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5TH YR- CMS2 > Cardiovascular disorders > Flashcards

Cardiovascular disorders Flashcards

1
Q

Describe arteries

A

Thick walled high pressure vessels which conduct the blood from the heart to the tissues

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2
Q

Describe veins

A

Thin walled lower pressure vessels returning blood to the heart

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3
Q

Name the different valves of the heart

A

Mitral valve
Aortic valve
Tricuspid valve

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4
Q

How does the myocardium relieve its blood supply

A

Via the right and left coronary arteries

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5
Q

Name the main cause of cardiovascular disease

A
  1. Coronary heart disease
  2. Cerebral vascular disease
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6
Q

Give examples of cardiovascular disease

A
  1. Atheroscleoriis
    2.
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7
Q

What does atherosclerosis affect

A

Only the arteries

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8
Q

What is the cause of atherosclerosis

A

Unknown

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9
Q

What are the risk factors of atherosclerosis

A
  1. Smoking
  2. Hypertension
  3. Diabetes melitus
  4. Hypercholesterolaemia
  5. Family history of cardiovascular disease
  6. Sedentary lifestyle
  7. Obesity
  8. Age
    9, Excess alcohol
  9. more men tend to get it than women
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10
Q

Which arteries are most affected by Atherosclerosis

A

Medium and large Calibre arteries

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11
Q

Name the 3 morphological stages of atherosclerosis

A
  1. Fatty streak
  2. Fibrolipid plaque
  3. Complicated plaque
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12
Q

What is the fatty streak

A

Accumulation of lipid in intima of the artery wall

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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

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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

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15
Q

What can intraplaque fissures cause

A

It exposes blood to plaque contents and consequently thrombosis develops over the plaque

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16
Q

What are the consequences of thrombosis

A

May partially or completely occlude the vessel limen

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17
Q

In which vessels can thrombus cause a serious issue

A

Narrow vessels such as the coronary arteries

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18
Q

What can partially occlude thrombi cause

A

Embolisms

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19
Q

What can damaged arteries show

A

Progressive calcification which can cause gradual permanent dilation of the artery forming an aneurysm

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20
Q

Give examples of classes of drugs that can be used to prevent atherosclerosis

A
  1. Statins
  2. Fibrates
  3. Nicotinic acid
  4. Ezetimibe
  5. Bile acid sequestrates
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21
Q

Name the first line of trematn for atherosclerosis

A

statins

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22
Q

How do statins work

A

They hinder the cholesterol synthesis by inhibiting the enzyme 3 hydroxy 3 methylglutaryl co enzyme A

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23
Q

What is a dental side effect of statins

A

Myopathy

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24
Q

When is the chance of myopathy increased in a patient taking statins

A

If the patent is also on erythromycin

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25
Q

Name the arteries most commonly effected by atherosclerosis

A
  1. Coronary arteries
  2. Cerebral arteries
  3. Aorta
  4. Mesenteric arteries
  5. Iliac and femoral arteries
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26
Q

What does atherosclerosis of the coronary arteries cause

A

Angina

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27
Q

What does thrombosis of the coronary arteries cause

A

Myocardial infarction

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28
Q

What can thrombosis over places in the vessels at the base of the brain cause

A

Cerebral infarction (Stroke)

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29
Q

What can thrombosis of atheroma within the aorta cause

A

Symptoms associated with systemic embolism and aortic aneurysm

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30
Q

What can thrombosis over plaques in the mesenteric vessels produce

A

Small bowl infarction, rupture and subsequent peritonitis

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31
Q

What can atheroma of the iliac and femoral vessels cause

A

Intermittent claudication (leg pain and weakness bough on by walking)

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32
Q

What can thrombosis of the iliac and femoral vessels cause

A

Gangrene of the lower extremities

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33
Q

What is an aneurysm

A

A localised permanent abnormal dilation of a blood vessel due to weakening of the blood vessel wall

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34
Q

Name the most common aneurysms

A

Those that develop as a consequence of atheroma

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35
Q

Where do atherosceloritc aneurysms form

A

Either at the arch of the aorta, the thoracic aorta or within the abdominal aorta just above the bifurcation of the iliac arteries

