Case 4 Notes Flashcards
(83 cards)
1
Q
name the two contractile proteins
A
myosin - globular heads with thick A bands and myosin ATPase
Actin - thin I bands made up of two alpha helix strands woven between two myosin filaments
2
Q
list the Regulatory proteins
A
Tropomyosin / troponin T/I/C
3
Q
Tropomyosin function
A
prevents contaction in resting state
4
Q
Troponin T function
A
ties Troponin to actin and tropomyosin
5
Q
Troponin I function
A
inhibits ATPase in actin
6
Q
Troponin C function
A
binds to Ca2+ ions - regulates the contraction process
7
Q
Medical term / cause for breathlessness
A
dyspnoea - decreased oxygen or increased CO2
8
Q
symptoms of dyspnoea
A
cough / chest pain / fever - graded from 1-4
noisy breathing / cyanosis / overuse of accessory muscles
9
Q
respiratory causes of dyspnoea
A
decreased elasticity / increased inflammation / ++ mucus caused by obstruction (COPD) / decrease in functioning tissue (scarring) / peroneal fluid / pneumothorax (collapsed lung)
10
Q
cardiac causes of dyspnoea
A
heart failure (pericarditis) / endocarditis / cardiomyopathy / cardiac effusion / aortic stenosis
11
Q
other causes of dyspnoea not cardiac or respiratory
A
lung cancer / anaemia / anxiety / asthma / obesity
12
Q
List the 3 heart infections
A
endocarditis
pericarditis
myocarditis
13
Q
endocarditis causes
A
infection of the inner lining and valves of heart
14
Q
endocarditis symptoms
A
flu / weight loss / cough / SOB / joint and muscle pain
15
Q
endocarditis diagnosis / treatment
A
blood cultures / surgery
16
Q
endocarditis increased risk?
A
pacemakers / HIV / male / heart defects
17
Q
pericarditis cause
A
infection of outer lining of the heart leading to pericardial effusion causing pressure build up and heart compression
18
Q
pericarditis symptoms
A
stabbing chest pain and signs of infection
19
Q
pericarditis healing time
A
acute - few weeks
chronic - 3+ months
20
Q
myocarditis causes
A
infection of heart muscle post chest or throat infection e.g. rubella or glandular fever
21
Q
myocarditis symptoms
A
chest pain / fever / sweats / increased or irregular heart rate
22
Q
arteriosclerosis definition
A
hardening or thickening of the arterial walls leading to reduced elasticity and decreased lumen diameter
23
Q
arteriosclerosis treatment
A
artery bypass / coronary angioplasty / lifestyle changes e.g. managing diabetes better
24
Q
monckebery medial calcific sclerosis definition
A
Ca2+ deposition in muscular arteries which does not inhibit lumen widening
25
atherosclerosis definition
fatty deposit buildup in vessel walls leading to stenosis (narrowing) / occlusion / chronic inflammation SMOKING
26
atherosclerosis stable angina steps (1-4)
1 LDL deposit cholesterol in damaged tunica intima
2 monocytes - macrophages try to remove deposits
3 macrophages - enlarge foam cells - fatty streaks
4 fibrous capsule called plaque formed
27
atherosclerosis ruptured plaque (steps 5-6)
5 plaque extends into the elastic layer then lumen
| 6 reduced blood flow ANGINA
28
atherosclerosis final stages (7-10)
7 calcium deposits cause plaque hardening
8 increased pressure casing plaque dislodge - rupture
9 further clotting - downstream blockage - MI/stroke
10 plaque - aneurism - hypovolemic shock
29
angina definition
dull sharp pain in the chest caused by ischemia to heart muscles by atherosclerosis / heart disease
30
angina risk factors
hypertension / diabetes / smoking / obesity / stress
31
types of angina (x3)
stable
prinzmetal variable angina
unstable
32
stable angina
brought on by obvious causes e.g. stress / exercises and relieved by rest or medication
33
prinzmetal variable angina
uncommon episodic variation - caused by coronary artery spasm
34
unstable angina
