Ischaemic Heart Disease/HTN Flashcards
normal bp
<80
prehypertensive
120-139/80-89
hypertensive I
140-160/90-99
hypertension II
> 160/>100
list risk factors of developing essential hypertension
related to increased CO and increased TPR age obesity diabetes physical inactivity excess salt intake excess alcohol intake family history black>white> asian
describe acute end organ damage
encephalopathy stroke retinal hemorrhages, exudats, hemorrhages MI HF aortic dissection
hypertensive predisposes to:
coronary artery disease LVH HF atrial fibrillation aortic dissection aortic aneurysm stroke chronic kidney disase retinopathy
signs of hyperlipidemia
xanthomas, tendinous sxanthoma, corneal arcus
hyaline arteriosclerosis
diabetes and essential hypertension due to thicekenign of vessel walsl - leaking
hyperplastic hypertension
onion skinning in severe hypertension due to proliferation of smooth muscle cells.
what is monckeberg?
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
describe what vessels atherosclerosis affects
elastic arteries
large and medium sized muscular arteries
a form of arteriosclerosis caused by buildup of cholesterol plaques
risk factors
modifiable: smoking, hypertension, hyperlipidemia, diabetes
nonmodifiable: age, sex - men and post menopausal women, family history
describe progressin of atherosclerosis
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
complciations of atherscloersis
aneurysms, ischemia, infarcts, peripheral vascular disease, thrombus, emboi
most common locatiosn of atherosclerosi
abdominal aorta > carotid arteries > popliteal artery > coronary artery
symptoms of atherosclerosis
angina, claudication, ASXTIC MOSTLY
abdominal aorti aneurysm associated with?
atherosclerosis
RF for abdominal aortic aneurysm
tobacco use
increased age
male
family history
RF for thoracic aortic aneurysms
hypertension
bicuspid aortic valve
Marfan
tertiary syphillis
assicated with aortic diseection are?
hypertension
bicuspid aortic valve
marfan
same as thoracic aneurysm minus syphillis
what is an aortic dissection?
longitudinal intimal tear forming a false lumen -
cxpx of aortic dissection?
tearing chest pain of acute onset radiating to the back with or without markedly unequal bp in arms
standor type A aortic dissecation
ascending aorta and may extend to aortic arch fo descending aorta
treatment is surgery
Stanford type B aortic dissection
descending and or aortic arch, no ascending
treat with beta blockers then vasodilators
complicatiosn of aortic dissection
rupture
pericardial tamponade
fatal
describe stable angina
secondary to atherosclerosis
extertional chest pain in classic disctribugion
ST depression
resolves with rest or NO
describe variant angina
occurs at rest secondary to vascular spasm
transient ST elevation
triggers: tobacco, cocaine, triptans
treat with CCB, nitrates, smoking cessation
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
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
myocardial infarction
most often due to acute thrombosis due to rupture of coronary artery atherosclerotic plaque
ECG in transmural MI
STEMI elevated + cardiac biomarkers
ECK in subendocardiacl MI
NSTEMI depressed + Cardiac biomarkers
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
chronic ischemic heart disease
progressive onset of HF over many years odue to chronic myocardial damage
what are most commonly occluded coronary arteries
LDA >RCA> LCX
MI presentation
diaphoresis, n/v, severe retrosternal pain, pain in let arm and or jaw, SOB, fatigue
0-4 hours of MI
no gross
no LM
increased risk of arrhtymia, cardiogenic shock, HF
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
1-3 days of MI
gross - red due to hyperemia
LM: extensive coagulative necrosis, PMN infiltration
risk of post infarction fibrinous pericarditis
3-14 days of MI
gross: yellow-brown softening - maximammly yellow and soft by 1- days
LM:
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
2 weeks to several months
gray white noncontractile tiss;ue
contracted scar complete
risk of Dressler syndrome, HG, arrhythmias, true ventricular aneurysm (mural thrombus)
time courase of CKMB
increases 6-12 hours, stays for 48 hours
godo for reinfarction
time course fo troponins
increased after 4 hours and stay up for 7 to 10 days
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
leads V1-V2 Mi
anteroseptal LAD
leads V3-V4 Mi
anteroapical distal LAD
leads V5-V6 Mi
anterolateral LAD or LCX
leads I, aVL Mi
lateral LCX
leads II, III, aVF
inferior RCA
when is ggreatest risk of rupture following MI?
