Heart disorders 1 Flashcards
1
Q
Name the 4 chambers of the heart
A
Right ventricle
Right atrium
Left ventricle
Left atrium
2
Q
What does the right hand side of the heart do?
A
Pumps deoxygenated blood to the lungs
3
Q
What does the left hand side of the heart do?
A
Pumps oxygenated blood to the rest of the body
4
Q
What does diastole mean?
A
Refers to the filing of the ventricles with blood (relaxation phase)
5
Q
What does systole mean?
A
Refers to the contraction phase of the ventricles where good is ejected from the ventricles
6
Q
Name the different valves of the heart
A
- Tricuspid valve
- Pulmonary valve
- Mitral valve
- Aortic Valve
7
Q
Wha does the tricuspid valve separate?
A
It separated the right atrium from the right ventricle
8
Q
What does the mitral valve separate ?
A
The left atrium from the left ventricle
9
Q
What does the pulmonary valve separate?
A
The right ventricle from the pulmonary artery
10
Q
What does the aortic valve separate
A
The aorta from the left ventricle
11
Q
Talk though the path blood takes starting from the vena cava
A
1 Vena cava into the right atrium 2. Cuspid valve 3 Right ventricle 4. Pulmonary valve into the pulmonary artery 5. Lungs 6. Re-enters via the pulmonary vein into the left atrium 7. Mitral valve 8. Left ventricle 9. Aortic valve 10. Aorta to rest of the body
12
Q
What is the general rule regarding blood found in the arteries (and which artery is the exception)
A
Arteries take OXYGENATED blood AWAY from the heart
apart from the pulmonary artery that carries DEOXYGENATED blood AWAY from the heart
13
Q
What is the general rule regarding blood found in the vein (and which vein is the exception)
A
Veins take DEOXYGENATED blood to VISIT the heart
apart from the pulmonary VEIN that carries OXYGENATED blood to VISIT the heart
14
Q
Name the 3 main vessels that supply OXYGENATED blood to the heart
A
- Left anterior descending artery
- The circumflex artery
- The right coronary artery
15
Q
Where is the left anterior descending artery found?
A
Passes down the front of the heart
16
Q
Where is the circumflex artery found?
A
Passes to the left hand side of the heart
17
Q
Where is the right coronary artery found?
A
Passes o the right hand side of the heart
18
Q
Which artery supplies the back of the heart (in most people)?
A
The right coronary artery
19
Q
What are the circumflex artery and left descending coronary artery branches of?
A
The left main coronary artery
20
Q
What is another name for the left main coronary artery?
A
The left main stem
21
Q
What is the significance of the left main corner artery?
A
It is a small branch of the aorta that splits into the
- Left anterior descending artery
- The circumflex artery
22
Q
What is ischaemic heart disease?
A
It describes a GROUP of clinical syndromes that relates to myocardial ischaemia
23
Q
Define ischaemia
A
Cell injury resulting from localised HYPOXIA induced by reduced blood flow, most commonly due to a mechanical arterial obstruction
24
Q
What s another name for ischaemic hart disease?
A
Coronary heart disease
25
What causes ischaemic heart disease in the majority of cases?
Coronary artery atherosclerosis causes this in 90% of cases
26
Give some clinical manifestations of ischaemic heart disease
1. Myocardial infarction
2. Angina (stable or unstable)
3. Chronic ichaemic heart disease and heart failure
4. Sudden cardiac death
27
Nme the leading cause of death in the uk and worldwide
ischaemic heart disease
28
How any deaths in the UK are accused by ischaemic heart disease?
64,000 per year
180 per day
1 every 8 mins
29
Death rates for ischaemic heart disease have fallen over the years why?
1. Awareness o modifiable life style factors
2. Awareness of medical risk factors
3. Better diagnosis and treatment
30
Give some treatment options we now have to manage ischaemic hear disease
1, Drugs like statins
2. Angioplasty
3. Stenting
4. Implantable defibrillators
5. Ventricular asst devices
31
Give some common risk factors fo ischaemic heart disease
1. Smoking
2. Obesity
3. Hypertension
4. Diabetes
5. Old Age
6. Family history
7. Dyslipidaemia
32
Who are more likley to get ischaemic heart disease men or women?
Men are at a grater risk than women
33
What us dyslipidaemia?
Abnormal lipid levels usually increased LDL levels relative t HDL
34
How can we treat dyslipidaemia?
Statins
35
What is the pathogenesis of ischaemic heart disease?
