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MAPP > Cardiovascular Disease + Respiratory Conditions > Flashcards

Cardiovascular Disease + Respiratory Conditions Flashcards

1
Q

What is cardiovascular disease?

A

Cardiovascular disease (CVD) is a term that refers to a group of conditions that affect the heart and blood vessels, including coronary artery disease, heart failure, valvular heart disease and arrhythmias.

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2
Q

What factors can contribute to the development of CVD?

A

Genetic predisposition

Hypertension

Hypercholesterolaemia

Diabetes

Obesity

Stress

Sedentary Lifestyle

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3
Q

Describe the pathophysiology of CVD

A

The pathophysiology varies depending on the specific condition, however many CVDs share a common underlying process known as atherosclerosis

CVDs such as arrhythmias or valve disorders often involve problems with electrical impulses that control the heart’s rhythm or the valves that regulate blood flow through the heart

Heart failure may involve different mechanisms that cause the heart to not pump blood effectively, often due to damage from a heart attack or hypertension. This can lead to pulmonary oedema.

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4
Q

Describe the pathophysiological process of atherosclerosis

A

It begins when the inner lining of an artery becomes damages, often due to factors such as hypertension, hypercholesterolaemia, smoking or prolonged hyperglycaemia seen in diabetes. This damage causes inflammation which causes the inner lining of the artery to become more thrombogenic, and triggers the build up of LDL cholesterol and other substances inside the artery wall, forming plaque.

The plaque can grow and harden over time, narrowing the artery and reducing blood flow. In some cases the plaque can rupture, causing a blood clot to form that can block the artery, lead to a heart attack or stroke

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5
Q

Describe some of the symptoms of CVD

A

Chest pain

Shortness of breath

Fatigue

Dizziness or lightheadedness

Oedema localised to the legs

Palpitations

Syncope

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6
Q

What diagnostic tests can be used to evaluate CVD?

A
  1. Electrocardiogram (ECG or EKG)
  2. Echocardiogram
  3. Cardiac stress test
  4. Cardiac catheterization
  5. CT scan or MRI
  6. Blood tests
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7
Q

How is CVD managed?

A

Depends on the specific condition but the following are often part of CVD management…

Lifestyle modification

Medications - Statins, ACE inhibitors, ARBs, calcium channel and beta blockers, anti-coagulants, anti-platelets, GTN sprays

Cardiac Rehab - Program of exercise + education

Surgical Intervention - Angioplasty, bypass, valve repair or replacement

Regular Monitoring + Follow Up Care

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8
Q

What are the podiatric implications of CVD?

A

CVD can cause or exacerbate various conditions affecting the lower limb…

PAD + Critical Limb Ischaemia

Venous Insufficiency

DVT

Diabetic Foot Complications - Ulcers, infection, neuropathy, amputation e.t.c

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9
Q

Name the 4 layers of the heart

A

Pericardium - surrounds the epicardium and protects and anchors the heart.

Epicardium - Outermost heart wall

Myocardium - The middle layer - the layer that actually contracts.

Endocardium - The innermost layer; continuous with linings of the blood vessels entering and leaving the heart.

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10
Q

Name the 4 chambers of the heart

A

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

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11
Q

Name the valves of the heart

A

The Artrioventricular Valves
Located between the atria and ventricles on each side…
Left side = Bicuspid/ Mitral
Right side = Tricuspid

The Semilunar Valves
Located between the ventricles and arteries leaving the heart…
Pulmonary Valve = Right ventricle to pulmonary artery
Aortic Valve = Left ventricle to aorta

Function - To prevent blood flowing back into the heart and ensure it only flows in one direction (atrium > ventricles > out)

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12
Q

Describe the route of blood flow through the heart

A

Deoxygenated blood enters the right atrium from the inferior and superior vena cava

Passes to the right ventricle and is pumped to the lungs via the pulmonary artery

Blood becomes oxygenated

Blood travels back to the heart through the pulmonary vein and enters the left atrium

Passes to left ventricle where it is pumped to the body’s tissues through the aorta

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13
Q

What is tachycardia?

A

A rapid heart rate of >100 bpm

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14
Q

What is bradycardia?

