Ischaemic Heart Disease/HTN Flashcards
1
Q
normal bp
A
<80
2
Q
prehypertensive
A
120-139/80-89
3
Q
hypertensive I
A
140-160/90-99
4
Q
hypertension II
A
> 160/>100
5
Q
list risk factors of developing essential hypertension
A
related to increased CO and increased TPR age obesity diabetes physical inactivity excess salt intake excess alcohol intake family history black>white> asian
6
Q
describe acute end organ damage
A
encephalopathy stroke retinal hemorrhages, exudats, hemorrhages MI HF aortic dissection
7
Q
hypertensive predisposes to:
A
coronary artery disease LVH HF atrial fibrillation aortic dissection aortic aneurysm stroke chronic kidney disase retinopathy
8
Q
signs of hyperlipidemia
A
xanthomas, tendinous sxanthoma, corneal arcus
9
Q
hyaline arteriosclerosis
A
diabetes and essential hypertension due to thicekenign of vessel walsl - leaking
10
Q
hyperplastic hypertension
A
onion skinning in severe hypertension due to proliferation of smooth muscle cells.
11
Q
what is monckeberg?
A
medial calcific sclerosis affects medium sized arteries calcification of elastic lamina of arteris - stiffening without cobstriuction PIPESTEM on CXR no obstruction fo blood flow intima is not involved
12
Q
describe what vessels atherosclerosis affects
A
elastic arteries
large and medium sized muscular arteries
a form of arteriosclerosis caused by buildup of cholesterol plaques
13
Q
risk factors
A
modifiable: smoking, hypertension, hyperlipidemia, diabetes
nonmodifiable: age, sex - men and post menopausal women, family history
14
Q
describe progressin of atherosclerosis
A
inflammation tis important
endothelia cell dysfunction – MO and LDL accumulation – foam cell formation – fatty streaks – smooth muscle cell migration (PDGF, and FGF) – proliferation and extracellular matrix deposition – fibrous plaque – complex atheromas when calcified
15
Q
complciations of atherscloersis
A
aneurysms, ischemia, infarcts, peripheral vascular disease, thrombus, emboi
16
Q
most common locatiosn of atherosclerosi
A
abdominal aorta > carotid arteries > popliteal artery > coronary artery
17
Q
symptoms of atherosclerosis
A
angina, claudication, ASXTIC MOSTLY
18
Q
abdominal aorti aneurysm associated with?
A
atherosclerosis
19
Q
RF for abdominal aortic aneurysm
A
tobacco use
increased age
male
family history
20
Q
RF for thoracic aortic aneurysms
A
hypertension
bicuspid aortic valve
Marfan
tertiary syphillis
21
Q
assicated with aortic diseection are?
A
hypertension
bicuspid aortic valve
marfan
same as thoracic aneurysm minus syphillis
22
Q
what is an aortic dissection?
A
longitudinal intimal tear forming a false lumen -
23
Q
cxpx of aortic dissection?
A
tearing chest pain of acute onset radiating to the back with or without markedly unequal bp in arms
24
Q
standor type A aortic dissecation
A
ascending aorta and may extend to aortic arch fo descending aorta
treatment is surgery
25
Stanford type B aortic dissection
descending and or aortic arch, no ascending
| treat with beta blockers then vasodilators
26
complicatiosn of aortic dissection
rupture
pericardial tamponade
fatal
27
describe stable angina
secondary to atherosclerosis
extertional chest pain in classic disctribugion
ST depression
resolves with rest or NO
28
describe variant angina
occurs at rest secondary to vascular spasm
transient ST elevation
triggers: tobacco, cocaine, triptans
treat with CCB, nitrates, smoking cessation
29
describe unstable angina
thrombobsis with incomplete coronary artery occution
with or without ST elevation and or T wave inversion
no cardiac biomarker elevation
increased frequency or intesnsitiy of chest pain or any chest pain at rest
30
coronary steal syndrome
distal to coronary stenosis vessels are maximally dialted at baseline. so if give casodilators - dilates normal vessels and shunts blood away from post stenotic region resulting in decreased flow and iscahemia
STRESS TEST
31
myocardial infarction
most often due to acute thrombosis due to rupture of coronary artery atherosclerotic plaque
32
ECG in transmural MI
STEMI elevated + cardiac biomarkers
33
ECK in subendocardiacl MI
NSTEMI depressed + Cardiac biomarkers
34
sudden cardiac death
death from cardiac causes within one hour of onset of symptoms.
most commonly due to lethal arrhythmia
associated with CAD, cardiomyopathy, hereditary ion channelopathies
35
chronic ischemic heart disease
progressive onset of HF over many years odue to chronic myocardial damage
36
what are most commonly occluded coronary arteries
LDA >RCA> LCX
37
MI presentation
diaphoresis, n/v, severe retrosternal pain, pain in let arm and or jaw, SOB, fatigue
38
0-4 hours of MI
no gross
no LM
increased risk of arrhtymia, cardiogenic shock, HF
39
4-24 horus of MI
gross: dark mottling, pale with tetrazolium stain
LM: early coagulative necrosis - edema, hemorrhage, wavy fibres
reperfusion injury causes CONTRACTION BANDS
increased risk of arrhythmia, cardiogenic shock, HF
40
1-3 days of MI
gross - red due to hyperemia
LM: extensive coagulative necrosis, PMN infiltration
risk of post infarction fibrinous pericarditis
41
3-14 days of MI
gross: yellow-brown softening - maximammly yellow and soft by 1- days
LM:
42
3-14 days of MI
gross: yellow-brown softening - maximammly yellow and soft by 1- days
LM: MO and then granulation tissue at margins
risk of free wall rupture s- tamponade
risk of papillary muscel rupture - mitral regurgitation
interventricular rupture - LV pseudoaneurysm or vsd
due to MO cleaning up
43
2 weeks to several months
gray white noncontractile tiss;ue
contracted scar complete
risk of Dressler syndrome, HG, arrhythmias, true ventricular aneurysm (mural thrombus)
44
time courase of CKMB
increases 6-12 hours, stays for 48 hours
| godo for reinfarction
45
time course fo troponins
increased after 4 hours and stay up for 7 to 10 days
46
ECG changes with MI
```
St elevation = STEMI, transmural
ST depression - NSTEMI, subendocardial
hyperacute/peaked T waves
T wave inversion
new LBBB
pathologic Q wave or poor R wave - evolving or old transmural infarct
```
47
leads V1-V2 Mi
anteroseptal LAD
48
leads V3-V4 Mi
anteroapical distal LAD
49
leads V5-V6 Mi
anterolateral LAD or LCX
50
leads I, aVL Mi
lateral LCX
51
leads II, III, aVF
inferior RCA
52
when is ggreatest risk of rupture following MI?
