Heart & blood vessels

Question 1

Name cardiac diseases

Answer 1

Ischaemia & MI, heart failure, valvular heart disease, pericarditis, myocarditis, endocarditis, cardiomyopathy

Question 2

Name vascular diseases

Answer 2

Atherosclerosis, aneurysms, hypertension, diabetic vascular disease, vein diseases

Question 3

Heart failure definition

Answer 3

heart unable to pump blood at rate required for normal functioning
clinically - breathlessness, swelling in legs
causes: IHD, hypertension, arrhythmias, valvular HD, cardiomyopathy, congenital HD
initially heart compensates = cardiac hypertrophy/dilation
eventually inability to maintain normal function
oedema (pulmonary & peripheral) & tiredness

Question 4

Signs & symptoms of heart failure

Answer 4

Symptoms:
left sided = shortness of breath, right sided = leg swelling, fatigue
Signs:
increased respiratory effort, crackles, raised jugular venous pressure, peripheral oedema, pulmonary effusion (fluid outside lungs)

Question 5

Classification of heart failure

Answer 5

Acute vs chronic
Left vs right
Severity
Class 1 = exercise does not cause fatigue, palpitations
Class 2 = exercise does cause fatigue,
Class 3 = less than ordinary exercise causes fatigue, palpitations
Class 4 = fatigue, palpitations, angina at rest

Question 6

Treatment of heart failure

Answer 6

ACE inhibitors, B-blockers to decrease mortality
Loop diuretics, spirolactone, digoxin to treat symptoms
Acutely = high dose IV diuretics and oxygen

Question 7

Valvular disease definition

Answer 7

Stenosis = narrowed valve, impedes forward flow, caused by primary valve cusp abnormality, chronic
Regurgitation = leaky valve, allows reverse flow, caused by disease to cusp but also damage to supporting structures eg tendinous chords, acute/chronic
Vegetation's = abnormal tissue growth on valve (clot/bacteria), causes stenosis, regurgitation, caused by bacteria--- infective endocarditis, inflammatory, clot (fibrin, platlets)

Question 8

Signs & symptoms of valvular disease

Answer 8

Symptoms: syncope (temporary fall in consciousness due to fall in BP), stroke/systemic emboli, arrhythmia, angina, SOB
Signs: cardiac murmur, same as heart failure

Question 9

Infective endocarditis definition

Answer 9

Microbial infection of the inner lining of the heart and its valves
Tends to affect abnormal valves
L sided more common: causes be strep
R sided caused by IV drug use: staph, affects normal valves

Question 10

Signs & symptoms of infective endocarditis

Answer 10

Symptoms: fever, weight loss, SOB, oedema, sepsis
Signs: finger chubbing, splinter haemorrhages

Question 11

Pericarditis & myocarditis definitions

Answer 11

Inflammation involving the heart sac or muscle
Causes by infection (viral, bacterial, TB, parasitic), uraemia, carcinoma, MI
Signs & symptoms:
chest pain, heart failure
Treatment: anti-inflammatory drugs

Question 12

Cardiomyopathy definition

Answer 12

Disease of the heart muscle
3 types:
- dilated = dilation of chambers, heart large and flabby, causes are alcohol
- hypertrophic = abnormal diastolic filling, end stage dilation can occur, causes are genetics
- restrictive = causes are amyloids, chemo/radiation

Question 13

Signs & symptoms of cardiomyopathy

Answer 13

SOB, chest pain, palpitations, sudden death!!!!!!!!

Question 14

Hypertension definition

Answer 14

Elevation of BP to a level likely to cause harm
BP >140/90 = offered monitoring
Categories:
mild = 95-104
moderate = 105-114
severe = >115

Question 15

Classification of hypertension

Answer 15

Primary:
risk factors - genetics = non-modifiable, diet (increase sodium),stress & exercise, smoking, alcohol = modifiable
Secondary:
renal causes - polycystic kidneys
endocrine causes - thyrotoxicosis
physical obstruction - coarctation of aorta
neurogenic causes - acute stress

Question 16

Benign & malignant hypertension

Answer 16

benign = manage with lifestyle changes/daily tablets, slow onset of complications 
malignant = accelerated disease, medical emergency, rapidly rising BP within hours, look for organ damage to heart, brain & kidneys

Question 17

Complications with hypertension

Answer 17

Blood vessels;
Large vessel disease (macroangiopathy) causing atherosclerosis
small vessel disease (macroangiopathy) causing atherosclerosis
Heart:
levels above 140/90 and prolonged = ventricular hypertrophy
Kidneys:
granular appearance due to scaring of glomeruli
can lead to renal failure
Eyes:
hypertensive retinopathy
Brain:
cerebral haemorrhage, cerebral infarction

Question 18

Treatment of hypertension

Answer 18

Smoking cessation, weight loss, exercise, lower cholesterol, anti-hypertensive drugs

Question 19

Aneurysm definition

Answer 19

Localised abnormal dilation of blood vessels
Causes are pressure, atheroma or infection (due to vessel wall weakness)
Treatment - stents, surgery, decrease arterial pressure

Question 20

Types of aneurysm

Answer 20

Atherosclerotic, aortic dissection, berry, micro-aneurysm, syphilitic, mycotic

Question 21

Diabetic vascular disease

Answer 21

damage to vessels = atherosclerosis
damage to kidneys = nephropathy
damage to brain = neuropathy
damage to retinas
complications:
gangrene, renal failure, peripheral neuropathy, blindness

Question 22

Deep vein thrombosis

Answer 22

Caused my immobility, malignancy, pregnancy, child birth and haematological disorders
Danger of pulmonary embolism

Question 23

Pulmonary embolism

Answer 23

Symptoms:
pleuritic chest pain, SOB, calf swelling, sudden death
Treatment - anticoagulation

Question 24

Varicose veins

Answer 24

Common problem
Tortous and distended veins
Caused by incompetent valve in legs, impaired venous return
Associated with ulceration on ankles and legs

Question 25

Congenital heart disease

Answer 25

Septal defect = hole between L and R sides of heart
Can be asymptomatic
Can cause stroke in case of DVT
|ncreased blood entering pulmonary = hypertension
|Pressure increases in R side until blood moves into L side = blood not oxygenated before it is sent round the body