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Cardiovascular System Flashcards

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0
Q

Name the 3 causes of anaemia

A

Reduced production of Hb
Increased losses of Hb
Increased demand of Hb

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1
Q

Define anaemia

A

Reduction in haemoglobin in the blood

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2
Q

Define aplastic anaemia

A

Reduced normal RBCs as a result of bone marrow failure

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3
Q

What is thalassaemia?

Give the two types

A

Normal haem production

Genetic mutation of globin chains

  • Alpha chains: Asians
  • Beta chains: Mediterraneans
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4
Q

What are the 5 clinical effects thalassaemia?

A 
Chronic anaemia
Marrow hyperplasia (skeletal deformities)
Splenomegaly
Cirrhosis
Gallstones
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5
Q

What 2 ways can you manage thalassaemia?

A

Blood transfusions

Prevent iron overload

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6
Q

What 2 reasons are there for an increased demand of Hb resulting in anaemia?

A

Pregnancy

Malignant disease

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7
Q

What ethnic group is sickle cell anaemia predominantly seen in?

A

Afro-caribbeans

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8
Q

Define sickle cell anaemia

A

Inherited Hb defect due to defect in structure of beta chain

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9
Q

Define HCT

A

Haematocrit: a measure of the total volume of RBC relative to the total volume of the whole blood in sample

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10
Q

Define microcytic anaemia and give its 2 causes

A

Small RBCs often hypochromic (pale) due to low Hb concentration

Caused by Fe deficiency and thalassaemia

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11
Q

Define macrocyclic anaemia and give its 2 causes

A

Large RBC; associated with maturation problems

Caused by vitamin B12/folate deficiency and retics

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12
Q

Define normacytic RBC and give its 3 causes

A

Normal RBCs

Caused by bleeding/renal/chronic disease

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13
Q

Define reticulocytes

A

Immature RBCs which are larger than RBCs

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14
Q

How can you detect anaemia using reticulocytes?

A

A reticulocyte percentage that is higher than normal is a sign of anaemia

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15
Q

What differences are there between reticulocytes and RBCs?

A

Reticulocytes are stained purple due to organelles/RNA

Reticulocytes are larger than RBCs

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16
Q

What are the 7 signs of anaemia?

A 
Pale mucosa
Smooth tongue (Fe deficiency)
'Beefy' tongue (Vit B12 deficiency)
Pale
Tachycardia (fast heart rate, due to lower O2 carrying capacity)
Enlarged liver
Enlarged spleen
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17
Q

What are 4 symptoms of anaemia?

A

Tired/weak
Dizzy
SOB (shortness of breath)
Palpitations

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18
Q

What 6 things can be investigated for anaemia?

A

Medical history
FBC (full blood count)
FOB (faecal occult blood)- blood in patients stool
Endoscopy/ colonoscopy
Renal function- patients with chronic renal disease will often become anaemic
Bone marrow examination

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19
Q

Name 3 ways anaemia can be treated

A

Replace haematinics (general term for nutrients required to make RBCs) e.g. Iron, folic acid, Vit b12

Blood transfusions

Erythropoietin- hormone; increases rate of RBC production

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20
Q

What 3 functions does blood have?

A

Transport of nutrients
Removal of waste
Transport of host defences

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21
Q

What are the 5 components of blood?

A 
Cell component
Plasma proteins: albumin
                            globulin
Lipids
Nutrients
Water
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22
Q

