What is coronary heart disease?
Astheroma formation in coronary arteries
What is Myocardial ischaemia?
Stroke - caused by plaque rupture or ulceration of coronary artery
What are the risk factors for CHD?
Non modifiable
- Age 40-60
- cellular celesence
- Plaque maturation
- genetics
- Family Hx - hyper cholesterol diabetes - Gender - oestregon, willingness to change
Modifiable
- Dyslipidemia - high cholesterol
- Smoking - Nicotine stress vessel, predispose to injury
- Hypertension - stress vessels
- Diabetes - Inc. cholesterol, Hyperlipidemia, insulin resistance
- Obesity
- Physical inactivity
Metabolic syndrome - 3/5 criteria
Obesity, diabetes, Dyslipidemia, Hypertension, Low HLD
Discuss the management for CHD risk factors?
Diet change increase exercise 150-300 a week stop smoking Take meds to regulate cholesterol and hypertension Diabetes meds
What are a mature atheroma and its structure?
Artheroma is a plaque = Fibrous caps of cells and connective tissue
How does atheroma develop?
1) Endothelial damage
2) Increase permeability of the wall and allow passage of ADL to Tunica intima
3) Chronic inflammation + add immune cells
4) gradual accumulation of lipid over time
What are some complications of atherosclerotic plaque formation.
Chronic ischaemia - narrowing of lumina
Thrombus formation
Aneurysm
Plaque calcification
- coronary artery - angina - chest pain
- peripheral artery - leg pain
- cerebral artery - dyspnea, numbness weakness in arms, loss of vision
What are the difference and clinical features between stable angina, unstable angina and myocardial infarction?
Stable Angina
- Dyspnea - Tachycardia
- Pallor - Nausea - Fatigue
Unstable Angina
- Same as angina but more intense and S&S mya present at rest
AMI
- Same as unAngina plus
- Diaphoresis
- tachycardia and tachyphonea
- Psychological stress
- loss of consciousness
What is cardiac arrhythmia?
A variation from a normal heart rhythm
What is the classification of arrhythmias?
- Regular irregular heartbeat
- Irregular irregular heartbeat
What are the risk factors for atrial fibrillation?
Hx Obesity sleep apnea Alcohol caffeine High-intensity exercise
Whats the clinical presentation for atrial fibrillation?
Palpitation dyspnea dizziness weakness hypotension Angina
What are pericarditis and endocarditis and their clinical features?
Pericarditis - Inflammation of the pericardium
- Chest P - Back shoulder referral - dysphagia - restlessness - anxiety - fatigue
Endocarditis - inflammation of endocardium due to infection
- Arythmia, chest pain, valvular dysfunction,
- fever, fatigue, loss of appetite, malaise
How to diagnose hypertension?
Hypertension is diagnosed by taking BP measurement patients with BP > 90/140
What are the risk factors for hypertension?
Primary Hx Inc. salt Age Gender Alcohol Obesity Physical inactivity smoking
Differentiate between the terms “primary hypertension” and “secondary hypertension”
Primary: Caused directly by patient habits
Secondary: Caused by other disease
List some potential causes of secondary hypertension
Pregnancy Stress renal disease medications endocrine disease atheroma
Define the terms “isolated systolic hypertension” and “malignant hypertension”?
isolated systolic hypertension: when the systolic pressure is > 140 but the diastolic remains normal <90
Malignant hypertension: BP> 180/120 medical emergency
Summarise the possible clinical features and complications of hypertension
Clinical Severe headache Fatigue or confusion Vision problems Chest pain Difficulty breathing Irregular heartbeat Blood in the urine
Complications AMI Heart Failure Haemorrage aortic aneurism
What is the management of hypertension
Lifestyle changes
Meds - diuretics, beta blockers, ace inhibitors
What is aortic dissection and how are they classified?
Tear in tunic intimate of aorta
classified by
Type A: dissection of ascending aorta aortic root
Type B: dissection of descending aorta
Describe risk factors and clinical features of aortic dissection
Risk
- HBP - Age, Male, genetic -Smoking
- Hx - drugs - Trauma
clinical
- Sudden onset, severe chest and upper back pain, sharp
- Shortness of breath (Dyspnea)
What causes common heart failure and what are the clinical features
Failure of the heart to maintain CO, despite normal volume
Clinical
Fatigue, weakness, chest P, dizziness, displaced apical beat, Tachycardia, thready pulse
How is chronic heart failure classified
Lt sided = systolic failure
Rt side = diastolic failure
