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2C The Cardiovascular System > Week 1 - Coronary Artery Disease > Flashcards

Week 1 - Coronary Artery Disease Flashcards

1
Q

Why do we need the cardiovascular system (3 things)

A
  1. Rapid transport of nutrients to tissue
  3. Rapid removal of metabolic waste from tissues
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2
Q

What are the 3 coronary arteries called

A

Right coronary artery, left anterior descending coronary artery, Left circumflex coronary artery

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3
Q

What is the main way of increasing oxygen supply to the heart during exercise

A

Metabolic hyperaemia

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4
Q

Define cardiac output (CO)

A

The volume of blood ejected by 1 ventricle in 1 minute

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5
Q

Define stroke volume

A

The volume of blood ejected from the ventricle in systole

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6
Q

What is typical cardiac output during rest

A

5L/min

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7
Q

What is preload in the intact heart?

A

The stretch on the ventricular fibres just before contraction (ie at the end of diastole)

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8
Q

What is starlings law

A

The greater the Preload
the greater the force of contraction the greater the stroke volume

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9
Q

How do you measure RV preload pressure

A

CVP (central venous pressure) determines RV (right ventricular) preload

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10
Q

Why is starlings law important

A

To balance the outputs of the RV and LV
… therefore contributes to increased SV during upright exercise. - Causes a fall in CO during standing - postural hypotension - dizziness

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11
Q

Define Afterload

A

Afterload can be thought of as the resistance the heart must overcome to eject its contents

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12
Q

What is tachycardia

A

Increased sympathetic activity

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13
Q

Bradycardia

A

Increased parasympathetic activity

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14
Q

What is the flow to cardiac output equation

A

Flow = ^pressure/resistance

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15
Q

What are the 2 inflow valves of the heart

A

Tricuspid val;ve, mitral valve

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16
Q

What are the 2 outflow valves

A

Aortic valve and pulmonary valvue

17
Q

What are the 2 issues that can happen to valves

A

Stenosis and regurgitation

18
Q

Which are the valves most commonly affected

A

Mitral and aortic valves

19
Q

What are common causes of regurge

A

Ischaemia heart disease
Hypertension
Cystic Medial Necrosis (age)
Aortic dissection
bicuspid aortic valve

20
Q

How does valve disease present

A

Incidental finding - ECHO, murmur
Heart failure symptoms - breathless, fatigue, peripheral oedema

Mitral valve disease - atrial fibrillation (AF), stroke
Aortic valve disease - angina, dizziness, sudden death

21
Q

What causes mitral stenosis

A

Commisural fusion

22
Q

How does rheumatic fever cause MS

A

Leaflet thickening so MS valve is <2cm. Due to commisural fusion

23
Q

What is the pathophysiology of MS

A

Increase pressure and volume in the LA
So there is a backlog of blood increasing pulmonary pressures and right heart pressures
Less blood out of LA to LV
So LA dilates (gets bigger) - giving rise to AF
Therefore reduced cardiac output

24
Q

What are the 4 classic findings of MS

A

Increased in heart sound (S1)
Hear opening snap - when mitral opens
Mid diastolic murmur
Pre-systolic accentuation

25
Q

How do you treat MS (mitral stenosis)

A

Balloon angioplasty - a catheter into the vein and push up to the heart and over the mitral valve then inflat the balloon

26
Q

That is the pathophysiology of mitral regurgitation

A

Valve should be closed in systoli - but it isn’t
Pan systolic murmur
LA dilates as blood flows back to it
Predisposing to AF
In the LV - reduced stroke volume as there is 2 ways for the blood to go
Reduced cardiac output
Frank-starling mechanism can compensate to increase preload and stroke volume but this cannot continue over time

27
Q

What is the most common cause of MV regurge

A

MV prolapse

28
Q

What are the 3 causes of aortic stenosis

A

Calcific - age
Bicuspid
Rheumatic fever

29
Q

Pathophysiology of AS

A

Thickening of aortic valve cause obstruction to outflow
Pressure gradient develops across the valve and turbulent flow causes a load murmur in systole.
LV is pressure loaded because of obstruction to flow and hypertrophies

30
Q

What are the symptoms of aortic stenosis

A

SOB on exertion
Exertion all dizziness and syncope
Aortic murmur and angina

31
Q

How do you calculate coronary percussion pressure

A

Coronary percussion pressure = Aortic diastolic pressure - left ventricular end-diastolic pressure (LVEDP)

32
Q

Aortic regurgitation

A

Blood flows back in diastole - blood goes back to LV rather than round the body
Less aortic diastolic pressure
Less Coronary perfusion pressure
Less myocardial O2 supply (angina)
LV dilates and hypertrophy
Have a collating pulse - increased JVP

33
Q

Risk factors for Coronary heart disease

A

Male, smoke, obesity, hypertension, high cholesterol, alcohol, stress, sedentary lifestyle, diet, age, ethnicity, family history

34
Q

What are the risk calculators for Coronary heart disease

A

Framingham Risk Score
QRISK3

35
Q

What are some secondary prevention methods to stop Coronary heart disease

A

Anti-platelets (Aspirin, Clopidogrel,
Prasugrel, Ticagrelor), Beta Blockers / Ivabradine, Statin, ACEi, Lifestyle modification, Psychosocial factors, Cardiac Rehabilitation

2C The Cardiovascular System (5 decks)

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