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Cardiovascular disease Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What innervates parasympathetic and sympathetic nerves?

A

Vagus nerve
Circulating catecholamines

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2
Q

What causes systolic failure?

A

Coronary heart disease - which is ineffective ejection of blood

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3
Q

What causes diastolic failure?

A
  • Fibrosis or hypertrophy of ventricles
  • Hypertension
  • Pericarditis
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4
Q

What are the signs / symptoms of heart failure?

A

Dyspnea - difficulty breathing
Fatigue
Exercise intolerance
Peripheral oedema - RHS failure
Pulmonary oedema - LHS failure

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5
Q

What are the causes of heart failure? (5)

A
  • Coronary artery disease and myocardial infarction
  • Hypertension
  • Faulty heart valves
  • Dilated cardiomyopathy (heart muscle)
  • Arrhythmia
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6
Q

How does coronary artery disease and MI lead to heart failure?

A
  • Atherosclerotic plaque build up in coronary arteries
  • Occlusion of arteries
  • Increases BP
  • Increases risk of plaque rupturing
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7
Q

How does hypertension cause heart failure?

A
  • Heart pumping harder to circulate blood
  • Extra exertion leads to fibrosis or or hypertrophy of myocardium
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8
Q

How can valves become faulty and cause heart failure?

A
  • Congenital defect / rheumatic fever / stenosis
  • E.g. aortic valve stenosis - left ventricle works harder to force blood through narrow valve, leads to left ventricular hypertrophy
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9
Q

What can lead to dilated cardiomyopathy (heart muscle)?

A

Genetics
Infection
Alcoholism
Cocaine

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10
Q

How can arrhythmia lead to heart failure?

A
  • HR increase
  • Not enough time for heart to fill with blood
  • Can lead to sudden death
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11
Q

What are the TX for heart failure? (3)

A
  • Lifestyle changes
  • Pharmacological agents
  • Surgery
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12
Q

Which lifestyle changes can treat heart failure?

A
  • Exercise
  • Limit alcohol
  • Stop smoking
  • Immunisations (against influenza, pneumonia etc)
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13
Q

What pharmacological agents can treat heart failure?

A
  • Diuretics (aid kidneys to remove XS salt and water, making it easier for the heart to pump)
  • ACE (angiotensin converting enzymes) inhibitors (dilate blood vessels)
  • Beta-blockers (slow down HR)
  • Digoxin (increases force of heart contractions)
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14
Q

Which surgeries can treat heart failure?

A
  • Coronary artery bypass graft CABG - treats atherosclerosis, restores normal blood flow to heart
  • Heart valve repairs / replacements
  • Implantable cardiac defibrillator ICD - continually monitors heart rhythm
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15
Q

What should you consider when giving oral healthcare to pt with heart failure? (4)

A
  • Meds e.g. anti-platelets / anti-coagulants, bleeding risk
  • Ability to lay flat in chair - possible pulmonary oedema
  • Medical care may be prioritised over oral care
  • Infective endocarditis risk for valve replacement pts
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16
Q

What is IE? What causes it?

A
  • Infection of hearts lining
  • Involves heart valves
  • Caused by bacteria entering blood from outside the body
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17
Q

What increases risk of IE / bacteria entering blood stream?

A
  • Invasive dental procedure e.g. XLA
  • Poor OH
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18
Q

What is the guidance on antibiotic prophylaxis and IE?

A
  • Dental procedures are no longer main cause of IE
  • Unclear if antibiotic prophylaxis prevents IE
  • Antibiotics give side effects e.g. allergies, nausea, diarrhoea, antibiotic resistance
  • No longer given prior to invasive dental procedures
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19
Q

What is peripheral arterial disease related to?

A

Atherosclerosis

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20
Q

What common areas of the body are affected by peripheral arterial disease?

A
  • Legs primarily
  • Ulcers on feet / gangrene
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21
Q

What are the impacts / effects of peripheral arterial disease? (3)

A

Intermittent claudication i.e. tightness
- Calf / thigh muscle pain with exercise
- Relieves with rest

Pain at rest
- Spontaneously
- Worsens with time

Critical ischaemia
- Pain and sensory loss
- Blue and cold limbs
- Ulceration
- Wet / dry gangrene

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22
Q

What is an aneurysm?

A

Localised, blood-filled dilation of a blood vessel caused by a disease or weakened vessel wall

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23
Q

What is an Abdominal Aortic Aneurysm?

A
  • Aorta up to 10cm + in diameter
  • Often asymptomatic until they dissect
  • Dissection is life threatening, causes death by massive blood loss, few people reach hospital in time
24
Q

What is carotid artery stenosis?
What is it a risk factor for?

A
  • Atherosclerosis of carotid artery
  • Can involve both carotids
  • RF for stroke and TIA (transient ischaemic attack)
25
Q

What are the management options for carotid artery stenosis? (2)

A
  • Lifestyle changes e.g. stop smoking, reduce BP, exercise, diet
  • Revascularise arteries by carotid endarterectomy +/- vascular graft
26
Q

What is coronary artery disease and what does it lead to?

A
  • Ischaemia to myocardium
  • Due to atherosclerosis
  • Leads to angina and MI
27
Q

What are the risk factors for coronary artery disease?

