cells cause inflammation of smooth muscle cells
List as many of the 11 signs and symptoms you can for CVD:
- Chest pain
- Difficulty breathing (Dyspnea)
- Swelling of feet
- Palpations
- Fever
- Fatigue
- Cyanosis
- Syncope (fainting)
- Cough with expectorations and hemoptysis (blood)
- Rt hypochondiral pain
- GIT S&S
Elfin Facies is an abnormality associated with which condition?
A. Supraventricular aortic stenosis
B. Marfan syndrome
C. Mitral stenosis with decreased cardiac output and systemic vasoconstriction
D. All of the above
A. Supraventricular aortic stenosis
Mitral Facies is an abnormality associated with which condition?
A. Supraventricular aortic stenosis
B. Marfan syndrome
C. Mitral stenosis with decreased cardiac output and systemic vasoconstriction
D. All of the above
C. Mitral stenosis with decreased cardiac output and systemic vasoconstriction
Supraventricular aortic stenosis = Elfin Facies
Marfan syndrome = High Arched Palate
Mitral stenosis w/ decreaed cariac output and systemic vasoconstriction = Mitral Facies
High Arched Palate is an abnormality associated with which condition?
A. Supraventricular aortic stenosis
B. Marfan syndrome
C. Mitral stenosis with decreased cardiac output and systemic vasoconstriction
D. All of the above
B. Marfan syndrome
Supraventricular aortic stenosis = Elfin Facies
Marfan syndrome = High Arched Palate
Mitral stenosis w/ decreaed cariac output and systemic vasoconstriction = Mitral Facies
Clinical manifestations of Elfin Facies include all of the following EXCEPT:
A. Malar flush
B. Receding jaws
C. Flared nostrils
D. Pointed ears
A. Malar flush
Elfin Facies:
- receding jaws
- flared nostrils
- pointed ears
High arched palate = Marfan syndrome
Mitral Facies:
- malar flush
- Pinkish/purple patches on the cheek
Which of the following is a clinical manifestation of Mitral Facies?
A. Pinkish purple patches on cheeks
B. Receding jaws
C. Flared nostrils
D. Pointed ears
A. Pinkish purple patches on cheeks
What are the 4 major defects of Tetralogy of Fallot?
- Pulmonary stenosis
- Right Ventricular hypertrophy
- Ventricular septal defect
- Overriding aorta
_______ is known as the “Silent Killer” of mankind.
Hypertension
- most pts are asymptomatic
(T/F)
Most people who have hypertension have been diagnosed by a doctor.
False
- Most people dont know they have hypertension
note: hypertension is defined as 140/90 or higher
How many people have high blood pressure?
1.13 billion people
Which of the following is hypertension more commonm in?
A. males
B. females
A. males
Male = 1/4 men
Female = 1/5 women
A hypertensive crisis is defined as a blood pressure higher than ________/________.
180/120
Primary (or) Essential hypertensioin:
A. Has an underlying cause such as renal disorders, endocrinal disturbances
B. Develops gradually over many years and has no underlying cause
B. Develops gradually over many years and has no underlying cause
Primary hypertensioin = 90% of ppl have this type
Secondary hypertension = 10% of people have this type
Secondary hypertension:
A. Has an underlying cause such as renal disorders, endocrinal disturbances
B. Develops gradually over many years and has no underlying cause
A. Has an underlying cause such as renal disorders, endocrinal disturbances
All of the following is true regarding Primary (Essential) hypertension EXCEPT:
A. Develops gradually over many years
B. Has no underlying disease
C. 10% of people have this type of hypertensioni
D. All of the above
C. 10% of people have this type of hypertensioni
note: 90% of people with hypertension have Primary (Essential) hypertension
How many of the 8 risk factors for hypertension can you list?
