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PATH 300 > Cardiovascular 2/3 > Flashcards

Cardiovascular 2/3 Flashcards

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1
Q

What is hypertension?

A

Hypertension, also known as essential (idiopathic) hypertension, is a sustained elevation in resting blood pressure (systolic ≥ 140 and diastolic ≥ 90).

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2
Q

How does blood pressure affect mortality?

A

With each increase in blood pressure, the risk of mortality goes up. Both high diastolic and systolic have the same effect on mortality/disease.

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3
Q

How does exercise affect blood pressure in a person with hypertension?

A

Before exercise, resting blood pressure is higher with hypertension. During exercise, the blood pressure is the same whether the person has hypertension or not. After exercise, blood pressure is higher with hypertension.

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4
Q

What factors control blood pressure?

A

Blood pressure is controlled by the kidney (renin-angiotensin system), diet (amount of salt and water), autonomic nervous system, heart/brain/adrenal/lung (hormones), and arteries (structural changes).

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5
Q

What are the risk factors for hypertension?

A

The risk factors for hypertension are high salt intake, obesity, low physical activity, smoking, high alcohol consumption, stress, and rarely due to family history (genetic factor).

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6
Q

What are the complications of hypertension?

A

Complications of hypertension include cardiac hypertrophy, structural changes in arteries, atherosclerosis in eye, kidney, adrenal, risk for stroke and Alzheimer’s, and can lead to a variety of things: stroke, heart failure, sexual dysfunction, vision loss, heart attack, kidney failure.

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7
Q

What is the treatment for hypertension?

A

Treatment for hypertension includes non-pharmacological control such as decreasing alcohol, eating healthy, decreasing weight, increasing physical activity, stopping smoking, and pharmacological control with drugs affecting heart, brain, kidney, autonomic nervous system, and blood vessels.

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8
Q

How does salt intake affect the incidence of hypertension?

A

The more salt people eat, the higher the incidence of hypertension.

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9
Q

How does salt pathogenesis occur in hypertension?

A

Salt pathogenesis is complex. It alters the microbiome, triggering inflammation. Dendritic cells respond, T cells are activated causing inflammation, and high salt in CSF affects the peripheral nervous system, causing peripheral vasoconstriction.

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10
Q

What is the effect of hypertension on the heart?

A

Hypertension can cause cardiac hypertrophy as the heart has to work harder to go against the high blood pressure.

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11
Q

What are the structural changes in arteries due to hypertension?

A

Hypertension can cause remodelling of the arterial wall, stiffening of the arterial media (middle layer) and adventitia (outer layer), hypertrophy and hyperplasia of the smooth muscle cells in the wall, and formation of myofibroblasts

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12
Q

What is the effect of hypertension on the brain?

A

Hypertension can increase the risk for stroke and Alzheimer’s. It can damage the blood-brain barrier, so more things can go in and out. It can also lead to aneurysms and possible occlusion.

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13
Q

What is the viscous cycle in hypertension?

A

Atherosclerosis makes hypertension worse and the hypertension makes atherosclerosis worse.

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14
Q

What is the prevention for hypertension?

A

Prevention for hypertension includes good lifestyle choices and monitoring blood pressure.

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15
Q

: What is ischemic heart disease?

A

Ischemic heart disease is a condition where there is not enough blood in the heart, which usually involves the coronary arteries: Left anterior descending CA, Left circumflex CA, and Right CA.

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16
Q

What is coronary heart disease?

A

Coronary heart disease is an impairment in one or more of the major coronary arteries, usually due to atherosclerotic plaque in proximal regions. With time, stenosis occurs, and a thrombus can form, leading to sudden death.

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17
Q

What is angina pectoris?

A

Angina pectoris is chest pain due to an imbalance between the supply and demand of blood in the heart. The supply comes in through the coronary arteries, and the demand increases with exercise, hypertension, and adrenaline.

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18
Q

What are the symptoms of angina pectoris?

A

Symptoms of angina pectoris include radiating pain that can be in the neck, jaw, upper abdomen, shoulders, and arms. Symptoms may be felt during exercise since O2 demand increases significantly. The severity is related to the extent of stenosis.

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19
Q

What is the treatment for angina pectoris?

A

Treatment for angina pectoris can include nitroglycerin, coronary artery bypass, balloon angioplasty, and stents.

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20
Q

What is a myocardial infarct?

A

A myocardial infarct is the death of cardiac muscle on different regions of the heart, depending on which vessel is occluded. If the blood supply is restored fast enough, the damage can be minimized.

