cv questions 2 Flashcards
features of coagulation disorders?
DEEP BLEEDING
DELAYED ONSET
SPORADIC BLEEDING INTO JOINTS
BLEEDING AFTER SURGERY
tests for coagulation disorders?
APTT, PT
BLOOD COUNT
CF ASSAYS
Which 3 conditions see a raised SPTT and normal PT?
HAEMOPHILIA A AND B
FACTOR 11 AND 12 DEfICIENCY
when is a normal APTT and raise PT seen?
factor 7 deficiency
which conditions see a normal APTT and raised PT
factor 7 deficiency
in which conditions are both aptt and pt raised?
liver failure
transfusion
dic
anticoagulant
what is seen in cryoprecipitate?
wvf
factor 2
factor 8
factor 13
what 2 new therapies could be used for haemophilia?
gene therapy
bispecific antibodies which bind to f9a and f10 and mimics the procoagulant function of 8
how does thrombophilia present?
YOUNG AGE,
THROMBOSIS DESPITE
ANTICOAGULATION
what do proteins c and s do
prevent clotting by inactivating 5a and 8a
what does antithrombin do?
inactivates 2a and 10a
how does warfarin work?
vit k inhibitor
what are the 3 layers of blood vessels?
ADVENTITIA - VASA VASORUM, NERVES
TUNICA MEDIA - SMOOTH MUSCLE
LAMINA INTIMA - ENDOTHELIUM
how are capillaries and venules supported?
1 cell thick
suppoted by matrix and mural cells
what 5 functions does the endothelium regulate?
ORGAN REGENERATION INFLAMMATION PROLIFERATION VASCULAR TONE AND PERMIABILITY HAEMOSTASIS AND THROMBOSIS
outline how an atheroscleroma form?
increased vascular permiability due to endothelial activation more LDLs in, bind to proteoglycan more immune cells macrophages in foam cells release metalloproteinases angioneogenesis
roles of no on endothelium?
VASODILATES
REDUCES PROLIFERSTION
LESS WHITE CELL ADGESION
LESS OXIDATION OF LDL
what does laminar flow promote?
antiinflammatory
antiproliferative
antithrombotic
what are the 3 laters of the heart?
endocardium
myocardium
epicardium
what is the tetrology of fallot
pulmonary stenosis
overriding aorta
VSD
rv hypertrophy
what is heard on ascultatino of aortic stenosis?
systolic murmur moving towards s2
risk factors of aortic stenosis?
rheumatic fever age elevated CRP hypertension ckd ldl
outline the pathophysiology of aortic stenosis
STIFFENING OF VALVES - MORE DIFFICULT TO GET BLOOD OUT -
REDUCED CARDIAC OUTPUT AFTER COMPENSATION MECHANISMS FAIL.
LEFT SIDED HYPERTROPHY.
SYSTOLIC HEART FAILUTE
how does aortic stenosis present?
tachynpoea, chest pain, ejection murmur
5 investivgations for aortic stenosis?
echo ecg cardiac mri cxr cardiac catheterisation
primary treatment for aortic stenosis?
valve replacement
beta blockers, alpha blockers, bp control, statins
2 things which may cause aortic vavle insufficiency
rupture due to infection or dilation of aortic root
sequelae of chronic aortic regurgitation
congestive heart failure
oedema
sequelae of acute aortic regurgiation?
acute decompensation,
cardiogenic shock,
pulmonary oedema
5 causes of aortic regurgitation?
infective endocarditis
rheumatic fever
marfans
trauma
outline the pathophysiiology of acute AR?
RUPTURE OF VALVES,
REDUCED CARDIAC OUTPUT, REDUCED DIASTOLIC PRESSURE,
BACKFLOW TO PULMONARY VEINS LEADING TO PULMONARY OEDEMA HYPOPERFUSION TO ORGANS AND SHOCK
outline the pathophysiology of chronic ar?
SAME BUT INSIDIOUS WITH COMPENSATION MECHANISMS.