A

A slowed heart rate of <60 bpm

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15
Q

Name the 3 layers of a blood vessel

A

From outermost to innermost…

Tunica Externa

Tunica Media

Tunica Intima

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16
Q

Describe the properties of an artery

A

Small lumen

Thick walls

Usually deep to the skin

Carries oxygen rich blood away from the heart

No valves

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17
Q

Describe the properties of a vein

A

Large lumen

Thin walls

Usually superficial

Carries deoxygenated blood to the heart

Uses valves, negative thoracic pressure and the skeletal muscle pump to carry blood back to the heart

18
Q

Define systolic and diastolic pressure

A

Blood pressure = The pressure exerted on the inner walls of vessels

Systolic pressure = The maximum pressure recorded when ventricles contract

Diastolic pressure = The minimum pressure recorded when ventricles relax

19
Q

What factors can contribute to decreased BP?

A

Increased diameter of the arterioles

Increased urine output

Sudden change in position from reclining to standing

Alcohol

Haemorrhage

20
Q

What factors can contribute to increased BP?

A

Increased blood viscosity

Increased cardiac output

Increased pulse rate

Anxiety

Physical exercise

Nicotine

Atherosclerosis

21
Q

Define hypertension

A

Increased BP = 140/90 or higher

Prolonged hypertension can cause heart strain and small tears in vessels

Can be caused by poor diet, obesity, familial predisposition, stress

22
Q

Define hypotension

A

Decreased BP = systolic pressure of 100 or lower

23
Q

What is critical limb ischaemia?

A

Advanced stage of PAD. Persistently recurring rest pain requiring analgesia for more than 2 weeks or ulceration or gangrene of the foot or toes and ankle pressure of <50mmHg or toe pressure of <30mmHg

24
Q

What is the respiratory system what is its function?

A

The respiratory system refers to the organs and tissues of the body that are involved in breathing and the exchange of gases including oxygen and carbon dioxide.

The major function of the respiratory system is to supply the body with oxygen and to dispose of carbon dioxide.

25
Q

What anatomical structures comprise the respiratory system?

A

Upper Respiratory Tract:
-Nasal cavity

-Paranasal sinuses

-Pharynx

-Portion of the larynx above the vocal cords

Lower Respiratory Tract:
-Larynx below the vocal cords

-Trachea

-Bronchi

-Bronchioles

-Lungs

26
Q

Define asthma and name some of it’s symptoms

A

A chronic respiratory condition associated with inflammation and muscle tightening around the airways, and mucus hyper secretion in the bronchi

-Shortness of breath (SOB)
-Chest tightness or pain
-Trouble sleeping due to SOB, coughing or wheezing
-Whistling or wheezing sound when exhaling (particularly in children)
-Coughing or wheezing which is worse during colds and flu’s
-Asthma attacks

27
Q

What are some differential diagnoses for asthma?

A

Tracheal and bronchial lesions

Upper respiratory tract infections

Pulmonary embolism

Sarcoidosis

Foreign body aspiration

Congestive Heart Failure

Sinus disease

28
Q

What causes asthma?

A

Triggers for asthma can include:
-Allergies – house dust mites, pollen etc
-Smoke or pollution
-Exercise
-Infections

The antibody immunoglobulin E (IgE) is thought to have a primary role in the inflammatory process of allergen triggered asthma

29
Q

What is used to manage the symptoms of asthma?

A

Short Acting Reliever Inhaler
-Used for quick relief of symptoms
-Usually blue in colour
-Contain a short acting beta2-agonist
-Widens airway making breathing easier
-Works in minutes
-Effect lasts for 15 minutes

Long Acting Reliever Inhaler
Not a rescue inhaler
Helps manage symptoms and prevent attacks
Usually contain steroids

30
Q

What diagnostic tests can be used in the diagnosis of asthma?

