cardiovascular Flashcards
1
Q
what is atherosclerosis?
A
stiffening and narrowing of artery walls due to plaque build up
2
Q
what is they highest risk factor for atherosclerosis?
A
hyperlipidaemia (lots of cholesterol in blood)
3
Q
how may hyperlipidaemia cause atherosclerosis?
A
cholesterol is deposited in BV walls causing inflammation which doesn’t heel
4
Q
what effect may an atheroma have on a BV?
A
narrow BV
block BV
weaken BV wall leading to rupture
5
Q
which non-modifiable factors may contribute to the development of atherosclerosis?
A
age
gender
genes (LDL receptor gene mutation)
6
Q
a LDL receptormuetation has what effect on cholesterol uptake?
A
reduced uptake
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
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
9
Q
atherosclerosis means less blood supply to tissues, what is this known as?
A
ischaemia
10
Q
sometimes atheroma may completely occlude a BV, leading to cell death, what is this known as?
A
infarction
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
12
Q
a piece of clot travelling through the blood is known as a ?
A
embolism
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
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
15
Q
total loss of circulation to legs and feet can cause what?
A
gangrene
16
Q
a weakening of an artery wall that creates a bulge is known as?
A
aneurysm
17
Q
what is the most common aneurysm and what does it result from?
A
abdominal aortic aneurysm - due to atherosclerosis
18
Q
accidental cell death typically caused by ischemia or infarction is known as?
A
coagulation necrosis
19
Q
describe a cell that has undergone coagulation necrosis?
A
retained outline
dark cytoplasm
remains of nucleus
striations lost
20
Q
congestive heart failure is a chronic condition affecting what aspect of the heart?
A
pumping power of heart muscles
21
Q
congestive heart failure usually follows on from what?
A
ischaemic heart disease
hypertension
valvular heart disease
22
Q
name 3 types of tumour to BVs
A
hamartoma
kaposi sarcoma
angio sarcoma
23
Q
a hamartoma (BV tumour) of vascular tissue is known as what?
A
haemangioma
24
Q
a haemangioma can be described as?
A
small collection of BVs under the skin
25
name 2 typesof benign cardiac tumour?
myxoma
| lipoma
26
what name is given to a malignant cardiac tumour?
angiosarcoma
27
how may valvular heart disease be acquired?
through other cardiac diseases
28
what is the most common valvular condition?
calcific aortic stenosis
29
what is calcific aortic stenosis?
calcific matter deposited in valve making it stiff and narrow
30
in rheumatic heart disease, the heart valves have been permanently damaged by which condition?
rheumatic fever
31
microbial infection of the heart valves is known as?
infective endocarditis
32
what is found in granulation tissue?
macrphages
fatty tissue
fibrous tissue
33
which 2 conditions may ischaemia lead to?
angina
| peripheral vascular disease
34
name 2 effects of infarction?
MI
| stroke
35
conditions associated with sudden, reduced flow to the heart are called?
acute coronary syndromes
36
acute coronary syndromes describe 3 types of coronary artery disease, these are?
unstable angine
NSTEMI (non st-segment elevation MI)
STEMI (st-segment MI)
37
what 3 things would u take to diagnose an acute coronary syndrome?
history
ECG
test biomarkers (troponin)
38
when is troponin released?
during injury to the heart
39
how do you distinguish classical engine from unstable?
classical - gets worse with exercise
| unstable - symptoms at rest. no biomarkers
40
describe the symptoms of classical angina
no pain at rest
pain at certain level of exertion
pain relived by rest
gradually deteriorates
41
what investigations may you carry out in patients with angina?
ECG
angiography (dye injected into artery)
echocardiography (sound waves to produce images)
isotope studies
42
what effect will angina have on a patients ECG?
st segment depression gets worse
43
in order to increase o2 delivery in patients with angina, you may want to carry out an angioplasty, hoe does this help?
dilates narrowed vessel
44
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?
bypasses blocked/narrowed artery
45
which drug is take to reduce MI risk?
aspirin
46
what drugs are give to patient suffering from hypertension?
diuretics
calcium channel antagonsists
ACE inhibitors
Beta blockers
47
what drugs reduce preload by dilating coronary vessels?
nitrates (short and long acting)
48
what emergency treatment is given to patients suffering from angina?
GTN spray
49
what are the disadvantages of a CABG?
major surgery so carries a mortality risk
only lasts 10 years
1 off operation
50
what is preferred, CABG or angioplasty and stent?
angioplasty and stent
51
what medication does a patient need to take after having an angioplasty?
dual antiplatelet therapy
52
how does an angioplasty work?
balloon is blown in blocked artery, squashing plaque then a metal tube inserted to keep artery open
53
what is thrombolysis?
dissolving a clot (must be done within 6hrs)
54
what is preferred, angioplasty or thrombolysis?
angioplasty
55
angioplasties must be carried out in what time frame?
