Cardiovascular Flashcards
(169 cards)
1
Q
What condition is this?
A
Aortic regurgitation
2
Q
What does concentric hypertrophy compensate for?
A
Increased afterload
3
Q
Define eccentric hypertrophy
A
Normal relative wall thickness
Increased LV mass
LV enlargement
4
Q
Define concentric hypertrophy
A
Increased relative wall thickness
Increased LV mass
No LV enlargement
5
Q
Define compliance
A
ability of any chamber to accept increased volume
6
Q
What type of blood vessels are these?
A
Arterioles
7
Q
What condition is this?
A
Mitral stenosis
8
Q
What is the molecular target of heparin?
A
Heparin enhances activity of antithrombin III, which inhibits factor Xa and thrombin
9
Q
What percentage of red blood cell dry content does Hb make up?
A
97%
10
Q
What 2 forms may a true aneurysm take?
A
Sacular (unilateral outpouching) and fusiform (bilateral outpouching)
11
Q
Name 4 outcomes of atherosclerosis that predispose to CV disease
A
- Stenosis
- Impaired vasodilation
- Unstable plaque
- Local prothrombotic environment
12
Q
What makes up about 97% of red blood cell dry content?
A
Hb
13
Q
What effects does sympathetic stimulation of the heart have?
A
Increased heart rate and force of contraction
14
Q
What does eccentric hypertrophy compensate for?
A
Increased volume (preload)
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
16
Q
What are 4 distinguishing features of the phrenic nerve course?
A
- Runs along scalenus anterior muscle
- Passes between subclavian artery and vein
- Passes anterior to lung root
- Pierce diaphragm
17
Q
What type of blood vessel is this?
A
Arteriole
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.
19
Q
How is bradykinin degraded?
A
By angiotension converting enzyme
20
Q
Define thrombus
A
Clotted mass of blood that forms within the cardiovascular system during life
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
22
Q
What effect does beta adrenoceptor stimulation have on the heart?
A
Increased heart rate and cardiac contractility
23
Q
What is it called when there is an infection of heart valves?
A
Endocarditis
24
Q
Where does the parasympathetic nervous system innervate the heart?
A
SA node and AV node
25
What is the function of lipoproteins?
liporoteins transport fats such as cholesterol in the blood
26
What effect does shifting the O2 saturation curve to the right have on Hb affinity for O2?
Decrease
27
When CO increases (beyond the equilibrium point), what happens to venous pressure?
Decreases
28
Name two mechanisms Hb uses to achieve variable sigmoid binding character for oxygen association
Subunit cooperativity and allosteric effectors
29
List 5 acute signs of hypovolaemia
Tachycardia
Hypotension
Cold/clammy skin
Poor capillary refill (\> 2 secs)
Tachypnea (if severe hypovolaemia)
30
What is the main risk factor for aortic disection?
Hypertension
31
What is the characteristic histological feature of elastic arteries?
Up to 50 layers of elastin in the media
32
How do beta blockers treat arrythymias?
Reduce sympathetic drive to SA node
33
34
What is a typical ejection fraction?
60% (Guyton and Hall, 1996)
(55%-70% healthy ranges)
35
What are the braches off the arch of the aorta from right to left?
Brachiocephalic a (branches into right subclavian a and right common carotid a)
Left common carotid a
Left subclavian a
36
What type of blood vessel is this?
Medium vein
37
What cardiac phase does S2 correspond to?
Isovolumetric relaxation (start of diastole)
38
What are the constitutive subunits of Hb in adults and foetuses?
Adults: 2 alpha and 2 beta Foetuses: 2 alpha and 2 gamma
39
At the level of which thoracic vertebrae does the heart sit?
T5 to T8
40
What is the order of the cardio exam?
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.
41
The names of angiotensin receptor antagonists end with what?
-sartan
42
Mitral regurgitaiton would typically cause which type of hypertrophy?
Eccentric hypertrophy
43
Define compliance
Ability of a chamber to accept a volume of fluid
44
Where is the sternal angle?
