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Phase 2a > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Describe the distribution of atherosclerotic plaques

A
  • Found within peripheral & coronary arteries
  • Focal distribution along the artery length - patches
  • Distribution may be governed by haemodynamic factors:
    • Change in flow/turbulence cause the artery to alter endothelial cell function
    • Wall thickness is also changed leading the neointima
    • Altered gene expression in the key cell types is key
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2
Q

Which of the following is not in the artery walls?

  • Tunica intima
  • Tunica media
  • Epithelial cells
  • Neutrophils - any blood cell will enter the artery wall
A

Epithelial cells - IT IS THE ENDOTHELIUM

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3
Q

What are coronary stents used in patients today made of?

  • Stainless steel
  • Plastic
  • Polymers
A

Stainless steel

(polymers would be ideal but not a strong enough one)

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4
Q

3 types of aortic stenosis

A

Supravalvular (narrowing above the valve)

Subvalvular

Valvular - majority

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5
Q

What does TAVI stand for?

A

Transcatheter aortic valve implantation

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6
Q

What is an aneurysm?

A

When an artery breaks or twists causing bleeding

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7
Q

How can acute rheumatic fever lead to infective endocarditis (IE)

A

Chronic scarring and deformity produced contracture of the valve and chordae tendinae

→ calcifies & distorts blood flow allowing local thrombosis

→ progressive cardiac dysfunction as a result of the slowly distorting valvular function

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8
Q

4 inflammatory disorders affecting cardiac valves

A

Systemic lupus erythematosus (SLE)

Rheumatoid arthritis

Anky spond (AS)

Other connective tissue disorders

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9
Q

Describe mitral valve prolapse

A

Degeneration of mitral valve with accumulation of mucopolysaccharide material

The valve cusps bow upwards and may not close adequately → incompetence/regurgitation

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10
Q

Types of cardiomyopathy

A
  • DCM - dilated
  • HCM - hypertrophic
  • ARVC - arrhythmogenic RV
  • Restrictive CM
  • Secondary
  • (rare forms)
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11
Q

Define vasculitis

A

An inflammation of vessels

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12
Q

Define an embolus

A

A detached intravascular solid, liquid or gas

(almost all are thrombus in origin although cholesterol, bone marrow, foreign body, tumour, amniotic fluid etc emboli must be considered)

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13
Q

2 main groups of vascular tumour

A

Angiomas

Angiosarcomas

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14
Q

Describe a haemangioma

A

A benign proliferation of blood vessel tissue

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15
Q

What complications can occur with a haemangioma?

A

Can cause compressive effects.

At a site where trauma could occur, they can readily bleed

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16
Q

What is a haemangioendothelioma?

A

A vascular tumour of endothelial cells of low grade malignancy

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17
Q

What is an angiosarcoma?

A

Highly aggressive malignant neoplasm of endothelial cells

18
Q

What does EDS stand for?

A

Ehler’s-Danlos syndrome

19
Q

What occurs in Ehlers-Danlos syndrome in terms of blood vessels

A

Weakening in blood vessels → small areas of aneurysmal dilatation

Can affect larger arteries

20
Q

Symptoms of heart failure

A

Breathlessness

Tiredness

Cold peripheries

Leg swelling

Increased weight

21
Q

Signs of heart failure

A

Tachycardia

Displaced apex beat

Raised jugular venous pressure

Added heart sounds & murmurs

Hepatomegaly, especially if pulsatile & tender

Peripheral & sacral oedema

Ascites

22
Q

In terms of hypertension, what can hypokalaemia cause?

A

A common cause of hyperaldosternosim

Which leads to high BP

23
Q

Define malignant hypertension

A

Extremely high BP can lead to immediate damage to an organ, eg eyes or kidneys

24
Q

Presentation of infective endocarditis

A

Presents as a really bad infection

Often presents non-specifically, most commonly with fever & symptoms/signs of embolism.

Consider historical sources of bacteraemia, such as indwelling vascular catheters, recent dental work, and intravenous drug use.

Symptoms are often subtle and&examination is often non-specific, but may demonstrate

  • cardiac murmur
  • peripheral emboli
  • Osler nodes
  • Roth spots
  • Janeway lesions.
25
Q

How can you diagnose infective endocarditis?

