Cardiovascular disease

Question 1

What are the risk factors for cardiovascular disease?

Answer 1

-family history
- male
-ethnicity
- hypertension
- high serum cholesterol levels
- smoking
- lack of exercise
- obesity

can be differentiated into reversible and non-reversible

Question 2

What does acute coronary syndrome encompass?

Answer 2

• unstable angina
• non st elevation mi
• st elevation infarction

Question 3

What is arteriosclerosis?

Answer 3

When the artery walls become firm and non-compliant in the large and medium arteries

Question 4

What is arteriolosclerosis?

Answer 4

When the artery walls become firm and non-compliant in the small arteries and arterioles.

Question 5

What is atherosclerosis?

Answer 5

The development of obstruction by cholesterol plaques and thrombus plaques on the walls of arteries.

Question 6

How does atherosclerosis occur?

Answer 6

When compliance in the blood vessels is lost, blood vessels can no longer accommodate changes in blood pressure.
This leads to damage of the tunica interna. Cholesterol then stick in the damaged area and causes a plaque.
The effect of this is reduced blood flow and oxygen supply.

Question 7

How does the body protect the plaques?

Answer 7

Cells migrate out from the smooth muscle layer to form a protective cap around the plaque.

Question 8

What happens when plaques get damaged?

Answer 8

If the cap breaks, a clot may form on the plaque, further reducing blood flow.

Question 9

What is ischemia?

Answer 9

When blood flow is reduced. It leads to hypoxia and reversible, temporary damage.

Question 10

What is infarction?

Answer 10

When a blood supply is cut off. This leads to necrosis, which is irreversible cellular death.

Question 11

What are the features and course of stable angina?

Answer 11

-There is at least 70% occlusion due to plaques but at rest, homeostasis can still be maintained
-During activity, the oxygen demand can no longer be met, leading to chest pain as the muscle becomes hypoxic as the cells release adenosine, which causes the chest pain.
-The symptoms will resolve on rest; should last 20 minutes or less

Question 12

What are the features and course of unstable angina?

Answer 12

-Plaques still occlude by at least 70%, although tend to be bigger
-Episodes can occur at rest, on exertion and don’t follow any pattern. They can wake the patient from sleep
-GTN not always as effective
-Even at rest, the myocardium can become hypoxic
-Greater risk of infarction than in stable angina

Question 13

What drugs/doses are given for anginas, and what do they do?

Answer 13

Aspirin - an anticoagulant to prevent platelets sticking together on clots. 300mg chewed or dissolved. No repeat doses

GTN - a vasodilator, acting against the natural vasoconstriction as a result of hypoxia. It results in a drop in blood pressure. 400-800mcg sublingual (under the tongue). Repeat doses after 5-10 minutes

Question 14

What are the general features of Myocardial Infarctions?

Answer 14

Cardiac muscle is deprived of coronary blood flow long enough that portions of the muscles die. Often complete occlusion of a coronary vessel. It causes ischemia and necrosis.
Caused by:
- occlusion by blood clot
- spasm of coronary artery
- reduction of blood flow from any cause

Question 15

What’s the difference between embolisms and thrombus?

Answer 15

Embolisms occlude vessels away from where they originate.
Thrombus is an occlusion where it originates.

Question 16

what are the features of non-stemi MIs?

Answer 16

Also known as a sub-endocardial MI.
There is the tiniest bit of blood supply, leading to partial thickness infarction and necrosis in the tissue furthest from the artery.
The ST segment is not elevated on and ECG.

Question 17

What is the treatment for MIs?

Answer 17

MONA
Morphine (20ml max)
Oxygen if sats lower than 94%
Nitrates (GTN)
Aspirin

But not in that order: Aspirin, Nitrates, (oxygen), morphine.

JRCALC says morphine should be first choice of painkiller in MIs.

Question 18

What is an abdominal aortic aneurysm (AAA)?

Answer 18

The ballooning/dilation of the aorta. To be considered an aneurysm, it has to grow by about 50% of the diameter. The aorta is normally 2-2.4cm so it has to be 3cm.
3-4.4cm considered a small aneurysm.
4.5-5.4cm is medium
5.5+ is large.
90% occur below the renal arteries.

Question 19

How do people with AAA rupture/leak present?

Answer 19

-Generalised abdominal pain. Radiating to back or groin is a key indicator
-Hypotension due to blood loss
-Tachycardia due to shock
-collapse
-Pulsating abdominal mass on palpation of the abdomen

Question 20

what is the management of AAA rupture/leak?

Answer 20

-Rapid blue light transfer with pre-alert
-Consider fluids, but don’t want to raise bp above 60-90 systolic, as it will lead to more fluid loss. Not able to replace oxygen-carrying capability, but hospital can.
-Prepare for cardiac arrest

Question 21

what are the risks/mortality for AAA rupture/leak?

Answer 21

-8cm aaa 400% likelihood of leak. The larger, the riskier.
- 80% mortality for rupture
- If it ruptures anteriorly, it can fill the peritoneal cavity, which is large, leading to high blood loss, and more likely to die.
-If it ruptures posteriorly it fills the retro-peritoneal cavity, which is a smaller space.
-Leaks lose blood slowly