CARDIOVASCULAR SYSTEM Flashcards
REVIEW THE CARDIAC CYCLE
- Vena cava on right, pulmonary vein on left atria ventricles pulmonary artery on right, aorta on left
- AV and SL node- prevent backflow
- Atrioventricular- atria + ventricles
- Tricuspid on right
- Mitral/bicuspid on left
- Semilunar connects ventricles to associated arteries
- Systole- contraction
- Diastole- relax
- Atrial systole- contraction of atria
- Ventricular systole- contraction of ventricles, follows atrial
- Diastole- relaxation of both
- Valves open when pressure is inc, vice versa to close due to pressure difference
- Atrial systole- AV opens so blood enters ventricles
- Ventricular systole- AV shuts, SL opens so blood leaves heart through arteries
CARDIOVASCULAR DISEASE - DEFINITION
- Cardiovascular disease (CVD), also called heart and circulatory disease, is an umbrella name for conditions that affect your heart or circulation
- These include high blood pressure, stroke and vascular dementia
CARDIOVASCULAR DISEASE - SIGNS AND SYMPTOMS
- Chest px
- Px, weakness or numb legs and/or arms
- Breathlessness
- Very fast or slow heartbeat
- Heart palpitations
- Fatigue
- Swollen limbs
CARDIOVASCULAR DISEASE - RISK FACTORS
- Smoking
- Stress
- Alcohol
- Hypertension
- High blood cholesterol
- Being physically inactive
- Being overweight or obese
- Diabetes
- Family history of heart disease
- Ethnic background
- Sex - men more likely
- Age - older people more likely
ANGINA - DEFINITION
Condition marked by a severe px in the chest, often also spreading to the shoulders, arms and neck, owing to an inadequate blood supply to the heart
ANGINA - POPULATION AFFECTED
Adults over 60
ANGINA - RISK FACTORS
- Unhealthy diet
- Lack of exercise
- Smoking
- Increasing age
- Family history of atherosclerosis or heart problems
ANGINA - TYPES
- Stable angina
o More common
o Attacks have triggers and stop within a few minutes of resting - Unstable angina
o More serious
o Attacks are more unpredictable and can continue despite resting
ANGINA - CLINICAL PRESENTATION
- Chest px and discomfort - feels like burning, fullness, pressure, squeezing
- Px may also be felt in arms, neck, jaw, shoulder or back
- Dizziness
- Fatigue
- Nausea
- Shortness of breath
- Sweating
ANGINA - PROGNOSIS
- Will probably have to take several medications for the rest of life
- May be given medicine to
o Treat attacks when they happen
o Prevent further attacks
o Reduce the risk of heart attacks and strokes - Nitrates
- Aspirin
- Beta blockers
- Statins
MYOCARDIAL INFARCTION - DEFINITION
Heart attack
MYOCARDIAL INFARCTION - CAUSE
- Blockage in one of the blood vessels that supplies the heart
- Occurs when the blood flow through one or more of the coronary arteries is decreases
- The low blood flow decreases the amount of oxygen your heart muscles receives
MYOCARDIAL INFARCTION - POPULATION AFFECTED
- All ethnicities affected relatively equally
- Obese people most affected
MYOCARDIAL INFARCTION - RISK FACTORS
- Smoking
- Diabetes
- High blood pressure
- High blood cholesterol levels
- High blood triglyceride level
- Obesity
- Waist circumference
o Over 30 inches for women and over 40 inches for men - Lack of physical activity
MYOCARDIAL INFARCTION - CLINICAL PRESENTATION
- Most common symptom is chest pressure or px, typically on the left side of the body
- Shortness of breath or trouble breathing
- Fatigue
- Insomnia
- Nausea or stomach discomfort
- Heart palpitations
- Anxiety or feeling of impending doom
- Sweating
- Feeling light headed, dizzy or passing out
- Women are less likely to experience chest px or discomfort that feels like indigestion
- Women are more likely to have shortness of breath, fatigue and insomnia that started before
MYOCARDIAL INFARCTION - PROGNOSIS
- A serious condition
- Chances of survival depend on the severity of the myocardial infraction
- Medicines to prevent blood clotting
o Anticoagulants
o Antiplatelets - Medicines to breakdown blood clots
o Thrombolytics
o Fibrinolytics - Coronary angioplasty
- Coronary artery bypass graft
AORTIC DISSECTION - DEFINITION
