Cardiovascular Disease 1

Question 1

What is the definition of ischemic heart disease?

Answer 1

inadequate blood supply to the myocardium

Question 2

What causes ischemic heart disease?

Answer 2

↓ coronary blood from (e.g. thrombus)
myocardial hypertrophy
imbalance in supply v demand

Question 3

where is low diastolic flow most likely?

Answer 3

sub-endocardial - furthest way from a blood supply

Question 4

how long does it take before ischemic heart disease damage is irreversible?

Answer 4

20-30 mins

Question 5

at what % does autoregulation of coronary blood flow breaks down?

Answer 5

> 75%

Question 6

at what % of stenosis may be insufficient at rest?

Answer 6

> 90%

Question 7

What are the 4 Ischaemic heart disease syndromes?

Answer 7

angina pectoris
acute coronary syndrome
sudden cardiac death
chronic ischemic heart diesease

Question 8

What are the 3 types of angina pectoris and which one is a ‘red flag’?

Answer 8

typical/stable: fixed obstructon, predictable symptoms depending on exertion
variant/prinzmental: coronary artery spasm
crescendo/unstable: often sue to plaque disruption. RED FLAG

Question 9

What are the two types of acute coronary syndrome?

Answer 9

acute myocardial infarction (+/- ECG ST elevation)

crescendo/unstable angina

Question 10

What are the two circumstances in which a sub-endocardial myocardium can occur without acute coronary occlusion?

Answer 10

stable atheromanous occlusion of the coronary circulation

acute hypotensive episode

Question 11

What is a transmural MI?

Answer 11

ischemic necrosis of the full thickness of the affected muscle segment(s) - from the endocardium through the myocardium to the epicardium

Question 12

What is the gross and microscopic appearance of an MI before 24 hours?

Answer 12

gross: normal/dark
microscopic: necrosis and neutrophils

Question 13

What is the gross and microscopic appearance of an MI from 3-7 days?

Answer 13

gross: hyperaemic border, yellow centre
microscopic: macrophages

Question 14

What is the gross and microscopic appearance of an MI from 3-6 weeks?

Answer 14

gross: scar
microscopic: collagen scar

Question 15

What is the main blood marker for cardiac myocyte damage?

Answer 15

Troponins T & I - detectable from 2-3 hours but peaks at 12 hours, up to 7 days
raised post MI and also PE, heart failure & myocarditis

Question 16

What are the 3 subtypes of the blood marker creatine kinase?

Answer 16

CK MM - muscle (cardiac and skeletal)
CK BB - brain, lung
CK MB - mainly cardiac, also skeletal muscle

Question 17

What are the complications of MI’s?

Answer 17

contractile dysfunction
chronic cardiac failure
arrhythmias
infarct extension
myocarial rupture
pericarditis - dresslers syndrome
mural thrombosis
ventricular aneurysms

Question 18

What are the two most common genes mutated in familial hypercholesterolaemia?

Answer 18

low density lipoprotein receptor

apolipoprotein B

Question 19

Is hetro or homozygous familial hypercholesterolaemia treatment less complex and more affective?

Answer 19

heterozygotes
develop xanthomas
early primary treatment with statins

Question 20

What is a normal BP?

Answer 20

120/80mmHg

abnormal around 140/90 and above

Question 21

Name some systems involved with causing primary hypertension

Answer 21

Cardiac baroreceptors
Renin-angiotensin- aldosterone system: angiotensin II = vasocontrictor, aldesterone = water retension

Kinin-kallikrekin system
Naturetic peptides
Adrenergic receptor system
Autocrine factors produced by blood vessels
Autonomic nervous system

Question 22

what are the effects of hypertension?

Answer 22

Hypertensive heart disease
Renal failure
Cerebrovascular accident

Question 23

what is the process of hypertensive heart disease?

Answer 23

Systemic hypertension → ↑ left ventricular blood pressure
Left ventricle hypertrophy in response to ↑ work needed to pump blood
When the pressure is too great = dilatation

Question 24

What is a ‘hypertensive crisis’?

Answer 24

BP >180/120mmHg
signs and symptoms of organ damage e.g. renal failure
urgent treatment required

Question 25

What is the Framingham risk score?

Answer 25

Calculates an individual’s risk of cardiovascular disease based on assessment of multiple risk factors

Question 26

What us Conn’s syndrome?

Answer 26

excess aldosterone secretion
usually due to adenocortical adenoma
low renin
low K+
diagnosed by CT of adrenal glands

Question 27

What is phaeochromocytoma?

Answer 27

tumour of the adrenal medulla
due to secretions of vascoconstrictive catecholamines e.g. adrenaline
symptoms: headache, pallor, Sweating, Nervousness, Hypertension
Diagnosis: 24hr urine collection for adrenaline metabolites

Question 28

What is cushing’s disease?

Answer 28

Overproduction of cortisol by adrenal cortex

Caused by: adrenocortical neoplasm, pituitary adenoma, paraneoplastic effect e.g. effect of small cell lung carcinoma