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AKT Cardiovascular Flashcards

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1
Q

Name two goals of cardiac rehabilitation

A
  1. Preserve or resume optimal functioning

2. Slow of reverse progression of disease

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2
Q

For which patients is cardiac rehabilitation most indicated? (4)

A

Post MI
Post CABG
Stable CAD
Chronic heart failure

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3
Q

What are some of the benefits of cardiac rehabilitation?

A 
Reduced mortality
Reduced adverse cardiac events (eg MI)
Reduced re-hospitalisations
Improved functional status
Lower BP and lipids
Better diabetic control
Higher smoking cessation rates
Weight reduction
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4
Q

Cardiac rehabilitation is _________ _______ better health outcomes

A

associated with

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5
Q

Name the six core components of the British Association for CV Prevention and Rehabilitation

A
  1. Health behaviour change and EDUCATION
  2. Lifestyle risk factor management
    • physical activity and EXERCISE
    • healthy EATING and body composition
    • TOBACCO CESSATION and relapse prevention
  3. Psychosocial health
  4. Medical risk management
  5. Long-term strategies
  6. Audit and evaluation
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6
Q

Name four specialists that are typically involved in a cardiac rehab MDT

A
  1. Nurse specialist
  2. Physiotherapist
  3. Exercise specialist
  4. Dietician
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7
Q

On the Borg scale of perceived exertion, what rate of perceived exertion should cardiac rehab patients be aiming to achieve with exercise?

A

Borg level of 4-6 (moderate activity)

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8
Q

What is the target BMI for cardiac rehabilitation patients?

A

20-25 kg/m2

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9
Q

What is the reason for most patients who do not take part in cardiac rehab fail to do so?

A

Because of issues with service organisation

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10
Q

Which parts of the country are performing very well in their key performance indicators (in cardiac rehabilitation)

A

The West of the country- Devon and Cornwall

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11
Q

Which part of the country is only meeting 3/7 of the key performance indicators for cardiac rehabilitation?

A

The Northeast of the country. This might reflect service disparity and health inequality across the UK.

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12
Q

This is a measure of the overall direction of the cardiac electrical impulse in the body

A

QRS axis

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13
Q

What can cause ST elevation on an ECG?

A

MI or pericarditis

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14
Q

What are the two main determinants of arterial BP?

A

Cardiac output and systemic vascular resistance

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15
Q

Contraindications for Beta blockers?

A

Do not use Beta blockers in severe asthma or in diabetics with recurrent hypoglycaemia

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16
Q

What is the most common form of primary hyperlipidemia?

A

Type 2b- combined hyperlipidemia (characterised by high levels of both cholesterol and triglyceride)
High LDL and high VLDL
Lipoprotein abnormality- apo B100

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17
Q

Which familial dyslipidaemia is associated with palmar xanthomas?

A

Familial dysbetalipoproteinemia

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18
Q

Which are the three most common types of familial dyslipidemia?

A

2b: Combined hyperlipidemia (high LDL & VLDL)
4: Hypertriglyceridemia (high VLDL)
2a: Hypercholesterolemia (high LDL)

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19
Q

Which of the familial dyslipidemias has a lipoprotein abnormality in the LDL receptors?

A

Type 2a: Hypercholesterolemia

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20
Q

Which type of familial dyslipidemias results in extremely high levels of triglycerides, and blood samples appear “creamy?”

A

Type 1: Hyperchylomicronemia

TREAT WITH FIBRATES

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21
Q

What is the therapeutic goal for LDL reduction after starting Statins?

A

LDL reduction of >40%

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22
Q

What are the QRisk and JBS3 scores used for?

A

Identifies patients who are at significant risk of adverse cardiac events.

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23
Q

What drugs are recommended for primary prevention of cardiac events based on estimated risk scores?

A

Statins

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24
Q

What are the BEHAVIOURAL risk factors contributing to the highest proportion of deaths in 2013?

