cardio theory Flashcards
(101 cards)
1
Q
depolarisation + repolarisation electrolyte movement (SA node)
A
- Ca2+ influx (de-)
- K+ efflux (re-)
2
Q
depolarisation + repolarisation electrolyte movement (myocytes)
A
- Na+ influx (up)
- Ca2+ influx (flat)
- K+ efflux (down)
3
Q
stroke volume (SV)
A
volume of blood ejected by each vent per beat
4
Q
SV =
A
EDV (end diastolic volume) - ESV (end systolic volume)
5
Q
cardiac output (CO)
A
volume of blood pumped by each vent per minute
6
Q
CO =
A
SV x HR
7
Q
systemic vascular resistance (SVR)
A
sum of resistance in all vasculature (sys circ)
8
Q
mean arterial pressure
A
CO x SVR
9
Q
MAP =
A
systolic + (diastolic x2)
/3
10
Q
most resistance in MAP
A
arterioles
11
Q
S1 cause
A
beginning of systole - mitral + tricuspid
12
Q
S2 cause
A
start of diastole - pulmonary + aortic
13
Q
blood vessel layers
A
- tunica intima (endo)
- internal elastic - - tunica media (SM)
- external elastic - - tunica adventitia (CT)
14
Q
elastic arteries
A
largest / aorta - sheets of elastic fibres in TM
15
Q
vasa vasorum
A
blood supply to outer parts of large blood vessels (far from lumen)
16
Q
arterioles his changes
A
very thin SM, almost no TA
17
Q
metarteriole his changes
A
SM replaced by pericytes (dis-continuous contractile cells)
18
Q
capillaries are absent
A
epithelial cells on BM
epidermis (skin / hair / nails)
cornea of eye
hyaline cartilage
19
Q
capillary types
A
- continuous (muscle / CT / lung / skin / nerve)
- fenestrated (gut mucosa / endocrine glands / kidney glomeruli)
- discontinuous (liver / spleen / bone marrow)
20
Q
thoroughfare channels
A
direct link between arterioles + venules - bypasses caps
21
Q
precapillary sphincters
A
SM, control flow into caps
22
Q
heart layers
A
- endocardium (endo + fibrous tissue)
- myocardium (SM)
- epicardium (meso + fibrous tissue)
23
Q
pericardium layers
A
- fibrous (fibrous + CT)
- serous (meso + CT)
24
Q
valve structure
A
lamina fibrosa -> continuous to fibrous skel
anchored to papilllary muscles by chordae tendineae
25
shock definition
inadequate tissue perfusion / oxygenation (circ sys abnormality)
26
shock types
1. hypovolaemic
2. cardiogenic
3. obstructive
4. distributive
27
hypovolaemic shock
physical lack of blood -> decreased CO / BP
28
cardiogenic shock
decreased cardiac contractility -> decreased CO / BP
29
obstructive shock (tension pneumothorax)
increased pressure -> decreased venous return
-> decreased CO / BP
30
distributive shock (neurogenic)
loss of sym tone -> decreased venous return + HR -> decreased CO / BP
31
distributive shock (vasoactive)
vasoactive mediators -> vasodilation / decreased venous return -> decreased CO / BP
32
baroreceptor resp to hypovolaemic shock
can comp til >30% loss
increase sympathetic activity (vasoconstriction + increase HR)
33
ECG physics
movement towards recording (+) electrode = UP
movement away = DOWN
34
limb leads
l - RA to LA
ll - RA to LL
lll - LA to LL
35
normal ECG intervals
P wave - 0.08 - 0.1
QRS - 0.1
PR - 0.12 - 0.2
QT - 0.36 - 0.44 (60bpm)
36
PR interval
start of P - start of QRS
37
ST segment
end of QRS - start of T
38
QT interval
start of QRS - end of T
39
augmented limb leads
aVR - RA records
aVL - LA records
aVF - LL (foot) records
40
chest leads dir
v1-v2 - septum
v3-v4 - anterior
v5-v6 - lateral
41
limb / augmented dir
l + aVL - lateral
