CV Flashcards
3 conditions/events that atherogenesis can lead to
MI
stroke
gangrene
risk factors for atherogenesis
age tobacco smoking ^serum cholesterol obesity hypertension diabetes fam history genetics
chemoattractants definition
chemicals that attracts leukocytes
when monocytes move into the plaque they become..?
macrophages
4 stages of atherogenesis:
- fatty streak
- intermediate lesion
- fibrous plaque/advanced lesion
- plaque rupture
new alternative drug to statins (where statins are ineffective or not tolerated), target..?
drugs target PCSK9 enzyme
what is PCSK9?
Enzyme - modulates plasma LDL-C levels & cholesterol homeostasis
major limitation of stenting? and solution
restenosis > drug eluting stents
what must happen to calcium in the heart muscle for relaxation to occur?
removal of Ca
is blood flow through myocardium, from aortic root systolic or diastolic?
DIASTOLIC
normal systolic ejection fraction is (%)
60-65%
examples of adaptive/physiological myocardial hypertrophy?
pregnancy, athletes
hypertrophic response triggered by..?
angiotensin 2
endothelin-1
IGF-1
TGF-beta
what does left-sided cardiac failure cause?
pulmonary congestion
then overload of right side
what does right sided cardiac failure cause?
venous hypertension and congestion
example of infection that can lead to congenital heart disease
rubella
example of condition that ^s risk of congenital heart disease
diabetes
causes of initial L>R shunt in congenital heart disease
VSD
ASD
PDA
truncus arteriosus
cause of initial R>L shunt in congenital heart disease
tetralogy of fallot
4 aspects of tetralogy of fallot
- RV outflow obstruction
- ventricular septal defect
- aorta dextroposition
- RV hypertrophy
congenital heart defects with no shunt
TGA [transposition of great vessels]
coarctation of aorta
pulmonary/aortic stenosis
etc.
eisenmenger’s syndrome:
L>R shunt due to congenital defect,
causes ^flow through pulm vasculature > pulm hypertension
ass. w/ R side hypertrophy and cardiac failure
what is coarctation
and where is blood diverted?
narrowing of the aorta
blood > carotid and subclavian
what is ebstein’s anomaly/malformation?
tricuspid valve defect
atrialisation of RV
what is a patent foramen ovale?
unfused fossa ovalis
channel between atria
what is a paradoxical embolism?
clot that travels from vein > artery
travels through foramen ovale, bypassing lungs that normally act as a ‘filter’
what is a berry aneurysm?
small aneurysm [looks like a berry]
classically occur in circle of Willis
frequently rupture
infective endocarditis definition
inflammation of inner tissues of the heart [e.g. valves]
caused by pathogens [usually bacteria]
what is dextrocardia?
normal anatomy of the heart reversed
ass. w/isomerism of visceral organs
ass. w/ severe cardiac abnormalities
danger of reperfusion of ischaemic tissue?
superoxide radical generation > further damage
cardiogenic shock
heart can’t pump enough blood for body’s needs
most often after severe MI
define hypertension in mmHg
> 140/90
cor pulmonale is…
RV hypertrophy & dilatation
due to pulmonary hypertension
e.g. emphysema
features of R side cardiac failure, seen in cor pulmonale
venous overload
peripheral oedema
progressive hepatic congestion
what is acute rheumatic fever?
group A beta-haemolytic streptococcus infection
where is the initial infection usually in acute rheumatic fever?
upper respiratory tract e.g. strep pharyngitis
peak age for acute rheumatic fever?
5-15
but can occur in adults
how does acute rheumatic fever affect the heart?
antibodies against strep cross react w/ cardiac myocytes & valvular glycoproteins
localised inflammation > scarring
what is chorea?
neurological disorder
spasmodic unintentional movements
shoulders/hips/face
what is erythema marginatum?
transient pink coalescent [joined] rings
on trunk & inner surfaces of limbs
[EXTENSOR SURFACES]
what is ESR?
erythrocyte sedimentation rate
non-specific inflammatory marker
disorders affecting cardiac valves
acute rheumatic fever
SLE
rheumatoid arthritis [stiffening]
ankylosing spondylitis
causes of infective endocarditis
rheumatic valvular disease mitral valve prolapse/ regurgitant valve IV drug abuse prosthetic valve surgery
what pathogens cause infective endocarditis characteristically?
streptococcus/staphylococcus
consequences of infective endocarditis?
cardiac failure sepsis infected thromboemboli kidney damage etc
what type of valve causes accelerated calcific aortic stenosis?
