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Case 4 > Case 4 Notes > Flashcards

Case 4 Notes Flashcards

1
Q

name the two contractile proteins

A

myosin - globular heads with thick A bands and myosin ATPase

Actin - thin I bands made up of two alpha helix strands woven between two myosin filaments

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2
Q

list the Regulatory proteins

A

Tropomyosin / troponin T/I/C

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3
Q

Tropomyosin function

A

prevents contaction in resting state

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4
Q

Troponin T function

A

ties Troponin to actin and tropomyosin

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5
Q

Troponin I function

A

inhibits ATPase in actin

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6
Q

Troponin C function

A

binds to Ca2+ ions - regulates the contraction process

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7
Q

Medical term / cause for breathlessness

A

dyspnoea - decreased oxygen or increased CO2

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8
Q

symptoms of dyspnoea

A

cough / chest pain / fever - graded from 1-4

noisy breathing / cyanosis / overuse of accessory muscles

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9
Q

respiratory causes of dyspnoea

A

decreased elasticity / increased inflammation / ++ mucus caused by obstruction (COPD) / decrease in functioning tissue (scarring) / peroneal fluid / pneumothorax (collapsed lung)

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10
Q

cardiac causes of dyspnoea

A

heart failure (pericarditis) / endocarditis / cardiomyopathy / cardiac effusion / aortic stenosis

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11
Q

other causes of dyspnoea not cardiac or respiratory

A

lung cancer / anaemia / anxiety / asthma / obesity

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12
Q

List the 3 heart infections

A

endocarditis
pericarditis
myocarditis

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13
Q

endocarditis causes

A

infection of the inner lining and valves of heart

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14
Q

endocarditis symptoms

A

flu / weight loss / cough / SOB / joint and muscle pain

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15
Q

endocarditis diagnosis / treatment

A

blood cultures / surgery

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16
Q

endocarditis increased risk?

A

pacemakers / HIV / male / heart defects

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17
Q

pericarditis cause

A

infection of outer lining of the heart leading to pericardial effusion causing pressure build up and heart compression

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18
Q

pericarditis symptoms

A

stabbing chest pain and signs of infection

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19
Q

pericarditis healing time

A

acute - few weeks

chronic - 3+ months

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20
Q

myocarditis causes

A

infection of heart muscle post chest or throat infection e.g. rubella or glandular fever

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21
Q

myocarditis symptoms

A

chest pain / fever / sweats / increased or irregular heart rate

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22
Q

arteriosclerosis definition

A

hardening or thickening of the arterial walls leading to reduced elasticity and decreased lumen diameter

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23
Q

arteriosclerosis treatment

A

artery bypass / coronary angioplasty / lifestyle changes e.g. managing diabetes better

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24
Q

monckebery medial calcific sclerosis definition

A

Ca2+ deposition in muscular arteries which does not inhibit lumen widening

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25
Q

atherosclerosis definition

A

fatty deposit buildup in vessel walls leading to stenosis (narrowing) / occlusion / chronic inflammation SMOKING

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26
Q

atherosclerosis stable angina steps (1-4)

A

1 LDL deposit cholesterol in damaged tunica intima
2 monocytes - macrophages try to remove deposits
3 macrophages - enlarge foam cells - fatty streaks
4 fibrous capsule called plaque formed

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27
Q

atherosclerosis ruptured plaque (steps 5-6)

A

5 plaque extends into the elastic layer then lumen

6 reduced blood flow ANGINA

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28
Q

atherosclerosis final stages (7-10)

A

7 calcium deposits cause plaque hardening
8 increased pressure casing plaque dislodge - rupture
9 further clotting - downstream blockage - MI/stroke
10 plaque - aneurism - hypovolemic shock

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29
Q

angina definition

A

dull sharp pain in the chest caused by ischemia to heart muscles by atherosclerosis / heart disease

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30
Q

angina risk factors

A

hypertension / diabetes / smoking / obesity / stress

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31
Q

types of angina (x3)

A

stable
prinzmetal variable angina
unstable

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32
Q

stable angina

A

brought on by obvious causes e.g. stress / exercises and relieved by rest or medication

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33
Q

prinzmetal variable angina

A

uncommon episodic variation - caused by coronary artery spasm

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34
Q

unstable angina

A

less predictable and continues when resting and is a warning of declining cardiovascular health MEDICAL EMERGENCY caused by ruptured plaque

