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cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

what is atherosclerosis?

A

stiffening and narrowing of artery walls due to plaque build up

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2
Q

what is they highest risk factor for atherosclerosis?

A

hyperlipidaemia (lots of cholesterol in blood)

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3
Q

how may hyperlipidaemia cause atherosclerosis?

A

cholesterol is deposited in BV walls causing inflammation which doesn’t heel

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4
Q

what effect may an atheroma have on a BV?

A

narrow BV
block BV
weaken BV wall leading to rupture

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5
Q

which non-modifiable factors may contribute to the development of atherosclerosis?

A

age
gender
genes (LDL receptor gene mutation)

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6
Q

a LDL receptormuetation has what effect on cholesterol uptake?

A

reduced uptake

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7
Q

what effect will a homozygous LDL receptor mutation have on cholesterol uptake and how would these be treated?

A

no uptake - treated with statin

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8
Q

briefly define the 5 stages of atherosclerosis

A

1) endothelial cell injury
2) permeability of vessel increases and lipids are deposited
3) macrophages move in
4) smooth muscle proliferates
5) healing phase - fibrous tissue formation over atheroma

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9
Q

atherosclerosis means less blood supply to tissues, what is this known as?

A

ischaemia

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10
Q

sometimes atheroma may completely occlude a BV, leading to cell death, what is this known as?

A

infarction

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11
Q

the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system is known as?

A

thrombosis

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12
Q

a piece of clot travelling through the blood is known as a ?

A

embolism

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13
Q

a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm is known as?

A

peripheral vascular disease

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14
Q

a common symptom of peripheral vascular disease is cramping in the leg when excessing, what is this known as and what causes it?

A

claudication - obstruction in vessel and so reduced blood flow

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15
Q

total loss of circulation to legs and feet can cause what?

A

gangrene

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16
Q

a weakening of an artery wall that creates a bulge is known as?

A

aneurysm

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17
Q

what is the most common aneurysm and what does it result from?

A

abdominal aortic aneurysm - due to atherosclerosis

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18
Q

accidental cell death typically caused by ischemia or infarction is known as?

A

coagulation necrosis

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19
Q

describe a cell that has undergone coagulation necrosis?

A

retained outline
dark cytoplasm
remains of nucleus
striations lost

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20
Q

congestive heart failure is a chronic condition affecting what aspect of the heart?

A

pumping power of heart muscles

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21
Q

congestive heart failure usually follows on from what?

A

ischaemic heart disease
hypertension
valvular heart disease

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22
Q

name 3 types of tumour to BVs

A

hamartoma
kaposi sarcoma
angio sarcoma

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23
Q

a hamartoma (BV tumour) of vascular tissue is known as what?

A

haemangioma

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24
Q

a haemangioma can be described as?

A

small collection of BVs under the skin

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25
Q

name 2 typesof benign cardiac tumour?

A

myxoma

lipoma

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26
Q

what name is given to a malignant cardiac tumour?

A

angiosarcoma

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27
Q

how may valvular heart disease be acquired?

A

through other cardiac diseases

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28
Q

what is the most common valvular condition?

A

calcific aortic stenosis

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29
Q

what is calcific aortic stenosis?

A

calcific matter deposited in valve making it stiff and narrow

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30
Q

in rheumatic heart disease, the heart valves have been permanently damaged by which condition?

A

rheumatic fever

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31
Q

microbial infection of the heart valves is known as?

A

infective endocarditis

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32
Q

what is found in granulation tissue?

A

macrphages
fatty tissue
fibrous tissue

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33
Q

which 2 conditions may ischaemia lead to?

A

angina

peripheral vascular disease

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34
Q

name 2 effects of infarction?

A

MI

stroke

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35
Q

conditions associated with sudden, reduced flow to the heart are called?

A

acute coronary syndromes

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36
Q

acute coronary syndromes describe 3 types of coronary artery disease, these are?

A

unstable angine
NSTEMI (non st-segment elevation MI)
STEMI (st-segment MI)

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37
Q

what 3 things would u take to diagnose an acute coronary syndrome?

