Definitions

Question 1

Heart Failure

Answer 1

• a complex of signs and symptoms caused by structural or functional impairment of ventricular filling and/or ejection of blood.

The inability of the heart muscle to pump out sufficient blood to meet the body’s metabolic needs (oxygen and substrates).

Question 2

Chronic Congestive heart failure

Answer 2

• a progressive condition that affects the pumping power of your heart muscle.
• CHF specifically refers to the stage in which fluid builds up within the heart and causes it to pump inefficiently.
• Fluid can collect in your lungs and make it difficult to breathe = Congestion.

Question 3

Acute left heart failure

Answer 3

left ventricular dysfunction = The left side of the heart is unable to pump out sufficient blood through the aorta to the rest of the body. Results in tissue hypoperfusion.

• backflow of blood into the lungs causing increased pulmonary capillary pressure.

Question 4

Acute circulatory failure

Answer 4

The heart is unable to pump out blood into the systemic circulation.

• A clinical syndrome characterized by inadequate effective blood flow and reduced tissue perfusion with decreased delivery of oxygen to the capillaries.
• The reduction in oxygen delivery leads to impaired oxidative metabolism, lactic acidosis, and cell death.

Question 5

Chronic pulmonary heart disease

Answer 5

Also known as Cor pulmonale

• Altered structure (hypertrophy, dilation) or impaired function of the right ventricle due to pulmonary hypertension resulting from a primary disorder of the respiratory or pulmonary artery system.
• Caused by increased right ventricular afterload.
• Right ventricular dysfunction is caused by lung disease, NOT a cardiac disease.

Question 6

Primary hypertension

Answer 6

Abnormally high blood pressure - not a result of a medical condition.

• No identifiable cause.
• also known as Essential Hypertension

Question 7

Hypertensive Crisis

Answer 7

• Severely high blood pressure
• Acute increase in BP that can cause or increase risk of end-organ damage.
  > 180 SBP, > 120 DBP

i. e., damage to the brain (e.g., encephalopathy, stroke), eyes (e.g., retinopathy), cardiovascular system (e.g., ACS, pulmonary edema, aortic dissection), and/or kidneys (e.g., acute renal failure).
- can be due to primary hypertension or precipitated by underlying conditions
(e. g., pheochromocytoma, pre-eclampsia, drug toxicity).

Question 8

Secondary Hypertension

Answer 8

An anbnormally high blood pressure that is caused by a specific underlying condition.

Typical underlying conditions include renal, endocrine, and vascular diseases (e.g., renal failure, primary hyperaldosteronism, coarctation of the aorta).

Question 9

Ischaemic heart Disease

Answer 9

Lack of oxygen/ blood supply to the cardiac tissue causing necrosis.

• Also known as Coronary Artery Disease.
• heart problems caused by narrowed heart (coronary) arteries that supply blood to the heart muscle.

Question 10

STEMI

Answer 10

An ST-elevation myocardial infarction (STEMI) is a type of heart attack that mainly affects your heart’s lower chambers. They are named for how they change the appearance of your heart’s electrical activity on a certain type of diagnostic test.

• Acute myocardial ischemia that is severe enough to cause ST-segment elevations on ECG

Question 11

NSTEMI

Answer 11

A non-ST-elevation myocardial infarction (NSTEMI) is a type of heart attack that usually happens when your heart’s need for oxygen can’t be met. This condition gets its name because it doesn’t have an easily identifiable electrical pattern (ST elevation) like the other main types of heart attacks.

• Acute myocardial ischemia that is severe enough to cause detectable quantities of myocardial injury biomarkers but without ST-segment elevations on ECG

Question 12

Acute Coronary Syndromes - without ST-elevation

NSTE-ACS

Answer 12

Acute coronary syndrome (ACS) is the clinical manifestation of myocardial infarct.

Based on ECG findings, patients are categorized into those with ST-elevation (STE-ACS) or non-ST-elevation ACS (NSTE-ACS).

