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MD1 FBS > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What condition is this?

A

Aortic regurgitation

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2
Q

What does concentric hypertrophy compensate for?

A

Increased afterload

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3
Q

Define eccentric hypertrophy

A

Normal relative wall thickness

Increased LV mass

LV enlargement

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4
Q

Define concentric hypertrophy

A

Increased relative wall thickness

Increased LV mass

No LV enlargement

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5
Q

Define compliance

A

ability of any chamber to accept increased volume

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6
Q

What type of blood vessels are these?

A

Arterioles

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7
Q

What condition is this?

A

Mitral stenosis

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8
Q

What is the molecular target of heparin?

A

Heparin enhances activity of antithrombin III, which inhibits factor Xa and thrombin

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9
Q

What percentage of red blood cell dry content does Hb make up?

A

97%

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10
Q

What 2 forms may a true aneurysm take?

A

Sacular (unilateral outpouching) and fusiform (bilateral outpouching)

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11
Q

Name 4 outcomes of atherosclerosis that predispose to CV disease

A
  • Stenosis
  • Impaired vasodilation
  • Unstable plaque
  • Local prothrombotic environment
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12
Q

What makes up about 97% of red blood cell dry content?

A

Hb

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13
Q

What effects does sympathetic stimulation of the heart have?

A

Increased heart rate and force of contraction

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14
Q

What does eccentric hypertrophy compensate for?

A

Increased volume (preload)

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15
Q

What are the 4 main classes of drug used to treat hypertension?

(2 re angiotensin ax, 2 re heart fx)

A

ACE inhibitors

Angiotensin receptor antagonists

Beta blockers

Calciium channel blockers

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16
Q

What are 4 distinguishing features of the phrenic nerve course?

A
  1. Runs along scalenus anterior muscle
  2. Passes between subclavian artery and vein
  3. Passes anterior to lung root
  4. Pierce diaphragm
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17
Q

What type of blood vessel is this?

A

Arteriole

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18
Q

Why does Hb carry nitric oxide bound to a globin thiol group? And when does Hb release it?

A

It rrelaxes vascular walls and enhance gas diffusion. Hb releases NO at the same time as oxygen.

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19
Q

How is bradykinin degraded?

A

By angiotension converting enzyme

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20
Q

Define thrombus

A

Clotted mass of blood that forms within the cardiovascular system during life

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21
Q

Define afterload

A

Load encountered by ventricle at the beginning of systole.

The amount of work the heart needs to do to eject blood

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22
Q

What effect does beta adrenoceptor stimulation have on the heart?

A

Increased heart rate and cardiac contractility

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23
Q

What is it called when there is an infection of heart valves?

A

Endocarditis

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24
Q

Where does the parasympathetic nervous system innervate the heart?

A

SA node and AV node

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25
Q

What is the function of lipoproteins?

A

liporoteins transport fats such as cholesterol in the blood

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26
Q

What effect does shifting the O2 saturation curve to the right have on Hb affinity for O2?

A

Decrease

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27
Q

When CO increases (beyond the equilibrium point), what happens to venous pressure?

A

Decreases

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28
Q

Name two mechanisms Hb uses to achieve variable sigmoid binding character for oxygen association

A

Subunit cooperativity and allosteric effectors

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29
Q

List 5 acute signs of hypovolaemia

A

Tachycardia

Hypotension

Cold/clammy skin

Poor capillary refill (> 2 secs)

Tachypnea (if severe hypovolaemia)

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30
Q

What is the main risk factor for aortic disection?

A

Hypertension

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31
Q

What is the characteristic histological feature of elastic arteries?

A

Up to 50 layers of elastin in the media

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32
Q

How do beta blockers treat arrythymias?

A

Reduce sympathetic drive to SA node

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33
Q
A
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34
Q

What is a typical ejection fraction?

A

60% (Guyton and Hall, 1996)

(55%-70% healthy ranges)

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35
Q

What are the braches off the arch of the aorta from right to left?

A

Brachiocephalic a (branches into right subclavian a and right common carotid a)

Left common carotid a

Left subclavian a

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36
Q

What type of blood vessel is this?

A

Medium vein

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37
Q

What cardiac phase does S2 correspond to?

A

Isovolumetric relaxation (start of diastole)

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38
Q

What are the constitutive subunits of Hb in adults and foetuses?

