Heart Disorders 1

Question 1

describe the structure of the heart.

Answer 1

right atrium
right ventricle
left ventricle
left atrium
aorta

Question 2

what valve separates the right atrium from the right ventricle?

Answer 2

bicuspid

Question 3

describe the circulation of blood in the heart (11)

Answer 3

right atrium
bicuspid valve
right ventricle
pulmonary valve
pulmonary artery
lungs
pulmonary veins
left ventricle
mitral valve - mitra - friends
left atrium
aorta

Question 4

what 3 vessels provide oxygenated blood to the heart?

Answer 4

left anterior descending coronary artery
circumflex coronary artery
right coronary artery

Question 5

describe the left main coronary artery.

Answer 5

arises from the aorta and branches into:
- left anterior descending coronary artery
- circumflex coronary artery

Question 6

describe diastole?

Answer 6

the relaxation of ventricles
fill the ventricles with blood

Question 7

describe systole

Answer 7

contraction of ventricles
blood is ejected from ventricles into pulmonary or systemic circulation

Question 8

define ischaemic heart disease

Answer 8

injury to the heart as a result of hypoxia
- from reduced blood flow
- due to mechanical obstruction to the coronal arteries

Question 9

give 7 risk factors for ischaemic heart disease

Answer 9

smoking
obesity
hypertension
diabetes
age
family history
dyslipidaemia

Question 10

what is dyslipidaemia? how do you treat it?

Answer 10

abnormal lipid levels
due to more LDL

treated with statins - medicine to lower cholesterol in blood

Question 11

give an aetiology which contributes to 90% of ischaemic heart disease

Answer 11

90% come from coronary artery atherosclerosis

Question 12

give 5 different outcomes for IHD (5)

Answer 12

• myocardial infarction from sustained hypoxia
• unstable and stable angina - chest pain
• chronic ischaemic heart disease
• heart failure
• sudden cardiac death

Question 13

what can be the complications of myocardial infarction?

think that heart attack, it has been attacked and electrified

Answer 13

impaired contractility of the heart

tissue necrosis

electrical instability

pericardial inflammation

Question 14

what is the pericardium?

Answer 14

a fibrous sac surrounding the heart

Question 15

with complications of MI, what can be 6 outcomes? 1 within the system, and 5 within the heart

Answer 15

stroke
cardiogenic shock
congestive heart failure
cardiac tamponade - heart compressed due to excess fluid in pericardium
arrthymias
pericarditis

Question 16

what can impaired contractibility of the heart lead to?

Answer 16

• promote thrombus = stroke, embolism

-hypotension - more ischaemia = cardiogenic shock

• congestive heart failure

Question 17

what can tissue necrosis of the heart lead to? (3)

Answer 17

• papillary muscle infarction
  = muscles in the ventricles
• valve collapsing = congestive heart failure
• ventricular wall ruptures = cardiac tamponade

Question 18

what is electrical instability called in the heart?

Answer 18

arrhythmias

Question 19

what does pericardial inflammation lead to?

Answer 19

pericarditis

Question 20

what are some treatments for ischaemic heart disease? (5)

Answer 20

drugs - statins

angioplasty - insert balloon to blocked artery to allow blood flow

stents - permanent tube to open lumen

arrhythmias - implantable defibrillator

heart failure - ventricular assist device - help the heart pump better

Question 21

what are the key clinical features of ischaemic heart disease (8) and how may it be triggered

Answer 21

• angina pectoris - strangled chest
  when the myocytes are damaged and release inflammatory mediators
• retrosternal chest pain - feels like its behind the chest
• radiation to epigastrium, back, neck, jaw or shoulders
• pale
• clammy
• sweaty
• nauseous
• weak pulse/low blood pressure
• breathlessness
• triggered by physical exertion, eating, exposure to cold or stress

Question 22

define ‘stable angina’, how it presents, how long it lasts and how it is relieved

Answer 22

a significant, progressive occlusion of the vessel

classic chest pain symptoms
- lasts 1-5 minutes
- relieved by rest or glyceryl trinitrate drug

Question 23

define ‘unstable angina’, how does it present, how long does it last and how does it come about?

Answer 23

when an unstable atherosclerotic plaque ruptures

• intense
• lasts a long time
• can be spontaneous or in periods of less exertion

Question 24

define ‘acute coronary syndromes’

Answer 24

the sudden dramatic onset of severe chest pain which isn’t relieved by rest

Question 25

what is a difference between myocardial infarction and unstable angina?

Answer 25

unstable angina - there is no detectable cell damage

Question 26

how can you diagnose ischaemic heart diseases? (3)

Answer 26

clinical features changes on ECG cardiac blood markers

Question 27

how are cardiac blood markers used?

Answer 27

marks the proteins within the myocytes - if myocytes die, proteins released into the bloodstream - can detect them and see if the cells have died

Question 28

what protein is found within the myocytes?

