Cardiovascular Diseases 1 (Cardiovascular Pathology)

Question 1

What is Ischaemic Heart Disease?

Answer 1

Inadequate blood supply to the myocardium caused by :

1) Reduced coronay blood flow (thrombus / atheroma)
2) Myocardial Hypertrophy

Question 2

When does autoregulation of coronary blood flow break down?

Answer 2

If there is MORE than 75% OCCULSION of an artery then autoregulation of coronary blood flow breaks down.

Question 3

What is Angina Pectoris?

Answer 3

chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn’t get as much blood as it needs.

Question 4

What is Acute coronary syndrome?

Answer 4

It is an umbrella term used when the heart is not recieving enough blood e.g. angina, MI.

Question 5

What is a subendocardial myocardial infarction?

Answer 5

If there is an ATHEROMANOUS OCCLUSION of coronary arteries or an acute HYPOTENSIVE episode then the submyocardial myocardium can infarct without any acute coronary occlusion.

Question 6

What are the blood markers of cardiac myocyte damage?

Answer 6

1) Troponins T & I (detectable up to 7 days)
2) Creatinine Kinase MB (detectable upto 3 days)
3) Myoglobin (peak at 2 hrs)
4) Lactate dehydrogenase isoenzyme 1 (detectable uptp 14 days)
5) Aspartat transaminase (not as useful as present in the liver)

Question 7

What percentage of sudden cardiac deaths have an MI?

Answer 7

less than 25%

Question 8

What are the complications of Myocardial Infarction?

Answer 8

• contractile dysfunction
• Arrhythmias
• Myocardial rupture
• Pericarditis
• Mural thrombus
• Ventricular Aneurysm

Question 9

What is a Haemopericardium?

Answer 9

Hemopericardium refers to blood in the pericardial sac of the heart.

Question 10

What is Chronic Ischaemic heart disease?

Answer 10

Coronart artery atheroma produces relative myocardial ischaemia and angina pectoris of exertion.

There is an increased risk of sudden death or an MI.

It causes cardia hypertrophy and dilation.

Question 11

Mutuations in what genes cause Familial Hypercholesterolaemia?

Answer 11

• Mutations involved in cholesterol metabolism
• Low Densitiy Lipoprotein Receptor gene
• Apolipoprotein B

Question 12

What is the importance of maintaining a normal blood pressure?

Answer 12

1) To ensure the perfusion of organs (to maintian function)

2) To minimalise damage to blood vessels / organs.

Question 13

What is the normal blood pressure?

Answer 13

120 / 80 mmHg

Question 14

What is considered abnormal blood pressure?

Answer 14

Sustained diastolic of 90mmHG

& Systolic 140mmHg

Question 15

What are the causes of primary hypertension?

Answer 15

Dysfunction of:

1) Cardiac baroreceptors
2) RAAS
3) Kinin-Kallikrekin system
4) Natural peptides
5) Adrenergic receptor system

Question 16

What are the causes of secondary hypertension?
Name at least one from each of the following categories:
1)Renal
2)Endocrine
3)Cardiovascular
4)Neurologic

Answer 16

RENAL:

• acute glomerulonephritis
• Chronic renal disease

ENDOCRINE:
Cushing's syndrome
Exogenous chemicals
Acromegaly
Hypo/Hyperthyroidism

CARDIOVASCULAR:

• Coarctation of Aorta
• Increased intravascular volume
• Increased cardiac output

NEUROLOGICAL:

• raised intracranial pressure
• Acute stree
• sleep apnoea

Question 17

What are the effects of hypertension?

Answer 17

Cardiovascular :
-Hypertensive heart disease

Renal failure

Question 18

What is Hypertensive heart disease?

Answer 18

• Systemic hypertension leads to increased left ventricular blood pressure
• LV hypertophy without dilation is the initial response to increased work needed to pump the bloof
• It is a cause of sudden death as when the pressure is too great the LV fails to pump blood at normal rate and dilates.

Question 19

How does hypertension affect the renal system?

Answer 19

Hypertension can cause renal failure. Vascular damage of the renal arteries means blood flow into/out of the kidney cannot be controlled.

Question 20

What is hypertensive cerebrovascular disease?

Answer 20

hypertensive encephalopathy is sudden elevation of arterial pressure usually preceded by severe headache, convulsions, coma.

• there is increased risk of rupture of arteries :
• Intracerebral haemorrhage
• Subarachnoid haemorrhage

Question 21

What is the blood pressure indicative of a hypertensive crisis?

Answer 21

BP greater than 190/120mmHg

Question 22

What are the symptoms od Acute Hypertensive Encephalopathy?

Answer 22

• confusion
• vomiting
• convulsions
• coma
• death

Question 23

What is the cause of pulmonary hypertension?

Answer 23

• COPD
• fibrosis
• Pulmonary Emboli / thrombosis
• can be secondary to LV failure

Question 24

What are the consequences of pulmonary hypertension?

Answer 24

• RV needs to work harder to pump blood
• RV hypertrophy (initially without dilation)
• later dilation and systemic Venous congestion as RV failure develops.

Question 25

What are the risk factors of cardiovascular disease?

Answer 25

• gender
• hypertension
• smoking
• high blood cholesterol
• diabetes
• sedentary lifestyle
• obesity
• alcohol
• south asian

Question 26

Describe the Renin-Aldosterone - Angiotensin System?

Answer 26

1) Renin is synthesised and stored in the juxtaglomerular apparatus in the kidney
2) Renin converts angiotensin to angiotensin 1
3) Angiotensin 1 is converted to angiotensin 2
4) Angiotensin 2 is a VASOCONSTRICTOR. & stimulates aldosterone production
5) Aldosterone causes sodium and water retension so blood volume increases

Question 27

What is Conn’s Syndrome?

Answer 27

1) Excess Aldosterone production caused by:
Adrenocortical Adenoma (benign tumour of the adrenal cortex which produced aldosterone)

2) this causes water and sodium retension.

Question 28

What is Phaemochromocytoma?

Answer 28

Phaemochromocytoma is the tumour of the adrenal medulla and presents with :

• Pallor
• Headache
• Sweating
• Nervousness
• Hypertension

Question 29

What is Cushing’s disease?

Answer 29

-Overproduction of cortisol by the adrenal cortex