Cardiovascular therapeutics Flashcards

Question

What are the 3 common aneurysm\*

Answer 1

``` Atheromatous aortic aneurysm (most likely to occur in abdominal area) Aortic dissection (when there is a tear in the innermost layer wall of the aorta) Cerebral berry ```

Answer 2

ACEIs Diuretics Beta blockers or CCIs Digoxin

Answer 3

ACEIs Ca2+ channel inhibitors (used instead of beta-blockers for asthmatics )

Answer 4

ST-segment depression

Answer 5

Lifestyle changes Coronary artery bypass grafting Balloon angioplasty and stenting

Answer 6

Balloon inflated at site of plaque and inserts stent Drug in stent prevent regrowth of blood vessel

Answer 7

Nitrate such as glyceryl trinitrate (GTN) Results in release of NO which leads to venodilatation (decreased preload anf reduction in cardiac work) ; coronary vasodilation also occurs (but minor effect) Nitrate tolerance can occur upon prolonged exposure

Answer 8

Due to failure of heart muscle or failure of the heart valves failure can occur in LV or RV or both Chronic or acute (post MI) Often secondary : most commonly (ischaemic heart disease), hypertension, cardiomyopathies (alcohol/viral)

Answer 9

Pregnancy Anaemia Hyper/hypothyroidism Fluid retaining drugs (glucocorticoids and NSAIDs)

Answer 10

Neurohormonal adaptation to compensate for circulatory failure * activation of SNS, RAAS + release of ADH, ANP(atrial natriuretic peptide) * Release of ANP is the only good effect ; * the other the effects causes afterload/preload/resistance(from vasoconstriction) to increase and blood pressure to decrease (in the short term cardiac output increases but long-term heart failure is exacerbated due to cardiac remodelling) * vicious cycle occurs; impaired renal function=more water/salt retention=further activation of RAAS(also due to decreased BP due to action of SNS/ADH)

Answer 11

Acts on kidneys causing increased K+ excretion this results in: reduction of extracellular fluid (ECF) volume, improved cardiac ejection fraction with resultant improved organ perfusion, decreased blood pressure,

Answer 12

Often secondary to hypertension poor output of LV = increase in left atrial/pulmonary venous pressure and pulmonary oedema (breathlessness)

Answer 13

Fatigue Poor exercise tolerance (determines grade) Cold peripheries Low blood pressure Reduced urine flow Weight loss Echocardiogram - ejection fraction \<45% BNP levels abnormal chest X-ray to check for cardiomegaly

Answer 14

Pulmonary oedema Breathlessness – sensation of drowning. *‘Cardiac asthma’* wet cough Orthopnoea – breathless on lying which is relieved by sitting up. Nocturnal problem*(paxosysmal nocturnal dyspnoea)* Inspiratory crepitations

Answer 15

Raised venous pressure Increased JVP - jugular venous pressure Enlarged liver Oedema – ankles; if lying down rises to thighs/abdomen

Answer 16

RV output fails causes: * often due to lung disease such as COPD (cor pulmonale) * pulmonary hypertension as an adaptation to prolonged hypoxia = increased preload = increase pressure on RHS of heart * pulmonary valvular stenosis * due to congenital or rheumatic heart disease * secondary to left sided heart failure * increased pressure in pulmonary vasculature due to backward flow of blood from dysfunctional LV/LA

Answer 17

When both chambers fail can be secondary to LVF due to pulmonary congestion or due to disease that affects both ventricles (such as ischaemic heart disease)

Answer 18

ACE inhibitors (they have -pril at the end) and beta-blockers (vasoprilol and very low dose)

Answer 19

Hyperkalaemia May cause severe hypotension ; treatment withdrawn for a few days cause deterioration of renal function in pre-existing renal disease cough

Answer 20

ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels This reduces afterload/preload reduce salt/water retention inhibits RAAS also used to treat hypertension start low go slow ; monitor eGFR and K+ before and during treatment

Answer 21

stenosis of renal arteries ; reduced blood flow to kidneys = xs renin secreted = renal function dependant on RAAS ; as ACEIs block this compensatory method they can cause renal failure in these patients

Answer 22

