Common Cardiovascular Conditions

Question 1

What is a congenital heart condition?

Answer 1

A range of developmental defects that affect the heart

Question 2

Define arrhythmias.

Answer 2

abnormalities of the electric rhythm of the heart

Question 3

Define bradycardia

Answer 3

abnormally slow rhythm of the heart

Question 4

Define tachycardia.

Answer 4

abnormally fast rhythm of the heart

Question 5

What are the aetiologies of congenital heart conditions?

Answer 5

genetic linkage
environmental factors
maternal illness
exposure to toxins during pregnancy

Question 6

What are the general categories of congenital heart conditions?

Answer 6

Apparent at or before birth
week to months before detection
years after or even in adulthood

Question 7

What are the key anatomical features before birth?

Answer 7

early development = sinus venosus becomes coronary sinus/part of the right atrial wall
before birth = ductus arteriosus, connects pulmonary trunk to aorta and foramen ovale, connects both to atria

Question 8

What are the 4 main congenital heart defects?

Answer 8

Atrial septal defects (ASD)
Ventricular septal defects (VSD)
Patent ductus arteriosus (PDA)
Congenital valve stenosis (CVS)

Question 9

What happens in atrial septal defects?

Answer 9

It is a hole in the heart which increases the amount of blood that flows through the lungs. Oxygenated blood from systemic enters pulmonary circulation, usually acyanotic. It is similar to sinus venosus defect where the pulmonary veins/left atrium shunts into the right ventricle. Also, similar to patent foramen ovale where the foramen ovale remain open post birth, can be unnoticed for years.

Question 10

What happens in ventricular septal defects?

Answer 10

The opening in the interventricular septum. Blood often flows from the left ventricle through the VSD to the right ventricle into the lungs, can cause a volume overload

Question 11

What happens in patent ductus arteriosus?

Answer 11

PDA results when the ductus fails to close, and left to right shunt can occur. The4re is normally a volume overload of pulmonary circulation, which can lead to left ventricular dilation or heart failure.

Question 12

What happens in congenital valve stenosis?

Answer 12

The aortic valve stenosis can cause the left ventricle hypertrophy, fatigue and tachypnoea. The pulmic valve can cause right ventricle hypertrophy, fatigue, dyspnoea with exertion and exercise intolerance.

Question 13

Explain what dilated cardiomyopathy does.

Answer 13

It is an acquired heart condition in childhood, and it can cause viral infection, septal defects, genetic linkage, reduced pumping efficiency, tachycardia, arrhythmia, and can lead to lung congestion or heart failure.

Question 14

Explain what endocarditis does.

Answer 14

It is an acquired heart condition in childhood, and it is relatively rare, it can cause infection of the heart valves and candida, and is more common in congenital heart disease or valve conditions.

Question 15

Explain what myocarditis does.

Answer 15

It is an acquired heart condition in childhood, and it is the necrosis and inflammation of the myocardium, which is usually linked to an infection. It can decreased the myocardial function, enlarge the heart, and cause pulmonary edema and congestive heart failure.

Question 16

Explain what pericarditis does.

Answer 16

It is an acquired heart condition in childhood and it is the infection of pericardium which causes fluid accumulation in pericardial space and cardiac tamponade. It causes a restricted place for the heart to work and haemodynamic compromise as pressure builds up around the heart. It also causes severe limitation to venous return and cardiac output, eventually severe hypotension, cerebral hypoperfusion and cardiac arrest.

Question 17

What is atherosclerosis?

Answer 17

An acquired condition in adults, which is the thickening or hardening of the arteries. This is caused by the buildup of plaque in the arteries, which causes a blockage or hypertension in the artery wall.

Question 18

What can happen after the removal of plaque?

Answer 18

It could lead to a severe stroke and ischemic necrosis of the brain tissue

Question 19

What are the risk factors of atherosclerosis?

Answer 19

Hyperlipidaemia
smoking
age
hypertension 
diabetes 
obesity 
genetic linkage

Question 20

What is an atherogenic lipoprotein?

Answer 20

It is a low density protein which is small, crosses endothelium easily, and facilitates carrying of lipids into the arterial wall. LDL above 190mg/dl is high risk, and LDL below 100mg/dl is low risk.

Question 21

What is an antiatherogenic lipoprotein?

Answer 21

It is a high density protein which is large, less able to cross endothelium, has poor transport of cholesterol into arterial wall. It captures cholesterol and carries it back to the liver. HDL below 40mg/dl is right risk, and HDL above 50mg/dl is low risk.

Question 22

Explain what happens in atherosclerosis in children.

