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Cardiovascular > PBL > Flashcards

PBL Flashcards

1
Q

what initiates the excitement of the heart

A

sino-atrial node

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2
Q

what does stroke volume respond to changes in

A

pre-load and after load (frank-starling curve)

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3
Q

what heart conditions can inherited

A

cardiomyopathies, inherited arrhythmias (LQTS, brugada), very high cholesterol levels

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4
Q

what should waist circumference be for men and women

A

men less than 94cm

women less than 80 cm

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5
Q

what should BMI be

A

18.5-24-9 healthy

more than 30 = obese

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6
Q

what are the three layers of the pericardium and which one is in contact with the heart

A

outermost- fibrous, parietal serous, visceral serous- innermost in contact with the heart

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7
Q

what is between the serous layers of the pericardium

A

pericardial space filled with pericardial fluid

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8
Q

where are the semilunar valves of the heart

A

at the base of the great vessels

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9
Q

where do most of the coronary veins drain into

A

the coronary sinus which drains into the right atrium

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10
Q

where are baroreceptors located and what are they sensitive to

A

located in the walls of the large arteries and are stretch receptors which are sensitive to changes in pressure

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11
Q

how do baroreceptors respond to changes in blood pressure

A

cause reflex changes to bring blood pressure back to normal

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12
Q

how does an increased arterial BP affect the medulla

A

an increased arterial BP causes an increase in action potential frequency to the cardio-regulatory centres in the medulla, causing an increase in parasympathetic activity to the heart, decreasing HR and force of contraction

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13
Q

how do chemoreceptors maintain BP

A

by monitoring blood oxygen, CO2 and pH. if decreased O2 or pH or increased CO2 or pH the chemo-receptors will cause a decrease in para symp stim

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14
Q

what are the natural mechanisms for long term BP maintenance

A

pressure natriuresis, RAA mechanism, ADH mechanism and natriuretic peptide hormone

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15
Q

what is pressure diuresis

A

increased urine output due to high arterial pressure- decreases blood volume

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16
Q

what is pressure natriuresis

A

increased sodium output due to high BP- decreases blood volume

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17
Q

what is the RAA mechanism and how does it control BP

A

renin-angiotensin-aldosterone

regulates kidney function which affects peripheral resistance, blood volume and blood pressure

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18
Q

when is renin secreted and from where

A

released from kidney when BP is reduced

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19
Q

what is the role of renin

A

cleaves protein angiotensin to angiotensin 1 which is later cleaved to angiotensin 2

also acts on adrenal cortex to secrete aldosterone which acts on kidney tubules to increase reabsorbtion of sodium- increasing blood volume

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20
Q

what does angiotensin 2 do

A

constricts arterioles and veins to increase venous return to the heart and increase arterial BP

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21
Q

what is ADH and when is it released

A

anti-diuretic hormone

when baroreceptors detect decrease in arterial blood pressure

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22
Q

what does ADH do

A

acts directly on blood vessels causing vasoconstriction and increases water absorption by the kidneys - increasing BP

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23
Q

what releases natriuretic peptides and when

A

synthesised by the heart, brain and other organs

released in response to cardiac distension or neurohormonal stimuli

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24
Q

what do natriuretic hormones do

A

cause excretion of salt and water in the kidneys - reducing blood volume

also decrease renin release and act as vasodilators

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25
Q

what are ‘gallop’ heart sounds

A

low frequency sounds associated with diastolic filling

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26
Q

where do you measure waist circumference and what does it show

A

between lower rib and iliac spine

distribution of fat

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27
Q

what are the normal ranges for cholesterol

A

LDL below 5

HDL above 1

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28
Q

what are the clinical signs of hypertension

A

loud aortic second sound, prominent left ventricular impulse, fourth heart sound, hypertensive retinopathy

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29
Q

describe the grading of hypertensive retinopathy

A

grade 1 slight narrowing
grade 3 exudates or flame haemorrhages
grade 4 optic nerve oedema

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30
Q

why is being female important in CV history

A

menopause, combined oral contraceptive pill

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31
Q

what drugs are used to treat hypertension

A

ace inhibitor, ARB, calcium channel blocker, thiazide like diuretic,

32
Q

when should fibrates be given

A

patients with very high triglyceride levels

33
Q

what does a loud second aortic sound suggest

A

systemic hypertension with a dilated proximal aorta (loud pulmonary sound would show pulmonary hypertension)

34
Q

what trophic features are associated with limb ischaemia

A 
cold feet
hair loss
shiny pale skin
poor or absent pulses
ulcers
gangrene of toes
amputations
35
Q

are ARBs and ACEis safe in pregnancy

A

no

36
Q

what is the ventricular rate in atrial flutter

A

17/150

37
Q

what are the common causes of peripheral vascular disease

A

smoking, hypercholesteraemia, hypertension, diabetes

38
Q

what drug treatment is used for hyperlipidaemia

A

statins or fibrates

39
Q

how does diabetes affect NO levels

A

reduces them = bad

40
Q

why does high levels of glucose in the blood accelerate the atherosclerotic process

A

as if a pro inflammatory mediator

41
Q

how do beta blockers work

A

completely inhibit the binding of noradrenaline to B1 adrenoceptors in the sympathetic system, resulting in less forceful contractions

