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PAR2021 Cardiology > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is Arteriosclerosis?

A

The thickening and loss of elasticity of the arteries.

Vessels thickening reducers diameter, which may compromise organ perfusion.

Loss of elasticity also increases likelihood of vessel rupture

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2
Q

What is Atherosclerosis?

A

Progressive, inflammitory disease or large and medium sized arteries.

Characterised by the accummulation of lipid in the vessel intima. With an associated inflammitory response and smooth muscle infiltrate.

-> results in partial or eventual complete occlusion of artery, due to white blood cell infiltration and smooth muscle proliferation

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3
Q

What disease accounts for 50% of deaths in western societies?

A

Atherosclerosis

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4
Q

What is an atheroma?

A

A plaque formation

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5
Q

What are the steps of Atherosclerosis?

A
  • Initial lesion
  • Fatty streak
  • Intermediate Lesion
  • Atheroma
  • Fibroatheroma
  • Complicated lesion
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6
Q

What are the steps of Atherosclerosis?

A
  • Initial lesion
  • Fatty streak
  • Intermediate Lesion
  • Atheroma
  • Fibroatheroma
  • Complicated lesion
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7
Q

What do macrophages do during atherosclerosis

A
  • after initial injury, LDL cholestorol moves into the wound
  • macrophages move in and feed on LDL
  • Become foam cells
  • Foam cells accummulate on surface of vessel and form a fatty streak
  • further activation of the immune system leads to further oxidisation of LDL
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8
Q

What is in an atheroma?

A
  • Core of extracellular lipids

- Smooth muscle migrate to intima and collagen deposited at surface

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9
Q

What is a Fibroatheroma?

A

Nectrotic layer is covered with a fibrotic and calcified outer layer

  • can be unstable
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10
Q

What is a complicated lesion?

A

Rupture or surface defect of atheroma, leads to thrombosis

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11
Q

Step out a flow chart of Atherosclerosis

A
  1. Chronic inflammation and injury causes damage to tunica intima (inner most layer of vessel wall)
  2. Allows LDL to penetrate and lodge in epithelium
  3. LDL becomes oxidised and attarcts monocytes
  4. Monocytes differentiate into macrophages
  5. macrophages consume LDL becoming foam cells
  6. Deposits of foam cells are eventually covered by smooth muscle forming fibrous cap
  7. Larger deposits eventually contain free lipids at core
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12
Q

Describe a complicated lesion

A

A fully developed atheroma that has ruptures, fractures or haemorrhaged into the vessel

  • exposure of plaque material causes platelet adhesion and aggregation
  • Activation of platelets and coagulation factors cause formation of fibrin clot
  • potentially blocking part or all of blood vessel
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13
Q

What are the layers of the vessel walls?

A
  • Intima (endothelial cells)
  • Media (smooth muscle cells)
  • Adventitia (fibroelastic tissue)
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14
Q

What is acute coronary syndrome?

A

Spectrum of diseases that share a common pathology of disrupted atherosclerotic plaque

  • STEMI
  • nSMETMI
  • UA
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15
Q

Is stable angina part of ACS?

A

Nooooooo

Pain of exertional angina is usually

  • episodic
  • Lasts less than 10 mins
  • Provoked by exertion
  • Relieved by nitrates or rest
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16
Q

Describe unstable angina

A
  • EPisodic anginal pain that has changed in pattern
  • new onset
  • more frequesnt, easily provoked or difficult to relieve
  • Occuring at rest for prolonged spells
  • Recurance of UA post procedure can be vasospasm
17
Q

Unstable angina shows no evidence of?

A

Myocardial injury

18
Q

what can cause nSTEMI?

A

Non occlusive thrombus

19
Q

What can be used to differentiate nSTEMI and UA on road?

A

indistinguishable… only troponin levels in blood can determine nSTEMI

20
Q

What causes a STEMI

A
  • occurs when the thrombus that has formed is completely occlusive.
  • Myocardial necrosis results from interruption to myocardial blood supply
21
Q

what are the STEMI indications in 12 lead ecg

A

Men <40 - 2.5mm ST elevation in leads V2-3

Men >40 - 2mm ST evelvation in leads V2-3

Women - 1.5mm ST Elevation in leads V2-3

> 1mm in other leads

22
Q

Define ischaemia

A

occurs when blood supply to tissue is inadequate to meet physiological demand

23
Q

What are the 3 processes of ischaemia

A
  • Hypoxia - inability to deliver oxygen to tissues
  • insufficient supply of metabolic substances
  • accumulation of metabolic waste
24
Q

Define Infarction

A
  • is tissue or organ necrosis/damage caused by ishcaemia

- leads to tissue death

25
Q

How is the zone of ishcaemia displayed on ECG?

A

ST segment depression as a result of altered repolaristation

26
Q

How is the zone of injury displayed on ECG?

A

ST elevation with or without loss of R wave

27
Q

How is the zone of infarction displayed on ECG?

A

deep Q waves resulting form absence of depolarising current from dead tissue

28
Q

What signals infarction on an ECG?

A

R wave amplitude diminished, depressed q wave, st elevation, T elevated

29
Q

How is AMI diagnosed?

A
  • clinical history
  • Serial ECGs
  • Blood Enzymes (troponin levels)
30
Q

How do you differentiate between STEMI and n STEMI?

A

STEMI has ST elevation on ECG

31
Q

How many people in Australia suffer from cardiovascular disease?

A

1 in 5
4.2 million people
29% of all deaths

32
Q

What communities have higher risk of cardiovascular disease?

A
  • Indigenous
  • remote communities
  • low socioeconomic
33
Q

What are some NON-MODIFIABLE risk factors for cardiovascular disease?

A
  • Age (>55)
  • Sex (males)
  • Family History
  • Ethnicity (Indians, Sri Lankans, Indigenous Australians)
34
Q

What are some MODIFIABLE risk factors for cardiovascular disease?

A

Behavioural factors:

  • Tobacco
  • Sedentary lifestyle
  • Dietary behaviour
  • Alcohol

Biomedical factors:

  • Hypertension
  • High blood cholesterol
  • Overweight
  • Depression
  • Shift work (23% more)
35
Q

What is a prodrome?

A
  • A prodrome in ACS is considered a symptom that may precede an ACS event
36
Q

What are some examples of prodomes?

A
  1. Fatigue
  2. Sleep disturbances
  3. Anxious
  4. Indigestion
  5. Chest pain
  6. Coughing
  7. Loss of breath
  8. Abdominal pain
  9. Dizziness
  10. General pain
37
Q

Which gender is more likely to show prodromes?

A

Women

38
Q

How many cases of of coronary heart disease report chest pain?

A

24%

PAR2021 Cardiology (12 decks)

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