Imbalance between supply of oxygen and demand
36
Talk through the brief stages hat occur in the heart that can lead to myocardial infarction
1. Insufficient coranary perfusion
2. Cardiac hypoxia
3. Cell injury sustained
4, Myocardial cell death
5. Myocardial infarction
37
How can we identify which coronary artery is blocked
By checking on an ECG to see which area of the heart is damaged
38
Which of the three coronary arteries is blocked in the majority of cases?
The left anterior descending artery is blocked in 50% of cases
This is also known as the artery of sudden death
39
Ona cellular level what damage leads to ischaemic heart disease
Mitochondria death which leads to reduced ATP production
| This leads to several problems
40
If the mitochondria becomes damaged what problems can that occur
1. Sodium pump damage causing ER ad cellular swelling and los of microvilli
2, Increased aerobic glycolysis increasing lactic acid levels causing clumping of nuclear chromatin
3. Detachment of ribosomes which decreases protein synthesis
41
What is atherosclerosis?
Material build up in the walls of arteries
42
Does atherosclerosis affect arteries more or veins
Arteries
43
Name three key things that ca lead to the build up of plaque in vessels
1. Build up of lipids
2. smoking
3. high blood pressure
44
Talk through how atherosclerosis can happen
1. Lipids build up in the walls
2 Macrophages try and get rid of the lipids
3. Macrophages die
4. Leads to an inflammatory response
5. Leads to the build up of fat and smooth muscle and fibrotic material in the blood vessel
45
The initial build up of lipids vessel is called what?
A fatty streak
46
What forms after the initial fatty streak and how?
Smooth muscle and lipid build up lead to the formation of:
| FIBROFATTY PLAQUE
47
What three things can happen if plaque accumulation in the vessels get too much?
1. Aneurysm and rupture
2. Occlusion by thrombosis
3. Critical stenosis
48
What is critical stenosis?
When so much plaque has occluded the arteries (>70%) that it has significantly affected blood flow
49
What happen to arteries if occlusion by thrombus occurs
The plaque can suddenly rupture and burst leading to the formation of a blood clot over the rupture plaque
sudden occlusion occurs and can cause unstable angina or myocardial infarction
50
The severe symptoms of unstable angina and acute myocardial infarction area termed as...?
Acute coronary syndrome (ACS)
51
What causes unstable angina and myocardial infarction
Unstable plaque rupture
52
What causes stable angina?
Significant and progressive occlusion of vessel
53
What are acute coronary syndromes?
More severe symptoms of unstable angina
54
What is the difference between unstable angina and myocardial infarction?
There is no detectable myocardial cell damage in unstable angina
55
What are the clinical features of ischaemic heart disease
1. Angina pectoris
2. Pale and clammy
3. Sweating
4. Nausea
5. Weak pulse or low BP
6. Breathlessness
56
What is angina pectoris
"stangled chest"
57
What causes angina pectoris?
Pain is due to inflammatory mediator release
58
Where is angina pectoris felt?
Retrosternal chest pain that radiates to epigastrium, back, neck, jaw or shoulders
59
What is stable angina?
Angina pectoris that occurs for 1-5 minutes and is relieved by rest or GTN or other drug
60
What is unstable angina?
Intense angina pectoris that last longer can occur spontaneous at ret
Can progressively get worse
61
How do we diagnose ischaemic heart disease
1. Look at clinical features of pain
2. Can look at changes on an electrocardiogram
3. Look for cardiac blood markers
62
How do cardiac blood markers work?
When myocardial cells die they release a protein that is specific to the
If you take a blood sample and see the specific proteins (eg troponin) then you know cardiac cells are dying
63
If you fear patient is having an unstable angina attack or myocardial infarction what should you do?
1. Call 999
2. Reassure patient and put them in a comfortable position
3. Give oxygen
4. Give lingual GTN
5. DO NOT GIVE an inter muscular injection
6. Aspirin 300mg and give note to hospital
7. CPR if they collapse
64
What do the NICE guidelines say regarding patients with nonsystematic ischaemic heart disease?
1. Vulnerable for 4 weeks following MI so check with medical practitioner before treatment
2. Low dose aspirin should not be stopped or altered before dental treatment
3. Antibiotics not recommended following surgery
BASIC RULE: don't stop treatment if minor procedure with low risk fo bleeding and I you are unsure consult a cardiologist
65
Name some complications that can arise after suffering from a myocardial infarction
1. Stroke
2. Cariogenic shock
3. Congestive heart failure
4. Cardiac tamponade
5. Arrhythmias
6. Pericarditis
66
Name the 4 main ways the heart can be effected after a myocardial infarction
1. Impaired contractility
2. Tissue necrosis
3. Electrical instability
4. Pericardial inflammation
67
What can impaired contractility cause?
