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The Cardiovascular System > Ischaemic Heart Disease and MI > Flashcards

Ischaemic Heart Disease and MI Flashcards

1
Q

When are fibrinolytic drugs used

A

For prophylaxis and after a myocardial infarction.

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2
Q

When are fibrinolytic effective to reduce mortality

A

If they are given immediately (less than 12 hours) after MI or stroke.

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3
Q

What do fibrinolytic drugs do

A

They act to accelerate conversion of plasminogen to plasmin which degrades fibrin in a thrombus.

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4
Q

What are two examples of fibrinolytic drugs

A

Tissue plasminogen activator (tPA) and streptokinase.

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5
Q

What is produced naturally by the body with fibrinolytic properties

A

Tissue plasminogen activator (tPA).

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6
Q

What is the risk associated with using fibrinolytic drugs

A

Bleeding

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7
Q

How many times a year can fibrinolytic drugs be used

A

Once

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8
Q

What reverses bleeding

A

Tranexamic acid

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9
Q

What surgical approaches are used for ischaemic heart disease

A
  • Balloon angioplasty

- Senting

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10
Q

Why are there now more people living with heart failure

A

Because we are better equipped to deal with it now so not as many die straight away from it.

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11
Q

What is the Frank-Starling mechanism

A

If there is increased blood volume, there will be increased stretch of the myocardium and increased force with which to pump blood out.

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12
Q

By what mechanism does the heart work

A

By stretch and recoil. The greater the stretch, the greater the degree of recoil up to a certain point.

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13
Q

What happens to preload when more blood returns to the heart

A

Preload increases.

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14
Q

What is venous return

A

The amount of blood entering the ventricle during diastole

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15
Q

What does venous return determine

A

Preload

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16
Q

What does increased preload result in

A

Increased stroke volume and increased cardiac output.

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17
Q

What factors determine the end diastolic volume and therefore preload

A
  • Venous tone and capacitance controlled by the sympathetic nervous system
  • Plasma volume controlled by sodium and water secretion from the kidney.
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18
Q

What increases preload

A

The sympathetic nervous system constricting smooth muscle of blood vessels and the RAAS increasing blood volume.

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19
Q

What is afterload

A

The force against which the heart has to pump

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20
Q

What is afterload determined by

A

The tone in resistance arterioles.

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21
Q

What increases afterload

A

Increased resistance in the arterioles.

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22
Q

In which conditions is preload increased

A
  • Hypervolemia
  • Regurgitation of cardiac valves
  • Heart failure
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23
Q

In which conditions is afterload increased

A
  • Hypertension

- Vasoconstriction

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24
Q

Why is preload often larger in heart failure

A

Because the kidneys are not being effectively perfused and this results in a decreased ability to get rid of fluid.

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25
Q

Where is blood pressure detected in the kidneys

A

The juxtaglomerular cells near the afferent arteriole

26
Q

What happens when low blood pressure is detected by the juxtaglomerular cells of the kidney

A

Renin is secreted into the plasma.

27
Q

What does renin do

A

Renin cleaves angiotensin to produce angiotensin I which is then converted to angiotensin II.

28
Q

Which enzyme converts angiotensin I to angiotensin II

A

Angiotensin converting enzyme (ACE).

29
Q

What is the action of angiotensin II

A

It is a vasoconstrictor so increases blood pressure and afterload. It also stimulates the release of aldosterone and ADH.

30
Q

Where is aldosterone secreted from

A

The adrenal cortex.

31
Q

What is the role of aldosterone

A

It increase reabsorption of sodium ions in the kidney tubules back into the blood.

32
Q

What do sympathetic nerves do to the heart

A

Act at beat 1 adrenoceptors to increase heart rate, conduction and contractility.

33
Q

What do sympathetic nerves do at arterioles

A

Act on alpha adrenoceptors to bring about vasoconstriction and increase afterload.

34
Q

What do sympathetic nerves do at the veins

A

Act on alpha receptors to bring about vasoconstriction and increase preload.

35
Q

What do parasympathetic nerves do to the heart

A

Act at M2 (muscarinic/cholinergic) receptors to reduce heart rate, conduction and contractility.

36
Q

What do sympathetic nerves do at the kidney

A

Act on beta-1 adrenoceptors to bring about activation of the renin-angiotensin system.

37
Q

What are the symptoms of heart failure

A
  • Breathlessness
  • Muscle weakness
  • Peripheral oedema
  • Cardiac arrhythmias
  • Poor tissue perfusion and organ failure.
38
Q

What are the causes of heart failure

A
  • Myocardial infarction
  • Pressure overload
  • Volume overload
  • Cardiomyopathy
  • Myocarditis
39
Q

What is digoxin used to treat

A

Heart failure

40
Q

What is digoxin

A

A cardiac glycoside

41
Q

What do cardiac glycosides do

A

Increase the force of contraction due to increased calcium within the cell - it is a positive inotrope.

42
Q

Other than digoxin, what is an example of another inotrope used to increase contractility

A

Dobutamine

43
Q

What type of drug is dobutamine

A

A beta 1 adrenoceptor agonist.

44
Q

Which drugs are used to break the cycle of heart failure and unload the heart

A
  • Diuretics
  • Inhibitors of the RAAS system - renin inhibitor, ACE inhibitor, angiotensin I receptor agonist, mineralcorticoid receptor agonists
  • Beta blockers
  • Other vasodilators.
45
Q

What structural changes can occur in heart failure

A
  • Fibroblasts laying down collagen leading to stiffness of vessels
  • Hypertrophy
46
Q

What is the aim at the kidney for treating heart failure

A

To increase sodium and water loss and therefore reduce blood volume and preload.

47
Q

What are two examples of loop diuretics

A
  • Frusemide

- Bumetamide

48
Q

What do loop diuretics do

A

Loop diuretics impair NA+/K+ and Cl- reabsorption in the ascending loop of Henle.

49
Q

What is an example of a mineralcorticoid receptor antagonist

A

Spironalactone

50
Q

What do mineralocorticoid receptor antagonists like spironolactone do

A

Block the effects of aldosterone on Na/K reabsorption to increase fluid loss.

51
Q

What do ACE inhibitors do

A

Inhibits angiotensin converting enzyme so angiotensin I is not converted to vasoconstrictor angiotensin II.

52
Q

Give two examples of ACE inhibitors

A
  • Enalapril

- Lisinopril

53
Q

What do angiotensin receptor antagonists do

A

Prevent the binding of angiotensin II to its receptor to prevent the initiation of vasoconstriction.

54
Q

Give two examples of angiotensin receptor antagonists

A
  • Losartan

- Valsartan

55
Q

Give two examples of beta 1 selective beta adrenoceptor antagonists

A
  • Atenolol

- Metoprolol

56
Q

What is the action of beta 1 selective adrenoceptor blockers

A

Reduce the sympathetic drive to the heart to reduce heart rate and block renin release from the kidney to decrease vasoconstriction so afterload and blood volume so preload.

57
Q

What is an example of a nitrovasodilator

A

Isosorbide mononitrate

58
Q

What is hydralazine

A

A vasodilator

59
Q

In what situations ate nitrates and hydralazine used

A

When there is acute heart failure or in patients with chronic heart failure who do not respond to other drugs.

60
Q

What happens to the heart wall in the progression of heart failure

A

it will become thicker and stiffer due to fibrosis and hypertrophy.

The Cardiovascular System (15 decks)

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