- Lack of exercise / Stress
- Family history / Age
- Alcohol / Smoking
- Increased salt intake / Too little potassium
All of the following are common target organs damaged by long standing hypertension EXCEPT:
A. Brain
B. Heart
C. Liver
D. Kidneys
E. Eyes
C. Liver
What are the 5C’s of complications of hypertension?
- Coronary artery disease
- Chronic renal failure
- Congestive heart failure
- Cardiac arrest
- Cerebrovascular accident (stroke)
***May be on EXAM***
Which of the following are symptoms of hypertension?
A. Headache
B. Dizziness
C. Epistaxis
D. All of the above
D. All of the above
List the 7 oral manifestations seen in patients who take antihypertensive drugs:
- Xerostomia
- Taste sense alteration
- Gingival overgrowth
- Lichenoid drug reaction
- Salivary gland swelling or pain
- Erythema multiforme
- Paresthesia
“___________” is a phenomenon in which individuals present with persistent elevated BP in a clinical setting but present with non-elevated BP in an ambulatory setting.
“White coat hypertension”
Coronary artery disease:
A. pumping blood against the higher pressure in the vessels causes the heart muscles to thicken
B. can lead to narrowing of blood vessels making them more likely to block from blood clots
C. constant high blood pressure can damage small blood vessels in the kidneys making it not able to function properly
D. high blood pressure can cause CAD, dmaged arteries cannot deliver enough oxygen to other parts of the body eventually leading to a heart attach
E. hypertension leads to atherosclerosis and hardening of the large arteries, which can result in blockages of small blood vessels in the brain
B. can lead to narrowing of blood vessels making them more likely to block from blood clots
Cerebrovascular Accident:
A. pumping blood against the higher pressure in the vessels causes the heart muscles to thicken
B. can lead to narrowing of blood vessels making them more likely to block from blood clots
C. constant high blood pressure can damage small blood vessels in the kidneys making it not able to function properly
D. high blood pressure can cause CAD, dmaged arteries cannot deliver enough oxygen to other parts of the body eventually leading to a heart attach
E. hypertension leads to atherosclerosis and hardening of the large arteries, which can result in blockages of small blood vessels in the brain
E. hypertension leads to atherosclerosis and hardening of the large arteries, which can result in blockages of small blood vessels in the brain
Chronic Renal Failure:
A. pumping blood against the higher pressure in the vessels causes the heart muscles to thicken
B. can lead to narrowing of blood vessels making them more likely to block from blood clots
C. constant high blood pressure can damage small blood vessels in the kidneys making it not able to function properly
D. high blood pressure can cause CAD, dmaged arteries cannot deliver enough oxygen to other parts of the body eventually leading to a heart attach
E. hypertension leads to atherosclerosis and hardening of the large arteries, which can result in blockages of small blood vessels in the brain
C. constant high blood pressure can damage small blood vessels in the kidneys making it not able to function properly
Cardiac Arrest:
A. pumping blood against the higher pressure in the vessels causes the heart muscles to thicken
B. can lead to narrowing of blood vessels making them more likely to block from blood clots
C. constant high blood pressure can damage small blood vessels in the kidneys making it not able to function properly
D. high blood pressure can cause CAD, dmaged arteries cannot deliver enough oxygen to other parts of the body eventually leading to a heart attach
E. hypertension leads to atherosclerosis and hardening of the large arteries, which can result in blockages of small blood vessels in the brain
D. high blood pressure can cause CAD, dmaged arteries cannot deliver enough oxygen to other parts of the body eventually leading to a heart attach
Congestive Heart Failure:
A. pumping blood against the higher pressure in the vessels causes the heart muscles to thicken
B. can lead to narrowing of blood vesPastesels making them more likely to block from blood clots
C. constant high blood pressure can damage small blood vessels in the kidneys making it not able to function properly
D. high blood pressure can cause CAD, dmaged arteries cannot deliver enough oxygen to other parts of the body eventually leading to a heart attach
E. hypertension leads to atherosclerosis and hardening of the large arteries, which can result in blockages of small blood vessels in the brain
A. pumping blood against the higher pressure in the vessels causes the heart muscles to thicken
List the 5C’s associated with the complications of hypertension:
- Coronary artery disease
- Chronic renal failure
- Congestive heart failure
- Cardiac arrest
- Cerebrovascular accident
________ is the term given to heart problems casued by narrowed heart arteries. When arteries are narrowed, less blood and oxygen reaches the heart muscle. This condition is also known as coronary artery disease or coronary heart disease and can lead to a heart attack.
