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Medicine year 1 > Cardiovascular principles > Flashcards

Cardiovascular principles Flashcards

(100 cards)

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1
Q

What is shock

A

abnormality of the circulatory system which results in inadequate tissue perfusion and oxygenation

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2
Q

What can inadequate tissue oxygenation lead to (3)

A

anaerobic metabolism
Accumulation of metabolic waste products
Cellular failure

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3
Q

What are the four causes of inadequate perfusion

A

loss of blood volume
Sudden severe impairment of heart
Obstruction to circulation
Excessive vasodilation and abnormal distribution of flow

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4
Q

What are the four types of shock

A

hypovolemic
Cardiogenic
Obstructive
Distributive

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5
Q

What are the types of causes of hypovolemic shock (2)

A

haemorrhagic and non-haemorrhagic

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6
Q

What is Cardiogenic shock

A

sustained hypotension due to rudimentary cardiac contractility

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7
Q

What are the types of causes of Cardiogenic shock (4)

A

contractility
Mechanical
Arrhythmia
Cardiotoxicity

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8
Q

What is obstructive shock

A

physical obstruction of blood flow outside the heart

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9
Q

What are the types of causes of obstructive shock (2)

A

outflow
Venous return

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10
Q

How do hypovolemic, Cardiogenic, and obstructive shock decrease CO and BP (and therefore cause inadequate tissue perfusion)

A

By decreasing stroke volume

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11
Q

What is distributive shock

A

abnormal distribution of blood flow

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12
Q

What are the causes of distributive shock (2)

A

neurogenic
Vasoactive

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13
Q

How does neurogenic distributive shock lead to inadequate tissue perfusion

A

loss of sympathetic tone causes vasodilation

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14
Q

How does vasoactive distributive shock lead to inadequate tissue perfusion

A

Release of vasoactive mediators causes vasodilation and increase capillary permeability

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15
Q

How is shock managed (3)

A

high flow oxygen (saturation should be above 94%)
IV access
Fluid resuscitation

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16
Q

What is syncope

A

a non-traumatic form of a transient loss of consciousness

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17
Q

What are the characteristics of syncope (3)

A

rapid onset
Short duration
Spontaneous and complete recovery

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18
Q

What are the three types of syncope

A

neurocardiogenic
Postural hypotension
Cardiac syncope

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19
Q

What are the two causes of neurocardiogenic syncope

A

Vagal stimulation
Depression of sympathetic activity

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20
Q

How does vagal stimulation affect cerebral perfusion (3)

A

cardioinhibiton
Decreases heart rate
Decreases cardiac output

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21
Q

How does depression of sympathetic activity affect cerebral perfusion (3)

A

decreases SVR
Decreases venous return, stroke volume, and cardiac output
Mean arterial pressure is decreased

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22
Q

what can trigger vasovagal syncope (3)

