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L15 Cardiovascular diseases Flashcards

1
Q

death rates and stuff with CVD

A

causes biggest amount of deaths
1 in 3 deaths are CVD
been a steady decline in deaths by CVD as treatments and lifestyle changes inc

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2
Q

major diseases that you need to know

A

Affecting the vessels
- hypertension
- stroke
- coronary heart disease
- thrombosis

Affecting the heart
- valvular disease
- arrhythmia
- myocardial infarction
- heart failure

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3
Q

diagram for what diseases affect bwhat part of the cardiac output,
see onenote

A

:)

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4
Q

HYPERTENSION: what bp counts as high blood pressure

A

over 140mmHg/90mmHg

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5
Q

how does hypertension affect afterload and therefore the SV

A

increases the afterload
which increases ESV
and thus decreased SV

see notes on bp regulation

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6
Q

how does hypertension affect filtration

A

increases filtration
can lead to oedema (increase in fluid)
see notes on capillary exchange

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7
Q

how many people on avg are affected by hypertension in UK

A

about 15mil people
and 1/3 of these usually goes undetected

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8
Q

what is the main thing that makes hypertension so dangerous

A

its a big risk factor for many diseases

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9
Q

how does hypertension lead to coronary artery disease & myocardial infarction

A

accelerates ATHEROSCLEROSIS
by increasing damage to endothelial walls of coronary arteries

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10
Q

what is artherosclerosis btw

A

thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery

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11
Q

how does hypertension lead to aneurysms

A

aneurysm is when weakness in blood vessel wall develops
so can bulge under pressure

increased wall stress
leads to aneurysms
and also makes it more liekly to rupture

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12
Q

what vessel is prone to aneurysm

A

aorta

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13
Q

what type of aneurysm can lead to stroke

A

saccular aeurysm - in the cerebral circulation

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14
Q

what are the 2 types of stroke

A

haemorrhagic - when a blood vessel inside the skull bursts and bleeds into and around the brain
and ischaemic - when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients

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15
Q

how does hypertension lead to stroke

A

damage to endothelial cells in the cerebral arteries

increasing atherosclerosis
which can lead to ischaemia by blocking arteries
or hamorragic by aneurysms that may form

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16
Q

how can hypertension damage the kidneys

A

can cause inc vasoconstriction of the renal arteries
and reduce blood supply to kidney

damaged the nephron and kidney function declines

causing chronic kidney disease

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17
Q

how can hypertension cause heart failure

A

chronic hypertension puts more strain on ventricles
by increasing afterload
and reducing cardiac output

the heart tries to compensate by hypertophy (when the organ literally increases in size via bigger cells)
this increases contractility
but it’s temporary and will decrease over time

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18
Q

Causes of hypertension:
2 classifications of causes - what is primary hypertension?

A

primary/essential hypertension:
= when no known cause
probs lots of contributing factors
e.g.
- genetic predisposition
- alcohol
- less excersise
- obesity
- diabetes
- intrauterine environment (maternal high bp can influence developing bp in later life)

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19
Q

Causes of hypertension:
2 classifications of causes - what is secondary hypertension?

A

when known medical cause of hypertension

e.g.

adrenal gland diseases
- pheochromacytoma (a tumour affecting this gland)
- leads to increased catecholamine production
- leads to more adrenaline circulating

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20
Q

how is chronic kidney disease a secondary cause of hypertension

A

chronic kidney disease
- less Na+ excretion
- more fluid retained
- so RAAS system is activated
(see BP reg notes)
- so inc vasoconstriction

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21
Q

how is endocrine disorders a secondary cause of hypertension

A

endocrine disorders
- diabetes (inc fluid, and inc arterial stiffness)
- cushings disease (when pituitary gland releases too much cortisol ie ACTH, and increased RAAS activation)

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22
Q

how is adrenal gland disease a secondary cause of hypertension

A

adrenal gland diseases
- pheochromacytoma (a tumour affecting this gland)
- leads to increased catecholamine production
- leads to more adrenaline circulating

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23
Q

treatment of hypertension: what are the 2 main things that treatments aim to fix for hypertension

A

reducing cardiac output
or
reducing vasocontriction

cuz BP = CO x total peripheral resistance

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24
Q

explain the 3 types of drugs that affect the RAAS system that is used to treat hypertension