A

Adults: 2 alpha and 2 beta Foetuses: 2 alpha and 2 gamma

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39
Q

At the level of which thoracic vertebrae does the heart sit?

A

T5 to T8

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40
Q

What is the order of the cardio exam?

A

General inspection. Palmar creases. Capillary refill. Radial pulse. BP. Conjunctiva. Lips and tongue. JVP. Carotid pulse. Palpate apex beat. Auscultation. Lungs. Shin oedema. Dorsal pedis pulse. Posterior tibial pulse.

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41
Q

The names of angiotensin receptor antagonists end with what?

A

-sartan

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42
Q

Mitral regurgitaiton would typically cause which type of hypertrophy?

A

Eccentric hypertrophy

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43
Q

Define compliance

A

Ability of a chamber to accept a volume of fluid

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44
Q

Where is the sternal angle?

A

Horizontal line between manubriosternal joint and T4/T5

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45
Q

What are the contraindications to treatment with ACE inhibitors?

A

Bilateral renal stenosis

Pregnancy

Angioneurotic oedema

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46
Q

What does the vascular funciton curve describe?

A

Describes what happens to venous pressure when CO varies

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47
Q

What is cardiac remodeling?

A

Increase of relative wall thickness without increase in left ventricle mass

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48
Q

What are the 3 components of Virchow’s triad of thrombosis?

A

Vessel wall Blood composition Blood flow

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49
Q

What is the descending order of WBC concentrations in the blood?

A

NLMEB

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50
Q

What are the 3 critical intermediates of cholesterol synthesis?

A

HMG-CoA (hdroxymethyglutaryl-CoA),

isoprene

squalene

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51
Q

Describe 5 steps in secondary haemostasis

A

1 vessel damage releases tissue factor 2 extrinsic pathway: parathrombin → thrombin, 3 fibrinogen to fibrin, 4 fibrin crosslinks under factor XIIIa control 5 meshwork

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52
Q

What is the ligamentum arteriosum a remnant of?

A

Ductous arteriosus

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53
Q

What do the names of ACE inhibitors end in?

A

-pril

The step before Satan (the drugs which end in -sartan are AII inhibitors, and ACE is the step before AII)

Btw Satan was born in April.

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54
Q

What is a typical SV?

A

70ml (Guyton and Hall, 1996)

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55
Q

What is the molecular target of warfarin?

A

Vitamin K reductase

Inhibition of this prevents reduced VitK acting as a cofactor for activation of factors 2, 7, 9 and 10

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56
Q

What are the 3 main components of the coagulation system?

A

Vasoconstriction, platelet plug and fibrin mesh

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57
Q

How do K+ channel blockers affect arrhythmias?

A

Prolong cardiac AP by slowing repolarisation

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58
Q

What percentage of the blood is in the arteries?

A

13%

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59
Q

Name 3 vasoactive agents that endothelium releases and describe their effect on vasculature

A

Vasoconstrictor: endothelin
Vasodilator: NO and prostacyclin (PGI2)

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60
Q

What type of noradrinergic receptors are found on the heart?

A

Beta 1 (because you have 1 heart)

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61
Q

List 5 factors that may affect the effects of warfarin

A

Diet (VitK)

Hepatic disease

Hypermetabolic state

Pregnancy

Drug interactions, eg NSAIDs, EtOH

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62
Q

What are the 3 general complications of atherosclerosis?

A

Infarct

Ischaemia

Aneurysm

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63
Q

Name 4 ways endothelium is implicated in atherosclerosis

A
  1. Endothelial damage increases permeability to LDL
  2. Damaged endothelium loses its normal anti-coagulant properties
  3. Endothelium recruits macrophages through expression of selectins, ICAM and VCAM
  4. Endothelial cells don’t produce as much prostacyclin or NO → impaired vasodilation
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64
Q

Volume overload would typically cause which type of LV hypertrophy?

A

Eccentric

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65
Q

Define atherosclerosis

A

Accumulation of lipid and fibrous connective tissue (plaque) in the intima of medium and large arteries

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66
Q

During which cardiac phase is ventricular volume greatest?

A

Isovolumetirc contraction

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67
Q

Define preload

A

The amount of stretch on cardiac myocyte fibres at the end of diastole.

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68
Q

Name 3 substances that have cholesterol as a precursor in their synthesis

A

Bile acids

VitD

Steroid hormones

69
Q

The names of beta blockers end in what?