Serious condition in which a tear occurs in the inner layer of the aorta. Blood rushes through the tear, causing the inner and middle layers of the aorta to dissect (split)
AORTOC DISSECTION - CAUSE
- Caused by a weakened area of the aortas wall
- Divided into 2 groups
o Type A - More common and dangerous type involves a tear in the part of the aorta where it exits the heart. The tear may also occur in the upper aorta (ascending aorta), which may extend into the abdomen
o Type B - Involves a tear in the lower aorta only (descending aorta) which may also extend into the abdomen
AORTIC DISSECTION - POPULATION AFFECTED
Men over 60
AORTIC DISSECTION - RISK FACTORS
- Hypertension
- Atherosclerosis
- Aortic aneurysm
- Aortic valve defect
o Bicuspid aortic valve - Narrowing of the aorta at birth
o Aortic coarctation - Certain genetic diseases
- Males
- Over 60
- Cocaine use
- Pregnancy
- High-intensity weightlifting
AORTIC DISSECTION - CLINICAL PRESENTATION
- Sudden severe chest or upper back px - Often described as a tearing or ripping sensation that spreads to the neck and down to the back
- Sudden severe stomach px
- Loss of consciousness
- Shortness of breath
- Symptoms similar to those of a stroke
o Sudden vision problems
o Difficulty speaking
o Weakness or loss of movement on one side of your body - Weak pulse in one arm or thigh compared to the other
- Leg px
- Difficulty walking
AORTIC DISSECTION - PROGNOSIS
- Around 20% of pt die before getting to hospital
- Best treatment is prevention
o Control blood pressure
o Quit smoking
o Maintain an ideal weight
o Work with a doctor
NON-CARDIAC CAUSES OF CHEST PAIN - GASTROESOPHAGEAL
Oesophageal disorders
o Perforation may be caused by forceful vomiting and diseases. Sudden, severe, constant P from neck to oesophagus, neck swelling
o Spasm- confused with cardiac condition as its relieved with nitrates, not related to exertion (unlike cardiac pain), swallowing extremely hot or cold substances often causes this which leads to chest P
o Reflux- burning sensation, referred to as heartburn, aggravated by lying down or after meals, chronic cough and dysphagia
NON-CARDIAC CAUSES OF CHEST PAIN - PULMONARY
o Pleuritic in nature- P varies with respiratory cycle, and is exacerbated during inspiration and coughing
o Typically, sharp and unilateral
o Usually caused by lower respiratory infections
o Spontaneous pneumothorax- results in sharp chest P that may radiate to ipsilateral shoulder, can be caused by underlying condition, typical Px is tall, thin, male smoker
o Pulmonary embolism- acute onset of dyspnoea, pleuritic chest P, severe hypoxia and risk factors such as recent surgery, underlying malignancy, bedridden/sedentary state
o Pneumonitis
o Bronchitis
o Intrathoracic neoplasm
NON-CARDIAC CAUSES OF CHEST PAIN - MSK
costochondritis
rib fracture
myalgia
- Palpation of chest may reproduce symptoms
NON-CARDIAC CAUSES OF CHEST PAIN - HERPES ZOSTER
Burning sensation, unilateral dermatomal distribution. Physical exam findings may be lacking as P often occurs before onset of vesicular lesions (blisters), making diagnosis difficult
VALVULAR HEART DISEASE - DEFINITION
- When any valve in the heart has damage or is diseased
- Causes poor blood flow through the heart to the body
VALVULAR HEART DISEASE - CAUSE
- Several causes
- Congenital conditions
- Infections
- Degenerative conditions
- Conditions linked to other types of heart disease
VALVULAR HEART DISEASE - POPULATION AFFECTED
Older adults
VALVULAR HEART DISEASE - RISK FACTORS
- Older age
- History of certain infections that can affect the heart
- History of certain forms of heart disease or heart attack
- High blood pressure, high cholesterol, diabetes and other heart disease risk factors
- Heart conditions present at birth
VALVULAR HEART DISEASE - CLINICAL PRESENTATION
- May not have symptoms for many years
- Whooshing sound (heart murmur) when a doctor is listening to the heart
- Chest px
- Abdominal swelling
- Fatigue
- Shortness of breath - Esp when lying down or active
- Swelling of ankles or feet
- Dizziness
- Fainting
- Irregular heartbeat