A

pain
Prolonged standing
Emotional stress

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23
Q

What is syncope

A

A faint during or immediately after a trigger

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24
Q

What causes hypersensitive carotid sinus syndrome

A

hypersensitive baroreceptors

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25
What are the three types of neurocardiogenic syncope
Vasovagal Situational Hypersensitive carotid sinus syndrome
26
In what demographic is HCSS more common
Elderly males
27
Postural/orthostatic hypotension description
Failure of the baroreceptors to respond to gravitational shifts in blood when moving from a horizontal to a vertical position
28
Describe cardiac syncope
transient loss of consciousness caused by a cardiac event which leads to a sudden drop in cardiac output
29
For which type of syncope is permanent cardiac pacing usually recommended
Hypersensitive carotid sinus syndrome
30
What is used to manage situational syncope (2)
avoiding dehydration Lying down
31
What factors regulate coronary blood flow (3)
Physical, neural, and metabolic
32
What can overcome sympathetic tone
Metabolic hyperaemia during exercise
33
Why is resting blood flow low
sympathetic vasoconstrictor tone
34
Why may blood pool in lower limbs
if venous valves become incompetent
35
What results from blood pooling in lower limbs
varicose veins
36
Why is blood pooling in lower limbs not accompanied by a decrease in cardiac output
due to a chronic compensatory increase in blood volume
37
What is paracellular movement (2)
movement of substances through gaps between cells
38
What is Transcellular movement (2)
movement of substances through cells
39
How does protein movement occur (2)
some fenestrated capillaries facilitate protein movement Pinocytotic vessels can facilitate protein movement
40
What types of pressure drive direction and magnitude of fluid movement (2)
hydrostatic pressure and osmotic pressure
41
Describe capillary hydrostatic pressure (3)
favour filtration Product of arterial and venous pressures Highest at the arterial end of a capillary
42
Describe interstitial hydrostatic pressure (2)
opposes filtration Normally low because the lymphatic system draws fluid out of the interstitial space
43
Describe capillary oncotic pressure (2)
opposes filtration Due to presence of proteins in the capillary lumen
44
Describe interstitial oncotic pressure (2)
Favours filtration Due to presence of proteins in interstitial fluid
45
At which ends of a capillary are filtration and reabsorption more common
Filtration is more common at the arteriolar end Reabsorption is more common at the venous end
46
Function of the lymphatic system
To return fluid from the interstitial fluid to the circulation via lymphatic capillaries Which transport lymph towards the thoracic duct
47
When can blood flow be heart with a stethoscope
if external pressure is between systolic and diastolic pressure When blood pressure exceeds external pressure and becomes turbulent
48
What does the first Korotkoff sound indicate
peak systolic pressure
49
What are the second third korotkoff sounds due to
turbulent spurts of flow which cyclically exceed cuff pressure
50
What does the fourth Korotkoff sound indicate
minimum diastolic pressure
51
What causes the first heart sound (auscultation)
closing of the mitral and tricuspid valves
52
What does the first heart sound signal
Beginning of systole
53
What causes the second heart sound
closure of aortic and pulmonary valves
54
What does the second heart sound signal
End of systole Beginning of diastole
55
Why can the second heart sound split (3)
during inspiration intrathoracic pressure decreases, increasing venous return to the right side of the heart Increased volume in the right ventricle increases right ventricular ejection time Pulmonary component of the second heart sound is delayed compared to the aortic component
56
What is the third heart sound
an early diastolic low frequency filling sound occurring immediately after the second heart sound
57
Where is the third heart sound most clearly heard
the apex of the heart
58
When would a third heart sound be pathological
in an older patient - could be caused by left ventricular systolic dysfunction
59
What is the fourth heart sound
a late diastolic low frequency filling sound occurring before the first heart sound
60
What causes the fourth heart sound
atrial contraction causing a rapid flow of blood into a less compliant ventricle Associated with myocardial ischaemia, hypertension, and aortic stenosis
61
Which heart sound is always pathological
4
62
Which type of murmurs coincides with the carotid pulse
systolic
63
What causes cardiac murmurs
Turbulent blood flow in the heart
64
Which type of murmur is always pathological
diastolic
65
Which type of systolic murmurs can be pathological (3)
ejection Late-peaking Pan-systolic
66
What are the general features of pathological murmurs (3)
radiation Poor localisation Associated abnormalities
67
Describe the events of a pacemaker potential (3)
slow depolarisation Further depolarisation involving calcium ion influx Repolarisation involving potassium ion efflux
68
What is the funny current
a mixed sodium and potassium inward current resulting in slow depolarisation
69
Describe the events of a myocardium action potential (5)
depolarisation (Na influx) Transient K efflux Ca influx K efflux Resting potential restored due to K efflux
70
Which type of cell has a plateau phase in the action potential
Myocardium
71
What occurs during the plateau phase of a myocardium action potential
calcium ion influx through L type calcium ion channels
72
What receptors are involved in sympathetic stimulation of th heart
beta one receptors
73
How does vagal stimulation affect the pacemaker potential
decreases the slope
74
Which medication poses the risk of hypokalaemia
thiazide and loop diuretics as they increase potassium excretion (step three of hypertension treatment)
75
what is an indirect effect of loop diuretics
venodilation
76
An inferior STEMI results in changes in what parts of an ECG
leads II, III, and AVF
77
An anterior STEMI leads to changes in which part of an ECG
Leads V1-V6
78
Which ECG leads are the precordial leads
V1-V6
79
Which artery supplies the anterior aspect of the myocardium
left anterior descending coronary artery
80
If a patient suffers from an anterior STEMI, which artery is likely to be involved
Left anterior descending coronary artery
81
Describe how hypertrophic cardiomyopathy arises
due to a mutation in sarcomeric genes Inherited in an autosomal dominant pattern
82
What test would be used if an abdominal aortic aneurysm is suspected
ultrasound
83
How does ventricular fibrillation present on an ECG (3)
Random, irregular rhythm with no identifiable QRS complexes or P waves Wandering baseline
84
How is first degree heart block characterised on an ECG
prolonged PR interval (greater than 0.2 seconds)
85
What can hypertrophic cardiomyopathy cause in relation to the structure of the heart
Asymmetric Hypertrophy of the inter-ventricular septum
86
What type of murmur is associated with hypertrophic cardiomyopathy
systolic crescendo-decrescendo (ejection) murmur along left sternal border
87
What type of murmur is associated with aortic stenosis + where is it heard
ejection systolic (crescendo-decrescendo) Heard at upper right sternal border Possibly radiating to carotids
88
What is the most common causative agent of acute bacterial endocarditis
staphylococcus aureus
89
What is the most common causative agent(s) of subacute endocarditis (2)
Streptococcus viridans Staphylococcus epidermidis
90
Symptoms of left sided heart failure (4)
Breathlessness Paroxysmal nocturnal dyspnoea Productive cough Bi-basal crackles
91
Symptoms of right sided heart failure (3)
raised JVP Hepatomegaly Peripheral oedema
92
What murmurs is associated with aortic regurgitation + where is it heart
Diastolic decrescendo murmur heard at the left lower sternal border
93
What are the symptoms of aortic regurgitation (2)
shortness of breath dizzines (as a result of regurgitation of blood back into the heart)
94
What conditions are associated with aortic regurgitation
Connective tissue diseases such as Marfan’s syndrome
95
Changes in leads V1-V4 are due to which artery
left anterior descending
96
Changes in leads II, III, and aVF are due to which artery
Right coronary
97
Changes in leads V1-V6, aVL are due to changes in which artery
proximal left anterior descending
98
Changes in leads I, aVL, ± V5-V6 are due to which artery
left circumflex
99
Changes in leads V1-V3 are due to which artery
left circumflex or right coronary
100

Medicine year 1 (35 decks)

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