Define leukopenia

A

Low white cell count

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23
Q

Define thrombocytopenia

A

Low platelets

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24
Define pancytopenia
All cells reduced
25
Define polycythaemia
Raised Hb
26
Define leukocytosis
Raised WCC
27
Define thrombocythaemia
Raised platelets
28
Define leukaemia
``` Neoplastic (abnormal) proliferation of white cells Usually disseminated (wide spread) ```
29
Define lymphoma
Neoplastic proliferation of white cells | Usually a solid tumour
30
In what 2 cases would someone receive a blood transfusion?
When one or more components of the blood has to be replaced quickly e.g. RBCs, platelets, clotting factors When bone marrow cannot produce blood cells
31
What 3 complications can result from a blood transfusion and what can they cause?
1. Incompatible blood - Cell lysis: fever, jaundice, death 2. Fluid overload - Heart failure 3. Transmission of infection - Blood borne viruses e.g. Hep B, HIV - Prion disease - Bacterial infections e.g. Syphilis
32
Describe the transfusion protocol (3 steps)
Blood is filtered to remove any clots The patients temperature, pulse and BP are monitored every 15 minutes during transfusion Transfusion is stopped if there is any significant change
33
Define haemostasis
The arrest of bleeding
34
What 3 components can result in a haemostatic disorder?
Vascular component- retraction of vessel (collagen disorder) Cellular component- platelets number and function Coagulation component- adequate clotting - adequate clot lysis
35
How would you investigate the platelet number and platelet function for haemostatic disorders?
Full blood count | 'Bleeding time'
36
How long does it take to make new platelets?
7-10 days
37
What are 3 visual signs of haemostatic disorders?
Purpura- skin rash from bleeding into skin from capillaries Ecchymosis- bruise from release of blood into tissues either from injury or spontaneous leaking from vessels Petechiae- small round flat dark red spots caused by bleeding into skin or beneath mucous membrane
38
What are the 3 types of inherited bleeding disorders?
Haemophilia A Haemophilia B Von Willebrands disease
39
What are 2 ways to develop an acquired bleeding disorder?
Warfarin | Liver disease
40
Define porphyria How many does it affect What are the 2 types
Abnormality of haem metabolism 1 in 10000 population affected 1. Hepatic porphyria 2. Erythropoietic porphyria
41
What are the clinical effects of porphyria?
Photosensitive rash Neuropsychiatric disturbance in acute attacks (motor and sensory changes, seizures) Hypertension Tachycardia
42
Name 5 triggers of porphyria
``` Many drugs Pregnancy Acute infections Alcohol Fasting ```
43
What name is given to low Hb
Anaemia
44
What name is given to low WCC?
Leukopenia
45
What name is given to low platelet count?
Thrombocytopenia
46
What name is given to raised Hb?
Polycythaemia
47
What name is given to raised WCC?
Leukocytosis
48
What name is given to raised platelet count?
Thombocythaemia
49
What name is given when all cell types are reduced?
Pancytopenia
50
What 3 features of cancer cells cause them to be malignant?
Uncontrolled proliferation Loss of apoptosis (cells don't self destruct) Loss of normal functions/products
51
Name 4 causes of leukaemia/lymphoma (aetiology)
Inherited DNA mutations (some associated with known syndromes) Chemicals Radiation Viruses
52
What is a blast?
Immature cell
53
What group of cancers does leukaemia refer to?
Cancers of the bone marrow
54
What does leukaemia prevent and what 3 things does this result in?
Prevents normal manufacture of blood Anaemia Infections: neutropenia- decreased WBC so increased susceptibility to disease Bleeding: thrombocytopenia- decreased platelets
55
What is the pathogenesis (disease process) of leukaemia?
1. Clonal proliferation 2. Replacement of bone marrow 3. Increased marginalisation of productive normal marrow resulting in: - marrow failure - organ infiltration (leading to organ failure)
56
Name 5 things that can be a clinical presentation of leukaemia
Anaemia Neutropenia- decreased WBCs Thrombocytopenia- decreased platelets Lymphadenopathy- neck lumps due to enlarged lymph nodes Splenomegaly/ Hepatomegaly - swollen abdomen Bone pain- especially in children
57
What 3 things can be clinical presentations of neutropenia?
1. Infections associated with portals of entry e.g. Tonsillitis, pneumonia, thrush 2. Reactivation of latent (dormant) infections 3. Increased severity and frequency of infections, and can rapidly lead to systemic infections
58
Name 2 symptoms of neutropenia
Recurrent infections | Unusual severity of infection
59
Name 3 signs of neutropenia
Unusual patterns of infection and rapid spread Will respond to treatment but recur Signs of systemic involvement e.g. Fever, rigors (shivers), chills
60
What investigation can be done for neutropenia?
Unusual pathogens, usually bacterial
61
What are 5 symptoms of thrombocytopenia?
``` Bruise easily/spontaneously Minor cuts fail to clot Gingival bleeding Nose bleeds Menorrhagia- abnormally heavy menstrual bleeding ```
62
Name 4 signs of thrombocytopenia
Bruising Petechiae- small dark bruises cause by bleeding into skin Bleeding on probing Bleeding/bruising following procedure
63
What is the peak age for acute lymphoblastic leukaemia?
4 y/o
64
What is the incidence of acute lymphoblastic leukaemia?
25 per 1,000,000 per year
65
What is the incidence of acute myeloid leukaemia?
25 cases per 1,000,000 per year
66
In what age group is acute myeloid leukaemia most prevalent?