3 hours
56
what treatment is available for MI?
thrombolysis
angiplasty
CABG
57
something temporarily blocking flow to the brain is known as?
transient ischameic attack
58
a blood clot preventing blood flowing to the brain is known as?
ischaemic stroke
59
a BV to the brain ruptures spilling blood into surrounding tissues is known as?
heamorrhage stroke
60
what are the symptoms of an MI?
```
pain
nausea
pale
sweaty
feel like going to die
```
61
how may an MI be indicated on an ECG?
st segment elevation
| t wave abnormality
62
what biomarkers may be present in patients that have had an MI?
troponin
creatine kinase
increase in LDH and AST
63
what medications are given to prevent a second MI?
aspirin
beta blocker
ace inhibitors
64
beta blockers decrease BP by blocking which hormone?
adrenaline
65
what are the risk factors for acute coronary syndromes?
```
diabetes type 2
lack of exercise
obesity
smoking
having an other coronary syndrome
```
66
how does GTN work?
causes vasodilation, reducing pressures on heart
67
what is the preload?
blood in heart waiting to be pumped out
68
what is after load?
blood being pumped
69
how would u manage an MI in dental practice?
oxygen
GTN
apirin
ambulance
70
elevated st segment indicates what?
MI
71
depressed st segment indicates what?
angina
72
statins interact with what other medication?
antifungals
73
calcium channel blockers may have what oral manifestation?
gingival hyperplasia
74
what is normal systolic BP?
120mmHg
75
what is considered a hypertensive systolic BP?
>140mmHg
76
what is considered a hypertensive diastolic BP?
>90mmHg
77
list some risks of hypertension
age, alcohol, stress, race, fam history, drugs, obsity, pregnancy
78
a are tumour of the adrenal glad that results in too much adrenaline release is called?
pheochromocytoma
79
a tumour producing too much cortisol from the adrenal gland therefore increasing chance of developing hypertension is called?
cushings syndrome
80
the aim of hypertension treatment is to restore BP to what?
120/90mmHg
81
what drugs may be used to treat hypertension?
thiazide diuretic
beta blocker
calcium channel blocker
ace inhibitor
82
what is the definition of heart failure?
output of heart incapable of meeting tissue demands
83
give 2 examples of conditions which may cause high output heart failure?
anaemia
| thyrotoxicosis
84
give 2 examples of conditions which may cause low output heart failure?
MI
| valave disease
85
heart failure is more common on what side of the heart and why?
left - left side wrks harder and under higher pressure
86
right side heart failure in isolation is most commonly due to what?
problems with right ventricle wall
87
the right side of the heart failing after the left is known as what?
congestive heart failure
88
what are the signs and symptoms of left heart failure?
difficulty breathing (dyspnoea)
tachycardia
low BP
low vol pulse
89
what are the signs and symptoms of right heart failure?
```
swollen ankles
fluid in abdomen (ascites)
raised jugular venous pressure
enlarged liver
poor GI absorption
```
90
what is emergency hospital treatment will be given immediately to acute heart failure patients?
oxygen
morphine
frusemide
91
what drugs are used to treat chronic heart failure?
diuretics
ACE inhibitors
nitrates
inotropes (digitoxin)
92
a fast heart rhythm is known as?
tachy arrhythmias
93
a slow heart rhythm is known as?
bardy arrythmias
94
cardiac pacemakers treat which type f heart rhythms ?
bradycardiarythmias
95
what does the P wave in ask ECG correspond to?
atrial depolarisation
96
what does the QRS complex in ask ECG correspond to?
ventricular depolarisation
97
what does the T wave in ask ECG correspond to?
ventricular repolarisation
98
unstable heart electrical activity is known as?
ventricular fibrillation
99
how would u identify ventricular fibrillation on an ECG?
extremely irregular
P wave absent
long QT
100
which heart rhythm causes cardiac arrest with no electrical activity?
asystole
101
which heart rhythm is associated with random contraction of the atria?
atrial fibrillation
102
high BP in a clinical setting due to nervousness about appointment is known as what?
white coat syndrome
103
heart failure when the heart is trying but tissues aren't getting what they need is what type?
high output
104
when the heart is not able to pump enough, this heart failure is known as?
low output
105
what are the two types of valve replacements available?
porcine and mechanical
106
patients with what type of valve replacement are always anticoagulated?
mechanical
107
what medication is given to patients that are anticoagulated?
warfarin
108
which 2 vales are most commonly replaced?
aortic and mitral (both left)
109
what does stenosis mean?
narrowed
110
infective endocarditis can affect which 2 structures the heart?
valves or walls
111
what is the normal range of BPM?
