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4th Yr - CMS 1 > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

what is hypertension?

A

damage to blood vessels after a certain BP

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2
Q

what is stage 1 HT?

A

BP persistently between 135/85 mmHg and 149/94mmHg

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3
Q

Stage 2 HT?

A

BP persistently > 150/95 mmHg

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4
Q

stage 3 HT?

A

systolic BP >180mmHg or diastolic >120mmHg
call 111
potential organ damage

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5
Q

malignant HT?

A

systolic BP >220mmHg
call 999 medical emergency

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6
Q

give a list of the consequences of high BP

A
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7
Q

what happens to the blood vessel walls with HT?

A

damaged and thickened eg. arterioles thickened therefore smaller diameter lumen with increased Peripheral resistance therefore increase BP

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8
Q

which organs are at risk of HT?

A

ones with lots of tiny vessels eg. kidneys and eyes can lead to chronic kidney disease and hypertensive retinopathy

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9
Q

name the condition when we have chronic HT affecting kidneys

A

chronic kidney disease

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10
Q

name the condition when we have chronic HT affecting eye?

A

hypertensive retinopathy

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11
Q

what can increase the risk of aneurysms, atheromas and peripheral vascular disease?

A
  • tough collagen and ca deposits on artery walls which makes them stiffer and less able to stretch with each pulse therefore can cause more damage to walls
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12
Q

how can HT lead to heart failure ?

A

high BP in aorta needs a higher pressure in left ventricle to push blood into it - ventricular hypertrophy

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13
Q

what the organs can be affected by HT?

A

brain eg. strokes and seizures
heart itself eg. acute cardiac ischemia

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14
Q

give an overview of the causes of hypertension?

A
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15
Q

how can we address obesity?

A
  • diet and exercise
  • need to advise pt of risks
  • goes hand in hand with diabetes which also increase risk of HT
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16
Q

addressing alcohol?

A
  • should advise pt of drinking too much and affect on BP
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17
Q

how does sodium play a role in HT?

A
  • Body removes salt through kidneys and water in blood follows –> reduces venous return, CO and BP
  • so high salt diet = increases water retention therefore –> high BP
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18
Q

how does smoking play a role in HT?

A

Chemicals in ciggs impair vasodilation and causes atherosclerosis, stiffening vessels and increasing BP

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19
Q

how does stress affect HR?

A
  • thru sympathetic fight or flight response which functions to increase BP
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20
Q

how do kidney and endocrine diseases cause HT?

A
  • salt excretion and hormones ie. renin angiotensin system (long term control) are controlled by the kidneys
  • kidney diease can cause HT and other endocrine disorders
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21
Q

what other endocrine disorders cause HT?

A
  • those that cause increase in catholamines
  • cons syndroms
  • pheochromocytoma
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22
Q

what’s important to note about medications?

A
  • can deliberately or give an unwanted side effect that cause high BP or their medications can interact with each other and prevent an antihypertensive from being affective
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23
Q

list the drugs for HT

A
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24
Q

how do diuretics decrease HT?

A

increase excretion of fluid via kidneys by reducing circulating vol an lower BP

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25
Q

what are the 2 ways ACE inhibitors reduce HT?

A
  • inhibit ACE enzyme therefore prevents formation of angiotensin 2 therefore decrease BP
  • also stops bradykinin from breaking down which is a vasodilator ( can cause dry cough or angeodema )
  • ACE inhibitors usually end in - april
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26
Q

what happens as result of bradykinin breaking down ?

A

can cause dry cough or angiodema (facial swelling

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27
Q

whats the alternative medicine to ACE inhibitors ?

A

angiotensin receptor blockers
ends with - sartan

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28
Q

how do angiotensin receptor blockers work?

A

block angiotensin at site of action

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29
Q

how do ca channel blockers work?

A
  • prevent vasoconstriction and reduce the rate and force of heart beat as its all ca dependant
  • therefore reducing muscle contraction
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30
Q

how do beta blockers work?

A
  • end in olol
  • prevent HR and SV from rising too high by blocking sympathetic pathways
  • they decrease rennin release
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31
Q

what 2 rarely used drugs block the SNS?

A

clondinin and methyldopa

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32
Q

how do alpha blockers work?

A

cause vasodilation

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33
Q

how do we manage pt who have HT in practice?

A
  • Think about the potential side effects of their meds eg. prone to postural hypertension hypotension (stand up and get dizzy) therefore we advise pt to get up slowly
  • use LA rather than general
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34
Q

give the timeline of the formation of atherosclerosis ?

