Cardiovascular 2 Pathologies Flashcards
What is Atherosclerosis
Narrowing and hardening of the arteries resulting in reduced blood flow through the arteries negatively impacting delivery of blood to target organs
What arteries do we often see atherosclerosis
Coronary Arteries
Carotoid artery (neck)
Cerebral arteries (brain)
Major arteries of the extremities
Aorta
What is the pathophysiology of atherosclerosis
- Damage to the vascular endothelium resulting in inflammation
- LDL’s deposit in the damaged tunica intima in an attempt to repair the damage, but are then oxidised which attracts phagocytes.
- Macrophages surround the fatty material in an attempt to destroy it and as a result create foam cells
- Vascular smooth muscle cells proliferate
- A cap is formed over the atherosclerotic plaque to wall off the plaque from the blood
What are the causes/risk factors for atherosclerosis
Hereditary, male sex, age men > 45 women > 55, obesity, hyperglycemia, hypertension, smoking alcohol, south asian, african and caribbean background, gut/oral dysbiosis
What are the signs/clinical manifestations of atherosclerosis
Angina Pectoris, Myocardial Infarction, - Ischaemic heart pain (from thrombosis or embolism)
Stroke, transient Ischaemic attack (from thrombosis, embolism or Haemorrhage)
What does Ischaemic mean
Inadequate blood supply to organ or tissue
What is the Allopathic treatment for Atherosclerosis
Statins, BP meds, stents surgery lifestyle changes
What is the first step necessary for atherosclerosis to occur? What is this often due to/
Endothelial damage is the first step. Often due to oxidative stress/free radicals, stress hyperglycemia and high blood pressure,
What does Hypercholesterolaemia mean
Elevated blood Cholesterol levels
What are the causes/risks for Hypercholesterolaemia
Familial - defect on chromosome 9 causing inability to remove LDL from the blood.
Age
Smoking
Diabetes
Diet high in trans fats table salt etc
Excessive Alcohol
Sedentary lifestyle
What are 2 of the clinical signs of Hypercholesterolaemia
Xanthelasma (zanthalasma) spot on the eyelids
Corneal Arcs - visible fat deposit around the cornea
What is the Allopathic treatment for Hypercholesterolaemia
Statins
What are the adverse side effects of statins
Muscle aches, insomnia, dizziness, fatigue, headaches gastro-intestinal effects, cataracts
What is Angina Pectoris
Ischaemic heart disease due to construction or vascular spasm of the coronary arteries
What do the symptoms associated with angina result from? What could this be due to?
The demands of the myocardium are not being met by its blood supply.
Due to atherosclerosis or vascular spasm
What are the 2 types of angina and explain each
Stable angina - pain is precipitated by exercise
Unstable Angina - Occurs randomly, even on rest and can be more severe and last longer.
What are the signs and symptoms of Angina Pectoris
Symptoms - Heavy constricting chest pain, radiating to arms, jaw neck and back, often on the left side but can be bilateral
Sign - Dyspnoea
In Allopathic treatment what is usually given for Angina Pectoris
GNT (Glyceryl Trinitrate sublingual
What are the effects of GNT
Is is converted into nitric oxide = vasculardilation
What is the long term allopathic treatment for Angina Pectoris
Anti-hypertensives, statins, low dose asprin and stents
Define Myocardial Infarction
Is also known as a heart attack. Necrosis of myocardial tissue due to Ischaemia. Usually due to the blockage of a coronary artery by a thrombus.
Infarcted areas produce scar tissue. The remaining tissue hypertrophies and can result in heart failure.
Signs and symptoms of Myocardial Infarction
Severe chest pain (central, radiating to the arms, neck , jaw and back.
Pain can be sharp, tight and heavy and does not improve on rest.
Sweating, nausea, vomiting pale and clammy skin. Shortness of breath light headed.
Overwhelming anxiety and feeling of impending doom.
How is a myocardial infarction diagnosed
Using an ECG
What is the management of Myocardial infarction?
Oxygen
Asprin
Angioplasty (unblocking of the artery)
Thrombotic Therapy (clot busters) they form plasmin which dissolves the cross links of fibrin molecules.
CPR
Define Heart failure
The heart is impaired as a pump failing to supply sufficient blood flow. The heart fails to pump blood forwards effectively so backflow of fluid occurs.
Can be acute or chronic
What are the causes of heart failure
Results from various cardiovascular conditions such as; coronary heart disease, hypertension, and in 10% of cases valve disease
Also, linked to insulin resistance - impaired myocardial glucose ustilisation.
What is the cause of right sided heart failure
Lung disease, Valve disease or previous heart attack.
What are the signs and symptoms of right sided heart failure
Systemic Oedema (legs feet hips)
Ascites (build up of fluid around the stomach)
Portal Hypertension - haemorrhoids
What is portal hypertension?
build up of blood going back through the portal vein.
What are the causes of left sided heart failure
Hypertension, Myocardial weakness and valve problems
Signs and symptoms of right sided heart failure
Pulmonary Oedema
Congestion bronchitis
Cardiac asthma often at night
Describe a stroke
A cerebrovascular accident - disruption of blood supply to the brain.
50% affect cerebral cortex (affects the contralateral body)
Just 4 minutes can cause irreversible cell damage.
characterised by rapidly developing signs of cerebral dysfunction lasting more than 24 hours.
What are the causes of a stroke
80% of the time due to a Thrombus/Embolus = Ischaemic stroke
Haemorrhagic stroke - blood vessel damage following a ruptured annurysm.
