Cardiovascular Pathologies

Question 1

What is coronary heart disease?

Answer 1

Astheroma formation in coronary arteries

Question 2

What is Myocardial ischaemia?

Answer 2

Stroke - caused by plaque rupture or ulceration of coronary artery

Question 3

What are the risk factors for CHD?

Answer 3

Non modifiable

• Age 40-60
  
  • cellular celesence
  • Plaque maturation
• genetics
  - Family Hx - hyper cholesterol diabetes
• Gender - oestregon, willingness to change

Modifiable
- Dyslipidemia - high cholesterol
- Smoking - Nicotine stress vessel, predispose to injury
- Hypertension - stress vessels
- Diabetes - Inc. cholesterol, Hyperlipidemia, insulin resistance
- Obesity
- Physical inactivity
Metabolic syndrome - 3/5 criteria
Obesity, diabetes, Dyslipidemia, Hypertension, Low HLD

Question 4

Discuss the management for CHD risk factors?

Answer 4

Diet change 
increase exercise 150-300 a week 
stop smoking 
Take meds to regulate cholesterol and hypertension 
Diabetes meds

Question 5

What are a mature atheroma and its structure?

Answer 5

Artheroma is a plaque = Fibrous caps of cells and connective tissue

Question 6

How does atheroma develop?

Answer 6

1) Endothelial damage
2) Increase permeability of the wall and allow passage of ADL to Tunica intima
3) Chronic inflammation + add immune cells
4) gradual accumulation of lipid over time

Question 7

What are some complications of atherosclerotic plaque formation.

Answer 7

Chronic ischaemia - narrowing of lumina
Thrombus formation
Aneurysm
Plaque calcification

• coronary artery - angina - chest pain
• peripheral artery - leg pain
• cerebral artery - dyspnea, numbness weakness in arms, loss of vision

Question 8

What are the difference and clinical features between stable angina, unstable angina and myocardial infarction?

Answer 8

Stable Angina

• Dyspnea - Tachycardia
• Pallor - Nausea - Fatigue

Unstable Angina
- Same as angina but more intense and S&S mya present at rest

AMI

• Same as unAngina plus
• Diaphoresis
• tachycardia and tachyphonea
• Psychological stress
• loss of consciousness

Question 9

What is cardiac arrhythmia?

Answer 9

A variation from a normal heart rhythm

Question 10

What is the classification of arrhythmias?

Answer 10

• Regular irregular heartbeat

- Irregular irregular heartbeat

Question 11

What are the risk factors for atrial fibrillation?

Answer 11

Hx 
Obesity 
sleep apnea
Alcohol
caffeine 
High-intensity exercise

Question 12

Whats the clinical presentation for atrial fibrillation?

Answer 12

Palpitation
dyspnea
dizziness
weakness
hypotension
Angina

Question 13

What are pericarditis and endocarditis and their clinical features?

Answer 13

Pericarditis - Inflammation of the pericardium
- Chest P - Back shoulder referral - dysphagia - restlessness - anxiety - fatigue

Endocarditis - inflammation of endocardium due to infection

• Arythmia, chest pain, valvular dysfunction,
• fever, fatigue, loss of appetite, malaise

Question 14

How to diagnose hypertension?

Answer 14

Hypertension is diagnosed by taking BP measurement patients with BP > 90/140

Question 15

What are the risk factors for hypertension?

Answer 15

Primary
Hx
Inc. salt 
Age
Gender
Alcohol
Obesity
Physical inactivity 
smoking

Question 16

Differentiate between the terms “primary hypertension” and “secondary hypertension”

Answer 16

Primary: Caused directly by patient habits

Secondary: Caused by other disease

Question 17

List some potential causes of secondary hypertension

Answer 17

Pregnancy
Stress
renal disease
medications
endocrine disease
atheroma

Question 18

Define the terms “isolated systolic hypertension” and “malignant hypertension”?