The elderly
67
What is the most common form of leukaemia?
Chronic lymphocytic (lymphoid) leukaemia
68
What is lymphoma?
Clonal proliferation of lymphocytes arising in lymph node or associated tissue
69
What is the incidence of lymphoma?
200 cases per 1,000,000 per year
70
What is the ratio of number of suffers of non-hodgkins lymphoma to Hodgkin's lymphoma?
6:1
71
Define Stage I of lymphoma tumour staging
Single lymph node region or single extra lymphatic site involved
72
Define Stage II of lymphoma tumour staging
Two or more sites on same side of diaphragm involved
73
Define Stage III of lymphoma tumour staging
Both sides of diaphragm involved
74
Define Stage IV of lymphoma staging
Diffuse involvement of extra lymphatic (and nodal disease)
75
What 3 tests may be used to help stage a tumour?
CT PET MRI
76
What 3 things does tumour staging take into account?
Number of nodes involved and site Extra nodal involvement Systemic symptoms
77
What is the peak age of Hodgkin lymphoma?
15-40 y/o
78
What is the clinical presentation of Hodgkin lymphoma?
Painless lymphadenopathy- enlargement of lymph nodes Fever, night sweats, weight loss, itching Infection
79
What are the 2 types of non-Hodgkin lymphoma and how are the divided?
B-cell: 85% | T-cell: 15%
80
What is the peak age to develop NHL?
Any age
81
What are 3 possible causes of NHL? (Aetiology)
1. Microbial factors e.g. EBV 2. Autoimmune disease e.g. Rheumatoid arthritis 3. Immunosuppression e.g. AIDS, post transplant
82
Name 4 aspects of clinical presentation of NHL compared to HL
1. Lymphadenopathy- enlarged lymph nodes (often widely disseminated) 2. Extra-nodal disease more common- e.g. Oropharyngeal involvement (noisy breathing and sore throat) 3. Symptoms of marrow failure e.g. Aplastic anaemia 4. Constitutional symptoms less common e.g. Fever, weight loss
83
Define Multiple Myeloma
The malignant proliferation of plasma cells (WBCs) in bone marrow
84
What are 3 clinical features of Multiple Myelomas?
1. Monoclonal paraprotein released by malignant plasma cells found in the blood and urine 2. Lytic bone lesions (destruction of bone cells)- pain and fracture likely 3. Excess plasma cells in bone marrow- leading to marrow failure
85
Name 5 treatment for haematological malignancies
``` Chemotherapy Radiotherapy Monoclonal antibodies Haemopoietic stem cell transplantation Supportive therapy e.g. Pain control, nutrition, psychological support ```
86
What does chemotherapy target?
Targets cells with high turnover rate (e.g. Mucosa) to induce cell death
87
What is a disadvantage of chemotherapy targeting?
Results in many unwanted effects in normal high turn over tissues
88
What are 3 side effects of chemotherapy?
Hair loss Nausea and vomiting Tiredness
89
What is a long term risk of chemotherapy?
Risk of oncogenesis (development of new abnormal growth) in surviving patients
90
Name 3 examples of chemo drugs
Methotrexate Cyclophosphamide Vincristine
91
Define radiotherapy
Cytotoxic effect of ionising radiation
92
Describe the treatment of monoclonal antibodies
Monoclonal antibodies specific to cancer cell antigens are produced artificially in large quantities and given to patient
93
What is a disadvantage of monoclonal antibodies and how are the drugs recognised?
Very expensive to produce and deliver Drug names end in "-mab"
94
Define allogeneic stem cell transplant
Stem cell from live donor, either relative or stranger who has been matched
95
Define autologous stem cell transplant
Stem cells from patient themselves
96
Name 6 oral manifestations of haematological malignancies
``` Gingival swelling Mucosal pallor Spontaneous bleeding Petechiae Oral ulceration Infection ```
97
What importance does the mouth have in patients receiving cancer therapy?
The mouth is a potential source of infection which can be life threatening in an immunocompromised patient
98
Pre-cancer treatment, what preventative measures would a dentist take with the patient?
OHI Dietary advice If gingival disease- alcohol free chlorohexidine Applicator trays for fluoride gel and tooth mousse High fluoride toothpaste High fluoride varnish application
99
Define mucositis
Acute inflammation of the mucosa
100
What preventative management can be done to for patients with mucositis?
Improve OH of patient so decreased healing time Ill fitting dentures/sharp restorations adjusted Mucosal shields (if radiotherapy)
101
Name 6 ways mucositis can be managed
1. Difflam spray 2. 2% lidocaine mouthwash prior to eating 3. Gelclair 4. Chlorohexidine 5. Ice chips- oral cooking 6. Cell transplant
102
Define xerostomia
Thick, acidic and viscous saliva with loss of protective functions
103
What 2 approaches are there to treat xerostomia?
Saliva stimulation | Saliva replacement
104
Name 4 ways to for stimulate saliva
Chewing sugar free gum Pilocarpine Acupuncture Acid pastilles (contraindicated in dentate)
105
Name 4 ways to replace saliva
Taking sips of water Saliva orthana Biotene Bio Astra
106
What 4 things should patients with xerostomia avoid?
Hard, spicy, strong flavoured foods Foaming toothpaste Alcohol and smoking tobacco Fizzy drinks and fruit drinks
107
Name 3 irreversible risk factors of CV disease
Age Sex Family history
108
Name 4 reversible behavioural risk factors for CV disease
Smoking Obesity Diet Exercise
109
Name 4 reversible medical risk factors for CV disease
Hypertension Hyperlipidaemia (high cholesterol) Diabetes Stress
110
Name 8 risk factors for hypertension