3-14 days post
MO going to town before scar tissue formed
what is a ventricular pseudoaneurysm ?
contained free wall rupture
decreased CO
increasd risk fo arrhtmia
embolus from mural rthrombus
when is greatest risk for ventricular pseudoanuerysm?
3-14 days tis a rupture
what is atrue ventricular aneurysm?
outward buldge during systole a dyskinesia.
fibrosis
when does a true ventricular aneurysm occur?
greatest risk 2 weeks to several motnsh
greatest risk of postinfarction fibrinous pericarditis?
1-3 days post MI
risk for dresslers?
2-12 weeks
how to treat unstable angina/NSTEMI
anticoagulation - heparin antiplatelet - aspirin, clopidogrel bbs ACEis statins control symptoms with nitroglycerin and morphine
how to treat a STEMI
heparin, aspirin and clopidogrel, bbs, ACEis, statins and reperfusion therapy is most important - percutaneous coronary intervention > fibrinolysis
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
result of dilated cardiomyopathy?
increased preload - eccentric hypertrophy - in series - systolic dysfunction - S3
cxfx of dilated cardiomyopathy?
HF, S3, systolic regurgitant murmur, dilated heart on echocardiogram, ballone appearance of heart on CXR
treatment of dilated cardiomyopathy?
na restriction, ACEi, bb, diuretics, digoxin, ICD, heart transplant
findings with hypertrophic cardiomyopathy?
S4
systolic murmur
mitral valve regurgitation bc it cant close
treatment of hypertrophic cardiomyopathy?
cessation fo high intensity athletics
BB, CCB
ICD if at high risk
result of hypertrophic cardiomyopathy?
increased afterload - concentric hypertrophy in parallel - diastolic dysfunction
what is obstructive hypertrophic cardiomyopathy
assymetric septal hypertrophy and systolic anterior motion fo the mitral valve - outflow obstruction - dyspnea nad syncope
what causes restrictive/infiltrative cardiomyoatphy
sarcoidosis amyloidosis endocardial fibroelastosis Loffler syndrome hemochromatosis
what is endocardial fibroelastosis
in children - thick fibroelastic tissue in endocardium
what is lofflers syndrome?
endomyocardial fibrosis with prominent eosinophilic infiltrate
what casues dilated and restrictive/infiltrative cardiomyopathy?
hemochromatosis can!
restrivitev/infiltrative cardiomyoatphy causes?
increased afterload - concentric hypertrophy - in parallele - diastolic dysfunction
describe the ECG in restrictive/infiltrative cardiomyopathy
can hav elow voltage ECG despite thick myocardium - especially amyloidosis
describe systolic dysfunction leading to congestive heart failure
increased preload - ischemia/MI or dilated cardiomyopathy - eccentric - inseries
reduced EF, increased EDV
decreased contractility
describe diastolic dysfunction leading to congestive heart failure
decreased compliance secondary to myocardial hypertrophy
increased afterload - concentric - parallel
normal EF, normal EDV
symptomso of LVF
orthopnea, paroxysmal nocturnal dyspnea, pulmonary oedema
symptoms of RVF
hepatomegaly/nutmeg liver/cardia cirrhosis
jufular venous distension
peripheral oedema
describe hypovolemic shock
caused by hemorrhage, dehydration burns
decreased CVP**, decreased CO, increased TPR
treat with IV fluids
describe cardiogenic shock
caused by acute MI, HF< valvular dysfunction, ;arrhythmia
increased CVP, decreased CO**, increased TP
treat with inotropes and diuresis
describe obstructive shock
caused by cardiac tamponase and PE
increased CVP , decreased CO **, increased TPR
treat by reliveing obstruction
describe distributive shock
caused by sepsis, CNS injury, anaphylaxis
decreased TPR** decreased CVP, increased CO
treat with pressors and IV fluid
what is systemic inflammatory response?
more than two of
a) fever
b) tachycardia
c) tachypnea
d) leukocytosis/leukopenia
what is the fist sign of shock?
tachycardia
which type of shock moves CVP in opposite direction of others
cardiogenic/obstructive - has increased CVP
which type of shock moves CO in opposite direction of others?
distributive - has increased CO
which type of shock moves TPR in opposite direction of others?
distributive - has decreased TPR
