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Medicine Year 1 > Week 126 - Chronic stable angina > Flashcards

Week 126 - Chronic stable angina Flashcards

1
Q

Why can Decreased ATP Production cause cell death?

A
  • Decreased Na/K pump -> influx of H20 -> cell swelling - ⇑Anaerobic glycolysis⇒ ⇓Glycogen and ⇓pH ⇒ Clumping of chromatin - Other effects such as detachment of ribosomes⇒ ⇓protein synnthesis
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2
Q

Why can high levels of calcium inside a cell cause damage

A

-ATPase ⇒ ⇓ATP -Phospholipases ⇒ ⇓ Phospholipds -Proteases ⇒ affects cytoskeleton + membrane -endonucleases ⇒ Chromatin breakdown

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3
Q

What is Prasugrel?

A

anti-platelet

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4
Q

What is Captopril ?

A

short acting ACE-inhibitor

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5
Q

How does GTN work?

A

cause smooth muscle relaxation and subsequent cardiac vasodilation

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6
Q

What are Rouleaux?

A

stacks of RBC

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7
Q

What is Perindopril?

A

ACE-inhibitor

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8
Q

What is Lisinopril?

A

ACE-inhibitor

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9
Q

What are Bisoprolol, Atenolol, Carvedilol?

A

Beta-Blockers

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10
Q

What is Clopidogrel?

A

an antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease

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11
Q

What is Ticagrelor?

A

anti-platelet

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12
Q

What is Ramipril?

A

ACE-inhibitor

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13
Q

how does Metabolic Hyperaemia control the Distribution of flow to organs?

A

A byproduct of metabolism is vasodilators, so when the vessels near active tissue dilate more blood is pulled towards it

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14
Q

For a pt who has had a Acute Coronary Syndrome, what meds should they be started on?

A
  • Aspirin - Clopidogrel - ACE-Inhibitor (e.g. Ramipril) - Beta-Blocker (e.g. Bisoprolol) - Statin (e.g. Simvastatin or Atorvastatin)
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15
Q

What is the cause of the Fahraeus-Lindqvist Effect?

A

Because all vessels have a plasma cell-free layer, which is proportaionally larger in small vessels caused by hydrodynamic forces the cells into the centre Or in very small capillaries BOLUS FLOW - where RBC take up entire diameter

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16
Q

Major classic sings/symptoms of angina?

A
  • Pain/Discomfort o Retrosternal o ‘Crushing’ o Radiating - Lt arm/Rt arm/Back/Neck/Jaw (Sites always remain the same for a person) o Stops within minutes of exertion stopping (class < 4) - Dyspnoea (SOB)
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17
Q

What is Atherosclerosis?

A

the thickening of vessel walls due to build up of calcium and fats

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18
Q

What is the action of an ACE-inhibitor?

A

Inhibits Angiotensin-Converting Enzyme (ACE). Prevents formation of Angiotensin II from Angiotensin I – preventing vasoconstriction and subsequent formation of aldosterone (which promotes sodium & water retention).

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19
Q

What are the 4 emergency situations that would cause chest pain

A

•Myocardial infarction •Pulmonary emboli •Tension pneumothorax •Dissecting thoracic aneurysm

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20
Q

What is Pouseille’s Law?

A

is a physical law that gives the pressure drop in a fluid flowing through a long cylindrical pipe Resistance = 8 x viscosity x length / pi x radius^4

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21
Q

What are the three Vasomotor Nerves?

A
  • Sympathetic Vasoconstrictors (Noradrenaline) - MAIN - Sympathetic Vasodilators – Peripheral (Acetylcholine) - Parasympathetic Vasodilators (Acetylcholine)
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22
Q

What is Atheroma?

A

the accumulation of lipid and fibrous tissue within the intima of arteries

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23
Q

What information can you learn from placing a Cardiac catheter?

A
  • Cardiac anatomy - aortic BP - O2 sats
24
Q

How will Ischaemia show on an ECG?

A

ST depression

25
Q

What is Acute Coronary Syndrome?

A
  • Unstable angina & Non-ST-segment elevation myocardial infarction (NSTEMI) - ST-segment elevation myocardial infarction (STEMI)
26
Q

Whats the initial management for someone with Acute Coronary Syndrome?

A

MONA - Morphine - via slow IV - Oxygen - Nitrates (GTN to releive chest pain) - Anti-platelets – Aspirin

27
Q

What are the side effects of Aspirin?

A

GI irritation (including GI haemorrhage) Bronchospasm

28
Q

How do Beta-Blockers work?

A

Reduces sympathetic drive to cause a reduction in heart rate & myocardial contractility.

29
Q

What is the main use for a GTN spray?

A

first line treatment for angina symptoms

30
Q

What is Autacoid Control and how does it work?