``` Age Race Obesity Alcohol Family history Pregnancy Stress Drugs e.g. non-steroidal, oral contraceptive ```
111
Name 6 ways you would test if someone is at high risk of CV disease
``` Family history Diet Smoking Test cholesterol Test blood pressure Test for type 2 diabetes ```
112
Name 4 ways someone can present with CV disease
Angina Myocardial infarction Stroke Claudication
113
Name 4 approaches to preventing/controlling CV disease
1. Lifestyle changes 2. Control total cholesterol- statin treatment - reduce cholesterol to
114
Name 2 ways drugs are used in CV system and give examples for each
1. Prevent FURTHER disease - anti platelet drugs - lipid lowering drugs - anti-arrhythmics 2. To reduce symptoms of current current disease - diuretics - anti-arrhythmics - nitrates - calcium channel blockers - ACE inhibitors
115
Give three examples of anti-platelet drugs
Aspirin Clopidrogel Dipyridamole
116
How does aspirin work?
It inhibits platelet aggregation By altering balance between Throboxane A2 and Prostacyclin It is irreversible for the life of the platelet
117
How does Clopidrogel work?
It inhibits ADP induced platelet aggregation
118
How does Dipyridamole work?
It inhibits platelet phosphodiesterase (enzyme which breaks phosphodiester bonds)
119
How do Lipid-Lowering drugs work?
They inhibit cholesterol synthesis in liver | Therefore reducing both the total cholesterol and LDL cholesterol
120
What side effect can lipid lowering drugs have?
Possible myositis (muscle disease) with some drug interactions
121
Give an example of an anti-arrhythmics and 2 types of it
Beta-adrenergic blockers (beta blockers) Atenolol- selective: B1 only Propranolol- non-selective: B1 and B2
122
What 3 effects so beta blockers have?
1. Prevent increase in HR - cause postural hypotension - prevent unusual heart rhythms which can lead to a MI 2. Reduce heart efficiency - make heart failure once 3. Block beta receptors in lungs - make asthma worse/difficult to treat
123
How do diuretics work?
They increase salt and water loss therefore decreasing plasma volume and decreasing cardiac workload
124
What is a side effect of diuretics?
Can lead to Na+/K+ imbalance if not monitored
125
Name 2 types of nitrates
``` Glyceryl trinitrate (GTN)- short acting Isosorbide Mononitrate- long acting ```
126
What 3 ways do nitrates work?
1. Dilate veins- reduce preload to heart 2. Dilate resistance arteries- reduce cardiac workload (afterload) - reduce cardiac oxygen consumption 3. Dilate collateral coronary artery supply- reduce anginal pain
127
What 3 ways can nitrates be administered and why?
Sublingual Transdermal Intravenous Inactivated by first pass metabolism
128
What side effect do nitrates have?
Headache
129
What 2 ways do calcium channel blockers work?
They block calcium channels in smooth muscle Some are more active in heart muscle - reduces strength of heart contractions - e.g. Verapamil Some are more active on peripheral blood vessels - relaxation and vasodilation - e.g. Nifedipine, amlodipine
130
Name a side effect of calcium channel blockers
Some cause gingival hyperplasia (increased number of cells) | - those acting on peripheral blood vessels
131
How do Angiotensin Converting Enzyme (ACE) inhibitors work and give examples?
Inhibit conversion of Angiotensin I to Angiotensin II Prevents aldosterone dependant reabsorption of salt and water Therefore decreases BP E.g. Enalapril, ramapril, lisinopril
132
Name 2 side effects of ACE inhibitors
Cough | Hypotension
133
What other drugs have the same effect as ACE inhibitors?
Angiotensin II blockers (e.g. Losartan) Inhibit same system but use different mechanism
134
Define thrombosis
The formation of a solid or semi-solid mass from the constituents of the blood within the vascular system during life
135
Name 3 factors predisposing to thrombosis
1. Abnormality of blood vessel wall particularly the endothelium (e.g. Atheroma) 2. Alterations in blood flow- stasis and/or turbulence 3. Hypercoagulable blood
136
Name 4 ways blood vessels are damaged
Atheroma Inflammation Trauma Bacterial toxins
137
Name 5 occurrences that blood is hypercoagulable
``` Following surgery In disseminated cancer During pregnancy While taking oral contraceptive pill In genetic deficiency states of blood clotting factors ```
138
Name 4 locations of thrombi
Arterial Venous Cardiac Capillaries
139
Name 4 causes of DVTs
Bed ridden following surgery Heart failure Severe tissue injury Pelvic tumours
140
Name the 3 fates of thrombi
1. Removal by fibrinolytic system 2. Organisation- replacement fibrosis 3. Embolism
141
Define embolism
Movement of solid, liquid or gaseous material through the blood and its impaction in a blood vessel at a site distant from its origin
142
What are the 2 main types of embolism and explain their mechanism
Systemic thrombo-embolism - thrombi form on left side of heart or in arteries, break free and Impact distally in systemic arterial tree causing ischaemia or infarction due to obstruction of blood flow Pulmonary Thrombo-embolism - thrombi arise in deep veins of leg or pelvis - if large, emboli obstruct main pulmonary arteries arising from right side of heart (sudden death) - if smaller, emboli obstruct smaller, more peripheral pulmonary artery branch (clinically silent)
143
Define atherosclerosis
Patches (plaques) of thickening of artery lining | Due mainly to accumulation of plasma lipids, proliferation of smooth muscle and formation of fibrous tissue
144
Site of occurrence of atherosclerosis
Any ARTERY
145
Name 4 clinical effects of atherosclerosis