Horizontal line between manubriosternal joint and T4/T5
45
What are the contraindications to treatment with ACE inhibitors?
Bilateral renal stenosis
Pregnancy
Angioneurotic oedema
46
What does the vascular funciton curve describe?
Describes what happens to venous pressure when CO varies
47
What is cardiac remodeling?
Increase of relative wall thickness without increase in left ventricle mass
48
What are the 3 components of Virchow's triad of thrombosis?
Vessel wall Blood composition Blood flow
49
What is the descending order of WBC concentrations in the blood?
NLMEB
50
What are the 3 critical intermediates of cholesterol synthesis?
HMG-CoA (hdroxymethyglutaryl-CoA),
isoprene
squalene
51
Describe 5 steps in secondary haemostasis
1 vessel damage releases tissue factor 2 extrinsic pathway: parathrombin → thrombin, 3 fibrinogen to fibrin, 4 fibrin crosslinks under factor XIIIa control 5 meshwork
52
What is the ligamentum arteriosum a remnant of?
Ductous arteriosus
53
What do the names of ACE inhibitors end in?
-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.
54
What is a typical SV?
70ml (Guyton and Hall, 1996)
55
What is the molecular target of warfarin?
Vitamin K reductase
Inhibition of this prevents reduced VitK acting as a cofactor for activation of factors 2, 7, 9 and 10
56
What are the 3 main components of the coagulation system?
Vasoconstriction, platelet plug and fibrin mesh
57
How do K+ channel blockers affect arrhythmias?
Prolong cardiac AP by slowing repolarisation
58
What percentage of the blood is in the arteries?
13%
59
Name 3 vasoactive agents that endothelium releases and describe their effect on vasculature
Vasoconstrictor: endothelin
Vasodilator: NO and prostacyclin (PGI2)
60
What type of noradrinergic receptors are found on the heart?
Beta 1 (because you have 1 heart)
61
List 5 factors that may affect the effects of warfarin
Diet (VitK)
Hepatic disease
Hypermetabolic state
Pregnancy
Drug interactions, eg NSAIDs, EtOH
62
What are the 3 general complications of atherosclerosis?
Infarct
Ischaemia
Aneurysm
63
Name 4 ways endothelium is implicated in atherosclerosis
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
64
Volume overload would typically cause which type of LV hypertrophy?
Eccentric
65
Define atherosclerosis
Accumulation of lipid and fibrous connective tissue (plaque) in the intima of medium and large arteries
66
During which cardiac phase is ventricular volume greatest?
Isovolumetirc contraction
67
Define preload
The amount of stretch on cardiac myocyte fibres at the end of diastole.
68
Name 3 substances that have cholesterol as a precursor in their synthesis
Bile acids
VitD
Steroid hormones
69
The names of beta blockers end in what?
- olol
e. g. atenolol, propranolol
70
Define diaphoresis
Profuse sweating
71
Where are cholinergic receptors on the heart found?
SA node and AV node
72
What is the upper limit for recommended cholesterol levels?
5.5 mmol/L
73
A new drug called dozatapril is on the market. What class of drug is this likely to be?
ACE inhibitor
74
Aortic stenosis would typically cause what kind of LV hypertrophy?
Concentric
75
Where does ligamentum arteriosum attach?
Bifurcation of pulmonary trunk to inferior aspect of aortic arch
76
What is the most common cause of LV hypertrophy?
Myocardial infarction
77
Define embolus
Intravascular mass carried in the blood stream to a remote site. May be solid, liquid or gaseous
78
What is the mechanism of action of statins?
All statins are competitive inhibitors of HMG-CoA reductase
79
What effect do Na+ channel blockers have on the cardiac action potential?
Reduce phase 0 (up phase) slope and peak of ventricular AP as well as shorten repolarisation
80
Which vessels contribute most to blood pressure?
Arterioles
81
What is the average heart mass of a healthy young adult?
159g
82
Name three factors that can shift the O2 saturation curve to the left
Decreased DPG Decreased temperature Increased pH
83
How do Ca2+ channel blockers improve arrhythmias?
