Cardiovascular Flashcards
Describe the distribution of atherosclerotic plaques
- 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
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
Epithelial cells - IT IS THE ENDOTHELIUM
What are coronary stents used in patients today made of?
- Stainless steel
- Plastic
- Polymers
Stainless steel
(polymers would be ideal but not a strong enough one)
3 types of aortic stenosis
Supravalvular (narrowing above the valve)
Subvalvular
Valvular - majority
What does TAVI stand for?
Transcatheter aortic valve implantation
What is an aneurysm?
When an artery breaks or twists causing bleeding
How can acute rheumatic fever lead to infective endocarditis (IE)
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
4 inflammatory disorders affecting cardiac valves
Systemic lupus erythematosus (SLE)
Rheumatoid arthritis
Anky spond (AS)
Other connective tissue disorders
Describe mitral valve prolapse
Degeneration of mitral valve with accumulation of mucopolysaccharide material
The valve cusps bow upwards and may not close adequately → incompetence/regurgitation
Types of cardiomyopathy
- DCM - dilated
- HCM - hypertrophic
- ARVC - arrhythmogenic RV
- Restrictive CM
- Secondary
- (rare forms)
Define vasculitis
An inflammation of vessels
Define an embolus
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)
2 main groups of vascular tumour
Angiomas
Angiosarcomas
Describe a haemangioma
A benign proliferation of blood vessel tissue
What complications can occur with a haemangioma?
Can cause compressive effects.
At a site where trauma could occur, they can readily bleed
What is a haemangioendothelioma?
A vascular tumour of endothelial cells of low grade malignancy
What is an angiosarcoma?
Highly aggressive malignant neoplasm of endothelial cells
What does EDS stand for?
Ehler’s-Danlos syndrome
What occurs in Ehlers-Danlos syndrome in terms of blood vessels
Weakening in blood vessels → small areas of aneurysmal dilatation
Can affect larger arteries
Symptoms of heart failure
Breathlessness
Tiredness
Cold peripheries
Leg swelling
Increased weight
Signs of heart failure
Tachycardia
Displaced apex beat
Raised jugular venous pressure
Added heart sounds & murmurs
Hepatomegaly, especially if pulsatile & tender
Peripheral & sacral oedema
Ascites
In terms of hypertension, what can hypokalaemia cause?
A common cause of hyperaldosternosim
Which leads to high BP
Define malignant hypertension
Extremely high BP can lead to immediate damage to an organ, eg eyes or kidneys
Presentation of infective endocarditis
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.
How can you diagnose infective endocarditis?
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
*
2 types of echocardiography
Transthoracic (TTE)
Transoesophageal (TOE)
Treatment of infective endocarditis
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
Common clinical presentation of Peripheral vascular disease (PVD)
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
Treatment for PVD
Risk factor modification
Revascularisation for critical ischaemia - either open up artery or do a bypass
Amputation
Define unstable angina
UA is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis
1st investigations to order if you suspect unstable angina
ECG
Troponin - no dynamic rise (rules out MI)
Chest xray - rule out other complications of ACS
FBC - checks for 2ndary causes (eg anaemia) & thrombocytopenia
Key diagnostic factors for unstable angina
Chest pain
RF for CVD
2 differentials to unstable angina
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
Management of unstable angina
Give loading dose of aspirin asap.
Pain relief with GTN (& morphine if necessary)
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?
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
First line of treatment for any pt you suspect has an ACS
Loading dose of aspirin
How to prevent or minimise myocardial damage in a pt you suspect is having an MI?
Prompt reperfusion
Primary PCI - best option usually
Cause of STEMI
Complete atherothrombotic occlusion of a coronary artery
Aetiology of NSTEMI
Usually a result of a transient or near complete occlusion of a coronary artery
Or acute factor that deprives myocardium of oxygen
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?
NSTEMI
Single loading dose of aspirin asap
Assess pt risk of bleeding
Offer GTN asap
Arrange coronary angiography (with input from seniour colleague)
Aetiology of atrial flutter
Generally results from structural or functional conduction abnormalities of the atrial
Eg atrial dilation.
Can be precipitated by toxin & metabolic conditions: thyrotoxicosis, alcoholism, pericarditis