Answer 18

isolated systolic hypertension: when the systolic pressure is > 140 but the diastolic remains normal <90

Malignant hypertension: BP> 180/120 medical emergency

Question 19

Summarise the possible clinical features and complications of hypertension

Answer 19

Clinical
Severe headache
Fatigue or confusion
Vision problems
Chest pain
Difficulty breathing
Irregular heartbeat
Blood in the urine

Complications
AMI
Heart Failure
Haemorrage
aortic aneurism

Question 20

What is the management of hypertension

Answer 20

Lifestyle changes

Meds - diuretics, beta blockers, ace inhibitors

Question 21

What is aortic dissection and how are they classified?

Answer 21

Tear in tunic intimate of aorta
classified by
Type A: dissection of ascending aorta aortic root
Type B: dissection of descending aorta

Question 22

Describe risk factors and clinical features of aortic dissection

Answer 22

Risk

• HBP - Age, Male, genetic -Smoking
• Hx - drugs - Trauma

clinical

• Sudden onset, severe chest and upper back pain, sharp
• Shortness of breath (Dyspnea)

Question 23

What causes common heart failure and what are the clinical features

Answer 23

Failure of the heart to maintain CO, despite normal volume

Clinical
Fatigue, weakness, chest P, dizziness, displaced apical beat, Tachycardia, thready pulse

Question 24

How is chronic heart failure classified

Answer 24

Lt sided = systolic failure

Rt side = diastolic failure

Question 25

How does right-hearted heart failure develop compared to AMI (left ventricular failure)

Answer 25

Rt side

• Lung disease
• pulmonary valve disease
• Lt heart failure
• congenital Heart disease

Lt side

• AMI
• HBP
• Aortic/ mitral valve disease
• inc. CO

Question 26

What is anaemia and what are the different types

Answer 26

Anaemia is decrease in RBC

• Iron deficiency anaemia - loss of iron
• B12 folliate anemia
• Thalassaemia- haemolytic anemia

Question 27

What is Iron deficiency anemia, and the difference between occult bleeding and Frank bleeding?

Answer 27

Loss of iron through loss of blood
Frank = external bleeding
Occult = internal bleeding

Question 28

What role do Vitamin B12 and folate play in haemopoiesis?

Answer 28

B12 is needed to produce RBC without it the cells are large and malformed. Deficiency of RBC leads to demyelination in CNS and ANS

Question 29

List the patient groups that are most likely to develop Vitamin B12 Deficiency Anaemia or Folate Deficiency Anaemia.

Answer 29

Pregnancy
vegans
alcoholics 
poor diet (elderly)
contraceptive medicine

Question 30

Describe the possible clinical features of anemia

Answer 30

parasthesia
depression
delirium
ataxia
reduced reproduction
irritability 
paranoia

Question 31

What is Thalassaemia and what types are there?

Answer 31

Haemolytic anemia = early cell death
Inherited disease resulting in early RBC death
Classified as:
- mayor = can’t produce beta and alpha
- minor = can’t produce either beta or alpha

Question 32

What is the importance of identifying the thalassaemia gene?

Answer 32

• Increase life span

- Genetic planning

Question 33

What is haemochromatosis and what are the types

Answer 33

Iron overload

• Primary = genetic bad production of hepcidin which limits iron storage
• Secondary = result of Thalassaemia major

Question 34

Clinical presentation for haemochromatosis?

Answer 34

male
>40
joint pain
bronze pigmentation

Question 35

What is Aortic regurgitation

Answer 35

The inability of aortic valve to close properly and allowing backflow.
Diastolic murmur
Lt Ventricular hypertrophy - dilation

Question 36

What is aortic stenosis?

Answer 36

narrowing of valve to restrict blood flow from lt ventricle to aorta.
Systolic murmur
Lt ventricle hypertrophy
Fatigue, dyspnea, angina, arrhythmia

Question 37

What is mitral stenosis?

Answer 37

Narrowing of the mitral valve restricting blood flow from Lt ventricle to Lt atrium
Diastolic murmur
Lt ventricle hypertrophy
atrial fibrillation and thrombus

Question 38

What is mitral regurgitation

Answer 38

mitral valve doesn’t shut and allows backflow to from Lt atrium to Lt ventricle.
systolic murmur
Lt hearted failure
fatigue palpitation dyspnea