1. Arterial narrowing sufficient to cause ischaemia 2. Predisposes to throbosis because of lumenal occlusion of artery 3. Embolism 4. Weakening of artery wall leading to aneurysm formation (swelling in wall of artery)
146
Name 6 major risk factors of atherosclerosis (aetiology)
1. Age- atheroma progresses slowly throughout adult life 2. Sex- lower incidence in women until menopause 3. Plasma lipids- hyperlipidaemia predisposes to atheroma 4. Hypertension- atheroma risk increases with increasing BP 5. Cigarette smoking 6. Diabetes mellitus
147
Define ischaemia
Deficient supply of blood to an area such that it becomes hypoxic (deficient 02 to tissues)
148
What is the aetiology of ischaemia?
Most commonly due to narrowing or obstruction of arterial supply caused by atheroma, thrombosis or embolism
149
Name the 2 types of ischaemia and their clinical effects
1. Partial ischaemia (blood flow reduced to a level that is adequate while resting, but hypoxia develops at times of increased oxygen demand e.g. Exercise) a) Angina pectoris- myocardial ischaemia due to narrowed, atheromatous coronary arteries- often induced by exercise and causes sever crushing central chest pain b) Intermittent claudication- atheromatous narrowing of leg arteries leading to pain in calf muscles induced by exercise 2. Complete ischaemia- no blood flow leading to tissue infarction (organs supplied by blocked artery dies)
150
Define infarction and give its aetiology
Tissue death or necrosis due to reduction or loss of blood supply. Usually due to arterial narrowing or occlusion which is often atheromatous and/or thrombotic in nature
151
What 2 things is tissue susceptibility to infarction dependant on?
1. Metabolic rate of tissue- brain more susceptible than fibrous tissue 2. Anatomy of vascular supply e.g. Occlusion of an end artery in brain- infarction
152
What is the fate of infarcts?
Dead tissue incites an inflammatory reaction followed by granulation tissue and eventually fibrous scar replacement
153
Define ischaemic heart disease and give its aetiology
An imbalance between myocardial oxygen supply and demand Most commonly due to narrowed atheromatous coronary arteries and/or thrombosis
154
Name 3 clinical effects IHD
Angina pectoris- myocardial ischaemia due to narrowed coronary arteries Sudden cardiac death Myocardial infarction
155
Name 3 complications of MIs
Cardiac arrhythmias Cardiac failure/ cardiogenic shock Mural thrombosis and/or thromboembolism
156
Define hypertension
Raised systemic arterial pressure with systolic >140mmHg, diastolic >90mmHg
157
What are the two classifications of hypertension?
Primary (essential, idiopathic)- no detectable underlying cause Secondary- resulting from renal diseases or adrenal diseases (e.g. Cushing's)
158
Name 3 pathological effects of hypertension
1. Risk factor for development of atheroma, cardiac failure, renal failure and cerebral haemorrhage 2. In heart, can lead to left ventricular hypertrophy 3. In brain, associated with rupture of micro aneurysms
159
What is the aetiology of both types of hypertension?
Primary- inherited defect of sodium handling by cell membranes (e.g. In the kidney) Secondary- the renin/angiotensin/aldosterone system is often involved
160
Define cardiac failure
Cardiac failure occurs when cardiac function (pump) fails to maintain a circulation adequate for metabolic needs of body DESPITE adequate blood volume
161
Name 3 causes of cardiac failure
1. Myocardial injury e.g MI 2. Increased workload e.g hypertension, valvular heart disease 3. Abnormal cardiac rhythm
162
Name the 3 manifestations of cardiac failure
Left ventricular failure Right ventricular failure Biventricular (congestive) cardiac failure
163
Define shock
Widespread hypofusion (low flow) of tissues due to inadequate effective circulating blood volume As a result there is systemic cellular hypoxia, increased anaerobic metabolism and progressive derangement of cellular function
164
Name and explain the 3 types of shock
1. Hypovolaemic shock May be due to: haemorrhage or fluid loss Overall effect: critical reduction in blood/plasma volume (not enough blood) 2. Cardiogenic shock May be due to: MI, cardiac rupture, massive pulmonary thromboembolism Overall effect: failure of myocardial pump due to damage or blood flow obstruction (adequate blood volume, but inadequate circulation) 3. Septic shock Due to: bacterial infection Overall effect: loss of vascular tone, pooling of blood in peripheral vessels (normal blood volume, abnormal blood distribution)
165
Name and describe the 3 pathological stages of shock
1. Compensated shock- mildly decreased BP, increased HR, peripheral vasoconstriction so skin cold and clammy 2. Decompensated shock- if circulatory deficiency persists compensatory mechanisms fail so further decrease in BP, increase in HR, systemic tissue hypoxia and worsening tissue damage 3. Irreversible shock- if circulatory defects not corrected, cell necrosis occurs in vital organs leading to coma and death
166
Define valve stenosis
Decrease in size of valve orifice so increased pressure load in preceding cardiac chamber
167
Define valve incompetence
Failure of complete valve closure, causes regurgitation of blood so increased volume load for cardiac chambers on both sides of valve
168
Define infective endocarditis (IE)
Colonisation of normal or damaged heart valves by microorganisms with the formation of friable, infected thrombi (vegetations) on the surface of the valve cusps and resultant valve injury
169
Name 3 predisposing factors to infective endocarditis
