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MBBS1 Thorax > Caroline's Hypertension > Flashcards

Caroline's Hypertension Flashcards

1
Q

What are the side effects of angiotensin receptor blockers?

A

Hypotension, affects renal function

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2
Q

Which layers of the heart are sensitive and via which nerves?

A

Parietal and visceral pericardium via phrenic nerves

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3
Q

Which alpha or beta receptors will adrenaline work at?

A

A1, B1, B2

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4
Q

What is the vertical ridge running from the superior to inferior vena cava in the right atrium?

A

The crista terminalis

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5
Q

Name a A1 blocker

A

Prazonin

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6
Q

What do papillary muscles do?

A

Anchor chordae tendineae to the ventricular wall

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7
Q

What do chordae tendineae do?

A

Attach to atrio-ventricular cusps to open and close when the papillary muscles contract

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8
Q

What does vasopressin (ADH) do?

A

Causes water reabsorption in the collecting duct and general vasoconstriction

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9
Q

What is a positive inotrophic effect?

A

Increasing heart contractility

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10
Q

When are K+ channel agonists used and why?

A

Only in hypertensive emergency situations as a large and rapid rise in BP can cause damage to kidneys, eyes etc

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11
Q

What are the layers of the heart?

A

Fibrous pericardium, parietal pericardium, pericardial cavity, visceral pericardium, epicardium, myocardium, endocardium

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12
Q

What is pressure equal to in terms of flow and resistance?

A

Pressure = flow x resistance therefore blood pressure = CO x TPR

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13
Q

Which substances generally cause vasoconstriction?

A

Noradrenaline, histamine, angiotensin II, vasopressin (ADH), adrenaline, endothelin, leukotrienes

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14
Q

What does heart sound S1 represent?

A

Initiation of ventricular systole, closure of AV valves

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15
Q

What is the difference, structurally, between an artery and a vein?

A

Veins have a thin tunica media with sparse smooth muscle as they are more dilatory than constrictating

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16
Q

Which nerve innervates the baroreceptors in the carotid sinus?

A

The glossopharyngeal nerve, IX

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17
Q

Name a B1 selective blocker

A

Atenolol

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18
Q

Which substances generally case vasodilation?

A

Nitric oxide, histamine, prostaglandins (PGE1 or 2) bradykinin, adenosine and adrenaline

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19
Q

Where is the mitral valve?

A

Between the left atrium and left ventricle

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20
Q

What would happen if you stimulated an A1 receptor?

A

Vasoconstriction

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21
Q

What is the moderator band?

A

The bundle passing from septum to anterior papillary muscle in the right ventricle, part of the heart conducting system

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22
Q

Which second messenger is nitric oxide associated with leading to vasodilation of vascular cells?

A

cGMP, which opens K+ channels in the cell membrane causing hyperpolarisation of the cell and relaxation as Ca2+ leaves

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23
Q

What are the adverse affects of calcium channel blockers?

A

Tachycarida, peripheral oedema, headache due to vasodilation in brain, bradycardia, negative inotrophy when non selective.

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24
Q

What is the infundibulum?

A

Smooth part of the right ventricle often fails to develop properly in foetus leading to a hole in the heart or ventricular septal defect

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25
Q

What is a positive chronotrophic effect?

A

Increasing the heart rate

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26
Q

Where is the tricuspid valve?

A

Between the right atrium and ventricle

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27
Q

How does calmodulin initiate smooth muscle contraction?

A

Calmodulin binds to Ca2+ which activates myosin light chain kinase, phosphorylating myosin to initiating contraction

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28
Q

Why can conduction of the heart not leave the heart and spread to other cells of the body?

A

The cardiac skeleton is non conductive and prevents this from happening

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29
Q

Which alpha or beta receptors will noradrenaline work at?

A

A1 and B1

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30
Q

What are the MAP values for head, thorax and feet?

A

60mmHg in head, 90mmHg in thorax, 180 mmHg in feet

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31
Q

Who are ACE inhibitors used on?

A

First line treatment for white patients younger than 55

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32
Q

What does heart sound S2 represent?

A

Closure of semi lunar valve and atrial filling

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33
Q

Name a drug which blocks B1 but stimulates B2 receptors

A

Pindolol

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34
Q

Where is the SAN?

A

Upper end of crista terminalis in right atrium, lying superficially

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35
Q

What is the blood supply of the pericardium and where does it arise from?

A

Pericardiacophrenic and musculophrenic arteries from the internal thoracic arteries

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36
Q

What is cardiac output at rest and during exercise?

A

6L/min at rest compared to 24L/min during exercise

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37
Q

What defines coronary dominance?

A

Which vessel, left or right coronary artery, gives supply to the posterior descending (interventricular) artery

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38
Q

Where does the sympathetic input to the heart arise from?

A

The three cervical ganglia (superior, middle, inferior) and T1-T4

39
Q

How do nerves reach the heart?

A

Via the cardiac plexus

40
Q

What is hypertension?

A

When systolic and/or diastolic blood pressure exceeds 140/90

41
Q

What do calcium channel blockers do?

A

Inhibit arteriole constriction by agonists (e.g. NA or ang II) by blocking voltage gated Ca2+ channels therefore decreasing TPR

42
Q

Name a B1 and A1 blocker

A

Carvedilol

43
Q

How do noradrenaline, nitric oxide and angiotensin II reach the blood, respectively?

A

NO and ang. II via blood whereas NA is released by sympathetic nerves at the blood vessel

44
Q

Name a calcium channel antagonist which is vascular selective and one which is non-selective

A

Vascular selective: amlodipine

Non selective: verapamil

45
Q

Where can the aortic valve be heard on the skin with a stethoscope?

