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Terms in this set (37)
What are the classic causes of AF?
- rheumatic heart disease
- alcohol intoxication
What are the common causes of AF?
- heart failure
What are the aetiologies of acute heart failure?
- ischaemic heart disease
- valvular heart disease
- acute and chronic kidney disease
What are the common causes of left heart failure?
- Aortic and mitral valve diseases
What is the pathology of ischaemic heart disease?
1. Chronic endothelial cell injury
2. Endothelial dysfunction
3. Macrophage activation, smooth muscle recruitment
4. Macrophages and smooth muscle cells engulf lipid
5. Smooth muscle proliferation, collagen and other extracellular matrix deposition
What are the mechanisms for development of thrombosis on plaques?
1. Superficial endothelial injury
2. Deep endothelial fissuring
What are the risk factors of atherosclerosis?
- Increased age
- Genetics (familial hypercholesterolaemia)
- Gender (men, postmenopausal women)
- Diet high in cholesterol and saturated fats
- Hyperlipidaemia (cho &TAG) + low HDL
- Lack of exercise
- Heavy alcohol consumption
- Diabetes mellitus
- Lack of psychosocial wellbeing
What is the threshold of occlusion for symptomatic ischaemia precipitated by exercise?
>70% reduction in cross sectional area
(>50% reduction in luminal diameter)
What is the pathophysiology of ACS/MI?
Insufficient coronary perfusion relative to myocardial demand due to:
- chronic vascular occlusion
- acute plaque change
What is stable angina?
1. Angina is not a new symptom
2. No change in frequency or severity of attacks
What is unstable angina?
1. Recent onset (<24 hr)
2. Deterioration of previously stable angina, attacks at rest
What is the difference between stable and unstable angina?
There is no disruption of atherosclerotic plaque in stable angina, only imbalance in coronary perfusion relative to myocardial demand.
There is disruption of atherosclerotic plaque in unstable angina.
Outline the management of stable angina.
1. Manage co-existing conditions (e.g. HTN, DM)
2. Correct risk factors (e.g. stop smoking, weight loss, exercise)
3. Aspirin 75 mg
5. Beta-blocker/ CCB
What are the symptoms of typical angina?
1. Constricting discomfort in chest, arm, neck, jaw
2. Precipitated by physical activity, emotional excitement, psychological stress, cold, after meals
3. Relieved by rest, vasodilators
What is atypical angina?
Angina that has 2 of 3 of the features of typical angina
What is non-anginal chest pain?
Chest pain that has only 1 of the 3 features of typical angina
What is the cause of Prinzmetal variant angina?
Coronary artery spasm
What is the definition of acute MI?
Detection of cardiac biomarkers + evidence of myocardial ischaemia
What is type 1 MI?
MI with ischaemia due to primary coronary event
What is type 2 MI?
MI with ischaemia due to increased O2 demand or decreased O2 supply
What is type 3 MI?
MI in sudden cardiac death
What is type 4 MI?
MI after PCI
What is type 5 MI?
MI after CABG
What are the complications of acute MI?
1. Heart failure, cardiogenic shock
2. Myocardial rupture, aneurysmal dilatation
4. Conduction disturbances
5. Pericarditis (Dressler syndrome)
What is Dressler syndrome?
pericarditis due to autoimmune response to myocardial damage following an acute MI
What is the early medical management for ACS?
1. Aspirin 300 mg chewed
2. Clopidogrel 300 mg
3. Sublingual GTN
4. Oxygen if SaO2 <98%
5. IV morphine 2.5-5 mg + IV metaclopromide 10 mg
6. Beta-blocker/ CCB
7. Ticagrelor 180 mg if STEMI
What is the post-ACS medical management?
1. Aspirin 75 mg oral
2. Clopidogrel/ ticagrelor
3. Simvastatin 40 mg
4. ACE inhibitor (e.g. ramipril)
5. Beta-blocker (e.g. metoprolol)
6. Aldosterone antagonist (if heart failure and LV systolic dysfunction)
What is involved in the post ACS cardiac rehabilitation programme?
1. Mediterranean diet
2. Safe alcohol consumption
3. 30 min physical activity per day
4. Stop smoking
5. Maintain healthy weight
6. Treat hypertension
7. Treat diabetes
What are the methods for coronary revascularisation?
What are the possible presentations of hypertension?
2. Headache, sweating, palpitation - Phaeochromocytoma
3. Breathlessness - LVH, cardiac failure
4. Severe headache, visual disturbances, fits, transient LOC, symptoms of cardiac failure - malignant hypertension
5. Angina - peripheral vascular disease
What are the cardiac changes in the pathogenesis of hypertension leading to CVD?
1. Resistance vessels (increased wall thickness, reduced lumen diameter)
2. Increased pulse wave velocity
3. Increased calcium and collagen deposition in large vessel wall leading to loss of compliance
4. LVH due to increased peripheral resistance
What are the renal changes in the pathogenesis of hypertension leading to CVD?
1. Reduced renal perfusion > reduced GFR > reduced Na and H2O excretion
2. Reduced renal perfusion > activate RAS > increased aldosterone > further Na and H2O retention
What are the cerebral changes in the pathogenesis of hypertension leading to CVD?
Small vessel changes > lacunae > dementia, stroke
What are the investigations for hypertension?
1. Bloods - FBC, U&Es, Creatinine, glucose and lipidd (fasting), pregnancy, plasma catecholamines
2. Urine - dipstick (protein, blood), metanephrines
4. Echocardiograohy/ MRI
What are the investigations for arrhythmias?
4. Ca, Mg
6. ECG (+/- 24 hr monitoring)
8. Exercise ECG
9. Cardiac catheterisation +/- electrophysiological studies
What is the main pathophysiology of heart failure?
1. Haemodynamic changes
2. Neurohormonal changes
3. Cellular changes
What are the main causes of heart failure?
2. Ischaemic heart disease
3. Lung disease leading to R then L heart failure
4. Valvular heart disease