VALVULAR HEART DISEASE - PROGNOSIS
- Not amazing
- Currently no medications to halt the progression of valvular heart disease and the deterioration of the heart
- Medications intent to treat symptoms and prevent the emergence of other complications like endocarditis and embolisms
DEEP VEIN THROMBOSIS - DEFINITION
Occurs when a blood clot forms in a deep vein. They usually begin in the lower leg, thigh or pelvis but can also occur in the arm
DEEP VEIN THROMBOSIS - CAUSE
- Anything that prevents blood from flowing or properly clotting
- Damage to vein from surgery or inflammation and damage due to infection or injury
DEEP VEIN THROMBOSIS - POPULATION AFFECTED
- Men
- Over 40
DEEP VEIN THROMBOSIS - RISK FACTORS
- Age- 60+
- Lack of movement
- Injury or surgery
- Pregnancy
- Birth control
- Obesity
DEEP VEIN THROMBOSIS - CLINICAL PRESENTATION
- Leg swelling
- Leg P, cramping or soreness that often starts in calf
- Change in skin colour of leg- such as red or purple
- Warmth
DEEP VEIN THROMBOSIS - PROGNOSIS
- Complications include pulmonary embolism, phospholipidic syndrome and treatment complications
- See a doctor if shortness of breath, feeling lightheaded, fainting, rapid breathing, coughing up blood
HYPERTENSION - DEFINITION
- High blood pressure
- Heart needs to work harder to pump blood
- 130/80 mm Hg or higher
- Normal- 120/80
- Elevated- 120-129/below 80
- Stage 1 hypertension- 130-139/80-89
- Stage 2- 140 or higher/90 or higher
- Above 180/120 mm Hg is hypertensive emergency or crisis
- Need 3 months of consistent readings to diagnose
HYPERTENSION - CAUSE
- Primary- no identifiable cause, develops gradually over many years, plaque builds up in arteries
- Secondary- underlying condition, tends to appear suddenly and cause higher blood pressure than primary (adrenal gland tumour, congenital heart defect, kidney disease, etc)
HYPERTENSION - POPULATION AFFECTED
- Men
- Black people more than white or Asian
HYPERTENSION - RISK FACTORS
- Age (inc with age)
- Family Hx
- Obesity
- Lack of exercise
- Tobacco use
- High sodium
HYPERTENSION - CLINICAL PRESENTATION
- Most asymptomatic
- Headaches
- Shortness of breath
- Nose bleeds
HYPERTENSION - PROGNOSIS
Can be treated
Untreated can lead to inc risk of heart attack, stroke, and other serious health problems
STROKE AND TIA - DEFINITION
- Very serious condition where the blood supply to part of the brain is cut off (stroke)
- Serious condition where the blood supply to your brain is temporarily disrupted. Also called a ‘mini stroke’ (TIA)
STROKE AND TIA - CAUSE
- Ischemic- blocked artery- most common
- Haemorrhagic- leaking or bursting of vessel- result of other condition such as uncontrolled high blood pressure, overtreatment with blood thinners, trauma
- Transient ischemic attack- mini stroke, doesn’t cause permanent damage, temporary block of blood supply
STROKE AND TIA - POPULATION AFFECTED
- People over 55
- African American and Hispanic
- Men
STROKE AND TIA - RISK FACTORS
- Obesity
- Physical inactivity
- Heavy or binge drinking
- High blood pressure
- High cholesterol
- Diabetes
STROKE AND TIA - CLINICAL PRESENTATION
- Trouble speaking
- Paralysis of numbness of face, arm or leg
- Problems seeing in one or both eyes
- Headache
- Trouble walking
STROKE AND TIA - PROGNOSIS
- Seek immediate attention
- FAST- face, arms, speech, time
ANEURYSM - DEFINITION
- An excessive localised swelling of the wall of an artery
- Abnormal bulge in wall of blood vessel
- Can rupture, causing internal bleeding
- Aortic, abdominal aortic, thoracic aortic, brain, peripheral aneurysm
ANEURYSM - CAUSE
- High blood pressure/hypertension over many years damage/weakening of blood vessels
- Atherosclerosis – weakens blood vessels
ANEURYSM - POPULATION AFFECTED
Some types - women 30 - 60
Aortic - men
ANEURYSM - RISK FACTORS
- Hypertension
- Size, location, growth
- Family history
ANEURYSM - CLINICAL PRESENTATION - BRAIN
o can lurk without symptoms
o can rupture and leak (haemorrhagic stroke- medical emergency)
o most don’t rupture
o severe headache
o nausea,
o blurred/double vision,
o seizure,
o photosensitivity.