less predictable and continues when resting and is a warning of declining cardiovascular health MEDICAL EMERGENCY caused by ruptured plaque
35
diagnosis of angina
ECG - abnormalities
ETT - exercise tolerance test to measure hearts capability to sustain exercise
Coronary angiography - catheter and dye then Xray to show circulation effectiveness
Myocardial perfusion scintingraphy - radioactive dye that is injected then tracked
36
referred pain defintion / cause
activated nociceptors in viscera localised to body surface where info from multiple nociceptors converge and the brain interprets visceral pain as superficial
37
what nerves can angina pain be referred from
intercostal
sympathetic
vagus
phrenic
38
referred pain pathway for angina
1 ischemia pain from heart muscles
2 sympathetic nerve to 1st-4th sympathetic ganglia
3 to T1 - T4
4visceral somatic pain fibres join in chest arm / forearm
39
heart murmurs definition
sounds from turbulent blood from within the heart
40
heart murmurs risk factors
anemia / diabetes / rubella / hypertension / injecting drugs
41
abnormal heart murmurs cause / symptoms
congenital in children but defect in adults
caused by septal defects / virus / valve calcification
blue skin / weight gain / SOB / chest pain / dizziness
42
types of heart murmurs (x2)
abnormal
| innocent
43
innocent heart murmurs cause / symptoms
no symtoms
| caused by pregnancy / physical activity / fever
44
smoking affect on cardiovascular system
smoke damage = atheroma - fatty deposit in artery
CO = reduced O2 carry capacity
nicotine = simulates adrenaline = increased HR + BP
tar - increases heart workload
inflammation
increased triglycerides
45
chronic heart disease definition
blocked coronary arteries leading to heart attack
46
peripheral arterial disease definition
narrowing of vessels causing restricted blood flow to arms and legs
47
abdominal aortic aneurism definition
weakened areas in wall of abdominal aorta leading to rupture EMERGENCY
48
effect of decreased oestrogen on cardiovascular system (menopause)
- affects NO availability (vasodilation) decreased NO synthase
- affects coagulation cascade (atherosclerosis)
- L-type calcium channels affected (contraction not prevented)
- LDL:HDL ratio increases
- decreased vasodilatory enzymes
49
menopause effects on cardiovascular system
```
increased fat distribution
increased blood pressure
increased coagulation
increased epithelial disfunction
decreased oestrogen
ATHEROSCLEROSIS / HEART DISEASE / STROKE
```
50
cholesterol biosynthesis
produced by liver / intestine / adrenal gland
51
cholesterol biosynthesis process
1 aceyl CoA from mitochondria to cytosol - HMG-CoA - mevalonate
2 melavonate - IPP - squalene - cholesterol
With HMG-CoA reductase being the limiting step (STATINS)
52
cholesterol defninition
lipid transported in blood with plasma proteins
53
cholesterol transportation types (x2)
specific
| non-specific (albumin)
54
metabolism of cholesterol types (x3)
auto oxidation
secondary oxidation
cholesterol metabolising enzyme oxidation
in liver to make bile salt and acids
55
cholesterol function (x5)
```
animal cell membrane component
component of myelin sheaths
Bile salt production
Molecule synthesis (vitamin D/ sex hormones)
decrease permeability of H+/Na+
```
56
Blood test results for an MI (shows myocardial necrosis)
- creatine kinase (non specific)
- CKMB (cannot be monitored over a long period)
- troponin (increases in hours after heart damage)
57
emergency MI protocols immediate
O2 / strong IV analgesia / NO3 / heparin
58
emergency MI protocols long term
```
low dose aspirin post event
primary aginoplasty (stent)
beta-adrenoreceptor blockers
insulin
pacemakers
coronary bypass graft
thrombolysis
```
59
```
MI healing states
1 immediately
2 few days after
3 weeks after
4 months after