1. Conditions which cause bacteraemia or septicaemia e.g. Dental procedures 2. Abnormalities of heart valves whether congenital or acquired 3. Immunosuppressed host
170
Name 3 clinical effects of bacterial endocarditis
1. Injury to valves (incompetence and/or stenosis) or adjacent myocardium (abscess formation, perforation) 2. Embolic events 3. Fever, malaise, weight loss
171
Name the 2 main types of angina
'Classical' angina | 'Unstable' angina
172
Name 4 symptoms of 'classical' angina
No pain at rest Pain with certain level of exertion Pain relieved by rest Gradual deterioration
173
Name signs of 'classical' angina
Often none
174
Name 5 investigations of angina
``` ECG- resting and exercise Eliminate other diseases e.g. Thyroid, anaemia, valve Angiography Echocardiography Isotope studies ```
175
Name the 2 main treatments of angina and ways they are done (2 each)
1. Reduce oxygen demands of heart - reduce afterload (blood pressure) - reduce preload (venous pressure) 2. Increase oxygen delivery to tissues - dilate blocked/ narrowed vessels (angioplasty) - bypass blocked/narrowed vessels (CABG)
176
Name 2 non-drug therapies for angina
1. Live with limitations | 2. Modify risk factors- stop smoking, graded exercise programme, improve diet/ control cholesterol
177
Name 4 situations drug therapy is used to treat angina and give examples of the drugs used
1. To reduce MI risk-- aspirin 2. To treat hypertension- diuretics, Ca channel antagonists - ACE inhibitors, Beta blockers 3. To reduce preload/dilate coronary vessels- nitrates 4. In emergency treatments- GTN spray/tab
178
Where is peripheral vascular disease usually located and what causes it?
Usually lower limb Atheroma in femoral vessels
179
Name 5 characteristics of peripheral vascular disease
1. Claudication pain in limb on exercise (cramping) 2. Limitation of function 3. Poor wound healing 4. May lead to tissue necrosis or gangrene 5. Aggravated by CV risk factors
180
What are the 2 main strategies for infarction and how are these done?
1. Reduce tissue loss from necrosis - open blood flow to ischaemic tissues (thrombolysis, angioplasty) - bypass obstruction (CABG, femoral bypass) 2. Prevent further episode - risk factor management - aspirin
181
Name 3 causes of a brain infarction (stroke)
Usually embolism from atheroma Occasionally cerebral bleed Rarely vessel thrombosis (good collateral blood supply)
182
Name a stroke that has symptoms lasting less than 24 hours
Transient ischaemic attacks (TIAs)
183
What are the symptoms and signs of MIs?
Central chest pain, nausea, pale, sweaty
184
Name 2 MI investigations
1. ECG- ST segment elevating/ T wave abnormalities 2. Cardiac enzymes- troponin - creatinine kinase - LDH and AST
185
What is the primary care of MIs?
Aim to get to hospital Analgesia (pain killer), aspirin, reassurance BLS if required (cardiac arrest)
186
What hospital care is given to MIs?
Thrombolysis if indicated, or acute angioplasty and stenting Drug treatment to reduce tissue damage Prevent reoccurence/complications
187
Name 2 drugs that can be used for thrombolysis
Streptokinase | TPA
188
Name 6 contraindications of thrombolysis
``` Injury Surgery Severe hypertension Diabetic eye disease Liver disease Pregnancy ```
189
Name 6 complications of MIs
1. Death 2. Arrhythmias 3. Heart failure 4. Ventricular hypofunction and thrombosis - damaged ventricular wall, clots could form on wall due to lack of movement 5. DVT and pulmonary embolism 6. Complication of thrombolysis
190
Define bacteraemia
It is the transient (short lived) presence of bacteria in the bloodstream
191
Define septicaemia
It is the persistent presence of bacteria in the blood stream, with attendant signs and symptoms
192
Define sepsis
"The host response to infection"
193
What 4 things make up the SIRS criteria?
Chills and fevers High HR Panting, increased CO2 in blood High/low WCC
194
What criteria equals sepsis
Infection + SIRS criteria (at least 2)
195
What criteria equals severe sepsis? | Give its mortality rate
Sepsis + Organ dysfunction 40% mortality
196
What criteria equals septic shock? | Give its mortality rate
Sepsis + Shock refractory to fluid resuscitation 60% mortality
197
Name 4 reactions of sepsis
Endothelial damage Micro vascular dysfunction Impaired tissue oxygenation Organ injury
198
What results in clinical features of gram negative septicaemia?
Result from endotoxin release (poison within bacteria)
199
What 4 events make people most susceptible to gram negative septicaemia?
Major GI surgery Immunosuppressive chemotherapy Burns Extremes of age
200
Where are most gram negative septicaemias acquired?
Hospital acquired
201
What is the most common isolate of gram negative septicaemia?
E. Coli
202
What causes clinical features in gram positive septicaemia?
Teichoic acid and peptidoglycan from cell wall of bacteria
203
Name 4 sources of infection of gram positive septicaemia
1. Skin e.g. Indwelling catheters 2. Respiratory tract e.g. S. Pneumoniae 3. Bone/joint infections e.g. S. Aureus 4. Oral cavity
204
Who is susceptible to fungal septicaemia and what is its most common isolate?
Immunosuppressed hosts e.g. Haematological malignancy, AIDS Candida albicans
205
How is septicaemia treated?
IV fluids, oxygen and other supportive measures 'Blind', empirical IV antibiotics- broad spectrum given as soon as infection suspected Identify and remove source where possible e.g. Foreign body, catheter
206
Define infective endocarditis
Microbial infection of endothelial lining of heart | Usually manifests are vegetations on heart valves