60-100bpm
112
which treatment carries out before dental treatment can decrease the risk of infective endocarditis?
antibiotic prophylaxis
113
what patients may receive antibiotic prophylaxis before dental treatment?
those with prosthetic valves
have had endocarditis
congenital heart disease
114
name the 4 heart valves
aortic (left)
mitral (left)
pulmonary (right)
tricuspid (right)
115
what is valve stenosis ?
valve doesn't open properly due to flaps thickening, stiffening or fusing together
116
which genetic condition makes sufferers more likely to develop valve disease?
down syndrome
117
which congenital abnormality causes valve disease?
bicuspid aortic valve
118
how may u investigate valve disease?
echocardiogram (ultrasound of heart)
| chest x-ray
119
which has shorter life, mechanical valve or porcine valve?
porcine
120
what is peripheral cyanosis generally due to?
cold environment
121
what is central cyanosis generally due to?
congenital herat disease
122
what is the antibiotic regime for antibiotic prophylaxis?
3g amoxicillin 1hr before procedure
123
what patients may receive antibiotic prophylaxis?
- those who've had previous infective endocarditis
- cardiac valve replacement surgery
- congenital heart problems
- surgically constructed systemic or pulmonary shunt
124
antibiotic prophylaxis is given for which kind of dental procedures?
those involving dents-gingival manipulation
125
name some procedures which involves the dent-gingival junction
- ectarction
- periodontal therapy
- implants
- restorations if gingival margin involved or matrix used
126
what antibiotic prophylaxis is given if the patient is allergic to amoxicillin?
1.5g clindamycin
127
what is the difference between primary and secondary prevention?
primary - preventing disease before u have it
| secondary - prevention after diagnosis
128
list some primary prevention of CVD
stop smoking
better diet
exercise
129
which medication is used to reduce cholesterol levels ?
statin
130
how does aspirin work as an anti-platelet drug?
inhibits platelet aggregation
131
name the drugs used to prevent CVD?
anti platelets
lipid lowering drugs
anti arrhythmias
anticoagulants
132
what drugs are used to reduce symptoms of CVD?
```
diuretics
anti arrythmias
nitartes
Ca channel blockers
ACE inhibitors
```
133
name 3 anticoagulant drugs
warfarin
rivarobaxin
apixaban
134
how do anticoagulant drugs work?
delay clotting of blood - reduce efficacy of coagulation
135
when you initially go on warfarin, it takes 2-3 days to work, what drug do you take in the mean time?
heparin
136
name some noeworal anticoagulants
rivaroxiban
apixoban
dabigastrian
137
name 2 lipid lowering drugs
simvastatin
| atrovastatin
138
how do statins work?
inhibit cholesterol synthesis in liver
139
name a selective and non-selective beta blocker
selective - atenolol (b1 only)
| non selective - propranolol (b1 an b2)
140
where are beta 2 receptors and what effect will blocking them have?
lungs and brain - blocking will make patient less anxious but will increase risk of asthma
141
where are beta 1 receptors and what effect will blocking them have?
heart - reduce HR and reduce mi risk
142
what effect do diuretics have when taken by those who have a risk of heart failure?
reduce fluid so BVs constrict
increase salt and water loss
decrease cardiac work load
143
name a short acting nitrate?
GTN
144
what is GTN used for?
emergency management of angina pectoris
145
name a long acting nitrate?
isosorbide mononitrate
146
what are long acting nitrates used for?
prevent angina pectoris
147
how do nitrates work?
dilate restrictive arteries, decreasing cardiac workload (afetrload) and decrease cardiac O2 consumption
148
how would you distinguish between angina pectoris and an MI in surgery?
GTN under the tounge - if patient recovers its angina and if not its MI
149
why is GTN given under the tongue and not taken orally?
it is inactivated by 1st pass metabolism so must enter bloodsteam directly
150
calcium channel blockers are used to treat what?
hypertension
151
calcium channel blockers end in pine, name 1?
nifedipine
152
what do ace inhibitors end in?
pril
153
ace inhibitors inhibit the conversion of what to what?
angiotensin 1 to angiotensin 2
154
what effect do ACE inhibitors have on aldosterone and sodium reabsorption?
increase both
155
what effect do ace inhibitors have on BP ?
decrease
