Cardiovascular Disease Flashcards
What are the risk factors for CVD
HTN, hyperlipidemia, smoking» DM, overweight, sedentary, obesity
What is the leading cause of death in US
Heart disease and then stroke
What are the forms of CVD
Coronary Heart Disease»_space; Stroke > Heart Failure, HTN, Congenital Heart Defects
What is the cardiovascular continuum?
Start with a predisposed risk factor which leads to atherosclerosis leading to coronary artery disease leading to MI then HF then Death
What is cholesterol for and where is it made and how is it transported
a compound produced by liver and uptake from diet and used for cell membranes and steroid hormones, vitamin D, and bile acid
Transported by lipoproteins because lipids are not soluble in blood
What is a chylomicron
From the small intestine to the liver
What is VLDL
very low density lipoprotein
From the liver to the peripheral tissues
What is LDL
from peripheral tissues to liver + vascular intima (not good!!)
What is HDL
from peripheral tissues to the liver to collect excess cholesterol and convert to bile acids for excretion
What is hyperlipidemia and its criteria and treatment?
excess amount of cholesterol / lipids
TG > 150
LDL > 100
HDL < 40
TC > 200
Tx: mainly lifestyle + meds
What is total cholesterol formula
TC = LDL + HDL + 0.2xTG
What is primary hyperlipidemia
genetic + more severe/rare
what is secondary hyperlipidemia
polygenetic and more common (high fat diet and lifestyle)
What are the ocular manifestations of hyperlipidemia
Arcus (very common in 50+): excess lipid in corneal stroma
Xanthelasma: foam cells in nasal position (macrophages with excess lipids)
- TG > 1000
Lipemia Retinalis: white vessels (ischemic)
- mostly genetic or diet (RARE) because TG >2500
What is atherosclerosis and its epidemiology
chronic inflammatory disorder of tunica intima (large or medium vessels) that form atheromas
M>F; most common chronic disease in US (80% of CVD)
What can atherosclerosis lead to
thrombus, ischemia, embolism, aneurysm
What are the steps of atherosclerosis
Risk factor will injure the intima (HTN, DM, Smoking)
Insudation: open path of excess lipids into the intima
Oxidation: free radicals initiate cell damage + draw in macrophages
Foam Cell: form atheroma in vessel wall
Fatty Streaks: body tries to heal but cannot get rid of it and so it activates fibroblasts which makes fibrous plaques (impedes blood flow)
If that plaque ruptures = thrombus formation
What is coronary heart disease and its risk factors
narrowing of coronary arteries because of atherosclerosis
DM, Stroke, HTN, Hyperlipidemia, Lifestyle
What are the 2 types of stenosis from CHD?
Critical: gradual development with 70-75% obstruction and usually asymptomatic (only symptomatic with increased demand or stress)
90% Stenosis: inadequate coronary blood flow at REST so you’ll get symptoms
What are the 2 clinical manifestations of CHD? How do you treat them?
Angina (myocardium ischemia, 30 mins, elicited by cold, stress, exertion, heavy meal, cocaine, or stress and treated with nitroglycerin (acute) or beta blockers (chronic)
Myocardial Infarction (due to ischemia + thrombosis, CHD, embolism, congenital heart anomaly, or idiopathic)
What are the symptoms of male MI
radiating chest pain, lighthead, sweating, nausea, SOB
What are the symptoms of female MI
weak, nausea, lighthead, LOWER CHEST discomfort, upper abdominal pressure
What is the diagnosis criteria for MI
ANS (tachy, sweat, pallor, brady, vomit)
Elevated Blood Levels (myoglobin, creatine kinase, cardiac troponin)
ECG
What are the types of MI
Most severe (left anterior descending coronary artery)
Transmural (occlusion of major CA and affects thickness)
Subendocardial (at risk areas, internal areas of heart)
What are some MI complications
cardiac arrhythmia (85%)
heart failure (acute or chronic)
myocardial rupture (rare): within days of MI - pericardial tamponade: compresses heart and decreases CO
Pericarditis: inflammatory reaction to myocardium death
Fever: endogenous pyrogens released
Mural Thrombosis and Emboli: part of wall lost function and blood is stagnant = thrombus forms
What is cardiac arrhythmia?
irregular heartbeat which leads to inefficient heart contractions, decreased CO, and can be fatal
What is heart failure and how is it caused
inadequate cardiac output to meet body’s metabolic demands
MI, HTN, valvular disease, cardiomyopathy, and cardiac arrhythmia
What are the damages leading to heart failure
blood loss (decreased BF from thrombus), conduction system failure, pump failure
congestion of heart or blood flow and inability to increase CO
What are the differences between left-sided and right-sided heart failure (symptoms?)
Left Sided: Pulmonary Edema (tachypnea and cyanosis)
- rapid breathing, hypoxic / blue
Right Sided: Peripheral Edema (hepatomegaly and ascites)
- most often caused by left-sided heart failure
What are the compensatory mechanisms to heart failure
temporarily restore CO but damaged in the long term
sympathetic activation, compensatory vasoconstriction, myocardial hypertrophy
What is cardiomyopathy
myocardial degeneration leading to heart failure
what are the causes of myocyte injury
MI, HTN, DM, viral infection
what is dilated cardiomyopathy
enlarged heart with normal heart wall thickness
increased ventricular chamber
decreased contractiIity
what is restrictive cardiomyopathy and how is it caused
normal heart size with reduced filling capacity and
normal contractility ~ rigid over time
Caused by amyloidosis or idiopathic
what is hypertrophic cardiomyopathy and what is the diagnostic criteria and genetic origin
larger heart with reduced filling capacity and normal contractility
intraventricular septum is thicker than 1.5cm
autosomal dominant
most common cause of sudden cardiac death in young adults
what is stenosis
valve that cannot open fully (there is a narrowing)
what is regurgitation
valve cannot close completely and there is backflow now
what is mitral valve regurgitation
damage to the left ventricle and blood flows back into atria
what is aortic valve stenosis and its causes as well as ocular manifestation
age-related calcification and congenital stenosis
calcium emboli: able to be observed downstream as hollenhorst plaque lodged in retinal arteries
What is a mitral valve prolapse and its epidemiology and ocular manifestation
degeneration of connective tissue in valve (2.5% of population)
valve leaflets balloon into the left atrium during systole (contraction) and leads to MVR + irregular blood flow and CRAO/BRAO/CO
Platelet Emboli – coagulation risk
what is endocarditis and its ocular manifestation
inflammation of inner lining of heart from strep or staphylococcus
predisposed by rheumatic endocarditis
Forms Roth Spots(red dot with white center) – choroiditis and endophthalmitis
what is rheumatic heart disease
occurs in 5-15 year olds 1-5 weeks after Group A streptococcal or scarlet fever
Type II hypersensitivity (molecular mimicry)
What is acute pericarditis and its causes
less than 6 weeks and confused with MI
caused by neoplasm, autoimmune or viral
what is chronic pericarditis and what is it caused by? Associations?
more than 6 months; scarring restricts movement and ability to protect heart
Caused by TB infection or idiopathic
Associated with SLE, uremia, rheumatic fever, and metastatic malignancies
