Cardiovascular Flashcards
define atherosclerosis
a build up of lipid rich ‘plaques’ on the inner walls of arteries
what are the 4 types of ischemic heart disease?
- angina
- heart attacks (unstable angina & acute coronary syndrome)
- arrhythmia
4 heart failure
what are the 2 consequences for atherosclerosis?
- ischemia (progressive narrowing)
2. infarction (due to plaque rupture)
what are the ‘big 5’ risk factors for atherosclerosis?
- smoking
- high cholesterol
- high blood pressure
- diabetes
- genes
who are at high risk of familial hypercholesterolaemia?
the young
what is the max % reduction in choesterol due to diet?
15%
types of food to reduce high cholesterol are…
fruit and veg nuts soya food oats and barley food with unsaturated fats
what medication is given to patients with high cholesterol?
statins
what are statins classfication?
lipid regulating drugs
what are 2 relevant side effects of statins?
- GI disturbance
- nasopharyngitis
what is the normal blood pressure?
120/80 (systolic/diastolic)
high blood pressure is diagnosed when the systolic pressure is >? or the diastolic pressure is >?
> 160 or >90
what is the incidence of hypertension in western society?
15-20%
what are the two types of hypertension?
primary (essential) and secondary
primary hypertension is less/more common than secondary hypertension?
more
what are 4 factors relating to primary hypertension?
- obesity
- alcohol
- high salt diet
- genetic
what are the 2 factors that cause secondary hypertension?
- kidneys not working
2. hormone excess
when are you likely to get symptoms from hypertension?
if it is very very high eg 240/130
what symptoms of hypertension can you get?
- fits
- confusion
- headache
- breathlessness
- chest pain
what are 5 drugs in management of hypertension?
- ACE inhibitors
- B-blockers
- Calcium channel blockers
- Diuretics
- angiotension II antagonist
4 lifestyle changes required in patients who have hypertension
- cut out alcohol
- low salt diet
- lose weight
- take exercise
what is the normal total cholesterol?
define peripheral vascular disease.
- atherosclerosis affecting the peripheral vessels esp lower limbs and abdominal aorta
what are the symptoms of chronic peripheral vascular disease?
leg pain when walking a long distance especially in calf
what are they symptoms of acute peripheral vascular disease?
leg pain at rest no sensation (numb) cannot move pale, cold (a medical emergency)
3 ways to manage peripheral vascular disease
- risk factor management
- exercise program
- surgery
what are the 2 surgery options for peripheral vascular disease?
stent
bypass graft
what category of people are at high risk of an abdominal aortic aneurysm?
men >65
what are the symptoms of an abdominal aortic aneurysm?
nil or vague abdominal pain
(on rupture) severe abdominal pain & collapse
what is the mortality rate for an abdominal aortic aneurysm?
50-90%
define angina
the narrowing of the coronary arteries = ischemia
what are the typical signs of angina?
- crushing central chest pain which may radiate down left arm
- may also have breathlessness
what is an atypical sign of angina?
- jaw
- back
- upper abdomen pain
when would angina be classified as unstable?
- pain at rest
- unpredictable onset
- increased frequency with reduced effort
angina is closely related with…
physical stress
3 investigations to diagnose angina
- ECG
- ECG & radiological investigation with exersice
- coronary angiogram
symptoms of a myocardial infarction
- central crushing chest pain that is usually worse than angina
- breathlessness
- nausea
- sweating
- feeling of imminent death
- cardiac arrest
what are the 2 types of structural heart disease?
- heart failure
2. vascular disease
what investigations do you carry out to test for structural heart disease?
- ECG
- Chest X-ray
- echocardiogram (chest ultrasound)
5 causes of structural heart failure?
- ischaemic heart disease
- hypertension
- valvular heart disease
- alcohol excess
- many rare condition
pump failure leads to oedema which causes what 2 things?
breathlessness on exertion or at rest
and
swelling at the peripheries
what are the treatment stages of heart failure?
