When the Cardiovascular System Goes Wrong - Lecture 15 Flashcards

1
Q

What are the figures for cardiovascular disease?

A

○ Affects 1 in 14 people worldwide
○ Kills 1 in 3 people worldwide
○ Kills 45% of Europeans: biggest single cause of death
○ Death rates in the UK are falling
○ 4 out of 5 deaths from CVD are associated with modifiable risk factors

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2
Q

What diseases does hypertension put you at risk of?

A

○ Coronary heart disease & myocardial infarction
○ Aneurysms
○ Stroke
○ Chronic kidney disease
○ Heart failure

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3
Q

How does hypertension give coronary heart disease & myocardial infarction?

A

Accelerates atherosclerosis by increasing stress and damage to endothelial walls of coronary arteries

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4
Q

How does hypertension give aneurysms?

A

Increased wall stress can lead to aneurysms and increase the risk of rupture

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5
Q

How does hypertension give stroke?

A

Damage to endothelial cells in cerebral arteries increases the risk of haemorrhagic or ischaemic stroke

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6
Q

How does hypertension give chronic kidney disease?

A

Can narrow the renal arteries and reduce the blood supply to the kidney which damages the nephron and kidney function declines

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7
Q

How does hypertension give heart failure?

A

○ Puts more strain on the ventricles by increasing afterload and reducing cardiac output
○ To compensate the heart remodels and hypertrophies to increase contractility but this deteriorates over time

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8
Q

What is the difference between primary and secondary hypertension?

A

○ Primary: of unknown medical cause
○ Secondary: of known medical cause

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9
Q

What are the likely contributing factors to primary hypertension?

A

○ Genetic predisposition
○ High alcohol consumption
○ Sedentary lifestyle
○ Obesity
○ Diabetes
○ Intrauterine environment

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10
Q

What are some examples of secondary hypertension?

A

○ Chronic kidney disease
○ Endocrine disorders
○ Adrenal tumour

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11
Q

What are the treatments for hypertension?

A

○ Thiazide Diuretic
○ Ca2+ channel blocker
○ RAAS inhibition

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12
Q

How does thiazide diuretic work?

A

○ Inhibits renal Na+ reabsorption to increase water loss to urine
○ Venous return and end diastolic volume decrease
○ Cardiac output decreases

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13
Q

How does Ca2+ channel blocker work?

A

○ Inhibits Ca2+ entry in cardiac and vascular muscle cells
○ Decreases contractility and stroke volume
○ Decreases vasoconstriction
○ Decreases cardiac output

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14
Q

How does RAAS inhibition work?

A

○ Decreases vasoconstriction
○ Decreases Na+ & water absorption
○ Decreases cardiac output

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15
Q

What are the three treatments for RAAS inhibition?

A

○ Angiotensin converting enzyme inhibitor
○ Angiotensin II receptor blocker
○ Aldosterone antagonist

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16
Q

What is athersclerosis?

A

Triggering factors:
○ Endothelial damage
○ High LDL cholesterol
Plaque formation:
○ Macrophage and lipid accumulation
○ Narrow lumen

17
Q

What are the risks for atherosclerosis?

A

○ Stroke
○ Vascular dementia
○ Coronary heart disease
○ Increases the likelihood of thromboembolism

18
Q

What is a treatment for atherosclerosis?

A

Statins:
○ Inhibit cholesterol synthesis -> decreases LDL
GTN spray:
○ Nitric oxide -> vasodilation

18
Q

What is thrombosis?

A

Blood clots forming in the circulation

18
Q

Why can thrombosis increase the risk for?

A

○ Stroke
○ Myocardial infarction
○ Pulmonary embolism

18
Q

What are the treatments for thrombosis?

A

○ Anticoagulants e.g. warfarin
○ Anti-platelet therapy e.g. aspirin

19
Q

What are the main risk factors for coronary heart disease & myocardial infarction?

A

○ Atherosclerosis of coronary artery: restricts myocardial blood flow
○ Atherothrombosis: Vessel occlusion cuts off myocardial blood flow

19
Q

What is myocardial infarction?

A

○ Muscle distal to blockage starts to die
○ Left anterior descending coronary artery most commonly affected

19
Q

What are the treatments for myocardial infarction?

A

○ Percutaneous coronary intervention: stent inserted into blocked artery to reopen it
○ Thrombolytics: to break up clot

19
What is stenosis?
○ Valvular disease ○ Thick/stiff valves fail to open properly ○ Increases afterload reducing ejection ○ Leads to LV hypertrophy and eventually failure
20
What is regurgitation?
○ Valvular disease ○ Valves fail to close properly ○ Results in backflow of blood ○ Reduces SV & CO
21
What treatment can be used on valvular disease?
Surgery to repair or replace damaged valves
22
What is heart failure?
○ When CO is inadequate to meet the body's demands ○ Heart can't fill: stiff and thick chamber so decrease in filling & EDV & SV ○ Heart can't pump: stretched and thin chambers so decrease in contractility and SV
23
What can cause heart failure?
○ Diseases increasing workload: hypertension ○ Damage to myocardium: myocardial infarction
24
What happens in right sided failure?
○ Blood pools in periphery due to increased pressure in systemic veins ○ Peripheral oedema
25
What happens in left sided failure?
○ Congestion in lungs due to pressure in pulmonary veins ○ Pulmonary oedema
26
What happens if both sides fail?
Congestive heart failure
27
How to treat heart failure?
○ Beta blockers: reduces SNS activity to reduce workload and prevents desensitisation ○ Anti-hypertensives: reduce fluid, vasoconstriction and workload ○ Heart transplant: low availability, surgical risks, immunorejection ○ Left ventricular assist device: mechanical heart, surgical risks, immunorejection
28
What is arrhythmia?
A deviation of the heart's normal sinus rate or rhythm
29
What is bradycardia and its treatment?
○ <60bpm Causes: ○ Slow signal from SA node (sinus bradycardia) ○ Block of signal due to SA node, AV node or conductive tissue damage ○ Treatment: pacemaker
30
What is tachycardia?
○ >100bpm Causes: ○ Cogenital, cardiomyopathy, ischaemia Types: ○ Sinus tachycardia: Drugs or hormones ○ Non-sinus tachycardia: additional abnormal impulses in ECG