• Depending on serum levels of cardiac troponin (cTn), NSTE-ACS can be categorized as NSTEMI or unstable angina (UA).

Question 13

Acute Coronary Syndromes - with ST - elevation

STE-ACS

Answer 13

Acute coronary syndrome (ACS) is the clinical manifestation of myocardial infarct.

Based on ECG findings, patients are categorized into those with ST-elevation (STE-ACS) or non-ST-elevation ACS (NSTE-ACS).

• STE-ACS patients require immediate revascularization therapy.

Question 14

Unstable Angina

Answer 14

Acute myocardial ischemia that is not severe enough to cause detectable quantities of myocardial injury biomarkers or ST-segment elevations on ECG.

Question 15

Rhythm disorders

Answer 15

• Also known as arrhythmia.
• an irregular heartbeat.

Heart rhythm problems (heart arrhythmias) occur when the electrical signals that coordinate the heart’s beats don’t work properly.

The faulty signalling causes the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly.

types - tachycardia, atrial fibrillation, atrial flutter, bradycardia, AV nodal re-entrant tachycardia, ventricular tachycardia ventricular fibrillation, premature contractions.

Question 16

Conduction disorders

Answer 16

A conduction disorder, also known as heart block, is a problem with the electrical system that controls your heart’s rate and rhythm. This system is called the cardiac conduction system.

Normally, the electrical signal that makes your heart beat travels from the top of your heart to the bottom.

The signal causes your heart muscle to beat and pump blood to your lungs and the rest of your body.

In conduction disorders, this electrical signal either does not get produced properly, does not travel the way it should through the heart, or both.

examples - AV block, bundle branch blocks, ion channel disorders.

Question 17

Antiarrhythmic agents

Answer 17

medications given to slow down or increase heart rhythm in order to bring it back to normal.

drugs are used to prevent recurrent arrhythmias and restore sinus rhythm in patients with cardiac arrhythmias.

Several classes of antiarrhythmics, including beta blockers, calcium channel blockers, amiodarone, cardiac glycosides, and lidocaine, also have other medical uses, which are discussed in their respective articles.

Question 18

Aortic valve regurgitation

Answer 18

• Aortic valve is found on the left side of the heart in the aorta.
• It prevents the backflow of blood from the aorta back into the left ventricle.
• Aortic regurgitation = Valvular heart disease, characterized by incomplete closure of the aortic valve leading to the reflux of blood from the aorta into the left ventricle (LV) during diastole.
• Leaky Valve
• It allows the blood to flow back into the ventricle.
• should be closed during diastole and open during systole.
• Ventricle needs to pump harder in order to account for the extra blood leaking backwards.

Question 19

Aortic valve stenosis

Answer 19

• narrowing of the aortic valve.
• the outflow of blood from the left ventricle into the aorta is obstructed.
• higher pressure, chronic and progressive excess load - left ventricle needs to work hard to pump blood through the valve.
• could lead to left ventricular failure.

Question 20

Mitral valve regurgitation

Answer 20

• Mitral regurgitation (MR) is the leakage of blood from the left ventricle into the left atrium due to incomplete closure of the mitral valve during systole.
• Mitral valve prevents the backflow of blood from the left ventricle back into the left atrium.
• Mitral valve should be open during diastole and closed during systole.
• But in mitral valve regurgitation, the valve does not close during systole - there is a backflow of blood into the left atrium.
• Atria have to pump harder - progressive excess load on the atrium.

Question 21

Mitral valve stenosis

Answer 21

• A valvular disease characterized by obstruction of blood flow from the left atrium into the left ventricle during diastole.
• narrowing of the mitral valve.
• The mitral valve prevents the backflow of blood from the left ventricle to the left atrium.
• Excessive pressure for blood to pass through the valve - puts pressure on the left atrium.
• progressively causing left atrial distension, pulmonary venous congestion, pulmonary hypertension, and congestive heart failure.