A

history
ECG
test biomarkers (troponin)

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38
Q

when is troponin released?

A

during injury to the heart

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39
Q

how do you distinguish classical engine from unstable?

A

classical - gets worse with exercise

unstable - symptoms at rest. no biomarkers

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40
Q

describe the symptoms of classical angina

A

no pain at rest
pain at certain level of exertion
pain relived by rest
gradually deteriorates

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41
Q

what investigations may you carry out in patients with angina?

A

ECG
angiography (dye injected into artery)
echocardiography (sound waves to produce images)
isotope studies

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42
Q

what effect will angina have on a patients ECG?

A

st segment depression gets worse

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43
Q

in order to increase o2 delivery in patients with angina, you may want to carry out an angioplasty, hoe does this help?

A

dilates narrowed vessel

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44
Q

in order to increase o2 delivery in patients with angina, you may want to carry out a coronary artery bypass graft, hoe does this help?

A

bypasses blocked/narrowed artery

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45
Q

which drug is take to reduce MI risk?

A

aspirin

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46
Q

what drugs are give to patient suffering from hypertension?

A

diuretics
calcium channel antagonsists
ACE inhibitors
Beta blockers

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47
Q

what drugs reduce preload by dilating coronary vessels?

A

nitrates (short and long acting)

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48
Q

what emergency treatment is given to patients suffering from angina?

A

GTN spray

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49
Q

what are the disadvantages of a CABG?

A

major surgery so carries a mortality risk
only lasts 10 years
1 off operation

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50
Q

what is preferred, CABG or angioplasty and stent?

A

angioplasty and stent

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51
Q

what medication does a patient need to take after having an angioplasty?

A

dual antiplatelet therapy

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52
Q

how does an angioplasty work?

A

balloon is blown in blocked artery, squashing plaque then a metal tube inserted to keep artery open

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53
Q

what is thrombolysis?

A

dissolving a clot (must be done within 6hrs)

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54
Q

what is preferred, angioplasty or thrombolysis?

A

angioplasty

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55
Q

angioplasties must be carried out in what time frame?

A

3 hours

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56
Q

what treatment is available for MI?

A

thrombolysis
angiplasty
CABG

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57
Q

something temporarily blocking flow to the brain is known as?

A

transient ischameic attack

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58
Q

a blood clot preventing blood flowing to the brain is known as?

A

ischaemic stroke

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59
Q

a BV to the brain ruptures spilling blood into surrounding tissues is known as?

A

heamorrhage stroke

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60
Q

what are the symptoms of an MI?

A 
pain
nausea
pale
sweaty 
feel like going to die
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61
Q

how may an MI be indicated on an ECG?

A

st segment elevation

t wave abnormality

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62
Q

what biomarkers may be present in patients that have had an MI?

A

troponin
creatine kinase
increase in LDH and AST

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63
Q

what medications are given to prevent a second MI?

A

aspirin
beta blocker
ace inhibitors

64
Q

beta blockers decrease BP by blocking which hormone?

A

adrenaline

65
Q

what are the risk factors for acute coronary syndromes?

A 
diabetes type 2
lack of exercise
obesity
smoking
having an other coronary syndrome
66
Q

how does GTN work?

A

causes vasodilation, reducing pressures on heart

67
Q

what is the preload?

A

blood in heart waiting to be pumped out

68
Q

what is after load?

A

blood being pumped

69
Q

how would u manage an MI in dental practice?

A

oxygen
GTN
apirin
ambulance

70
Q

elevated st segment indicates what?

A

MI

71
Q

depressed st segment indicates what?

A

angina

72
Q

statins interact with what other medication?

A

antifungals

73
Q

calcium channel blockers may have what oral manifestation?

A

gingival hyperplasia

74
Q

what is normal systolic BP?

A

120mmHg

75
Q

what is considered a hypertensive systolic BP?

A

> 140mmHg

76
Q

what is considered a hypertensive diastolic BP?

A

> 90mmHg

77
Q

list some risks of hypertension

A

age, alcohol, stress, race, fam history, drugs, obsity, pregnancy

78
Q

a are tumour of the adrenal glad that results in too much adrenaline release is called?

