Cardiovascular Disease + Respiratory Conditions Flashcards
What is cardiovascular disease?
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.
What factors can contribute to the development of CVD?
Genetic predisposition
Hypertension
Hypercholesterolaemia
Diabetes
Obesity
Stress
Sedentary Lifestyle
Describe the pathophysiology of CVD
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.
Describe the pathophysiological process of atherosclerosis
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
Describe some of the symptoms of CVD
Chest pain
Shortness of breath
Fatigue
Dizziness or lightheadedness
Oedema localised to the legs
Palpitations
Syncope
What diagnostic tests can be used to evaluate CVD?
- Electrocardiogram (ECG or EKG)
- Echocardiogram
- Cardiac stress test
- Cardiac catheterization
- CT scan or MRI
- Blood tests
How is CVD managed?
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
What are the podiatric implications of CVD?
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
Name the 4 layers of the heart
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.
Name the 4 chambers of the heart
Left Atrium
Right Atrium
Left Ventricle
Right Ventricle
Name the valves of the heart
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)
Describe the route of blood flow through the heart
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
What is tachycardia?
A rapid heart rate of >100 bpm
What is bradycardia?
A slowed heart rate of <60 bpm
Name the 3 layers of a blood vessel
From outermost to innermost…
Tunica Externa
Tunica Media
Tunica Intima
Describe the properties of an artery
Small lumen
Thick walls
Usually deep to the skin
Carries oxygen rich blood away from the heart
No valves
Describe the properties of a vein
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
Define systolic and diastolic pressure
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
What factors can contribute to decreased BP?
Increased diameter of the arterioles
Increased urine output
Sudden change in position from reclining to standing
Alcohol
Haemorrhage
What factors can contribute to increased BP?
Increased blood viscosity
Increased cardiac output
Increased pulse rate
Anxiety
Physical exercise
Nicotine
Atherosclerosis
Define hypertension
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
Define hypotension
Decreased BP = systolic pressure of 100 or lower
What is critical limb ischaemia?
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
What is the respiratory system what is its function?
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.
What anatomical structures comprise the respiratory system?
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
Define asthma and name some of it’s symptoms
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
What are some differential diagnoses for asthma?
Tracheal and bronchial lesions
Upper respiratory tract infections
Pulmonary embolism
Sarcoidosis
Foreign body aspiration
Congestive Heart Failure
Sinus disease
What causes asthma?
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
What is used to manage the symptoms of asthma?
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
What diagnostic tests can be used in the diagnosis of asthma?
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
Define COPD and name some of it’s symptoms
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
What are the grades of the MRC Dyspnoea Scale?
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
Describe the pathology of COPD
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
Name some risk factors that contribute to the development of COPD
Exposure to tobacco smoke
Occupation exposure to dusts and chemicals
Exposure to fumes from burning fuel
Age
Genetics/ familiar predisposition
What are some differential diagnoses for COPD?
Asthma
Chronic cough
Congestive heart failure
Pulmonary embolism
Name some of the treatments involved in the management of COPD
Smoking cessation advice
Medications to manage infection and inflammation
Oxygen therapy
Lung transplant
Palliative care in end stage COPD
What are some of the podiatric implications of COPD?
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
Define pulmonary embolism and name some of it’s symptoms
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
Describe the pathology of pulmonary embolism
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
Name some risk factors that contribute to the development of pulmonary embolism
Immobilisation (such as after surgery).
Surgery and trauma
Pregnancy
Oral contraceptives
Tumours
Hereditary factors
Systemically unwell
Hypercoagulable states
What diagnostic tests can be used to diagnose pulmonary embolism?
Clinical Scoring Systems – PE Wells Score
D-Dimer test
Duplex Ultrasound (for DVT)
Chest Xray / Chest CT
What treatments can be used for pulmonary embolism?
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
