Cardiovascular II

Question 1

Rheumatic Fever

Answer 1

Multi-system inflammatory disease with major cardiac manifestations

Question 2

Who does Rheumatic Fever often affect?

Answer 2

Children between 5-15 years of age

Question 3

When does rheumatic fever usually occur?

Answer 3

1-4 weeks after an acute episode of tonsillitis
other infection caused by group A β-hemolytic streptococci

Question 4

Diagnosis of RF is based on..

Answer 4

Jones criteria
- MAJOR AND MINOR CRITERIA

Question 5

What is the major criteria for the diagnosis of RF?

Answer 5

Migratory polyarthritis
Carditis
Subcutaneous nodules
Erythema marginatum - long lasting rash
Sydenham’s chorea - involuntary movements

Question 6

What is the minor criteria for the diagnosis of RF?

Answer 6

Fever
Joint pain
Previous rheumatic fever
Raised ESR
Prolonged PR interval on ECG

Question 7

Pathogenesis of RF

Question 8

Complications of RF

Answer 8

Permanent damage to the heart caused by inflammation of RF. The damage results in:

• Valve stenosis
• Valve regurgitation
• Damage to heart muscle
• Atrial fibrillation
• Heart failure

Question 9

Investigation of RF

Answer 9

Throat swab for group A β-hemolytic streptococci

Anti-streptolysin O titer and sometimes antistreptokinase titers are raised.

ESR and C reactive proteins are usually elevate

Question 10

Treatment of RF

Answer 10

Complete bed rest
Aspirin, and corticosteroid to reduce inflammation

Antibiotics to remove residual streptococcal infection and long-acting penicillin monthly injection for 5 years, in case of carditis this treatment for 40 years.

Question 11

What is blood pressure?

Answer 11

The amount of force on the walls of the arteries as the blood circulates around the body.

Question 12

Regulation of blood pressure =

Answer 12

cardiac output x peripheral resistance

Question 13

Cardiac output =

Answer 13

cardiac output = stroke volume x heart rate
CO = SV X GR

Question 14

What is the average cardiac output for an adult?

Answer 14

5 L/min and in exercise it may rise to 35 L/min.

Question 15

What is hypertension?

Answer 15

high blood pressure

Question 16

Systolic vs Diastolic Blood pressure

Answer 16

Systolic Blood Pressure - when the heart beats - upper number

Diastolic Blood Pressure - when the heart relaxes - lower number

Measured in mm Hg

Question 17

What are the causes of hypertension?

Answer 17

90% of cases cause are unknown (AKA primary)
with 5% malignant and 85% benign
- Genetics 40%
- Environment 60% (lifestyle)

(secondary)
10 % of cases cause is known - is due to underlying disease

Question 18

Classifications of hypertention

Answer 18

Benign and Malignant

Question 19

Cardiovascular risk factors

Answer 19

High blood pressure
Smoking
High cholesterol
Diabetes
Low physical activity
Stress
Obesity
Diet
Excess alcohol consumption

Question 20

9 ways to control hypertension

Answer 20

Healthy diet
Exercise (45-60 minutes 4-5 times / week)
Control your weight
Limit daily alcohol to 2 drinks/day or less
Low salt intake
Do not smoke
Take time to relax
Take medications as prescribed
Check your BP at home

Question 21

Why is high blood pressure bad for you?

Answer 21

Overtime, hypertension leads to arteriosclerosis and atherosclerosis

these can:
- damage the walls of the arteries
- block arteries and decrease blood flow

Question 22

Hyaline arteriosclerosis

Answer 22

Deposition of pink material (degenerated proteins)
Occurs in the elderly but is worse in hypertension and diabetic patients

Question 23

Hyperplastic arteriolosclerosis

Answer 23

due to hyperplasia of smooth muscle cells
- associated with malignant hypertension

Question 24

What can untreated lead to?

Answer 24

Strokes
Dementia
Heart failure
Kidney failure
Hypertensive retinopathy
Poor circulation – impotence, leg cramps when walking
Premature death

Question 25

Hypertensive retinopathy

Question 26

What are the benefits of treating hypertention?

Answer 26

Decrease chance of heart attack (15%), heart failure (50%), stroke (38%) and death (10%)

Question 27

How long should antihypertensive drugs be taken for?

Answer 27

To be taken for life unless a doctor stops the medication. Need to be continued, even though you feel well.

Question 28

What are the major classes of anti-hypertensive drugs

Answer 28

1. Thiazide Diuretics 2. ACE inhibitors 3. Angiotensin receptor blockers (ARB) 4. Calcium channel blocker (CCB) 5. Beta 1 adrenergic R-blockers 6. Alpha-adrenergic R-blockers

Question 29

Thiazide Diuretics:

Answer 29

Inhibit sodium reabsorption at distal convoluted tubule, causing increased loss of sodium water. Most commonly used diruetic e.g. Hypochlorothiazide, Chlorothiazide, Hydrochlorothiazide Cyclopenthiazide, Bendroflumethiazide.

Question 30

Loop Diuretics:

Answer 30

Inhibit sodium reabsorption at the loop of henle e.g. furosemide, torsimide

Question 31

α1-adrenoceptor antagonists

Answer 31

Cause vasodilation by blocking the binding of noradrenaline to their receptors on smooth muscle. doxazosin, prazosin and terazosin

Question 32

What are the targets for the major antihypertensive drugs?

Answer 32

Renin-angiotensin-aldosterone system

Question 33

ACE inhibitors

Answer 33

responsible for conversion of angiotensin I into angiotensin II, a potent vasoconstrictor) e.g. captopril, ramipril, lisinopril.

Question 34

Angiotensin receptor blockers

Answer 34

block angiotensin action that causes blood vessels to constrict e.g. losartan, valsartan, irbesartan

Question 35

Calcium Channel Blocker (CCB)

Answer 35

block calcium influx and its utilization within cells, thus decreasing the force of heart contraction + relaxing the smooth muscle of blood vessel e.g. Amlodipine, Felodipine, Nifedipine, Verapamil

Question 36

Beta 1 adrenergic R -blockers

Answer 36

decrease the amount of blood the heart pumps, slow the heart rate e.g. Propranolol, Atenolol, Bisoprolol.