LV HYPERTROPHY, DYSNPNOEA, LOW CORONARY PERFUSIUON
how does acute ar present?
austin flint murmur
tachycardia
pulmonary oedema
how does chronic ar present
wide pulse pressure
pistol shot pulse
how is chronic ar treated?
ASYMPTOMATIC - BETA BLOCKERS AND BP MEDICATIONS
SEVERE ASYMOTOMATIC - REPLACEMENT
SYMPTOMATIC - REPLACEMENT
how is acute ar treated?
valve replacement and vasodilators
how does mitral stenosis cause pulmonary hypertension?
STIFFENING OF MITRAL VALVE, BACKFLOE INTO PULMONARY VEINS AND PULMONARY HYPERTENSION
3 causes of mitral stenosis?
theumatoid fever
sle
carcinoid syndrome
how does mitral stenosis present?
dyspnoea, haemoptysis, chest pain, diastolic murmur
when is a balloon valvectomy offered in mitral stenosis/
severe asymptomatic
severe symptomatic
pathophysiology of mitral tegurgitation?
BACKFLOW, PROLONGED VOLUME OVERLOAD, VENTRICULAR DYSFUNCTION, LV FAILURE
how does mitral regurgitation present?
murmur,
deminished s1
atrial fibrilation
how is acute mitral regurgitation treated?
replacement
intraaortic balloon counterpulsation
preop diuretics
how is chronic asymptomatic ar treated?
ACEi
drugs and surgery if EF<60
what is the first line treatment for mr if ef is low?
intraaortic balloon counterpulsation
pathyphysiology of dilated cardiomyopathy?
enlargemet of lv low ef increase in esv and wall stress compensation fails hf
presentation of dilated cardiomyopathy
displaced apex beat
treatment of dilated cardiomyopathy
councelling diet modification treat underlying condition ace i b blockers diuretics heart transplant
hypertrophic cardiomyopathies
abnormal diastolic function as small cavity increased ventricular pressure ventricular failure ischaemia t ocoronary vessels myopathy death
investifations for hypertrophic cardiomyopathy
hb level (low) bnp troponin (higher levels of these indicate higher risk) echo chest xray cardiac mri
management of hypertrophic cardiomyopathy?
beta blockers
veramapril (ccb)
pacemaker
septal ablation
what is restrictive cardiomyopathy?
characterised by diastolic dysfunction and normal systolic function
volume and thickness of ventricles usually normal
the muslce is stiffened so cant contract properly in diastole
some causes of restrictive cardiomyopathy?
familial (troponin muttion)
sacoidosis
fabrys disease
scleroderma
outline the pathophysiology of restrictive cardiomyopathy
muscle is stiff so cant relax or contract properly in diastole - reduced compliance
increased stiffness leads to increased ventricular pressure, reduced compliance, cant fill properly
lower co
presentation of restrictive cardiomyopathy
comfortable in sitting pos hepatomegaly weight loss easy bruising low sv and co
investigations for restrictinve myopathy
cbc serology, amyloidosis check xray ecg cho catheterisation
management
heart failure medication (acei and arbs, diuretics)
anti arrhythmia
steriods for immunosuppression
pacemaker
cardiac transplantation
what is the equation for ph?
[H+]= 10(-pH)
what is the role of macrophage scavenger receptors a and b?
A - BINDS TO OXIDISED LDL AND DEAD CELLS AND BACTERIA
B - BINDS TO OXIDISED LDL AND MALARIA
what free radicals do macropgages release?
METALLOPROTEINASES
NADPH OXIDASE
MYELOPEROXIDASE
what does il 1 do to vcam
upregulates it
what 3 other things do macrophage do to cause atherosclerosis
CYTOKINES IL1
CHEMOKINES - MCP UP
EXPRESS CHEMOATTRACTANTS
FREE RADIACS
what does nuclear factor kappa b do?
MASTER REGULATOR OF ATHEROSCLEROSIS
MATRIX METALLOPROTEINASES
NO SYNTHASE
IL1
