Cardiovascular 2 Flashcards
Insufficient blood supply to the heart for less than 20 minutes =
Angina (chest pain)
Insufficient blood supply to the heart for more than 20 minutes=
Myocardial infarction (heart attack)
Infarction is cell death through ………….resulting from prolonged or severe ischaemia
Necrosis
Clinically, Angina will be more painful. true or false
False.
myocardial infarction will be more painful and is unrelieved by rest
Biochemical markers that will be raised after myocardial infarction include
Creatine kinase-MB and cardiac troponin
Modifiable risk factors for ischaemic heart disease include:
- Dyslipidaemia
- Hypertension
- Obesity, sedentary lifestyle
- Diabetes mellitus, insulin resistance
- Smoking
- Inflammation
Non-modifiable risk factors for ischaemic heart disease include:
- Increasing age
- Male gender
- Female after menopause
- Family history of heart disease
The lack of blood supply to a tissue is called
Ischaemia
Causes of myocardial ischaemia include:
- Insufficient blood supply to myocardium
* Increased myocardial demand for oxygen
Clinical features of myocardial ischaemia include:
- Hypoxia activates nociceptors (pain receptors)
- Chest pain often radiating to neck, lower jaw, left shoulder, arm
- increased HR, ECG changes
- Pallor
- Diaphoresis (excess sweating)
- Dyspnoea
- Anxiety
With myocardial ischaemia, cell changes after several minutes include:
- Insufficient ATP
- Anaerobic respiration for up to 20 minutes
- impaired contractility
Name the 3 types of stable angina Pectoris…
- Stable angina
- Prinzmetal (variant)
- Silent
Explain angina Pectoris :
• pain or discomfort due to myocardial ischaemia
…. Often mistaken for indigestion
… Recurrent, predictable
• cell changes are reversible
… No permanent damage if blood supply restored quickly
Explain stable angina (most common):
• usually exertional or stress-related
… Fibrous/hard plaque: narrow coronary arteries can’t dilate during physical activity or stress
Angina Pectoris is relieved by rest and/or glyceryl trinitrotoluene. True or false
True
• coronary artery vasodilation
• peripheral coronary vasodilation
Define infarction:
Region of necrosis in the tissue
Pathophysiology of unstable angina:
• soft plaque:
… Prone to rupture, causing thrombosis and vasoconstriction
• warning that a MI may occur soon
Myocardial infarction…
When myocytes don’t get enough oxygen, they release …
- adrenaline and noradrenaline: vasoconstriction and increased HR
- angiotensin II: vasoconstriction, coronary artery spasm
MI…
After 20 minutes of hypoxia, there is irreversible injury. True or false
True…
Cardiac muscle does not regenerate and there is permanent loss of function in affected region
50% of patients with heart attack have no pain. True or false
False: 20% experience no pain
Explain penumbra…
Region of vulnerable tissue, surrounding ischaemic region
Damage to the heart is repaired by 8weeks. True or false
False
The heart is very weak for 10-14 days and is repaired by 6 weeks
Which of the following cardiac bio markers is the preferred marker
A. LD-1 (lactate dehydrogenase)
B. Cardiac troponin (I or T)
C. CL-MB (creative kinase-MB)
They are all cardiac bio markers but the answer is
B. Cardiac troponin…which is raised for 5-14days
MI…
Non-STEMI involves full thickness of the ventricle wall. True or false
False
Non-stemi involves only inner part of the ventricle wall (subendocardial)
…Stemi involves full thickness (trans mural)
MI …
On an ECG, STEMI shows as ST segment _______whereas Non-STEMI shows as ST segment ________
Elevation
Depression
Explain angiogram
Viewing of arteries without treatment
…via the insertion of a catheter
Explain angioplasty
Insertion of a catheter with balloon into artery…inflation of balloon to displace blockage…usually deployment of a stent to maintain vessel diameter
Risk factors for hypertension include:
- family history
- smoking
- obesity
- alcohol
- makes
- females post-menopause
- high intake of Na
- low intake of K
- chronic inflammation
- hyperglycaemia
Explain hypertension
Blood pressure consistently greater than 140/90 due to • increased peripheral resistance (vasoconstriction) and • increased cardiac output (increased blood volume)
Evaluation for hypertension includes:
- repeatedly elevated blood pressure
- blood tests…electrolytes, LDL & HDL
- urinalysis … Blood and protein
- ECG
Lifestyle modifications for hypertension include:
- exercise
- diet
- weight loss
- decreased smoking, alcohol
Medication management for hypertension includes:
- diuretics
- ACE inhibitors
- angiotensin II blockers
- a & b blockers
Left ventricular hypertrophy, heart failure, aneurysm and retinal haemorrhage are clinical manifestations of…
Hypertension
Localised abnormal dilation of a blood vessel is called an a______ and is caused by __________…
Aneurysm
Cause by arthrosclerosis or congenital weakness of the tunica media
Aneurysm risk factors include:
- atherosclerosis
- hypertension
- smoking
What are the treatments for aneurysm …
For slow growing: reduce blood pressure
For rapidly dilating: surgery
Arthrosclerotic aneurysm usually occurs in the a_______ a______.