```
1 coagulative necrosis with some bleeding
2 neutrophils enter and breakdown dead cardiomyocytes
3 ingrowth of small blood vessels / meshing fibroblasts + type three collagen (most dangerous phase)
4 granulation tissue forms
5 type 3 replaced by type 1 collagen (NON CONTRACTILE)
60
cardioversion definition
shocking the heart back into normal rhythm
61
DNR definition
Do Not Resuscitate
| when the consequences of CPR is greater than the potential benfits
62
heartblocks definition
abnormal heart rhythm where heart beat too slowly and the electrical signals are blocked between atria / ventricles
63
STEMI vs NSTEMI
Non-ST-elevation myocardial infarction - partial obstruction of the blood flow
ST-elevation myocardial infarction - sudden complete blockage of the blood flow to heart
64
ECG STEMI vs NSTEMI
STEMI - ST elevation
| NSTEMI - ST depression
65
MI risk factors
age - atherosclerosis
gender - men
family history
obesity - increase blood cholesterol / blood pressure
diabetes - nerve damage = silent heart attack
66
Types of heart block (x4)
1st degree
Wenckebach
Mobitz
3rd degree
67
1st degree heart block
No symptoms
| PR interval prolongation
68
Wenckebach (Mobitz I) heart block
```
No symptoms
Varying PR (progressively prolonged) intervals
```
69
Mobitz II heart block
Dizziness
| Blocked P wave with constant PR intervals
70
Third degree heart block
P waves (atrial depolarizations) being completely unrelated to the QRS complexes (ventricular depolarizations) ― meaning the P waves occur at one rate and the QRS complexes at another. Ventricles begin to depolarise themselves
71
Chest electrode placement
```
V1 right 4th intercostal space
V2 left 4th intercostal space
V3 midway between V1/2
V4 5th intercostal space (middle)
V5 left auxiliary line (height of V4)
V6 left mid auxiliary line
```
72
acebutolol
beta blocker
T = high blood pressure / angina / irregular heartbeats
SE = tiredness / stomach upset / vomiting / headache
DT = asthma / adrenal gland tumour / diabetes
73
ivabradine
sinus node inhibitor (decrease HR)
T = angina / heart failure
SE = blurred vision
DT = kidney or liver probs / pacemaker / recent stroke or MI
74
atenolol
beta blocker
T= high blood pressure / arrhythmias / angina / post heart attacK
SE= stomach upset / dizziness / cold extermities
DT= asthma / kidney probs / sugar diabetes / psoriasis
75
verapamil
calcium channel blocker
T - abnormal heart rhythm / high blood pressure / angina
SE = constipation
DT = no grapefruit juice / liver failure / porphyria / hyPOtension / heart failure
76
nicorandil
potassium channel activator (vasodilation)
T= angina
SE= headaches
DT= low blood pressure / heart attack / pulmonary oedema
77
low dose aspirin
anti-platelet (secondary prevention)
T = heart attack / angina / stroke / peripheral arterial disease
SE = bleeding in stomach
DT = asthma
78
statins (atrovastatin / fluvastatin)
enzyme inhibitor (in cholesterol production)
T = high cholesterol / atheroma
SE = headaches / nausea / diarrhoea
DT = liver disease no grapefruit juice
79
amlodipine
calcium channel blocker
T = high blood pressure / angina
SE = headaches / peripheral oedema / nausea
DT = liver problems
80
heparin
anticoagulant - prevents further blood clots / stroke
81
warfarin
anticoagulant - prevents further blood clots / stroke
T = atrial fibrillation
SE = hair loss / blood in stool / diarrhoea / jaundice
DT = hypertension / bacterial endocarditis / stroke / stomach ulcer
82
(Digoxin) lanoxin
digitalis
T = atrial fibrillation / flutter and heart failure
SE = nausea / rash / blurred or yellow vision
DT = kidney or thyroid problems / asthma
83
nitroglycerin tablets
vasodilator
T = angina
SE = headache / fast heartbeat
DT = liver/kidney problems / glaucoma / heart attack / anemia
