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Phase 2a > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What us atherosclerosis the principal cause of?

A

MI, stroke and gangrene of the extremities.

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2
Q

Describe the distribution of atherosclerosis plaques?

A

Focal distribution along the artery length and found within peripheral and coronary arteries.

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3
Q

Describe the composition of atherosclerosis plaques?

A

Lipid, necrotic core, connective tissue and fibrous cap.

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4
Q

What are the three main drugs for the treatment of coronary artery disease?

A

Aspirin, clopidogrel and statins.

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5
Q

How many stages are there in the progression of atherosclerosis?

A

5.

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6
Q

What are the exacerbating factors of chronic coronary syndrome?

A

Environmental, supply and demand.

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7
Q

What is the main risk factor for atherosclerosis?

A

Age - arteries hardens over time.

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8
Q

What can changes in wall thickness lead to?

A

Neointima.

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9
Q

What is the term used to describe endothelial cells becoming ‘sticky’ after being subjected to an injury?

A

Endothelial dysfunction.

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10
Q

What causes inflammation a cause of atherosclerosis?

A

Infections of the upper respiratory tract e.g. pneumonia.

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11
Q

Describe when inflammation is a good response in the body?

A

When responding to pathogens, parasites, tumours and wound healing.

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12
Q

Describe when inflammation is a bad response in the body?

A

When responding to atherosclerosis, asthma, shock, ibs and ischaemic heart disease.

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13
Q

How does LDL cause inflammation in the arterial wall?

A

Can pass in and out of the arterial wall, can accumulate and can undergo oxidation and glycation.

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14
Q

What wbc’s is attracted to a site of inflammation by chemoattractants?

A

Leukocytes and neutrophils.

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15
Q

What is interleukin-8?

A

A chemoattractant.

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16
Q

What are the 5 stages of leukocyte recruitment to a vessel wall?

A

Capture, rolling, slow rolling, firm adhesion and transmigration.

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17
Q

What is stage 1 of atherosclerosis?

A

Fatty streaks that appear at a very early age and consist of aggregations of lipid-laden macrophages and T-lymphocytes within the intimal layer.

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18
Q

What is stage 2 of atherosclerosis?

A

Intermediate lesion that contains foam cells, vascular SM cells, isolated pools of extracellular lipid and aggregation of platelets on vessel wall.

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19
Q

What is stage 3 of atherosclerosis?

A

Advanced lesions that impedes blood flow and can show ECG changes. It is prone to rupture and is covered by a fibrous cap made of collagen, elastin and SM cells. It can also be calcified.

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20
Q

What is stage 4 of atherosclerosis?

A

Plaque rupture that leads to an MI/sudden death. The fibrous cap that stabilises the plaque has to be resorbed and redeposited in order to be maintained. If enzyme activity increases, the cap becomes weak and the plaque ruptures leading to M, collagen and necrotic tissue exposed, a thrombus formation and vessel occlusion.

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21
Q

What is stage 5 of atherosclerosis?

A

Plaque erosion - fibrous cap may be disrupted by collagen which triggers thrombosis (instead of tissue factor).

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22
Q

What is the second most prevalent cause of coronary thrombosis?

A

Plaque erosion - stage 5.

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23
Q

What is the treatment of coronary artery disease?

A

PCI - percutaneous coronary intervention.

24
Q

What drugs are used in the treatment of coronary artery disease?

A

Aspirin, cylopidogrel, statins and PCSK9 inhibitors.

25
Q

What causes residual inflammation, even with low LDL?

A

IL-1.

26
Q

What are the types of aortic stenosis?

A

Supravulvular, subvalvular and valvular.

27
Q

What are the congenital and acquired aetiology of aortic stenosis?

A

Congenital aortic stenosis/bicuspid valve, degenerative calcification and rheumatic heart disease.

28
Q

What is the management of aortic stenosis?

A

General = fastidious dental hygiene/care, IE prophylaxis in dental procedures. Surgery = TAVI.

29
Q

What is the main cause for mitral stenosis?

A

Rheumatic carditis.

30
Q

What does abnormal p waves on an ECG mean?

A

Low atrial rhythm

31
Q

What does ST elevation in L2 and L3 and aVF mean on an ECG?

A

Acute inferior MI and complete heart block.

32
Q

Define depolarisation.

A

Contraction of any muscle is associated with electrical changes called depolarisation.

33
Q

What is the intrinsic rate of the SA node?

A

60-100bpm.

34
Q

What is the intrinsic rate of AV node?

A

40-60bpm.

35
Q

What is the intrinsic rate of ventricular cells?

A

20-45bpm.

36
Q

What does negative deflection in a ECG represent?

A

Wave of depolarisation is away from the electrode.

37
Q

How many bipolar leads are there and what are they called?

A

3 bipolar leads, all of which are standard limb leads.

38
Q

How many unipolar leads are there and what are they called?

A

9 unipolar leads, 3 of which are augmented limb and 6 are precordial leads.

39
Q

ECG - what anatomy does lead II, III and aVF refer to?

A

Inferior wall of the LV.

40
Q

ECG - what anatomy does lead I, aVL, V5 and V6 refer to?

A

Lateral wall of the LV.

41
Q

ECG - what anatomy does lead VI and V2 refer to?

A

RA, RV and LV septum.

42
Q

ECG - what anatomy does lead V3 and V4 refer to?

A

Anterior wall.

43
Q

What does a long PR interval on an ECG mean?

A

First degree heart block.

44
Q

How to determine a regular heart rate.

A

Count the number of ‘big boxes’ between two complexes and divide into 300 for regular rhythms.

45
Q

How to determine an irregular heart rate.

A

Count the number of beats present and multiply by 6.

46
Q

What is the left axis deviation?

A

-30 to -90 degrees.

47
Q

What is the right axis deviation?

A

+90 to +180 degrees.

48
Q

What are the pros and cons of PCI?

A

Pros - less invasive and repeatable.

Cons - risk stent thrombosis and restenosis and dual anti-platelet therapy.

49
Q

What are the pros and cons of CABG?

A

Pros - prognosis and deals with complex disease.

Cons - invasive risk of bleeding, can’t do if frail/comorbid, long recovery/

50
Q

When ST elevation MI is associated with LBBB what does this mean?

A

Larger infarcts.

51
Q

What does a non-Q wave MI show on an ECG?

A

Poor R wave progression, ST elevation and biphasic T wave.

52
Q

What does a Q wave MI show on an ECG?

A

Complete loss of R wave.

53
Q

What care issues may present in congenital heart patients?

A

Intellectual disability in 10% of patients, psychosocial issues, building independence and self reliance.

54
Q

When should a foetal echo take place if queried congenital heart patients

A

18-22 weeks.

55
Q

What are the four conditions within tetralogy of Fallot?

A
  1. Ventricular septal defect.
  2. Pulmonary stenosis.
  3. Hypertrophy of RV.
  4. Overriding aorta.

Phase 2a (6 decks)

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