week 4 Flashcards
inflammatory heart disease mechanism
immune cells attack heart causing inflammation and damage leading to scarring and fibrosis
pericarditis 4 characteristics
pleural inflammation
pericardial effusion
ST elevation on ECG
Serious cases leads to pericardial tamponade
myocarditis 3 characteristics
myocardium inflammation
elevated troponin and inflammatory markers
endocarditis 2 characteristics
endocardium inflammation
often due to vegetations of immune complexes
RHD progression 5
Infection
Sore throat and skin sores
Rheumatic fever
Recover and fibrosis or recurrent infection
rheumatic HD
immune complex disease definition and cause
antigen antibody complexes which deposit in tissue causing inflammation
occur when there is excessive antigen/antibody present which are not cleared
infective endocarditis and immune complexes
immune complexes attack endocardium cause inflammation, seed to structures incl valves
RHD key tissue manifestations
brain (chorea), skin (subctuaneous noduels), MSK (arthritis)
complications of RHD
emboli - from vegetations
AF
stroke
infective endocarditis
common pathogens implicated in endocarditis
staphylococcus aureas
streptococcus viridians
infective endocarditis clinical features (4 main tissue manifestations)
Skin: janeway lesions, osler nodes and splinter haemorhages
Joints: Arthritis
Kidneys: Glomerularnephritis
Eyes: conjunctivale haemorhages, ROth spots
major features of infective endocarditis 2
- positive blood culture
- echocardiogram w vegetation
complications infective endocarditus
emboli
HF
sepsis
pathology of infective endocarditis 6 steps
infection->bacteraemia->seeding and adhesion->immune response->immune complex formation->chronic inflammation
infective endocarditis management 3
antibiotics
HF management
Palliative treatment
what calcium channel opens first in pacemaker production and what triggers it
the T type calcium channel opens first allowing rapid depolarisation
triggered by influx of sodium reaching minimum threshold
sympathetic influence on HR (not BP) 3
adrenaline and noradrenaline release = chronotropy and inotropy increasing calcium channel currents and sodium channel currents
parasympathetic activation of heart
acetylcholine release
binds to muscarinic receptors
increases potassium channel currents
causing hyperpolarisation
4 key causes for AF
electrical remodelling
structural remodelling
Ca handling abnormalities
Neural remodelling
where do ectopic beats normally come from in AF
pulmonary veins
what are the key reasons for AF occuring from the four causes listed prior
reduced refractory period, shorter AP time
reason for palpitations, dyspnoea, exercise intoleance, fatigue, chest discomfort, dizziness and syncope in atrial arhythmias
palpitations = irregular heartbeat
dyspnoea+exercise intolerance+fatigue = comprimised CO
chest discomfort = ischaemia
dizziness+ syncope = reduced blood flow to brain
4 key drugs in AF management
rate drugs: beta blockers calcium channel anyagonists
rhythm drugs: Amiodarone
anticoagulation
risk factor management
scoring system used to link AFib and stroke risk
CHADVAS2 score
1> men = anticoagulation
2> women = anticoagulation
4 types of bradyarrhythmia
sinus bradycardia
sinus arrhythmia
sinus ageing
sick sinus syndrome
Bradyarrhythmia diagnoses (ECG AV blocks)
type 1 = prolonged PR intervals
type 2 mobitz = continually prolonged until one p wave missing
type 2 = intermittent
type 3 = comple dissociation between atrial and ventricular impulses
list management of bradyarrhythmias
cardiac pacemakers
types of pacemakers 3
single chamber
dual chamber
biventricular
sudden cardiac arrest
sudden cessation of cardiac activity
sudden cardiac death
sudden and unexpected death occuring within an hour of sympotm onsent or within 24hrs of asymptomatic
risk factros for sudden cardiac arrest 3
hypertension
smoking
obesity
types of ventricular arrhythmias 5
polymorphic incl torsades des pointes
bidirectional
monomorphic
ventricular flutter
ventricular fibrillation
list of basic management in ventricular arrhythmias 4
defibrillation
CAD management
anti-arrhythmic management
risk factor management
difference between cardiac blues and depressino
cardiac blues: after MI/surgery, will resolve
depression: long term, underlying factor, check FHx and SHx
presentation of AFIB on ECG signs 2
irregular irregular rate and rhythm
invasive management technique in AF
pulmonary vein catherisation and electrical isolation preventing the regeneration and dissemination of ectopic beats
what is the rhythm control drug in afib
amiodarone
mech of action in amiodarone
blocks potassium channels in myocardial cells resulting in hyperpolarisation whcih decreases rate of contraction and firing
criteria of CHADVAS
C = congestive HF
H = hypertension
A = age<75
D = diabetes
V = vascular disease
A = age>75
S = sex
reasons for sinus bradychardia 5
increased vagal tone
SA remodelling/dysfunction
decreased sympathetic
medication
athlete
what does sinus arrhythmia look like on an ecg
will always have p waves but the RR intervals are irregular