A
  • olol
    e. g. atenolol, propranolol
70
Q

Define diaphoresis

A

Profuse sweating

71
Q

Where are cholinergic receptors on the heart found?

A

SA node and AV node

72
Q

What is the upper limit for recommended cholesterol levels?

A

5.5 mmol/L

73
Q

A new drug called dozatapril is on the market. What class of drug is this likely to be?

A

ACE inhibitor

74
Q

Aortic stenosis would typically cause what kind of LV hypertrophy?

A

Concentric

75
Q

Where does ligamentum arteriosum attach?

A

Bifurcation of pulmonary trunk to inferior aspect of aortic arch

76
Q

What is the most common cause of LV hypertrophy?

A

Myocardial infarction

77
Q

Define embolus

A

Intravascular mass carried in the blood stream to a remote site. May be solid, liquid or gaseous

78
Q

What is the mechanism of action of statins?

A

All statins are competitive inhibitors of HMG-CoA reductase

79
Q

What effect do Na+ channel blockers have on the cardiac action potential?

A

Reduce phase 0 (up phase) slope and peak of ventricular AP as well as shorten repolarisation

80
Q

Which vessels contribute most to blood pressure?

A

Arterioles

81
Q

What is the average heart mass of a healthy young adult?

A

159g

82
Q

Name three factors that can shift the O2 saturation curve to the left

A

Decreased DPG Decreased temperature Increased pH

83
Q

How do Ca2+ channel blockers improve arrhythmias?

A

Reduce heart rate and conduction through SA and AV node

84
Q

Name 7 modifiable risk factors for atherosclerosis

A
  • Hypertension
  • Smoking
  • Diabetes mellitus
  • Obesity
  • High LDL:HDL ratio
  • Physical inactivity
  • Proteinuria
85
Q

What are the ‘big 5’ risk factors for atherosclerosis?

A

Hypertension

Diabetes

Hypercholesterolaemia

Smoking

Family history

86
Q

How is ejection fraction calculated?

A

EF = (SV/EDV) * 100

87
Q

Where does the sympathetic nervous system innervate the heart?

A

SA node, AV node and ventricles

88
Q

Which factors does warfarin inhibit?

A

2, 7, 9, 10

89
Q

Which 3 things will affect SV?

A

Preload

Cardiac contractility

Afterload

90
Q

Describe 4 steps in primary haemostasis

A

1 Vessel damage exposes von Willibrand factor on basement membrane and collagen 2 vWF binds to Gp1b on platelets 3 Platelet: adhere, flatten, recruit, degranulate (ADP and thromboxin A2) 4 platelet plug

91
Q

Hypertension would typically cause which type of LV hypertrophy?

A

Concentric

92
Q

What are the 3 layers of a blood vessel?

A

Intima

Media

Adventitia

93
Q

Which ventricle is less compliant?

A

Left (because has thicker wall)

94
Q

What percentage of the blood is in the heart?

A

7%

95
Q

What percentage of the blood is in the capillaries?

A

5%

96
Q

During which cardiac phase is ventricular volume least?

A

Isovolumetric relaxation

97
Q

Identify these valve events

A
98
Q

A new drug called buprolol is on the market. What class of drug is this likely to be?

A

Beta blocker

99
Q

How is hypertension Dx?

A

Chronic BP greater than 140/90 mmHg

100
Q

Branches of the descending aorta supply which 4 structures?

A

Intercostal aas

Pericardium

Esophagus

Bronchial aas

101
Q

What cardiac phase does S1 correspond to?

A

Isovolumetirc contraction

102
Q

What are the 4 major classes of drugs used for arrhythmias?

A

Beta blockers

Calcium channel blockers

Sodium channel blockers

Potassium channel blockers

103
Q

What is APTT

A

Activated partial thrombin time

104
Q

What effects does parasympathetic stimulation of the heart have?

A

Decreased heart rate

105
Q

Fluid in the pericardial cavity is called what?

A

Pericardial effusion

106
Q

What are these areas?

A
107
Q

What is a typical cardiac output?

A

5-5.25 L/min

108
Q

What is INR and how is it calculated?

A

International normalised ratio INR = (patient PT/normal PT)^ISI INR = (Patient prothrombin time/mean normal prothrombin time)^international sensitivity index

109
Q

What is a typical EDV?

