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Year 1 - Cardiovascular (DP) > Vascular and Ischaemia Heart Disease > Flashcards

Vascular and Ischaemia Heart Disease Flashcards

0
Q

What is infarction?

A

Ischaemic necrosis due to occlusion/reduction of blood flow

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1
Q

What is Ischaemia?

A

Impaired vascular perfusion

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2
Q

Why can slow, turbulent flow result in thrombus?

A

Platelets contact endothelium
Active clotting factors not diluted due to less flow
Anticoagulant inflow slowed

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3
Q

When does slow, turbulent flow arise?

A 
DVT
Fibrosed-myocardium post MI
Aneurysms
AF
MS and LV dilation
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4
Q

What are lines of Zahn?

A

Alternating platelet + fibrin/RBC + WBC bands

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5
Q

What occurs in a mural thrombus?

A

Forms in ventricles
- MI
- Arrhythmias
Forms in aorta

These adhere to the wall of large vessels and typically show lines of Zahn

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6
Q

How do venous thrombi appear?

A

Reddish-blue and adhered to wall

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7
Q

What types of embolism exist?

A 
Thromboembolism
Fat
Marrow
Air
Septic
Amniotic fluid
Tumour
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8
Q

What shape is a pulmonary infarct?

A

Wedge shaped

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9
Q

How could a venous embolus infarct peripheral arteries? What would this phenomenon be called?

A

ASD/VSD

Paradoxical embolus

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10
Q

When would a fat embolism occur?

A

Major soft tissue/bone injury

- Fat enters lung globules

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11
Q

Arteriosclerosis is a general term for three conditions. What are they?

A

Atherosclerosis
Monckeberg Medial Calcific Sclerosis - Medium vessels
Arteriolosclerosis - Small vessels

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12
Q

Where is atherosclerosis common?

A

Aorta
Coronary arteries
Cerebral arteries

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13
Q

What is the basic structure of the atheromatous plaque?

A

Lipid core

Fibrous cap

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14
Q

How can an atheromatous plaque lead to an aneurysm?

A

Media progressively degraded

Vessel wall weakens

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15
Q

What are the key stages to atherosclerosis?

A
  1. Chronic endothelial injury
  2. Endothelial dysfunction
  3. Macrophage activation
  4. Lipoprotein oxidation
  5. Foam cell formation
  6. Plaque formation and growth
    (7. Distribution)
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16
Q

What are some haematological risk factors for DVT and PE?

A 
Polycythaemia rubra vera
Thrombocytosis
Hyperhomocysteinaemia
Antithrombin deficiency
Protein C/S deficiency
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17
Q

Symptoms and signs of DVT?

A

Calf/leg

  • Pain
  • Swelling
  • Redness
  • Hot
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18
Q

What investigations can be done into a DVT?

A

D Dimers - Rule out, not rule in

US Doppler

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19
Q

What is venous plethysomography and how does it work?

A

Strain gauge around affected limb
Venous emptying by compression
If there is slow refill = clot

20
Q

Treatment for DVT

A 
LMWH/Warfarin
Compression stockings (TEDs for 6 weeks)
21
Q

What is phlegmasia dolens?

A

A highly severe DVT
Results in reliance on superficial venous drainage
Blood gathers in limb
Blocks arterial inflow

22
Q

Symptoms of PE?

A 
Dyspnoea
Syncope
Pleuritic chest pain
Haemoptysis
Sudden death
23
Q

Imaging for PE

A

CXR
V/Q scan
CTPA - Breath holding needed
Echo

24
What is the BNF regimen for tPA?
- 10mg bolus over 2-5 minutes - 90mg infusion over 2 hours - Max 1.5mg/kg if <65kg
25
What are some examples of oral anticoagulants?
Dabigatran (Antithrombin) | Apixaban, Rivaroxaban (anti-Xa)
26
Which is the preferred therapy in pregnancy, warfarin, heparin or LMWH?
Heparin
27
How is heparin dosing monitored?
Activated partial thromboplastin time (APTT)
28
What is the duration of PE therapy?
``` If temporary risk factor present - 4-6 weeks If idiopathic PE - 3-6 months (longer the more distal) Second idiopathic event - Lifelong ```
29
Common presentation of angina
``` Heavy chest pain Possible radiation Exacerbation by exertion/stress/cold wind Relieved by resting/GTN Risk factors present ```
30
Presentation of aortic dissection/pericarditis
Pleuritic Focal pain No pattern - at rest No risk factors
31
Central chest pain relieved by sitting forward is typically?
Pericarditis
32
Sharp focal chest pain exacerbated by breathing?
Pleuritic pain - Aortic dissection (tearing) - PE (dull)
33
What investigations can be done into chest pain (not MI)?
Exercise testing Perfusion imaging CT angiography Angiography
34
What vessels are harvested during a CABG?
Long saphenous vein | Internal mammary artery
35
What incision is made for a CABG?
Median sternotomy
36
What is PCI and what is its alternate name?
Percutaneous Coronary Intervention | Coronary angioplasty
37
When is PCI used?
In a STEMI
38
What drug therapy is used during a PCI?
Dual antiplatelet therapy (aspirin and clopidogrel) | Anticoagulants
39
What is claudication?
Intermittent leg pain due to muscle Ischaemia during exercise
40
What is ABPI and what are the values in 1. A normal individual 2. A patient suffering from claudication 3. Patient with severe claudication
Ankle Brachial Pressure Index 1. 0.9-1.2 2. 0.4-0.85 3. <0.4
41
What symptoms are indicative of critical limb Ischaemia?
Rest pain - toe/foot ischaemia while sleeping/lying down Ulcers and gangrene if very severe - due to trauma Worse at night Helped by putting dependence on leg/walking
42
Pathogenesis of aortic aneurysm?
Elastin/Collagen regulation in wall Aneurysmal dilation Increased aortic wall stress Progressive dilation - Tension
43
Symptoms of an abdominal aortic aneurysm?
Tachycardia Hypotension Pulsatile, expansile mass Transmitted pulses
44
What investigations can be done into an AAA?
USS | CT Scan - Arterial phase
45
What are varicose veins?
Dilated, tortuous superficial veins | Due to deep vein pressure
46
What signs suggest varicose veins?
Visibility of veins - more prominent when standing Complications - Bruising - Thrombophlebitis
47
Differential diagnoses for a stroke?
``` Hypoglycaemia Seizure Migraine Tumour Function hemiparesis ```
48
Medical management of a stroke
Aspirin 75mg + Dipyridamole (modified release) 200mg twice daily Clopidogrel 75mg once daily Statins If in AF - Anticoagulants If hypertensive - Perindopril + Indapamide

Year 1 - Cardiovascular (DP) (6 decks)

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