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36
Q

What serious risk do aneurysms pose

A

Risk of rupture

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37
Q

What can a ruptured aneurysm cause

A

A torrential and often fatal retroperitoneal bleed

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38
Q

What does berry aneurysm affect

A

The circle of willis at the base of the brain

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39
Q

Describe the berry aneurysm

A

A small saccular dilation that develops at points of breaching on the circle of willis

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40
Q

In whom is the berry aneurysm common

A

Typically develops in young hypertensive individuals who have a defect of the muscular wall of the arteries that comprise the circle of willis

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41
Q

What can rupture of a berry aneurysm cause

A

Subarachnoid haemorrhage

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42
Q

Other than predisposition and genetics what else can cause aneurysms

A

Infections such as gang (mycotic) and syphilitic

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43
Q

What are myocitic aneurysms a consequence of

A

Localised infection of an arterial wall

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44
Q

Name one well recognised source of infection that can lead to aneurysms

A

Embolic material produced during infective endocarditis
These can produce a mycotic aneurysm at the site of impaction

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45
Q

What can rupture of an aneurysm in the cerebral vessels cause

A

Cerebral haemorrhage

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46
Q

What is a syphilitic aneurysm caused by

A

chronic infection with Treponema pallidum

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47
Q

Name the most common site for a syphilitic aneurysm

A

Root of the aorta

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48
Q

What are Microaneurysms

A

Aneurysms forced within capillaries

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49
Q

Which vessels are commonly affected by Microaneurysms

A

Cerebral and retinal capillary

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50
Q

In whom are Microaneurysms seen in

A

Hypertensive patients
Diabetics

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51
Q

What is a dissecting aneurysm also known as

A

a false aneurysm

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52
Q

Why is a false aneurysm given this name

A

As is it actually a blood filled space caused rupture of the aorta rather than dilation of the vessel

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53
Q

What is the term for a blood filled space

A

Haemotoma

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54
Q

Where are dissecting (false) aneurysms most commonly found

A

At the arch of the aorta

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55
Q

In which patients is a dissecting (false) aneurysm seen

A

Usually elderly and hypertensive patients
Also seen in patient witch connective tissue abnormalities eg marinas syndrome

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56
Q

What do patients with a dissecting (false) aneurysm present with

A

Severer inter scapular back pain, loss of peripheral pulses or fatal haemopericardium and/or retroperitoneal haemorrhage.

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57
Q

What is a thrombus

A

A solid mass of blood constituents formed within the vascular system during

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58
Q

What is an embolism

A

A mass of material flowing free in the vascular system able to become lodges within a vessel and block its lumen

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59
Q

What is Ischaemia

A

An inappropriate reduction in blood sappy to an organ or tissue

60
Q

What is infarction

A

Death of tissue due to its ischaemia

61
Q

Name the 3 factor that predispose a person to the formation of a thrombus

A

1.. Changes in the surface of the vessel
2. Pattern of blood flow
3. blood constituents

62
Q

What are the 3 factors that predispose a person to the formation of a thrombus known as

A

Virchows triad

63
Q

Where can thrombosis occur

A

Within the arterial or venous system and within the heart

64
Q

What is a thrombosis within the heart called

A

Cardiac thrombosis

65
Q

Where does arterial thrombosis occur

A

On atheromatous plaques

66
Q

Describe the platelets found in a person who smokes tobacco

A

They are abnormally sticky

67
Q

Describe atheromatous plaque

A

It protrudes into the lumen of the artery and disturbs the laminar flow of blood setting up local turbulence

68
Q

What can turbulence in the lumen of an artery cause

A

Can produce shear forces that can cause endothelial ulcerations

69
Q

What do endothelial ulcerations lead to

A

platelet aggregation
activation of coagulation cascade and deposition of fibrin

70
Q

Describe the different layers of a thrombus

A

alternating layers of platelets `and fibrin and erythrocytes
This forms a lamellate structure

71
Q

Where do the incremental layers of a thrombus tend to accumulate

A

On the downstream side of the atheroma and hence the thrombus grows in the direction of the blood flow

