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Cardiovascular System > Symptoms and signs of disease > Flashcards

Symptoms and signs of disease Flashcards

1
Q

What accumulates in ischaemic muscle? Why?

A

Lactic acid

Lack of oxygen
so anaerobic glycolysis occurs
produces lactic acid

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2
Q

What is the effect of lactic acid accumulation?

A

Drop in pH

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3
Q

What is the effect of drop in pH?

A

Substance P is released

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4
Q

What is substance P?

A

Neuropeptide

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5
Q

What is the effect of substance P?

A

Increases sensitivity of pain afferents in muscle

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6
Q

What does ischaemia mean?

A

Ischaemia mean insufficient blood supply to cell, tissue or organ
compared to its requirement

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7
Q

What is the damaging effect of ischaemia?

A

The lack of oxygen is damaging

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8
Q

Why might someone with uncontrolled thyrotoxicosis develop angina or MI?

A

Tachycardia
less time in diastole
reduced perfusion of coronary arteries
reduced perfusion of myocardium

Whilst the heart is contracting more often
so actually requires more oxygen
more vulnerable to ischaemia

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9
Q

How do patients often describe ischaemic muscle pain?

A

Tight, constriction, vice-like

Heavy, crushing, cramping, pressing, pressure

Tearing

Choking in throat

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10
Q

When might a patient describe tearing pain?

A

Dissection of blood vessels

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11
Q

What gestures do patients often make to describe anginaa?

A

Clenched fists, sometimes placed over chest

Hand over chest

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12
Q

Whest gestures do patients often make to describe itntermittent claudication?

A

Hand pressed over calf

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13
Q

What are the outcomes of cardiac muscle ischaemia?

A

Stable angina
Unstable angina
MI

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14
Q

What is referred pain?

A

Pain located away from actual organ that is causing pain

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15
Q

What are the sites of cardiac referred pain?

A 
Left ear
Jaw
Neck
Arms
Central abdomen
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16
Q

Why does chest pain in stable angina increase with exercise and stress?

A

Increased sympathetic activity
Increased heart rate, force of contraction
Reduced time in diastole, reduced perfusion of coronary arteries, myocardium
But heart is working harder so actually demands more oxygen
More prone to ischaemia

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17
Q

Why does chest pain in stable angina increase with cold weather?

A

Peripheral vasoconstriction
Increases resistance, TPR
Increased afterload
Heart has to contract harder, generate higher pressures in order to pump blood into aorta

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18
Q

Why does chest pain in stable angina increase after a meal?

A

Blood is redirected to the gut

reduced blood supply to heart

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19
Q

Why is chest pain in stable angina relieved with rest?

A

Increased parasympathetic activity
Reduced heart rate, force of contraction
More time in diastole for perfusion of coronary arteries, myocardium
And heart has reduced demand for oxygen

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20
Q

Why is chest pain in stable angina relieved with GTN?

A

Generates nitric oxide
Vasodilates veins and collateral coronary arteries
Veins hold more blood, reduced preload

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21
Q

How is unstable angina different to angina?

A

Chest pain occurs at rest

More intense
May last longer

Does not respond to GTN

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22
Q

What are the ECG features of unstable angina?

A

ST segment depression

T wave inversion

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23
Q

What are the levels of cardiac markers in unstable angina?

A

Cardiac markers are normal

Because no cell death has occurred

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24
Q

What can unstable angina lead on to?

A

MI

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25
Q

How is MI different to angina?

A

More intense than angina pain

26
Q

How does a patient with MI present?

A 
Sweaty
Nauseated
Dyspnoeic
Pale
Clammy
27
Q

Why is a patient with MI pale and sweaty/clammy?

A

Due to increased sympathetic activity

28
Q

What is a palpitation?

A

Noticeable rapid, strong or irregular heartbeat

29
Q

When might palpitations occur?

A 
Exercise
Stress
Night - more aware of heartbeat 
Caffeine
Smoking, alcohol, drugs
30
Q

What can palpitations be associated with?

A

Dizzyness

Loss of consciousness

31
Q

Why are palpitations associated with dizziness, loss of consciousness?

A

Reduced cardiac output
Reduced blood supply to brain, CNS
becomes hypoperfused

32
Q

What causes palpitations?

