Cardiovascular disorders Flashcards
1
Q
Describe arteries
A
Thick walled high pressure vessels which conduct the blood from the heart to the tissues
2
Q
Describe veins
A
Thin walled lower pressure vessels returning blood to the heart
3
Q
Name the different valves of the heart
A
Mitral valve
Aortic valve
Tricuspid valve
4
Q
How does the myocardium relieve its blood supply
A
Via the right and left coronary arteries
5
Q
Name the main cause of cardiovascular disease
A
- Coronary heart disease
- Cerebral vascular disease
6
Q
Give examples of cardiovascular disease
A
- Atheroscleoriis
2.
7
Q
What does atherosclerosis affect
A
Only the arteries
8
Q
What is the cause of atherosclerosis
A
Unknown
9
Q
What are the risk factors of atherosclerosis
A
- Smoking
- Hypertension
- Diabetes melitus
- Hypercholesterolaemia
- Family history of cardiovascular disease
- Sedentary lifestyle
- Obesity
- Age
9, Excess alcohol - more men tend to get it than women
10
Q
Which arteries are most affected by Atherosclerosis
A
Medium and large Calibre arteries
11
Q
Name the 3 morphological stages of atherosclerosis
A
- Fatty streak
- Fibrolipid plaque
- Complicated plaque
12
Q
What is the fatty streak
A
Accumulation of lipid in intima of the artery wall
13
Q
Describe the fibrolipid plaque
A
Deposition of collagen and progressive fibrosis
Lesion has a fibrous cap that bulges into the lumen of the vessel
14
Q
What can happen in the complicated plaque phase
A
The fibrous cap becomes unstable and develops surface defects referred to as ulcers of intraplaque fissures
15
Q
What can intraplaque fissures cause
A
It exposes blood to plaque contents and consequently thrombosis develops over the plaque
16
Q
What are the consequences of thrombosis
A
May partially or completely occlude the vessel limen
17
Q
In which vessels can thrombus cause a serious issue
A
Narrow vessels such as the coronary arteries
18
Q
What can partially occlude thrombi cause
A
Embolisms
19
Q
What can damaged arteries show
A
Progressive calcification which can cause gradual permanent dilation of the artery forming an aneurysm
20
Q
Give examples of classes of drugs that can be used to prevent atherosclerosis
A
- Statins
- Fibrates
- Nicotinic acid
- Ezetimibe
- Bile acid sequestrates
21
Q
Name the first line of trematn for atherosclerosis
A
statins
22
Q
How do statins work
A
They hinder the cholesterol synthesis by inhibiting the enzyme 3 hydroxy 3 methylglutaryl co enzyme A
23
Q
What is a dental side effect of statins
A
Myopathy
24
Q
When is the chance of myopathy increased in a patient taking statins
A
If the patent is also on erythromycin
25
Name the arteries most commonly effected by atherosclerosis
1. Coronary arteries
2. Cerebral arteries
3. Aorta
4. Mesenteric arteries
5. Iliac and femoral arteries
26
What does atherosclerosis of the coronary arteries cause
Angina
27
What does thrombosis of the coronary arteries cause
Myocardial infarction
28
What can thrombosis over places in the vessels at the base of the brain cause
Cerebral infarction (Stroke)
29
What can thrombosis of atheroma within the aorta cause
Symptoms associated with systemic embolism and aortic aneurysm
30
What can thrombosis over plaques in the mesenteric vessels produce
Small bowl infarction, rupture and subsequent peritonitis
31
What can atheroma of the iliac and femoral vessels cause
Intermittent claudication (leg pain and weakness bough on by walking)
32
What can thrombosis of the iliac and femoral vessels cause
Gangrene of the lower extremities
33
What is an aneurysm
A localised permanent abnormal dilation of a blood vessel due to weakening of the blood vessel wall
34
Name the most common aneurysms
Those that develop as a consequence of atheroma
35
Where do atherosceloritc aneurysms form
