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Cardiovascular System > Symptoms and signs of disease > Flashcards

Symptoms and signs of disease Flashcards

(60 cards)

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1
Q

What accumulates in ischaemic muscle? Why?

A

Lactic acid

Lack of oxygen
so anaerobic glycolysis occurs
produces lactic acid

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2
Q

What is the effect of lactic acid accumulation?

A

Drop in pH

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3
Q

What is the effect of drop in pH?

A

Substance P is released

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4
Q

What is substance P?

A

Neuropeptide

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5
Q

What is the effect of substance P?

A

Increases sensitivity of pain afferents in muscle

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6
Q

What does ischaemia mean?

A

Ischaemia mean insufficient blood supply to cell, tissue or organ
compared to its requirement

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7
Q

What is the damaging effect of ischaemia?

A

The lack of oxygen is damaging

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8
Q

Why might someone with uncontrolled thyrotoxicosis develop angina or MI?

A

Tachycardia
less time in diastole
reduced perfusion of coronary arteries
reduced perfusion of myocardium

Whilst the heart is contracting more often
so actually requires more oxygen
more vulnerable to ischaemia

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9
Q

How do patients often describe ischaemic muscle pain?

A

Tight, constriction, vice-like

Heavy, crushing, cramping, pressing, pressure

Tearing

Choking in throat

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10
Q

When might a patient describe tearing pain?

A

Dissection of blood vessels

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11
Q

What gestures do patients often make to describe anginaa?

A

Clenched fists, sometimes placed over chest

Hand over chest

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12
Q

Whest gestures do patients often make to describe itntermittent claudication?

A

Hand pressed over calf

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13
Q

What are the outcomes of cardiac muscle ischaemia?

A

Stable angina
Unstable angina
MI

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14
Q

What is referred pain?

A

Pain located away from actual organ that is causing pain

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15
Q

What are the sites of cardiac referred pain?

A 
Left ear
Jaw
Neck
Arms
Central abdomen
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16
Q

Why does chest pain in stable angina increase with exercise and stress?

A

Increased sympathetic activity
Increased heart rate, force of contraction
Reduced time in diastole, reduced perfusion of coronary arteries, myocardium
But heart is working harder so actually demands more oxygen
More prone to ischaemia

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17
Q

Why does chest pain in stable angina increase with cold weather?

A

Peripheral vasoconstriction
Increases resistance, TPR
Increased afterload
Heart has to contract harder, generate higher pressures in order to pump blood into aorta

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18
Q

Why does chest pain in stable angina increase after a meal?

A

Blood is redirected to the gut

reduced blood supply to heart

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19
Q

Why is chest pain in stable angina relieved with rest?

A

Increased parasympathetic activity
Reduced heart rate, force of contraction
More time in diastole for perfusion of coronary arteries, myocardium
And heart has reduced demand for oxygen

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20
Q

Why is chest pain in stable angina relieved with GTN?

A

Generates nitric oxide
Vasodilates veins and collateral coronary arteries
Veins hold more blood, reduced preload

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21
Q

How is unstable angina different to angina?

A

Chest pain occurs at rest

More intense
May last longer

Does not respond to GTN

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22
Q

What are the ECG features of unstable angina?

A

ST segment depression

T wave inversion

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23
Q

What are the levels of cardiac markers in unstable angina?

A

Cardiac markers are normal

Because no cell death has occurred

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24
Q

What can unstable angina lead on to?

