Cardiovascular Disease Flashcards
What is ischaeimia?
Reduction of blood supply
What is infarction?
Thrombus formation and occlusion of blood supply
What are the stages of atherosclerosis?
Foam cell Fatty streak Intermediate lesions Atheroma Fibrous plaque Complicated lesion/ rupture
What are the big 5 risk factors for atherosclerosis?
Smoking High cholesterol High bp Diabetes Genetics
With regards to smoking, what medication could be offered re. Smoking management?
Bupropion ( zyban)
What predisposes a person to high cholesterol?
Poor lifestyle/ diet
Genetic contribution - family hypercholosterolaemia
How is high cholesterol managed?
Drugs- statins
Dietary modification
What is systolic bp at normal?
120
What is diastolic bp at normal?
80
When is it considered high bp?
160/90
What can high bp be related to?
Obesity
Alcohol
High salt intake
Genetic
What can be secondary’s causes of high bp?
Endocrine- hormone excess
Renal- poor kidney function
Is high bp normally symptomatic?
Not unless very high
What indicated very high bp?
250/130
What signs might there be of very high bp?
Fits Confusion Headache Breathlessness Chest pain
What is the management of high bp?
If untreated.. Postpone surgery requiring anaesthetic until controlled.
What drugs are used in management of high bp?
Beta blockers- bisoprolol, atenalol Diuretics- bendroflumethiazde ACE inhibitors- ramapril Angiotensin ll antagonists- valsartan Calcium channel blockers- amlodopine
How can you identify those at risk from family hx?
Score system
What indicates…the healthy individual?
Non smoker 30 mins physical activity x5 weekly Healthy diet Not overweight Bp less than 140/90 Total cholesterol less than 5 mmol Normal glucose metabolism Avoidance of stress
What is peripheral vascular disease?
Atherosclerosis affecting peripheral vessels
- lower limbs
- abdominal aorta
What are the chronic symptoms of peripheral vascular disease?
Intermittent Claudication- leg pain in calf when walking a distance
What are the acute symptoms of peripheral vascular disease?
Ischaemic limb
Pain at rest
Pale, cold and numb limb
No sensation or movement
What is the management of peripheral vascular disease?
Risk factor modification Exercise program Surgery - bypass graft -stent
What is an abdominal aortic aneurysm?
Damage to vessel wall from atherosclerosis
- dilated aorta
What are the risks of abdominal aortic aneurysm?
Rupture or tear
What are the symptoms of abdominal aortic aneurysm?
Vague abdominal pain - acutely Severe ab pain Collapse High mortality
Who is screening offered to re. Abdominal aortic aneurysms?
Males over 60
Name clinical manifestations of ischaemic heart disease
Angina
Acute coronary syndromes- heart attack/ unstable angina
Heart failure
Arrhythmias
What is angina?
Visceral pain caused by lack of blood supply to the heart due to narrowing of arteries
What are symptoms of angina?
Central chest pain, down left arm
Atypically- jaw pain, upper abdomen, back
Sometimes perceived as heaviness or breathlessness
Often related to effort
What are warning signs of unstable angina?
Angina at rest
Unpredictable onset
Increasing frequency
Reduction of exertion
What is unstable angina a warning sign for?
Heart attack
What investigations can be done re. Ischaemic heart disease?
Electrocardiogram
Exercise testing
Coronary angiography
What is a coronary angiography?
Access via femoral arteries
Visualises blood vessels of the heart
Can be combined with intervention- stents, balloon dilation
How is stable angina managed?
Anti platelets- aspirin, clopidogrel Cholesterol- statins Symptom relief- beta blockers Calcium antagonists- amlodopine Nitrates- GTN, isosprbide mononitrate
Surgical- coronary angioplasty
Coronary artery bypass grafting
What can be described as a cute coronary syndromes?
Myocardial infarction
Unstable angina
What are symptoms of mi?
Crushing central chest pain Sweating Nausea Light headed Feeling of impending doom Cardiac arrest
How would you manage acute coronary syndrome?
Hospitalisation
O2, morphine, nitrates
Diagnose- ecg, angiography
Clear clot- thrombolysis, angioplasty
When would you not operate re. Symptoms of uncontrolled angina?
New onset
Angina at rest
Worsening
Describe the basic pathology of atherosclerosis
Accumulation of lipid rich plaques in arterial walls
