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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
Q

What is the BNF regimen for tPA?

A
  • 10mg bolus over 2-5 minutes
  • 90mg infusion over 2 hours
  • Max 1.5mg/kg if <65kg
25
Q

What are some examples of oral anticoagulants?

A

Dabigatran (Antithrombin)

Apixaban, Rivaroxaban (anti-Xa)

26
Q

Which is the preferred therapy in pregnancy, warfarin, heparin or LMWH?

A

Heparin

27
Q

How is heparin dosing monitored?

A

Activated partial thromboplastin time (APTT)

28
Q

What is the duration of PE therapy?

A 
If temporary risk factor present
- 4-6 weeks
If idiopathic PE
- 3-6 months (longer the more distal)
Second idiopathic event
- Lifelong
29
Q

Common presentation of angina

A 
Heavy chest pain
Possible radiation
Exacerbation by exertion/stress/cold wind
Relieved by resting/GTN
Risk factors present
30
Q

Presentation of aortic dissection/pericarditis

A

Pleuritic
Focal pain
No pattern - at rest
No risk factors

31
Q

Central chest pain relieved by sitting forward is typically?

A

Pericarditis

32
Q

Sharp focal chest pain exacerbated by breathing?

A

Pleuritic pain

  • Aortic dissection (tearing)
  • PE (dull)
33
Q

What investigations can be done into chest pain (not MI)?

A

Exercise testing
Perfusion imaging
CT angiography
Angiography

34
Q

What vessels are harvested during a CABG?

A

Long saphenous vein

Internal mammary artery

35
Q

What incision is made for a CABG?

A

Median sternotomy

36
Q

What is PCI and what is its alternate name?

A

Percutaneous Coronary Intervention

Coronary angioplasty

37
Q

When is PCI used?

A

In a STEMI

38
Q

What drug therapy is used during a PCI?

A

Dual antiplatelet therapy (aspirin and clopidogrel)

Anticoagulants

39
Q

What is claudication?

A

Intermittent leg pain due to muscle Ischaemia during exercise

40
Q

What is ABPI and what are the values in

  1. A normal individual
  2. A patient suffering from claudication
  3. Patient with severe claudication
A

Ankle Brachial Pressure Index

  1. 0.9-1.2
  2. 0.4-0.85
  3. <0.4
41
Q

What symptoms are indicative of critical limb Ischaemia?

A

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
Q

Pathogenesis of aortic aneurysm?

A

Elastin/Collagen regulation in wall
Aneurysmal dilation
Increased aortic wall stress
Progressive dilation - Tension

43
Q

Symptoms of an abdominal aortic aneurysm?

A

Tachycardia
Hypotension
Pulsatile, expansile mass
Transmitted pulses

44
Q

What investigations can be done into an AAA?

A

USS

CT Scan - Arterial phase

45
Q

What are varicose veins?

A

Dilated, tortuous superficial veins

Due to deep vein pressure

46
Q

What signs suggest varicose veins?

A

Visibility of veins - more prominent when standing
Complications
- Bruising
- Thrombophlebitis

47
Q

Differential diagnoses for a stroke?

A 
Hypoglycaemia
Seizure
Migraine
Tumour
Function hemiparesis
48
Q

Medical management of a stroke

A

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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