A

Medial end of 2nd right intercostal space

46
Q

What do K+ channel agonists do?

A

Opens K+ channels in vascular smooth muscle cells causing hyperpolarisation and relaxation

47
Q

How long is P-R on an ECG?

A

120 ms

48
Q

How long is Q-T?

A

300 ms

49
Q

When are A1 blockers used?

A

4th line drug used in combination with others

50
Q

Which body system contributes most to TPR?

A

Muscle due to large vascular bed

51
Q

What does heart sound S4 represent?

A

Atrial systole, only heard if EDP is increased

52
Q

What would happen if you stimulated a B1 receptor?

A

Increased heart rate and contractility.

53
Q

Where can the mitral valve be heard on the skin with a stethoscope?

A

5th intercostal space at the mid clavicular line

54
Q

What is the fossa ovalis?

A

The remnant of the foramen ovale of the fetus, a pit in the right atrium left from a closed up hole

55
Q

What is the auricle of the left atrium?

A

The only thing in the left atrium that disturbs its smooth walled appearance, reflects the invasion of endothelium of pulmonary veins during development

56
Q

Name a thiazide type diuretic.

A

Bendroflumethiazide

57
Q

Where is there a lot of ACE in the body and why is it there?

A

In the lungs because it is produced on endothelium and the lungs have a lot of endothelium due to need for gas exchange

58
Q

How do thiazide type diuretics work?

A

Increased water and sodium excretion by kidneys so decrease blood volume therefore pressure

59
Q

Which nerve innervates the baroreceptors in the aortic arch?

A

The vagus nerve, X

60
Q

Where can the pulmonary valve be heard on the skin with a stethoscope?

A

Medial end of 2nd left intercostal space

61
Q

Name an ACE inhibitor

A

Ramapril

62
Q

What would happen if you stimulated a B2 receptor?

A

Bronchodilation, vasoconstriction of skin and diversion of blood flow from skin and viscera to skeletal muscle

63
Q

What is endothelin?

A

A vasoconstrictor which antagonises nitric oxide and is produced in the lungs

64
Q

Name a K+ channel agonist.

A

Minoxidil

65
Q

What is pressure naturesis?

A

Increased pressure in renal artery leading to increased excretion of Na+ and water

66
Q

When do coronary arteries fill with blood?

A

During diastole

67
Q

Name a non-selective B blocker

A

Propanolol

68
Q

What are the sinus venarum and musculi pectinati?

A

The sinus venarum is the smooth wall of the right atrium behind the crista terminalis whereas the musculi pectinati is the muscular, comb like wall in front of the crista terminalis

69
Q

Where can the tricuspid valve be heard on the skin with a stethoscope?

A

5th intercostal space either side of the sternum

70
Q

Where is the heart in terms of surface anatomy?

A

Upper right border: 3rd costal cartilage
Lower right border: 6th costal cartilage
Upper left border: 2nd intercostal space
Lower left border: 5th intercostal space

The heart reaches the mid clavicular line on the left

71
Q

How is mean arterial blood pressure (MAP) calculated?

A

[Diastolic pressure + (systolic-diastolic)] divided by 3

72
Q

Where does the right coronary artery supply?

A

The ‘right heart’ myocardium, SAN and AVN

73
Q

What are A1 blocker side effects?

A

Postural hypotension, ankle oedema, drowsiness

74
Q

What is the parasympathetic input to the heart?

A

Vagus nerve

75
Q

What do ACE inhibitors do?

A

Block production of angiotenion II and inhibit bradykinin breakdown

76
Q

Where does the left coronary artery supply?

A

The ‘left heart’ myocardium and intra ventricular septum

77
Q

What are the four layers of an artery?

A

1) Endothelium
2) Tunica intima (contains elastic lamina)
3) Tunica media (SM cells connected by gap junctions)
4) Tunica adventitia (nerves, blood vessels, fibroblasts)

78
Q

How does oxidative stress interfere with the ability of blood vessels to dilate?

A

Reactive oxygen species react with NO preventing it from mediating vasodilatation

79
Q

What percentage of the general population, and the over 50s have hypertension?

A

25% of general population and 50% of over 50s

80
Q

Which blood pressure represents TPR?

A

Diastolic

81
Q

What are the adverse affects of ACE inhibitors?

A

Chronic dry cough, hypotension, affects renal function

82
Q

What are trabecular carneae?

A

The highly muscular ridges of myocardium in the ventricles

83
Q

Name an angiotensin receptor blocker.

A

Losartan

84
Q

What could a diastolic murmer indicate?

A

Stenonis of the AV valves as they are open during diastole

85
Q

What does heart sound S3 represent?

A

Opening of AV valves and rapid filling

86
Q

Who should propanolol not be used on?

A

Asthmatics as it blocks B2 receptors as well as B1 and blocking B2 causes bronchoconstriction

87
Q

When are thiazide type diuretics used?

A

In patients over 55 when calcium channel blockers are not suitable

88
Q

How is membrane depolarisation initiated in smooth muscle contraction?

A

Na+ and Ca2+ influx via a G protein coupled receptor gated ion channel. Once the ion concentration reaches threshold Ca2+ voltage gated channels open and Ca2+ floods in adding to depolarisation

89
Q

What are the side effects of thiazide type diuretics?

A

Hypokalemia and high plasma cholesterol

90
Q

What is vascular remodelling?

A

Where the artery wall gets thicker in response to sustained hypertension, increasing TPR

91
Q

When are calcium channel blockers used?

A

First line for black patients of any age, or white patients over 55

92
Q

Where is the AVN?

A

Near the atrio-ventricular junction, lying deep

93
Q

How long is QRS on an ECG?

A

80 ms

MBBS1 Thorax (6 decks)

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