Cardio Week 3 Flashcards
what is atherosclerosis
progressive disease characterised by build up of plaque
what is the normal level for triglycerides
2.3mmol/l
what is the role of HDL
protective effect for risk of atherosclerosis and CHD
what are markers of high cholesterol
xanthelasma (xanthomas of eyelids), tendon xanthomas, tuberous xanthomas or eruptive xanthomas (small reddish-yellow pauples)
what is the events leading up to the formation of a fatty streak or plaque
damage - productive of adhesion molecules - attachment of monocytes and T cells - migration to sub endothelial space - macrophages take up oxidised LDL - forms lipid rich foam cells
what diseases are attributable to hypertension
aortic aneurysm, HR, LVH, MI, CHD, cerebral haemorrhage, preeclampsia, stroke, chronic kidney disease, blindness
what is the risk factors for CVD that most hypertensives have
dyslipidemia, diabetes, age, male gender, smoking, family history
what lifestyle modifications can be made to reduce risk of CVD
lose weight, limit alcohol intake, increase physical activity, reduce salt intake, stop smoking, limit intake of foods rich in fat and cholesterol
what is hypertension a risk factor for
cerebral haemorrhage, atheroma, renal failure, sudden cardiac death
what is primary hypertension
90% of cases, no obvious cause, increase in dietary salt leads to increase in BP
what is secondary hypertension
underlying disease implicated
what are common causes of secondary hypertension
renal disease (salt and water overload), sleep apnoea, aldosteronism, Reno-vascular disease
what are uncommon causes of secondary hypertension
cushings (excess corticosteroids), pheochromocytoma (excess noradrenaline) hyperparathyroidism, aortic coarctation (congenital narrowing)
what is benign hypertension
life threatening, asymptomatic, incidental finding, eventually causes LVH, congestive cardiac failure, increases atheroma, aneurysm rupture and renal disease
what is the process behind left ventricular hypertrophy
increased LV load - poor perfusion - interstitial fibrosis - micro infarcts - diastolic dysfunction results in cardiac death or failure
what is the cause of hypertensive atherosclerosis
blood vessel wall changes (esp in retina and kidney), thickening of media and hyaline arteriosclerosis where plasma proteins forced into vessel wall
what is malignant hypertension
serous, diastolic >130, can develop from either benign primary or secondary hypertension or arise de-novo - urgent treatment needed
causes of malignant hypertension
cerebral oedema (seen as papillodema), acute renal failure, acute heart failure, headache and cerebral haemorrhage
what is the consequence of pregnancy associated hypertension and proteinuria
pre-eclampsia - obstetric emergency and the hypertension is secondary to silent renal or systemic disease
what is the virchows triad that leads to thrombosis
endothelial injury, turbulent blood flow, hypercoaguable blood
what causes endothelial injury
hypertension, autoimmune disease (eg primary vasculitis)
thrombus via intravascular coagulation is caused by what two things
platelet activation and fibrin production via coagulation cascade
what is special about activated platelets
more sticky, attract and aggregate with other platelets, aggregate with fibrin (fibrin is end point of coagulation cascade)
what happens when endothelial damage occurs and endothelium is lost
collagen exposed, binds to Ia/IIb on platelets as does vWF, there is increase in platelet integrins, IIb/IIIa binds fibrogen and activated platelets release granules to attract other platelets (vWF, platelet activating factor PAD, TXA2 and ADP)