A

Peak Flow Test - Simple test to measure how fast you can blow air out of your lungs in one breath, measured with a peak flow meter

Spirometry - Measures the movement of air into and out of the lungs (ventilation), the main component of pulmonary function tests

Pulse Oximetry Assessment - Useful in acute asthma, helps to exclude hypoxemia

Chest X-Ray - Typically does not show evidence of asthma but is useful for exclusion of pneumonia or a foreign body in the airway

Full Blood Count and Serum IgE - Eosinophilia >4% (300-400 /uL) supports diagnosis of asthma but absence does not exclude asthma and high levels of IgE (>81 KU/l) may help guide therapy

31
Q

Define COPD and name some of it’s symptoms

A

A lung disorder characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

Occasionally termed chronic bronchitis or emphysema however both terms are outdated.

-Shortness of breath, especially during physical activity

-Wheezing, Chest tightness

-Dyspnoea (laboured breathing)

-Having to clear throat 1st thing in morning due to mucus

-A chronic productive cough - mucus/sputum may be clear, white, yellow or green

32
Q

What are the grades of the MRC Dyspnoea Scale?

A

Grade 1 - Not troubled by breathlessness except on strenuous exercise

Grade 2 - Short of breath when hurrying on a level or when walking up a slight hill

Grade 3 - Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace

Grade 4 - Stops for breath after walking 100 yards or after a few minutes on level ground

Grade 5 - Too breathless to leave the house or breathless when dressing or undressing

33
Q

Describe the pathology of COPD

A

COPD is characterised by poorly reversible airflow obstruction and an abnormal inflammatory response in the lungs. The latter represents the innate and adaptive immune responses to long term exposure to noxious particles and gases, particularly cigarette smoke

Normal inflammatory response is amplified

Increased numbers of leukocytes and macrophages

Can result in some lung tissue destruction

34
Q

Name some risk factors that contribute to the development of COPD

A

Exposure to tobacco smoke

Occupation exposure to dusts and chemicals

Exposure to fumes from burning fuel

Age

Genetics/ familiar predisposition

35
Q

What are some differential diagnoses for COPD?

A

Asthma

Chronic cough

Congestive heart failure

Pulmonary embolism

36
Q

Name some of the treatments involved in the management of COPD

A

Smoking cessation advice

Medications to manage infection and inflammation

Oxygen therapy

Lung transplant

Palliative care in end stage COPD

37
Q

What are some of the podiatric implications of COPD?

A

Patients with COPD…

May struggle with their mobility and everyday activities of daily living, this combined with increased intrathoracic pressure associated with COPD can decrease venous return to the heart and lead to venous insufficiency of the lower limb

May be on antibiotics or corticosteroids

Have increased risk of post operative complications and the development of pressure ulcers

38
Q

Define pulmonary embolism and name some of it’s symptoms

A

A complication of DVT

A sudden blockage of a pulmonary artery caused by an embolus usually traveling from a vein in the leg

Shortness of breath (sudden onset)
Sudden chest pain – worse when breathing
Rapid heart rate
Rapid breathing
Sweating
Coughing up blood or foam
Fainting

39
Q

Describe the pathology of pulmonary embolism

A

Thrombus formation usually occurs in the deep veins of the lower limb, the clot then dislodges and travels to the lungs

Virchow’s Triad = Factors that contribute to thrombus development…
-Endothelial injury

-Stasis or turbulence of blood flow

-Hypercoagulability

40
Q

Name some risk factors that contribute to the development of pulmonary embolism

A

Immobilisation (such as after surgery).
Surgery and trauma
Pregnancy
Oral contraceptives
Tumours
Hereditary factors
Systemically unwell
Hypercoagulable states

41
Q

What diagnostic tests can be used to diagnose pulmonary embolism?

A

Clinical Scoring Systems – PE Wells Score

D-Dimer test

Duplex Ultrasound (for DVT)

Chest Xray / Chest CT

42
Q

What treatments can be used for pulmonary embolism?

A

Thrombolysis – clot busting drugs / thrombolytic agents

Anticoagulants – unfractionated heparin, LMWH, fondaparinux, warfarin

Embolectomy – catheter procedures to destroy or remove the embolus

Vena Cava Filter – a filter placed via catheter to the inferior vena cava (usually below level of kidney). Helps to prevent PE

Long term management includes compression stockings, anticoagulation therapy, long term monitoring of INR

MAPP (9 decks)

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