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Flashcards in cardiovascular disease Deck (77)
1

what might you see on an ecg with angina

ST depression

due to sub endocardial ischaemia

2

what two mechanisms control coronary flow

autoregulation / myogenic
metabolic regulation

3

what is coronary flow reserve

maximum vasodilation - autoregulated flow

4

what determines myocardial oxygen consumption

tension
contractility
HR
basal activity
mass of tissue

5

what 4 types of drug are used in angina

B blockers
nitrates
ca channel blockers
Ikf channel inhibitors

6

what events increase the likelihood of mi

time of day
inflammatory activity
infection
high BP
catecholamines (adrenaline)

7

what preventative drugs would you give someone after a stemi

b blockers
ace inhibitors
statins

8

what are common complications of stemis

arrhythmia
heart failure
rupture
mitral valve insufficiency
VSD
mural thrombus and embolism
LV dilation
recurrent MI

9

how would you treat a nstemi

antiplatelet
b blockers and nitrates
statin
ace inhibitors

10

describe age related vascular changes

fibrosis
accumulation of ground substances
fragmentation of elastic lamina

11

what are the 3 components of atheroma

lipid deposition
inflammation
fibrosis

also: neovascularisation, smooth muscle, macrophages, lymphocytes, collagen

necrotic core: cell debris, cholesterol crystals, foam cells, debris

12

where are atherosclerotic aneurysms usually found

abdominal aorta, distal to renal arteries

saccular or fusiform, may contain thrombi. often palpable or abdom bruits

13

where are the origins of dissecting aneurysms found

aortic valve

14

what is the most common cause of death in a dissecting aneurysm

dissection outward into the peritoneal, pleural or pericardial cavities

15

what might be the result of a berry aneurysm

sub arachnoid haemorrhage

16

what is a capillary microaneurysm

small aneurysm of the middle cerebral artery. may lead to intra cerebral haemorrhage

17

where are syphilitic microaneurysm normally found

thoracic aorta

18

what is a mycotic aneurysm

wall of artery is weakened often in the brain

19

what is giant cell arteritis

granulomatous inflammation of arteries, usually temporal, vertebral and opthalmic

20

what is takaysu arteritis

pulseless disease- (intermittent claudication of UL arteries)

21

what is polyarteritis nodosa

arteries of abdo organs
fibrinoid necrosis

22

what is kawasakis disease

very young children
fever , eye and mouth lesions

23

what are the type of vascular tumours (benign)

angioma
haemangioma
juvenile
capillary
cavernous
lymphangioma

24

what are some types of malignant tumours

angiosarcoma
kaposis sarcoma
angioproliferative tumour

25

what causes dysrhythmia

changes to heart cells
changes in conduction of the impulse

26

what are the 4 classes of arrhythmias

atrial/ SV
junctional (AVN)
ventricular
tachy/brady cardia

27

what are the 4 types of arrhythmia event

heart block
ectopic
delayed after depolarisation
circus re entry

28

what does a delayed after depolarisation cause

atrial or ventricular tachycardias

29

what usually causes heart block

ischaemia

usually affects AVN, slows or blocks impulses

30

describe the features of a first degree heart block

conduction is slowed
abnormally long PR interval
every p wave is passed to QRS

normal PR interval is 0.12- 0.2

31

describe a mobitz 2 heart block

some Ps don't get through
constant PR interval except when there is missed QRS

32

describe a wenkebach heart block

progressive lengthening of the PR Interval until a dropped QRS

33

describe a 3rd degree heart block

complete block
ventricles depolarise at their inherent rate

34

what are ectopic pacemakers

when other areas of the heart develop pacemaker activity
eg due to
damage
sympathetic activity
catecholamines
digoxin

ischaemic damage may cause cells to become leaky to Na
catecholamines (B1 rec) increase rate of depolarisation

35

what is an early after depolarisation

occurs towards the end of phase 2

triggered by increase in Ca permeability
can set off self sustaining depolarisations - tachycardia

long QT

36

what is a delayed after depolarisation

increase in Ca eg due to cardiac glycosides causes an after depolarisation

can become self perpetuating and trigger an AP

may be due to delayed repolarisation (long qt)

can lead to ventricular dysrhythmia

37

what is circus reentry

an electrical impulse re enters a region of the heart after its refractory period
comes from an unusual direction and at the wrong time

no extinction by collision due to impulse dying out

may cause paroxysmal tachycardia

38

what is wolf Parkinson white syndrome

due to an additional electrical connection between the atria and ventricles thereby passing the AVN
causes paroxysmal tachycardia and re entry
delta waves on the ecg
wide qrs
st changes