Either at the arch of the aorta, the thoracic aorta or within the abdominal aorta just above the bifurcation of the iliac arteries
36
What serious risk do aneurysms pose
Risk of rupture
37
What can a ruptured aneurysm cause
A torrential and often fatal retroperitoneal bleed
38
What does berry aneurysm affect
The circle of willis at the base of the brain
39
Describe the berry aneurysm
A small saccular dilation that develops at points of breaching on the circle of willis
40
In whom is the berry aneurysm common
Typically develops in young hypertensive individuals who have a defect of the muscular wall of the arteries that comprise the circle of willis
41
What can rupture of a berry aneurysm cause
Subarachnoid haemorrhage
42
Other than predisposition and genetics what else can cause aneurysms
Infections such as gang (mycotic) and syphilitic
43
What are myocitic aneurysms a consequence of
Localised infection of an arterial wall
44
Name one well recognised source of infection that can lead to aneurysms
Embolic material produced during infective endocarditis
These can produce a mycotic aneurysm at the site of impaction
45
What can rupture of an aneurysm in the cerebral vessels cause
Cerebral haemorrhage
46
What is a syphilitic aneurysm caused by
chronic infection with Treponema pallidum
47
Name the most common site for a syphilitic aneurysm
Root of the aorta
48
What are Microaneurysms
Aneurysms forced within capillaries
49
Which vessels are commonly affected by Microaneurysms
Cerebral and retinal capillary
50
In whom are Microaneurysms seen in
Hypertensive patients
Diabetics
51
What is a dissecting aneurysm also known as
a false aneurysm
52
Why is a false aneurysm given this name
As is it actually a blood filled space caused rupture of the aorta rather than dilation of the vessel
53
What is the term for a blood filled space
Haemotoma
54
Where are dissecting (false) aneurysms most commonly found
At the arch of the aorta
55
In which patients is a dissecting (false) aneurysm seen
Usually elderly and hypertensive patients
Also seen in patient witch connective tissue abnormalities eg marinas syndrome
56
What do patients with a dissecting (false) aneurysm present with
Severer inter scapular back pain, loss of peripheral pulses or fatal haemopericardium and/or retroperitoneal haemorrhage.
57
What is a thrombus
A solid mass of blood constituents formed within the vascular system during
58
What is an embolism
A mass of material flowing free in the vascular system able to become lodges within a vessel and block its lumen
59
What is Ischaemia
An inappropriate reduction in blood sappy to an organ or tissue
60
What is infarction
Death of tissue due to its ischaemia
61
Name the 3 factor that predispose a person to the formation of a thrombus
1.. Changes in the surface of the vessel
2. Pattern of blood flow
3. blood constituents
62
What are the 3 factors that predispose a person to the formation of a thrombus known as
Virchows triad
63
Where can thrombosis occur
Within the arterial or venous system and within the heart
64
What is a thrombosis within the heart called
Cardiac thrombosis
65
Where does arterial thrombosis occur
On atheromatous plaques
66
Describe the platelets found in a person who smokes tobacco
They are abnormally sticky
67
Describe atheromatous plaque
It protrudes into the lumen of the artery and disturbs the laminar flow of blood setting up local turbulence
68
What can turbulence in the lumen of an artery cause
Can produce shear forces that can cause endothelial ulcerations
69
What do endothelial ulcerations lead to
platelet aggregation
activation of coagulation cascade and deposition of fibrin
70
Describe the different layers of a thrombus
alternating layers of platelets `and fibrin and erythrocytes
This forms a lamellate structure
71
Where do the incremental layers of a thrombus tend to accumulate