ll + lll + aVF - inferior
42
syncope definition
TLOC due to cerebral hypoperfusion (rapid onset / short duration / spontaneous recovery)
43
syncope types
1. reflex (neural reflexes)
2. orthostatic hypo
3. cardiac (cardiac event)
44
reflex syncope
neural reflexes -> cardioinhibition or vasodepression -> drop in MAP
45
reflex syncope types
1. vasovagal (stress)
2. situational (trigger)
3. carotid sinus (mech manipulation of neck)
46
coronary venous drainage
coronary sinus
47
coronary blood flow - intrinsic mechs
PO2 decrease = vasodilation
metabolic hyperaemia
adenosine (ATP) = vasodilator
48
coronary blood flow - extrinsic mechs
sym stim overridden by metabolic hyperaemia = still vasodilation
49
SkM blood flow in exercise
sym tone overridden by metabolic hyperaemia = vasodilation regardless
(+ CO helps)
50
S3
early diastolic filling
AFTER S2
rapid blood flow into compliant ventricle - APEX
only pathological in older / cardiac disease
51
S4
late diastolic filling
BEFORE S1
rapid blood flow into stiff ventricle - APEX
ALWAYS pathological
52
murmur grades
1 - heard by expert
2 / 3 - non-expert, no thrill
4 / 5 - thrill
6 - you dont even need a stethoscope
53
innocent murmur
turbulence through normal valve - hyperdynamic sys
pulmonary area
localised
no radiation
no other cardiac abnormalities
54
cardio RF
smoking
sedentary life
obesity
alcohol
age
gender
ethnic bg
FHx
55
cardio RF (comorbid)
HTN
high cholesterol
irregular heartbeat
high blood glucose
diabetes
chronic kidney disease
inflamm conditions
atypical antipsychotics
56
sites to asses CVD risk
QRISK
ASSIGN
57
HTN definition
BP level where treatment does more good than harm
58
HTN stages
1 - ≥140/90 clinic
≥135/85 ABPM/HBPM
2 - ≥160/100 clinic
≥150/95 ABPM/HBPM
severe (3) - ≥180 sys clinic
OR ≥110 dias clinic
59
HTN monitoring
urine - haematuria, Alb:Cr
bloods - FBC, U+E, eGFR, glucose, fasting lipids, electrolytes
fundoscopy
ECG - LVH, past MI
60
HTN targets
ABPM / HBPM
<80 - <135/85
80+ - <145/85
diabetes - <130/80 (clinic)
61
secondary HTN causes
renal disease
sleep apnoea
endocrine (aldosteronism / cushing's / adrenal malig)
aortic coarctation
pregnancy HTN assoc
62
virchow's - hypercoagulable state
malignancy
pregnancy
oestrogen therapy
IBD
sepsis
thrombophilia
combined pill
63
virchow's - endothelial injury
venous disorders
venous valvular damage
trauma / surgery
indwelling catheters
64
virchow's - circ stasis
LV dys
immobility / paralysis
venous insufficiency
venous obstruction (tumour / obesity / pregnancy)
65
HERDOO2 scale
Hyperpigmentation
Edema
Redness
D-dimer high
Obesity
Older age
women 0-1 no, ≥2 yes
men yes
66
post thrombotic syndrome
1/3 of patients w/ idiopathic DVT (5ys)
pain
oedema
hyperpigmentation
eczema
varicose collateral veins
venous ulceration
67
chronic thromboembolic pulmonary hypertension
PE complication - 5%
initially asymptomatic
progressive SOB + hypoxaemia
RHF frequently occurs
68
true aneurysm
all 3 artery layers involved
69
false aneurysm
defect in wall of artery - restrained by surrounding structures
70
types of aneurysm
1. saccular
2. fusiform
71
EVAR pro/con
safer
faster recovery
only possible in 75%
needs follow ups / further interventions
72
open AAA repair pro/con
possible in (alm) everyone
effective for life
greater morality risk
slower recovery
73
aortic dissection classes
