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CVS Flashcards

1
Q

2 main principles of vascular disease?

A

Stenosis or obstruction

Weakening of vessel wall

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2
Q

Risk Factors for Atherosclerosis?

A

Age, Male, hypercholesterolaemia, DM, HTN, smoking, familial history

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3
Q

3 stages of atherosclerosis?

A

Fatty Streaks, Fibro lipid plaques, complicated lesions

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4
Q

Consequences of Atherosclerosis?

A

Narrowing (stable angina), occlusion (MI), embolism (stroke), rupture of AAA

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5
Q

Define IHD

A

imbalance between blood and oxygen supply and demand in the heart

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6
Q

3 Acute Coronary Syndromes?

A

Unstable Angina, NSTEMI, STEMI

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7
Q

What causes and relieves stable angina?

A

Reversible narrowing of the lumen (70%)
Exercise and stress
Rest and vasodilators

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8
Q

What causes prinzmental/variant angina?

A

Vasospasm rather than stenosis

Rare

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9
Q

Characteristics of Unstable Angina?

A

Partial Occlusion of the lumen
Chest pain at increasingly less levels of exercise or at rest
No biochemical or ECG markers
Warning for MI

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10
Q

Definition of MI?

A

irreversible necrosis of cardiac myocytes

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11
Q

What time frame can limit damage with an MI?

A

3 hours

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12
Q

Who frequently suffers ‘silent MIs’?

A

Diabetics

Elderly

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13
Q

What can be seen 24-48 hours post-MI?

A

pale oedematous grossly

oedema, inflammatory cells, myocyte necrosis

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14
Q

What can be seen 3-4 days post-MI?

A

yellow centre with haemorrhagic border

necrosis, inflammation and early granulation tissue

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15
Q

What can be seen 1-3 weeks post-MI?

A

pale and thin tissue

granulation tissue

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16
Q

What can be seen 6 weeks post-MI?

A

Scar tissue

Dense fibrosis

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17
Q

Complication of MI within hours?

A

Death- Ventricular Fibrillation

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18
Q

Complication of MI 24-48 hours?

A

Arrhythmias

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19
Q

Complication of MI first few days?

A

Mitral incompetence due to papillary muscle dysfunction

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20
Q

Complication of MI 3-5 days?

A

Cardiac rupture -> cardiac tamponade

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21
Q

Complication of MI 1 week?

A

Mural thrombosis

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22
Q

Complications of MI that occur at various times?

A

Ventricular Aneurysm, Pericarditis, Heart Failure

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23
Q

What percentage of HTN is secondary?

A

Around 5%

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24
Q

Causes of secondary HTN?

A

Renal disease (CKD, Renal Artery Stenosis, Renin-producing tumours)
Endocrine (Pheochromocytoma, Cushing’s, Conn, adrenal hyperplasia)
CVS- Coarctation of aorta
Other- drugs (cocaine)