Answer 28

troponin

Question 29

define heart failure

Answer 29

an inability of the heart to pump enough blood to meet metabolic demands of the body

Question 30

describe the aetiology of heart failure (4)

Answer 30

- work overload - valvular heart disease or hypertension - myocardial damage

Question 31

describe the pathogenesis of heart failure (8)

Answer 31

the heart tries to compensate - increased contractibility - cardiac hypertrophy - neurohumoural responses : renin angiotensin system is activated : regulate the volume : fluid is retained : fluid overload

Question 32

what are the key clinical features of heart failure? (4)

Answer 32

fatigue breathlessness peripheral oedema swelling

Question 33

what are the clinical guidelines for patients with stable angina?

Answer 33

if there is previous history - must carry glyceryl trinitrite spray or tablets - use them if they present pain - hospital admission only if necessary

Question 34

what are the clinical guideline for patients with unstable angina or myocardial infarction?

Answer 34

call 999 - comfortable position - give oxygen - give sublingual GTN not intramuscular injection - if you can, give 300mg Aspirin with confirmation

Question 35

what are the clinical guidelines if a patient has non-symptomatic ischaemic heart disease?

Answer 35

a patient is vulnerable 4+ weeks following MI - check with medical practitioner before treatment - low dose aspirin (75mg) should not be stopped before or after dental treatment - antibiotic prophylaxis after coronary artery bypass surgery is not recommended

Question 36

generically, what are the guidelines for IHD patients?

Answer 36

dont stop treatment if there is a low risk of bleeding - delay treatment if required - consult a cardiologist for definitive advice

Question 37

describe valvular heart disease

Answer 37

dysfunction of the heart valves

Question 38

what are the different forms of valvular heart disease and their underlying aetiologies

Answer 38

regurgitation - after heart attack, mitral valve is faulty stenosis - atherosclerosis of aortic valve atresia - congenital - valves are fused

Question 39

what is Ejection Fraction? how is the ejection fraction affected with systolic and diastolic dysfunction?

Answer 39

the proportion of blood within the ventricle that is actually pumped out - usually 55-70% systolic dysfunction = decreased contractibility, EF = <40% diastolic dysfunction - heart is too stiff and cannot fill properly

Question 40

what are the three types of heart failure?

Answer 40

left heart failure right heart failure congestive cardiac failure - combo of both sides

Question 41

what is left heart failure?

Answer 41

- damage to the left ventricle or valves - blood in the pulmonary circuit has nowhere to go = build up and stasis of blood in the left system = inadequate perfusion of organs

Question 42

what are the symptoms of left heart failure?

Answer 42

pulmonary congestion breathlessness oedema systemic hypofusion (organ failure)

Question 43

what is right sided heart failure?

Answer 43

occurs from left sided failure or respiratory disease - increased back pressure through pulmonary and venous circulation, affecting the right side

Question 44

what are the 2 symptoms of right sided heart failure?

Answer 44

leg swelling organ congestion

Question 45

what is congestive cardiac failure? 3 symptoms

Answer 45

a combination of both sides breathlessness pulmonary and peripheral oedema

Question 46

what valve issues can you have?

Answer 46

failure to open fully - stenosis failure to close fully - regurgitation vegetations - become ineffective abnormal valve function

Question 47

define stenosis, what are the 2 types and the most 2 common aetiologies?

Answer 47

when valves fail to open and there is impaired forward flow mitral stenosis aortic stenosis aetiologies: - chronic valvular injury - rheumatic valvular disease

Question 48

what is mitral stenosis? what is it's aetiology and what does it cause?

Answer 48

failure of valve between left atrium and left ventricle to close properly - caused by rheumatic fever causes: obstruction to left atrium - pulmonary congestion - right ventricular hypertrophy - right sided heart failure

Question 49

define regurgitation/incompetence/insufficiency, what are the two types?

Answer 49

failure for valves to close fully and there is flow reversal mitral regurgitation aortic regurgitation

Question 50

where are the papillary muscles?

Answer 50

in the ventricles of the heart

Question 51

how can mitral regurgitation occur (5) ? what does it lead to? how can it be treated?

Answer 51

- calcification of the valve ring - fibrous scarring - from IHD - papillary muscle rupture - endocarditis - mitral valve prolapse leads to pan systolic murmur treated by valve replacement

Question 52

how does aortic regurgitation occur?

Answer 52

- dilation of the ascending aorta - endocarditis - syphilis - rheumatoid arthiritis

Question 53

what are effects of abnormal valve function, what is the overall name for it?

Answer 53

valvular heart disease abnormal blood flow clot formation risk of infection

Question 54

what happens if the valve injury is acute?

Answer 54

can lead to sudden death

Question 55

what happens if the valve injury is chronic and progressive?

Answer 55

leads to heart failure