On the downstream side of the atheroma and hence the thrombus grows in the direction of the blood flow
72
Give soem risk factors of deep vein thrombosis
1. Oestrogen replacement therapy or the oral contraceptive pill
2. Smoking
3. Immobility
4. History of pelvic surgery
5. Previous history of deep vein thrombosis
6. Pelvic tumours
7. Pregnancy
8. Surgery
73
Where does venous thrombosis tend to imitate
At the valves
74
What do venous thrombosis develop as a consequence of
Venous state and other predisposing factors such as phlebitis
75
What happens to a vein following thrombosis
Tends to become inflamed
76
What is inflammation of the veins following thrombosis called
thrombophlebitis
77
Name the most common veins to be affected by venous thrombosis
Deep veins of the leg
78
What are the typical clinical signs of deep vein thrombosis
Swollen and painful leg
79
What is the most clinically important consequence of deep vein thrombosis
Pulmonary embolism
80
What does cardiac thrombosis typically affect
1. Chambers of the left side of the heart
2. Walls of the heart (mural thrombus)
3. Heart valves
81
What is arterial thrombosis caused by
Atrial fibrillation and mitral valve stenosis
82
Where does ventricular thrombosis occur
At the site of myocardial infarction
83
What is valvular thrombosis a feature of
Rheumatic dever
Infective endocarditis
84
Is thrombosis reversible
In some cases it can be if the thrombus is broke down by the fibrinolytic pathway
85
What is the reversal of a thrombus called
Lysis and resolution
86
Can a thrombus heal
Yes if granulation tissue grows into the thrombus and there is organisation and fibrosis
87
What does healing of a thrombus cause
Retraction of the thrombus and the patency of the vessel lumen being restored
88
Other than healing or several what can happen to a thrombus
Progressive fibrosis and scarring of thrombus and vessel wall can result in a permanent stenosis (narrowing) of the vessel.
89
What is an embolus
A mass of material in the vascular system able to become lodges within a vessel and block its lumen
90
Where is embolic material usually derived from
Thrombus
91
Other than thrombus what are soem other causes of embolism
1. atheromatous debris
2. heart valve vegetations
3. tumour emboli
4. fat droplets
5. amniotic fluid
6. gas (caisson disease)
7. foreign material.
92
What can embolism cause in terms of Cardiovascular disease
Thrombotic debris which can result in sudden death
93
Name the most clinically recognised embolic event
Pulmonary embolism
94
What is pulmonary embolism usually derived from
Fragments of a deep vein thrombosisocated in the calf or ileofemoral venous segment.
95
How does a pulmonary embolism occur
1. Fragments of a thrombus become detached from the development site in the vein
2. the fragment travels through the venous system to the right side of the heart
3.Embolus is then pumped out through the pulmonary arteries into the lungs
96
What are the clinical effects of a pulmonary embolism determined by
The size of the embolus
97
Where can a large embolus get lodged
at the bifurcation of the pulmonary arteries - saddle embolus
98
Where Can a small embolus get lodged
In the peripheral branch of the pulmonary artery resulting in a wedge shaped infaract go lung tissue
99
what would a patient with a small lodged embolus complain of
Chest pain
Breathlessness
Coughing up blood
100
What are systemic embolisms derived from
Thrombus within the left side of the heart or hrombus formed on atheromatous plaque
101
What can embolism to the cerebral vessels case
cerebral infarction and stroke
102
What can emboli lodging into the speed or kidney cause
Segmental infarcts which are usually asymptomatic
103
What can emboli lodging int eh mesenteric vessels cause
Death of large segments of small intestine with bowel perforation and peritonitis.