Ischemic heart disease (IHD)
_________ is the most common cause of Ischemic Heart Disease (IHD).
Atherosclerosis
List as many of the 11 risk factors for Ischemic Heart Disease (IHD):
- Age (premenopausal women have decreased risk)
- Sex (Estrogen as a cardiac protective mechanism)
- Family history
- Tobacco / Alcohol
- Obesity / Dietary factors
- Physical activity (inactivity doubles the risk)
- Type 2 diabetes
- Hypertension / Hypercholesterolemia
All of the following are examples of Primary prevention of IHD EXCEPT:
A. Modify risk factors in populations through diet and lifestyle
B. Public restriction of smoking
C. Modifying risk factors in pts who have a history of heart disease
D. All of the above are examples of primary prevention
C. Modifying risk factors in pts who have a history of heart disease
note: Secondary prevention is modifying risk factors in pts who already have evidence of atheromatous vascular disease
________ is a major sign and symptom of IHD when a patient feels chest pain due heart muscles not receiving enough oxygen-rich blood.
Angina Pectoris
All of the following are true regarding angina pectoris EXCEPT:
A. a type of chest pain
B. is a form of disease
C. described as “heavy”, “tight” or “gripping”
D. associated breathlessness
E. typically central/retrosternal
B. is a form of disease
note: Angina pectoris is NOT a disease. It is a symptom of an underlying heart problem such as IHD
Angina during ordinary activity with mild limitation of activities is charcteristic of _______.
A. Class I angina
B. Class II angina
C. Class III angina
D. Class IV angina
B. Class II angina
Class I = Angina w/ strenuous activity
Class II = Angina during ordinary activity w/ mild limitation of activities
Class III = Angina with low levels of activity, with marked restriction of activities
Class IV = Angina at rest or with any level of exercise
Angina only during strenuous activity and NOT during ordinarry activity is charcteristic of _______.
A. Class I angina
B. Class II angina
C. Class III angina
D. Class IV angina
A. Class I angina
Class I = Angina w/ strenuous activity
Class II = Angina during ordinary activity w/ mild limitation of activities
Class III = Angina with low levels of activity, with marked restriction of activities
Class IV = Angina at rest or with any level of exercise
Angina at rest or with any level of exercise is charcteristic of _______.
A. Class I angina
B. Class II angina
C. Class III angina
D. Class IV angina
D. Class IV angina
Class I = Angina w/ strenuous activity
Class II = Angina during ordinary activity w/ mild limitation of activities
Class III = Angina with low levels of activity, with marked restriction of activities
Class IV = Angina at rest or with any level of exercise
Angina with low levels of activity with marked restriction of activities is charcteristic of _______.
A. Class I angina
B. Class II angina
C. Class III angina
D. Class IV angina
C. Class III angina
Class I = Angina w/ strenuous activity
Class II = Angina during ordinary activity w/ mild limitation of activities
Class III = Angina with low levels of activity, with marked restriction of activities
Class IV = Angina at rest or with any level of exercise
Classical or Exertional Angina Pectoris is characterized by all of the following EXCEPT:
A. Constricting discomfort in the front of the chest
B. Provoked by physical exertion, especially after meals and in cold
C. Relieved with rest or glyceryl trinitrate
D. All of the above are true
D. All of the above are true
Typical angina = all three features
Atypical angina = two of the three
Non-anginal chest pain = one or less of the three
What are the 4 types of angina?
