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Y3 IWB > PATHOLOGY- Heart disorders 1 > Flashcards

PATHOLOGY- Heart disorders 1 Flashcards

1
Q

Name the 4 chambers of the heart

A

Right ventricle
Right atrium
Left ventricle
Left atrium

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2
Q

What does the right hand side of the heart do?

A

Pumps deoxygenated blood to the lungs

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3
Q

What does the left hand side of the heart do?

A

Pumps oxygenated blood to the rest of the body

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4
Q

What does diastole mean?

A

Refers to the filing of the ventricles with blood (relaxation phase)

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5
Q

What does systole mean?

A

Refers to the contraction phase of the ventricles where good is ejected from the ventricles

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6
Q

Name the different valves of the heart

A
  1. Tricuspid valve
  2. Pulmonary valve
  3. Mitral valve
  4. Aortic Valve
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7
Q

Wha does the tricuspid valve separate?

A

It separated the right atrium from the right ventricle

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8
Q

What does the mitral valve separate ?

A

The left atrium from the left ventricle

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9
Q

What does the pulmonary valve separate?

A

The right ventricle from the pulmonary artery

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10
Q

What does the aortic valve separate

A

The aorta from the left ventricle

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11
Q

Talk though the path blood takes starting from the vena cava

A 
1 Vena cava into the right atrium
2. Cuspid valve
3 Right ventricle 
4. Pulmonary valve into the pulmonary artery  
5. Lungs 
6. Re-enters via the pulmonary vein into the left atrium
7. Mitral valve
8. Left ventricle
9. Aortic valve
10. Aorta to rest of the body
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12
Q

What is the general rule regarding blood found in the arteries (and which artery is the exception)

A

Arteries take OXYGENATED blood AWAY from the heart

apart from the pulmonary artery that carries DEOXYGENATED blood AWAY from the heart

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13
Q

What is the general rule regarding blood found in the vein (and which vein is the exception)

A

Veins take DEOXYGENATED blood to VISIT the heart

apart from the pulmonary VEIN that carries OXYGENATED blood to VISIT the heart

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14
Q

Name the 3 main vessels that supply OXYGENATED blood to the heart

A
  1. Left anterior descending artery
  2. The circumflex artery
  3. The right coronary artery
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15
Q

Where is the left anterior descending artery found?

A

Passes down the front of the heart

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16
Q

Where is the circumflex artery found?

A

Passes to the left hand side of the heart

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17
Q

Where is the right coronary artery found?

A

Passes to the right hand side of the heart

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18
Q

Which artery supplies the back of the heart (in most people)?

A

The right coronary artery

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19
Q

What are the circumflex artery and left descending coronary artery branches of?

A

The left main coronary artery

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20
Q

What is another name for the left main coronary artery?

A

The left main stem

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21
Q

What is the significance of the left main corner artery?

A

It is a small branch of the aorta that splits into the

  1. Left anterior descending artery
  2. The circumflex artery
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22
Q

What is ischaemic heart disease?

A

It describes a GROUP of clinical syndromes that relates to myocardial ischaemia

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23
Q

Define ischaemia

A

Cell injury resulting from localised HYPOXIA induced by reduced blood flow, most commonly due to a mechanical arterial obstruction

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24
Q

What s another name for ischaemic heart disease?

A

Coronary heart disease

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25
Q

What causes ischaemic heart disease in the majority of cases?

A

Coronary artery atherosclerosis causes this in 90% of cases

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26
Q

Give some clinical manifestations of ischaemic heart disease

A
  1. Myocardial infarction
  2. Angina (stable or unstable)
  3. Chronic ichaemic heart disease and heart failure
  4. Sudden cardiac death
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27
Q

Name the leading cause of death in the uk and worldwide

A

ischaemic heart disease

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28
Q

How any deaths in the UK are accused by ischaemic heart disease?

A

64,000 per year
180 per day
1 every 8 mins

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29
Q

Death rates for ischaemic heart disease have fallen over the years why?

A
  1. Awareness of modifiable life style factors
  2. Awareness of medical risk factors
  3. Better diagnosis and treatment
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30
Q

Give some treatment options we now have to manage ischaemic hear disease

A
  1. Drugs like statins
  2. Angioplasty
  3. Stenting
  4. Implantable defibrillators
  5. Ventricular asst devices
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31
Q

Give some common risk factors fo ischaemic heart disease

A
  1. Smoking
  2. Obesity
  3. Hypertension
  4. Diabetes
  5. Old Age
  6. Family history
  7. Dyslipidaemia
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32
Q

Who are more likley to get ischaemic heart disease men or women?