104
What is the progression of ischaemia to infarction determined by
1. Vascular anatomy
2. Duration of occlusion
3. Metabolic requirements of the tissue
4.General circulation
5. Anaemia
6. Concept of reperfusion injury
105
List some of the symptoms of cardiovascular disease
1. Chest pain
2. Breathlessness / dyspnoea
3. Raised pressure in the systemic veins and capillaries
4. Swelling of the ankles and legs
5. Palpitations
6. Syncope
106
How might the patient describe chest pain they are having due to cardiovascular disease
Tigh and hack pain across the chest that may radiate to the arms the neck and jaw
107
What is chest pain characteristically Brought on by in cardiovascular disease
exertion
108
What can chest pain be accompanied with in an MI
Sweating
nausea
breathlessness
palpitations
109
What does the term palpitations refer to
An abnormal awareness of the heart beat
110
What are palpation's usually a symptom of
Cardiac arrhythmia
111
List some differential diagnosis of chest pain
1. Myocardial infarction
2. Angina
3. Gastro-oesopheal reflux disease
4. Pleuritic pain
5. Musculoskeletal pain
6. Pain secondary to trauma
7. Panic attack
112
What is syncope
A loss of consciousness due to lack of blood flow to the brain
113
How can breathlessness be detected
By observation and measuring the respiratory rate
114
What is considered an abnormal respiratory rate
Anything greater than 20 breaths per min
115
What can pallor indicate
Anaemia
Poor cardiac output
116
Where ca =n we measure the pulse
1. At the radial artery in the wrist
2. Brachial artery on the medial side of the arm in front of the elbow
3. Carotid below the angle of the jaw
117
What is a normal pulse rate
60-100 beats per min
118
What does a completely irregular pulse usually indicate
Atrial fibrillation
119
What can a weak or thready pulse indicate
Poor cardiac output or shock
120
What can a strong pulse indicate
Can indicate a state of vasodilation such as thyrotoxicosis or pyrexia due to infection
121
What can a raised jugular venous pressure indicate
A sign of venous congestion in heart failure
122
What can chronic elevation of the venous pressure result in
A detectable pitting oedema of the ankles
123
What is peripheral cyanosis
A blue tinge due to deoxygenated blood in the peripheral circulation
124
What can peripheral cyanosis indicate
Peripheral arterial insufficiency
Shock
Heart failure
125
How is central cyanosis detected
In the lips and tongue
126
What does central cyanosis indicate
Reduced oxygenation of the arterial blood leaven the left side of the heart more commonly seen in lung disease
127
Give examples of what blabbing of the fingers can indicate
1. Chronic lung disease
2. Inflammatory bowel disease
3. Infective endocarditis
4. Congenital heart malformations
128
Describe the fingers of a person with endocarditis
1. more than 5 splinter haemorrhages in the nails (characteristic sign)
2. Oslers nodes (rare)
3. Janet spots (rare)
129
Describe splinter haemorrhages in the nails
They appear as small dark longitudinal marks under the nail
130
Describe Oslers nodes
Small painful nodules in the finger pulp
131
Describe laneway spots
Red marks in the palm due to capillaritis
132
What does a full examination of the cardiovascular system include
Examination of the heart lungs and pulses
133
What are heart murmurs
Sounds of turbulent blood flow due to dysfunction the heart valves
134
What do we use to carry out cardiac investigation
1. ECG
2. Exercise EXG
3. Echocardiogram
4. Ambulatory blood pressure monitoring
5. 24 hour ECG tapes
6. Angiography W
135
Where is an ECG recorded from
Skin electrodes placed over the chest and limbs
136
How do we diagnose iangina
ECG monitoring during graded exercise on a treadmill
137
What does echocardiography provide
Real life ultrasound images of the heart via a transducer moved over the chest wall
138
What can an echocardiogram show
The structures and function of the valves, the size and contractility of the chambers and can detect fluid in the pericardium
139
What does cardiac catheterisation involve
Involves the insertion of long catheters into the heart usually via the femoral artery and vein in the groin
140
What do cardiac catheterisation show
Measurements of the intra cardiac pressure and oxygen saturation to assess the function of the chambers and valves
141
How does MI typically present
With prolonged and severe ischameic type chest pain that is unresponsive to angina medications
142
List some associating symptoms of an MI
1. Sweating
2. Nausea
3. Vomiting
4. Palpitations
5. Breathlessness
6. Faintness
143
How is diagnosis of MI confirmed using an ECG
ECG usually shows elevation of the ST segment
144
What is the standard treatment for an MI
emergency thrombolysis with an intravenous infusion of streptokinase or recombinant tissue plasminogen activator.
145
What is the aim of mI treatment
To unblock the artery by dissolving the clot thereby minimising the damage to the myocardium
146
How is a diagnosis of angina often made
By using the clinical history
147
What is the initial treatment for angina
Sublingual GTN usually as a spray
