CVS medicine Flashcards
What is arterioscelorosis?
The hardening and loss of elacity in arterial walls
What is Atheroscelorosis?
A hardening of an artery specfically due to atheromatous plaque
What is the most important risk factor of Atheroscelorsis?
Hyperlipidemia
What does Atheroscelorosis normlly result in the formation of?
An atheroma
What are the 2 processes involved in the formation of an Atheroma?
A Chronic inflammation process followed by a healing response
What happens in the chronic inflammation process of a atheroma formation?
- There is a C. Inflam. response to lipoproteins which damages endothelial cells
- Endothelial cells change cell surface receptor and become more permeable to lipids
- Change in adhesion molecules for monocytes so they can attach to endothelium allowing them to move into the blood vessel walls
- These monocytes include macrophages and T cells which result in the formation of Foam cells and fatty streaks
What happens in the healing phase of a atheroma formation?
- There is a proliferation of smooth muscle cells
- Fibrous tissue begins to form
- Growth factors are produced (such as PDGF, FGF)
- A Fibro fatty plaque forms with central mass of lipid and necrotic tissue
- neovascularization, haemorrhage and calcification may occur
What are foam cells?
During the formation of an atheroma the macrophages engulf the lipids making them large and pale, resulting in the name foam cells
What are the effects of atheroscelorosis?
Ischemia, Thrombosis, Embolism, Infarcation
What is a kaposi sarcoma?
A low grade malignant blood vessel tumour
What is primary prevention?
Trying the prevent the disease from happening in the first place e.g. trying to encorage a healthier diet
What is secondary prevention?
trying to detect disease early and prevent it from getting worse
How do antiplatelet drugs affect platelets?
They affect platelet function or the number of platelets
How do anticoagulent drugs affect platelets?
They interfere with the coagulation cascade
What drug should be given to a victim of a heart attack immediatly
Aspirin
What is a major side effect of aspirin
G.I. bleeding
What drug is key in the management of unstable angina and NSTEMI
Clopidogrel (is a antiplatelet)
Name 2 anticoagulents
Warafin, Rivaroxiban, Apixaban, Dabigatran, Edoxaban
How do Statins work
They inhibit cholesterol synthesis in the liver
Statins are given to patients who have or at risk of high?
Cholesterol
What common dental drug do statins have a possible mytosis with
Fluconazole
What are Beta blockers used for
To manage arrhythmia and protect the heart from a second heart attack or cardiac arrest
What type of chrontropes are Beta blockers
negative
What are diuretics used for
As a antihypertensive and for heart failure
How do diuretics works
They increase salt and water loss
What are the 2 types of diuretics and what are they mainly used for
Thiazide diuretics- mainly given for high blood pressure
Loop diuretics- mainly given for heart failure (by treating oedema)
What are the 2 types of Nitrates
Short and long acting
what is a short acting nitrate used for and give an example of 1
Emergency treatment of angina pectoris, and Glyceryl trinitrate(GTN)
What is a long acting nitrate used for and give an example of 1
Prevention of angina pectoris, and Isosorbide Mononitrate
What is angina pectoris
Reversible ischaemia of heart muscle
How do nitrates work
By dilating veins, resistance arteries and coloateral coronary artery supply
What are Calcium channel blockers used for
To treat Hypertension and migranes
what are ACE inhibitors used for
Treating high blood pressure, heart failure and are often presribed following a heart attack
How do ACE inhibitors works
By inhibiting conersion of Angiotensin I to II
Name a ACE inhibitor
Enalapril, Ramapril (pril ending)
what are possible oral reactions to ACE inhibitors
Angio oedema, Lichenoid reaction
What is coronary heart disease
when the blood vessels suppplying the heart are blocked or narrowed
What are the 2 types of angina pectoris
Stable and unstable