A

pheochromocytoma

79
Q

a tumour producing too much cortisol from the adrenal gland therefore increasing chance of developing hypertension is called?

A

cushings syndrome

80
Q

the aim of hypertension treatment is to restore BP to what?

A

120/90mmHg

81
Q

what drugs may be used to treat hypertension?

A

thiazide diuretic
beta blocker
calcium channel blocker
ace inhibitor

82
Q

what is the definition of heart failure?

A

output of heart incapable of meeting tissue demands

83
Q

give 2 examples of conditions which may cause high output heart failure?

A

anaemia

thyrotoxicosis

84
Q

give 2 examples of conditions which may cause low output heart failure?

A

MI

valave disease

85
Q

heart failure is more common on what side of the heart and why?

A

left - left side wrks harder and under higher pressure

86
Q

right side heart failure in isolation is most commonly due to what?

A

problems with right ventricle wall

87
Q

the right side of the heart failing after the left is known as what?

A

congestive heart failure

88
Q

what are the signs and symptoms of left heart failure?

A

difficulty breathing (dyspnoea)
tachycardia
low BP
low vol pulse

89
Q

what are the signs and symptoms of right heart failure?

A 
swollen ankles
fluid in abdomen (ascites)
raised jugular venous pressure
enlarged liver
poor GI absorption
90
Q

what is emergency hospital treatment will be given immediately to acute heart failure patients?

A

oxygen
morphine
frusemide

91
Q

what drugs are used to treat chronic heart failure?

A

diuretics
ACE inhibitors
nitrates
inotropes (digitoxin)

92
Q

a fast heart rhythm is known as?

A

tachy arrhythmias

93
Q

a slow heart rhythm is known as?

A

bardy arrythmias

94
Q

cardiac pacemakers treat which type f heart rhythms ?

A

bradycardiarythmias

95
Q

what does the P wave in ask ECG correspond to?

A

atrial depolarisation

96
Q

what does the QRS complex in ask ECG correspond to?

A

ventricular depolarisation

97
Q

what does the T wave in ask ECG correspond to?

A

ventricular repolarisation

98
Q

unstable heart electrical activity is known as?

A

ventricular fibrillation

99
Q

how would u identify ventricular fibrillation on an ECG?

A

extremely irregular
P wave absent
long QT

100
Q

which heart rhythm causes cardiac arrest with no electrical activity?

A

asystole

101
Q

which heart rhythm is associated with random contraction of the atria?

A

atrial fibrillation

102
Q

high BP in a clinical setting due to nervousness about appointment is known as what?

A

white coat syndrome

103
Q

heart failure when the heart is trying but tissues aren’t getting what they need is what type?

A

high output

104
Q

when the heart is not able to pump enough, this heart failure is known as?

A

low output

105
Q

what are the two types of valve replacements available?

A

porcine and mechanical

106
Q

patients with what type of valve replacement are always anticoagulated?

A

mechanical

107
Q

what medication is given to patients that are anticoagulated?

A

warfarin

108
Q

which 2 vales are most commonly replaced?

A

aortic and mitral (both left)

109
Q

what does stenosis mean?

A

narrowed

110
Q

infective endocarditis can affect which 2 structures the heart?

A

valves or walls

111
Q

what is the normal range of BPM?

A

60-100bpm

112
Q

which treatment carries out before dental treatment can decrease the risk of infective endocarditis?

A

antibiotic prophylaxis

113
Q

what patients may receive antibiotic prophylaxis before dental treatment?

A

those with prosthetic valves
have had endocarditis
congenital heart disease

114
Q

name the 4 heart valves

A

aortic (left)
mitral (left)
pulmonary (right)
tricuspid (right)

115
Q

what is valve stenosis ?

A

valve doesn’t open properly due to flaps thickening, stiffening or fusing together

116
Q

which genetic condition makes sufferers more likely to develop valve disease?

A

down syndrome

117
Q

which congenital abnormality causes valve disease?

A

bicuspid aortic valve

118
Q

how may u investigate valve disease?