A

110 to 120ml (Guyton and Hall, 1996)

110
Q

What effect does shifting the O2 saturation curve to the left have on Hb affinity for O2?

A

Increase

111
Q

What condition is this?

A

Aortic stenosis

112
Q

Which substance mediates endothelial vasoconstriction in coagulation?

A

Endothelin

113
Q

What effect does altitude adaptation have on the O2 saturation curve?

A

Shifts it to the right

114
Q

Describe 5 steps in the feedback loop of short term regulation of low blood pressure

A
  1. Low blood pressure sensed by stretch receptors in carotid sinus in internal carotid artery
  2. Less stretch causes less firing of glossopharyngeal nerve to nucleus of solitary tract in medulla
  3. Sympathetic nervous system stimulated
  4. Sympathetic nervous system:
    - Increases heart rate (chronotropic)
    - Decreases AV conduction time
    - Increases cardiac contractility (inotropic) (more Ca2+ released per contraction)
    - Increases TPR (alpha adrenocetpors)
    - Increase venous tone (don't want blood hanging around uselessly in the veins)
  5. Blood pressure increased
115
Q

Define left ventriuclar hypertrophy

A

Increase in lefr ventricle mass relative to body size

116
Q

How do beta blockers lower blood pressure?

A

Reduce cardiac output and renin release through antagonism of beta 1 +/- beta 2 adrenocetpors

117
Q

How is left ventrilce relative wall thickness calculated?

A

T/D

Thickness of wall / Diametre of chamber

118
Q

What percentage of the blood is in the lungs?

A

10%

119
Q

What are 3 important qualities to establish when taking a history of palpitations?

A

1 Rhythm. Regular or irregular? Can you tap out the rhythm?

  1. Rate. Faster or slower than normal?
  2. Strength. Stronger or more forceful than normal?
120
Q

What percentage of the blood is in the veins?

A

65%

121
Q

List 8 actions of thrombin

A

Fibrinogen → fibrin V -> Va VIII -> VIIIa IX -> IXa XI -> XIa XIII -> XIIIa Binds to thrombomodulin (inhibits Va and VIIIa) Platelet activation

122
Q

Which factors is vitamin K a co-factor for?

A

2, 7, 9, 10

ie the same cofactors that warfarin affects

123
Q

A raised INR indicates which 2 possible things?

A

There is a problem with Factor VII or the patient is on warfarin

124
Q

Define anaemia and which two blood tests are used most often in diagnosis

A

A reduction of the total circulating red cell mass below normal limits.

Haematocrit and haemoglobin concentration

125
Q

Dietary deficiences of which 3 substances may cause anaemia?

A

Iron, VitB12, folate

126
Q

Name three factors that can shift the O2 saturation curve to the right

A

Increased DPG Increased temperature Decreased pH

127
Q

What is the molecular action of calcium channel blockers?

A

Inhibit voltage-gated L-type Ca2+ channels

128
Q

What effect does adrenaline have on TPR and how?

What receptors are involved?

A

Increases TPR due to vasoconstriction.

Stimulation of alpha adrenoceptors.

129
Q

A new drug called stortosartan is on the market. What class of drug is this likely to be?

A

Angiotensin receptor antagonist

130
Q

What percentage of respiratory carbon dioxide does Hb carry as carbaminohaemoglobin?

A

15%

131
Q

Name 2 substances that may be elevated in blood after death of cardiac myocytes

A

Troponin I and T

Creatine kinase MB

132
Q

What type of aneurysm is classically seen on the circle of Willis and what is this called?

A

Sacular aneurysm

Called a berry aneurysm

133
Q

What is the most lateral structure in the mediastinum?

A

Phrenic nerves

134
Q

At what vertebral level does the aorta pass behind the diaphragm?

A

T12

Diaphragm apertures spinal levels:

Vena cava T8

Oesophagus T10

Aortic hiatus T12

mnemonic: via number of letters

135
Q

Identify these stages of the cardiac cycle

A
136
Q

What is a typical ESV?

A

40-50ml (Guyton and Hall, 1996)

137
Q

What type of blood vessel is this?

A

Small vein.

The wall of the vein consists of two to three layers of smooth muscle fibres. Note the wide diameter of the lumen relative to the thickness of the wall.

138
Q

What type of blood vessel is this?

A

Capillary

139
Q

At what vertebral level does the inferior vena cava pass through the diaphragm?