35
Q

diagnosis of angina

A

ECG - abnormalities
ETT - exercise tolerance test to measure hearts capability to sustain exercise
Coronary angiography - catheter and dye then Xray to show circulation effectiveness
Myocardial perfusion scintingraphy - radioactive dye that is injected then tracked

36
Q

referred pain defintion / cause

A

activated nociceptors in viscera localised to body surface where info from multiple nociceptors converge and the brain interprets visceral pain as superficial

37
Q

what nerves can angina pain be referred from

A

intercostal
sympathetic
vagus
phrenic

38
Q

referred pain pathway for angina

A

1 ischemia pain from heart muscles
2 sympathetic nerve to 1st-4th sympathetic ganglia
3 to T1 - T4
4visceral somatic pain fibres join in chest arm / forearm

39
Q

heart murmurs definition

A

sounds from turbulent blood from within the heart

40
Q

heart murmurs risk factors

A

anemia / diabetes / rubella / hypertension / injecting drugs

41
Q

abnormal heart murmurs cause / symptoms

A

congenital in children but defect in adults
caused by septal defects / virus / valve calcification
blue skin / weight gain / SOB / chest pain / dizziness

42
Q

types of heart murmurs (x2)

A

abnormal

innocent

43
Q

innocent heart murmurs cause / symptoms

A

no symtoms

caused by pregnancy / physical activity / fever

44
Q

smoking affect on cardiovascular system

A

smoke damage = atheroma - fatty deposit in artery
CO = reduced O2 carry capacity
nicotine = simulates adrenaline = increased HR + BP
tar - increases heart workload
inflammation
increased triglycerides

45
Q

chronic heart disease definition

A

blocked coronary arteries leading to heart attack

46
Q

peripheral arterial disease definition

A

narrowing of vessels causing restricted blood flow to arms and legs

47
Q

abdominal aortic aneurism definition

A

weakened areas in wall of abdominal aorta leading to rupture EMERGENCY

48
Q

effect of decreased oestrogen on cardiovascular system (menopause)

A
  • affects NO availability (vasodilation) decreased NO synthase
  • affects coagulation cascade (atherosclerosis)
  • L-type calcium channels affected (contraction not prevented)
  • LDL:HDL ratio increases
  • decreased vasodilatory enzymes
49
Q

menopause effects on cardiovascular system

A 
increased fat distribution
increased blood pressure
increased coagulation 
increased epithelial disfunction 
decreased oestrogen 
ATHEROSCLEROSIS / HEART DISEASE / STROKE
50
Q

cholesterol biosynthesis

A

produced by liver / intestine / adrenal gland

51
Q

cholesterol biosynthesis process

A

1 aceyl CoA from mitochondria to cytosol - HMG-CoA - mevalonate
2 melavonate - IPP - squalene - cholesterol
With HMG-CoA reductase being the limiting step (STATINS)

52
Q

cholesterol defninition

A

lipid transported in blood with plasma proteins

53
Q

cholesterol transportation types (x2)

A

specific

non-specific (albumin)

54
Q

metabolism of cholesterol types (x3)

A

auto oxidation
secondary oxidation
cholesterol metabolising enzyme oxidation
in liver to make bile salt and acids

55
Q

cholesterol function (x5)

A 
animal cell membrane component
component of myelin sheaths
Bile salt production
Molecule synthesis (vitamin D/ sex hormones) 
decrease permeability of H+/Na+
56
Q

Blood test results for an MI (shows myocardial necrosis)

A
  • creatine kinase (non specific)
  • CKMB (cannot be monitored over a long period)
  • troponin (increases in hours after heart damage)
57
Q

emergency MI protocols immediate

A

O2 / strong IV analgesia / NO3 / heparin

58
Q

emergency MI protocols long term

A 
low dose aspirin post event 
primary aginoplasty (stent)
beta-adrenoreceptor blockers
insulin 
pacemakers 
coronary bypass graft
thrombolysis
59
Q 
MI healing states 
1 immediately 
2 few days after 
3 weeks after 
4 months after
A