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25
Malignant HTN measurements?
Systolic >200mmHg | Diastolic> 120mmHg
26
Aneurysm Definition?
localised abnormal permanent dilation of a blood vessel
27
Where is Berry aneurysm most common?
Circle of Willis
28
AAA risk factors?
Atherosclerosis, HTN, men, smokers
29
Site of AAA?
below the origin of renal arteries and above aortic bifurcation
30
Aortic Dissection Aetiology?
HTN, Marfan's, Ehler's Danlos
31
Types of aortic dissection?
ascending aorta | distal to subclavian artery
32
Diagnosis of dissecting aorta on CT?
Double-barrel aorta
33
Left Ventricular Failure Symptoms?
orthopnoea, dyspnoea, cough, PND, pre-renal renal failure, alveolar haemorrhage- rusty sputum
34
Rusty Sputum indicates?
Alveolar haemorrhage- LVF
35
Most common cause of RVF?
LVF
36
Cor Pulmonale Definition?
RHF due to pulmonary hypertension
37
Clinical Features of RHF?
raised JVP, peripheral oedema, systemic and hepatic congestion, ascites, hepatosplenomegaly
38
Gold standard for diagnosing heart failure?
Echo
39
Biochemical Marker for Heart failure?
BNP
40
Types of Cardiomyopathies?
Dilated, Hypertrophic, Arrhythmic Right Ventricular, Restrictive, SADS/channelopathies
41
Cardiomyopathy that presents in early adulthood and causes sudden death in athletes?
HOCM
42
Systemic causes of restrictive cardiomyopathy?
sarcoidosis, amyloidosis, scleroderma
43
Max intensity ejection murmur in mid to late systole indicates?
Aortic Stenosis
44
Water-hammer pulse indicates?
Aortic Regurgitation
45
Causes of aortic regurgitation?
Dilation of aortic root (old age), valve disease
46
Complications of aortic regurgitation?
LVH and LVF
47
Pan-systolic murmur?
Mitral Regurgitation
48
What murmur is heard in mitral regurgitation?
Pan-systolic murmur
49
Mid-systolic click?
Mitral Valve Prolapse
50
What murmur is heard in mitral valve prolapse?
mid systolic click and late systolic murmur
51
Mitral Stenosis murmur?
Opening snap and diastolic murmur
52
Main cause of mitral stenosis?
Rheumatic Heart Disease
53
Complications of Mitral Stenosis?
Right-heart failure A Fib Thromboembolism
54
Rheumatic fever bloods?
High anti-streptolysin O titre
55
When does rheumatic fever occur?
Post-strep throat infection
56
Infective Endocarditis Risk Factors?
Rheumatic valve disease, poor dental hygiene, IV drug use, valve replacement, pacemaker insertion, DM, sepsis, immunosuppression, surgery, IV catheter
57
What causes non-infective endocarditis?
small thrombotic vegetations on valves | cancer (marantic)
58
What causes Libman-Sachs endocarditis?
SLE
59
Non-cyanotic Congenital Heart Diseases?
LtR VSD ASD PDA
60
What is Eisenmenger's Syndrome?
LtR -> inc. pulmonary vascular resistance -> RtL
61
ASD murmur?
Diastolic Rumbling Murmur
62
VSD murmur?
loud pansystolic murmur and thrill
63
PDA murmur?
machinery-like murmur, loudest at 2nd heart sound
64
Treatment of PDA?
IV Indomethacin
65
Cyanotic Congenital Heart Diseases?
Tetralogy of Fallot Transposition of Great Arteries Tricuspid Atresia
66
4 steps to Tetralogy of Fallot?
1) Right Ventricular Obstruction 2) Right Ventricular Hypertrophy 3) VSD 4) Aorta overrides the VSD
67
When is transposition of great arteries compatible with life?
If there is a ASD, VSD or PDA present to allow mixing of the blood
68
What is transposition of the great arteries?
Pulmonary artery drains left side of the heart | Aorta drains right side of the heart
69
Hypertension in upper body and hypotension in lower body indicates?
Coarctation of the aorta
70
Bacterial colonisation of IV catheter?
Staph aureus | Staph epidermidis
71
Two causes of bacterial endocarditis?
Bacteraemia (through the blood) | During cardiac valve surgery
72
What is the most common cause of bacterial endocarditis?
Bacteraemia
73
Routes to bacteraemia causing bacterial endocarditis?
Through the mouth- strep mutans | Through the skin- staph aureus, staph epidermidis
74
Bacteria that causes bacteraemia and bacterial endocarditis through the mouth?
Strep mutans
75
What is the single commonest cause of infective endocarditis in developed countries?
Staph aureus
76
Abnormalities that predispose infective endocarditis?
Rheumatic fever Degenerative valve disease Mitral valve prolapse Valve surgery/prosthesis
77
Signs in the hands for infective endocarditis?
Splinter haemorrhages, Janeway lesions, Osler nodes
78
Duke Categories for Infective Endocarditis?
Definite- 2 major, 1 major and 3 minor, 5 minor Possible- 1 major and 1 minor, 3 minor Rejected- alternative diagnosis, no evidence, resolution
79
Major criteria for Duke Infective Endocarditis?
Typical organism in 2 separate blood cultures Any organism in persistent blood cultures Signs on ECHO New valvular regurgitation
80
Minor criteria for Duke Infective Endocarditis?
``` Predisposing features Fever Vascular phenomena Immunological phenomena Suggestive microbiology ```
81
Infective Endocarditis treatment?
IV antibiotics for minimum of 2 weeks
82
Streptococcal endocarditis treatment?
Penicillin Benzylpenicillin +/- Gentamicin
83
Enterococci endocarditis treatment?
Ampicillin Amoxycillin + gentamycin if low level resistance + streptomycin if high level resistance
84
Staphylococci endocarditis treatment?
If methicillin sensitive- flucloxacillin If methicillin resistant- vancomycin If prothesis present- add gentamycin
85
Persistent fever after treatment of infective endocarditis?
Abscess at aortic root Drug hypersensitivity Infection in IV line
86
Prophylaxis for Infective Endocarditis during dentistry?
Only in high risk patients Only for procedures needing gingival manipulation Only if oral mucosa perforated
87
What patients are considered high risk for infective endocarditis?
Previous history Prosthetic valve Cyanotic Congenital Heart Disease Any congenital heart disease repaired with prosthetic material (for 6 months after)
88
Lipids as CVS risk factors?
``` High LDL Low HDL High non HDL High TG (weak) TC:HDL (stronger than either alone) apoB:apoA-1 (may be stronger again) ```
89
Primary hyperlipidaemias?
Familial hypercholesterolaemia 'Common' polygenic hypercholesterolaemia Familial dysbetalipoproteinaemia

Pathology (13 decks)

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