Heart disorders

Question 1

describe normal heart anatomy

Answer 1

there are 2 atrium 2 ventricles

Question 2

what valve lies in between the left atrium and left ventricle

Answer 2

the mitral valve/ bi CUSPID

Question 3

how does blood travel around the heart

Answer 3

deoxygenated blood enters the Vena cava into the right atrium the tricuspid valve opens and blood moves into the RV after the SL valve opens and blood is carried into the pulmonary artery to get oxygen oxygenated blood is passed into the LA and then LV into the aorta to flow around the body

Question 4

what is diastole

Answer 4

the filling of the ventricles when the heart is relaxed

Question 5

what is systole

Answer 5

when the heart is contracting forcing blood out of the ventricles

Question 6

what are the three main vessels that supply oxygenated blood directly to the heart

Answer 6

right coronary artery left anterior descending artery circumflex artery

Question 7

what are the branches of the left main coronary artery

Answer 7

the circumflex artery left anterior descending artery

Question 8

where does the left main coronary artery branch from

Answer 8

the aorta

Question 9

definition of ischaemic heart disease

Answer 9

a group of clinical syndromes( signs and symptoms) that relate to myocardial ischaemia

Question 10

definiton of ischaemia

Answer 10

is cell injury resulting from hypoxia induced by reduced blood flow most commonly due to a mechanical arterial obstruction

Question 11

how many people die of ischaemia per year

Answer 11

64000

Question 12

what are the clinical manifesations of ischaemic heart disease

Answer 12

MI

angina

chronic ischaemic heart disease

sudden cardiac death

Question 13

why have death rates fallen by ischameic heart disease

Answer 13

due to awareness/prevention

and diagnosis and treatment

Question 14

what can people to to prevent ischaemic heart disease

Answer 14

diet and exercise and modifiable risk factors such as hypertension and diabetes

Question 15

what medications can people use to lower cholesterol

Answer 15

statins

Question 16

what treatment can people undergo to reduce the likelihood of death by ischaemic heart disease

Answer 16

drugs- statins

acute presentations- antioplasty, stenting etc

arrythmias- implantable defib

heart failure- ventricular assist devices

Question 17

what are the risk factors of ischamic heart disease

Answer 17

smoking

obesity

hypertension

diabetes

age

dsylipidaemia

family history

higher risk in men > woman

Question 18

what is dyslipidaemia

Answer 18

due to increased levels of LDL in the blood

Question 19

how do we treat dyslipidaemia

Answer 19

with the use of statins

Question 20

what is the pathogenesis of ischaemic heart disease

Answer 20

insufficient coronary perfusion –> cardiac hypoxia –> cell injury which is sustained –> myocardial cell death leading to MI

Question 21

describe LAD obstruction

Answer 21

sudden death artery AKA widowmaker

anterior infartion

50% of cases

Question 22

descirbe circumflex obstruction

Answer 22

lateral infarction

20% of cases

Question 23

describe right coronary artery obstruction

Answer 23

interior infarction

30% of cases

can involve the posterior septum

Question 24

what can happen in ischamic heart disease on a cellular level

Answer 24

can lead to a reduction in oxidative phosphrylation and therefore reduction of ATP

Question 25

As ATP levels falls what three pathways can occur

Answer 25

1. reduction in the Na+ pump 2. increase in anaerobic respiation 3. dettatchment of ribosomes

Question 26

what happens when there is a reduction in the sodium pump

Answer 26

leads to influx of ca2+, H20 and Na+ efflux of K+ leading to endoplasmic reticulum swelling and loss of microvilli

Question 27

what does an increase of anaerobic respiration lead to

Answer 27

decreased glycogen increased lactic acid therefore low pH clumping together of nuclear chromatin

Question 28

what happens in ribosomes dettach

Answer 28

leading to decrease in protein synethesis

Question 29

explain the three pathways that occur when there is reduction in oxidative phosphorylation in the cellular level of ischaemic heart disease

Answer 29

Question 30

what is artherosclerosis

Answer 30

material build up in the arterial wall due to fatty deposits

Question 31

what are risk factors for artherosclerosis

Answer 31

smoking and BP

Question 32

what else is located near the artherosclerosis

Answer 32

macrophaged which can initiate an inflammatory response

Question 33

what does the pre clinical phase include of atherosclerosis

Answer 33

normal artery leads to fatty streak --\> fibrofatty plaque --\> advanced vunerable plaque