A

T8

140
Q

Name these volumes or pressures

A
141
Q

What is the molecular target of ACE inhibitors?

A

Block conversion of Angiotensin I to Angiotensin II by inhibiting angiotensin converting enzyme

142
Q

Where does left anterior descending artery supply?

A

LAD supplies anterior surface and anterior 2/3 of interventricular septum

143
Q

Where does circumflex artery supply?

A

lateral wall of LV

144
Q

Where does posterior interventricular artery supply?

A

Inferior part of LV and posterior 1/3 of interventricular artery

145
Q

How soon after an AMI will cardiac enzymes begin to possibly be elevated?

A

3 hours

146
Q

How long after the event will cardiac enzymes be a sensitive measure of AMI?

A

6 hours

147
Q

How soon after an AMI must repurfusion be to be effective?

A

6 hours

148
Q

Which artery most commonly supplies the atrio-
ventricular node?

A

Right coronary artery

149
Q

What is the most common inherited genetic disease of hypercoagulability of blood?

A

Factor V Leiden mutation

150
Q

Which bacteria classically causes subacute bacterial endocarditis?

A

Viridans strep

151
Q

Why is aspirin given in low doses as a blood thinner?

A

Low dose maintains selectivity for platelets because it will be at a low concentration by the time it reaches endothelium

152
Q

Why do some NSAIDs increase bleeding time?

A

They impair thromboxane A2, thus impairing platelet aggregation

153
Q

Where is the SA node?

A

In the right atrium, at the top of the crista terminalis and sweeps across in front of the SVC

154
Q

Where is the AV node

A

In the right atrium, between tricuspid valve and coronary sinus

155
Q

In what form does Hb carries about 15% of its respiratory carbon dioxide?

A

carbaminohaemoglobin

156
Q

Title these diagrams.

A
157
Q

What is the name of the muscle ridges in the ventricles? Atria?

A

Trqabeculae carneae

musculi pectinati

158
Q

The velocity of blood is slowest in ________

a) veins
b) arteries
c) capillaries
d) arterioles
e) large arteries

A

Capillaries

159
Q

True or false; Arterial hypertension is irrelevant to oedema?

A

True.

160
Q

Are cardiac muscle cells uninucleate or multinucleate?

A

Uninucleate.

161
Q

What is isovolumetric contraction?

A

The period between mitral valve closure and aortic valve opening; the time where all the blood is sitting in the LV and it’s just starting to contract (but not enough to cause the aortic valve to open). Considered isovolumetric as the volumes are not changing in the LV.

162
Q

What is systolic ejection?

A

Period between aortic valve opening and closing.

163
Q

What is isovolumetric relaxation?

A

Period between aortic valve closing and mitral valve opening. Nothing is entering the LV; Considered isovolumetric as the volumes are not changing in the LV.

164
Q

Location of beta-1 and beta-2 receptors?

A

Beta-1 vs Beta-2 receptor location “You have 1 heart and 2 lungs” Beta-1 are therefore primarily on heart Beta-2 primarily on lungs

165
Q

Describe the action of Beta-1, beta-2, alpha-1 and alpha-2 receptors.

A

Beta 1 receptors - heart muscle contraction

Chronotropic (chrono- time, tropic- a turn) act on the SA node to increase HR

Dromotropic (dromo-running) act on AV node to increase conduction–> increased HR

  • *Inotropic** affects myocardial contractility (strength of contraction of heart muscle)
  • *Beta 2 receptors** - smooth muscle relaxation - bronchodilator
  • *Alpha 1 receptors** - smooth muscle contraction (BV constriction)
  • *Alpha 2 receptors** - smooth muscle contraction and neurotransmitter (noradrenaline) inhibition (prejunctional autoinhibition)
166
Q

What is the difference between pharmacodynamics and pharmacokinetics?

A

pharmacodynamics is the effect that drugs have on the body; while pharmacokinetics is the study of the way in which drugs move through the body dur- ing absorption, distribution, metabolism and excretion. Before a drug can begin to exert any effect on the body it has to be absorbed into the body systems.

Mnemonic: Girl is keen, says “adme”

167
Q

What is the immediate pharmacological treatment for a suspected AMI?

A

MONA Morphine Oxygen Nitrates Aspirin

168
Q

A normal respiratory rate is:

A

12-16 breaths/min

169
Q

Define orthopnea

A

Shortness of breath when lying down

MD1 FBS (28 decks)

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