Cardiovascular disease

Question 1

Atherosclerosis

Answer 1

Not hardening - plaques
Fatty substances + cholesterol depositing on innerlining of vessel wall
affects large + mediums sized vessels
leads to thrombo + emboli

Question 2

Atherosclerosis - Mechanisms

Answer 2

3 stages
- early proliferative [early plaques]2
Arteriosclerosis

Hardening of vessel wall

3
- progressing phase [ plaques reduce lumen size - necrotic smooth muscle]
- late ulcerative phase [raised, irregular ulcerative plaques]
Complications = tortuosity + lumen size changes results in aneurysms

Question 3

Common sites for Atherosclerosis

Answer 3

• Cerebrals [acute local ischaemia - stroke]
• Carotid [TIA]
• Coranories [acute myocardial infarct]
• Abnormal aorta [aneurysm]
• Renal arteries [kidney ischaemia]
• Visceral + lower limb [Gangrene]

Question 4

Atherosclerosis - factors

Answer 4

Gender [M>F]
Genetic predisposition
Elevated cholesterol + trigilserides [high LDL + low HDL]
Diet
Smoking
Obesity + Sedentry
Systemic disease [Hypertension, DM, Hypothyroidism]

Question 5

Blood Vessel Layers:

Answer 5

Tunica Intima
Tunica Media
Tunica Adventitia

Question 6

Arteriosclerosis

Answer 6

Hardening of vesselwall - tunica media looses elasticity [replaced with fibrous tissue, proteaglycans + Ca++
Aggravated by HTN + DM

Question 7

Hyaline arteriosclerosis

Answer 7

muscle tissue replaced with hyaline not Ca++ [affects smaller vessels]

Question 8

Hypertension

Answer 8

Silent Killer
Increase risk of cardiovascular disease
Results in Left Ventricular Hypertrophy [heart muscle size increase - reduced cardiac output]

Question 9

HTN classification

Answer 9

Essential 
-idiopathic [90% incidence]
Secondary
-Kidney disease
-Endocrine disorder
-Narrowing of aorta
-pre-eclampsia
-drugs

Question 10

Arteritis

Answer 10

Inflamm of arteries
assoc with TB + Syphilis
Leads to necrosis of arterial walls
Infectious vs Non-infectious

Question 11

Aneurysms

Answer 11

2 types of enlargements

• Fusiform [swells]
• Sacular wall [outpouches]

Question 12

Hypertensive retinopathy

Ocular signs

Answer 12

General vasoconstriction
Attenuation of arterioles [copper wire]
Hard exudates [lipids]
Flame haemorrhages
CWS
ON oedema

Question 13

Arteriosclerosis

Ocular signs

Answer 13

AV crossing [nipping]
Copper - Silver wire
Haemorrhages + occlusions
CMO 
Neovascularisation

Question 14

CRAO

Answer 14

Embolism driven
Sudden painless vision loss [NLP]
Cherry redspot with pale retina
Optic Atrophy

Question 15

BRAO

Answer 15

Acute VF defect
Smaller emboli
Signs confined to segment [pale retina]

Question 16

CRVO

Answer 16

Venous compression by vein [Artherosclerosis/HTN]
Ischaemic vs Non-Ischaemic
Acute vision loss
ON oedema
Haemorrhages
CWS
Dilated tortuous vessels

Question 17

BRVO

Answer 17

Same as CRVO but site dependent

Question 18

AION

Answer 18

Type 3 Hypersensitivity [GCA + SLE]
Occl of post cilliary arteries [sudden vision loss]
ONH swelling
Optic atrophy [pallor]

Question 19

Rubeosis Irides - RI

Answer 19

Ischemic driven - VEGF route

Question 20

Peripheral Vascular Disease

Answer 20

Intermittent Claudication - limping

Amaurosis Fugax [bilat if @ occipital lobe][unilateral if @ carotid]