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21
Q

What are the symptoms of a myocardial infarct?

A

Symptoms of a myocardial infarct include intense pain, trouble breathing, feeling of passing out, usually in the left chest, arm, shoulder, and/or face.

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22
Q

What is the impact of collateral circulation on the consequences of ischemic heart disease?

A

If there is minimal stenosis, a complete occlusion is usually accompanied by myocardial infarction since there will be little anastomoses. When there is a gradual stenosis, anastomosis open up, meaning that complete occlusion may be accompanied by only minor damage.

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23
Q

What is variant angina?

A

Variant angina is a type of angina that is due to coronary artery spasm.

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24
Q

How is angina pectoris detected?

A

Angina pectoris is detected by performing an ECG (electrocardiogram).

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25
What are the causes of a myocardial infarct?
A myocardial infarct can be caused by a thrombus that forms on the spot, an embolus that was transported, hemorrhage at the site, or spasms.
26
What is the short-term strategy for treating angina?
The short-term strategy for treating angina is nitroglycerin, which eases the pain by relaxing the veins, and therefore decreases the workload on the heart.
27
What are the surgical treatments for angina?
Surgical treatments for angina include coronary artery bypass, where an artery (or vein, which will eventually change its properties to become more like an artery) is added to bypass the obstructed area, and balloon angioplasty, where a catheter is inserted in the vessel and a balloon is blown up to open up the occluded region. And, the addition of a stent, which is a permanent “balloon-like” cage that ideally keeps the vessel open (can do this in the periphery too).
28
What is mechanical failure in the context of ischemic heart disease diagnosis?
Mechanical failure refers to the condition where part of the heart can no longer contract. The severity is related to the extent and location of the failure.
29
What is electrical failure in the context of ischemic heart disease diagnosis?
Electrical failure refers to the condition where the pacemaker activity of the heart may be abnormal, which may lead to arrhythmias. This can be detected by looking at an ECG.
30
What happens in the blood after a myocardial infarction?
After a myocardial infarction, there will be leucocytosis (up to 1 week) where neutrophils mobilize by chemotaxis of necrotic muscle, and enzymes are released from necrotic muscle which can indicate the extent of injury.
31
What is the aim of immediate and long-term therapy for ischemic heart disease?
The aim of immediate and long-term therapy is to prevent death, minimize areas of necrosis that is going to occur, and maximize the chance of survival to allow the heart to heal.
32
What are the complications of ischemic heart disease?
The complications of ischemic heart disease include risk of rupture as the dead cells are reabsorbed and the wall thins (cardiac dilatation), risk of embolus, cardiac rupture, papillary muscle rupture (which impairs the ability to contract), ventricular aneurysm (which increases the risk of thrombus and decreases cardiac efficacy), damage to ventricular septal which has to be repaired surgically, and heart failure.
33
What are the risk factors for ischemic heart disease?
The risk factors for ischemic heart disease include metabolic syndrome, obesity, fatty liver, hypertension, smoking, diet, etc. These risks are additive, but they are modifiable.
34
What is the role of the coronary care unit in the treatment of ischemic heart disease?
In the coronary care unit, various treatments can be used such as electroshock, antiarrhythmic drugs, and many other drugs as appropriate to maximize the chance of survival and allow the heart to heal.
35
What is cardiac dilatation in the context of ischemic heart disease complications?
Cardiac dilatation is a risk of rupture as the dead cells are reabsorbed and the wall thins.
36
What is a ventricular aneurysm in the context of ischemic heart disease complications?
A ventricular aneurysm is a complication of ischemic heart disease that increases the risk of thrombus and decreases cardiac efficacy.
37
how is heart rate affect in exercise in a normal vs a person with hypertension?
heart rate about the same for a person with and without hypertension.
38
how does incidence of hypertension change with age?
goes up linearly with age (not normal – blood pressure should not increase with age)
39
what is the equation of blood pressure?
Blood pressure = Cardiac output (CO) x peripheral resistance (PR)
40
how does risk due to hypertension change with blood pressure? what risks can be seen?
- Risks increase as blood pressure increases: - Hypertension syndrome: can have many problems at the same time – e.g. abnormal metabolism, obesity, changes in renal function, etc.
