Heart Disorders 1 Flashcards
describe the structure of the heart.
right atrium
right ventricle
left ventricle
left atrium
aorta
what valve separates the right atrium from the right ventricle?
bicuspid
describe the circulation of blood in the heart (11)
right atrium
bicuspid valve
right ventricle
pulmonary valve
pulmonary artery
lungs
pulmonary veins
left ventricle
mitral valve - mitra - friends
left atrium
aorta
what 3 vessels provide oxygenated blood to the heart?
left anterior descending coronary artery
circumflex coronary artery
right coronary artery
describe the left main coronary artery.
arises from the aorta and branches into:
- left anterior descending coronary artery
- circumflex coronary artery
describe diastole?
the relaxation of ventricles
fill the ventricles with blood
describe systole
contraction of ventricles
blood is ejected from ventricles into pulmonary or systemic circulation
define ischaemic heart disease
injury to the heart as a result of hypoxia
- from reduced blood flow
- due to mechanical obstruction to the coronal arteries
give 7 risk factors for ischaemic heart disease
smoking
obesity
hypertension
diabetes
age
family history
dyslipidaemia
what is dyslipidaemia? how do you treat it?
abnormal lipid levels
due to more LDL
treated with statins - medicine to lower cholesterol in blood
give an aetiology which contributes to 90% of ischaemic heart disease
90% come from coronary artery atherosclerosis
give 5 different outcomes for IHD (5)
- myocardial infarction from sustained hypoxia
- unstable and stable angina - chest pain
- chronic ischaemic heart disease
- heart failure
- sudden cardiac death
what can be the complications of myocardial infarction?
think that heart attack, it has been attacked and electrified
impaired contractility of the heart
tissue necrosis
electrical instability
pericardial inflammation
what is the pericardium?
a fibrous sac surrounding the heart
with complications of MI, what can be 6 outcomes? 1 within the system, and 5 within the heart
stroke
cardiogenic shock
congestive heart failure
cardiac tamponade - heart compressed due to excess fluid in pericardium
arrthymias
pericarditis
what can impaired contractibility of the heart lead to?
- promote thrombus = stroke, embolism
-hypotension - more ischaemia = cardiogenic shock
- congestive heart failure
what can tissue necrosis of the heart lead to? (3)
- papillary muscle infarction
= muscles in the ventricles - valve collapsing = congestive heart failure
- ventricular wall ruptures = cardiac tamponade
what is electrical instability called in the heart?
arrhythmias
what does pericardial inflammation lead to?
pericarditis
what are some treatments for ischaemic heart disease? (5)
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
what are the key clinical features of ischaemic heart disease (8) and how may it be triggered
- 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
define ‘stable angina’, how it presents, how long it lasts and how it is relieved
a significant, progressive occlusion of the vessel
classic chest pain symptoms
- lasts 1-5 minutes
- relieved by rest or glyceryl trinitrate drug
define ‘unstable angina’, how does it present, how long does it last and how does it come about?
when an unstable atherosclerotic plaque ruptures
- intense
- lasts a long time
- can be spontaneous or in periods of less exertion
define ‘acute coronary syndromes’
the sudden dramatic onset of severe chest pain which isn’t relieved by rest
what is a difference between myocardial infarction and unstable angina?
unstable angina - there is no detectable cell damage
how can you diagnose ischaemic heart diseases? (3)
clinical features
changes on ECG
cardiac blood markers
how are cardiac blood markers used?
marks the proteins within the myocytes
- if myocytes die, proteins released into the bloodstream
- can detect them and see if the cells have died
what protein is found within the myocytes?
troponin
define heart failure
an inability of the heart to pump enough blood to meet metabolic demands of the body
describe the aetiology of heart failure (4)
- work overload - valvular heart disease or hypertension
- myocardial damage
describe the pathogenesis of heart failure (8)
the heart tries to compensate
- increased contractibility
- cardiac hypertrophy
- neurohumoural responses
: renin angiotensin system is activated
: regulate the volume
: fluid is retained
: fluid overload
what are the key clinical features of heart failure? (4)
fatigue
breathlessness
peripheral oedema
swelling
what are the clinical guidelines for patients with stable angina?
if there is previous history
- must carry glyceryl trinitrite spray or tablets
- use them if they present pain
- hospital admission only if necessary
what are the clinical guideline for patients with unstable angina or myocardial infarction?
call 999
- comfortable position
- give oxygen
- give sublingual GTN not intramuscular injection
- if you can, give 300mg Aspirin with confirmation
what are the clinical guidelines if a patient has non-symptomatic ischaemic heart disease?
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
generically, what are the guidelines for IHD patients?
dont stop treatment if there is a low risk of bleeding
- delay treatment if required
- consult a cardiologist for definitive advice
describe valvular heart disease
dysfunction of the heart valves
what are the different forms of valvular heart disease and their underlying aetiologies
regurgitation - after heart attack, mitral valve is faulty
stenosis - atherosclerosis of aortic valve
atresia - congenital - valves are fused
what is Ejection Fraction? how is the ejection fraction affected with systolic and diastolic dysfunction?
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
what are the three types of heart failure?
left heart failure
right heart failure
congestive cardiac failure - combo of both sides
what is left heart failure?
- 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
what are the symptoms of left heart failure?
pulmonary congestion
breathlessness
oedema
systemic hypofusion (organ failure)
what is right sided heart failure?
occurs from left sided failure or respiratory disease
- increased back pressure through pulmonary and venous circulation, affecting the right side
what are the 2 symptoms of right sided heart failure?
leg swelling
organ congestion
what is congestive cardiac failure? 3 symptoms
a combination of both sides
breathlessness
pulmonary and peripheral oedema
what valve issues can you have?
failure to open fully - stenosis
failure to close fully - regurgitation
vegetations - become ineffective
abnormal valve function
define stenosis, what are the 2 types and the most 2 common aetiologies?
when valves fail to open and there is impaired forward flow
mitral stenosis
aortic stenosis
aetiologies:
- chronic valvular injury
- rheumatic valvular disease
what is mitral stenosis? what is it’s aetiology and what does it cause?
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
define regurgitation/incompetence/insufficiency, what are the two types?
failure for valves to close fully and there is flow reversal
mitral regurgitation
aortic regurgitation
where are the papillary muscles?
in the ventricles of the heart
how can mitral regurgitation occur (5) ? what does it lead to? how can it be treated?
- 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
how does aortic regurgitation occur?
- dilation of the ascending aorta
- endocarditis
- syphilis
- rheumatoid arthiritis
what are effects of abnormal valve function, what is the overall name for it?
valvular heart disease
abnormal blood flow
clot formation
risk of infection
what happens if the valve injury is acute?
can lead to sudden death
what happens if the valve injury is chronic and progressive?
leads to heart failure