bicuspid aortic valve
causes of calcific aortic stenosis
degenerative
rheumatic aortic valve disease
effect of calcific aortic stenosis on the heart
obstruction to LV outflow
> pressure overload
> hypertrophy
calcific aortic stenosis increases risk of…
MI
infective endocarditis
describe heart sound in mitral valve prolapse
S3 [extra heart sound after S1 & S2]
snap of redundant leaflets as they prolapse into left atria
what is myocarditis & most common cause?
inflammation of the myocardium
most commonly due to virus
describe what happens in the 2 phases of myocarditis [acute & healing]
ACUTE PHASE: lymphocyte infiltrate destroying fibres
HEALING PHASE: patchy fibrosis
describe giant cell myocarditis
very rare, highly aggressive, often fatal
macrophage giant cells > muscle cell death
cardiomyopathy definition
chronic disease of the heart muscle
describe dilated cardiomyopathy
dilated LV
contracts poorly
causes of secondary dilated cardiomyopathy
alcohol
drugs
pregnancy
describe hypertrophic cardiomyopathy
& what causes it?
ventricular hypertrophy > impaired diastolic filling, decreased stroke vol
sarcomeric protein gene mutations
arrhythmogenic RV cardiomyopathy
fibro-adipose replacement of RV wall
> ventricular tachycardia
describe primary restrictive cardiomyopathy
& most common cause?
rigid myocardium, restricts diastolic filling
most common cause is amyloidosis
what is sarcoid?
chronic granulomatous disease
w/ numerous non-caseating giant cell granulomas
how does sarcoid affect the heart?
widespread areas of fibrosis
& compensatory hypertrophy
can produce restrictive disorder
what are channelopathies?
ion channel protein gene mutations
what is cardiac myxoma?
most common type of heart tumour - benign
2 ways that viruses cause damage in myocarditis
direct viral toxicity & cell-mediated immunity damage
describe type of cells in cardiac myxoma
jelly-like proliferation of myxoid cells
in which chambers is cardiac myxoma more commonly found?
atria
narrow QRS complex suggests what kind of tachycardia?
supraventricular
what is the most common sustained arrhythmia?
atrial fibrillation
causes of secondary bradyarrhythmias
hypothyroidism
myocarditis
drugs [beta blockers]
atrial ischaemia
symptoms of SAN or AVN bradyarrhythmias
syncope
palpitations
dyspnoea
definition of bradycardia in bpm
definition of tachycardia in bpm
> 100bpm
types of sinus pause bradyarrhythmias
sinus arrest
sinoatrial exit block
how do AVN bradyarrhythmias look on ECG
PR interval is prolonged
what is AV block?
intermittent failure of supraventricular impulse being conducted to the ventricles
what causes atrioventricular nodal re-entry tachycardia [AVNRT]
‘ring’ conducting pathway in the AV node - each ‘limb’ has a different conduction time
commonest supraventricular tachycardia?
AV node re-entry tachy
what causes AV reciprocating tachy [AVRT]?
an accessory pathway
leading to 2 electrical pathways depolarising the ventricles
example of an AVRT
wolf-parkinson-white syndrome
treatment for AVNRT
use a high energy catheter to ‘burn’ away one of the 2 pathways
infective endocarditis: when to operate?
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
treatment of infective endocarditis
antimicrobials
treat complications e.g. arrhythmia, embolus
surgery
diagnostic tools in infective endocarditis
echo - TTE [trans-thoracic], TOE [trans-oesophageal] cultures ECG JVP (jugular venous pressure) -tricuspid auscultation [murmur]
presentation of infective endocarditis
systemic infection [fever]
valve dysfn. [arrhythmia, heart failure]
embolisation [stroke, PE, MI, kidney dysfn.]
endocardial lined structures [other than valves] where infective endocarditis can occur
septal defects
pacemaker leads
surgical patches
what are vegetations?
lumps of infected fibrin/clot hanging off heart valves
what is a nidus?
place where bacteria have multiplied/ focus of infection
most common cause of infective endocarditis after dental complications?
streptococcus viridans
presentation of rheumatic fever
name 3
fever large joint pain [polyarthritis] loss of appetite chest pain [carditis] subcutaneous nodules erythema marginatum Sydenham's chorea
what would a blood count show in a patient with rheumatic fever?
raised ESR
leucocytosis
what does the Duckett Jones criteria for diagnosing rheumatic fever involve?
clinical features
+ evidence of recent strep infection
treatment for rheumatic fever
bed rest
high dose aspirin
penicillin [treat initial infection + prophylaxis for people with cardiac damage]