41
hypertension drugs decrease the risk of what?
coronary heart disease and stroke
42
what are preventive measures that can be taken against hypertension?
good lifestyle choices and watch blood pressure
43
what are the demands of the heart?
- Preload: venous return – goes up with exercise - Afterload: blood pressure – goes up with exercise, hypertension - Rate and force of contractility goes up with exercise, ANS/adrenaline.
44
what are properties of cardiac myocytes?
- high energy requirement: electrical (depolarize all the time) and mechanical (for contraction) - low energy reserve (not lost of room to store fat) - must work continually.
45
how often do myocardial infarcts lead to sudden death?
20%
46
causes of myocardial infarct
Thrombus that forms on the spot, embolus that was transported, hemorrhage at the site, spams.
47
how fast must thrombotic drugs be given after a myocardial infarct? why?
Minimize areas of necrosis that is going to occur – can give thrombolytic drugs within 4 hours to help dissolve clots.
48
what is the speed of the pacemaker activity of the SA node, AV node, and ventricles?
- 60-100 bpm - 40-60 bpm - 20-45 bpm
49
what do the waves seen on an EKG represent?
P: atrial depolarization QRS: depolarization of ventricles T: repolarization of ventricles
50
what are the different pacemakers and their roles?
- SA: dominant pacemaker - AV node: slows down for a little, then spreads to ventricles (Has pacemaker activity (but slower) – backup pacemaker.) - Atria and ventricles are insulated, so electrical signals have to go through the proper channels. (Connected through intercalated disk. ) - Purkinje fibers: spreads signal almost instantaneously so that the whole ventricle gets the signal at the same time. (Ventricles can have some pacemaker activity if all else fails)
51
how can a conduction block cause an arrythmia?
impulse begins but cannot go through the heart, not permanent, but before it unblocks, you may pass out. Only see a P-wave.
52
how can ectopic focus cause an arrythmia?
- impulse not in the place it ought to be. - Injured tissue can generate electrical impulse – uncoordinated conduction.
53
what is atrial fibrillation?
uncoordinated conduction in atria (independent of each other), but blood will flow – will not kill you, ventricles take over.
54
what is ventricular fibrillation?
uncoordinated conduction in ventricle, much more dangerous
55
what is circus (re-entry)?
one way block with re-entry causing “circus movement” – goes a round in a circle since one wave blocked, so will not be “cancelled out” in the direction that it is not supposed to go.
56
how fast is atrial flutter?
200-400 bpm
57
where is valvular heart disease more common?
underdeveloped countries
58
what happens to the valves in systole and diastole?
- In systole: pulmonic and aortic valve open; tricuspid and mitral valve closed. - In diastole: tricuspid and mitral valve open; pulmonic and aortic valve closed.
59
what is stenosis? what does it cause?
- thickening at the sides of the valves, so opening is smaller and not able to open and close all the way - Decreases the flow of blood. - Incompetency: when cannot open and close properly (malfunction).
60
what does b-hemolytic streptococcal infection cause and how?
- T-cell and antibodies cross react with antigens on cardiac muscle and in particular the glycopeptides on the cardiac valve. - Causes damage to the valves predominantly but can also damage the muscle - also causes regurgitation and stenosis
61
what is regurgitation?
the blood will flow backwards since valves cannot close properly during contraction.
62
other than b-hemolytic streptococcal, what other infections can lead to similar issues? how are they spread?
Other pathogens may also cause direct damage (IV drug users, immunocompromised, sepsis (generalized infection in the blood): streptococci, staphylococcus, fungi, etc.),
63
what are the consequences of valvular heart disease?
- Heart initially adapts. (No symptoms until advanced stenosis or regurgitation.) - Can progress to heart failure: may produce pulmonary hypertension/fibrosis- causes atrial and aortic stenosis and regurgitation
64
what happens with aortic stenosis?
- ventricle has to work harder to push blood through the valve. - The left ventricle hypertrophies, but eventually can lead to left ventricular failure since it cannot pump it through the valve. - Angina will be felt since coronary flow is obstructed.
65
what happens with aortic regurgitation?
- Valve cannot close properly, so ventricle will dilate, but now has to deal with a lot of blood, can lead to heart failure. - Usually leads to fatigue and dyspnea (since have to work very hard all the time).
66
what happens with mitral stenosis?
- left atrium hypertrophies and dilates. - this impacts the pulmonary circulation: normally a low-pressure system in the lungs, so if valve is narrowed, some of the blood will go backwards (back into pulmonary circulation, which will increase the pressure, so then: - right ventricle hypertrophies trying to push the blood through the pulmonary circuit into the other side of the heart. - Causing fatigue and dyspnea.