o Unruptured- Px above/behind eye, dilated pupil, change in vision, numbness of one side of face
ANEURYSM - CLINICAL PRESENTATION - AORTIC
o back Px
o cough
o weak/scratchy voice
o shortness of breath
o tenderness in chest
ANEURYSM - CLINICAL PRESENTATION - ABDOMINAL
o Dizziness
o P in lower back
o sweaty/pale/clammy skin
o fast heartbeat
o shortness of breath
ANEURYSM - CLINICAL PRESENTATION - PERIPHERAL
o pulsating lump that can be felt
o leg px/cramping with exercise
o ulcers of toes/fingers
o radiating px
o gangrene/tissue death
ANEURYSM - PROGNOSIS
- Some have below risk of rupture
- Doctor required to identify size/risk of rupture
- Rupture = fatal (especially in the brain)
PALPITATIONS - DEFINITION
A noticeably rapid, strong, or irregular heartbeat due to agitation, exertion or illness
PALPITATIONS - CAUSE
- Stress
- Depression
- Strenuous exercise
- Stimulants
o Caffeine
o Nicotine
o Cocaine - Hormone changes
PALPITATIONS - POPULATION AFFECTED
Adults
PALPITATIONS - RISK FACTORS
- Stress
- Anxiety disorders
- Panic disorders
- Pregnancy
- Hyperthyroidism
PALPITATIONS - CLINICAL PRESENTATION
- Feeling of fast-beating, fluttering or pounding heart
- May be felt in throat or neck as well as chest
- Can occur at rest or during activity
PALPITATIONS - PROGNOSIS
- Usually harmless
- Rarely a symptom of a more serious condition
DYSNOEA - DEFINITION
Difficult, painful breathing or shortness of breath
DYSNOEA - CAUSE
- Strenuous exercise
- Extreme temps
- Obesity
- Higher altitude
- Likely sign of medical problem in situations other than above
DYSNOEA - POPULATION AFFECTED
DYSNOEA - RISK FACTORS
- Heart disease
- Respiratory infection
- Cancer
o Especially lung - Asthma
- Obesity
DYSNOEA - CLINICAL PRESENTATION
- Shortness of breath
- Intense tightening of chest
DYSNOEA - PROGNOSIS
- Bronchodilators can open airways
- Steroids reduce swelling
- Px medication
SYNCOPE - DEFINITION
- Temporary loss of consciousness caused by a fall in blood pressure
- Triggers heart rate and blood pressure to drop suddenly
- Leads to reduced blood flow to the brain brief loss of consciousness
SYNCOPE - CAUSE
- Occurs when part of nervous system that regulates HR and blood pressure malfunctions to a trigger
- HR slows and blood vessels in legs dilate
- Allows blood to pool in legs, which lowers blood pressure
- Combined drop in blood pressure and slowed HR quickly reduces blood flow to your brain fainting
- Common triggers- heat exposure, standing for long period of time, seeing blood, having blood drawn, fear of bodily injury
SYNCOPE - POPULATION AFFECTED
Most common in children and young adults
SYNCOPE - RISK FACTORS
- Over heating
- Dehydration
- Heavy sweating
- Sudden changes of body position- blood pooling in legs
SYNCOPE - CLINICAL PRESENTATION
- Pale skin
- Light-headedness
- Tunnel/blurred vision
- Nausea
- Feeling warm
- Cold, clammy sweat
- During episode- dilated pupils, slow, weak pulse, and jerky movements
SYNCOPE - PROGNOSIS
- Usually harmless and requires no treatment
- Potential to injure yourself during syncope episode
- Doctor may recommend tests to rule out more-serious causes, such as heart disease
- Cant prevent- lie down and lift legs if feeling faint
OEDEMA - PITTING VS NON-PITTING - DEFINITION
A condition characterised by an excess of watery fluid collecting in the cavities or tissues of the body
OEDEMA - PITTING VS NON-PITTING - CAUSE
- Non-pitting- due to lymphatic blockage, cant get rid of excess water, typically cancer or lymphatics