Abdominal aorta
Berry aneurysm is a congenital defect and occurs in the c____ __ w____
Circle of Willis
inability of heart to pump sufficient blood to meet oxygen needs of the tissues is known as…
Heart failure
Backward effects of left heart failure include:
Pulmonary oedema, cough, dyspnoea, fatigue and limited exercise tolerance
Forward effects of left heart failure include:
• Activation of RAAS ...Retention of salt and water ...increased blood pressure ...increases preload and afterload ...peripheral oedema
Backward effects of right heart failure include:
- Increased jugular venous pressure (JVP)
- development of peripheral oedema in legs and ankles
- enlargement of the liver (hepatomegaly) and spleen (splenomegaly)
- abdominal oedema, pulmonary oedema
Forward effects of right heart failure include:
Reduced output to Pulmonary circulation
The overall rates of rheumatic heart disease in Australia are low. true or false
True but there are high rates in the aboriginal population
Rheumatic heart disease clinical manifestations include:
Fever tachycardia abdominal pain nausea vomiting
Heart failure management includes…lose weight, limit sodium intake, limit fluid intake and restrict alcohol consumption. True or false
True
Pathophysiology of rheumatic heart disease includes:
- Inflammation of the heart tissue
- damage to heart valves
- left heart failure
Treatment of rheumatic heart disease includes:
- Antibiotics: penicillin
- anticoagulation
- valve surgery
List the two types of heart valve disease
- Stenosis (narrowing)
* regurgitation (insufficiency)
Valve stenosis is obstruction of an open valve and causes include:
Atherosclerosis, hypertension,
calcification
Valve regurgitation is incomplete closure of valve, leading to back flow of blood and causes include:
Congenital abnormalities,
Rheumatic heart disease
Treatment of heart valve disease includes:
- Surgery to repair the valve
* valve replacement
Explain bradycardia
Bradycardia is a slow heart rate below 60 bpm
Explain tachycardia
Tachycardia is a fast heart rate above 100 bpm
Look up Jess in the dictionary 😉
Sinus rhythm is…
Normal regular rhythm of the heart
Sinus arrhythmia is:
Normal fluctuations in heart rate with the respiratory cycle
Arrhythmias can be due to:
•Abnormal impulse generation
•abnormal impulse conduction
and can result in cardiac arrest
In cardiac arrest death may be prevented by:
- CPR
* Defibrillation (particularly if the cause is an arrhythmia)
Congenital heart defects are the most common type of heart disease in children and includes:
Abnormal openings (shunts) between atria and ventricles...example, ventricular septal defect or failure of foramen ovale to close • it allows mixing of pulmonary and systemic blood
Circulation changes at birth include:
- Closing of foramen ovale
- Closing of ductus arteriosus and ductus venosus
- Closing of umbilical arteries and umbilical vein
Depending on the severity of the arrhythmia, slight bradycardia or tachycardia may correct itself… True or false
True…if the underlying cause is addressed
Cardiac arrest, commonly arises from…
- MI
* also arrhythmia
Third degree heart block is not serious…true or false
False
Third degree heart block is life threatening. There is no conduction through the AV node
Explain heart block
- abnormal impulse conduction
* Delay or total inability of conduction to reach the atrioventricular node
First degree heart block is life-threatening…true or false
False
First degree is not serious.
Every SA signal reaches the AV node but is delayed
Abnormal impulse generation: atrial flutter …contracts _____ but very ______.
Regularly
rapidly
Abnormal impulse generation: ventricular fibrillation….contracts in an ________manner
Uncoordinated
ventricular fibrillation is life-threatening
In valve replacement, what is the difference between mechanical valves and donor tissue valve replacement
•Mechanical valves last a lifetime but require treatment with warfarin •donor tissue valve replacement may not last as long but warfarin is not necessary