A

Men are at a grater risk than women

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33
Q

What is dyslipidaemia?

A

Abnormal lipid levels usually increased LDL levels relative to HDL

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34
Q

How can we treat dyslipidaemia?

A

Statins

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35
Q

What is the pathogenesis of ischaemic heart disease?

A

Imbalance between supply of oxygen and demand

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36
Q

Talk through the brief stages that occur in the heart that can lead to myocardial infarction

A
  1. Insufficient coranary perfusion
  2. Cardiac hypoxia
  3. Cell injury
    If sustained
  4. Myocardial cell death
  5. Myocardial infarction
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37
Q

How can we identify which coronary artery is blocked

A

By checking on an ECG to see which area of the heart is damaged

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38
Q

Which of the three coronary arteries is blocked in the majority of cases?

A

The left anterior descending artery is blocked in 50% of cases
This is also known as the artery of sudden death

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39
Q

On a cellular level what damage leads to ischaemic heart disease

A

Mitochondria death which leads to reduced ATP production

This leads to several problems

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40
Q

If the mitochondria becomes damaged what problems can that cause

A
  1. Sodium pump damage causing ER ad cellular swelling and los of microvilli
  2. Increased aerobic glycolysis increasing lactic acid levels causing clumping of nuclear chromatin
  3. Detachment of ribosomes which decreases protein synthesis
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41
Q

What is atherosclerosis?

A

Material build up in the walls of arteries

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42
Q

Does atherosclerosis affect arteries more or veins

A

Arteries

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43
Q

Name three key things that can lead to the build up of plaque in vessels

A
  1. Build up of lipids
  2. smoking
  3. high blood pressure
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44
Q

Talk through how atherosclerosis can happen

A
  1. Lipids build up in the walls
  2. Macrophages try and get rid of the lipids
  3. Macrophages die
  4. Leads to an inflammatory response
  5. Leads to the build up of fat and smooth muscle and fibrotic material in the blood vessel
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45
Q

The initial build up of lipids vessel is called what?

A

A fatty streak

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46
Q

What forms after the initial fatty streak and how?

A

Smooth muscle and lipid build up lead to the formation of:
FIBROFATTY PLAQUE

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47
Q

What three things can happen if plaque accumulation in the vessels get too much?

A
  1. Aneurysm and rupture
  2. Occlusion by thrombosis
  3. Critical stenosis
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48
Q

What is critical stenosis?

A

When so much plaque has occluded the arteries (>70%) that it has significantly affected blood flow

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49
Q

What happen to arteries if occlusion by thrombus occurs
What can it lead to

A

The plaque can suddenly rupture and burst leading to the formation of a blood clot over the rupture plaque
sudden occlusion occurs
can cause unstable angina or myocardial infarction

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50
Q

The severe symptoms of unstable angina and acute myocardial infarction area termed as…?

A

Acute coronary syndrome (ACS)

51
Q

What causes unstable angina and myocardial infarction

A

Unstable plaque rupture

52
Q

What causes stable angina?

A

Significant and progressive occlusion of vessel

53
Q

What are acute coronary syndromes?

A

More severe symptoms of unstable angina

54
Q

What is the difference between unstable angina and myocardial infarction?

A

There is no detectable myocardial cell damage in unstable angina

55
Q

What are the clinical features of ischaemic heart disease

A
  1. Angina pectoris
  2. Pale and clammy
  3. Sweating
  4. Nausea
  5. Weak pulse or low BP
  6. Breathlessness
56
Q

What is angina pectoris

A

“strangled chest”

57
Q

What causes pain in angina pectoris?

A

Pain is due to inflammatory mediator release

58
Q

Where is angina pectoris felt?

What is it preipitated by

A

Retrosternal chest pain that radiates to epigastrium, back, neck, jaw or shoulders

exertion, eating, exposure to cold or emotional stress

59
Q

What is stable angina?

A

Angina pectoris that occurs for 1-5 minutes and is relieved by rest or GTN or other drug

60
Q

What is unstable angina?

A

Angina pectoris that is more intense, lasts longer, can occur spontaneous at rest and can be prcicipiated by less exertion
Can progressively get worse

61
Q

what are the clinical symptoms of ischaemic heart disease

A

chest pain
pale and clammy
sweating
nausea and vomiting
weak pulse/low blood pressure
breathlessness

62
Q

How do we diagnose ischaemic heart disease

A
  1. Look at clinical features of pain
  2. Can look at changes on an electrocardiogram
  3. Look for cardiac blood markers
63
Q

How do cardiac blood markers work?