Answer 22

The development of atherosclerosis begins in early life. Arterial fatty streaks invade LDL carrying lipids, which causes immune cells to have symptomatic changes. The fatty streaks are deposited in the intima of large muscular arteries. In children the risk factors are increased BMI, hypertension, cholesterol levels and LDL levels. The full development of atherosclerosis is rare but possible.

Question 23

What is the first stage of the developmental stages in atheroma’s?

Answer 23

Stage one is injury to the endothelium of the blood vessel. There are haemodynamic stresses, such as turbulent blood flow, there is a buildup of cholesterol, pathogenic chemicals enter, such as smoking, hypertension occurs, ineffective agents enter, such as bacteria or viruses, and damaged endothelial tissues release pro-inflammatory signals.

Question 24

What is the second stage of the developmental stages in atheroma’s?

Answer 24

Stage two is the accumulation of oxidised lipids. Endothelial damage triggers an inflammatory response, low density lipoprotein carries the lipids into the tunica intima, this lipid then oxidises, the damage surrounding the tissue attracts macrophages, and the macrophages take up the LDL to become foam cells.

Question 25

What is the third stage of developmental stages of atheroma’s?

Answer 25

Stage three is the proliferation of smooth muscle and fibrous cap formation. Smooth muscle cells proliferate, lymphocytes get attracted to that area, elastic and collagen fibres accumulate there, some foam cells die and released their lipid content, core of the dead and dying foam cells develops, fibrous cap develops, and the surface of the plaque can become pro-thrombic.

Question 26

What is the complicated plaque?

Answer 26

Fragile blood vessels invade the plaque, which can bleed into the mass. Smooth muscle cells differentiate and produce calcified regions. Hydrodynamic forced can lead to erosion or rupture of the unstable plaque, and circulating blood may even undermine and life the plaque. Haemorrhage and thrombosis combine to obstruct the vessel.

Question 27

What are the complications of atherosclerosis?

Answer 27

Arterial suffering and hypertension
Vessel constriction leading to chronic ischemia
thrombus - blood clot
acute occlusion with risk of ischemic necrosis
aneurysm formation

Question 28

What are the key sites atherosclerosis can have complications?

Answer 28

abdominal aorta iliac arteries 
proximal coronary arteries
thoracic aorta 
main arteries in leg 
main vessels supplying brain

Question 29

What does stable angina endothelial cell look like?

Answer 29

The lumen is narrowed by plaque, with vasoconstriction and a reduced blood flow. This can be a trigger for emotional distress or exertion, increased heart rate which increases oxygen consumption, and ischemic condition in myocardium.

Question 30

What does unstable angina endothelial cell look like?

Answer 30

The plaque is ruptured, there is platelet aggregation, thrombus formation, unopposed vasoconstriction, unstable atherosclerotic plaque rupture, platelet thrombosis, and a reduced blood flow.

Question 31

What does variant angina endothelial cell look like?

Answer 31

There is no overt plaques, intense vasospasm, reduced blood flow due to vasospasm only, no clear evidence of atherosclerosis. Increased heart rate, which increases oxygen consumption, hence ischemic symptoms.

Question 32

What is coronary heart disease?

Answer 32

When the coronary arteries cannot deliver enough oxygen rich blood to the heart. It is a very common cause of heart attack. Acute coronary syndromes are usually linked to atherosclerosis.

Question 33

What is the CHD pathway?

Answer 33

Disruption of atherosclerotic plaque, platelet aggregation and thrombus formation, risk of embolus formation, thrombus/embolus blocking blood flow to myocardium.

Question 34

What are the aetiologies of myocardial infarction?

Answer 34

Atherosclerotic plaque rupture or erosion with super impose thrombus
vasculitis syndromes
coronary embolism
congenital abnormalities of coronary arteries
severe coronary artery spasm
states of reduced oxygen supply

Question 35

Explain how myocardial infarction is associated with pain

Answer 35

The location of the blockage determines the site of ischemic damage. Stressed and ischemic cardiomyocytes release inflammatory mediators. The activation of nociceptors results in pain.

Question 36

What is arrhythmias?

Answer 36

Abnormalities of the electric rhythm. It is associated with a wide range of common clinical problems, such as common benign palpitation. It can cause problems with impulse formation, abnormally slow heart rhythm and abnormally fast rhythms.

Question 37

Define Angina pectoris

Answer 37

Persistent chest pain that is caused by limited blood flow to the heart

Question 38

Define aneurism

Answer 38

Blood filled bulge of a blood vessel and swelling in the artery wall