72
Q

Give soem risk factors of deep vein thrombosis

A
  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
Q

Where does venous thrombosis tend to imitate

A

At the valves

74
Q

What do venous thrombosis develop as a consequence of

A

Venous state and other predisposing factors such as phlebitis

75
Q

What happens to a vein following thrombosis

A

Tends to become inflamed

76
Q

What is inflammation of the veins following thrombosis called

A

thrombophlebitis

77
Q

Name the most common veins to be affected by venous thrombosis

A

Deep veins of the leg

78
Q

What are the typical clinical signs of deep vein thrombosis

A

Swollen and painful leg

79
Q

What is the most clinically important consequence of deep vein thrombosis

A

Pulmonary embolism

80
Q

What does cardiac thrombosis typically affect

A
  1. Chambers of the left side of the heart
  2. Walls of the heart (mural thrombus)
  3. Heart valves
81
Q

What is arterial thrombosis caused by

A

Atrial fibrillation and mitral valve stenosis

82
Q

Where does ventricular thrombosis occur

A

At the site of myocardial infarction

83
Q

What is valvular thrombosis a feature of

A

Rheumatic dever
Infective endocarditis

84
Q

Is thrombosis reversible

A

In some cases it can be if the thrombus is broke down by the fibrinolytic pathway

85
Q

What is the reversal of a thrombus called

A

Lysis and resolution

86
Q

Can a thrombus heal

A

Yes if granulation tissue grows into the thrombus and there is organisation and fibrosis

87
Q

What does healing of a thrombus cause

A

Retraction of the thrombus and the patency of the vessel lumen being restored

88
Q

Other than healing or several what can happen to a thrombus

A

Progressive fibrosis and scarring of thrombus and vessel wall can result in a permanent stenosis (narrowing) of the vessel.

89
Q

What is an embolus

A

A mass of material in the vascular system able to become lodges within a vessel and block its lumen

90
Q

Where is embolic material usually derived from

A

Thrombus

91
Q

Other than thrombus what are soem other causes of embolism

A
  1. atheromatous debris
  2. heart valve vegetations
  3. tumour emboli
  4. fat droplets
  5. amniotic fluid
  6. gas (caisson disease)
  7. foreign material.
92
Q

What can embolism cause in terms of Cardiovascular disease

A

Thrombotic debris which can result in sudden death

93
Q

Name the most clinically recognised embolic event

A

Pulmonary embolism

94
Q

What is pulmonary embolism usually derived from

A

Fragments of a deep vein thrombosisocated in the calf or ileofemoral venous segment.

95
Q

How does a pulmonary embolism occur

A
  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
Q

What are the clinical effects of a pulmonary embolism determined by

A

The size of the embolus

97
Q

Where can a large embolus get lodged

A

at the bifurcation of the pulmonary arteries - saddle embolus

98
Q

Where Can a small embolus get lodged

A

In the peripheral branch of the pulmonary artery resulting in a wedge shaped infaract go lung tissue

99
Q

what would a patient with a small lodged embolus complain of

A

Chest pain
Breathlessness
Coughing up blood

100
Q

What are systemic embolisms derived from

A

Thrombus within the left side of the heart or hrombus formed on atheromatous plaque

101
Q

What can embolism to the cerebral vessels case

A

cerebral infarction and stroke

102
Q

What can emboli lodging into the speed or kidney cause

A

Segmental infarcts which are usually asymptomatic

103
Q

What can emboli lodging int eh mesenteric vessels cause

A

Death of large segments of small intestine with bowel perforation and peritonitis.

104
Q

What is the progression of ischaemia to infarction determined by

A
  1. Vascular anatomy
  2. Duration of occlusion
  3. Metabolic requirements of the tissue
    4.General circulation
  4. Anaemia
  5. Concept of reperfusion injury
105
Q

List some of the symptoms of cardiovascular disease

A
  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
Q

How might the patient describe chest pain they are having due to cardiovascular disease

A

Tigh and hack pain across the chest that may radiate to the arms the neck and jaw