67
what is the treatment for valvular heart disease?
- Antibiotics when caused by bacteria. - Valve replacement: - Ball of cage valve (mechanical): when upper chamber contraction ball is pushed down into the cage, and blood flows in, and it closes when lower chamber contracts. - Biological valves: can transplant from pig/horse.
68
how do valvular disease and arrythmias cause congestive heart failure?
inefficient pumping action, so workload increases.
69
where does edema occur in congestive heart failure?
peripheral; pulmonary - fluid in lungs, feet, ankles, leg
70
series of steps leading to congestive heart failure?
Loss of myocardial efficiency initiation of compensatory mechanisms failure of compensatory mechanisms (no longer adequate) heart failure.
71
what adaptations are seen in the heart?
1. Heart is enlarged (hypertrophy) – trying to cope with the problem. 2. Tachycardia 3. Starling’s Law: relates cardiac output to end-diastolic volume. - What happens here is that there is an inability to increase the cardiac output, leading to heart dilation. 4. Hypertrophy and dilation causes: - Left ventricular hypertrophy: hypertension. - Right ventral and dilation: COPD - Left and right ventricular hypertrophy and dilation: mitral valve disease.
72
what is forward and backward heart failure?
- Forward failure: heart unable to pump properly, so not enough blood in tissue, retention of salt and water by kidney, increased blood volume, leading to edema and congestion of tissue. - Backward failure: heart unable to pump properly, blood “back’s up” in venous circulation, increase of venous pressure, high capillary pressure, leakage of fluid from capillaries, leading to edema and congestion of tissue.
73
what are symptoms of heart failure?
edema, cyanosis (not enough oxygenated blood delivered), dyspnea, orthopnea (when lying down), fatigue, weakness, nocturia (more urine produced during the night since when lying down, blood flow to kidneys is higher)
74
how do you treat heart failure?
- Treat precipitating factor: Hypertension – treat with drugs. Arrythmia – put pacemaker for example. Valvular defect – fix it using surgery for example. - Drugs to reduce symptoms: Myocardial contractility, diuretics for edema, others.
75
consequences of heart failure?
- Cor pulmonale: right-sided heart failure: Enlargement of the right ventricle due to high blood pressure in the lungs usually caused by chronic lung disease. Can be due to COPD and pulmonary hypertension, leading to right heart failure. Not common but can happen. - Cardiogenic shock: flow to organs is inadequate, leading to death due to cardiorespiratory failure: Usually due to left ventricular heart failure, but any types of heart failure can lead to this.
76
what is the 1st cause of disability?
cerebrovascular diseases
77
how much of CO goes to the brain?
-20% of cardiac output goes into the brain – requires enormous continual supply of glucose.
78
what causes strokes?
- Serious atherosclerosis in brain vessels. - Usually something that happens in the brain such as ischemic stroke (blocked flow of blood – most common), or hemorrhagic stroke (rupture).
79
which regions are more vulnerable to strokes?
Middle cerebral artery is a common site of stroke.
80
what is a saccular aneurysm and what can you do about it?
- bulges, common in the circle of Willis (which is located at the base of the brain) - When rupture, 50% mortality and also very high impairment in the rest. - But may go unnoticed for the person’s entire life. - Surgical techniques to prevent rupture: Clip the bulge, thread a coil into aneurysm and leave it there (stent).
81
what are symptoms of stroke?
Rapid onset of dramatic symptoms (seen on one side of the body). can’t see/speak/walk properly. FAST: face, arm, speech, time
82
risk factors for stroke
High-fat diet, high cholesterol, high BP, diabetes, smoking (including second-hand smoke), lack of exercise (e.g. risk factors of heart disease)
83
what is Cerebral hemorrhage? when can this occur?
sometimes 7-10 days after the initial injury, there may be cerebral vasospasm caused by the release of mediators in the brain as it heals.
84
what do consequences related to strokes depend on?
- Site: symptom directly related to the site (aka the vessel that was affected) Many regions control speech and language understanding. - Extent of damage (how big the vessel was). - Collateral circulation: extensive collateral flow if in middle but limited in other places
85
what is Multi-infarct dementia
small strokes all over the place.
86
what can happen if you have a stroke in the middle cerebral region?
- Contralateral hemiplegia (paralysis on one side of the body) - Hemianesthesia (anesthesia on one side of the body) - Speech impairment
87
what is Hemianopsia
doesn’t recognize one side of the body.

PATH 300 (9 decks)

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