A

1) Fatty streak - due to lipid builup în tunica intima
2) Collagen deposition follows- makes walls stiffer
3) Fibrolipid plaque - a fibrotic cap forms over the fatty streak (cap can be damaged by high BP eg. due to HT and bifurcations (blood is usually more turbulent) of arteries or wiggly areas )
4) can progress into complicated fibrolipid plaque if cap gets damaged
5) thrombosis - mass of platelets and RBC and fibrin that sit on vessel walls due to sticky blood for the way the blood flows, damage to walls, turbulence, bifurcations ie VIRCHOWS TRIAD

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35
Q

what link does atherosclerosis, and its outcomes like coronary heart disease, have with periodontal disease?

A
  • their is a correlation due to underlying factors such as how your bodies’ tendencies to fight off inflammation and cytokine endotoxin release.
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35
Q

what happens when we have reduced blood flow to an organ

A

ischemia

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36
Q

what happens when the tissue dies as a result of reduced blood flow

A

infarction

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37
Q

what is a thrombus called when it breaks off ?

A

embolus

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38
Q

what does the embolus do?

A

travels thru blood stream until lodged in a vessel with a small enough diameter that it blocks blood flow - leads to infraction

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39
Q

what do symptoms of thrombus depend on?

A

location of the thrombus or embolism

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40
Q

what causes acute cardiac ischaemia?

A

reduced perfusion via the coronary artery ( or severe hypotension or severe anaemia that reduced 02 capacity to heart but rare)

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41
Q

how does ACI feel?

A
  • crushing pain and tightness due to spinal level of nerve that supplies the heart ( spinal level also supplies to other parts of body)
    -BUT not all pt experience pain in the same area
42
Q

what is it called when the body misinterprets heart damage as pain coming from somewhere else in body?

A

referred pain

43
Q

where else can pts feel pain when experiencing ACI?

A

neck jaw arm and back

44
Q

What happens when perfusion to heart becomes significantly less

A

cell death

45
Q

How can we identify if ACI has progressed to ACS?

A

THE DRS acronym

45
Q

what is stable angina an example of?

A

cardiac ischemia

46
Q

what is ACS an eg of?

A

infraction or very soon

47
Q

what happens when cells in heart are damaged or die?

A

unable to contract
affects less SV, CO and perfusion to other organs

48
Q

signs and symptoms of ACI

A
49
Q

how does breathlessness occur in ACI?

A

trying to compensate lack of oxygen at other organs
- pressure can also buildup behind heart in pulmonary side of circulation ie pulmonary vein= can cause fluid to leak out of blood vessels in lungs = pulmonary oedema

50
Q

how does pulmonary oedema occur in ACI?

A

pressure can buildup behind the heart in pulmonary side of circulation ie pulmonary vein which can cause fluid to leak out of vessels in the lungs

51
Q

what signs and symptoms can show that one has fluid buildup in the lungs with ACI?

A

hypoxia and cyanosis (blue fingertips or mouth) as there is a reduction in the efficiency of gas exchange

52
Q

how does lightheadedness affect us during ACI?

A

reduced perfusion to brain from effected CO due to heart damage
low bp
*the SNS will try to increase HR and SV to maintain CO and BP which can make us clammy

53
Q

why will some pts look sweaty but cool to touch in ACI?

A

peripheral vasoconstriction = constriction in less essential areas to redirect circulating volume to more essential organs

54
Q

why do we feel nauseous during ACI?

A
  • SNS is responsible
54
Q

why do pts feel palpitations during ACI?

A

cardiac damage can result in abnormal electrical rhythms or irregular heartbeat

55
Q

how can you check if a pt has aarrhymia or heart palpitations ?

A

take a manual pulse

56
Q

what are the steps for when someone is having ACS?

A
57
Q

what is aspirin?

A

antiplatelt which prevents blood form clotting further

58
Q

what does a GTN spray do?

A

vasodilator that dilates coronary artery and increase blood flow in heart
- it can also dilate other arteries in body too therefore reduces BP
- so check BP is above 90 sys before giving GTN
- if BP drop critically below 90 = cardiac arrest rather than just myocardial infarction

58
Q

once pt arrives at hospital what will most likely be done?

A

ECG and blood test

59
Q

what does ECG tell us?

A

may distinguish infarction from ischeamia as dead cells can disrupt electrical activity

60
Q

what does troponin in blood mean ?

