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Grace Phase 2 > CV > Flashcards

CV Flashcards

1
Q

3 conditions/events that atherogenesis can lead to

A

MI
stroke
gangrene

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2
Q

risk factors for atherogenesis

A 
age
tobacco smoking
^serum cholesterol
obesity
hypertension
diabetes
fam history
genetics
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3
Q

chemoattractants definition

A

chemicals that attracts leukocytes

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4
Q

when monocytes move into the plaque they become..?

A

macrophages

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5
Q

4 stages of atherogenesis:

A
  1. fatty streak
  2. intermediate lesion
  3. fibrous plaque/advanced lesion
  4. plaque rupture
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6
Q

new alternative drug to statins (where statins are ineffective or not tolerated), target..?

A

drugs target PCSK9 enzyme

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7
Q

what is PCSK9?

A

Enzyme - modulates plasma LDL-C levels & cholesterol homeostasis

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8
Q

major limitation of stenting? and solution

A

restenosis > drug eluting stents

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9
Q

what must happen to calcium in the heart muscle for relaxation to occur?

A

removal of Ca

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10
Q

is blood flow through myocardium, from aortic root systolic or diastolic?

A

DIASTOLIC

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11
Q

normal systolic ejection fraction is (%)

A

60-65%

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12
Q

examples of adaptive/physiological myocardial hypertrophy?

A

pregnancy, athletes

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13
Q

hypertrophic response triggered by..?

A

angiotensin 2
endothelin-1
IGF-1
TGF-beta

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14
Q

what does left-sided cardiac failure cause?

A

pulmonary congestion

then overload of right side

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15
Q

what does right sided cardiac failure cause?

A

venous hypertension and congestion

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16
Q

example of infection that can lead to congenital heart disease

A

rubella

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17
Q

example of condition that ^s risk of congenital heart disease

A

diabetes

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18
Q

causes of initial L>R shunt in congenital heart disease

A

VSD
ASD
PDA
truncus arteriosus

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19
Q

cause of initial R>L shunt in congenital heart disease

A

tetralogy of fallot

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20
Q

4 aspects of tetralogy of fallot

A
  1. RV outflow obstruction
  2. ventricular septal defect
  3. aorta dextroposition
  4. RV hypertrophy
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21
Q

congenital heart defects with no shunt

A

TGA [transposition of great vessels]
coarctation of aorta
pulmonary/aortic stenosis
etc.

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22
Q

eisenmenger’s syndrome:

A

L>R shunt due to congenital defect,
causes ^flow through pulm vasculature > pulm hypertension
ass. w/ R side hypertrophy and cardiac failure

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23
Q

what is coarctation

and where is blood diverted?

A

narrowing of the aorta

blood > carotid and subclavian

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24
Q

what is ebstein’s anomaly/malformation?

A

tricuspid valve defect

atrialisation of RV

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25
Q

what is a patent foramen ovale?

A

unfused fossa ovalis

channel between atria

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26
Q

what is a paradoxical embolism?

A

clot that travels from vein > artery

travels through foramen ovale, bypassing lungs that normally act as a ‘filter’

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27
Q

what is a berry aneurysm?

A

small aneurysm [looks like a berry]
classically occur in circle of Willis
frequently rupture

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28
Q

infective endocarditis definition

A

inflammation of inner tissues of the heart [e.g. valves]

caused by pathogens [usually bacteria]

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29
Q

what is dextrocardia?

A

normal anatomy of the heart reversed

ass. w/isomerism of visceral organs
ass. w/ severe cardiac abnormalities

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30
Q

danger of reperfusion of ischaemic tissue?

A

superoxide radical generation > further damage

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31
Q

cardiogenic shock

A

heart can’t pump enough blood for body’s needs

most often after severe MI

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32
Q

define hypertension in mmHg

A

> 140/90

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33
Q

cor pulmonale is…

A

RV hypertrophy & dilatation
due to pulmonary hypertension
e.g. emphysema

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34
Q

features of R side cardiac failure, seen in cor pulmonale

A

venous overload
peripheral oedema
progressive hepatic congestion

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35
Q

what is acute rheumatic fever?

A

group A beta-haemolytic streptococcus infection

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36
Q

where is the initial infection usually in acute rheumatic fever?

A

upper respiratory tract e.g. strep pharyngitis

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37
Q

peak age for acute rheumatic fever?

A

5-15

but can occur in adults

38
Q

how does acute rheumatic fever affect the heart?

A

antibodies against strep cross react w/ cardiac myocytes & valvular glycoproteins
localised inflammation > scarring

39
Q

what is chorea?

A

neurological disorder
spasmodic unintentional movements
shoulders/hips/face

40
Q

what is erythema marginatum?

A

transient pink coalescent [joined] rings
on trunk & inner surfaces of limbs
[EXTENSOR SURFACES]

41
Q

what is ESR?

A

erythrocyte sedimentation rate

non-specific inflammatory marker

42
Q

disorders affecting cardiac valves

A

acute rheumatic fever
SLE
rheumatoid arthritis [stiffening]
ankylosing spondylitis

43
Q

causes of infective endocarditis

A 
rheumatic valvular disease
mitral valve prolapse/ regurgitant valve
IV drug abuse
prosthetic valve
surgery
44
Q

what pathogens cause infective endocarditis characteristically?

A

streptococcus/staphylococcus

45
Q

consequences of infective endocarditis?

A 
cardiac failure
sepsis
infected thromboemboli
kidney damage
etc
46
Q

what type of valve causes accelerated calcific aortic stenosis?