207
What 6 types of patients are 'at risk' of infective endocarditis?
1. Acquired valvular heart disease 2. Prosthetic heart valve 3. Structural congenital heart disease (abnormalities of heart tissue) 4. Previous endocarditis 5. Hypertrophic cardiomyopathy (enlarged heart) 6. Recurrent bacteraemia
208
Name 3 clinical feature of IE
Fever Heart murmur Splenomegaly
209
Name 2 common microbial culprits of IE
Streptococci -- oral streptococci Staphylococci-- staphylococcus aureus
210
Where is the primary habitat of oral streptococci?
Oral cavity/ upper respiratory tract
211
Name 4 ways IE is diagnosed
1. Clinical signs 2. Blood cultures (3 sets over 24hrs) 3. Echocardiography- visualise lesions 4. DUKE criteria
212
Name 2 outcomes of hypertension and what they can lead to
1. Accelerated atherosclerosis - MI - Stroke - Peripheral vascular disease 2. Renal failure
213
What are common causes of hypertension?
There are none
214
Name 2 rare causes of hypertension
1. Renal artery stenosis (narrowing) 2. Endocrine tumours - phaechromocytoma - Cushing's syndrome
215
What are signs of symptoms of hypertension?
Usually none May get headache May get TIAs
216
Name 5 ways hypertension can be investigated
1. Urinalysis- look at what kidneys are excreting in urine 2. Serum biochemistry 3. Serum lipids 4. ECG 5. Renal ultrasound, renal angiography, hormone estimations
217
What is the aim of treating hypertension
To get BP to less than 140/90mmHg
218
Name 2 ways hypertension can be treated
1. Modify risk factors- smoking, exercise, weight | 2. Single daily drug dose
219
Define heart failure
"output of heart incapable of meeting demands of tissues"
220
Give examples of both high and low output cardiac failure
High output failure- anaemia, thyrotoxicosis Low output failure- cardiac defect e.g. MI, valve disease
221
What is the biggest cause of heart failure?
Ischaemic heart disease
222
Name 5 things that can cause low output heart failure (aetiology)
1. Heart muscle disease e.g. MI 2. Pressure overload e.g. Hypertension, aortic stenosis 3. Volume overload e.g. Mitral/aortic incompetence 4. Arrhythmias e.g. Atrial fibrillation, heart block 5. Drugs e.g. Beta blockers, corticosteroids
223
Name 8 symptoms of heart failure
``` SOB Ankle swelling Chronic lack of energy Difficulty sleeping due to breathing Swollen/tender abdomen Cough with frothy sputum Increased urination at night Confusion and/or impaired memory ```
224
Name signs of left heart failure
LUNGS and systolic effects | - dyspnoea (difficulty breathing), tachycardia, low BP, low volume pulse
225
Name signs of right heart failure
Venous pressure elevated - swollen ankles, ascites (accumulation of fluid- abdominal swelling), raised JVP (jugular venous pressure), tender enlarged liver, poor GI absorption
226
What treatment would be given for acute heart failure
Emergency hospital management | - O2, morphine, frusemide (diuretic used to treat fluid retention)
227
What treatment would be given for chronic heart failure?
Community based - improve myocardial function - decrease 'compensation' effects (decrease salt and water retention) - where possible, treat cause
228
What 4 types of drugs may be used in chronic heart failure and why
1. Diuretics- increase salt and water loss 2. ACE inhibitors- decrease salt and water retention 3. Nitrates- decrease venous filling pressure 4. Inotropes e.g. Digoxin
229
What drugs would be stopped when treating heart failure and why
Stop negative inotropes e.g. Beta blockers | - decrease HR and makes heart beat less efficiently
230
Name the 4 heart valves and state what side they are on
Left- aortic, mitral (bicuspid) Right- pulmonary, tricuspid
231
The heart valves on what side of the heart most commonly fail and why?
Left side | Valves have to do more work under higher pressure
232
What 4 things cause valve disease?
1. Congenital abnormality e.g bicuspid aortic valve (instead of tricuspid) 2. MI 3. Rheumatic fever - MAY cause valve damage - Patients with history MUST be investigated for RHD - If no disease, no antibiotic prophylaxis is required 4. Dilation of aortic root
233
What 2 types of replacement valves are there?
``` Mechanical Porcine (pig valve) ```
234
Give 3 facts about porcine valves
Only last 10 years Do not need anticoagulant Good for elderly and young
235
Name 4 congenital heart defects and describe them
1. Atrial septal defects- hole in wall between the 2 atria 2. Ventricular septal defects- hole in wall between 2 ventricles 3. Patent ductus arteriosus- opening between 2 major blood vessels leading from heart (usually closes after birth) 4. Great vessel malformations
236
What is cyanosis, give the 2 types and when it occurs
Bluish discolouration of skin and mucous membranes resulting from inadequate amounts of O2 in blood Central- from congenital heart disease Peripheral- cold environment Exists when there is 5g/dL or more if DEoxygenated Hb in blood
237
What is the term for a fast heart rate/rhythm and give 2 examples
Tachy arrhythmias - atrial fibrillation - ventricular tachycardia-- diastolic time decreases so chambers less filled
238
What is the term for slow heart rates/rhythms and give 2 examples
Brady arrhythmias - heart block (electrical impulses impaired) - drug induced-- beta blockers, digoxin
239
What are pace makers used to treat and how do they work?
Treat bradyarrhythmias Senses electrical impulses in heart and stimulates heart beat if one does not occur
240
What is the term for a normal heart rhythm and explain the wave