Question 22

Acute Rheumatic fever

Answer 22

• Acute rheumatic fever (ARF) is an inflammatory disease involving the heart, joints, skin, and central nervous system (CNS) that occurs two to four weeks after an untreated infection with group A Streptococcus (GAS).

Question 23

Congenital heart diseases

Answer 23

• heart defects that are present from birth that make it difficult to pump blood
• Congenital heart disease is a general term for a range of birth defects that affect the normal way the heart works. The term “congenital” means the condition is present from birth.
• Left to right heart shunts = ACYANOTIC CONGENITAL HEART DEFECTS
• right-to-left heart shunting = CYANOTIC CONGENITAL HEART DEFECTS

Question 24

Cardiomyopathy

Answer 24

• Problems with the heart muscle.
• Cardiomyopathies are diseases of the muscle tissue of the heart.
• Types of cardiomyopathies include dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy.
• Myocardium affected
• Contractility of the muscle is affected - making it harder for the heart to pump blood.
• Cardiomyopathy can make your heart stiffen, enlarge, or thickened and can cause scar tissue.
• As a result, your heart can’t pump blood effectively to the rest of your body.

Question 25

Myocarditis

Answer 25

- An inflammation of the myocardium, which can impair cardiac output and the cardiac conduction system.

Question 26

Diseases of the pericardium

Answer 26

- Diseases that affect the outermost layer of the heart. - Fibrous sac that surrounds the heart. - Can be divided into three layers - the fibrous pericardium, the parietal pericardium, and the visceral pericardium. The parietal and visceral pericardia together form the serous pericardium.

Question 27

Pericardial effusion

Answer 27

- Build-up of fluid in the pericardium. - Pericardial effusion is the acute or chronic accumulation of fluid in the pericardial space (between the parietal and the visceral pericardium) and is often associated with a variety of underlying disorders. - The fluid can be either bloody (e.g., following aortic dissection) or serous (usually idiopathic).

Question 28

Infective endocarditis

Answer 28

- Infection and inflammation of the innermost layer of the heart - the endocardium. - It typically affects one or more of the valves. - The condition is usually a result of bacteremia, which is most commonly caused by dental procedures, surgery, distant primary infections, and nonsterile injections.

Question 29

Systemic rheumatological disorders

Answer 29

- Disorders that affect the joints, tendons, ligaments, bones, and muscle. - Systemic rheumatic diseases are chronic, inflammatory autoimmune disorders, such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis (scleroderma).

Question 30

Systemic Lupus erythematous

Answer 30

- Autoimmune disorder. - Systemic lupus erythematosus (SLE) is a chronic disease that causes inflammation in connective tissues, such as cartilage and the lining of blood vessels, which provide strength and flexibility to structures throughout the body. - a multisystem autoimmune disease that predominantly affects women of childbearing age and is the most common form of lupus.

Question 31

Rheumatoid arthritis

Answer 31

- Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disorder that primarily affects the joints (e.g., causes pain, swelling, synovial destruction, deformities), but may also manifest with extra-articular features (e.g., rheumatoid nodules, pulmonary fibrosis).

Question 32

Ankylosing spondylitis

Answer 32

- fusion of the spinal column - A chronic inflammatory disease of the axial skeleton that leads to partial or even complete fusion and rigidity of the spine. - bambooo spine

Question 33

Reactive arthritis

Answer 33

- An immune-mediated condition that typically occurs 1-4 weeks after bacterial infection of the gastrointestinal or genitourinary tract.

Question 34

Osteoarthritis

Answer 34

Osteoarthritis is a disabling joint disease characterized by degeneration of the joint complex (articular cartilage, subchondral bone, and synovium) that can have various causes, most notably advanced age and overuse. It mainly affects weight-bearing joints and joints that are heavily used, such as the hip, knee, hands, and vertebrae. Despite the widespread view that osteoarthritis is a condition caused exclusively by degenerative “wear and tear” of the joints, newer research indicates that there are various causes, including preexisting joint abnormalities, genetics, local inflammation, mechanical forces, and biochemical processes that are promoted by proinflammatory mediators and proteases.

