PATHOLOGY- Heart disorders 1 Flashcards
1
Q
Name the 4 chambers of the heart
A
Right ventricle
Right atrium
Left ventricle
Left atrium
2
Q
What does the right hand side of the heart do?
A
Pumps deoxygenated blood to the lungs
3
Q
What does the left hand side of the heart do?
A
Pumps oxygenated blood to the rest of the body
4
Q
What does diastole mean?
A
Refers to the filing of the ventricles with blood (relaxation phase)
5
Q
What does systole mean?
A
Refers to the contraction phase of the ventricles where good is ejected from the ventricles
6
Q
Name the different valves of the heart
A
- Tricuspid valve
- Pulmonary valve
- Mitral valve
- Aortic Valve
7
Q
Wha does the tricuspid valve separate?
A
It separated the right atrium from the right ventricle
8
Q
What does the mitral valve separate ?
A
The left atrium from the left ventricle
9
Q
What does the pulmonary valve separate?
A
The right ventricle from the pulmonary artery
10
Q
What does the aortic valve separate
A
The aorta from the left ventricle
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
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
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
14
Q
Name the 3 main vessels that supply OXYGENATED blood to the heart
A
- Left anterior descending artery
- The circumflex artery
- The right coronary artery
15
Q
Where is the left anterior descending artery found?
A
Passes down the front of the heart
16
Q
Where is the circumflex artery found?
A
Passes to the left hand side of the heart
17
Q
Where is the right coronary artery found?
A
Passes to the right hand side of the heart
18
Q
Which artery supplies the back of the heart (in most people)?
A
The right coronary artery
19
Q
What are the circumflex artery and left descending coronary artery branches of?
A
The left main coronary artery
20
Q
What is another name for the left main coronary artery?
A
The left main stem
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
- Left anterior descending artery
- The circumflex artery
22
Q
What is ischaemic heart disease?
A
It describes a GROUP of clinical syndromes that relates to myocardial ischaemia
23
Q
Define ischaemia
A
Cell injury resulting from localised HYPOXIA induced by reduced blood flow, most commonly due to a mechanical arterial obstruction
24
Q
What s another name for ischaemic heart disease?
A
Coronary heart disease
25
What causes ischaemic heart disease in the majority of cases?
Coronary artery atherosclerosis causes this in 90% of cases
26
Give some clinical manifestations of ischaemic heart disease
1. Myocardial infarction
2. Angina (stable or unstable)
3. Chronic ichaemic heart disease and heart failure
4. Sudden cardiac death
27
Name the leading cause of death in the uk and worldwide
ischaemic heart disease
28
How any deaths in the UK are accused by ischaemic heart disease?
64,000 per year
180 per day
1 every 8 mins
29
Death rates for ischaemic heart disease have fallen over the years why?
1. Awareness of modifiable life style factors
2. Awareness of medical risk factors
3. Better diagnosis and treatment
30
Give some treatment options we now have to manage ischaemic hear disease
1. Drugs like statins
2. Angioplasty
3. Stenting
4. Implantable defibrillators
5. Ventricular asst devices
31
Give some common risk factors fo ischaemic heart disease
1. Smoking
2. Obesity
3. Hypertension
4. Diabetes
5. Old Age
6. Family history
7. Dyslipidaemia
32
Who are more likley to get ischaemic heart disease men or women?
Men are at a grater risk than women
33
What is dyslipidaemia?
Abnormal lipid levels usually increased LDL levels relative to HDL
34
How can we treat dyslipidaemia?
Statins
35
What is the pathogenesis of ischaemic heart disease?
Imbalance between supply of oxygen and demand
36
Talk through the brief stages that occur in the heart that can lead to myocardial infarction
1. Insufficient coranary perfusion
2. Cardiac hypoxia
3. Cell injury
If sustained
4. Myocardial cell death
5. Myocardial infarction
37
How can we identify which coronary artery is blocked
By checking on an ECG to see which area of the heart is damaged
38
Which of the three coronary arteries is blocked in the majority of cases?
The left anterior descending artery is blocked in 50% of cases
This is also known as the artery of sudden death
39
On a cellular level what damage leads to ischaemic heart disease
Mitochondria death which leads to reduced ATP production
| This leads to several problems
40
If the mitochondria becomes damaged what problems can that cause
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
41
What is atherosclerosis?