42
Q

when is ivabradine used and what does it do

A

alongside beta blockers in angina

blocks HCN channels, delaying pacemaker potential and slowing HR

43
Q

what drugs should never be given together

A

beta blocker and calcium channel antagonist

44
Q

what are the types of necrosis

A

coagulative, caseous, fat, fibroid, gangrenous

45
Q

what is the difference between athero and arterio sclerosis

A

athero lifestyle, lipid build up

arterio purely BP

46
Q

what are the causes of acute severe chest pain

A 
acute coronary syndromes including myocardial infarction
pulmonary embolism
aortic dissection
pneumothorax
herpes Zoster
pericarditis
47
Q

what are the mechanical complications of an MI

A 
acute left ventricular failure
cardiogenic shock
cardiac rupture
pericardial tamponade
ventricular aneurysm
ventricular septal defect
mitral regurgitation
48
Q

what is the treatment for an acute MI

A

Morphine + anti emetic
Oxygen
Nitroglycerin
Aspirin

tricagrelor

thrombolysis if PCI if more that 120 mins from hospital

49
Q

why is CK levels not completely trustworthy

A

can be raised in lots of conditions

50
Q

how is pulmonary oedema seen on a CXR

A

ABCDE of pulmonary oedema on CXR: A - Alveolar oedema (Bat’s wings), B - Kerley B lines (interstitial oedema), C - Cardiomegaly, D - Dilated prominent upper lobe vessels, E - Pleural effusion

51
Q

what is acyanotic heart disease

A

class of congenital heart disease where blood is shunted from the left to the right

  • atrial septal defect
  • ventricular septal defect
52
Q

name 4 ventricular septal defects

A

Patent ductus arteriosus

Aortic stenosis

Coarctation of the aorta

Pulmonary stenosis

53
Q

give examples of cyanotic congenital heart disease

A

Fallots and etology

Transposition

Ebstein’s Anomaly (with ASD)

Hypoplastic left heart

Total anomalous pulmonary venous drainage

Tricuspid or pulmonary artesia

54
Q

how are cardiomyopathies classified

A

Hypertrophic
Idiopathic dilated
Restrictive
Alcohol associated

55
Q

what are cardiac causes of shortness of breath

A 
Cardiac failure
Valvular heart disease
Obstructive airways disease
Restrictive lung disease
Pulmonary hypertension
Pulmonary embolism
Anaemia
56
Q

what can cause cardiac valve disease

A 
Congenital
Rheumatic
Ischaemic
Degenerative
Infective
Miscellaneous
57
Q

what conditions predispose to infective endocarditis

A

Valvular heart disease
Prosthetic heart valves
Congenital heart disease

58
Q

what can cause atrial fibrillation

A 
Rheumatic heart disease
Ischaemic heart disease
Thyrotoxicosis
Alcohol
Hypertension
Lone atrial fibrillation
59
Q

what is rheumatic heart disease

A

Rheumatic fever is an inflammatory disorder caused by Group A strep throat infection. This may progress to rheumatic heart disease, wherein one or more heart valves are damaged or scarred in the process.

60
Q

what are the clinical signs of rheumatic heart disease

A

tapping apex beat- mitral stenosis

AF

61
Q

how does rheumatic heart disease cause AF

A

Increased preload due to mitral stenosis, thus the atria are stretched. This causes erratic electrical activity.

62
Q

name this murmur:

Crescendo-decrescendo, ejection systolic murmur, radiating to the carotids

A

aortic stenosis

63
Q

name this murmur:

Decrescendo early-diastolic murmur.

A

aortic regurgitation

64
Q

name this murmur:

Low-pitch, mid-diastolic murmur with opening snap.

A

mitral stenosis

65
Q

name this murmur:

Harsh, pansystolic murmur radiating to axilla

A

mitral regurgitation

66
Q

name this murmur:

High-pitched, holosystolic radiating to right lower sternal border

A

tricuspid regurgitation

67
Q

what do loop diuretics do

A

leads to the excretion of water from the body

68
Q

what do thiazide diuretics do

A

promote potassium excretion but inhibit calcium excretion

69
Q

what drugs are used to treat heart failure

A

diuretics, beta blockers (reduces HR and BP), ace inhibitors (reduced BP), spironolactone (Aldosterone receptor antagonist), ivabradine (HCN blocker)

70
Q

what is a transthoracic echo

A

shows heart motion and structure as sound waves directed at heart across chest

71
Q

what is a transesophageal echo

A

closer look at valves as scanner down oesophagus

72
Q

what are C-reactive protein and plasma viscosity tests for

A

inflammation, higher the levels the more active the disease

73
Q

what is tetralogy of fallot

A

congenital heart disease = made up of ventricular septal defect, pulmonary stenosis, RVH and a displaced aorta. This causes mixing of oxygenated and non-oxygenated blood leading to cyanosis

74
Q

what is pericarditis

A

inflammation of the pericarditis

75
Q

what can cause pericarditis

A
  • Myocardial infarction (Dressler’s syndrome)
  • Systemic inflammatory disorders e.g. lupus and rheumatoid arthritis.
  • Trauma to your heart or chest
  • Kidney failure
  • AIDS
  • Tuberculosis
  • Cancer
  • Medications although this is unusual

Cardiovascular (34 decks)

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