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HD 3 - dental relevance > cardiovascular disease > Flashcards

cardiovascular disease Flashcards

1
Q

what is the natural pacemaker of the heart?

A

Sino-atrial node

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2
Q

2 types of heart valve failure

A
  1. stenosis

2. regurgitation/incompetence

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3
Q

what do DVT embolise to?

A

pulmonary embolisms

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4
Q

5 major sites for atherosclerosis

A
  1. coronary - MI
  2. cerebral - stroke
  3. femoral - claudication
  4. mesenteric - bowels
  5. aorta
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5
Q

4 risk factors for atherosclerosis

A
  1. smoking
  2. diabetes
  3. hypertension
  4. hyperlipidaemia/chloesterol
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6
Q

difference between ischaemia + infarction?

A 
ischamia = reduced blood blow
infarction = no blood flow, death of tissue
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7
Q

3 causes of ichaemia/infarction

A
  1. atherosclerosis
  2. thrombosis
  3. embolism
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8
Q

what is heart black?

A

arrhythmia caused by impaired conduction through AV node

ventricular bradycardia but normal atrial activity

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9
Q

what is atrial fibrillation?

A

uncoordinated atrial activity with irregular ventricle activity

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10
Q

why is it important to be aware of patients with arrhythmias?

A

can be on warfarin - AF especially due to thrombus risk

care with adrenaline

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11
Q

3 developmental stages of atheroscleosis

A
  1. fatty streak
  2. fibrolipid plaque
  3. complicated lesion
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12
Q

what is virchows triad?

A

3 major determinants for thrombus formation

  1. changes in intimal surface of vessel
  2. changes in pattern of blood flow
  3. change in blood constituents
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13
Q

AF + mitral stenosis may cause what type of thrombus to form?

A

atrial

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14
Q

rheumatic fever + endocarditis may cause what type of thrombus to form?

A

valvular

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15
Q

previous MI may cause what type of thrombus to form?

A

ventricular

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16
Q

how does ECG show difference between angina + MI

A

ST depression in angina

ST elevation in MI

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17
Q

chronic/late complications of MI

A

arrhythmias, heart failure, angine, recurrent MI

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18
Q

4 cause of valvular heart disease

A
  1. rheumatic fever
  2. congenital
  3. degenerative - aortic stenosis common
  4. infective
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19
Q

3 common symptoms of heart failure

A
  1. breathlessness
  2. tiredness
  3. swelling of ankles
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20
Q

how does blood pressure alter between aortic stenosis + aortic regurgitation

A 
AS = low
AR = high
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21
Q

what is rheumatic fever?

A

condition occurs 2-3 weeks after streptococcal URTI
self limiting but recurrent
inflammation at multiple sites - heart, arteries, joint, skin

can cause calcification of heart valves

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22
Q

3 sites IE occurs

A
  1. valve
  2. mural endocardium
  3. congenital defect

focal area

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23
Q

how does IE occur?

A
  1. focal area of abnormal endocardium has collagen exposed
  2. platelets stick + fibrin deposition
  3. bacteraemia occurs from an outside source e.g. dentist
  4. colonise vegetation
  5. more platelets, fibrin, bacteria
  6. vegetation grows - embolism/ischaemia may happen
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24
Q

what does idea blood pressure lie between?