A

When myocardial cells die they release a protein into the blood that is specific to those cells
If you take a blood sample and see the specific proteins (eg troponin) then you know cardiac cells are dying

64
Q

what do you see with a sudden coronary artery thrombosis and why

A

nothing because theres no time for the tissues to react

65
Q

what do patients who have a previous history of angina usually carry

A

GTN spray or tablets

66
Q

If you fear patient is having an unstable angina attack or myocardial infarction what should you do?

A
  1. Call 999
  2. Reassure patient and put them in a comfortable position
  3. Give oxygen
  4. Give sublingual GTN if patient has it
  5. DO NOT give an inter muscular injection
  6. Aspirin 300mg and give note to hospital
  7. CPR if they collapse
67
Q

What do the NICE guidelines say regarding patients with nonsystematic ischaemic heart disease?

A
  1. Vulnerable for 4 weeks following MI so check with medical practitioner before treatment
  2. Low dose aspirin should not be stopped or altered before dental treatment
  3. Antibiotic prophylaxis not recommended following surgery
    BASIC RULE: don’t stop treatment if minor procedure with low risk fo bleeding and I you are unsure consult a cardiologist
68
Q

Name some complications that can arise after suffering from a myocardial infarction

A
  1. Stroke (embolism)
  2. Cardiogenic shock (inability of the heart to sufficiently profuse the body as a result of sudden cardiac injury)
  3. Congestive heart failure (chronic impaired contractility)
  4. Cardiac tamponade (accumulation of blood in the pericardial sac)
  5. Arrhythmias (abnormal heart rhythms)
  6. Pericarditis (inflammation in the pericaridum (sac around heart))
69
Q

Name the 4 main ways the heart can be effected after a myocardial infarction

A
  1. Impaired contractility
  2. Tissue necrosis
  3. Electrical instability
  4. Pericardial inflammation
70
Q

What can impaired contractility cause?

A

1, Can lead to ventricular thrombus leading to stroke

  1. Hypotension that can increase ischaemia and cause cardiogenic shock
  2. Congestive heart failure
71
Q

What can tissue necrosis cause?

A
  1. Papillary muscle infarction leading to congestive heart failure
  2. Ventricular wall rupture that causes cardiac tamponade
72
Q

What is cardiac tamponade

A

Accumulation of blood in the pericardial sack

73
Q

What can electrical instability in the heart cause|

A

Arrhythmias

74
Q

What are arrhythmias

A

Abnormal heart rhythm

75
Q

What can pericardial inflammation cause

A

Pericarditis

76
Q

What is pericarditis

A

Pericardium inflammation

77
Q

What is an aneurysm

A

An abnormal dilation of the ventricle due to myocardial infarction

78
Q

What is heart failure?

A

Inability of the heart to pump enough blood to meet metabolic demands of the body

79
Q

When can heart failure occur?

A

It is usually the end stage of many forms of chronic heart disease
- Work overload e.g. valvular heart disease / hypertension
- Myocardial damage (IHD) - acute severe IHD can cause severe HF

80
Q

Give symptoms of heart failure

A
  1. Fatigue
  2. Breathlessness
  3. Peripheral oedema/ swelling
81
Q

What are the 3 responses of the heart to heart failure?

A

Initially the heart will compensate to try and maintain function. It does this by either:

  1. Increasing contractility
  2. Cardiac hypertrophy
  3. Neurohumoural reposens
82
Q

What is cardiac hypertrophy?

A

The heart increasing in size to try and maintain function and cardiac output after heat failure

83
Q

Give some neurohumoural responses of the body in response to heart failure

A

Fluid is retained after low cardiac output is sensed

This ultimately leads to fluid overload

84
Q

What is the ejection fraction?

A

It is the proportion of blood within the ventricle that is actually pumped out

85
Q

What is the ejection fraction in a healthy individual?

A

55-70%

86
Q

Name 2 different causes of heart failure

A
  1. Systolic dysfunction
  2. Diastolic dysfunction
87
Q

What happens to ejection fraction in systolic dysfunction?

A

Decreased contractility which leads an ejection fraction of <40%

88
Q

What can cause systolic dysfunction

A
  1. Ischaemic heart disease
  2. Valve disease
89
Q

What can cause diastolic dysfunction?

A

Heart is too stiff and cannot fill properly

90
Q

Wha effect does systolic dysfunction have on the ejection fraction?