1 coagulative necrosis with some bleeding
2 neutrophils enter and breakdown dead cardiomyocytes
3 ingrowth of small blood vessels / meshing fibroblasts + type three collagen (most dangerous phase)
4 granulation tissue forms
5 type 3 replaced by type 1 collagen (NON CONTRACTILE)

60
Q

cardioversion definition

A

shocking the heart back into normal rhythm

61
Q

DNR definition

A

Do Not Resuscitate

when the consequences of CPR is greater than the potential benfits

62
Q

heartblocks definition

A

abnormal heart rhythm where heart beat too slowly and the electrical signals are blocked between atria / ventricles

63
Q

STEMI vs NSTEMI

A

Non-ST-elevation myocardial infarction - partial obstruction of the blood flow
ST-elevation myocardial infarction - sudden complete blockage of the blood flow to heart

64
Q

ECG STEMI vs NSTEMI

A

STEMI - ST elevation

NSTEMI - ST depression

65
Q

MI risk factors

A

age - atherosclerosis
gender - men
family history
obesity - increase blood cholesterol / blood pressure
diabetes - nerve damage = silent heart attack

66
Q

Types of heart block (x4)

A

1st degree
Wenckebach
Mobitz
3rd degree

67
Q

1st degree heart block

A

No symptoms

PR interval prolongation

68
Q

Wenckebach (Mobitz I) heart block

A 
No symptoms 
Varying PR (progressively prolonged) intervals
69
Q

Mobitz II heart block

A

Dizziness

Blocked P wave with constant PR intervals

70
Q

Third degree heart block

A

P waves (atrial depolarizations) being completely unrelated to the QRS complexes (ventricular depolarizations) ― meaning the P waves occur at one rate and the QRS complexes at another. Ventricles begin to depolarise themselves

71
Q

Chest electrode placement

A 
V1 right 4th intercostal space
V2 left 4th intercostal space 
V3 midway between V1/2
V4  5th intercostal space (middle)
V5 left auxiliary line (height of V4)
V6 left mid auxiliary line
72
Q

acebutolol

A

beta blocker

T = high blood pressure / angina / irregular heartbeats

SE = tiredness / stomach upset / vomiting / headache

DT = asthma / adrenal gland tumour / diabetes

73
Q

ivabradine

A

sinus node inhibitor (decrease HR)

T = angina / heart failure

SE = blurred vision

DT = kidney or liver probs / pacemaker / recent stroke or MI

74
Q

atenolol

A

beta blocker

T= high blood pressure / arrhythmias / angina / post heart attacK

SE= stomach upset / dizziness / cold extermities

DT= asthma / kidney probs / sugar diabetes / psoriasis

75
Q

verapamil

A

calcium channel blocker

T - abnormal heart rhythm / high blood pressure / angina

SE = constipation

DT = no grapefruit juice / liver failure / porphyria / hyPOtension / heart failure

76
Q

nicorandil

A

potassium channel activator (vasodilation)

T= angina

SE= headaches

DT= low blood pressure / heart attack / pulmonary oedema

77
Q

low dose aspirin

A

anti-platelet (secondary prevention)

T = heart attack / angina / stroke / peripheral arterial disease

SE = bleeding in stomach

DT = asthma

78
Q

statins (atrovastatin / fluvastatin)

A

enzyme inhibitor (in cholesterol production)

T = high cholesterol / atheroma

SE = headaches / nausea / diarrhoea

DT = liver disease no grapefruit juice

79
Q

amlodipine

A

calcium channel blocker

T = high blood pressure / angina

SE = headaches / peripheral oedema / nausea

DT = liver problems

80
Q

heparin

A

anticoagulant - prevents further blood clots / stroke

81
Q

warfarin

A

anticoagulant - prevents further blood clots / stroke

T = atrial fibrillation

SE = hair loss / blood in stool / diarrhoea / jaundice

DT = hypertension / bacterial endocarditis / stroke / stomach ulcer

82
Q

(Digoxin) lanoxin

A

digitalis

T = atrial fibrillation / flutter and heart failure

SE = nausea / rash / blurred or yellow vision

DT = kidney or thyroid problems / asthma

83
Q

nitroglycerin tablets

A

vasodilator

T = angina

SE = headache / fast heartbeat

DT = liver/kidney problems / glaucoma / heart attack / anemia

Case 4 (2 decks)

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