Case 2 - Cardiac Flashcards
Describe the process of atherosclerosis formation
Endothelium becomes injured
Lipids accumulate and oxidize in the tunica intima
Smooth muscle cells proliferate and a fibrous cap forms over plaque
Plaque becomes unstable and may rupture
What happens when there is a plaque in an artery
Plaque caused hypertension by causes stenosis of the vessel and decreasing the diameter. Endothelial cells damaged by the plaque release nitric oxide and prostacyclin which along with LDLs cause an increased risk of a clot.
Cardiac causes of dyspnoea
heart failure
mitral regurgitation
hypertension
What are the three main arteries of the heart
Left circumflex
Left anterior descending
Right coronary
What are vascular relaxing agents
Nitric oxide, prostacyclin
What are vascular contracting agents
angiotensin II, endothelin I
Effect of nitric oxide and prostacyclin on blood vessels
Inhibits platelet aggregation, potent vasodilator, inhibits proliferation of smooth muscle. Nitric oxide can also be carried around the body
Effect of endothelin I
potent vasoconstrictor, stimulates proliferation of vascular smooth muscle
What are heart murmurs
sounds most commonly originate from the abnormal movement of blood across valves and between cardiac chambers. When this occurs, turbulence results, which produces vibrations in the chambers of the heart or outflow vessels
How is a heart attack diagnosed
troponin test
How might women present with a heart attack
back or neck pain, indigestion, heartburn, lightheadedness, shortness of breath, fatigue, nausea, or pain in the back of the jaw.
Why does heart attack pain radiate
Dermatomes of the phrenic nerve
How does stable angina differ from acute coronary syndrome
Stable angina is a repeatable and expected discomfort on exertion, whereas acute coronary syndrome could be anything from unstable angina to a hear attack
Why do you develop breathlessness and chest pain with ischaemia
If your heart cannot pump enough blood to meet your body’s needs, you may develop shortness of breath or extreme fatigue with exertion. Angina is chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood
How can myocardial ischemia be illustrated on an ECG
ST depression on exersion
Treatment for angina
GTN Ca2+ blockers Beta blockers Nicorandil Ivabradine Lifestyle changes
Risk factors for CVD
smoking alcohol obesity genetics sex activity level ethnicity diabetes poor diet high blood pressure/ cholesterol
percutaneous investigations for CVD
Angiography
CT coronary angiography
echocardiogram
Treatment options for CVD
medication
surgery
PCI
What surgery is commonly performed for CVD
Coronary artery bypass graft (CABG)
What vessels are usually harvested for a CABG
Great saphenous vein
Mammary artery
What is cardiac catheterization
Checks the inside of your arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within the heart and the strength of blood flow through the heart’s chambers as well as collect blood samples from the heart or inject dye into the arteries of the heart
What is a coronary angiogram
Uses X-rays to detect dye injected via cardiac catheterization.
What is an exercise stress test used for
to:
Diagnose coronary artery disease
Diagnose a possible heart-related cause of symptoms such as chest pain, shortness of breath or lightheadedness
Determine a safe level of exercise
Check the effectiveness of procedures done to improve coronary artery circulation in patients with coronary artery disease
Predict risk of dangerous heart-related conditions such as a heart attack.