A

bicuspid aortic valve

47
Q

causes of calcific aortic stenosis

A

degenerative

rheumatic aortic valve disease

48
Q

effect of calcific aortic stenosis on the heart

A

obstruction to LV outflow
> pressure overload
> hypertrophy

49
Q

calcific aortic stenosis increases risk of…

A

MI

infective endocarditis

50
Q

describe heart sound in mitral valve prolapse

A

S3 [extra heart sound after S1 & S2]

snap of redundant leaflets as they prolapse into left atria

51
Q

what is myocarditis & most common cause?

A

inflammation of the myocardium

most commonly due to virus

52
Q

describe what happens in the 2 phases of myocarditis [acute & healing]

A

ACUTE PHASE: lymphocyte infiltrate destroying fibres

HEALING PHASE: patchy fibrosis

53
Q

describe giant cell myocarditis

A

very rare, highly aggressive, often fatal

macrophage giant cells > muscle cell death

54
Q

cardiomyopathy definition

A

chronic disease of the heart muscle

55
Q

describe dilated cardiomyopathy

A

dilated LV

contracts poorly

56
Q

causes of secondary dilated cardiomyopathy

A

alcohol
drugs
pregnancy

57
Q

describe hypertrophic cardiomyopathy

& what causes it?

A

ventricular hypertrophy > impaired diastolic filling, decreased stroke vol
sarcomeric protein gene mutations

58
Q

arrhythmogenic RV cardiomyopathy

A

fibro-adipose replacement of RV wall

> ventricular tachycardia

59
Q

describe primary restrictive cardiomyopathy

& most common cause?

A

rigid myocardium, restricts diastolic filling

most common cause is amyloidosis

60
Q

what is sarcoid?

A

chronic granulomatous disease

w/ numerous non-caseating giant cell granulomas

61
Q

how does sarcoid affect the heart?

A

widespread areas of fibrosis
& compensatory hypertrophy
can produce restrictive disorder

62
Q

what are channelopathies?

A

ion channel protein gene mutations

63
Q

what is cardiac myxoma?

A

most common type of heart tumour - benign

64
Q

2 ways that viruses cause damage in myocarditis

A

direct viral toxicity & cell-mediated immunity damage

65
Q

describe type of cells in cardiac myxoma

A

jelly-like proliferation of myxoid cells

66
Q

in which chambers is cardiac myxoma more commonly found?

A

atria

67
Q

narrow QRS complex suggests what kind of tachycardia?

A

supraventricular

68
Q

what is the most common sustained arrhythmia?

A

atrial fibrillation

69
Q

causes of secondary bradyarrhythmias

A

hypothyroidism
myocarditis
drugs [beta blockers]
atrial ischaemia

70
Q

symptoms of SAN or AVN bradyarrhythmias

A

syncope
palpitations
dyspnoea

71
Q

definition of bradycardia in bpm

A
72
Q

definition of tachycardia in bpm

A

> 100bpm

73
Q

types of sinus pause bradyarrhythmias

A

sinus arrest

sinoatrial exit block

74
Q

how do AVN bradyarrhythmias look on ECG

A

PR interval is prolonged

75
Q

what is AV block?

A

intermittent failure of supraventricular impulse being conducted to the ventricles

76
Q

what causes atrioventricular nodal re-entry tachycardia [AVNRT]

A

‘ring’ conducting pathway in the AV node - each ‘limb’ has a different conduction time

77
Q

commonest supraventricular tachycardia?

A

AV node re-entry tachy

78
Q

what causes AV reciprocating tachy [AVRT]?

A

an accessory pathway

leading to 2 electrical pathways depolarising the ventricles

79
Q

example of an AVRT

A

wolf-parkinson-white syndrome

80
Q

treatment for AVNRT

A

use a high energy catheter to ‘burn’ away one of the 2 pathways

81
Q

infective endocarditis: when to operate?

A 
infection not cured by antibiotics
severe valve damage
aortic root abscess
remove infected device
replace valve when infection cleared
remove large vegetations before they embolise
82
Q

treatment of infective endocarditis

A

antimicrobials
treat complications e.g. arrhythmia, embolus
surgery

83
Q

diagnostic tools in infective endocarditis

A 
echo - TTE [trans-thoracic], TOE [trans-oesophageal]
cultures
ECG
JVP (jugular venous pressure) -tricuspid
auscultation [murmur]
84
Q

presentation of infective endocarditis

A

systemic infection [fever]
valve dysfn. [arrhythmia, heart failure]
embolisation [stroke, PE, MI, kidney dysfn.]

85
Q

endocardial lined structures [other than valves] where infective endocarditis can occur

A

septal defects
pacemaker leads
surgical patches

86
Q

what are vegetations?

A

lumps of infected fibrin/clot hanging off heart valves

87
Q

what is a nidus?

A

place where bacteria have multiplied/ focus of infection

88
Q

most common cause of infective endocarditis after dental complications?

A

streptococcus viridans

89
Q

presentation of rheumatic fever

name 3

A 
fever
large joint pain [polyarthritis]
loss of appetite
chest pain [carditis]
subcutaneous nodules
erythema marginatum
Sydenham's chorea
90
Q

what would a blood count show in a patient with rheumatic fever?

A

raised ESR

leucocytosis

91
Q

what does the Duckett Jones criteria for diagnosing rheumatic fever involve?

A

clinical features

+ evidence of recent strep infection

92
Q

treatment for rheumatic fever

A

bed rest
high dose aspirin
penicillin [treat initial infection + prophylaxis for people with cardiac damage]

Grace Phase 2 (9 decks)

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