Reduce heart rate and conduction through SA and AV node
84
Name 7 modifiable risk factors for atherosclerosis
- Hypertension
- Smoking
- Diabetes mellitus
- Obesity
- High LDL:HDL ratio
- Physical inactivity
- Proteinuria
85
What are the 'big 5' risk factors for atherosclerosis?
Hypertension
Diabetes
Hypercholesterolaemia
Smoking
Family history
86
How is ejection fraction calculated?
EF = (SV/EDV) \* 100
87
Where does the sympathetic nervous system innervate the heart?
SA node, AV node and ventricles
88
Which factors does warfarin inhibit?
2, 7, 9, 10
89
Which 3 things will affect SV?
Preload
Cardiac contractility
Afterload
90
Describe 4 steps in primary haemostasis
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
Hypertension would typically cause which type of LV hypertrophy?
Concentric
92
What are the 3 layers of a blood vessel?
Intima
Media
Adventitia
93
Which ventricle is less compliant?
Left (because has thicker wall)
94
What percentage of the blood is in the heart?
7%
95
What percentage of the blood is in the capillaries?
5%
96
During which cardiac phase is ventricular volume least?
Isovolumetric relaxation
97
Identify these valve events
98
A new drug called buprolol is on the market. What class of drug is this likely to be?
Beta blocker
99
How is hypertension Dx?
Chronic BP greater than 140/90 mmHg
100
Branches of the descending aorta supply which 4 structures?
Intercostal aas
Pericardium
Esophagus
Bronchial aas
101
What cardiac phase does S1 correspond to?
Isovolumetirc contraction
102
What are the 4 major classes of drugs used for arrhythmias?
Beta blockers
Calcium channel blockers
Sodium channel blockers
Potassium channel blockers
103
What is APTT
Activated partial thrombin time
104
What effects does parasympathetic stimulation of the heart have?
Decreased heart rate
105
Fluid in the pericardial cavity is called what?
Pericardial effusion
106
What are these areas?
107
What is a typical cardiac output?
5-5.25 L/min
108
What is INR and how is it calculated?
International normalised ratio INR = (patient PT/normal PT)^ISI INR = (Patient prothrombin time/mean normal prothrombin time)^international sensitivity index
109
What is a typical EDV?
110 to 120ml (Guyton and Hall, 1996)
110
What effect does shifting the O2 saturation curve to the left have on Hb affinity for O2?
Increase
111
What condition is this?
Aortic stenosis
112
Which substance mediates endothelial vasoconstriction in coagulation?
Endothelin
113
What effect does altitude adaptation have on the O2 saturation curve?
Shifts it to the right
114
Describe 5 steps in the feedback loop of short term regulation of low blood pressure
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
Define left ventriuclar hypertrophy
Increase in lefr ventricle mass relative to body size
116
How do beta blockers lower blood pressure?
Reduce cardiac output and renin release through antagonism of beta 1 +/- beta 2 adrenocetpors
117
How is left ventrilce relative wall thickness calculated?
T/D
Thickness of wall / Diametre of chamber
118
What percentage of the blood is in the lungs?
10%
119
What are 3 important qualities to establish when taking a history of palpitations?
1 Rhythm. Regular or irregular? Can you tap out the rhythm?
2. Rate. Faster or slower than normal?
3. Strength. Stronger or more forceful than normal?
120
What percentage of the blood is in the veins?
65%
121
List 8 actions of thrombin
Fibrinogen → fibrin V -\> Va VIII -\> VIIIa IX -\> IXa XI -\> XIa XIII -\> XIIIa Binds to thrombomodulin (inhibits Va and VIIIa) Platelet activation
122
Which factors is vitamin K a co-factor for?
2, 7, 9, 10
ie the same cofactors that warfarin affects
123
A raised INR indicates which 2 possible things?
There is a problem with Factor VII or the patient is on warfarin
124
Define anaemia and which two blood tests are used most often in diagnosis
A reduction of the total circulating red cell mass below normal limits.
Haematocrit and haemoglobin concentration
125
Dietary deficiences of which 3 substances may cause anaemia?