A

Blood cultures & an echo

2 major criteria

  • Pathogen grown from blood cultures
  • Evidence of endocarditis on echo

5 minor criteria

  • Predisposing factors
  • Fever
  • Vascular phenomena
  • Immune phenomena
  • Equivocal blood cultures
    *
26
Q

2 types of echocardiography

A

Transthoracic (TTE)

Transoesophageal (TOE)

27
Q

Treatment of infective endocarditis

A

Antimicrobials

Treat complications

Can operate if:

  • Cannot be cured with antibiotics
  • To remove infected devices
  • To replace valve
  • To remove large vegetations before they embolise
28
Q

Common clinical presentation of Peripheral vascular disease (PVD)

A

Calf or foot cramping with walking that is relieved with rest

Thigh or buttock pain with walking that is relieved with rest

Erectile dysfunction

Pain worse in one leg

Diminished pulse

29
Q

Treatment for PVD

A

Risk factor modification

Revascularisation for critical ischaemia - either open up artery or do a bypass

Amputation

30
Q

Define unstable angina

A

UA is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis

31
Q

1st investigations to order if you suspect unstable angina

A

ECG

Troponin - no dynamic rise (rules out MI)

Chest xray - rule out other complications of ACS

FBC - checks for 2ndary causes (eg anaemia) & thrombocytopenia

32
Q

Key diagnostic factors for unstable angina

A

Chest pain

RF for CVD

33
Q

2 differentials to unstable angina

A

Stable angina - pain occurs in context of exertion/emotional stress. Relieved by nitrates or rest

Prinzmetal angina - occurs without probocation & resolves spontaneously. ST elevation during acute episode

34
Q

Management of unstable angina

A

Give loading dose of aspirin asap.

Pain relief with GTN (& morphine if necessary)

35
Q

A 50-year-old man presents with a complaint of central chest discomfort of 2 weeks’ duration, occurring after walking for more than 5 minutes or climbing more than one flight of stairs. The chest discomfort resolves with rest within several minutes. He is obese, has a history of hypertension, and smokes 10 cigarettes a day. His father died from a myocardial infarction at the age of 54 years. On examination, his blood pressure is 144/92 mmHg with a heart rate of 82 bpm. The remainder of his examination is normal.

What diagnosis do you suspect?

What tests will you do to confirm/refute your suspicion?

A

Angina

Resting ECG - likely normal

Hb - rule out anaemia

Fasting blood glucose - diabetes is a big RF for IHD

Exercise ECG - ST-segment elevation & depression

36
Q

First line of treatment for any pt you suspect has an ACS

A

Loading dose of aspirin

37
Q

How to prevent or minimise myocardial damage in a pt you suspect is having an MI?

A

Prompt reperfusion

Primary PCI - best option usually

38
Q

Cause of STEMI

A

Complete atherothrombotic occlusion of a coronary artery

39
Q

Aetiology of NSTEMI

A

Usually a result of a transient or near complete occlusion of a coronary artery

Or acute factor that deprives myocardium of oxygen

40
Q

A 69-year-old man develops worsening substernal chest pressure after shovelling snow in the morning before work. He tells his wife he feels a squeezing pain that is radiating to his jaw and left shoulder. He appears anxious and his wife calls for an ambulance, as he is distressed and sweating profusely. Past medical history is significant for hypertension and he has been told by his doctor that he has borderline diabetes. On examination in the accident and emergency department he is very anxious and diaphoretic. His heart rate is 112 bpm and blood pressure is 159/93 mmHg. The ECG is significant for ST depression in the anterior leads.

What diagnosis do you suspect & what would be your first line of treatment?

A

NSTEMI

Single loading dose of aspirin asap

Assess pt risk of bleeding

Offer GTN asap

Arrange coronary angiography (with input from seniour colleague)

41
Q

Aetiology of atrial flutter

A

Generally results from structural or functional conduction abnormalities of the atrial

Eg atrial dilation.

Can be precipitated by toxin & metabolic conditions: thyrotoxicosis, alcoholism, pericarditis

42
Q
A

Phase 2a (12 decks)

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