Cardiovascular Diseases Flashcards
What is hypertension
High blood pressure
What is Arteriosclerosis in relation to hypertension
The tunica (walls of vessel) media thickens, limiting the space of the lumen(the space blood moves through)
What affects happen when vessels undergo arteriosclerosis
The tunica media thickens
Vessels become anchored to the extra cellular matrix (stiffer, less elastic)
These vessels have more resistance to the blood flowing through them, so the heart must beat harder (ie: more pressure) to move the blood.
What is atherosclerosis
Blood vessels can also become clogged by deposits of fat (cholesterol and other lipids).
This is called atherosclerosis, and also increases resistance to blood flow → increased blood pressure.
What is left ventricular hypertrophy
the harder the heart has to pump to get blood around the body, the bigger the left ventricle myocardium will grow.
If BP becomes too high, the muscle can grow pathologically large, reducing space in the left ventricle for blood.
LV hypertrophy is more common, but RV hypertrophy also occurs.
Name some treatments for hypertension
Drugs that interfere with the renin angiotensin system ACE Inhibitors. Ramipril,Candersartan.
Drugs that increase urine output e.g indapamide, bendroflumethiazide
Drugs that widen blood vessels by blocking calcium channels e.g amlodipine
What is CHC
Coronary heart disease
Describe what Cornary heart disease
Aka coronary artery disease, ischemic heart disease.
Occurs when the coronary arteries become narrower(stenosis) because of :Arteriosclerosis: High BP causes vascular remodelling, thickening and stiffening the arteries.
Atherosclerosis: fats (cholesterol and other lipids) accumulate in a plaque inside the artery.
This means that the myocardium does not get enough oxygen: becomes ischemic
Define ischemia
Ischemia occurs when the amount of oxygen in the myocardium is less than the cells need to produce energy.
This leads to reversible changes in the cells.
What is acute coronary syndrome ACS
A more serious acute manifestation of CHC: ischemia in the mycocardium is so serve it begins to infarct.
Occurs when an atherosclerotic plaque ruptures, forming a blood clot (thrombus), reducing blood flow further (or even completely via blockage).
What is thrombus
A blood clot
Define what embolism
Term for a blockage
Specific term for a complete blockage within a vessel or artery
Thromboembolism
Angina two types name them and what it is
Caused by myocardium infarction CHC ACS
Stable angina
Unstable angina
Angina two types name them and what it is
Caused by myocardium infarction CHC ACS
Stable angina
Unstable angina
Stable angina
Aka effort angina - this is usually brought on by trigger example are exercise,stress etc. usually resolves it self after trigger is removed
Unstable angina
More acute conditions, begin to consider ACS
Consistent pain more than 20 minutes no trigger needed unpredictable
Define an MI
Myocardium infarction. Is caused by myocardium ischemia CHC OR ACS commonly resulting in complete blockage of a coronary artery by a ruptured atherosclerosis plaque leading to a thromboembolism and then ischemia.
How can an MI be detected
An ECG can determine whether an MI is NSTEMI OR STEMI. Both are urgent but STEMI indicates longer period of interrupted blood flow
What is an ECG
Electric cardiogram
How can ACS be treated
Medications:
Dialysing blood vessels - GTN
Reduce blood clotting -Asprin
Provide pain relief -paracetamol,morphine,entonox
Take to hospital for a STENT
What is a normal heart rhythm called
Sinus rhythm
Describe the sequence the electrical signal take 1-4
SA NODE - sinoatrial node
AVN NODE- atrioventricular node
Bundle of his
Purkinje fibres
What is the average HR for a healthy ADULT
60-100BPM
Define Arrhythmias
Abnormal rhythm slower then 60 BPM faster then 100BPM
Arrythimias - name 2
Running produces Sinus tachycardia- aka tachyarrythimias
Sleeping produces sinus bradycardia
Define tachyarrhythmia
Tachycardia is quite normal in many people, but very fast and prolonged tachycardia with no obvious cause is pathological.
All cells in the heart can generate a heartbeat on their own. This property is called automaticity. In healthy hearts they’re coordinated and kept in time by the SAN.
In pathological tachyarrhythmias, other parts of the heart generate heartbeat signals, because of:
Increased automaticity: some chemicals lower the threshold for activation, like hormones (eg: adrenaline) or drugs (eg: cocaine).
Re-entry: if a scar forms in the myocardium (eg: because of an MI), a circuit of excitable tissue will form around it. This can connects two areas, which then hype each other up > heartbeat.
Triggered activity: electrolyte disturbances, hypoxia, long QT syndrome.
We can categorise different tachycardia bases on the area within the heart that they originate from and pattern within the ECG. Name the where
Sinus tachycardia originates
Originates from the SAN node - normal in response to exercise fright and some drugs.
We can categorise different tachycardia bases on the area within the heart that they originate from and pattern within the ECG. Name the where
Sinus tachycardia originates
Originates from the SAN node - normal in response to exercise fright and some drugs.
We can categorise different tachycardia bases on the area within the heart that they originate from and pattern within the ECG. Name the where
Supra-ventricular tachycardia SVT originates from
Originates in the atria SUPRA means above
Supra ventricular tachycardia SVT originated in the atria. Name two other which also show here
Atrial flutter can ‘degenerate’ into Atrial Fibrillation (AF/A-Fib)
Wolff–Parkinson–White syndrome (WPWS).
