Cardiovascular Diseases Flashcards
Pitting Oedema:
Oedema occurs in ‘dependent’ areas e.g. ankles, sacrum (base of spine) and scrotum (gravity)
Oedema resolves on raising the affected body part e.g. leg.
An indentation (‘pitting’) is left when the oedematous tissue is pressed for 5 seconds.
This can be indicative of which significant disease:
Heart Failure
Pitting oedema is a consequence of a chronic health problem and is multi-factorial
- Raised right atrial pressure in heart failure is an important cause
Non-pitting Oedema:
Oedema may involve any part of the body and may be localized or generalized depending on the cause
**An indentation not left when oedematous tissue pressed for 5 seconds
Associated with many different clinical conditions such as:
Acute hypersensitivity reaction
e.g.
Urticaria (hives - raised, itchy, red rash that can move around)
Angioedema (rapid oedema of the area beneath the skin or mucosa) - tissues are very tense due to the inappropriate rapid accumulation of tissue fluid - e.g. Type I Hypersensitivity reaction
Blood pressure control influenced by 4 Key Determinants:
- Cardiac Output - SV x HR
- Total peripheral resistance
- Circulating blood volume
- Blood viscosity
Risk Factors for Hypertension
- Increasing Age - Total peripheral resistance increases as vessel elasticity reduces
- Ethnic Origin - high prevalence in pts of Afro-Caribbean origin, Obese Westernised Asian patients
- Family History - Genetic factors
- Obesity & physical inactivity
- Pharmacological
o Alcohol
o Cocaine
o NSAIDS
o Corticosteroids
o Combined oral contraceptive pill
o Ciclosporin - High salt diet
- Stress
Pharmacological management of Hypertension
A C D
A - ACE-inhibitor
- Angiotensin II receptor antagonist (if can’t take ACE-inhibitors)
C - Calcium channel blocker
D - Diuretic
- Beta-Blockers (no longer used)
- Anti-platelet drugs e.g. aspirin, clopidogrel
Secondary Events of Hypertension
Complications of Hypertension 1. Cardiac Left ventricular Hypertrophy Left ventricular failure Coronary artery atherosclerosis --> Angina or Myocardial Infarction Heart failure Atrial fibrillation or Ventricular Arrhythmias
2. Renal Parenchymal damage (damage to functional parts of an organ) Vascular disease - atherosclerosis --> Renal Impairment Renal Failure
3. Cerebral Vascular disease - Large & small vessel walls - Ischaemia and infarction (including distant emboli) --> Transient Ischaemic Attack (TIA) Stroke
4. Retinal Vascular disease - Small vessel walls - Ischaemia & infarction --> Visual Impairment Blindness
.’. potentially considerable morbidity and mortality. Reduce with effective management.
PERIPHERAL ARTERIAL DISEASE (PAD) =
Atherosclerosis related pathologies of large arteries:
- Stenosis (narrowing)
- Thrombus (blood clot)
- Impact site for emboli
- -> ISCHAEMIA
PERIPHERAL ARTERIAL DISEASE
Risk Factors:
- Smoking - single most critical factor
- Diabetes mellitus - 2-4x ↑risk factor
- Dyslipidemia
- Hypertension
Diabetics who smoke
High risk of lower limb amputation
~ 1 in 3 within 5 years
PERIPHERAL ARTERIAL DISEASE
Signs
Skin - initially in tact
o Smooth with loss of hair
o Nail changes
o Colour changes - erythema
Skin - later ulcerates
o Ulcers chronic and prone to infection
Deep tissues o Wet (infected) or dry gangrene
PERIPHERAL ARTERIAL DISEASE
Symptoms
Intermittent Claudication
- Muscle pain on exercise
- Relieved by rest
Rest pain
o Pain in foot at rest
o Typically worsens with time
Critical Ischaemia o Pain & sensation loss o Blue & cold o Ulceration o Wet or dry gangrene
PERIPHERAL ARTERIAL DISEASE
Management
Lifestyle changes
- Smoking
- Exercise programme
Limit secondary complications
- Reduce risk of thrombus formation
- Improve lipid profiles
- Control diabetes, hypertension…
Revascularisation
- Angioplasty +/- arterial stent
- Arterial reconstruction
o Thrombo-endarterectomy - remove thrombus & atherosclerotic plaque
o Vascular grafts - Veins / Man-made materials e.g. Goretex
Amputation
- Especially in patients with diabetes
- Can be the only effective management
- Can be life saving - prevent overwhelming sepsis
- Long term morbidity depends on type of amputation
ABDOMINAL AORTIC ANEURYSM
Aneurysm =
A localised, pathological, blood-filled dilation of a blood vessel caused by a
disease or weakening of the vessel’s wall.
ABDOMINAL AORTIC ANEURYSM
Risk Factors
- Elderly
- Family history
- Atherosclerosis
- Hypertension
- Enlargement of the abdominal aorta
~ 2cm diameter in health
Aneurysms can be large - >10cm
Often asymptomatic until large
Aneurysm rupture is life-threatening
ABDOMINAL AORTIC ANEURYSM
Management
Elective repair
- Reduce risk of rupture
- Grafts - may also involve iliac arteries
Acute repair
- After rupture
RENAL ARTERY STENOSIS (narrowing)
Caused by:
- Atherosclerosis (build up of fatty plaque in artery); or
- Fibromuscular dysplasia (non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery)
Diminished blood flow to kidney triggers increased RENIN secretion, resulting in Hypertension.
CAROTID ARTERY STENOSIS
- Atherosclerosis involving carotid arteries - carotid bifurcation = a common site
- Important risk factor for: TIA or Stroke
Atrial Fibrillation =
most common sustained arrhythmia. It is characterised by chaotic, uncoordinated and ineffectual depolarisation of the atria.
Atrioventricular node act as an important check-point in controlling ventricular depolarisation. Loss of atrial synchrony leads to: Irregular and often rapid ventricular rhythm.
-> Reduction in cardiac output by up to 25%
Paroxysmal Atrial Fibrillation
Transient episode of AF that self-corrects with reversion to sinus rhythm in <7days
Persistent Atrial Fibrillation
AF lasts >7days, but treatment can restore sinus rhythm