A

Arrythmias

33
Q

Which arrythmias can cause palpitations?

A

Sinus tachycardia
Atrial or ventricular ectopic beats
Atrial tachycardias
Ventricular tachycardia, fibrillation

34
Q

What are the different types of atrial tachycardias?

A

Supraventricular rhythms
Atrial flutter
Atrial fibrillation

35
Q

What is dyspnoea?

A

Breathlessness

36
Q

What causes dyspnea in terms of cardiac ischaemia?

A

Pulmonary oedema

37
Q

What causes pulmonary oedema?

A 
Blood backing up in pulmonary veins
Increases hydrostatic pressure
More loss of fluid than intake
Fluid builds up in alveoli
Reduces gas exchange
38
Q

What is orthopnea?

A

Breathlessness when lying flat

39
Q

What is paroxysmal nocturnal dyspnoea?

A

Attacks of shortness of breath at night

40
Q

Why do orthopnea and paroxsymal nocturnal dyspnoea occur?

A

Fluid in lungs spreads out in alveoli and lungs
rather than being pooled at the bottom

Equal effect of gravity over body
get increased venous return to right side of heart
more blood enters pulmonary circulation
increases hydrostatic pressure further in pulmonary vessels…

41
Q

Why are orthopnea and paroxysmal nocturnal dyspnoea relieved by sitting up?

A

Fluid pools at bottom of alveoli and lungs again

Effect of gravity
reduced venous return to right side of heart

42
Q

What is another cause of dyspnoea and it being worse at night?

A

Asthma

43
Q

Which arrythmias in particular may lead to loss of consciousness?

A

Ventricular tachycardia

Ventricular fibrillation

44
Q

What is postural hypotension?

A

Low blood pressure when standing

45
Q

How can you tell that an arrythmia was the cause of loss of consciousness?

A

Had palpitations before, during or after the loss of consciousness

46
Q

What is actually being felt when feeling a pulse?

A

The change in pressure that arrives before the blood itself

47
Q

What should be assessed when taking a pulse?

A

Rate
Rhythm
Quality

48
Q

What is the normal pulse rate?

A

60-100 per minute

49
Q

What are the different types of pulse rhythms?

A

Regular

Regularly irregular

Irregularly irregular

50
Q

Give an example of a regularly irregular arryhthmia. Why is it regularly irregular?

A

Second degree heart block

Not in sinus rhythm, so it’s irregular
but has a pattern, so it’s regularly irregular

51
Q

Give some examples of irregularly irregular arrythmias. Why are they irregularly irregular?

A

Atrial fibrillation
Atrial ectopic beats
Ventricular ectopic beats

Because not in sinus rhythm, so are irregular
And they occur randomly, no pattern, so are irregularly irregular

52
Q

What is the pulse pressure? - can be measured in aorta

A

Difference between diastolic and systolic pressure

ESP - EDP

53
Q

How does atrial fibrillation affect pulse pressure?

A

Pulse pressure varies with AF
due to depolarisation and contraction of ventricles occurring irregularly
different heart rate, time in diastole
get different EDVs, EDPs

54
Q

How do ventricular ecoptic beats affect pulse pressure?

A

Compensatory pause before normal heart beat
increased time in diastole, EDV, EDP
gives bounding heart beat and pulse

55
Q

What causes a bounding pulse?

A

Lower EDP usually

  • low TPR
  • bradycardia
  • aortic regurgitation
56
Q

How does low TPR cause a bounding pulse?

A

Reduced pressure in arteries
more blood flows out of aorta into arteries
lower pressure in aorta
so get reduced end-diastolic pressure

57
Q

What can cause low TPR?

A

Exercise

Pregnancy

58
Q

How does bradycardia cause a bounding pulse?

A

More time in diastole
more time for more blood to leave aorta
lower pressure in aorta
lower end-diastolic pressure

59
Q

How does aortic regurgitation cause a bounding pulse?

A 
Aortic valve is incompetent
Backflow of blood from aorta into LV during diastole
less blood in aorta
lower pressure in aorta
lower end-diastolic pressure
60
Q

What are the causes of a thready pulse?

A

Shock

Left ventricular failure

Cardiovascular System (22 decks)

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