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Conditions + definitions > Cardio > Flashcards

Cardio Flashcards

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1
Q

What is the endocardium?

A

Inner most layer of heart
Lines heart chambers
Made of simple squamous epithelium on basement membrane
Forms valves

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2
Q

What is the myocardium?

A 
The middle layer of the heart, thickest
Made of cardiac muscle
Striated with lots of mitocondria
Rich capillary bed
Myocytes connected by intercalated discs
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3
Q

What are intercalated discs?

A 
Complex junctions that connect myocytes
Desmosomes
>Binds myocytes together
Gap junctions
>Electrical communication
>Essential cor o-ordination oc cardiac cycle
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4
Q

What is the epicardium?

A

Outer layer of heart
Made up of connective tissue and BM with simple squamous pithelium
>Epithelium same as visceral layer of serous pericardium
Contains main branches of coronary arteries

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5
Q

What are the features of the heart valves?

A

Control direction of blood
Cusps - thin structures derived from endocardium
Work passively
Chordae tendineae and papillary muscles prevent valve failure

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6
Q

What are the heart valves?

A

Semilunar - Pulmonary /Aortic

Atrio-ventricular - bicupsid (mitral) / tricupsid

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7
Q

What is the cardiac skeleton?

A

Connective tissue that provides structural support to the heart
Provides electrical insulation

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8
Q

What are the coronary arteries?

A

Left and right - have smaller subdivisions
Found in epicardium
During systole aortic sinuses shielded by aortic valve cusps
In diastole blood can then enter

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9
Q

What makes up the cardiovascular system?

A

Heart
arteries, veins, capillaries
Lymphatics

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10
Q

What are the layers of a blood vessel?

A 
Tunica intima
>simple squamous Epithelium + BM + epithelium
Tunica media
>Muscle - smooth or elastic
Tunica adventitia
>Connective tissue
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11
Q

What are the types of arteries?

A

Elastic
Muscular
Arterioles

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12
Q

What are elastic arteries?

A

For large conducting arteries - like Aorta
Work as a pressure reservoir
Stretched during systole, and during dystole they recoil maintianing pressure on blood
Due to elastic fibres in tunica media in laminae

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13
Q

What are muscular arteries?

A

For distribution of blood to regions - like femoral
No elastic laminae, but smooth muscle cells
Do have elastic fibres in internal elastic lamina and external elastic lamina
>Found underneath epithelium and between Tunica media and adventitia

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14
Q

What are arterioles?

A

Terminal branches before capillaries
No internal elastic lamina
Only 1 or 2 layers of smooth muscle in tunica media
And no tunica adventitia
They control blood flow to capillary beds
And control systemic blood pressure

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15
Q

What are capillaries?

A

Main site of echange for nutrients and gases
Thin walled with only tunica intima
Have pericytes that help control bloof flow

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16
Q

What are pericytes

A

an incomplete layer of cells surrounding basment membrane of capillaries
Have contractile properties

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17
Q

What are the three types of capillary?

A

Continuous
Fenestrated
Discontinuous

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18
Q

What are the features of continuous capillaries?

A

Can control what is exchanged in and out
Material must pass through cell of between cell
Selective transport mechanims
Foundin muscle

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19
Q

What are the features of fenestrated capillaries?

A

Have pores in the lining (fenestrations)
Can be with or without protein diaphgrams (which filter moecules by weight or charge)
Found in endocrine glands/renal corpsucle

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20
Q

What are the features of discontinuous capillaries?

A

Have gaps between endothelial cells (and basement membrane)
Allow free passage of fluid and cells
Found in Liver, spleen, bone marrow

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21
Q

What are sinusoids?

A

Large diameter discontinuous capillaries
Found where large amount of exchange takes place
T. intima contains phagocytic cells

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22
Q

What is the structure of a vein?

A 
Thin T intima
IEL/EOL thin or absent
T mediat thin or absent
T adventitia made of collagenous tissue
Have valves to prevent backflow
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23
Q

What is the difference between superficial veins and deep veins?

A

Superficial are thick walled and have no surrounding support

Deep are thin walled and have surrounding support from deep fascia and muscle

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24
Q

What is teh lymphatic system?