Material build up in the walls of arteries
42
Does atherosclerosis affect arteries more or veins
Arteries
43
Name three key things that can lead to the build up of plaque in vessels
1. Build up of lipids
2. smoking
3. high blood pressure
44
Talk through how atherosclerosis can happen
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
45
The initial build up of lipids vessel is called what?
A fatty streak
46
What forms after the initial fatty streak and how?
Smooth muscle and lipid build up lead to the formation of:
FIBROFATTY PLAQUE
47
What three things can happen if plaque accumulation in the vessels get too much?
1. Aneurysm and rupture
2. Occlusion by thrombosis
3. Critical stenosis
48
What is critical stenosis?
When so much plaque has occluded the arteries (>70%) that it has significantly affected blood flow
49
What happen to arteries if occlusion by thrombus occurs
What can it lead to
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
50
The severe symptoms of unstable angina and acute myocardial infarction area termed as...?
Acute coronary syndrome (ACS)
51
What causes unstable angina and myocardial infarction
Unstable plaque rupture
52
What causes stable angina?
Significant and progressive occlusion of vessel
53
What are acute coronary syndromes?
More severe symptoms of unstable angina
54
What is the difference between unstable angina and myocardial infarction?
There is no detectable myocardial cell damage in unstable angina
55
What are the clinical features of ischaemic heart disease
1. Angina pectoris
2. Pale and clammy
3. Sweating
4. Nausea
5. Weak pulse or low BP
6. Breathlessness
56
What is angina pectoris
"strangled chest"
57
What causes pain in angina pectoris?
Pain is due to inflammatory mediator release
58
Where is angina pectoris felt?
What is it preipitated by
Retrosternal chest pain that radiates to epigastrium, back, neck, jaw or shoulders
exertion, eating, exposure to cold or emotional stress
59
What is stable angina?
Angina pectoris that occurs for 1-5 minutes and is relieved by rest or GTN or other drug
60
What is unstable angina?
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
what are the clinical symptoms of ischaemic heart disease
chest pain
pale and clammy
sweating
nausea and vomiting
weak pulse/low blood pressure
breathlessness
62
How do we diagnose ischaemic heart disease
1. Look at clinical features of pain
2. Can look at changes on an electrocardiogram
3. Look for cardiac blood markers
63
How do cardiac blood markers work?
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
what do you see with a sudden coronary artery thrombosis and why
nothing because theres no time for the tissues to react
65
what do patients who have a previous history of angina usually carry
GTN spray or tablets
66
If you fear patient is having an unstable angina attack or myocardial infarction what should you do?
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
What do the NICE guidelines say regarding patients with nonsystematic ischaemic heart disease?
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
Name some complications that can arise after suffering from a myocardial infarction
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
Name the 4 main ways the heart can be effected after a myocardial infarction
1. Impaired contractility
2. Tissue necrosis
3. Electrical instability
4. Pericardial inflammation
70
What can impaired contractility cause?
1, Can lead to ventricular thrombus leading to stroke
2. Hypotension that can increase ischaemia and cause cardiogenic shock
3. Congestive heart failure
71
What can tissue necrosis cause?
1. Papillary muscle infarction leading to congestive heart failure
2. Ventricular wall rupture that causes cardiac tamponade
72
What is cardiac tamponade
Accumulation of blood in the pericardial sack
73
What can electrical instability in the heart cause|
Arrhythmias
74
What are arrhythmias
Abnormal heart rhythm
75
What can pericardial inflammation cause
Pericarditis
76
What is pericarditis
Pericardium inflammation
77
What is an aneurysm
An abnormal dilation of the ventricle due to myocardial infarction
78
What is heart failure?
Inability of the heart to pump enough blood to meet metabolic demands of the body
79
When can heart failure occur?
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
Give symptoms of heart failure
1. Fatigue
2. Breathlessness
3. Peripheral oedema/ swelling
81
What are the 3 responses of the heart to heart failure?
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
What is cardiac hypertrophy?
The heart increasing in size to try and maintain function and cardiac output after heat failure
83
Give some neurohumoural responses of the body in response to heart failure
Fluid is retained after low cardiac output is sensed
| This ultimately leads to fluid overload
84
What is the ejection fraction?