A

120/80 - 90/60 mmHg

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25
what is primary + seconding hypertension
primary - diagnosis of exclusion | secondary - caused by renal problems or Endocrinology problems
26
4 lifestyle choices that increase BP
1. lack of exercise 2. obesity 3. salt intake 4. alcohol smoking affects cardiovascular risk but not BP
27
3 major complications of hypertension
MI stroke peripheral vascular disease
28
6 risk factors for stroke, from most common to least common
1. hypertension 2. vascular disease elsewhere 3. smoking 4, diabetes 5, TIA 6. atrial fibrillation
29
how does angiotensin II affect BP?
increases BP
30
what converts angiotensin I into angiotensin II?
ACE
31
what BP measurement classfies as hypertension?
140/90
32
for pts under 55, what is the pathway for antihypertensive drugs?
1. ACE inhibitor 2. ACE + calcium channel blocker 3. A + C + diuretic 4. A + C + D + alpha/beta blockers
33
for pts over 55 or black person, what is the pathway for antihypertensive drugs?
1. calcium channel blocker 2. C + ACE 3. C + A + Diuretic 4. A + C + D + alpha/beta blockers
34
4 factors contributing to BP
1. HR 2. contractility 3. angiotensin II 4. peripheral resistance
35
how do thiazide like diuretics work?
decrease peripheral resistance increase secretion of NA, Cl, K in nephron can cause Na deficiency + gout flare -Ide
36
how do beta blockers lower BP?
b-adrenoreceptor antagonists decrease HR + contractility also inhibit RAS + decrease peripheral resistance B1 > B2 (resp side effects)
37
what is atenolol?
beta blocker selective to B1 (less respiratory side effects)
38
how do calcium channel blockers lower BP?
block Ca entry into smooth muscle cells = vasodilation some inhibit ca current into sinus + AV node
39
which calcium channel blocker causes gingival hyperplasia?
amlodipine
40
how do ACE inhibitors lower BP?
inhibit conversion of ang I - ang II inhibits degradation of bradykinin which is a vasodilator reduces aldosterone secretion renal vasodilation
41
what is aldosterone?
secreted by adrenal cortex controls secretion in kidney, increases retention of water + Na
42
2 relevant side effects of ACE inhibitors
cough - caused by bradykinin | burning mouth syndrome
43
how do angiotensin receptor blockers work + what used for?
inhibit action of Ang II do not produce cough like ACE mainly heart failure
44
how do alpha blockers lower BP?
a1 adrenoreceptor blocked - stops vasoconstriction first dose phenomenon
45
5 drug therapies for angina?
1. nitrates 2. beta blockers 3. calcium channel blokcers 4. potassium channel activators 5. ivadridine
46
how do nitrates treat angina?
NO release, reacts with SH group, increases cGMP causes smooth muscle relaxation also dilate coronary arteries
47
what happens to nitrate therapy over a long period of time?
effect decreases 8hr gap needed
48
how do beta blockers treat angina?
decrease myocardial oxygen demand by decreasing HR + contractility
49
how do potassium channel blockers treat angina?
e.g. nicorandil activate K+ channels, causes vasodilation
50
how does ivabradine treat angina?
selectively inhibits If channels in cardiac pacemaker | lower HR
51
adverse effect of ivabradine?
visual effects - spots at edges of vision
52
where do 95% of cases of IE affect?
left side of heart - mitral + aortic
53
what bacteria is acute IE normally caused by?
staphylococcus aureus
54
what causes right sided IE?
IV drug abuse | immunosuppressed
55
what oral bacteria causes IE?
streptococci
56
signs of IE
oslers nodes finger clubbing splinter haemorrhage >8 janeway lesions
57
what criteria is used to diagnose IE?
DUKE criteria
58
what is a cardiopulmonary bypass?
blood removed from heart, oxygenated outside of body, back into aorta used in CABG
59
what is percutaneous coronary intervention (PCI)?
angioplasty +/- stenting
60
3 options for management of coronary artery disease
1. drugs 2. PCI 3. CABG
61
2 surgical options for valvular heart disease?
1. TAVI = transcatheter aortic valve implantation | 2. SAVR = surgical aortic valve replacement
62
what is claudication?
leg pain on walking due to blocked/narrowed artery 70-80% narrowing pain due to lactic acid build up, as blood can't take away
63
drug therapy for claudication?
``` BP control statins anti-platelets ACE inhibitor control diabetes ```
64
how does diabetes effect vascular system?
accelerated athersclerosis
65
what is critical ischaemia?
pain at rest +/ gangrene, ulcers
66
treatment for critical ischaemia?
balloon angioplasty +/- stent | bypass surgeries
67
what is acute ischaemia?
sudden onset caused mainly due to thrombus or embolism also caused by trauma/compression/vasoconstrictor drugs