What would an ECG have on a patient that has angina
A S-T segment depression
What is peripheral vacular disease
‘Angina’ of the tissues outwith the heart and brain
What are the 2 types of myocardinal infarction
STEMI and NSTEMI
what is dealier, STEMI or NSTEMI
STEMI
What would there be increased levels of in a patient with myocardinal infarction
Troponin levels
What are the differences between STEMI and a NSTEMI, both on a ECG and in the actual heart
STEMI= a S-T segement elavation on the ECG and complete occlusion of the blood vessel NSTEMI= No S-T segment elevation in an ECG and there is only a partial occlusion of the blood vessel
What drugs would be given to a victim of a MI to prevent a further one
beta blockers, ACE inhibitors, Aspirin
What values of systolic and diastolic blood pressure would be classed as high BP
a Systolic BP > 140mm/Hg
a Diastolic BP> 90 mm/Hg
What drugs treat hypertension
Thiazide diuretics, Beta blockers, Ca channel blockers and ACE inhinitors
What is dysponea
Difficult or laboured breathing
What are the valves of the heart
Aortic, Pulmonic, Mitral, Tricuspid
Who are valve defects common with
Elderly and the Downs
What are the causes of valve disease
Cogneital abnormality
MI
Dilation of the aortic root
Rheumatic failure
What valves most commonly fail in the heart
The left valves (Aortic and Mitral)
What is valve stenosis
Narrowing of the valve opening
What is the best way to investigate valve disease
Doppler ultrasound
Is it ok to replace an infected valve
No
What is the clinical life of a mechanical valve
<30 yrs
What is the clinical life of a tissue valve
<10 yrs
What medication is needed for a patient with a metal valve
Warafin
What is the drug therapy for heart failure
- diuretics to increase salt/water loss
- ACE inhibitors to decrease salt/water retention
- nitrates to decreased venous filling pressure
- inotrope to increase strength of contraction
What is tachycardia
when the heart beats too fast, >100bpm
Name 2 tachyarrhythmias
Atrial fibrillation
Ventricular vibrillation
What is Bradycardia
When the heart beats too slow <60bpm
Name 2 Bradyarrhythmias
Heart block
Drug inuced
What on a ECG shows heart block
prolonged p-q intervals
What is heart block
Slow/no conduction through AV node to ventricles of impulse from SA node
How does a tachyarrhythmia affect cardiac function
It impairs cardiac function by reducing diastolic filling time
What does a atrial tachyarrhythmia look like on a ECG
Narrow QRS
What does a ventricular tachyarrhythmia look like on a ECG
Broad QRS
what can a ventricular tachyarrhythmia lead to
Ventricular fibrillation then death
What is no clear P wave on a ECG mean
Atrial fibrillation
What is atrial fibrillation
Rapid atrial impulses conducted to ventricles giving high HR and disorganised atrial activity
What type of pulse does atrial fibrillation give
An irregularly irregular pulse
What do pacemakers treat
Bradyarrhythmias
What dental instrument is best to avoid theoretically in a patient with a pace maker
Induction scaler
What is ventricular fibrillation
Unstable heart electrical activity
Can you treat Ventricular F with a Defib
yes
Can you treat astyole with a Defib
No
Most common congenital heart defect?
Atrial septal defect
What is cyanosis
when there is 5g/dl or more of deoxygenated Hb in the blood
What is the cause of central cyanosis
cogenital heart disease
Ventricular septal defect can lead to what?
long term heart failure
what is patent ductus arteriosus
A connection between Aorta and pulmonary artery
What test is there to confirm angina
rest and exersize ECG, Angiography, Blood test for troponin levels
What cardiac medicine can cause xerostomia
Diuretics (in the elderly)
MI symptoms and signs?
Swaeting, nausea Pale, Feelig as if they are going to die, short breath
What causes a myocardial infarction and what happens to the tissue as a result
ATHEROMA in the CORONARY VESSELS
PLAQUE surface DETATCHES AND GETS TRAPPED DOWNSTREAM
BLOOD FLOW TO TISSUE IS STOPPED COMPLETELY TISSUE NECROSIS BEGINS
What is bacteraemia
bacteria in the bloodstream