A

Reduces the ejection fraction

91
Q

Wha effect does diastolic dysfunction have on the ejection fraction?

A

Ejection fraction is preserved

92
Q

Wha can cause diastolic dysfunction?

A

Hypertrophy

93
Q

What happens if the left side of the heart fails?

A

Impaired output causing

  1. congestion in the pulmonary circulation
  2. Stasis of blood in the left side
  3. Inadequate perfusion of organs
94
Q

If the left side of a patents heart is damaged what signs of symptoms may you see

A
  1. Breathlessness
  2. Oedema due to organ failure (systemic hypoperfusion)
95
Q

What happens if the right side of the heart fails?

A

Increased “back pressure” through the pulmonary and venous circuit

96
Q

If the right side of a patents heart is damaged what signs of symptoms may you see

A

Leg swelling and organ congestion

97
Q

Is right handed failure of left side failure more common?

A

Neither is more common they both usually occur in combination (known as congestive heart failure)

98
Q

Name some diseases that affect the valves

A
  1. Valvular stenosis
  2. Valvular regurgitation/ incompetence
  3. Infective endocarditis
99
Q

What happens in valvular stenosis

A

They can fail to open leading to impaired forward flow of blood (stenosis)

100
Q

What happen in valvular regurgitation/ incompetence

A

Valves fail to close fully leading to the backflow of blood

101
Q

What happens in Infective endocarditis

A

The valves can get infected with vegetations which can lead to embolism and impaired mobility of the valves

102
Q

What are the 3 likely outcomes abnormal valve function

A
  1. Abnormal blood flow
  2. Clot formation
  3. Risk of infection (endocarditis)
103
Q

What is valvular stenosis almost always due to?

A

Chronic injury/ rheumatic fever

104
Q

Name the 2 types of stenosis

A
  1. Mitral stenosis
  2. Aortic stenosis
105
Q

what is aortic stenosis
what does it result in

A

narrowing of the aortic valve resulting in impaired blood flow through the aortic valve

106
Q

what can acute valve disease lead to
what can chronic valve disease lead to

A

sudden death
heart failure

107
Q

Give some pathological causes of mitral stenosis

A

Rheumatic valvular disease

108
Q

Give some pathological causes of aortic stenosis

A

Calcific degeneration (caused by general wear and tear)
or
Rheumatic valvular disease

109
Q

What is valvular incompetence/insufficiency usually due to?

A

Disease of the cusps or supporting structures

There are may causes and they can be acute or chronic

110
Q

Name the 2 types of valvular incompetence

A
  1. Mitral incompetence
  2. Aortic incompetence
111
Q

What can damage to the atrio ventricular valves cause?

A

Atrial fibrillation (unusual electrical signal in the atrium)

112
Q

Name the valvular disease the is most common

A

Aortic stenosis

113
Q

How can you treat aortic stenosis?

A

Valve replacement
Balloon dilation

114
Q

what does aortic stenosis do to the left ventricle

A

causes hypertrhophy of left ventricle

115
Q

what can put you at risk of aortic stenosis

A

bicuspid valve- congenital

116
Q

what can aortic stenosis cause

A
  1. Left ventricle hypertrophy -> ischaemia or loss of function
  2. syncope (passing out suddenly)
  3. eventually leading to decompensated CHF
117
Q

what is the distinctive feature that patients with aortic stensosis have

A

ejection systolic murmur (abnormal heart sound when the heart contracts )

118
Q

What 3 things cause mitral regurgitation/incompetence

A
  1. calcification of valve ring (annulus)
  2. ischaemic heart disease causing fibrous scarring of papillary muscle and tethering valve leaflets
  3. papillary muscle rupture
  4. infective endocarditis
  5. mitral valve proplapse
119
Q

what is mitral valve proplapse

A

Congenital condition myxomatous degeneration of mitral valve leaflets

120
Q

what is the distinctive feature that patients with mitral incompetence have

A

pan systolic murmur

121
Q

how would you treat mitral incompetence

A

valve replacement

122
Q

what 6 things can aortic regurgitation/insufficiency be caused by

A
  1. dilation of thr ascending aorta, often secondary to hypertension and/or aging
  2. infective endocarditis
  3. syphilis
  4. ankylosing spondylitis
  5. rheumtoid arthiritis
  6. marfan syndrome
123
Q

what is vrtually the only cause of mitral stenosis

A

rheumatic fever/heart disease

124
Q

what effect does mitral stenosis have

A
  • Obstruction to left atrium
  • Pulmonary congestion
  • Right ventricular hypertrophy
  • Right sided heart failure

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