Question 35

Drugs influencing RAAS

Answer 35

There are well-established drugs that interfere with the renin-angiotensin-aldosterone system (RAAS) at several sites: (1) angiotensin-converting enzyme inhibitors (ACEIs) (2) angiotensin II type I (AT 1) receptor blockers (ARBs), (3) direct renin inhibitors (DRIs), (4) mineralocorticoid receptor antagonists RAS-acting agents are medicines acting on a hormone system that helps to control blood pressure and the amount of fluid in the body. They are used to treat conditions like high blood pressure or heart failure (when the heart cannot pump blood around the body as well as it should).

Question 36

Beta adrenoreceptor blocking agents

Answer 36

- Beta-blockers are drugs that can lower stress on the heart and blood vessels. - Beta blockers, also spelled β-blockers, are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack after a first heart attack.

Question 37

Vasodilators

Answer 37

- Vasodilators are medications that open (dilate) blood vessels. - They affect the muscles in the walls of the arteries and veins, preventing the muscles from tightening and the walls from narrowing. - As a result, blood flows more easily through the vessels. The heart doesn't have to pump as hard, reducing blood pressure. ``` benazepril (Lotensin) captopril (Capoten) enalapril (Vasotec, Epaned) fosinopril (Monopril) lisinopril (Prinivil, Zestril) moexipril (Univasc) perindopril (Aceon) quinapril (Accupril) ```

Question 38

Diuretics

Answer 38

- Diuretics, sometimes called water pills, help rid your body of salt (sodium) and water. - Most of these medicines help your kidneys release more sodium into your urine. - The sodium helps remove water from your blood, decreasing the amount of fluid flowing through your veins and arteries. This reduces blood pressure. ``` - Aldactone (spironolactone) Bumex (bumetanide) Demadex (torsemide) Esidrix (hydrochlorothiazide) Lasix (furosemide) Zaroxolyn (metolazone) ```

Question 39

Cardiac glycosides

Answer 39

- Cardiac glycosides are medicines for treating heart failure and certain irregular heartbeats. They are one of several classes of drugs used to treat the heart and related conditions. These medicines are a common cause of poisoning. - Digoxin (Lanoxicaps, Lanoxin, Digibind) Digitoxin (Crystodigin)

Question 40

Fibrinolytic, anticoagulant and antiplatelet drugs

Answer 40

fibrinolytic drug, also called thrombolytic drug, any agent that is capable of stimulating the dissolution of a blood clot (thrombus). Fibrinolytic drugs work by activating the so-called fibrinolytic pathway. Fibrinolytic therapy is used in selected patients with venous thromboembolism. For example, patients with massive PE can benefit from systemic or catheter-directed fibrinolytic therapy. Anticoagulants are medicines that help prevent blood clots. They're given to people at a high risk of getting clots, to reduce their chances of developing serious conditions such as strokes and heart attacks. A blood clot is a seal created by the blood to stop bleeding from wounds. Antiplatelets are medicines that stop cells in the blood (platelets) from sticking together and forming a clot. A blood clot can lead to a heart attack or stroke. Aspirin is the most common antiplatelet.

Question 41

Drugs for treatment of lipoprotein disorders

Answer 41

Lipid (or lipoprotein) altering agents encompass several classes of drugs including statins, cholesterol absorbing inhibitors, fibric acid derivatives, bile acid sequestrants, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, nicotinic acid, and others.

Question 42

Difference between antiplatelet and anticoagulant drugs

Answer 42

There are two classes of antithrombotic drugs: anticoagulants and antiplatelet drugs. Anticoagulants slow down clotting, thereby reducing fibrin formation and preventing clots from forming and growing. Antiplatelet agents prevent platelets from clumping and also prevent clots from forming and growing.