A

Poor diet and smoking

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25
According to the WHO, what percentage of illnesses and causes of death are correlated with lifestyle (ie preventable by changing our behaviour)?
60%
26
People living in the most _________ areas of England are almost 4x as likely to die prematurely of CVD
Deprived
27
What lifestyle changes could reduce premature death, cancers, and vascular dementias?
smoking cessation improving diet increased physical activity
28
What is the WHO's current recommendation for weekly amounts of moderate physical activity?
150 minutes per week
29
What is the correlation between deprivation, motherhood, and obesity?
Poor mothers tend to prioritise their childrens' nutrition over their own. Will skip meals so their kids can eat, and later fill up on high calorie, low nutrition foods.
30
What behaviour change might be suggested to pregnant women who are still smoking?
It is now advisable to encourage pregnant women to cut back on smoking rather than just quit cold turkey, as that advice hasn't been very effective in helping women quit.
31
What condition is considered the "entry" to acute coronary syndromes?
Unstable angina
32
A major occlusion of a coronary vessel leads to what type of infarct?
ST elevation MI
33
Which blood test is most specific for diagnosing an MI?
Troponin (T&I)
34
What type of creatine kinase is specific to cardiac muscle?
CK MB
35
Acute management for acute coronary syndromes?
Aspirin LMW Heparin (Enoxaparin) Nitrates Revascularisation
36
If ischaemia is untreated, after many minutes will cardiac myocyte death begin to occur?
15 minutes
37
Myocardium can be salvaged up to ________ hours after coronary occlusion
12
38
What does "thrombolysis" invovle?
Streptokinase and aspirin
39
Where should patients presenting with MI symptoms be taken?
If transfer for PCI can be achieved in <2 hours this is the optimum strategy
40
List the four medications indicated for secondary preventative treatment post-MI
DAPT Ace-inhibitors Beta blockers Stains
41
What is the most common cause of sudden cardiac death in patients over 30 years old?
IHD (eg acute MI)
42
What is the most common cause of sudden cardiac death in patients less than 30 years old?
Hypertrophic cardiomyopathies
43
The citrate malate cycle involves the process of moving acetyl coA from the ___________ into the __________.
mitochondria, cytosol
44
What is the rate-limiting step of fatty acid synthesis?
The conversion of Acetyl CoA into Malonyl CoA via ACETYL CO-A CARBOXYLASE
45
Which 3-carbon intermediate is only found in fatty acid biosynthesis?
Malonyl CoA
46
Which hormone plays a role in the conversion of Acetyl CoA into Malonyl CoA?
Glucagon
47
What type of fatty acid chain is produced at the end of fatty acid synthesis?
A 16 carbon palmitate
48
In FA synthesis, citrate must first be converted into _______ in order to cross the mitochondrial membrane
pyruvate
49
If there is already a high amount of palmitate in circulation, which enzyme does this inhibit?
Acetyl CoA carboxylase
50
Which two hormones INACTIVATE acetyl coA carboxylase?
Glucagon and adrenaline | Remember, when the glucose is gone, you don't want to create fat to store it, you want to break it down to use it!
51
Fatty acid synthesis occurs in the...
cytosol
52
Where is cholesterol mainly synthesized?
In the liver
53
What is the rate-limiting step of cholesterol biosynthesis?
HMG CoA reductase
54
HMG CoA reductase activity is regulated by which two hormones?
Insulin and glucagon
55
Acetyl CoA is converted into __________ via HMG CoA reductase
Mevalonate
56
Most bile acids are reabsorbed by the gut and returned to the _______ to be recycled.
liver
57
Which enzyme do Statin drugs target?
HMG CoA reductase
58
What two substances are feedback inhibitors in cholesterol biosynthesis?
Cholesterol and mevalonate
59
What three substances are produced during each cycle of beta oxidation?
Acetyl CoA FADH2 NADH
60
Where does beta-oxidation of fatty acids occur?
In the mitochondria
61
What is the rate-limiting step of beta oxidation?
The transfer of aceyl groups across the mitochondrial membrane via the carnitine shuttle (CPT 1 to CPT2 via ACYLC CARNITINE TRANSLOCASE)
62
Mutations in which group of dehydrogenase enzymes can result in SIDS?
FADH2
63
In step 1 of beta oxidation, fatty acids are first activated by attachment to which co-enzyme?
CoEnzyme A
64
Briefly list the 3 steps of beta oxidation
1. BETA OXIDATION: Long chains of FA's are broken down into 2c bits of Acetyl CoA 2. Oxidation of Acetyl CoA into CO2 in the citric acid cycle 3. Transfer of elections to the mitochondrial respiratory chain
65
These are special proteins that carry lipids through the bloodstream
Lipoproteins
66
What is the key lipoprotein for LDL's?
Apo-B 100
67
What is the key lipoprotein for HDL?
Apo E
68
The density of an IDL is between ______ and ______/
VLDL and LDL
69
Which lipoprotein carries cholesterol to the muscle, adrenal glands and ADIPOSE TISSUE?
LDL
70
Which lipoprotein returns cholesterol to the liver?
HDL
71
Which lipoprotein activates lipoprotein lipase?
Apo C-II
72
The exogenous pathway of lipid transport involves ________ giving up lipids to the tissues by the action of tissue-bound ________.
chylomicrons, lipases
73
In the exogenous pathway of lipid transport, the liver recognises remnants of chylomicron particles by their ________ content, and take them up by endocytosis.
Apo-E
74
What type of lipoprotein has "reverse" lipid transport?
HDL. Returns cholesterol to the liver
75
What type of lipoprotein has exogenous transport of lipids?
Chylomicrons (remember Apo E lipoprotein plays a role)
76
What two types of lipoproteins have endogenous lipid transport?
VLDL and LDL (transports lipids to muscle and adipose tissue)
77
Activation of which enzyme causes the release of FFA's into the tissues?
Lipoprotein lipase
78
How does a particle of VLDL become an LDL?
By losing TG via lipoprotein lipase (remember that the liporoteins that have Apo-C II on their surface, chylomicrons and VLDL, is what activates lipoprotein lipase in the tissues
79
Reverse cholesterol transport- HDL particles bound by _________ receptor B1 mediates transfer of cholesterol into the cell.
scavenger (SR-B1)
80
Extra-hepatic tissues take up LDL particles via endocytosis by recognition of the _________ lipoprotein on the surface of the LDL.
Apo-B 100
81
What three types of extra-hepatic tissue has LDL receptors?
Adipose tissue, muscle, and adrenal glands
82
Re-entry is the mechanism for almost all cardiac ________ abnormalities
arrythmia
83
Which cardiac tissue (site of action) is Digoxin most effective in?
AV node
84
How helpful are medications for arrhythmias?
They can help control the heart rate and frequency of arrhythmias, but they do not improve prognosis
85
Epsilon waves are pathognomonic for what type of cardiomyopathy?
arrhythmogenic RV cardiomyopathy
86
What is the hallmark of AFib on ECG?
Hallmark is that heart rate is RAPID and irregular, gap between complexes are random

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