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Human Disease Y3 > Ischemic Heart Disease and Heart Failure > Flashcards

Ischemic Heart Disease and Heart Failure Flashcards

1
Q

what is ischemic heart disease ?

A

reduced blood supply to heart muscle from coronary arteries

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2
Q

what is the main cause of IHD ?

A

atheroma

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3
Q

what is the definition of ischemia ?

A

reduced blood supply to a tissue leading to reduced supply of oxygen and glucose

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4
Q

What is the definition of infarction ?

A

Tissue death due to ischemia

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5
Q

What is coronary artery disease ?

A

Obstruction of coronary blood flow

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6
Q

What are the causes of coronary artery disease ?

A

Atheroma, thrombosis, vasospasm, embolus, IE, tumour

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7
Q

What is atherosclerosis ?

A

Pathological, focal, symmetric narrowing of the arterial lumen due to atheromatous plaque build up

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8
Q

How does atherosclerosis progress ?

A

LDLs accumulate and oxidise, macrophages phagocytose oxidised LDL and form foam cells, necrosis, cell debris and for,action of cholesterol core, fibrous cap formation, fatty streak increases, fibrous plaque of cholesterol rich lipid core and smooth muscle proliferation, acute event - thromboembolism or plaque rupture

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9
Q

What are the risk factors for ischemic heart disease ?

A

Smoking, high bp, diet and cholesterol, diabetes, family history

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10
Q

What is the spectrum of IHD classified into ?

A

Stable angina.

Acute coronary syndromes - unstable angina and MI

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11
Q

What are the clinical symptoms of stable angina ?

A

Central crushing chest pain, pallor, sweating, nausea, vomiting, palpitations, induced by exercise, relieved by GTN

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12
Q

What are the clinical symptoms of acute coronary syndromes ?

A

Onset of pain at rest, not relieved by GTN, lasting over 30 minutes, impending sense of doom, sudden cardiac arrest

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13
Q

What is the pathogenesis of ACS ?

A

Fibrous cap of atheromatous plaque ruptures, platelet activation and thrombosis, some platelet activation and vasospasm, ischemia of myocardium (unstable angina), infarction of myocardium (NSTEMI, STEMI)

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14
Q

How is IHD diagnosed ?

A

ECG, troponin, angiography, myocardial perfusion study, stress echo, exercise treadmill test, CT calcium scoring

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15
Q

What is angioplasty ?

A

Stenting

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16
Q

What is the management for acute ACS ?

A

Oxygen, GTN, morphine, anti emetics, anti platelets, factor Xa inhibitors

17
Q

How is cardiovascular disease prevented in patients with IHD ?

A

Risk factor modification, aspirin, statin, ACEi, anti anginal

18
Q

What is the relevance of IHD to dentistry ?

A

Avoid GA or sedation, LA with adrenaline problematic if given iv

19
Q

What drug interactions are relevant to IHD and dentistry ?

A

Statins and erythromycin or fluconazole may increase risk of statin related myopathy

20
Q

What is heart failure ?

A

The heart fails to maintain adequate circulation to meet demands of the body despite adequate venous filling pressure

21
Q

What is the term for heart failure involving both sides of the heart ?

A

Congestive cardiac failure

22
Q

What are the causes of heart failure ?

A

Pump failure - IHD, cardiomyopathy, arrhythmias, IE.
Excessive afterload - hypertension, aortic stenosis.
Excessive preload - renal failure, mitral regurgitation, iv fluids.
Restriction - pericarditis, cardiac tamponade.
High output failure - severe anaemia, hyperthyroidism, pregnancy, hypoxia, pagets

23
Q

What are the symptoms of left sided heart failure ?

A

Pulmonary oedema causing breathlessness, coughing, orthopnea, reduced exercise tolerance.
Reduced organ perfusion causing low concentration, tiredness, confusion, fatigue, reduced kidney function, muscle wasting and weight loss

24
Q

What are the symptoms of right sided heart failure ?

A

Peripheral oedema causing ankle swelling.
Ascites.
Hepatomegaly.
Increased JVP

25
Q

What investigations are made in heart failure ?

A

Chest X Ray showing pulmonary congestion with bilateral pleural effusions and cardiomegaly.
Plasma brain natriuretic peptide.
ECG may show LV hypertrophy.
Echocardiogram to check for structural abnormalities and the ejection fraction

26
Q

What is the management for heart failure ?

A

Diuretics, ACEi, beta blockers, digoxin, spironolactone

27
Q

What is the relevance of heart failure to dentistry ?

A

Orthopnea, caution with NSAIDs as react with ACEi, digoxin interacts with macrolides, postural hypotension if taking diuretics

Human Disease Y3 (24 decks)

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