Aldosterone is a sodium retaining K+ losing enzyme ACEIs cause K+ retention so plasma [K+] increase

Answer 23

AT₁ Receptor antagonists - block the action of AII ; inhibits vasoconstriction ; less likely to cause cough so can be given to people who experience severe coughing with ACEIs

Answer 24

Often used in COPD treatment reduce sympathetic stimulation/heart rate/O2 consumption/anti-arrhythmic/oppose neurohormonal activation during CHF (especially ischaemic heart failure) start with low dose for CHF ; symptoms may get worse at first

Answer 25

Loop diuretics used to treat CHF such as furosemide reduce circulating volume/pre-load/oedema some may cause hypokalaemia

Answer 26

+ve inotrope - increases force of heart contraction ; inhibits Na+/K+ ATPase = accumulation of Na+ in myocyte which is exchanged with Ca2+ = more intracellular [Ca2+]

Answer 27

To treat AF/CHF in elderly patients positive ionotropic (increased contractility but slowed down SAN conduction = slower HR); while also inhibiting SNS and RAAS rarely used now - reserved for HF with AF or when ACEIs/diuretics fails its effects are enhances by ACEIs

Answer 28

Myocyte apoptosis changed expression of contractile proteins remodelling of matrix dilatation

Answer 29

Alveolar walls are congested by fluid

Answer 30

Raised end diastolic pressure raised atrial and JVP raised central venous pressure liver distension(abdominal discomfort) and peripheral oedema

Answer 31

Heart failure diminishes blood flow and in response, your body tends to retain fluid in an effort to maintain adequate blood volume. But a failing heart is unable to accommodate this extra fluid, so it is transferred out of your blood vessels and into your tissues -- usually in those body parts that are lower than others. also increased venous pressure opposes re absorption of fluid

Answer 32

Abnormal creatinine levels indicate impaired renal function If there is a problem with your kidneys, creatinine can build up in the blood and less will be released in urine

Answer 33

They are fluid retaining so can exacerbate CHF?

Answer 34

Take in morning to prevent sleep disturbance may cause falls due to dizziness side effect - be careful omit dose when patient has diarrhoea or vomiting furosemide dosing is interrupted as few days before administering beta-blockers

Answer 35

Yes; When the heart is no longer pumping efficiently it becomes congested with blood, causing pressure to build up in the main vein connected to the kidneys and leading to congestion of blood in the kidneys, too. The kidneys also suffer from the reduced supply of oxygenated blood.

Answer 36

Symptom of failing ventricles ; BNP primarily is secreted by the ventricles in the heart as a response to left ventricular stretching or wall tension ; only released after prolonged volume overload

Answer 37

Purpose - to treat heart failure expect blood presssure to go lower take at night to reduce the effects of low blood pressure

Answer 38

ACEI can cause hyperkalaemia because aldosterone causes K+ excretion so reduced aldosterone release = increased K+ retention Furosemide can cause hypokalemia as its a diuretic (loss of all electrolytes in blood)

Answer 39

in patients with mechanical heart valve replacements

Answer 40

It increases the work of the heart whilst also lessening the ejection fraction

Answer 41

Dark areas - centrolobular congestion pale areas - periportal fatty change

Answer 42

lung disease thromboemboli Pulmonary valve stenosis

Answer 43

emphysema destroys alveolar walls and capillaries hypoxia constricts pulmonary arteries pulmonary hypertension

Answer 44

100 mL/min

Answer 45

most caused by ontracerebral haemorrhage some caused by subarachnoid haemorrhage

Answer 46

Area of ischaemic necrosis due to abrupt cessation of arterial supply (arterial infarction) OR venous drainage (venous Infarction) arterial infarction is the most common pale or white infarct occur in solid organs such as the heart and spleen (due to lack of blood flow) red or haemorrhagic infarcts occur in loose spongy tissue rich in blood supply or has dual blood supply (ischemia results in vessels bursting) causes - septic (due to vegetation of sub acute bacterial endocarditis )