1, Can lead to ventricular thrombus leading to stroke
2. Hypotension that can increase ischaemia and cause cardiogenic shock
3. Congestive heart failure
68
What can tissue necrosis cause?
1. Papillary muscle infarction leading to congestive heart failure
2. Ventricular wall rupture that causes cardiac tamponade
69
What is cardiac tamponade
Accumulation of blood in the pericardial sack
70
What can electrical instability in the heart cause|
Arrhythmias
71
What are arrhythmias
Abnormal heart rhythm
72
What can pericardial inflammation cause
Pericarditis
73
What is pericarditis
Pericardium inflammation
74
What is an aneurism
An abnormal dilation of the ventricle due to myocardial infarction
75
What is heart failure?
Inability of the heart to pump enough blood to meet metabolic demands of the body
76
When can heart failure occur?
It is usually the end stage of many forms of chronic heart disease:
77
Give symptoms of heart failure
1. Fatigue
2. Breathlessness
3. Peripheral oedema/ swelling
78
What happens in heart failure?
Initially the heart will compensate to try and maintain function. It does this by either:
1. Increasing contractility
2. Cardiac hypertrophy
3. Neurohumoural reposens
79
What is cardiac hypertrophy?
The heart increasing in size to try and maintain function and cardiac output after heat failure
80
Give some neurohumoural responses of the body in repose to heart failure
Fluid is retained after low cardiac output is sensed
| This ultimately leads o fluid overload
81
What is the ejection fraction?
It is the proportion of blood within the ventricle that is actually pumped out
82
What is the ejection fraction in a healthy individual?
55-70%
83
Name some different types and causes of heart failure
1. Systolic dysfunction
| 2. Diastolic dysfunction
84
What happens in systolic dysfunction?
Decreased contractility which leads an ejection fraction of <40%
85
What can cause systolic dysfunction
1.Iscaemic heart disease
2. Valve disease
Heart is too stiff and cannot fill properly
86
What can cause systolic dysfunction?
Heart is too stiff and cannot fill properly
87
Wha effect does systolic dysfunction have on the ejection fraction?
Reduces the ejection fraction
88
Wha effect does diastolic dysfunction have on the ejection fraction?
Ejection fraction is preserved
89
Wha can cause diastolic dysfunction?
Hypertrophy
90
What happens if the left side of the heart fails?
Impaired output causing
1. congestion in the pulmonary circulation
2. Stasis of blood in the left side
3. Inadequate perfusion of food
91
If the left side of a patents heart is damaged what signs of symptoms may you see
1. Breathlessness
| 2. Oedema due to organ failure
92
What happens if the right side of the heart fails?
Increased "back pressure" through the pulmonary and venous circuit
93
If the right side of a patents heart is damaged what signs of symptoms may you see
Leg swelling and organ congestion
94
Is right handed failure of left side failure more common?
Neither is more common they both usually occur in combination: congestive heart failure
95
Name some diseases that affect the valves
1. Valvular stenosis
2. Valvular regurgitation/ incompetence
3. Infective endocarditis
96
What happens in valvular stenosis
They can fail to open leading to impaired forward flow of blood (stenosis)
97
What happen in valvular regurgitation/ incompetence
Valves fail to lose fully leading to the back Flow of blood
98
What happens in Infective endocarditis
The valves can get infected with vegetations which can lead to embolism and impaired mobility
99
What are the 3 likely outcomes abnormal valve function
1. Abnormal blood flow
2. Clot formation
3. Risk of infection (endocarditis)
100
What is valvular stenosis almost always due to?
Chronic injury/ rheumatic fever
101
Name the 2 types of stenosis
1. Mitral stenosis
| 2. Artic stenosis
102
Give some pathological causes of mitral stenosis
Rheumatic valvular disease
103
Give some pathological causes of aortic stenosis
Calcific degeneration
or
Rheumatic valvular disease
104
What is valvular incompetence usually due to?
Disease of the cusps or supporting structures
| There are may causes and they can be acute or chronic
105
Name the 2 types of valvular incompetence
1. Mitral incompetence
| 2. Aortic incompetence
106
Give some pathological causes of mitral incompetence
1. Dilation of mitral valve
2. Papillary muscle fibrosis and dysfunction
3. Mucoid degeneration of valve cusps
4. Rheumatic valvular disease
107
Give some pathological causes of mitral incompetence
1. Dilation of otic root
2. Infective endocarditis
3. Some Rheumatic disorders
108
What can damage to the atrio ventricular valves cause?
Atrial fibrillation (unusual electrical signal in the atrium)
109
Name the valvular disease the is most common
Aortic stenosis
110
How can you treat aortic stenosis?
Valve replacement
| Balloon dilation