It is the proportion of blood within the ventricle that is actually pumped out
85
What is the ejection fraction in a healthy individual?
55-70%
86
Name 2 different causes of heart failure
1. Systolic dysfunction
2. Diastolic dysfunction
87
What happens to ejection fraction in systolic dysfunction?
Decreased contractility which leads an ejection fraction of <40%
88
What can cause systolic dysfunction
1. Ischaemic heart disease
2. Valve disease
89
What can cause diastolic dysfunction?
Heart is too stiff and cannot fill properly
90
Wha effect does systolic dysfunction have on the ejection fraction?
Reduces the ejection fraction
91
Wha effect does diastolic dysfunction have on the ejection fraction?
Ejection fraction is preserved
92
Wha can cause diastolic dysfunction?
Hypertrophy
93
What happens if the left side of the heart fails?
Impaired output causing
1. congestion in the pulmonary circulation
2. Stasis of blood in the left side
3. Inadequate perfusion of organs
94
If the left side of a patents heart is damaged what signs of symptoms may you see
1. Breathlessness
2. Oedema due to organ failure (systemic hypoperfusion)
95
What happens if the right side of the heart fails?
Increased "back pressure" through the pulmonary and venous circuit
96
If the right side of a patents heart is damaged what signs of symptoms may you see
Leg swelling and organ congestion
97
Is right handed failure of left side failure more common?
Neither is more common they both usually occur in combination (known as congestive heart failure)
98
Name some diseases that affect the valves
1. Valvular stenosis
2. Valvular regurgitation/ incompetence
3. Infective endocarditis
99
What happens in valvular stenosis
They can fail to open leading to impaired forward flow of blood (stenosis)
100
What happen in valvular regurgitation/ incompetence
Valves fail to close fully leading to the backflow of blood
101
What happens in Infective endocarditis
The valves can get infected with vegetations which can lead to embolism and impaired mobility of the valves
102
What are the 3 likely outcomes abnormal valve function
1. Abnormal blood flow
2. Clot formation
3. Risk of infection (endocarditis)
103
What is valvular stenosis almost always due to?
Chronic injury/ rheumatic fever
104
Name the 2 types of stenosis
1. Mitral stenosis
2. Aortic stenosis
105
what is aortic stenosis
what does it result in
narrowing of the aortic valve resulting in impaired blood flow through the aortic valve
106
what can acute valve disease lead to
what can chronic valve disease lead to
sudden death
heart failure
107
Give some pathological causes of mitral stenosis
Rheumatic valvular disease
108
Give some pathological causes of aortic stenosis
Calcific degeneration (caused by general wear and tear)
or
Rheumatic valvular disease
109
What is valvular incompetence/insufficiency usually due to?
Disease of the cusps or supporting structures
| There are may causes and they can be acute or chronic
110
Name the 2 types of valvular incompetence
1. Mitral incompetence
2. Aortic incompetence
111
What can damage to the atrio ventricular valves cause?
Atrial fibrillation (unusual electrical signal in the atrium)
112
Name the valvular disease the is most common
Aortic stenosis
113
How can you treat aortic stenosis?
Valve replacement
Balloon dilation
114
what does aortic stenosis do to the left ventricle
causes hypertrhophy of left ventricle
115
what can put you at risk of aortic stenosis
bicuspid valve- congenital
116
what can aortic stenosis cause
1. Left ventricle hypertrophy -> ischaemia or loss of function
2. syncope (passing out suddenly)
3. eventually leading to decompensated CHF
117
what is the distinctive feature that patients with aortic stensosis have
ejection systolic murmur (abnormal heart sound when the heart contracts )
118
What 3 things cause mitral regurgitation/incompetence
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
what is mitral valve proplapse
Congenital condition myxomatous degeneration of mitral valve leaflets
120
what is the distinctive feature that patients with mitral incompetence have
pan systolic murmur
121
how would you treat mitral incompetence
valve replacement
122
what 6 things can aortic regurgitation/insufficiency be caused by
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
what is vrtually the only cause of mitral stenosis
rheumatic fever/heart disease
124
what effect does mitral stenosis have
* Obstruction to left atrium
* Pulmonary congestion
* Right ventricular hypertrophy
* Right sided heart failure
