CV Flashcards
1
Q
3 conditions/events that atherogenesis can lead to
A
MI
stroke
gangrene
2
Q
risk factors for atherogenesis
A
age tobacco smoking ^serum cholesterol obesity hypertension diabetes fam history genetics
3
Q
chemoattractants definition
A
chemicals that attracts leukocytes
4
Q
when monocytes move into the plaque they become..?
A
macrophages
5
Q
4 stages of atherogenesis:
A
- fatty streak
- intermediate lesion
- fibrous plaque/advanced lesion
- plaque rupture
6
Q
new alternative drug to statins (where statins are ineffective or not tolerated), target..?
A
drugs target PCSK9 enzyme
7
Q
what is PCSK9?
A
Enzyme - modulates plasma LDL-C levels & cholesterol homeostasis
8
Q
major limitation of stenting? and solution
A
restenosis > drug eluting stents
9
Q
what must happen to calcium in the heart muscle for relaxation to occur?
A
removal of Ca
10
Q
is blood flow through myocardium, from aortic root systolic or diastolic?
A
DIASTOLIC
11
Q
normal systolic ejection fraction is (%)
A
60-65%
12
Q
examples of adaptive/physiological myocardial hypertrophy?
A
pregnancy, athletes
13
Q
hypertrophic response triggered by..?
A
angiotensin 2
endothelin-1
IGF-1
TGF-beta
14
Q
what does left-sided cardiac failure cause?
A
pulmonary congestion
then overload of right side
15
Q
what does right sided cardiac failure cause?
A
venous hypertension and congestion
16
Q
example of infection that can lead to congenital heart disease
A
rubella
17
Q
example of condition that ^s risk of congenital heart disease
A
diabetes
18
Q
causes of initial L>R shunt in congenital heart disease
A
VSD
ASD
PDA
truncus arteriosus
19
Q
cause of initial R>L shunt in congenital heart disease
A
tetralogy of fallot
20
Q
4 aspects of tetralogy of fallot
A
- RV outflow obstruction
- ventricular septal defect
- aorta dextroposition
- RV hypertrophy
21
Q
congenital heart defects with no shunt
A
TGA [transposition of great vessels]
coarctation of aorta
pulmonary/aortic stenosis
etc.
22
Q
eisenmenger’s syndrome:
A
L>R shunt due to congenital defect,
causes ^flow through pulm vasculature > pulm hypertension
ass. w/ R side hypertrophy and cardiac failure
23
Q
what is coarctation
and where is blood diverted?
A
narrowing of the aorta
blood > carotid and subclavian
24
Q
what is ebstein’s anomaly/malformation?
A
tricuspid valve defect
atrialisation of RV
25
what is a patent foramen ovale?
unfused fossa ovalis
| channel between atria
26
what is a paradoxical embolism?
clot that travels from vein > artery
| travels through foramen ovale, bypassing lungs that normally act as a 'filter'
27
what is a berry aneurysm?
small aneurysm [looks like a berry]
classically occur in circle of Willis
frequently rupture
28
infective endocarditis definition
inflammation of inner tissues of the heart [e.g. valves]
| caused by pathogens [usually bacteria]
29
what is dextrocardia?
normal anatomy of the heart reversed
ass. w/isomerism of visceral organs
ass. w/ severe cardiac abnormalities
30
danger of reperfusion of ischaemic tissue?
superoxide radical generation > further damage
31
cardiogenic shock
heart can't pump enough blood for body's needs
| most often after severe MI
32
define hypertension in mmHg
>140/90
33
cor pulmonale is...
RV hypertrophy & dilatation
due to pulmonary hypertension
e.g. emphysema
34
features of R side cardiac failure, seen in cor pulmonale
venous overload
peripheral oedema
progressive hepatic congestion
35
what is acute rheumatic fever?
group A beta-haemolytic streptococcus infection
36
where is the initial infection usually in acute rheumatic fever?
upper respiratory tract e.g. strep pharyngitis
37
peak age for acute rheumatic fever?
5-15
| but can occur in adults
38
how does acute rheumatic fever affect the heart?
antibodies against strep cross react w/ cardiac myocytes & valvular glycoproteins
localised inflammation > scarring
39
what is chorea?
neurological disorder
spasmodic unintentional movements
shoulders/hips/face
40
what is erythema marginatum?
transient pink coalescent [joined] rings
on trunk & inner surfaces of limbs
[EXTENSOR SURFACES]
41
what is ESR?
erythrocyte sedimentation rate
| non-specific inflammatory marker
42
disorders affecting cardiac valves
acute rheumatic fever
SLE
rheumatoid arthritis [stiffening]
ankylosing spondylitis
43
causes of infective endocarditis
```
rheumatic valvular disease
mitral valve prolapse/ regurgitant valve
IV drug abuse
prosthetic valve
surgery
```
44
what pathogens cause infective endocarditis characteristically?
streptococcus/staphylococcus
45
consequences of infective endocarditis?
