CV Flashcards
what is neointima?
growth of new vessel walls
what is stage 1 of atherosclerosis?
fatty streaks
what is syncope?
loss of consciousness
what should the speed and gain of an ECG be set at?
speed 25mm/s
gain 10mm/mV
what is the order of conduction in the heart?
SA-AV-bundle of his-bundle branches-purkinje fibres
above what is considered high BP?
140/90mmHg
in hypertensive patients what does pharmacology target?
peripheral resistance
what can ECGs identify? (6)
arrhythmias ischaemia and infarction chamber hypertrophy pericarditis electrolyte imbalance drug toxicity
what is the dominant pacemaker of the heart?
sinoatrial node
what is the intrinsic rate of the SA node?
60-100bpm
what are the backup pacemakers?
atrioventricular node and ventricular tissue
what is the intrinsic rate of the AV node?
40-60bpm
what are tachycardia and bradycardia?
tachy-fast heart beat
brady-slow heart beat
what is dextrocardia?
heart on the wrong side of the chest
what is stroke volume?
volume ejected from each ventricle during systole
what are risk factors for atherosclerosis?
age obesity smoking diabetes cholesterol hypertension family history
what are 4 components of atherosclerotic plaque?
lipid, necrotic core, connective tissue, fibrous cap
what initiates atherosclerosis?
endothelial damage
what are 3 inflammatory cytokine found in plaques?
IL-1 ***
IL-6
IFN gamma
what is angina?
chest pain caused by ischaemia
what is characteristic of stable angina?
induced by effort
relieved by rest
what is characteristic of unstable angina?
continues at rest
what is the first line for treatment of angina?
GTN spray
how does GTN spray help relieve angina?
- causes systemic veno-dilation meaning the venous return to the heart is less and hence preload is lower. This means the demand on the heart is less.
- causes coronary arteries to dilate
what does PCI stand for?
percutaneous coronary intervention
what are positives of PCI?
less invasive
short recovery
repeatable
what are the negatives associated with PCI?
risk of stent thrombosis
infection
not good for complex cases
what does CABG stand for?
coronary artery bypass graft
what are the negatives associated with CAGB?
invasive
stroke and bleed risk
long recovery time
one off treatment
what are the positives with CABG?
good prognosis
deals with complex disease
which conditions make up acute coronary syndromes?
STEMI
N-STEMI
unstable angina
what are the characteristics of a patient with STEMI in:
a) coronary artery
b) heart muscle ?
a) full occlusion of coronary artery
b) full thickness damage to muscle
what are the characteristics of a patient with NSTEMI in:
a) coronary artery
b) heart muscle
a) partial or complete occlusion
b) partial thickness damage to muscle
what is the detectable difference between NSTEMI and unstable angina?
high serum troponin or creatine kinase MB
what are 5 stages of atherosclerosis leading to MI/stroke?
- fatty streak
- fibrotic plaque
- atherosclerotic plaque
- rupture and thrombus
- MI/stroke
what test can be used to check for cardiomegaly, pulmonary oedema or widened mediastinum due to aortic rupture?
chest xray
what is the target range for oxygen sats in a normal individual?
94-98%
what is the target range for oxygen sats in someone with COPD?
88-92%
what type of drug is aspirin and how does it work?
antiplatelet
COX1 inhibitor- blocking formation of thromboxane A2
what are the consequences of hypertension?
‘cerebrovascular events’- stroke
IHD
peripheral vascular disease
what level is considered hypertension?
140/90 mmHg
at what level, in clinic, does hypertension reach stage 2?
160/100mmHg in clinic
how is severe hypertension quantified?
systolic 180mmHg+
diastolic 110mmHg+
what causes of hypertension make up primary hypertension?
primary cause unknown but any combination of:
- genetics
- sympathetic activity
- high salt
- faulty membrane transporters
- RAAS abnormalities
what are the causes of secondary hypertension?
renal disease
pregnancy
what is the most common cause of secondary hypertension?
chronic kidney disease
what is the most common cause of chronic kidney disease?
diabetes
which drugs can cause hypertension?
corticosteroids erythropoietin contraceptive pill alcohol ecstasy cocaine
what are risk factors of hypertension?
age race family history obesity lack of exercise smoking salt intake alcohol diabetes stress
what is malignant hypertension?
high blood pressure with life threatening side effects, risk to one or more organs
what are the consequences of malignant hypertension?
cardiac failure
blurred vision
renal failure
severe headache
what are the treatments for hypertensives?
