CV Path

Question 1

what is the definition of ischamic heart disease

Answer 1

genetic designation or a group of syndromes resulting from myocardial ischameia - an imbalance between oxygen supply and demand

Question 2

what are 4 types of ischaemic heart disease syndromes

Answer 2

myocardial infarction - ischaemia causing myocardial cell death

angina pectoris - less severe ischameia with no death

chronic IHD - HF

sudden cardiac arrest

Question 3

apart from IHD syndromes what other syndrome is associated with IHD

Answer 3

acute coronary syndrome

Question 4

what are the risk factors of IHD

Answer 4

high total cholesterol to HDL ie higher LDL Conc, high BP, life factors ie smoking weight

Question 5

what pathologically causes IHD

Answer 5

coronary atherosclerosis

Question 6

what is the pathogenesis of IHD

Answer 6

atherosclerosis and endothelial dysfunction - vessel narrowing and abnormal vascular tone - imbalance of O2

Question 7

what does narrowing of coronary arteries initially cause

Answer 7

stable angina

Question 8

what are two types of thrombus that form in coronary arteries and what do they cause

Answer 8

mural thrombus - doesn’t complete block - unstable angina

occlusive angina - completely blocks - MI or sudden cardiac death

Question 9

what are two types of tissue MI

Answer 9

transmural - full thickness of myocardium death

subendocardial - inner one third of the wall

Question 10

what myocardial changes occur during MI

Answer 10

1-2 days = pale oedema and myocyte necrosis

3-4 days - yellow with haemorrhagic edges, necrosis and macrophages

1-3 weeks = pale, thin, granulation tissue, fibrosis

3-6 weeks - fibrous scars

Question 11

what complications can occur due to MI

Answer 11

arrhythmia 
congestive heart failure 
thromboembolism 
ventricular aneurysm leading to cardiac tamponade 
cariogenic shock

Question 12

what are the blood markers of IHD

Answer 12

troponins T&I - from damaged myocytes (HF, PE, myocarditis)

creatine kinase MB - myocardium and skeletal muscle

myoglobin - skeletal muscle

lactate dehydrogenase isoenzyme 1

aspartate transaminase - also present in the liver so not good specific marker

Question 13

what level of sustained blood pressure increased would mean primary HT

Answer 13

140/90

Question 14

what BP is classed as malignant hypertension

Answer 14

180/120 or greater - urgent treatment required before organ damage

Question 15

what is the cause of 90% primary hypertension cases

Answer 15

idiopathic

multifactorial - genetics, obesity, alcohol, smoking, stress

Question 16

what is the cause of secondary hypertension

Answer 16

caused by underlying condition
cushings - increased cortisol - stimulates sympathetic nervous system

conns - increased aldosterone - more na a fluid upstate

pheochromocytoma - increased catecholamine

coarctation of aorta

renal artery stenosis

Question 17

what are the 4 main complications of having raised BP

Answer 17

renal disease - renal cortical scarring
cerebrovascular disease - subarachnoid haemorrhage secondary to berry anuyreusm
systemic heart disease - left sided heart disease
cor pulmonale - right sided heart disease due to hypertension in pulmonary vessels

Question 18

what diseases can cause cor pulmonale

Answer 18

diseases of the pulmonary parenchyma
diseases of pulmonary vessels
disorders affecting chest movement
arterial compression

Question 19

what is an aneurysm

Answer 19

a localised abnormal dilation of blood vessel or the wall of the heart

Question 20

name 4 types of aneurysms

Answer 20

true aneurysm - all arterial wall dilates outward (tinuca adventitia, media and intima)

false - a breach in the vascular wall leading to extravascular haematoma that freely communicates with the intravascular space

arterial dissection - same as false bu haematoma dissects the layers

mycotic - infected aneurysm - can be secondary to infective endocarditis

Question 21

what is the aetiology (cause) of aneurysm

Answer 21

atherosclerosis, cystic medial degernation (necrosis of tunica media of arteries), trauma, congenital defects, infections

Question 22

which syndrome is assciated with necrosis of tunica media of arteries and aneurysm

Answer 22

marfan syndrome

Question 23

what is obliterative endarteritis

Answer 23

inflammation of the intimacy vessels often caused by the tertiary stage of syphillis