107
Q

What is chest pain characteristically Brought on by in cardiovascular disease

A

exertion

108
Q

What can chest pain be accompanied with in an MI

A

Sweating
nausea
breathlessness
palpitations

109
Q

What does the term palpitations refer to

A

An abnormal awareness of the heart beat

110
Q

What are palpation’s usually a symptom of

A

Cardiac arrhythmia

111
Q

List some differential diagnosis of chest pain

A
  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
Q

What is syncope

A

A loss of consciousness due to lack of blood flow to the brain

113
Q

How can breathlessness be detected

A

By observation and measuring the respiratory rate

114
Q

What is considered an abnormal respiratory rate

A

Anything greater than 20 breaths per min

115
Q

What can pallor indicate

A

Anaemia
Poor cardiac output

116
Q

Where ca =n we measure the pulse

A
  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
Q

What is a normal pulse rate

A

60-100 beats per min

118
Q

What does a completely irregular pulse usually indicate

A

Atrial fibrillation

119
Q

What can a weak or thready pulse indicate

A

Poor cardiac output or shock

120
Q

What can a strong pulse indicate

A

Can indicate a state of vasodilation such as thyrotoxicosis or pyrexia due to infection

121
Q

What can a raised jugular venous pressure indicate

A

A sign of venous congestion in heart failure

122
Q

What can chronic elevation of the venous pressure result in

A

A detectable pitting oedema of the ankles

123
Q

What is peripheral cyanosis

A

A blue tinge due to deoxygenated blood in the peripheral circulation

124
Q

What can peripheral cyanosis indicate

A

Peripheral arterial insufficiency
Shock
Heart failure

125
Q

How is central cyanosis detected

A

In the lips and tongue

126
Q

What does central cyanosis indicate

A

Reduced oxygenation of the arterial blood leaven the left side of the heart more commonly seen in lung disease

127
Q

Give examples of what blabbing of the fingers can indicate

A
  1. Chronic lung disease
  2. Inflammatory bowel disease
  3. Infective endocarditis
  4. Congenital heart malformations
128
Q

Describe the fingers of a person with endocarditis

A
  1. more than 5 splinter haemorrhages in the nails (characteristic sign)
  2. Oslers nodes (rare)
  3. Janet spots (rare)
129
Q

Describe splinter haemorrhages in the nails

A

They appear as small dark longitudinal marks under the nail

130
Q

Describe Oslers nodes

A

Small painful nodules in the finger pulp

131
Q

Describe laneway spots

A

Red marks in the palm due to capillaritis

132
Q

What does a full examination of the cardiovascular system include

A

Examination of the heart lungs and pulses

133
Q

What are heart murmurs

A

Sounds of turbulent blood flow due to dysfunction the heart valves

134
Q

What do we use to carry out cardiac investigation

A
  1. ECG
  2. Exercise EXG
  3. Echocardiogram
  4. Ambulatory blood pressure monitoring
  5. 24 hour ECG tapes
  6. Angiography W
135
Q

Where is an ECG recorded from

A

Skin electrodes placed over the chest and limbs

136
Q

How do we diagnose iangina

A

ECG monitoring during graded exercise on a treadmill

137
Q

What does echocardiography provide

A

Real life ultrasound images of the heart via a transducer moved over the chest wall

138
Q

What can an echocardiogram show

A

The structures and function of the valves, the size and contractility of the chambers and can detect fluid in the pericardium

139
Q

What does cardiac catheterisation involve

A

Involves the insertion of long catheters into the heart usually via the femoral artery and vein in the groin

140
Q

What do cardiac catheterisation show

A

Measurements of the intra cardiac pressure and oxygen saturation to assess the function of the chambers and valves

141
Q

How does MI typically present

A

With prolonged and severe ischameic type chest pain that is unresponsive to angina medications

142
Q

List some associating symptoms of an MI

A
  1. Sweating
  2. Nausea
  3. Vomiting
  4. Palpitations
  5. Breathlessness
  6. Faintness
143
Q

How is diagnosis of MI confirmed using an ECG

A

ECG usually shows elevation of the ST segment

144
Q

What is the standard treatment for an MI

A

emergency thrombolysis with an intravenous infusion of streptokinase or recombinant tissue plasminogen activator.

145
Q

What is the aim of mI treatment

A

To unblock the artery by dissolving the clot thereby minimising the damage to the myocardium

146
Q

How is a diagnosis of angina often made

A

By using the clinical history

147
Q

What is the initial treatment for angina

A

Sublingual GTN usually as a spray

5TH YR- CMS2 (7 decks)

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