```
cardiac failure
sepsis
infected thromboemboli
kidney damage
etc
```
46
what type of valve causes accelerated calcific aortic stenosis?
bicuspid aortic valve
47
causes of calcific aortic stenosis
degenerative
| rheumatic aortic valve disease
48
effect of calcific aortic stenosis on the heart
obstruction to LV outflow
> pressure overload
> hypertrophy
49
calcific aortic stenosis increases risk of...
MI
| infective endocarditis
50
describe heart sound in mitral valve prolapse
S3 [extra heart sound after S1 & S2]
| snap of redundant leaflets as they prolapse into left atria
51
what is myocarditis & most common cause?
inflammation of the myocardium
| most commonly due to virus
52
describe what happens in the 2 phases of myocarditis [acute & healing]
ACUTE PHASE: lymphocyte infiltrate destroying fibres
| HEALING PHASE: patchy fibrosis
53
describe giant cell myocarditis
very rare, highly aggressive, often fatal
| macrophage giant cells > muscle cell death
54
cardiomyopathy definition
chronic disease of the heart muscle
55
describe dilated cardiomyopathy
dilated LV
| contracts poorly
56
causes of secondary dilated cardiomyopathy
alcohol
drugs
pregnancy
57
describe hypertrophic cardiomyopathy
| & what causes it?
ventricular hypertrophy > impaired diastolic filling, decreased stroke vol
sarcomeric protein gene mutations
58
arrhythmogenic RV cardiomyopathy
fibro-adipose replacement of RV wall
| > ventricular tachycardia
59
describe primary restrictive cardiomyopathy
| & most common cause?
rigid myocardium, restricts diastolic filling
| most common cause is amyloidosis
60
what is sarcoid?
chronic granulomatous disease
| w/ numerous non-caseating giant cell granulomas
61
how does sarcoid affect the heart?
widespread areas of fibrosis
& compensatory hypertrophy
can produce restrictive disorder
62
what are channelopathies?
ion channel protein gene mutations
63
what is cardiac myxoma?
most common type of heart tumour - benign
64
2 ways that viruses cause damage in myocarditis
direct viral toxicity & cell-mediated immunity damage
65
describe type of cells in cardiac myxoma
jelly-like proliferation of myxoid cells
66
in which chambers is cardiac myxoma more commonly found?
atria
67
narrow QRS complex suggests what kind of tachycardia?
supraventricular
68
what is the most common sustained arrhythmia?
atrial fibrillation
69
causes of secondary bradyarrhythmias
hypothyroidism
myocarditis
drugs [beta blockers]
atrial ischaemia
70
symptoms of SAN or AVN bradyarrhythmias
syncope
palpitations
dyspnoea
71
definition of bradycardia in bpm
72
definition of tachycardia in bpm
>100bpm
73
types of sinus pause bradyarrhythmias
sinus arrest
| sinoatrial exit block
74
how do AVN bradyarrhythmias look on ECG
PR interval is prolonged
75
what is AV block?
intermittent failure of supraventricular impulse being conducted to the ventricles
76
what causes atrioventricular nodal re-entry tachycardia [AVNRT]
'ring' conducting pathway in the AV node - each 'limb' has a different conduction time
77
commonest supraventricular tachycardia?
AV node re-entry tachy
78
what causes AV reciprocating tachy [AVRT]?
an accessory pathway
| leading to 2 electrical pathways depolarising the ventricles
79
example of an AVRT
wolf-parkinson-white syndrome
80
treatment for AVNRT
use a high energy catheter to 'burn' away one of the 2 pathways
81
infective endocarditis: when to operate?
```
infection not cured by antibiotics
severe valve damage
aortic root abscess
remove infected device
replace valve when infection cleared
remove large vegetations before they embolise
```
82
treatment of infective endocarditis
antimicrobials
treat complications e.g. arrhythmia, embolus
surgery
83
diagnostic tools in infective endocarditis
```
echo - TTE [trans-thoracic], TOE [trans-oesophageal]
cultures
ECG
JVP (jugular venous pressure) -tricuspid
auscultation [murmur]
```
84
presentation of infective endocarditis
systemic infection [fever]
valve dysfn. [arrhythmia, heart failure]
embolisation [stroke, PE, MI, kidney dysfn.]
85
endocardial lined structures [other than valves] where infective endocarditis can occur
septal defects
pacemaker leads
surgical patches
86
what are vegetations?
lumps of infected fibrin/clot hanging off heart valves
87
what is a nidus?
place where bacteria have multiplied/ focus of infection
88
most common cause of infective endocarditis after dental complications?
streptococcus viridans
89
presentation of rheumatic fever
| name 3
```
fever
large joint pain [polyarthritis]
loss of appetite
chest pain [carditis]
subcutaneous nodules
erythema marginatum
Sydenham's chorea
```
90
what would a blood count show in a patient with rheumatic fever?
raised ESR
| leucocytosis
91
what does the Duckett Jones criteria for diagnosing rheumatic fever involve?
clinical features
| + evidence of recent strep infection
92
treatment for rheumatic fever
bed rest
high dose aspirin
penicillin [treat initial infection + prophylaxis for people with cardiac damage]
