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cardiovascular disease Flashcards

1
Q

what might you see on an ecg with angina

A

ST depression

due to sub endocardial ischaemia

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2
Q

what two mechanisms control coronary flow

A

autoregulation / myogenic

metabolic regulation

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3
Q

what is coronary flow reserve

A

maximum vasodilation - autoregulated flow

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4
Q

what determines myocardial oxygen consumption

A 
tension 
contractility
HR
basal  activity 
mass of tissue
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5
Q

what 4 types of drug are used in angina

A

B blockers
nitrates
ca channel blockers
Ikf channel inhibitors

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6
Q

what events increase the likelihood of mi

A 
time of day
inflammatory activity
infection
high BP 
catecholamines (adrenaline)
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7
Q

what preventative drugs would you give someone after a stemi

A

b blockers
ace inhibitors
statins

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8
Q

what are common complications of stemis

A 
arrhythmia
heart failure
rupture
mitral valve insufficiency
VSD
mural thrombus and embolism
LV dilation
recurrent MI
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9
Q

how would you treat a nstemi

A

antiplatelet
b blockers and nitrates
statin
ace inhibitors

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10
Q

describe age related vascular changes

A

fibrosis
accumulation of ground substances
fragmentation of elastic lamina

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11
Q

what are the 3 components of atheroma

A

lipid deposition
inflammation
fibrosis

also: neovascularisation, smooth muscle, macrophages, lymphocytes, collagen

necrotic core: cell debris, cholesterol crystals, foam cells, debris

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12
Q

where are atherosclerotic aneurysms usually found

A

abdominal aorta, distal to renal arteries

saccular or fusiform, may contain thrombi. often palpable or abdom bruits

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13
Q

where are the origins of dissecting aneurysms found

A

aortic valve

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14
Q

what is the most common cause of death in a dissecting aneurysm

A

dissection outward into the peritoneal, pleural or pericardial cavities

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15
Q

what might be the result of a berry aneurysm

A

sub arachnoid haemorrhage

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16
Q

what is a capillary microaneurysm

A

small aneurysm of the middle cerebral artery. may lead to intra cerebral haemorrhage

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17
Q

where are syphilitic microaneurysm normally found

A

thoracic aorta

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18
Q

what is a mycotic aneurysm

A

wall of artery is weakened often in the brain

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19
Q

what is giant cell arteritis

A

granulomatous inflammation of arteries, usually temporal, vertebral and opthalmic

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20
Q

what is takaysu arteritis

A

pulseless disease- (intermittent claudication of UL arteries)

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21
Q

what is polyarteritis nodosa

A

arteries of abdo organs

fibrinoid necrosis

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22
Q

what is kawasakis disease

A

very young children

fever , eye and mouth lesions

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23
Q

what are the type of vascular tumours (benign)

A 
angioma 
haemangioma
juvenile
capillary
cavernous
lymphangioma
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24
Q