- Stable angina
- Unstable angina
- Refractory angina
- Variant (Prinzmetal’s) angina
_______ occurs in patients with severe coronary disease in whom revascularization is not possible and angina is not controlled by medical therapy.
A. Stable angina
B. Unstable angina
C. Refractory angina
D. Variant (Prinzmetal’s) angina
C. Refractory angina
________ is characterized as episodic clinical syndrome where there is no change in severity of attacks.
A. Stable angina
B. Unstable angina
C. Refractory angina
D. Variant (Prinzmetal’s) angina
A. Stable angina
Deterioration in previous stable angina with symptoms frequently occuring at rest i.e. acute coronary syndrome:
A. Stable angina
B. Unstable angina
C. Refractory angina
D. Variant (Prinzmetal’s) angina
B. Unstable angina
_______ typically occurs without provocation, usually at rest, as a result of coronary artery spasm and is more frequent in women.
A. Stable angina
B. Unstable angina
C. Refractory angina
D. Variant (Prinzmetal’s) angina
D. Variant (Prinzmetal’s) angina
Which of the following is the most important factor in diagnosing angina pectoris?
A. Age
B. Gender
C. History
D. Diet
C. History
All of the following are dental managment of angina pectoris EXCEPT:
A. Preoperative glyceryl trinitrate and oral sedation sometimes advised
B. Dental care carried with minimal anxiety and oxygen saturation
C. Post angioplasty elective dental care deffered for 6 months, emergency dental care in hospital setting
D. Pts w/ bypass grafts - antibiotic cover against infective endocarditis
E. Local anesthesia w/ adrenaline is indicated
E. Local anesthesia w/ adrenaline is indicated
Dental Management of Angina Pectoris:
- Preoperative glyceryl trinitrate and oral sedation sometimes advised
- Dental care carried with minimal anxiety and oxygen saturation
- Monitor pulse and BP
- Post angioplasty elective dental care deffered for 6 months, emergency dental care in hospital setting
- Pts with bypass grafts - antibiotic cover against infectious endocarditis
- LA containing adrenaline is contraindicated
Drugs used too treat angina may cause which of the following oral adverse effects?
A. lichenoid reaction
B. gingival swelling
C. ulcers (nicorandil)
D. Two of the above
E. All of the above
E. All of the above
_________ occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle.
Myocardial Infarction
- also called coronary thrombosis or heart attack
- more than 50% of pts are asymptomatic
- MI may be preceded by angina often felt as indigestion like pain (heart burn)
All of the following are signs and symptoms of myocardial infarction EXCEPT:
A. Arm, neck, jaw or back pain
B. Fatigue / sleep disturbance
C. Anxiety / feelings of doom
D. Nausea / indigestion
E. Cyanosis / fever
E. Cyanosis / fever
note: Cyanosis or fever are symptoms of CVD
Other signs and symptoms of MI:
- sympathetic activation: pallor, sweating, tachycardia
- vagal activation: vomiting, bradycardia
- signs of impaired myocardial function
- hypotension
- narrow pulse pressure
- raised JVP
- third heart sound
- quiet first heart sound
- diffuse apical impulse
- lung crepitations
- tissue damage: fevver
- pericarditis
All of the following are ways to diagnose Myocardial Infarction EXCEPT:
A. Plasma renin activity testing
B. ECG
C. Blood tests looking for elevated ESR, CRP, CPK or troponin
D. Echocardiography
A. Plasma renin activity testing
note: plasma renin activity is tested to diagnose hypertension
Describe the dental management of patients on warfarin:
Warfarin is an antithrombin medication that may increase risk of oral bleeding following surgical procedures
Monitor INR (international normalized ratio) which is calculated based on international sensitivity index (ISI)
- INR ranges from 2.0-3.5 are required before surgery