A

Dyslipidaemia - high LDL and low HDL (should be other way)
High BP (systolic >140)
Smoking
Diabetes

28
Q

What happens in stable angina when active?

A

Insufficient blood flow to myocardium
O2 demands not met
Causes pain, breathlessness, dizziness and sweating
Pain radiates to central chest, left arm / neck / mandible
Predictable
Relieved by short acting nitrate e.g. GTN

29
Q

What are short acting nitrates, how do they work? Give example

A
  • Relax vascular muscles
  • Dilate coronary arteries
  • Improve o2 supply to myocardium
  • Glyceryl trinitrate
30
Q

What is beta-blocker, how does it work? Give example

A
  • Block effects of adrenaline / epinephrine
  • Cause HR to decrease, lowers BP
  • Help widen vessels
  • Drugs ending in -olol
31
Q

How does unstable angina differ pathologically to stable angina?

A
  • There are cracks in luminal surfaces of plaques, these fissures are thrombogenic (can cause thrombi AKA clots to form)
32
Q

How can unstable angina lead to MI?

A

• Thrombus forms around fissure, occluding vessel more
• Further angina symptoms
• Emboli shed from fissured plaque and can further impact narrowed vessel
• If emboli block significant portion of end vessel then no oxygenation of tissue = MI

33
Q

What is a MI?

A

Critically reduced blood flow to myocardium
No oxygenation
Leads to death of tissue

34
Q

How can you diagnose an MI? (2)

A
  • ECG - ST elevation
  • Cardiac enzyme levels - Troponin
35
Q

How to manage MI? (4)

A

Analgesia - morphine
Anti-platelet - aspirin
Anti-coagulant - low molecular weight heparin e.g. Enoxaparin
Thrombolysis - streptokinase

36
Q

What considerations should be made for pt with arterial disease when treating them?

A
37
Q

What considerations should be made for pt with arterial disease when treating them? Triggers?

A

Possible triggers for stable angina - Stress / anxiety / pain

38
Q

How long should you wait post MI? And why?

A
  • 6 months
  • Potential for arrhythmia
  • Arrhythmia can be induced by vasoconstrictors in LA
39
Q

What is a normal systolic BP? and diastolic BP?

A

Less than 120 mmHg
Less than 80 mmHg

40
Q

What are the 4 determinants of normal BP?

A

Cardiac output
Total peripheral resistance
Circulating volume
Blood viscosity

41
Q

What receptors and where can detect blood flow and signal to autonomic NS?

A

Arterial baroreceptors in aortic arch and carotid artery

42
Q

What effect does the autonomic NS have on CO? What are its 2 branches?

A

Increase CO
Sympathetic branch can increase BP (by increasing TPR, SV and HR via SAN)
Parasympathetic branch can decrease BP (by decreasing TPR, SV and HR via SAN)

43
Q

How do arterial baroreceptors respond to BP changes?

A
  • Hypertension - can increase BP if low
  • Hypotension - can decrease BP if high
44
Q

How is BP regulated long term? (4)

A
  • Low pressure baroreceptors
  • Renin-angiotensin system RAS
  • Aldosterone from adrenal cortex
  • Anti-diuretic hormone ADH from posterior pituitary gland
45
Q

What are risk factors for hypertension? (6)

A
  • Diet - high fat / salt intake
  • Age - TPR increases and vessel elasticity decreases with age
  • Ethnicity - Afro-caribbeans and South asians
  • FH - genetic predisposition
  • Obesity
  • Pharmacological - alcohol / cocaine / chronic use of NSAIDs / corticosteroids
  • Stress
46
Q

Which RFs are non modifiable?

A

Age
Ethnicity
Genetics / FH

47
Q

What are the pharmacological treatments for hypertension? (3)

A
  • ACE inhibitors (angiotensin converting enzyme)
  • Calcium channel blocker
  • Diuretics
48
Q

Example of ACE inhibitor? (-suffix)

A

Benazepril
-pril

49
Q

Example of Calcium channel blocker? -suffix?

A

Amlodopine
-dipine

50
Q

What are the potential complications from hypertension tx? (4)

A
  • Cardiac - angina / MI / heart failure / arrhythmia
  • Renal - impairment / failure
  • Cerebral - TIA / stroke
  • Retinal - impairment / blindness
51
Q

What is atrial fibrillation the leading cause of?

A

Stroke

52
Q

Which type of drugs can prevent further complications from atrial fibrillation?

A

Therapeutics:
- NOACs (novel oral anticoagulants) e.g. Apixaban, Rivaroxaban, Dabigastran
- Warfarin - older its still on, NOACs / DOACs safer

53
Q

What are NOACs?

A

Novel oral anticoagulant drugs
Work by preventing formation of thrombus (blood clotting) - inhibit factor Xa
Safer than Warfarin

54
Q

What are examples of long term anti-arrhythmic meds?

A

Beta blockers - e.g. Bisprolol / Metoprolol
-olol

Amidarone

55
Q

Which medications are pts who have recurrent episodes of atrial fibrillation on?

A

Flecanide
Propafenone

56
Q

Which procedure can re-establish sinus rhythm?

A

Cardioversion - low energy shocks
80% success rate

57
Q

What should you be aware of when delivering oral healthcare to pt with AF?

A
  • How AF currently managed
  • Which anticoagulant pt on

CMS (10 decks)

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