A

echocardiogram (ultrasound of heart)

chest x-ray

119
Q

which has shorter life, mechanical valve or porcine valve?

A

porcine

120
Q

what is peripheral cyanosis generally due to?

A

cold environment

121
Q

what is central cyanosis generally due to?

A

congenital herat disease

122
Q

what is the antibiotic regime for antibiotic prophylaxis?

A

3g amoxicillin 1hr before procedure

123
Q

what patients may receive antibiotic prophylaxis?

A
  • those who’ve had previous infective endocarditis
  • cardiac valve replacement surgery
  • congenital heart problems
  • surgically constructed systemic or pulmonary shunt
124
Q

antibiotic prophylaxis is given for which kind of dental procedures?

A

those involving dents-gingival manipulation

125
Q

name some procedures which involves the dent-gingival junction

A
  • ectarction
  • periodontal therapy
  • implants
  • restorations if gingival margin involved or matrix used
126
Q

what antibiotic prophylaxis is given if the patient is allergic to amoxicillin?

A

1.5g clindamycin

127
Q

what is the difference between primary and secondary prevention?

A

primary - preventing disease before u have it

secondary - prevention after diagnosis

128
Q

list some primary prevention of CVD

A

stop smoking
better diet
exercise

129
Q

which medication is used to reduce cholesterol levels ?

A

statin

130
Q

how does aspirin work as an anti-platelet drug?

A

inhibits platelet aggregation

131
Q

name the drugs used to prevent CVD?

A

anti platelets
lipid lowering drugs
anti arrhythmias
anticoagulants

132
Q

what drugs are used to reduce symptoms of CVD?

A 
diuretics
anti arrythmias
nitartes
Ca channel blockers
ACE inhibitors
133
Q

name 3 anticoagulant drugs

A

warfarin
rivarobaxin
apixaban

134
Q

how do anticoagulant drugs work?

A

delay clotting of blood - reduce efficacy of coagulation

135
Q

when you initially go on warfarin, it takes 2-3 days to work, what drug do you take in the mean time?

A

heparin

136
Q

name some noeworal anticoagulants

A

rivaroxiban
apixoban
dabigastrian

137
Q

name 2 lipid lowering drugs

A

simvastatin

atrovastatin

138
Q

how do statins work?

A

inhibit cholesterol synthesis in liver

139
Q

name a selective and non-selective beta blocker

A

selective - atenolol (b1 only)

non selective - propranolol (b1 an b2)

140
Q

where are beta 2 receptors and what effect will blocking them have?

A

lungs and brain - blocking will make patient less anxious but will increase risk of asthma

141
Q

where are beta 1 receptors and what effect will blocking them have?

A

heart - reduce HR and reduce mi risk

142
Q

what effect do diuretics have when taken by those who have a risk of heart failure?

A

reduce fluid so BVs constrict
increase salt and water loss
decrease cardiac work load

143
Q

name a short acting nitrate?

A

GTN

144
Q

what is GTN used for?

A

emergency management of angina pectoris

145
Q

name a long acting nitrate?

A

isosorbide mononitrate

146
Q

what are long acting nitrates used for?

A

prevent angina pectoris

147
Q

how do nitrates work?

A

dilate restrictive arteries, decreasing cardiac workload (afetrload) and decrease cardiac O2 consumption

148
Q

how would you distinguish between angina pectoris and an MI in surgery?

A

GTN under the tounge - if patient recovers its angina and if not its MI

149
Q

why is GTN given under the tongue and not taken orally?

A

it is inactivated by 1st pass metabolism so must enter bloodsteam directly

150
Q

calcium channel blockers are used to treat what?

A

hypertension

151
Q

calcium channel blockers end in pine, name 1?

A

nifedipine

152
Q

what do ace inhibitors end in?

A

pril

153
Q

ace inhibitors inhibit the conversion of what to what?

A

angiotensin 1 to angiotensin 2

154
Q

what effect do ACE inhibitors have on aldosterone and sodium reabsorption?

A

increase both

155
Q

what effect do ace inhibitors have on BP ?

A

decrease

biological and medical sciences 2 (11 decks)

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