Week 126 - Chronic stable angina Flashcards
Why can Decreased ATP Production cause cell death?
- 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
Why can high levels of calcium inside a cell cause damage
-ATPase ⇒ ⇓ATP -Phospholipases ⇒ ⇓ Phospholipds -Proteases ⇒ affects cytoskeleton + membrane -endonucleases ⇒ Chromatin breakdown
What is Prasugrel?
anti-platelet
What is Captopril ?
short acting ACE-inhibitor
How does GTN work?
cause smooth muscle relaxation and subsequent cardiac vasodilation
What are Rouleaux?
stacks of RBC
What is Perindopril?
ACE-inhibitor
What is Lisinopril?
ACE-inhibitor
What are Bisoprolol, Atenolol, Carvedilol?
Beta-Blockers
What is Clopidogrel?
an antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease
What is Ticagrelor?
anti-platelet
What is Ramipril?
ACE-inhibitor
how does Metabolic Hyperaemia control the Distribution of flow to organs?
A byproduct of metabolism is vasodilators, so when the vessels near active tissue dilate more blood is pulled towards it
For a pt who has had a Acute Coronary Syndrome, what meds should they be started on?
- Aspirin - Clopidogrel - ACE-Inhibitor (e.g. Ramipril) - Beta-Blocker (e.g. Bisoprolol) - Statin (e.g. Simvastatin or Atorvastatin)
What is the cause of the Fahraeus-Lindqvist Effect?
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
Major classic sings/symptoms of angina?
- 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)
What is Atherosclerosis?
the thickening of vessel walls due to build up of calcium and fats
What is the action of an ACE-inhibitor?
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).
What are the 4 emergency situations that would cause chest pain
•Myocardial infarction •Pulmonary emboli •Tension pneumothorax •Dissecting thoracic aneurysm
What is Pouseille’s Law?
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
What are the three Vasomotor Nerves?
- Sympathetic Vasoconstrictors (Noradrenaline) - MAIN - Sympathetic Vasodilators – Peripheral (Acetylcholine) - Parasympathetic Vasodilators (Acetylcholine)
What is Atheroma?
the accumulation of lipid and fibrous tissue within the intima of arteries
What information can you learn from placing a Cardiac catheter?
- Cardiac anatomy - aortic BP - O2 sats
How will Ischaemia show on an ECG?
ST depression
What is Acute Coronary Syndrome?
- Unstable angina & Non-ST-segment elevation myocardial infarction (NSTEMI) - ST-segment elevation myocardial infarction (STEMI)
Whats the initial management for someone with Acute Coronary Syndrome?
MONA - Morphine - via slow IV - Oxygen - Nitrates (GTN to releive chest pain) - Anti-platelets – Aspirin
What are the side effects of Aspirin?
GI irritation (including GI haemorrhage) Bronchospasm
How do Beta-Blockers work?
Reduces sympathetic drive to cause a reduction in heart rate & myocardial contractility.
What is the main use for a GTN spray?
first line treatment for angina symptoms
What is Autacoid Control and how does it work?
Intrinsic Reactive Regulation Autacoids released in damaged tissue/inflammation & vasodilate E.g. Histamine, Bradykinin, Prostaglandins
Explain Plethysmography? (Blood flow measuring techniques )
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)
What alternative could you use in a pt who is intolerant to ACE-inhibitors?
Angiotensin-II receptor blockers (ARBs)
Effects of Adrenaline on local blood vessel & BP
Vasodilates f&f organs, heart, lungs, muscles Vasoconstricts skin, GIT
Possible surgical treatments for angina
stents CABG
Risk factors of angina?
- Smoking - Diet – High in fat/low in antioxidants - Hypertension
Breifly explain how Renin/Angiotensin II work together
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
What controls the Distribution of flow to organs?
Metabolic Hyperaemia
How is angina classified?
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)
Explain Fick’s Principle (Blood flow measuring techniques)
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)
Explain Tissue Clearance? (Blood flow measuring techniques )
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
Explain Autoregulation - what is it, how, where?
- Maintenance of near constant flow through an organ across range of BPs - Intrinsic process, largely due to Myogenic Response - Occurs in kidneys, brain, myocardium
What is the Fahraeus-Lindqvist Effect?
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
What is an infarction
‘Irreversible cell damage (cell death) due to ischaemia and hypoxia
Possible pharma treatments for angina
- beta blockerss (Atenolol, Metoprolol) - vasodialators (GTN spray) - statins
What is Myogenic Response and how does it work?
Intrinsic Autoregulation Vascular smooth muscle contracts in response to increased BP
What is an avulsion fracture and how does it occur?
Where a segment of bone is torn away from its body via Tension
Differences of stable/unstable angina
- Stable = Predictable - symptoms brought on by exertion & subside in minutes - Unstable = Unpredictable – e.g. symptoms may come on at rest TREAT AS EMERGENCY
What factors effects the resistance of a fluid passing through a tube? (air/blood)
- viscosity of the blood - the length of the vessel - the width of the vessel
What is Laminar Flow?
steamlined flow - flow is current is perfect.
Explain Endothelial Controls of BP
Endothelial-secreted substances that induce vasodilation for example NO – (Nitric Oxide ) - High Shear causes increased NO secretion - NO acts as a vasodilator upstream
What is Metabolite Control and how does it work?
– 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
WHAT COINCIDES WITH ATRIAL CONTRACTION?
A WAVE
WHAT COINCIDES WITH CLOSURE OF THE AORTIC AND PULMONARY VALVES?
SECOND HEART SOUND
WHAT COINCIDES WITH THE BEGINNING OF ISOVOLUMETRIC CONTRACTION?
FIRST HEART SOUND
WHAT IMMEDIATELY PRECEDES ATRIAL CONTRACTION?
P WAVE
WHAT IMMEDIATELY FOLLOWS THE V WAVE?
Y DESCENT