3-14 days post
| MO going to town before scar tissue formed
53
what is a ventricular pseudoaneurysm ?
contained free wall rupture
decreased CO
increasd risk fo arrhtmia
embolus from mural rthrombus
54
when is greatest risk for ventricular pseudoanuerysm?
3-14 days tis a rupture
55
what is atrue ventricular aneurysm?
outward buldge during systole a dyskinesia.
| fibrosis
56
when does a true ventricular aneurysm occur?
greatest risk 2 weeks to several motnsh
57
greatest risk of postinfarction fibrinous pericarditis?
1-3 days post MI
58
risk for dresslers?
2-12 weeks
59
how to treat unstable angina/NSTEMI
```
anticoagulation - heparin
antiplatelet - aspirin, clopidogrel
bbs
ACEis
statins
control symptoms with nitroglycerin and morphine
```
60
how to treat a STEMI
heparin, aspirin and clopidogrel, bbs, ACEis, statins and reperfusion therapy is most important - percutaneous coronary intervention > fibrinolysis
61
what causes dilated cardiomyopathy
```
idiopathic/familial. ABCCCDHSP
alcohol abuse
wet beri beri
chronic cocain
chagas disease
coxsackie B virus
doxorubicin
hemochromatosis
sarcoidosis
peripartum cardiomyopathy
increased preload
```
62
result of dilated cardiomyopathy?
increased preload - eccentric hypertrophy - in series - systolic dysfunction - S3
63
cxfx of dilated cardiomyopathy?
HF, S3, systolic regurgitant murmur, dilated heart on echocardiogram, ballone appearance of heart on CXR
64
treatment of dilated cardiomyopathy?
na restriction, ACEi, bb, diuretics, digoxin, ICD, heart transplant
65
findings with hypertrophic cardiomyopathy?
S4
systolic murmur
mitral valve regurgitation bc it cant close
66
treatment of hypertrophic cardiomyopathy?
cessation fo high intensity athletics
BB, CCB
ICD if at high risk
67
result of hypertrophic cardiomyopathy?
increased afterload - concentric hypertrophy in parallel - diastolic dysfunction
68
what is obstructive hypertrophic cardiomyopathy
assymetric septal hypertrophy and systolic anterior motion fo the mitral valve - outflow obstruction - dyspnea nad syncope
69
what causes restrictive/infiltrative cardiomyoatphy
```
sarcoidosis
amyloidosis
endocardial fibroelastosis
Loffler syndrome
hemochromatosis
```
70
what is endocardial fibroelastosis
in children - thick fibroelastic tissue in endocardium
71
what is lofflers syndrome?
endomyocardial fibrosis with prominent eosinophilic infiltrate
72
what casues dilated and restrictive/infiltrative cardiomyopathy?
hemochromatosis can!
73
restrivitev/infiltrative cardiomyoatphy causes?
increased afterload - concentric hypertrophy - in parallele - diastolic dysfunction
74
describe the ECG in restrictive/infiltrative cardiomyopathy
can hav elow voltage ECG despite thick myocardium - especially amyloidosis
75
describe systolic dysfunction leading to congestive heart failure
increased preload - ischemia/MI or dilated cardiomyopathy - eccentric - inseries
reduced EF, increased EDV
decreased contractility
76
describe diastolic dysfunction leading to congestive heart failure
decreased compliance secondary to myocardial hypertrophy
increased afterload - concentric - parallel
normal EF, normal EDV
77
symptomso of LVF
orthopnea, paroxysmal nocturnal dyspnea, pulmonary oedema
78
symptoms of RVF
hepatomegaly/nutmeg liver/cardia cirrhosis
jufular venous distension
peripheral oedema
79
describe hypovolemic shock
caused by hemorrhage, dehydration burns
decreased CVP**, decreased CO, increased TPR
treat with IV fluids
80
describe cardiogenic shock
caused by acute MI, HF< valvular dysfunction, ;arrhythmia
increased CVP, decreased CO**, increased TP
treat with inotropes and diuresis
81
describe obstructive shock
caused by cardiac tamponase and PE
increased CVP , decreased CO **, increased TPR
treat by reliveing obstruction
82
describe distributive shock
caused by sepsis, CNS injury, anaphylaxis
decreased TPR** decreased CVP, increased CO
treat with pressors and IV fluid
83
what is systemic inflammatory response?
more than two of
a) fever
b) tachycardia
c) tachypnea
d) leukocytosis/leukopenia
84
what is the fist sign of shock?
tachycardia
85
which type of shock moves CVP in opposite direction of others
cardiogenic/obstructive - has increased CVP
86
which type of shock moves CO in opposite direction of others?
distributive - has increased CO
87
which type of shock moves TPR in opposite direction of others?
distributive - has decreased TPR