Iron, VitB12, folate
126
Name three factors that can shift the O2 saturation curve to the right
Increased DPG Increased temperature Decreased pH
127
What is the molecular action of calcium channel blockers?
Inhibit voltage-gated L-type Ca2+ channels
128
What effect does adrenaline have on TPR and how?
What receptors are involved?
Increases TPR due to vasoconstriction.
Stimulation of alpha adrenoceptors.
129
A new drug called stortosartan is on the market. What class of drug is this likely to be?
Angiotensin receptor antagonist
130
What percentage of respiratory carbon dioxide does Hb carry as carbaminohaemoglobin?
15%
131
Name 2 substances that may be elevated in blood after death of cardiac myocytes
Troponin I and T
Creatine kinase MB
132
What type of aneurysm is classically seen on the circle of Willis and what is this called?
Sacular aneurysm
Called a berry aneurysm
133
What is the most lateral structure in the mediastinum?
Phrenic nerves
134
At what vertebral level does the aorta pass behind the diaphragm?
T12
Diaphragm apertures spinal levels:
Vena cava T8
Oesophagus T10
Aortic hiatus T12
mnemonic: via number of letters
135
Identify these stages of the cardiac cycle
136
What is a typical ESV?
40-50ml (Guyton and Hall, 1996)
137
What type of blood vessel is this?
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
What type of blood vessel is this?
Capillary
139
At what vertebral level does the inferior vena cava pass through the diaphragm?
T8
140
Name these volumes or pressures
141
What is the molecular target of ACE inhibitors?
Block conversion of Angiotensin I to Angiotensin II by inhibiting angiotensin converting enzyme
142
Where does left anterior descending artery supply?
LAD supplies anterior surface and anterior 2/3 of interventricular septum
143
Where does circumflex artery supply?
lateral wall of LV
144
Where does posterior interventricular artery supply?
Inferior part of LV and posterior 1/3 of interventricular artery
145
How soon after an AMI will cardiac enzymes begin to possibly be elevated?
3 hours
146
How long after the event will cardiac enzymes be a sensitive measure of AMI?
6 hours
147
How soon after an AMI must repurfusion be to be effective?
6 hours
148
Which artery most commonly supplies the atrio-
ventricular node?
Right coronary artery
149
What is the most common inherited genetic disease of hypercoagulability of blood?
Factor V Leiden mutation
150
Which bacteria classically causes subacute bacterial endocarditis?
Viridans strep
151
Why is aspirin given in low doses as a blood thinner?
Low dose maintains selectivity for platelets because it will be at a low concentration by the time it reaches endothelium
152
Why do some NSAIDs increase bleeding time?
They impair thromboxane A2, thus impairing platelet aggregation
153
Where is the SA node?
In the right atrium, at the top of the crista terminalis and sweeps across in front of the SVC
154
Where is the AV node
In the right atrium, between tricuspid valve and coronary sinus
155
In what form does Hb carries about 15% of its respiratory carbon dioxide?
carbaminohaemoglobin
156
Title these diagrams.
157
What is the name of the muscle ridges in the ventricles? Atria?
Trqabeculae carneae
musculi pectinati
158
The velocity of blood is slowest in \_\_\_\_\_\_\_\_
a) veins
b) arteries
c) capillaries
d) arterioles
e) large arteries
Capillaries
159
True or false; Arterial hypertension is irrelevant to oedema?
True.
160
Are cardiac muscle cells uninucleate or multinucleate?
Uninucleate.
161
What is isovolumetric contraction?
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
What is systolic ejection?
Period between aortic valve opening and closing.
163
What is isovolumetric relaxation?
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
Location of beta-1 and beta-2 receptors?
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
Describe the action of Beta-1, beta-2, alpha-1 and alpha-2 receptors.
**_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
What is the difference between pharmacodynamics and pharmacokinetics?
**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
What is the immediate pharmacological treatment for a suspected AMI?
MONA Morphine Oxygen Nitrates Aspirin
168
A normal respiratory rate is:
12-16 breaths/min
169
Define orthopnea
Shortness of breath when lying down