A

Intrinsic Reactive Regulation Autacoids released in damaged tissue/inflammation & vasodilate E.g. Histamine, Bradykinin, Prostaglandins

31
Q

Explain Plethysmography? (Blood flow measuring techniques )

A

Measure blood flow through limb - Pressure cuff used to occlude venous drainage (not arterial inflow; pressure kept low) from limb. Initial swelling in limb measured (swelling tails off after a while)

32
Q

What alternative could you use in a pt who is intolerant to ACE-inhibitors?

A

Angiotensin-II receptor blockers (ARBs)

33
Q

Effects of Adrenaline on local blood vessel & BP

A

Vasodilates f&f organs, heart, lungs, muscles Vasoconstricts skin, GIT

34
Q

Possible surgical treatments for angina

A

stents CABG

35
Q

Risk factors of angina?

A
  • Smoking - Diet – High in fat/low in antioxidants - Hypertension
36
Q

Breifly explain how Renin/Angiotensin II work together

A

1 - kidneys release renin due to low BP 2 - renin Cleaves angiotensinogen to angiotensin I 3 - Angiotensin I cleaved to II in lung by ACE 4 - Angiotensin II is a vasoconstrictor 5 - Aldosterone released caused increased reabsorbtion of water in kidneys

37
Q

What controls the Distribution of flow to organs?

A

Metabolic Hyperaemia

38
Q

How is angina classified?

A

Class 1 – Occurs only during strenuous/prolonged physical activity Class 2 Class 3 Class 4 – Angina at rest, or inability to perform any activity without angina (treat as unstable)

39
Q

Explain Fick’s Principle (Blood flow measuring techniques)

A

Measures blood flow through organ - Constituents of blood before & after passing through an organ measured, and compared to normal rate of increase/depletion of that constituent in organ (per unit blood)

40
Q

Explain Tissue Clearance? (Blood flow measuring techniques )

A

Measures blood flow through small area of tissue - Radioactive substance injected into tissue; time taken for radioactivity to decline due to seepage into bloodstream measured

41
Q

Explain Autoregulation - what is it, how, where?

A
  • Maintenance of near constant flow through an organ across range of BPs - Intrinsic process, largely due to Myogenic Response - Occurs in kidneys, brain, myocardium
42
Q

What is the Fahraeus-Lindqvist Effect?

A

is an effect where the viscosity of a fluid, in this case blood, changes with the diameter of the tube it travels through; there’s a decrease of viscosity as the tube’s diameter decreases

43
Q

What is an infarction

A

‘Irreversible cell damage (cell death) due to ischaemia and hypoxia

44
Q

Possible pharma treatments for angina

A
  • beta blockerss (Atenolol, Metoprolol) - vasodialators (GTN spray) - statins
45
Q

What is Myogenic Response and how does it work?

A

Intrinsic Autoregulation Vascular smooth muscle contracts in response to increased BP

46
Q

What is an avulsion fracture and how does it occur?

A

Where a segment of bone is torn away from its body via Tension

47
Q

Differences of stable/unstable angina

A
  • Stable = Predictable - symptoms brought on by exertion & subside in minutes - Unstable = Unpredictable – e.g. symptoms may come on at rest TREAT AS EMERGENCY
48
Q

What factors effects the resistance of a fluid passing through a tube? (air/blood)

A
  • viscosity of the blood - the length of the vessel - the width of the vessel
49
Q

What is Laminar Flow?

A

steamlined flow - flow is current is perfect.

50
Q

Explain Endothelial Controls of BP

A

Endothelial-secreted substances that induce vasodilation for example NO – (Nitric Oxide ) - High Shear causes increased NO secretion - NO acts as a vasodilator upstream

51
Q

What is Metabolite Control and how does it work?

A

– Intrinsic Reactive Regulation - Products of respiration act as vasodilators (K+, CO2, Adenosine) - Main vasodilator varies organ-organ N.B. Reactive Hyperaemia – Ischaemia leads to build up of metabolic products & vasodilation, th. high blood-flow on restoration of norm

52
Q

WHAT COINCIDES WITH ATRIAL CONTRACTION?

A

A WAVE

53
Q

WHAT COINCIDES WITH CLOSURE OF THE AORTIC AND PULMONARY VALVES?

A

SECOND HEART SOUND

54
Q

WHAT COINCIDES WITH THE BEGINNING OF ISOVOLUMETRIC CONTRACTION?

A

FIRST HEART SOUND

55
Q

WHAT IMMEDIATELY PRECEDES ATRIAL CONTRACTION?

A

P WAVE

56
Q

WHAT IMMEDIATELY FOLLOWS THE V WAVE?

A

Y DESCENT

Medicine Year 1 (39 decks)

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