- Pitting- venous, typically CV, kidney or liver
- Unilateral- deep vein thrombosis, soft tissue infection, trauma, immobility, lymphatic obstruction
- Bilateral- heart failure, chronic venous insufficiency, drugs (e.g., NSAIDs), inferior vena cava obstruction, immobility
- Pregnancy
OEDEMA - PITTING VS NON-PITTING - POPULATION AFFECTED
- Older adults
- Pregnant women
OEDEMA - PITTING VS NON-PITTING - RISK FACTORS
- Being pregnant
- Certain medication
- Having long-lasting illness, e.g., congestive heart failure
- Having surgery that involves a lymph node
OEDEMA - PITTING VS NON-PITTING - CLINICAL PRESENTATION
- Swollen lower limbs (can affect anywhere in body)
- Pitting- leaves dimple
- Puffiness
- Stretched or shiny skin
- If left too long legs may turn brown, haemosiderin- toxin in blood comes to surface to try and be removed
OEDEMA - PITTING VS NON-PITTING - PROGNOSIS
- See a doctor if shortness of breath, irregular heartbeat, chest P
- Mild usually goes away- compression socks, raising affected arm/leg higher than heart
PERIPHERAL VASCULAR DISEASE - DEFINITION
PERIPHERAL VASCULAR DISEASE - CAUSE
- Usually due to atherosclerosis
- Blood vessel inflammation
- Injury to arms or legs
- Radiation exposure
- Changes in muscles or ligaments
PERIPHERAL VASCULAR DISEASE - POPULATION AFFECTED
- People over 60
- People with diabetes
- Men
PERIPHERAL VASCULAR DISEASE - RISK FACTORS
- Family Hx
- High blood pressure
- High cholesterol
- Increasing age (65+)
- Obesity (BMI over 30)
PERIPHERAL VASCULAR DISEASE - CLINICAL PRESENTATION
- Mild or no symptoms- mainly leg P whilst walking
- Coldness in lower leg or foot
- Numbness or weakness
- P cramping in one or both hips, thighs, calf muscles after certain activities
- Shiny skin on legs
- Skin colour changes
- Hair loss/slow growth on legs
- Sores on toes, feet or legs that won’t heal
PERIPHERAL VASCULAR DISEASE - PROGNOSIS
- Inform doctor if in P, numbness or other symptoms of PVD
- Complications are critical limb ischemia (causes tissue death, symptoms are open sores on limbs that don’t heal) and stroke/heart attack
- Prevention- don’t smoke, healthy/active lifestyle, low saturated fat diet
VASCULITIS - DEFINITION
- Inflammation of the blood vessels
- Causes walls of blood vessel to thicken, reducing pathway through vessel, restricting blood flow to tissues leading to damage
VASCULITIS - CAUSE
- Not fully understood
- Some types related to genetic makeup
- Others from immune system attacking blood vessel cells by mistake
- Immune system reaction include
o Infections, such as hepatitis B and hepatitis C
o Blood cancers
o Immune system diseases
Rheumatoid arthritis
Lupus
Scleroderma
o Reactions to certain drugs
VASCULITIS - POPULATION AFFECTED
Adults over 50
VASCULITIS - RISK FACTORS
- Age
o After 50 - Family history
o Of Behcet’s disease, granulomatosis - Lifestyle
o Smoking
o Use of recreational drugs - Medications
o Minocycline
o Allopurinal - Infections
o Hep B and C - Sex
o Women more than men
VASCULITIS - CLINICAL PRESENTATION
- Fever
- Headache
- Fatigue
- Weight loss
- General aches and pains
- Other parts of the body may be affected
o Digestive system
Px after eating
o Ears
Ringing
o Eyes
Red appearance with itch/burn
o Hands and feet
Numbness and weakness
o Lungs
Shortness of breath
o Skin
Bleeding under the skin can show up as red sports
VASCULITIS - PROGNOSIS
Complications can lead to organ damage, blood clots and aneurysms, vision loss and blindness or infections
