cardiovascular risk factors plus other stuff Flashcards
Risk factors for various cardiovascular diseases. Plus some information on infarction, atherosclerosis, acute coronary syndrome, MI, and heart failure.
infarction risk factors
obesity, smoking, cholesterol
atherosclerosis risk factors
poorly managed diabetes, smoking, HTN, hyperlipidaemia, FH, obesity (inflammatory cytokines), inflammatory conditions (cap weakened -> plaque ruptures)
acute coronary syndromes risk factors
coronary thrombosis, anaemia, bradycardia, tachycardia, diabetes, smoking
myocardial infarction risk factors
lack of exercise, smoking, diet high in fat
heart failure risk factors
valve disease, HTN, MI, CAD, connective tissue disease, infection, pericardial disease, cardiomyopathy, arrhythmias
myocardial dysfunction due to IHD, alcohol, valvular disease, endocardial disease
oestrogen protects against IHD
hypertension risk factors
family history, environment, hyperaldosteronism (as more salt is retained –> higher bp)
atrial fibrillation risk factors
IHD, HTN, PE, hyperthyroidism
atrial flutter risk factors
idiopathic, IHD, atrial dilation
1st and 2nd degree heart block risk factors
family history, athletes, sick sinus syndrome, IHD, acute myocarditis, drugs (e.g. digoxin)
3rd degree heart block risk factors
IHD, idiopathic (fibrosis), congenital, aortic valve calcification, surgery, trauma, digoxin, infiltration(abscesses, granulomas, tumours, parasites)
sinus tachycardia risk factors
pain, infection, exercise, system vasodilation
accessory pathway causes arrhythmias
supra ventricular tachycardia risk factors
genetic
ventricular tachycardia risk factors
CHD, aortic stenosis, MI electrolyte imbalance
ventricular ectopic beat risk factors
genetic, lifestyle (caffeine intake, potassium deficiency)
prolonged QT syndrome risk factors
inherited, low potassium/calcium, family history, pre-existing CVD
Wolff-Parkinson-White syndrome risk factors
Ebstein anomaly (genetic)
atherosclerotic aortic aneurysm risk factors
age, family history, inherited collagen defects
dissecting aortic aneurysm risk factors
systemic hypertension, Marfan’s syndrome (disorder of fibrillar expression)
berry aneurysm risk factors
HTN, smoking
capillary micro aneurysm (Charcot-Bouchard) risk factors
HTN, diabetes
infective mycotic aneurysm risk factors
bacterial or fungal infections of arterial walls
syphilitic aneurysm risk factors
tertiary syphilis
claudication risk factors
peripheral vascular disease
critical limb ischaemia risk factors
smoking, diabetes mellitus
pericarditis risk factors
idiopathic, pacemaker implant, post-MI, Dressler’s, post-surgery
aortic stenosis risk factors
congenital, degenerative calcification, rheumatic heart disease
mitral regurgitation risk factors
post MI, ischaemic heart disease, degenerative calcification, myxomatous degeneration, rheumatic heart disease, pure volume overload
cardiomyopathy risk factors
inherited
pathology of infarction
ischaemic necrosis of tissue –> inflammation
signs of infarction
peripheral necrosis
gangrene
complications of infarction
reperfusion in surgery
treatment of infarction
lifestyle modifications
beta blockers
statins
what is gangrene?
infarction of mixed tissues in bulk
pathology of atherosclerosis
damage of endothelial cells (smoking, HTN, diabetes, lipids)
thrombus forms around tear and heals to leave fibrous tissue –> cumulative build up –> atheroma
stages of atherosclerosis
initial lesion fatty streak intermediate lesion atheroma lesion fibroatheroma complicated lesion
why are statins used to treat atherosclerosis?
cause foam cells to die
inhibit HMG CoS reductase during cholesterol synthesis
treatment of atherosclerosis
statins diet surgery (percutaneous coronary intervention) aspirin clopidogrel
action of clopidogrel
inhibits P2Y12 ADP receptor on platelets
action of aspirin
irreversible inhibitor of platelet cyclo-oxygenase –> stops production of thromboxane
causes of acute coronary syndromes
rupture of plaque coronary vasospasm cocaine (causes coronary spasm) dissection of coronary artery dissection of aorta descending into coronaries
signs of acute coronary syndrome
chest pain radiating to jaw and left arm
what is poor R wave progression a sign of?
myocardial ischaemia
treatment of acute coronary syndrome
antihypertensives
quit smoking
anti-coagulants
diagnosis of acute coronary syndrome
angiogram (give fondaparinux to pts waiting for angiogram)
ECG
pathology of myocardial infarction
necrosis of heart muscle due to impaired blood flow
necrosis is followed by inflammatory infiltration and fibrous repair
enzymes are released from necrotic muscle and leucocytosis are diagnostic markers
what does troponin indicate?
cardiac muscle injury
what does an NSTEMI look like on an ECG?
small R wave and no Q wave
signs of myocardial infarction
tight chest pain
pain in jaw
pain in left arm
tiredness
complications of myocardial infarction
arrhythmias cardiac failure mitral incompetence myocardial rupture leading to haemopericardium mural thrombus leading to embolism cardiac embolism
treatment of myocardial infarction
lifestyle modification beta blockers statins revascularisation ACEi anticoagulants antipaltelets
initial management of MI
MONA Morphine Oxygen Nitrates (dilates arteries --> reduces bp) Aspirin - 300mg oral
definition of heart failure
an inability of the heart to deliver blood at a rate commensurate with the requirements of metabolising tissues, despite normal or increased cardiac filling pressures
pathology of heart failure
ventricles unable to contract and relax normally
neurohormonal changes in heart failure
sympathetic - increased afterload
RAAS - increased afterload/preload
vasopressin - increased afterload and preload
signs of right sided heart failure
raised JVP hepatomegaly ascites pitting oedema nausea epistaxis anorexia
signs of left sided heart failure
cardiomegaly weight loss tachycardia murmur exertional dyspnoea orthopnoea paroxysmal nocturnal dyspnoea fatigue pink frothy nocturnal cough
heart failure signs (non-specific to which side)
breathlessness leg swelling increased weight fluid retention fatigue cold peripheries
complications of heart failure
renal dysfunction rhythm disturbances systemic thrombo-embolism DVT PE LBBB bradycardia hepatic dysfunction neurological
treatment of heart failure
diuretics ACEi ARB BB spironolactone digoxin vasodilators (hydralazine and isosorbide dinitrate)
diagnosis of heart failure
CXR bloods B-type natriuretic peptide (elevated) ECG trans thoracic echocardiogram displaced apex beat 3rd heart sound abnormally high noradrenaline, arginine, and renin