A

all lead to RAAS inhibtion

  1. Angiotensin Converting Enzyme inhibitor (ACEi)
  2. Angiotensin II receptor blocker (ARB)
  • these 2 both reduce vasoconstriction cuz angiotensin causes vasoconstric
  1. Aldosterone antagonist (Spironalactone)
  • aldosterone stimulates Na+ and water reabsorption
  • so when this is stopped, this reduces Na+ and water reabsorption
  • reducing cardiac output
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25
in treating hypertension, what do Ca2+ channel blockers do?
Ca2+ stiulates muscle contrarction so this drug inhibits entry of Ca2+ into cardiac and vascular muscle cells reducing contractility and strok volume therefore reducing CO
26
in treating hypertension, what are thiazide diuretics
diuretics - effects kidney this inhibits renal Na+ reabsorption increasing water loss in uring thus decreasing venous return and EDV reducing CO
27
in summary, what are the 3 main types of drugs used to treat hypertension
- RAAS inhibitors - Ca2+ channel blockers - thiazide diuretics
28
what are the levels and classes of drugs used to treat hypertension
1 drug = target angiotensin or Ca2+ blocker if dont respond, 2 drugs = add in more angiotensin blocker, Ca2+ blocker or a thizide diuretic if still dont respond, 3 drugs = all 3 classes of drugs
29
what is it called when the patient doesnt respond to all 3 classes of drugs?
resistant hypertension add in aldosterone antagonist OR a beta blocker (which blocks sympathetic pathway) this is last step
30
vascular disorders: ATHEROSCLEROSIS, what is it
narrowing of vessels, fatty plaque narrow the blood vessel
31
what are the 2 main triggering factors for atherosclerosis
endothelial damage (BP, smokeing, diabetes) high LDL cholesterol
32
describe plaque formation
the triggering factors increase the mrisk of inflammatory cells e.g. macrophages and lipid accumulation and fibrous tissure forms a little cap and fatty streak which forms plaque also thrombus formation because theres high chance of rupturing this can lead to clot formation
33
see onenote for atherosclerosis diagram
:)
34
what ar the 2 circulations where this damage is most common
cerebral coronary
35
Effects of atherosclerosis in coronary circulation
redued blood supply to myocardium causes chest pains = angina pectoris or if complete blockage in vessel = ischaemic heart disease
36
Effects of atherosclerosis in cerebral circulation
complete cut off = stroke partial cut off = brain cells die = vascular dementia
37
how do we treat therosclerosis
statins inhibits cholesterol synthesis = lowers LDL acc the most prescribed drugs in the uk
38
vascular diseases - THROMBOSIS, what is it
blood clots
39
what might cause thrombosis
static/low blood flow e.g. immobility and atrial fibrilation (where heart rate is slower than avg)
40
where is thrombosis most likely to occur
in legs cuz mobility helps venous return so immobility means skeletal muscle pumps not working
41
explain formation of thrombosis venous circulation
e.g. starts in leg in immobility swelling and thrombus forms usually in veins near valves risk of part of this breaking off and embolise to form embolus this goes up minto the circulation back through heart will be fine on the way to the heart cuz vessels get bigger but when leaves the heart to the pulmonary circ will evetually encounter vessel it cant get trhoguh = pulmonary embolism blood supply to lungs cut off vry bad
42
explain formation of thrombosis in arterial circulation
e.g. if atrial fibrilation - so blood flow in heart is not very good thrombus happens in atria and breaks off can go from L atrium to L ventricle gets pumped into aorta and get lodged or could go into cerebral circ and cause stroke or into coronary circulation and cause myocardial infarction
43
how do we treat thrombosis
anticoagulants: e.g. warfarin anti platelet therapy: e.g. aspirin
44
cardiac disorders: CORONARY ARTERY DISEASE and myocardial infarction, what is it
biggest killer worldwide starts with ATHEROSCLEROSIS of coronary artery can restrict myocardial blood flow can lead to angina (due to lack of O2)
45
what treatment for angina in CAD
GTN spray basically nitric oxide - leads to vasodilation
46
what can the atheroscleorsis of coronary artey lead to
atherothrombosis where the plaque ruptures or there's an embolism this causes the vessel to get completely cut off leading to MI any muscle that is supplied by the vessel that's blocked starts to die pretty quickly
47
whats the most commmon vessel to be affected by this
the left anterior descending coronary artey supplies the left ventricle
48
what is the treatment for myocardial infarction
percutaneous coronary intervention = minimally invasive operation using catheter (inserted via femoral or radial artery) inserts a stent to reopen blocked artery and also given thrombolyitcs = medication to break up clot
49
cardiac disorders - VALVULAR DISEASE, what are the 2 types