39

how might you diagnose a left anterior fascicular hemiblock

left axis deviation

40

how might you diagnose a left posterior fascicular hemiblock

right axis deviation

41

what might cause a bradycardia

b blockers
diltiazem (Ca channel blocker)
hypothyroidism
sinus node disease
electrolyte abnormalities

you might treat with a pace maker

42

how do you diagnose a right bundle branch block

widened qrs complex
two r waves

43

how do you diagnose a left bundle branch block

widening of QRS complex
a notch in the qrs

44

what is a narrow complex tachycardia

superventricular
atrial/junctional/re-entry
usually no p waves

45

what is a broad complex tachycardia

usually ventricular

46

how would you treat an AV node tachycardia eg avnrt or avrt

adenosine
causes transient AV block

47

how would you treat AF

diltazem, verapamil, b blocker

48

what is polymorphic ventricular tachycardia also known as

torsade de points

must also have QT prolongation. associated with early after depolarisations

sudden cardiac death after adrenergic setting

49

what might cause secondary hypertension

renal disease, phaeochromocytoma, cushings, diabetes, coarctation, eclampsia
drugs eg illegal drugs and contraceptive pill

50

what is stage 1 hypertension

140/90 in the clinic
135/85 ambulatory

51

what is stage 2 hypertension

160/100

52

what is severe hypertension

180 syst
or 110 diastolic

may have left axis deviation and inverted t waves on the ecg
albinuria

53

what can cause an increase in TPR

sympathetic nerve activity
increased vascular reactivity

54

what are the effects of hypertension on the body

accelerated atherosclerosis and narrowing
retinopathy
renal failure
dilatation

55

what is stenosis

narrowing of the valve outlet caused by thickening of valve cusps, increased rigidity or scarring

56

what is valve incompetence

an incomplete seal allowing blood to flow backwards

57

what are common causes of valve disease

congenital heart disease
cardiomyopathy
acquired - rheumatic fever, MI, age, calcific stenosis, endocarditis

58

what might result from aortic stenosis

RVH
syncope
sudden cardiac death
dyspnoea
angina

59

what are causes of aortic incompetence

marfan's
rheumatic fever
infective endocarditis(may causes perforation)

may have calcification of a congenital bicuspid valve

60

what is the most common cause of mitral incompetence or stenosis

rheumatic fever

leads to pulmonary hypertension and RVH due to back pressure
may cause atrial fibrillation

61

what is infective endocarditis

infection of the valve with thrombotic vegetations

62

what are the risk factors for infective endocarditis

valve damage
dental
catheterisation
immunosuppression

63

what is rheumatic fever

3 weeks post streptococcal infection (usually pharyngitis)
immune mediated
occurs in children
multisystem disease

64

what might be found in a vegetation

group D strep
gut commensals
skin strep

65

what are the complications of endocarditis

splinter haemorrhages
clubbing
emboli
renal infarcts
pneumonia
osler's nodes and janaway lesion

66

what is acute on chronic heart failure

chronic failure becomes decompensated by an acute event

67

what is systolic failure

failure to pump blood in systole
reduced ejection fraction

may be caused by
reduced contractility
volume overload
pressure overload (stenosis/hypertension)
regurgitation
dilated cardiomyopathy
severe hypertension
increased preload (EDV) dilation and increased tension

68

what is diastolic failure

failure of the ventricle wall to relax
restrictive, stiff ventricle (cardiomyopathy)
may be caused by scaring or amyloidosis
also may be increased wall thickness( hypertrophy)
or delayed relaxation or increased heart rate
tamponade
normal ejection fraction but impaired filling

69

what are the causes of heart failure

coronary heart disease
hypertension
cardiomyopathies
drugs
toxins
endocrine
nutritional
infiltrative

70

what is backward heart failure

increased venous pressure
increased heart filling pressures

71

what is forward failure

reduced tissue perfusion
usually advanced failure

72

what do cardiac glycosides inhibit

Na/ Ca exchange

73

what is the NYHA classification of heart failure

1 no limitation
2 slight limitation on physical activity
3 marked limitation
4 unable to carry out physical activity, discomfort at rest

74

what are the compensatory mechanisms in heart failure

frank starling
sympathetic activity
renin angiotensin

75

what is the problem with RAAS as compensation for heart failure

increased renin release and angiotensin and aldosterone

vasoconstriction, water reabsorption, increased preload
inflammatory response leading to fibroblast deposition

76

what is the problem with sympathetic activity as compensation for heart failure

tachycardia, vasoconstriction, decreased tissue perfusion, increases the heart workload
desensitisation of b receptors

77

what is the problem with the frank starling mechanism in heart failure

pulmonary congestion
increased muscle stretch and O2 consumption