A

Drains tissue fluid lost from capillaries
Drains into venous system
Nodes found alongside major veins/artery origins
Valves direct flow

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25
What are lymph capillaries?
Blind ended capillaries lined by vey thin epithelium No fenestations Absent basal lamia Lumen contained via negative hydrostatic pressure >has collagenous filaments linking to surrounding tissue to keep lumen open No red blood cells enter
26
Where is the blood/lymphatic cupply of blood vessels?
Blood - vasa vasorum in T adventitia | Lymphatics in T adventitia
27
What is the cardiac cycle?
Diastole Atrial systole Ventricular contraction Ventricular ejection
28
What is the pressure volume loop?
A – ventricular diastole + filling sees a gradual increase in volume and pressure. B – mitral valve closes and the ventricle contracts, pushing pressure up rapidly. C – Aortic valve opens and the ventricle is still contracting increasing its pressure, decreasing volume. D – Aortic valve closes and the ventricle relaxes causing a rapid decrease in pressure.
29
What is the phonocardiogram?
Should hear mitral and tricupsid valves closing together Then a little later tha aortic + pulmonary closing "lub-dub" extra hear sounds can be heard in pathology
30
Why is cardiac muscle unable to exhibit tetanus?
Has a longer refractory period than skeletal muscle Means that when last contraction is ending, new one begins Stops tetanus from occuring
31
What affects electrical activity of the heart?
``` Temperature Calcium plasma levels hyper=tachycardia + increased contraction, vice versa Potassium serum levels Drugs >CCBs, >Cardiac glycosides ```
32
What is the conducting system of the heart?
SAN through atria AVN Through bundle of his Through purkinje fibres
33
What do the waves on an ECG correspond to?
P - atrial depolarisation QRS - corresponds to ventricular depolarisation T - ventricular repolarisation
34
Where are the ECG limb leads placed?
Right wrist left wrist Left leg Placed on right leg but used to earth
35
What is the PR interval?
The time ti takes from atrial depolarisation to ventricular depolarisation
36
What do the precordial leads view?
Gives same information, however in the transverse plane
37
How large should a square on ECG paper run?
5mm - 0.2 seconds | I.e 30 squares to a minute
38
What is a STEMI?
ST elevated myocardial infarction (worse than if it didn't exist)
39
What is the normal range for the PR interval?
0.12-0.2 seconds
40
What is the normal range for the QRS interval?
no more than 0.12 seconds
41
What is the normal range for the QT interval?
0.42 seconds
42
What HR is normal, bradycardic, tachycardic?
Less than 60 = bradycardic 60-100 normal Above 100 = tachycardic
43
What are starling's forces?
Capillary hydrostatic pressure vs ISF hydrostatic pressure Plasma osmotic pressure vs ISF osmotic pressure Net filtration pressure = (Pc - Pif) - (piP - piIF)
44
What is darcy's law?
Flow = pressure/resistance
45
What is poseuille's law?
Resistance is proportional to length of tube * the viscosity of the fluid /radius
46
What determines mean arterial pressure?
Cardiac output * total peripheral resistance
47
How is MAP controlled extrinsicly?
Neural control through sympathetic nerves Hormonal control through adrenaline >Both constriction and dilation, dependent on tissue Angiotensin Vasopressin All above are constriction ANP?BNP - arterial dilation
48
What are the intrinsic mechanisms for controlling MAP?
Metabolic driven (to "flush") Pressure autoregulation Reactive (due to occlusion) Injury response
49
What contributes to venous return?
``` Gravity skeletal muscle pump respiratory pump venomotor tone systemic filling pressure ```
50
What is the vasalva maneuvre?
Forced expiration against a closed glottis | Activates baroreceptor reflex due to decreasing venous return momentarily
51
What are the signs of hyperlipidaemia?
``` Corneal arcus Tendon xanthomata Xanthelasmata Family history Biochemical evidence ```
52
What is virchow's triad?
Risk factors for thrombosis Changes in blood vessel wall Changes in blood constiuents Changes in pattern of blood flow
53
How do beta blockers help myocardial demand?
Decrease heart rate Decrease contracility Decrease systolic wall tension Thus decrease CO/BP
54
What is the rebound phenomena?
Sudden cessation of beta blocker therapy may precipitate myocardial infarction
55
What are the contraindications fo beta blockers?
``` Asthma Peripheral Vascular Disease >Relative contraindication Raynauds Syndrome Heart failure >Those patients who are dependent on sympathetic drive Bradycardia / Heart block ```