class A - starts before branches (cardiothoracic)
class B - starts after branches (vascular)
74
CABG vs PCI
PCI generally safer, time constraint
75
angina vs ACS
fixed stenosis
demand led ischaemia
dynamic stenosis
supply led ischaemia
76
ACS distinction
STEMI - total occlusion
NSTEMI - subtotal occlusion
UA - subtotal occlusion, only, ischaemia no infarction
77
MI types
inferior - ll, lll, aVF
anteroseptal - v1-v4
anterolateral - l, aVL, v1-v6
78
old MI ECG
1. Q waves
2. inverted T waves
79
ACS complications
death
arrhythmic comp
structural comp - rupture, VSD, valve regurg
functional - acute vent failure, HF, cardiogenic shock
80
troponin complexes
TnC - cardiac + SkM
TnI + TnT - cardiac specific
81
MI classifications
class 1 - spontaneous + ischaemia due to primary coronary event
class 2 - secondary to ischaemia due to O2 supply / demand imbalance
class 3 - SCD
class 4 - iatrogenic
82
movement through capillary walls
fluid - pressure gradient
lipid soluble - endothelial cells
water soluble - water-filled pores
(large molecules do Not)
83
starling forces
favouring filtration -
cap hydrostatic pressure
ISF osmotic pressure
opposing filtration -
cap osmotic pressure
ISF hydrostatic pressure
84
starling force favouring
arteriolar end - filtration
venular end - reabsorption
85
oedema definition
accumulation of fluid in interstitial spaces
86
pulmonary oedema consequences
diffusion distance increases -> gas exchange compromised
lung compliance decreases
87
causes of oedema
raised cap hydrostatic pressure -
arteriolar dilation
raised venous pressure (RHF - per / LHF - pulm)
((RAAS upregulation in HF))
reduced plasma osmotic pressure -
malnutrition
protein malabsorption
excessive renal secretion
hepatic failure
lymphatic insufficiency -
lymph node damage
filariasis
changes in cap perm -
inflammation
88
NYHA classification of HF
1 - no limitation of physical activity
2 - slight limitation of ordinary activity
3 - marked limitation of physical activity, less than ordinary causes Sx
4 - unable to carry out physical activity without Sx, Sx at rest
89
ejection fraction (EF)
percentage of blood pumped out of heart in each beat
normal ≥50%
90
HFrEF
reduced ejection fraction
≤40% EF
LV unable to eject adequate blood
91
HFpEF
preserved ejection fraction
LV unable to properly fill (myocardial stiffness), less blood to pump
92
types of AVRT
orthodromic - clockwise
antidromic - anticlockwise
93
cardiorespiratory arrest causes
hypoxia
hypovolaemia
hypothermia
hypo / hyperkalaemia
tension pneumothorax
tamponade
toxins
thrombus
94
ECG axis determination
aVF = 6, l = 2/3
normal - aVF ^, l ^
left - aVF \/, l ^
right - aVF ^, l \/
extreme right - aVF \/, l \/
95
right sided murmurs
louder with inspiration
96
ductus venosus
umbilical vein -> IVC
bypasses liver
97
foramen ovale
opening in atrial septum
closed by change in pressure
98
ductus arteriosus
connects pulmonary bifurcation to descending aorta
maintained by prostaglandin E2
closed by lack of ^ + increase O2
99
infective endocarditis mech
1/ heart valve damaged
2. turbulent blood flow over roughened endothelium
3. platelets / fibrin deposited
4. bacteraemia
5. organisms settle in thrombi + become microbial vegetation
100
amyloid
abnormal deposition of any protein
waxy pink histology
101
myxoma
most common heart tumour
carney's syndrome - multiple ^