68
what is the critical time for irreversible change in acute ischaemia?
4-6hours
69
aortic aneurysms are common in which people?
men over 65, smoke, hypertensive
70
when are AA treated?
above 5.5cm
71
what is carotid disease?
carotid artery stenosis normally at bifurcation of artery causes TIA/stroke by embolism
72
4 steps of haemostasis
1. contrition of damaged vessel 2. mechanical blockage of hole by platelet 3. coagulation cascade 4. thrombolysis - plasmin breaks down clot
73
what stimulates platelet activation + aggregation?
thromboxane A2 aggregation also ADP
74
what is thrombolysis?
fibrin mesh prevented from increasing + dissolved by plasmin
75
3 ways drugs treat thrombus disorders
1. antiplatelet 2. anticoagulant 3. thrombolytic
76
how is aspirin used long term
75mg a day prophylaxis
77
how does aspirin work?
cox inhibitor, irreversible inhibitor of platelet thromboxane
78
CI for aspirin use?
``` <12years active peptic ulceration recent gastrointestinal bleeding recent intracranial bleeding bleeding disorders severe liver sides ```
79
what is clopidogrel?
ADP receptor antagonist inhibits ADP receptor on platelets which would otherwise caused aggregation
80
benefits of clopidogrel>aspirin?
safer GI bleeding
81
what types of drugs does clopidogrel interact with?
PPI
82
what is dipyridamole?
adenosine reuptake inhibitor CI - uncontrolled angina
83
how does heparin cause anticoagulation?
vit k antagonist enhances activity of antithrombin III, inactivates prothrombin, impares platelet function
84
why can heparin only be given parentally?
poorly absorbed in gut
85
advantage of LMWHs>heparin?
once daily dosing no need to monitor APTT reduced risk of thrombocytopenia used on outpatient
86
what is used to reverse effects of heparin?
protamine sulphate
87
unwanted effects of heparin?
haemorrhage - GIT thrombocytopenia long term - osteoporosis, liver disease
88
how does warfarin cause anticoagulation?
vit k antagonist
89
which clotting factors are vit k dependant?
2, 7, 9, 10
90
what is used to reverse effects of warfarin?
vit k
91
main drug interactions with warfarin
aspirin fluconazole + miconazole erythromycin metronidazole - NEVER
92
when to check INR?
ideally within 24hrs if stably anticoagulated then up to 72hrs
93
how does dabigatran cause anticoagulation
direct thrombin inhibitor
94
how does rivaroxaban cause anticoagulation
direct factor Xa inhibitor
95
if high risk procedure and take apixaban or dabigatran how should you alter dose?
miss morning, give evening >4hrs post op
96
if high risk procedure and take rivaroxaban how should you alter dose?
take once a day if in morning - delay and >4hrs post op if in evening - no change >4hrs post op
97
5 common types of drugs used for heart failure
1. inotropes 2. diuretics 3. beta blockers 4. ACE inhibitors 5. angiotensin receptor blockers
98
how do inotroped treat heart failure?
adrenoreceptor agonists - increase contractility stimulates B1 receptors
99
what are cardiac glycoside e.g. digoxin used for?
treat arrhythmias via vagus nerve
100
2 types of diuretics
1. K+ losing - e.g. thiazide like | 2. K+ sparing - use aldosterone
101
how does the vagus nerve effect the heart?
decreases HR
102
how does atropine treat bradycardia?
blocks vagal inhibition
103
how does isoprenaline treat bradycardia?
B1/B2 agonist - increase HR
104
classification for arrhythmia drugs?
vaughan williams singh
105
2 types of heart failure
acute + chronic
106
2 keys signs of acute heart failure
breathlessness + pulmonary oedema
107
4 cardiac causes of heart failure
1. heart muscle disease - ischaemia + cardiomyopathy 2. xs volume load - valvular incompetence 3. xs pressure - hypertension + stenosis 4. arrhythmias
108
3 non-cardiac causes of heart failure
1. xs demand e.g. anaemia, hyperthyroidism, shunts 2. fluid overloads e.g. IV therapy, renal failure 3. COPD - cor pulmonale
109
what is the conflicting near-humoral compensatory mechanism 1
1. reduced cardiac output 2. RAAS activated + vasoconstriction 3. increase BP 4. damages heart further
110
what stimulates ACE?
renin - secreted by kidney when reduced renal blood flow
111
cardiac cycle
1. SA node 2. atrial systole 3. AV node 4. pause 5. to ventricle 6. bundle of his 7. purkinje fibres
112
what is sinus tachycardia?
normal response to exercise/emotion
113
what is ventricular tachycardia associated with?
ichaemic heart disease
114
type of fibrillation in cardiac arrest?
ventricular fibrillation
115
what are korotkow sounds?
systolic when appear | diastolic when disappear
116
what cardiac drug may cause angioedema?
ACE inhibitors

HD 3 - dental relevance (7 decks)

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