-lifestyle changes
-ACD
ace inhibitors
calcium channel blockers
diuretics
what is treatment goal for BP in hypertensives?
140/90mmHg
how do hypertensives usually present clinically?
asymptomatic unless malignant hypertension
what tests can be done in a hypertensive do detect LV hypertrophy?
ECG, echocardiography
what is infective endocarditis?
infection of the endocardium or vascular endothelium of the heart
what type of endocarditis is common in IVDU?
right sided endocarditis
which type of virulent organisms commonly infect normal valves?
streptococcus pneumoniae
staphylococcus aureus
what are risk factors for infective endocarditis?
IV drug use poor dental hygiene dental treatment IV cannula pacemaker cardiac surgery
how does poor dental hygiene increase risk of infective endocarditis?
gum disease causes bleeding gums and therefore bacteria is able to enter bloodstream
what are the 4 valvular heart diseases?
mitral stenosis
aortic stenosis
mitral regurgitation
aortic regurgitation
what type of valve is the mitral and where does it sit?
bicuspid valve
between left atrium and ventricle
what is heart failure?
inability of the heart to deliver blood (o2) at equivalent rate to requirement of metabolising tissue
what is the main cause of heart failure?
IHD
what are causes of heart failure?
IHD cardiomyopathies valvular diseases cor pulmonale (pul hypertension causes) hypertension alcohol arrhythmias pregnancy etc
risk factors for heart failure
65+ African descent male obesity previous MI
what are the 2 types of acute MI?
STEMI and NSTEMI
what is an acute myocardial infarction?
necrosis of cardiac tissue due to prolonged ischaemia from occlusion of artery by thrombus
what are the risk factors for MI?
age male CHD premature menopause diabetes smoking hypertension high lipids obesity family history
what are clinical presentations of someone suffering MI?
chest pain- radiating left arm, jaw, neck breathlessness fatigue anxiety pale, clammy. sweating hypotension brady or tachy
what type of valve is the aortic valve and where is it located?
tricuspid valve
separates left ventricle from aorta
how big is the aortic valve in normal adult heart?
3-4cm2
what is the most common valvular disease in the western world?
aortic stenosis
what are the 3 types of aortic stenosis?
supravalvular
valvular
subvalvular
which type of aortic stenosis is most common?
VALVULAR
what type of aortic stenosis is common in elderly?
CAVD- calcific aortic valvular disease
what type of aortic stenosis is a common congenital disease?
BAV- bicuspid aortic valve
calcification of BAV
which congenital disease predisposes to aortic stenosis?
congenital bicuspid aortic valve
from which cells do platelets form?
megakaryocytes
what is menorrhagia?
heavy periods
what are possible causes of macrocytic anaemia?
b12/folate deficiency
liver disease/alcoholism
hypothyroidism
what is anaemia?
reduced red cell mass
what are consequences of anaemia?
reduced o2 transport
tissue hypoxia
what are the compensatory changes as a consequence of anaemia?
increased tissue perfusion
increased O2 transfer to tissues
increased red cell production
what is the normal range roughly for erythrocyte volume in humans?
80-100 fl
what are the 3 categories for anaemia clinically?
macro, normo and microcytic
what are 3 causes of microcytic anaemia?
iron deficiency
chronic disease
thalassaemia
what are 3 causes of normocytic anaemia?
acute blood loss
anaemia of chronic disease
combined haematinic deficiency
how long does a normal red cell survive?
120days
how can a small decrease in red cell numbers be compensated for?
increased erythropoietin
decreased apoptosis
what are the 3 classifications of B thalassaemia clinically?
major, intermedia, carrier
at what age does a patient with B thalassaemia major commonly present~?
6-12 months, baby
what is the lifespan of platelets?
7-10days
what are possible causes of low platelets?
congenital marrow problems drugs splenomegaly autoimmune haemorrhage
what is the name given to the condition of low platelet count?
thrombocytopenia
where are platelets produced and destroyed?
bone marrow
spleen