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PHCY 310 > L 36 > Flashcards

L 36 Flashcards

1
Q

How much does the heart weigh?

A

240g-340g

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2
Q

Flow between chambers is controlled by ….

Flow out of ventricles is controlled by …

A

Flow between chambers is controlled by two atrioventricular valves.
Flow out of ventricles is controlled by the pulmonary valve and the aortic valve.

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3
Q

Average resting cardiac output?
Average hepatic flow?
Average renal blood flow?
Average heart rate in adults?

A

Average resting cardiac output: 5.5L/min
Average hepatic flow 1.2L/min
Average renal blood flow 1L/min
Average heart rate in adults 75bpm

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4
Q

Arteries carry … (except the … artery which carries ….) and veins carry … (except for the pulmonary vein which carries…..)

A

Arteries carry oxygenated blood (except the pulmonary artery which carries deoxygenated blood) and veins carry deoxygenated blood (except for the pulmonary vein which carries oxygenated blood)

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5
Q

What do IHD, CAD and CHD stand for? What is their relationship?

A

IHD = ischaemic heart disease
CAD = coronary artery diseease
CHD = coronary artery disease
Relationship: they are all the same

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6
Q

What are the 2 subtypes of acute coronary syndrome?

A

Unstable angina and myocardial infarction

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7
Q

What are the 2 subtypes of myocardial infarction?

NSTEMI and STEMI
What is a white clot?

A

A platelet rich clot. These are not the same as clots that form in veins.

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8
Q

What is atherosclerosis?

How does it occur (pathogenesis)?

A
  1. Lipid deposition forms in the subendothelial space of the artery.
  2. The lipid deposition –> endothelial dysfunction with a decreased nitric oxide production –> less vasodilation and an increased risk of platelet adhesion.
  3. Macrophages –> inflammation —> calcification and narrowing of blood vessels (due to increasing plaque)
  4. High risk of plaque rupture
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9
Q

Brief pathogenesis of pathogenesis of atherosclerotic rupture –> clotting

A
  1. Rupture results in the release of tissue factor (TF) and von Willebrand factor (vWF).
  2. vWF causes platelets to adhere, activate and aggregate.
  3. Coagulation cascade becomes activated resulting in fibrinogen binding platelets to one another = clot formation
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10
Q

What is the ultimate purpose of the coagulation cascade?

A

To form a blood clot to stop bleeding.

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11
Q

What is IHD? What is it caused by?

A

A decreased supply of oxygenated blood to the heart muscle.
Caused by stenosis in one or more of the major coronary arteries that supply blood to the heart - commonly by atherosclerotic plaques

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12
Q

When does ischaemia occur?

A

When there is an imbalance between myocardial oxygen supply and oxygen demand.
Along with stroke, … is the leading cause of death and disability
Along with stroke, IHD is the leading cause of death and disability.

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13
Q

Modifiable IHD risk factors x8

A 
Smoking
Physical activity
Low fruit/vege consumption
High alcohol consumption
Elevated LDL/total cholesterol + reduced HDL
Diabetes
Hypertension
Obesity
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14
Q

Non-modifiable risk factors for IHD?

A

Age (>45 for men, >55 for women)
Sex (men)
Family history of premature CVD (<55 for male relatives or <65 for female relatives)

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15
Q

What are the 2 broad subtypes of IHD/CAD/CHD?

A

Stable angina (SA) and acute coronary syndrome (ACS)

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16
Q

2 subtypes of ACS?

A
  1. Unstable Angina (USA)/NSTACS (non-ST elevated acute coronary syndrome)
  2. Myocardial infarction (MI)
17
Q

2 subtypes of MI?

A

NSTEMI and STEMI

18
Q

What does NSTEMI and STEMI stand for?

A

Non-ST elevated myocardial infarction

ST-elevated myocardial infarction

19
Q

What is angina? What is it caused by?

A

Chronic stable angina is a chest pain caused by reduced blood flow to the heart.
The obstruction is often caused by atherosclerotic lesions in the coronary artery.

20
Q

What effect does vasospasm have on angina?

A

Vasospasm at the site of an atherosclerotic plaque may further constrict the blood flow and contribute to angina.

21
Q

Can vasospasm also cause angina?

A

Vasospasm can sometimes produce angina and precipitate ACS without atherosclerosis.
Stable angina vs unstable angina
Stable angina: only occurs during exercise (e.g when blood flow needs to be increased)
Unstable angina: occurs during exercise and during rest (e.g not only during increased blood flow requirements).

22
Q

What is the clinical presentation of angina? (e.g pain type)

A
  • Pain described as a sensation of pressure, heaviness, tightness, or squeezing in the anterior chest area.
  • Pain may radiate to the neck/jaw/shoulder/back/arm.
  • Pain may be accompanied by dyspnoea, N, V, or diaphoresis.
  • Pain is provoked by exertion or emotional stress.
23
Q

Dyspnoea meaning?

A

Shortness of breath
Diaphoresis meaning
Sweating

24
Q

How can angina pain be relieved?

A

A few minutes rest or sublingual nitroglycerin

25
Q

Chronic stable angina is the initial manifestation of…. in about … of patients?

A

Chronic stable angina is the initial manifestation of IHD in about 50% of patients.
ACS is the first sign of …. in about … of patients
ACS is the first sign of IHD in about 50% of patients.

26
Q

What does ACS stand for?

A

Acute coronary syndrome

27
Q

What is ACS caused by?

A

ACS is caused by an atherosclerotic plaque rupture and subsequent thrombus formation.

28
Q

What does the plaque rupture of ACS involve? (e.g pathogenesis)

A

Plaque rupture involves fissuring of the fibrous cap (of plaque) and release of TF and vWF.

29
Q

What are the differences between the ACS and SA fibrous caps?

A

ACS: thinner fibrous cap
SA: thicker and more stable fibrous cap

30
Q

How is the diagnosis of ACS determined?

A

The onset and the extent of the ischaemia (e.g severity of signs and symptoms) usually determine the diagnosis of ACS.

31
Q

Why is the ACS fibrous cap thinner?

A

Because the plaque size has got bigger, so the cap has stretched.

32
Q

What is the clinical presentation of ACS? x5

A
  • Severe substernal angina pain (20+ mins), often at rest
  • Pain can radiate to the shoulder, down the left arm, and to the back or jaw.
  • ECG may show ST-segment elevation or depression, and a T wave inversion
  • Increased cardiac enzymes in the plasma
  • Pain can be accompanied by dyspnoea, nausea, vomiting, or diaphoresis. Also, arrhythmias, tachycardia, bradycardia, or heart block.
33
Q

What is an example of a cardiac enzyme?

A

Troponin

34
Q

How can the thrombus be visualized in ACS?

A

Using angiography (x-ray of blood vessels)
IHD is a …. CVD which is caused by the ….
IHD is a common cardiovascular disease that is caused by the narrowing/blockage of the coronary arteries.

35
Q

What is the blockage of IHD caused by?

A

Atherosclerotic plaques

36
Q

Unstable plaques can cause …..?

A

Unstable plaques can cause thrombus formation

37
Q

The urgency and severity of IHD depend on the ….?

A

The urgency and severity of IHD depend on the extent of blockage and resulting cardiac ischemia.

PHCY 310 (65 decks)

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