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Module 103: Theme 3: Physiology of the cardiovascular system. Principles of pathology, diagnosis and treatment of cardiovascular disease > Introducing how the cardiovascular system fails > Flashcards

Introducing how the cardiovascular system fails Flashcards

1
Q

What is a stroke?

A

Rapid loss of brain function due to loss of perfusion to parts of the brain

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2
Q

Give another name for a stroke

A

Cerebrovascular accident

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3
Q

List the two types of stroke

A

Ischemic

Haemorrhagic

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4
Q

Define an ischemic stroke

A

Cerebral blood vessels become blocked

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5
Q

Define haemorrhagic stroke

A

Cerebral blood vessels rupture

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6
Q

List some stresses which may cause a blood vessel to burst

A

High blood pressure
High wall tension/Large diameter
Low elasticity
Turbulent flow

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7
Q

List some damages which may cause blood vessels to burst

A

Diabetes
Trauma eg. PCI
Atherosclerosis

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8
Q

Define aneurysm

A

A pathological, localized, blood-filled balloon-like bulge in the wall of a blood vessel

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9
Q

Define ruptured aneurysm

A

When the aneurysm bursts and blood leaks out

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10
Q

What is tension in a cylinder?

A

The force tangential to the circumference of the cross section that is trying to rip the wall apart

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11
Q

What is the wall tension like in a larger vessel?

A

Greater

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12
Q

Give the equation for wall tension in a cylinder

A

Wall tension = pressure x radius

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13
Q

What is compliance?

A

The change in volume caused by a change in pressure

Stretchiness

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14
Q

What happens if there is low compliance

A

A change in pressure results in a very little change in volume

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15
Q

What reduces arterial blood pressure?

A

Age
Disease
Build up of connective tissue
Atherosclerosis

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16
Q

Do veins or arteries have more compliance?

A

Veins

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17
Q

Describe the two characteristics of laminar flow

A

All molecules travel in the same direction

Slower speed at the edges

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18
Q

Describe the causes of turbulent flow

A

When the low viscosity molecules flow at high speeds in random directions passing junctions and mixing

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19
Q

List the activities of the endothelium

A 
Angiogenesis
Haemostasis 
White cell recruitment
Hormone trafficking 
Blood vessel tone
Fluid filtration
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20
Q

Describe the symptoms of acute myocardial infarction

A

Extremely painful chest pain
However some women present atypically where there is an absence of chest pain but they experience jaw, back, neck or head pain followed by symptoms of nausea, cough, dyspnoea or weakness

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21
Q

When can an AMI become fatal?

A

When it leads to arrhythmia or heart failure after many AMIs

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22
Q

What does an AMI cause?

A

Reduced capacity of the heart to pump

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23
Q

Give the symptoms of atherosclerosis

A

Asymptomatic however causes other diseases which possess symptoms

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24
Q

List the main causes of atherosclerosis

A

Immune action
Hyperlipidemia
Unknown aetiology

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25
Q

What is coronary artery disease?

A

Narrowing/obstruction of the arteries supplying the heart

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26
Q

Give the 2 causes of CAD

A

Atherosclerosis

Coronary vasospasm

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27
Q

What is a plaque rupture?

A

When a fibrous plaque bursts open

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28
Q

How safe are atheromas?

A

Quite safe even if they occlude 50% of the vessel.

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29
Q

What happens if a plaque rupture occurs in a coronary artery, thrombus or embolism?

A

A myocardial infarction occurs

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30
Q

Describe the ways the sympathetic nervous system responds to an MI

A

Release of noradrenaline and adrenaline in response to haemodynamic abnormalities and pain

31
Q

Describe the ways the sympathetic nervous system responds to heart failure

A

Increase heart rate
Increase contractility
Increase peripheral resistance
Increased risk of arrhythmia

32
Q

Give the equation for net pressure

A

Net pressure = hydrostatic pressure + osmotic pressure

33
Q

What is pulmonary oedema and explain its cause?

A

Fluid accumulation in the lungs caused by left heart failure. Damming of the blood leads to increase in hydrostatic pressure in pulmonary circulation

34
Q

List the symptoms of pulmonary oedema

A

Dyspnoea
Orthopnoea
Hypoxia

35
Q

What is ascites?

A

The accumulation of fluids in the peritoneal canal

36
Q

What is the main cause of ascites?

A

Heart failure

37
Q

What is peripheral oedema?

A

The swelling of tissues especially in the ankles

38
Q

State the main cause of peripheral oedema

A

Chronic low output heart failure

39
Q

What is compensation?

A

Maintaining homeostasis of a physiological function despite stressors/malfunctions. Happens via endogenous physiological feedback using starling’s law

40
Q

What is decompensation?