Signs & Symptoms of a stroke
Sudden weakness, numbness, tingling dysphasia, loss of vision severe headaches, confusion unsteadiness
How is a stroke diagnosed
CT or MRI Scan
What is the treatment for a stroke
Oxygen, Angioplasty, thrombolytic treatment
What is Transient Ischaemic attack (TIA)
Mini stroke - temporary loss of circulation to the brain. Similar to a stroke but lasts for less than 24 hours and is a warning for a full stroke
What are the causes of a TIA
Hypertension, thrombus/embolus or Haemorrhagic stroke from blood vessel damage following ruptured aneurysm.
What is a thrombus
fixed clot
What is an embolus
Mobile clot
Signs and Symptoms of a TIA
tingling, numbness sudden weakness, difficulty speaking, loss of vision, severe headaches confusion unsteadiness,
What is an aneurysm
abnormal local dilations of arteries due to a weakness of the vessel wall (often secondary to atherosclerosis)
Give 2 common examples of aneurysms
Abdominal aortic aneurysm AAA:
Asymptomatic until it bursts
Pulsatile abdominal mass and tearing lower back pain
Berry aneurysm - Occurs at the centre of the cerebrum causing a subarachnoid haemorrhage. Presents as a severe headache. May lead to a Haemorrhagic stroke
What is Hypertension
Major risk factor for cardiovascular disease and cerebrovascular events. It is often asymptomatic
What readings are defined has hypertension
140/90 mmHgs
What are the 2 types of hypertension
Primary - accounts for 95% generally lifestyle and family history, smoking, age, sedentary, stress, alcohol, high table salt intake, nutritional deficiencies i.e magnesium
Secondary - 5% secondary to other disease such as diabetes
What is the Allopathic treatment for Hypertension
Medication to to reduce and maintain blood pressure. Diuretics, calcium channel blockers, beta blockers.
Weight loss, avoid salt, reduce stress and alcohol avoid caffine
What are ACE Inhibitors
Anti-hypertension
What are the complications of Hypertension
Cardiovascular events - myocardial infarction, heart failure aneurysm.
Stroke
Chronic Kidney disease
Vascular dementia
Premature death
Retinal damage
What are the 2 heart valve pathologies
Valve Stenosis - Fibrosis and calcification of valve leading to reduced blood flow to the chambers. To compensate the heart hypertrophies - causing heart failure
Valve regurgitation - Inadequate valve closure causing backflow. Heart hypertrophies and dilates to accommodate more blood - again leading to heart failure
What heart rate indicates Bradycardia
below 60 beats pm
What is a physiological cause of Bradycardia
Athlete
What is a pathological cause of Bradycardia
Diseases effecting the SA or AV node (myocardial infarction)
What is an Arrythmia
Any disorder of the heart rate
How many beats per minute indicates Tachycardia?
Over 100
What is Atrial Fibrillation
Irregular rhythm and force leading to inadequate blood supply.
What is the most common cardiac Arrhythmia
Atrial Fibrillation (AF)
Define AF
Irregular Rhythm
Associated with stagnation of blood in the atria leading to thrombus formation and risk of embolism (stroke)
Patients may present with breathlessness, palpitations, dizziness, chest discomfort or stroke.
Define Cardiac Arrest
Conduction arrest, which approx 70-% occur due to coronary heart disease.
Occurs when the heart develops and arrhythmia causing it to stop.
What is the treatment for a cardiac arrest
CPR Cardiopulmonary resuscitation
Primary function of capillaries
Exchange of substances
What is an acute illness
Quick and very treatable
What is a chronic illness
Long term and usually require treatment for the rest of your life
Why is chestpain worsened when breathing deeply with Pericarditis
Because the Pericardium attaches do the diaphragm so when you breath in you are pulling on pericardial sack so if it’s inflamed will cause pain.
What is Endocarditis
An inflammation of the endocardium and valves
What is Endocarditis usually due to
A bacterial infection or dental infection
Signs and Symptoms of Endocarditis
Flu like symptoms, Dyspnoea and persistent cough
Oslers Nodes, splinter haemorrhages, petechiae
What is Myocarditis
Inflammation of the Myocardium
What causes Myocarditis
Usually due to a viral infection (flu). Side effect from the covid vaccine. Drug/Heavy Metal toxicity.
Signs and Symptoms of Myocarditis
Chest pain, fatigue, dyspnoea palpitations tachycardia
What is the treatment for Myocarditis
Treat the cause/anti-inflammatory meds
What is Pericarditis
Inflammation of the pericardium
What is Pericarditis caused from
Usually a viral infection, can also be due to systemic inflammatory condition e.g RA
Signs and Symptoms of pericarditis
Chest pain radiating to the back, relieved by sitting up and forward
Dyspnoea when laying back
Low grade Fever
Fatigue
Oedema
Pericardial Friction rub on auscultation
What are the 2 main complications of Pericarditis and explain each?
Constrictive pericarditis - Thickened and fibrotic pericardium
Cardiac Tamponade (Pericardial effusion) Fluid collects in the pericardium, putting pressure on the heart inhibiting it from filling completely.
What is the Allopathic treatment for Pericarditis
Anti inflamms/ NSAID’s antibiotics steroids
Serious cases surgical drainage
What is Deep Vein Thrombosis
Thrombus formation in the deep veins of the legs
What can happen if a clot dislodges
pulmonary embolism
What are the risks of a DVT
Reduced blood flow due to immobility, pressure on a vein by a tumour.
Long hall flights
Varicose veins
Changes in blood (Dehydration, polycythaemia, sticky platelets
Damage to blood vessel wall.
Signs and Symptoms of DVT
Limp pain, calf swelling, tenderness along vein increased skin temperature and local redness (erythema)
How is a DVT diagnosed
Usually by sight - but Ultrasound and D-dimer test
What does a d-dimer test show?
Proteins that are formed when a clot breaksdown