A

MI

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25
How is MI different to angina?
More intense than angina pain
26
How does a patient with MI present?
``` Sweaty Nauseated Dyspnoeic Pale Clammy ```
27
Why is a patient with MI pale and sweaty/clammy?
Due to increased sympathetic activity
28
What is a palpitation?
Noticeable rapid, strong or irregular heartbeat
29
When might palpitations occur?
``` Exercise Stress Night - more aware of heartbeat Caffeine Smoking, alcohol, drugs ```
30
What can palpitations be associated with?
Dizzyness | Loss of consciousness
31
Why are palpitations associated with dizziness, loss of consciousness?
Reduced cardiac output Reduced blood supply to brain, CNS becomes hypoperfused
32
What causes palpitations?
Arrythmias
33
Which arrythmias can cause palpitations?
Sinus tachycardia Atrial or ventricular ectopic beats Atrial tachycardias Ventricular tachycardia, fibrillation
34
What are the different types of atrial tachycardias?
Supraventricular rhythms Atrial flutter Atrial fibrillation
35
What is dyspnoea?
Breathlessness
36
What causes dyspnea in terms of cardiac ischaemia?
Pulmonary oedema
37
What causes pulmonary oedema?
``` Blood backing up in pulmonary veins Increases hydrostatic pressure More loss of fluid than intake Fluid builds up in alveoli Reduces gas exchange ```
38
What is orthopnea?
Breathlessness when lying flat
39
What is paroxysmal nocturnal dyspnoea?
Attacks of shortness of breath at night
40
Why do orthopnea and paroxsymal nocturnal dyspnoea occur?
Fluid in lungs spreads out in alveoli and lungs rather than being pooled at the bottom Equal effect of gravity over body get increased venous return to right side of heart more blood enters pulmonary circulation increases hydrostatic pressure further in pulmonary vessels...
41
Why are orthopnea and paroxysmal nocturnal dyspnoea relieved by sitting up?
Fluid pools at bottom of alveoli and lungs again Effect of gravity reduced venous return to right side of heart
42
What is another cause of dyspnoea and it being worse at night?
Asthma
43
Which arrythmias in particular may lead to loss of consciousness?
Ventricular tachycardia | Ventricular fibrillation
44
What is postural hypotension?
Low blood pressure when standing
45
How can you tell that an arrythmia was the cause of loss of consciousness?
Had palpitations before, during or after the loss of consciousness
46
What is actually being felt when feeling a pulse?
The change in pressure that arrives before the blood itself
47
What should be assessed when taking a pulse?
Rate Rhythm Quality
48
What is the normal pulse rate?
60-100 per minute
49
What are the different types of pulse rhythms?
Regular Regularly irregular Irregularly irregular
50
Give an example of a regularly irregular arryhthmia. Why is it regularly irregular?
Second degree heart block Not in sinus rhythm, so it's irregular but has a pattern, so it's regularly irregular
51
Give some examples of irregularly irregular arrythmias. Why are they irregularly irregular?
Atrial fibrillation Atrial ectopic beats Ventricular ectopic beats Because not in sinus rhythm, so are irregular And they occur randomly, no pattern, so are irregularly irregular
52
What is the pulse pressure? - can be measured in aorta
Difference between diastolic and systolic pressure | ESP - EDP
53
How does atrial fibrillation affect pulse pressure?
Pulse pressure varies with AF due to depolarisation and contraction of ventricles occurring irregularly different heart rate, time in diastole get different EDVs, EDPs
54
How do ventricular ecoptic beats affect pulse pressure?
Compensatory pause before normal heart beat increased time in diastole, EDV, EDP gives bounding heart beat and pulse
55
What causes a bounding pulse?
Lower EDP usually - low TPR - bradycardia - aortic regurgitation
56
How does low TPR cause a bounding pulse?
Reduced pressure in arteries more blood flows out of aorta into arteries lower pressure in aorta so get reduced end-diastolic pressure
57
What can cause low TPR?
Exercise Pregnancy
58
How does bradycardia cause a bounding pulse?
More time in diastole more time for more blood to leave aorta lower pressure in aorta lower end-diastolic pressure
59
How does aortic regurgitation cause a bounding pulse?
``` Aortic valve is incompetent Backflow of blood from aorta into LV during diastole less blood in aorta lower pressure in aorta lower end-diastolic pressure ```
60
What are the causes of a thready pulse?
Shock Left ventricular failure

Cardiovascular System (22 decks)

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