Cardiovascular pathology Flashcards
Atherosclerosis; Heart failure; Hypertension; Coronary heart disease; Emboli; Thrombosis; Chest pain; Cardiomyopathy; Atrial fibrillation; Valvular heart disease; Infective endocarditis; Cardiovascular disease
What are the clinical features of atrial fibrillation?
Dizziness and confusion
Palpitations, chest pain, dyspnoea
How is atrial fibrillation diagnosed?
ECG showing:
- oscillating baseline = atria contracting asynchronously
- Rhythm irregular and slow HR
Hows is atrial fibrillation managed?
Anti-arrhythmia medication or beta blockers
Assess stroke risk and then decide if anti-coagulants necessary - turbulent flow increases clot risk
Monitor progress and adjust/refer if needed
What is hypertension?
When the level of blood pressure is above 140/90 mmHg
Level of BP above which investigation and treatment fo more good than harm
Leading global cause of death
Higher BP, higher mortality risk
What are risk factors for primary/essential hypertension?
Majority of cases have no identifiable cause
Genetics - complex polygenic commoner than monogenic
Environment e.g. dietary salt, obesity/overweight, lack of exercise, alcohol, pregnancy
What are causes of secondary hypertension?
Renal disease
Tumours
Contraceptive pill
How does hypertension occur?
Increased total peripheral resistance caused by:
-Active narrowing of arteries via vasoconstriction
-Structural narrowing of arteries via growth and remodelling
-Loss of capillaries via rarefaction
Decreased arterial compliance
Normal CO
Normal blood volume
Central shift in volume 2° to reduced venous compliance
What is isolated systolic hypertension and what causes it?
Hypertensive systolic BP but normal diastolic
Caused by increasing stiffness of large arteries, common in eldery
TPR doesnt necessarily increase
What are the main consequences associated with hypertension?
Heart - left ventricular hypertrophy → 3x increased risk of heart failure
Large arteries - Arterial dilation → aneurysm, arterial rupture → thrombotic event/stroke
Eyes - retinopathy
Kidneys - nephropathy, renal dysfunction, renal failure
Microalbuminuria due to reduced glomerular filtration rate
What is the treatment available for hypertension?
Weight loss, exercise, healthy eating, less alcohol
ACE inhibitors - reduce AngII production
Angiotensin receptor blockers
-aim of blocking AngII is to stop vasoconstriction, to decrease TPR and water retention
Thiazide diuretic - act on DCT
Beta blockers - block β1 receptors in heart and kidneys to reduce contractility and HR, and reduce the activity of the RAAS
Calcium channel blockers - Reduce Ca2+ influx to reduce cross bridge cycling in VSMC, reduce contractility in heart
What are the main suspected causes of 1° hypertension?
Kidney-has a key role in BP regulation, closely related to salt intake
Endocrine/paracrine factors
SNS - high sympathetic activity links to hypertension development