What is VT
Ventricular tachycardia
What is VT
Ventricular tachycardia
Where does VT Orientate
Within the ventricles. VT can degenerate into ventricular fibulation VF
What can VT degenerate into
VF - Ventricular fibulation
What can Atrial flutter degenerate into
Atrial fibulation AF /AF FIB
When does VT occur
When the ventricles contract rapidity with their own rhythm
Define ventriclar fibulation
Rapid, unsynchronised, chaotic,contractions/twitching. V-Fib means no cardiac output. Heart failure
What is a heart block
Heart blocks are conditions which delay or restrict the flow of electrical signals through the heart, causing changes to the heart’s rhythm.
Heart blocks can occur in the SAN or AVN.
There are 3 types of heart blocks
first degree
Second degree
Third degree
What is first degree heart block AV block
Can run in families. Usually not pathological.
The impulse can still move from the SAN to SVN but there is a delay doing so.
Seen on an ECG as prolonged PR intervals
What is 2nd degree AV block aka mobitz block. There are two types
P waves are blocked from initiating/causeing QRS complexes:
Type 1 2nd AV block mobitz 1
Type 2 2nd degree AV block mobitz 2
How to identify a 1 2nd degree AV block mobitz 1
the PR interval gradually gets larger, until eventually a beat is dropped: the P wave will not be followed by a QRS complex
How to identify a 2 2nd degree AV block mobitz 2
PR interval remains constant, but some P waves fail to initiate a QRS complex.
In some severe cases, every 2nd or 3rd beat is dropped. This is usually associated with episodes of syncope
What is a 3rd degree AV block
Complete heart block, no electrical signals from the SAN NODE reach the AV Node
What happens if a patient has a 3rd degree AV block
Complete heart block, no electrical signals are reaching from the SAN Node to the AV Node
This means SAN only coordinates atrial contractions, and the AVN acts as the pacemaker for the ventricles (escape rhythm)
How would a patient appear if they where having a 3rd degree AV block
Patients will usually be bradycardic, sometimes severely so (eg: 15-50 bpm), which can be life threatening due to inadequate perfusion of tissues with oxygen.
How would a 3rd degree AV Block appear on an ECG
you’ll see two separate rhythms, one for the P waves (regular P-P interval) and one for the QRS complexes (regular R-R interval), with no relationship between P waves and QRS complexes (very variable/random P-R interval).
Name the three layers of the heart wall
Endocardium
Myocardium
Pericardium
Name the three layers of the heart wall
Endocarditis
Myocardium
Pericarditis
Heart inflammation, what are the layers called when inflamed
Endocarditis
Myocarditis
Pericarditis
What is endocarditis
Inflammation (usually an infection) of the endocardium the inner lining of the heart
What is myocarditis
Inflammation (usually and infection) of the myocardium aka cardiac tissue
What is pericarditis
Inflammation (usually an infection) of the pericardium aka the sac around the heart
Symptoms of endocarditis
Dyspnoea (especially during physical activity)
Headaches
Night sweats.
Less common: skin discolouration: red/brown/purple spots on the skin (eg: petechiae) or red/brown lines under the nails.
Symptoms of myocarditis
Dyspnoea (either during physical activity or at rest)
Chest pain
Arrythmia
Light-headedness/pre-syncope
swelling of legs/ankles/feet.
Symptoms of pericarditis
Chest pain: usually sharp/stabbing, radiating to the shoulders/arms or abdomen, worsening upon deep breathing/coughing, swallowing or laying down, especially when lying on the left side
General symptoms of heart inflammation
High temperature/fever
Fatigue
Body aches
Joint pain
Cough
Cardiac tamponade aka pericardial tamponade
Caused by a large and/or rapid buildup of fluid in the pericardial space, which compresses the heart, squeezing the ventricles and reducing the amount of blood they can hold.
This reduction in stroke volume can cause tachycardia, and if severe enough, cardiac arrest.
Frequently associated with pericarditis, but can also be caused by myocardial infarction, chest trauma (blunt or penetrating) and some cancers (eg: Hodgkin’s Lymphoma)
Symptoms of cardiac tamponade aka pericardial tamponade
Symptoms include: Hypotension, increased jugular venous pressure (bulging veins in neck), muffled heart sounds, low QRS height on ECG.
Also check for symptoms of pericarditis ie: chest pain
When does Cardiac arrest / heart failure occur
When the heart is no outputting enough blood to meet the demands of the body and the lungs aka shock and global ischemia
Name the reversible cause of cardiac arrest 4 H 4 T
Hypoxia
Hypovolvemic
Hypothermia
Metabolic disturbances like hypoglycaemia,hypocalcaemia or hypo/hyperkalemia
Thrombosis
Cardiac tamponade : pericardial effusion
Toxins
Tension pneumothorax
What is an aneurysm
weakening of the wall of a blood vessel, leading to permanent deformation, like widening/ ballooning.
Define what a ruptured aneurysm or dissection is
aneurysms can burst or tear, causing blood to pour into the surrounding tissue (haemorrhage). This will damage the surrounding tissue and start to deprive the whole circulatory system of oxygenated blood.
We call this a dissecting or ruptured aneurysm.
Aortic aneurysms
Aneurysm within the aorta. If it occurs in the thoracic aorta this is called a thoracic aortic aneurysm TAA
What is a TAA
Thoracic aortic aneurysm.
Aneurysm in the thoracic aorta