stenosis and regurgitation
50
what is stenosis
thick/stiff valves that fail to open properky this increases the afterload, reducing ejection
51
common cause of stenosis
rheumatic fever these symptoms can appear years after infection
52
what can stenosis lead to
LV hypertrophy -> eventual heart failure
53
what is regurgitaion
valves fail to close properly so backflow of blood reduces stroke volume and cardiac output
54
treatments for valvular disease
surgery to repair valves or can replace w/ sythetic valves
55
cardiac disorders- HEART FAILURE, what are the 2 types
heart cant keep up with body's demands normally is secondary to other diseases, e.g. hypertension or myocardial infarction diastolic and systolic
56
what is diastolic heart failure
caused by thickening or stiff chambers in ventricles so heart cant relax properly and can't fill with blood this reduces EDV and reduces SV
57
what is sytolic heart failure
heart cant pump stretched thin chambers arent effecient at contracting so reduced contractility and reduced SV
58
causes of heart failure
is secondary so diseases that increase workload: - hypertension - aortic stenosis causes pressure overload on ventricle increases afterload hypertrophy occurs and you get thinner walls and larger chambers damage to myocardium - after myocardial infarction can happen years after lose a lot of myocytes so the rest of heart tissue has to work harder myocytes arent replaced- instead you get a fibrous scar leads to heart failure
59
how can heart failure affect pulmonary circulation
if left sided heart failure then not enough blood pumping out of the aorta causes a backflow through the LA and LV means the blood in the pulmonary circ gets backed up also inc pressure in pulmonary veins causing pumonary oedema which is why shortness of breath and coughing
60
how can heart failure affect systemic circ
right sided failure blood pools in peripheral as increased pressure in systemic veins = peripheral oedema
61
what is it caleld when heart failure affects both sides of heart
congestive heart failure
62
how does heart failure affect cardiac output and how is this a cycle
reduced cardiac output naturally leads to activation of RAAS and SNS this might be alright short term but it icreases the amount of fluid, vasoconstriction (thus resistance), and workload increases this again reduces cardiac output cua the heart cant deal
63
how do we treat heart fialure then, 4 key treatments
no curative treatments damaged myocardiocytes cant be replaced but can use > beta blockers > anti-hypertensives surgical: > left ventricular assist device > heart transplant
64
explain beta blockers in heart failure treatment
specifically beta adrenoreceptor antagonists reduces SNS activity to reduce worload and to prevent desensitisation (which tends to happen after constant activation of SNS, so this means when SNS is acc needed its sensitive to it)
65
explain anti hypertensives in heart failure treatment
same drugs used in hypertension treatment reduces fluid to relieve symptoms reduces vasoconstriction reduces workload
66
explain left ventricular assist device and heart transplant as treatment
mechanical heart pump or transplant from healthy donor but surgical risks immunorejection also heart failure candidates usually older and frail so not good for these high risk surgeries
67
cardiac disorder: ARRHYTHMIAS, what is it
devation heart's normal sinus rhythm can be asymptomatic or palpitations, faitning, heart failure, cardiac arrest, death
68
2 main arrhythmias
bradychardia tachycardia
69
what is bradycardia
<60bpm slow signals from SA node SINUS BRADYCARDIA or can be caused by damage to SA node, AV node or conductive tissue which will block signals
70
treatment for bradychardia
pacemaker
71
what is tachycardia
>100bpm 2 type: > sinus tachycardia (normal PQRST wave, but quicker) caused by: drugs, hormones(e.g. thyroid) > non-sinus tachycardia = additional abmornal impulses in ECG
72
some types of arrythmia
atrial fibrilation (AF) long QT syndrome (LQTS) Ventricular tachcardia(VT) Ventricular fibrilation (VF)
73
what is atrial fibrilation (AF)
most common - rapid impulses - so it quivers but doesnt quite contract - can go undetected - cause palpitations, fatining - increases risk of stroke (due to the statis in blood flow cuz less contraction)
74
what is long QT syndrome
prolongs the QT interval affects mostly young people under 25 caused by genetic channelopathies (leading to prolonged action potential) can cause additional ventricular depolarisations can lead to ventricular tachycardia
75
what is ventricular tachycardia
early depolarisation leads to premature ventricul contraction and not adequate filling before the heart contracts prolonged VT can lead to ventricular fibrilation
76
what is ventricular fibrilation
ie cardiac arrest ventricles dont pump w/o treament - death

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