56
How is HR regulated?
Sympathetic - increases Parasympathetic - decreases Both act on SAN
57
What is afterload?
Afterload is the load against which the muscle tries to contract Set by arterial pressure In turn determined by TPR (inversely proportional)
58
How is stroke volume affected by calcium + infacrction + barbituates?
Hypercalcaemia - increaes Hypocalcaemia - decreaes Infacrction - decreaes Barbituates - decreaes
59
What are the types of CCBs?
Rate limiting | Vasodilation
60
How do you treat an ischaemic stroke?
Ateplase within 4.5 hours | After confirmed on CT head
61
What is secondary prevention for a stroke?
Clopidogrel Or aspirin + diprydamole Statins
62
What are the common sites for varicose veins?
Long and short saphenous veins
63
What are the S&S of varicose veins?
``` Cosmesis Localised or generalised discomfort in the leg Nocturnal cramps Swelling Acute haemorrhage Superficial thrombophlebitis Pruritus - itching Skin changes ```
64
When should you treat varicose veins?
Superficial thrombophlebitis Signs of chronic venous insufficiency Bleeding
65
How do you treat varicose veins?
``` Surgery High tie, stripping, multiple stab avulsions Injection (sclerotherapy) Minimally invasive procedures Compression Conservative (may include compression) ```
66
What is the presentation of chronic venous insufficency?
``` Ankle oedema Telangectasia Venous eczema Haemosiderin pigmentation Hypopigmentation “atrophie blanche” Lipodermatosclerosis Venous ulceration ```
67
What is the pathogensis of CVI?
Venous hypertension Venous engorgement and stasis Imbalance of Starling forces and fluid exudate Often due to standing still Or high AVP
68
What is a leg ulcer?
breach in the skin between knee and ankle joint, present for over 4 weeks
69
How do you treat CVI?
compression therapy EXCLUDE ARTERIAL DISEASE Dressings- non-adherent dressings if painful- hydrocolloid/ foam dressing Exercise – calf muscle pump
70
What are the causes of lymphodema?
``` Primary: >Congenital >Praecox >Tarda Secondary >Malignancy >Surgery (Radical mastectomy; groin/axillary dissection) >Radiotherapy >Infection (Filariasis/tuberculosis/pyogenic) ```
71
What abnormalities is downs associated with?
Atrioventircal septal defects | Duodenal atresia
72
What abnormalities is turner syndrome associated with?
coarctation of aorta short stature gonadal dysgenesis puffy hands
73
What abnormalities is nooan syndrome associated with?
Pulmonary stenosis Short stature neck webbing cryptorchidism
74
What abnormalities is 22q11 deletion syndrome associated with?
``` C ardiac malformation A bnormal facies T hymic hypoplasia C left palate H ypoparathyroidism ```
75
What abnormalities is williams syndrome associated with?
``` Aortic stenosis (supravalvar) Hypercalcemia 5th finger clinodactyly characteristic face cocktail party manner ```
76
What abnormalities is marfansyndrome associated with?
Connective tissue disorder Mitral valve prolapse Pneumothorax!
77
What is a true aneurysm?
``` Weakness and dilation of vessel wall - include all layers Associated with: Hypertension Atherosclerosis Smoking Collagen abnormalities (Marfan’s) Trauma Infection (mycotic/syphillis) ```
78
What is a false aneurysm?
Rupture of aortic wall | Haematoma contained by adventitial layer or surrounding soft tissue
79
How does a false aneurysm present?
Thrill Bruit Pulsatile mass Ischaemia Rupture
80
How does a thoracic aneurysm present?
shortness of breath or even heart failure (AR) dysphagia and hoarseness (ascending aorta, chronic) Sharp chest pain radiating to back –between shoulder blades –Possible dissection! Pulsatile mass Hypotension
81
What are the risk factors for aortic dissection?
Hypertension Atherosclerosis Trauma Marfan's syndrome
82
What is takayasu's artertitis?
``` Granulomatous vasculitis Affects women more than men Presents with stenosis, Thrombosis Aneurysms Renal artery stenosis Neurological symptoms ```
83
What is a bicupsid aortic valave?
``` Most common congenital abnormality Prone to stenosis +/- regurgitation Associated with: coarctation Abnormal aorta (reduced tensile strength) Prone to aneurysm/ dissection Monitor with echo/ MRI ```
84
What are the signs of coarctation?
Cold legs Poor leg pulses If before left subclavian artery: >Radial – radial and RIGHT radial-femoral delay If after left subclavian artery: >No radial- radial delay >Right and left radio-femoral delay
85
What are the symptoms of chronic limb ischaemia?
Intermittent claudication “Critical limb ischaemia” Rest pain ulceration & gangrene (wet/dry)

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