Question 34

what does the clinical phase of artherosclerosis include

Answer 34

aneurysm and rupture occlusion by thrombus critical stenosis

Question 35

what are unstable angina and MI caused by

Answer 35

plaque rupture

Question 36

what is the difference between angina and MI

Answer 36

there is no detectable cell damage in angina

Question 37

what are the clinical features of angina pectoris

Answer 37

strangled chest pain due to inflammatory mediator pain can be behind restrosternal chest pain, radiationto the epigastric shoulders precipitated by running, eating, exposure to cold or stress

Question 38

what is stable angina

Answer 38

1-5 minutes relieved by GTN spray

Question 39

what are the characterisrics of unstable angina

Answer 39

intense lasts longer less exertion spontaneous at rest progressive pain

Question 40

what are symrpoms of unstable angina

Answer 40

pale and clammy sweating weak pulse nausea and vomitting breathlessness

Question 41

how do we diagnose ischamic heart disease

Answer 41

clinical features- severity of pain changes on ECG cardia blood markers

Question 42

what is the theory of seeing cardiac blood markers in the blood

Answer 42

proteins such as troponin are normally held in cardiomyocytes --\> released when the myocyte is necrotic and released into the blood stream

Question 43

what do we do if GTN spray doesnt work

Answer 43

Call 999 Reassure/comfortable position Give oxygen Sublingual GTN No Intra muscular injections! As they are too slow, and risk of bleeding Give aspirin 300mg- provide note for hospital admin If pt is unconscious begin resuscitation

Question 44

what about non symptomatic ischaemic heart disease pts

Answer 44

patients are vunerable for upto 4+ weeks following MI or sudden increase in angina symptoms

Question 46

what do we not recommend for patients who had coronary artery bypass graft

Answer 46

antibiotic prophylaxis

Question 47

what are complications of an MI

Answer 47

Impaired contractility tissue necrosis electrical instability pericardial inflammation

Question 48

# 6 results what can be the issues with MI

Answer 48

stroke cardiogenic shock congenetive HF cardiac tamponade arrythmias pericarditis

Question 49

what is HF

Answer 49

an inability to pulp enough blood to meet metabolic demands of the body

Question 50

symptoms of HF

Answer 50

fatigue breathless ness peripheral oedema

Question 51

which mechanisms help the failing heart maintain function

Answer 51

increase contractility cardiac hypertrophy neurohumoral responses

Question 52

describe neurohumoral responses

Answer 52

fluid overload fluid retention to maintain renin angiotensin system low cardiac output

Question 53

what is cardiac hypertropy characterised by

Answer 53

increased heart size and mass increased protein synthesis fibrosis abnormal proteins

Question 54

what is the ejection fraction

Answer 54

the proportion of the blood that is actually ejected from the ventricles

Question 55

what is systolic dysfuction

Answer 55

decreased contraxctility and therefore the ejection function decreeases to less than \<40% heart failure with reduced ejection function HRrEF

Question 56

what is the typical ejection fraction

Answer 56

55-70%

Question 57

what do we DIASTOLIC dysfunction

Answer 57

heart cannot fill proeprly with blood heart failure with preserved ejection fracture HFpEF

Question 58

describe left heart failure

Answer 58

damage to the left ventricles or valve can lead to Congestion in the pulmonary circulation, stasis of blood in the LS and inadequate perfusion of organs

Question 59

what are the symptoms of Left heart disease

Answer 59

Breathlessness Oedema due to pulmonary congestion systemic hypoperfusion (organ failure

Question 60

describe right heart failure

Answer 60

Increased back pressure through the pulmonary and venous circulation Therefore leg swells Most people have a combination of both

Question 61

how do people get right heart failure

Answer 61

from left heart failure or pulmonary issues

Question 62

what are the different types of valvular heart diseases

Answer 62

fail to fully open eg stenosis fail to fully close eg flow reversal vegetations - infective nodules the formation of infective vegetations on the heart is called infective endocarditis

Question 63

what does abnormal valve function

Answer 63

abnormal blood flow clot formation risk of infection

Question 64

what is stenosis due to

Answer 64

chronic injury / rheumatic fever

Question 65

what is the pathological cause of mitral stenosis

Answer 65

rheumatic valvular disease

Question 66

what can left ventricular hypertrophy lead to

Answer 66

ischaemia syncope decompensated Congenitive heart failure

Question 67

why can we get mitral regurgitation

Answer 67

Calcification of the valve ring Fibrous scarring of the papillary muscle and tethering valve leaflets The papillary muscle can also rupture Infective endocarditis

Question 68

how can we fix mitral regurgitation

Answer 68

valve replacement