A

dying heart cells

61
Q

what are the ways in which we can manage coronary artery disease ? (2)

A

unblock coronary artery
- chemical thromobolysis eg. streptokinase
- manual eg. angioplasty
- replace vessels eg. coronary artery bypass graft

62
Q

how does angioplasty work?

A
  • inflating a balloon inside the vessel to open it up
  • place stent to open it up
  • remove blood clot
63
Q

what will pts have to take longer term after CAD ?

A
  • statin- which reduces LDL cholesterol (fatty streak buildup)
  • beta blocker and ace inhibitor - reduce strain on heart
  • antiplatelet eg. aspirin (prevent clot buildup )
  • anti coagulant given after immediate aftermath
64
Q

what condition will a pt get after a heart attack ?

A

arrhythmia due to scar tissue interrupting normal flow of electricity and risk of heart failure due to damage

65
Q

what can we advise as dentists to someone with coronary artery disease ?

A
66
Q

why do we advise healthy diet and exercise ?

A

to lower body weight and prevent fatty streak formation

67
Q

what are the 2 ways smoking affects ppl with CAD?

A

-athersocelroiss
- thrombosis

68
Q

how does smoking lead to atherosclerosis ?

A
  • impedes vasodilation
  • free radicals from smoke inflame lining of vessels through oxidative stress
69
Q

how does smoking lead to thrombosis ?

A

makes platelets stickier
stimulates clot formation whilst impairing clot breakdown

70
Q

how does CO in smoke cause CAD?

A

reduces 02 carrying capacity of RBC
body makes more to compensate
this however makes blood sticky and thicker = clot

71
Q

how should we deal with a pt that has angina?

A

book them in the morning to reduce their wait time if they’re anxious - emotional stress is a trigger for angina

72
Q

what should we do if pt is newly diagnosed with angina ?

A

delay apt to ensure its well controlled

73
Q

how do we deal with pts who have had a myocardial infacrtion within the last yr ?

A

delay elective dental tx

74
Q

atherosclerosis can cause P——- v—— d—–?

A

peripheral vascular disease

75
Q

what is PVD also known as ?

A

peripheral arterial disease

76
Q

what is PVD?

A

build up of fatty deposits in arteries restricts blood supply to leg muscles.

77
Q

what do ppl with PVD experience?

A

claudication - pain when walking
can settle with rest

78
Q
A
79
Q

what can severe critical ischemia lead to?

A

arterial ulcers, gangrene or pain that doesn’t go away with rest - these pt need urgent vascular surgeon appts to get their vessels replaced or dilated

80
Q

how do we monitor PVD?

A

Compare BP of arms and legs = if similar - GOOD
- if less than 0.9 - diagnostic
- less than 0.5 - critical ischemia

81
Q

what is critical ischaemia?

A

comes on chronically and reaches to the point that the pt is in pain at rest

82
Q

what is acute ischemia ?

A

emergency
leg becomes suddenly ishceemiac

83
Q

how can we recognise acute ischemia ?

A

6 P’S

84
Q

how quick does a pt with acute ischemia need to be treated before limb amputation?

A

4-6hrs

85
Q

what are aneurysms caused by?

A

atherosclerosis

86
Q

what can an anuerysm create?

A

a fistula into nearby vessels if it happen gradually or compress nearby structures

87
Q

what condition is shown in the pic below

A

abdominal aortic aneurysm

88
Q

what happens if an abdominal aortic aneurysm ruptures?

A

abdominal pain, cardiovascular collapse

89
Q

what is the mortality rate?

A

50%

90
Q

how are pts with AAA managed?

A
  • surgerically fixed once it reaches a certain size before rupture
  • monitored
  • long term radiological follow ups
91
Q

what are varicose veins?

A

swollen veins in legs
due to incompetent valves in veins
can be painful
skin changes eg. itching swelling

92
Q

what are venous ulcers?

A
  • looks less punched out
  • use of compression bandages
93
Q

what are embolisms?

A
  • clot that can lodge anywhere
94
Q

what happens if we have a pulmonary embolism?

A
95
Q

plerutic chest pain?

A

sharp inhale due to membrane of lungs rubbing together

96
Q

how do we diagnose a pulmonary embolism?

A

CT scan w/ contrast in veins to see where blockages are

97
Q

how do we treat pulmonary embolism?

A

blood thinners

98
Q

who do we give prophylaxis to to prevent a DVT?

A

pts who are bed bound

99
Q

what are mechanical prophylaxis ?

A

TED stockings (bandages)

4th Yr - CMS 1 (27 decks)

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