- address underlying cause
- medication
- surgical
what are the 4 medications that would be given for heart failure?
- ACE inhibitors
- Beta-blockers
- Diuretics
- digoxin
what are the 3 surgical options for heart failure?
- CABG/PTCA (percutaneous transluminal coronary angioplasty) ONLY if pre-existing angina/valvular disease
- rarely transplant
- pacemaker
what are the dental aspects of heart failure?
- avoid tx if unstable condition
- polypharmacy common with these patients (drug side effect and interactions)
- avoid NSAIDs as they can cause fluid retention
- caution when lying patient flat
- acute heart failure presenting in dental chair (ABCDE)
what is the pathophysiology of VALVULAR heart failure?
- what is the side most affected?
- what valves can be affected?
- what can cause heart failure?
- can it be congenital?
- can it be age related?
- left side most affected
- aortic/mitral valves affected
- causes = infective endocarditis & rheumatic fever
- can be congenital
- often age related
what is rheumatic fever?
- complication of strep infection (often in childhood)
- increasingly rare
what is regurgitation in the cardiac sense?
loss of valve integrity
- leaky
- becomes ‘floppy’
(HEART FAILURE)
what is stenosis?
the narrowing of valve that obstructs the flow
INADEQUATE PUMP OUTPUT FAILURE
what are the treatment options for valvular heart disease?
- medication (ACE inhibitors/Beta-blockers/diuretic/digoxin)
- surgery = Valve replacement (porcelain/metal) - have the potential to thrombose if inadequate anti-coagulation
what is the ideal INR for patients who have a metal heart valves?
> 3
what is a normal cardiac rhythm called?
sinus rhythm
what is an abnormal cardiac rhythm called?
arrhythmia
name the 4 arrhythmias
- irregular
- tachyarrhythmia (too fast)
- bradyarrhythmia (too slow)
- abnormal beat conduction
give 5 symptoms of cardiac arrhythmias
- nil
- palpitations
- chest pain
- heart failure
- syncope (temporary loss in BP causing unconsciousness)
what is the other name for irregular cardiac arrhythmias?
atrial fibrillation
what is the incidence of atrial fibrillation?
common (10% of elderly)
is atrial fibrillation symptomatic?
often not
what is atrial fibrillation associated with?
CVD - angina, hypertension, heart failure
what is the treatment for atrial fibrillation?
medication and rarely surgery
what is the worry with atrial fibrillation?
it comes with an increased risk of stroke so anticoagulants should be prescribed
name a type of tachyarrhythmia
supraventricular tachycardia (SVT)
what is the incidence of SVT?
common ( in otherwise well people )
is SVT dangerous?
Benign unless wolff-parkinson white syndrome
what is wolff parkinson white syndrome?
a congenital condition where an extra electrical connection is present
what symptoms can you get from SVT? and when are they commonly present?
- palpitations
- breathlessness
- chest pain
caffeine, injections, anxiety
what is the the treatment of SVT?
drugs and surgery to prevent
vagal manouveres, carotid sinus massage, and drugs (adenosine) at time
when is a resting heart rate considered too fast?
> 100bpm
when is a resting heart rate considered too slow?
at what heart rate would a patient experience blackout/dizziness?
what are 4 causes of bradycardia?
- ischaemia
- age
- drugs
- physiological (ie fit athletes)
what is the treatment for bradycardia?
- remove underlying cause
2. may require pacemaker
abnormal conduction is also known as?
ventricular arrhythmia/vantricular tachycardia
is abnormal conduction serious?
always a medical emergency (peri-arrest rhythm)
what are the 4 causes of abnormal conduction (ventricular arrhythmia)?
- ischaemic heart disease (incl heart attack)
- drugs
- congenital
- electrolyte disturbance
what are the symptoms of abnormal conduction?
- breathlessness
- dizzy
- chest pain
- palpitations
- cardiorespiratory arrest
what is ventricular fibrillation always?
cardiorespiratory arrest