Sinus rhythm P-wave: atrial depolarisation QRS complex: ventricular depolarisation T-wave: ventricular repolarisation Q wave most seen in patients who've suffered MIs
241
What is the term for a heart no longer beating and why is this the case?
Asystole No electrical activity (defibrillator won't help)
242
Define ventricular fibrillation
Unstable electrical activity (usually during MI) No cardiac output Treat with defibrillation
243
Name 5 dental treatments that would require no special care for those with coagulation problems
``` Hygiene therapy RPDs Restorative (including crowns and bridges) Endodontics Orthodontics ```
244
Name 4 dental treatments that would require special care for those with coagulation problems
Extractions Minor oral surgery Periodontal surgery Biopsies
245
What 5 things need to be considered/done when performing extractions/surgery on patient with coagulation problems
1. Appropriate monitoring prior to treatment 2. Atraumatic treatment 3. Consider antibiotics 4. Observe to ensure haemostasis (arrest in bleeding) 5. Comprehensive post-op instructions
246
What are the 2 main types of antithrombotic medication
Oral anti coagulation | Antiplatelet medications
247
What are 5 indications for the use of oral anticoagulants?
``` Atrial fibrillation DVT Heart valve disease Mechanical heart valves Thrombophilia ```
248
Name the 4 main types of oral anticoagulants available and an example of each
1. Coumarins e.g. Warfarin 2. Indanediones e.g. Phenindione 3. Direct thrombin (DT) inhibitor e.g. Dabigatian 4. Factor Xa inhibitor e.g. Apixaban
249
What is the daily dose of warfarin?
1-15mg
250
How is warfarin response measured?
INR (international normalised ratio)
251
What is INR?
Ratio of the patients prothrombin time (PT) to a standardised 'normal' PT INR= patient PT/mean normal PT
252
What is the target INR for 1. Mechanical heart valves 2. Recurrent VTE while adequately anti coagulable 3. Other cases
1. 3.0-4.0 2. 3.0-4.0 3. 2.0-3.0
253
Name 4 medications that should be avoided by people with coagulation problems (on warfarin)
Aspirin (as an analgesic) Co-proxamol Ketorolac Azole anti-fungal drugs
254
What is major risk for warfarin users
Haemorrhage
255
Name 4 characteristics of DT and FXa inhibitors
No routine blood tests required Standard dose for each patient Tablets take either once or twice a day No reversal agent available
256
Name 5 anti-platelet medications
``` Low dose aspirin Clopidogrel Dipyridamole Tirofaban Ticagrelor ```
257
What 3 effects do antiplatelet drugs have on clotting
Inhibit platelet aggregation | Inhibit thrombosis formation
258
Define inherited bleeding disorders
A genetic defect which effects the coagulation of blood
259
Name 3 things inherited bleeding disorders may affect
1. Coagulation cascade - a reduction in one or more of the coagulation factors 2. Platelets - number - function 3. A combined deficieny
260
Name 4 common inherited bleeding disorders and give the different subtypes for each (where applicable)
1. Factor VIII deficiency - haemophilia - haemophilia A 2. Factor IX deficiency - Christmas disease - Haemophila B 3. Von Willebrands disease (reduced factor VIII level) 4. Factor XI deficiency
261
Describe the inheritance of factor VIII and IX deficiencies
Sex-linked recessive Males are affected Females are carriers
262
How are severe and moderate cases of factor VIII deficiency treated
Require use of recombinant factor VIII
263
How are mild sufferers and carriers of factor VIII deficiency treated?
Majority respond to DDAVP Very mild cases may only require oral tranexamic acid
264
How are sufferers of Factor IX deficiency treated?
Require recombinant factor IX Does not respond to DDAVP
265
Describe the inheritance of Von Willebrands disease
Autosomal dominant Sexes affected equally
266
How is Von Willebrands disease treated
Majority respond to DDAVP | Very mild cases may only need oral tranexamic acid
267
Name 3 'safe' LA injection sites for patients with bleeding disorders
Buccal infiltration Intraligamentary injections Intrapapillary injections
268
Name 3 'dangerous' sites for LA injections
Inferior alveolar nerve block Lingual infiltration Posterior superior nerve block
269
Name 5 steps taken when performing extractions/surgery on patient with bleeding disorder
1. Appropriate care from haemophilia unit 2. Atraumatic treatment 3. Consider antibiotics 4. Observe after surgery - 2-3 hours for mild/carriers - overnight for severe/moderate 5. Comprehensive post-op instructions
270
Define thrombophilia
Increased risk of developing blood clots
271
Name 4 types of inherited thrombophilia syndromes
Protein C deficiency Protein S deficiency Factor V Leiden Antithrombin III deficiency
272
Name 6 ways to acquire thrombophilia
``` Antiphospholipid syndrome Oral contraceptives Surgery Trauma Cancer Pregnancy ```
273
What is the term for decreased platelet numbers
Thrombocytopenia
274
What is the term for normal platelet numbers but abnormal function
Qualitative disorders
275
What is the term for increased platelet numbers
Thrombocythemia
276
At what platelet count can dental treatment be safely done in thrombocytopenia patients
Platelet count >50*10x9
277
Name 3 common causes of liver disease
Alcohol Hepatitis Drug induced
278
What haematological changes occur in those with liver disease in terms of: 1. Hb 2. Platelets 3. PT (prothrombin time) 4. APTT (activated partial thromboplastin time) 5. Thrombin time
1. Little change 2. Decrease 3. Increase 4. Increase 5. Increase

BAMS (9 decks)

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