what are some types of malignant tumours

A

angiosarcoma
kaposis sarcoma
angioproliferative tumour

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25
what causes dysrhythmia
changes to heart cells | changes in conduction of the impulse
26
what are the 4 classes of arrhythmias
atrial/ SV junctional (AVN) ventricular tachy/brady cardia
27
what are the 4 types of arrhythmia event
heart block ectopic delayed after depolarisation circus re entry
28
what does a delayed after depolarisation cause
atrial or ventricular tachycardias
29
what usually causes heart block
ischaemia usually affects AVN, slows or blocks impulses
30
describe the features of a first degree heart block
conduction is slowed abnormally long PR interval every p wave is passed to QRS normal PR interval is 0.12- 0.2
31
describe a mobitz 2 heart block
some Ps don't get through | constant PR interval except when there is missed QRS
32
describe a wenkebach heart block
progressive lengthening of the PR Interval until a dropped QRS
33
describe a 3rd degree heart block
complete block | ventricles depolarise at their inherent rate
34
what are ectopic pacemakers
``` when other areas of the heart develop pacemaker activity eg due to damage sympathetic activity catecholamines digoxin ``` ischaemic damage may cause cells to become leaky to Na catecholamines (B1 rec) increase rate of depolarisation
35
what is an early after depolarisation
occurs towards the end of phase 2 triggered by increase in Ca permeability can set off self sustaining depolarisations - tachycardia long QT
36
what is a delayed after depolarisation
increase in Ca eg due to cardiac glycosides causes an after depolarisation can become self perpetuating and trigger an AP may be due to delayed repolarisation (long qt) can lead to ventricular dysrhythmia
37
what is circus reentry
an electrical impulse re enters a region of the heart after its refractory period comes from an unusual direction and at the wrong time no extinction by collision due to impulse dying out may cause paroxysmal tachycardia
38
what is wolf Parkinson white syndrome
due to an additional electrical connection between the atria and ventricles thereby passing the AVN causes paroxysmal tachycardia and re entry delta waves on the ecg wide qrs st changes
39
how might you diagnose a left anterior fascicular hemiblock
left axis deviation
40
how might you diagnose a left posterior fascicular hemiblock
right axis deviation
41
what might cause a bradycardia
``` b blockers diltiazem (Ca channel blocker) hypothyroidism sinus node disease electrolyte abnormalities ``` you might treat with a pace maker
42
how do you diagnose a right bundle branch block
widened qrs complex | two r waves
43
how do you diagnose a left bundle branch block
widening of QRS complex | a notch in the qrs
44
what is a narrow complex tachycardia
superventricular atrial/junctional/re-entry usually no p waves
45
what is a broad complex tachycardia
usually ventricular
46
how would you treat an AV node tachycardia eg avnrt or avrt
adenosine | causes transient AV block
47
how would you treat AF
diltazem, verapamil, b blocker
48
what is polymorphic ventricular tachycardia also known as
torsade de points must also have QT prolongation. associated with early after depolarisations sudden cardiac death after adrenergic setting
49
what might cause secondary hypertension
renal disease, phaeochromocytoma, cushings, diabetes, coarctation, eclampsia drugs eg illegal drugs and contraceptive pill
50
what is stage 1 hypertension
140/90 in the clinic | 135/85 ambulatory
51
what is stage 2 hypertension
160/100
52
what is severe hypertension
180 syst or 110 diastolic may have left axis deviation and inverted t waves on the ecg albinuria
53
what can cause an increase in TPR
sympathetic nerve activity | increased vascular reactivity
54
what are the effects of hypertension on the body
accelerated atherosclerosis and narrowing retinopathy renal failure dilatation
55
what is stenosis
narrowing of the valve outlet caused by thickening of valve cusps, increased rigidity or scarring
56
what is valve incompetence
an incomplete seal allowing blood to flow backwards
57
what are common causes of valve disease
congenital heart disease cardiomyopathy acquired - rheumatic fever, MI, age, calcific stenosis, endocarditis
58
what might result from aortic stenosis
``` RVH syncope sudden cardiac death dyspnoea angina ```
59
what are causes of aortic incompetence
marfan's rheumatic fever infective endocarditis(may causes perforation) may have calcification of a congenital bicuspid valve
60
what is the most common cause of mitral incompetence or stenosis
rheumatic fever leads to pulmonary hypertension and RVH due to back pressure may cause atrial fibrillation
61
what is infective endocarditis
infection of the valve with thrombotic vegetations
62
what are the risk factors for infective endocarditis
valve damage dental catheterisation immunosuppression
63
what is rheumatic fever
3 weeks post streptococcal infection (usually pharyngitis) immune mediated occurs in children multisystem disease
64
what might be found in a vegetation
group D strep gut commensals skin strep
65
what are the complications of endocarditis
``` splinter haemorrhages clubbing emboli renal infarcts pneumonia osler's nodes and janaway lesion ```
66
what is acute on chronic heart failure
chronic failure becomes decompensated by an acute event
67
what is systolic failure
failure to pump blood in systole reduced ejection fraction ``` may be caused by reduced contractility volume overload pressure overload (stenosis/hypertension) regurgitation dilated cardiomyopathy severe hypertension increased preload (EDV) dilation and increased tension ```
68
what is diastolic failure
failure of the ventricle wall to relax restrictive, stiff ventricle (cardiomyopathy) may be caused by scaring or amyloidosis also may be increased wall thickness( hypertrophy) or delayed relaxation or increased heart rate tamponade normal ejection fraction but impaired filling
69
what are the causes of heart failure
``` coronary heart disease hypertension cardiomyopathies drugs toxins endocrine nutritional infiltrative ```
70
what is backward heart failure
increased venous pressure | increased heart filling pressures
71
what is forward failure
reduced tissue perfusion | usually advanced failure
72
what do cardiac glycosides inhibit
Na/ Ca exchange
73
what is the NYHA classification of heart failure
1 no limitation 2 slight limitation on physical activity 3 marked limitation 4 unable to carry out physical activity, discomfort at rest
74
what are the compensatory mechanisms in heart failure
frank starling sympathetic activity renin angiotensin
75
what is the problem with RAAS as compensation for heart failure
increased renin release and angiotensin and aldosterone vasoconstriction, water reabsorption, increased preload inflammatory response leading to fibroblast deposition
76
what is the problem with sympathetic activity as compensation for heart failure
tachycardia, vasoconstriction, decreased tissue perfusion, increases the heart workload desensitisation of b receptors
77
what is the problem with the frank starling mechanism in heart failure
pulmonary congestion | increased muscle stretch and O2 consumption

MD3001 (33 decks)

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