A

A medical emergency where the heart fails to maintain adequate circulation after long standing previously compensated vascular disease

41
Q

Describe cardiac remodelling

A

The growth of cardiac muscle leading to changes in shape, size and function caused by injury such as MI, hypertension or valve disease. The result is hypertrophy or dilation. May become pathological

42
Q

Name the treatments that inhibit cardiac remodelling

A

ACE inhibitors

Spironolactone

43
Q

Name the two types of ventricular hypertrophy

A

Eccentric

Concentric

44
Q

Describe eccentric ventricular hypertrophy

A

Dilation due to volume overload

45
Q

Describe concentric ventricular hypertrophy

A

Thicken due to pressure overload

46
Q

What does ADH do?

A 
Decreases diuresis (loss of water as urine) 
Causes kidneys to reabsorb more water
47
Q

Where is ADH released from?

A

Posterior pituitary gland

48
Q

What does aldosterone do?

A

Increases the reabsorption of NaCl in the kidneys thus decreases diuresis

49
Q

Where is aldosterone released from?

A

The adrenal cortex

50
Q

What effect does decreased diuresis have on blood pressure?

A

Increases blood pressure

51
Q

What do diuretic drugs do?

A

Antagonise the hormones ADH and aldosterone leading to fluid loss and an increase in blood pressure

52
Q

What does angiotensin 2 do?

A

Increases blood pressure by stimulating the release of ADH and Aldosterone, causes vasoconstriction and hypertrophy and cardiac remodelling

53
Q

Describe the sequence of the renin-angiotensin- aldosterone system

A

Angiotensinogen- renin enzyme- angiotensin I- ACE enzyme- Angiotensin II- aldosterone

54
Q

What do thiazide and thiazide like diuretics do?

A

Block reabsorption at the DCT

55
Q

Give an example of a thiazide and thiazide like diuretic

A

Indapamide

56
Q

What do loop diuretics do?

A

Block reabsorption at the loop of henle

57
Q

Give an example of a loop diuretic

A

Furosemide

58
Q

What do K+sparing diuretics do?

A

Inhibit aldosterone receptors at the cortical collecting duct

59
Q

Give an example of a K+ sparing diuretic

A

Spironolactone

60
Q

Define heart failure

A

The cardiac output does not meet the needs of the lungs and body

61
Q

Describe chronic low output heart failure

A

There is a low cardiac output usually due to accumulated heart damage
Chronic condition with poor 5 year survival rate

62
Q

Describe decompensated heart failure and how the body responds.

A

Medical emergency which can lead to death if not treated.
Kidney increases plasma volume to compensate for poor perfusion and leads to fluid overload. The heart is unable to pump the extra fluid so fluid damming leads to increased venous hydrostatic pressures. Increased back pressure further damages the heart. Capillaries become leaky and gas exchange can not occur

63
Q

What symptoms are present in left heart failure and why?

A

Respiratory symptoms
Right heart pumps into lungs but left atrium is too full therefore there is an increased hydrostatic pressure in pulmonary circulation

64
Q

Describe congestive heart failure

A

The pulmonary vasculature becomes congested and in extreme cases the lungs fill with fluid from blood vessels

65
Q

Describe right heart failure

A

This causes systemic symptoms. Increase in central venous pressure causes peripheral oedema and ascites

66
Q

How does the body respond to heart failure?

A

Loss of cardiac output stimulates sympathetic nervous system to compensate by increasing heart rate and peripheral resistance

67
Q

List the symptoms of heart failure

A

Oedema
Fatigue
Dyspnoea- orthopnoea and paroxysmal nocturnal dyspnoea

68
Q

Define in terms of blood pressure cardiogenic shock

A

Systolic blood pressure less than 90 mmHg

69
Q

How does cardiogenic shock progress?

A

Positive feedback

70
Q

Describe the treatment for shock

A

Aggressive IV fluid and oxygen while monitoring airways

71
Q

List 3 chronic heart failure treatments

A

ACE inhibitors
Diuretics
Beta blockers

72
Q

Describe the homeostatic mechanisms for low cardiac output

A

Increase sympathetic activity- increase HR, increase heart contractility and vasoconstriction
Kidneys accumulate fluid- Decrease glomerular filtrate rate, increase venous return and preload and increase central venous pressure

73
Q

List the low output heart failure treatment goals

A

Prevent acute decompensated heart failure
Counteract cardiac remodelling
Minimize symptoms

Module 103: Theme 3: Physiology of the cardiovascular system. Principles of pathology, diagnosis and treatment of cardiovascular disease (19 decks)

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