Answer 47

Vascular occlusion - degree of obstruction rate of development of occlusion - is it abrupt or gradual nature of vascular supply - is there dual blood supply or just one artery to that organ/tissue type of tissue - neurones can only survive minutes without oxygen, myocardium can survive 20-40 mins, fibroblasts can survive many hours

Answer 48

Wedge shapes infarct - apex at occluded artery occurs in all organs except the brain inflammatory response (tissue turns red from pale) followed by reparative response and scar tissue formation

Answer 49

Troponin, myoglobin CK MB

Answer 50

Coagulative necrosis occurring nuclei are breaking down and streaks in muscle (mottling)

Answer 51

Macrophagic removal of debris and vascular granulation tissue formation area of necrosis is pale and still soft hyperaemic(excess blood) border around area of necrosis

Answer 52

fibrous granulation tissue becomes tough scar tissue

Answer 53

Early : sudden death due to dysrhythmia, rupture of myocardium during healing stage = heart fills with blood (haemopericardium) and cardiac tamponade, rupture of papillary muscle = acute valve failure = LVF, mural thrombus (blood clot form on wall on heart/vessel where the infarct has occurred ) = embolism elsewhere fibrinous pericarditis = pericardium becomes rough, granular, and has many fibrous adhesions late : CHF ventricular aneurysm - loss of flexibility of ventricular wall

Answer 54

Usually caused by emboli from the L side of heart wedge shaped pale area with surrounding hyperaemia heals by scar formation

Answer 55

Liquedative necrosis due to the lack of CT in the brain; Brain cells have a large amount of digestive enzymes (hydrolases). These enzymes cause the neural tissue to become soft and liquefy. results in hypoperfusion and microembolism heals by astrocytic gliosis (perforation of glial cells) - loss of cells

Answer 56

Arterial infarction in extremities or bowel Complication of necrosis caused by ischaemia following Injury or infection common in diabetics tissue becomes black (bacteria break down dead tissue to form black iron sulfate) and smells bad dry gangrene occurs when the arterial blood supply is occluded but the venous drainage is intact wet gangrene occurs when the venous drainage is occluded plus putrefaction; can also be caused by bacterial infection (without the need of ischaemia)

Answer 57

Occur when venous drainage from an organ or tissue is and remains completely obstructed tissues become congested with blood and capillaries/venules may rupture ; arterial blood cannot enter as venous pressure\>arterial pressure = hypoxia bowel infarction - volvulus(bowel twists on itself), hernial strangulation torsion in testes and ovaries

Answer 58

usually administered subcutaneously so unpleasant for patient; unsuitable for renal failure; short acting and good intial treatment

Answer 59

pros - only needs to be take once daily ; several reversal agents ; cheaper cons; requires close INR monitoring, many drug/food interactions, variable dosing

Answer 60

pros - no monitoring required; lower risk of haemorrhage; cons - reversible agents less available; may need to be taken twice a day, more expensive

Answer 61

eGFR - to guide which medication to give ; long term hypertension can also cause a decline in eGFR glucose later haemoglobin (HbA_1c) to test for diabetes (hypertensive diabetics have higher risk of stroke and MI) or hypertension can be a symptom of diabetes plasma potassium levels - low potassium can be a cause of hypertension (symptom of overactivation of the RAAS)

Answer 62

a) ACEIs or ARB (AT₁ Receptor Blockers) b) CCI c) CCI (you start adding one drug at a time if hypertension persists)

Answer 63

Ischaemic stroke - when a thrombus or embolus gets stuck in the cerebral vessels → necrosis of neurons → release of hydrolyses → inflammation haemorrhagic stroke : stress up brain tissue → vessel rupture → infarction 2 types : intracerebral (bleeding inside brain) due to hypertension or XS use of anticoagulants/thrombolytics and subarachnoid due to head injury or cerebral aneurysm

Cardiovascular therapeutics Flashcards

(89 cards)