Cardiovascular Disease Flashcards
Name the risk factors
Gender (males have greater risk)
Age (4/5 deaths over 65 years)
Genetics
Name the modifiable risk factors
High blood cholesterol Smoking Obesity Stress Diabetes Excessive alcohol Pregnancy & oral contraceptives
How would you manage hypertension?
change lifestyle ACE inhibitors/ calcium channel blockers (vasodilators) Beta blockers (Slow HR by blocking adrenalin)
How would you manage diet?
Decrease sodium and potassium as increase BP
Decrease sugar as T2D inc risk
Decrease alcohol as inc BP and body fat
How would you manage high blood cholesterol?
Diet change (high levels of LDL leads to atherosclerosis) Statins (inhibit enzyme responsible for production of cholesterol in liver)
What is Familial hypercholesterolemia (FH)?
Mutation in gene associated with lipid metabolism.
Autosomal dominant
Symptoms = yellow cholesterol deposits around eyes and tendons (Xanthomas)
Heterozygous- 1/300 people (40-60 yrs when dev)
Homozygous- 1 in mill (0-30 yrs)
Describe Atherosclerosis
fatty streak develops between intima & media walls
Unstable plaque dev with fatty core and fibrous cap
plaque can sometimes be ruptured
If blocks artery tissues supplied by this, die.
Describe the process of plaque formation in Atherosclerosis.
1) endothelial damaged- due to LDL, smoking, hypertension.
2) Lymphocyte adherence- inc. expression of adhesion markers (monocytes).
3) Transmigration- of monocytes through endothelium
4) smooth muscle cell migration- induced by endo. damage and cytokine release.
5) Macrophages ingest LDL- foam cells & release lipids into core.
Name some of the pathological consequences of Atherosclerosis
Acute myocardial infarction Ischemic heart disease (Angina) Ischemic Stroke Aortic Aneurysm PVD Vascular calcification
Describe AMI
occurs when one coronary artery becomes occluded by embolus = heart muscle ischemic
Chest pains, shortness of breath, anxiety, weakness
Serum troponin elevation (shows cardiac muscle death)
Describe Angina
Obstruction/ spasm of coronary artery, dec. oxygen supply to myocardium.
Unstable angina = MI, so treat with nitrate, Ca2+ channel or beta blocker.
What are the two surgical treatments that can be given for CAD?
Angioplasty Bypass (Coronary artery bypass graft) performed with advanced atherosclerosis/ multi-vessel disease. Involves grafting vessel from another (usually saphenous vein) to bypass blockage. Single, double, triple or quadruple.
Describe Ischemic stroke
Blood supply to part of brain compromised.
Occur due to thrombus that developed in brain or plaque that rupture elsewhere commonly carotid.
Tissue plasminogen activator (tPA) is a thrombolytic agent.
Anticoagulants & carotid endarterectomy
Describe how you would identify vulnerable carotid plaques.
Referred after displaying symptoms
Duplex ultrasound to visualise
Dopler sonography to measure flow
more than 70% stenosis (abnormal narrowing)- carotid endarterectomy (removal of material inside)
What is an aortic aneurysm?
Pro-atherogenic stimuli= stiffening of aorta.
Weakening/ bulging of aortic wall
AAA rupture= serious and fatal in over 80% of cases.
What is PVD?
Peripheral venous disease
obstruction of large vessels in other places besides the brain and heart. leads to acute or chronic ischemia. Claudication and ulcers common
What is vascular calcification?
Deposits within walls which stiffen vessel and increase blood pressure.
Most individuals 60+ have calcification.
Leads to aortic stenosis and increase risk of MI and stroke.
What is ventricular fibrillation?
most serious cardiac rhythm disturbance.
some due to inheritance eg. K+ channel genes
Implantable cardioverter defibrillator (ICD) recommended.
What is heart block?
electrical disturbance between SA and AV node (arrhythmia) 3 types: 1 st degree- 0.2s delay 2nd degree- longer delay 3rd degree- completely blocked.
What is cardiomyopathy?
dilated = enlargement of ventricles
hypertonic = thickening of heart walls
occurs due to genetics, infection, CHD and endocrine dysfunction.
What is Rheumatic heart disease?
Inflammation that occurs following untreated infection.
Streptococcus cell wall have highly antigenic M protein that induces production of antibodies.
Antibodies cross react with myocardium and joints leading to cytokine release and tissue damage.
Fibrinous repair causes valve damage and carditis.
What is carditis?
Inflammation of the heart.
