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cv Flashcards

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1
Q

chonotropic

A

relating to Heart rate

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2
Q

ionotropic

A

relating to force of heart contraction

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3
Q

how do MI, ACS, angina, IHD, CHD and atherosclerosis , atherogenesisrelate?

A

IHD (ischeamic heart disease) is the same as CHD (coronary heart disease) and is the same as coronary atherosclerosis.

These terms refer to MI (heart attack) and ACS (acute coronary syndrome, = unstable angina) and stable angina.

atherosclerosis (formation = atherogenesis) is the cause for angina, ACS, and MI .

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4
Q

types of angina
5
what they are

A

stable angina (=pectoris) - painful periods are regular

unstable angina (=ACS, = crescendo angina) - painful periods are increasing in severity / frequency/ occurring at rest

prinzemental’s (=variant) = spasm of coronary arteries

microvascular = stenosis of small coronary vessels – increase in resistance and pressure

decubitus = when lying down/recumbent

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5
Q

excarbeating factors of angina (4)

A
  • cold
  • exercise/activity
  • post prandial
  • stress
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6
Q

opioid vs opiate

A

opiates are naturally occurring, acting on opioid receptors.

opioid is a synthetic/partially synthetic molecule - may act/ replicate opiates to get same response

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7
Q

orthopnea=

A

sob when lying down

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8
Q

paroxysmal nocturnal dyspnoea

A

sudden attacks of severe sob and coughing occurring at night

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9
Q

stage 1 hypertension

stage 2 hypertension

stage 3 hypertesnion

A

1

  • clinic : 140/90 - 160/100
  • ABPM: 135/85 - 150/95

2

  • clinic: 160/100 - 180/110
  • ABPM: 150/95 +

3
- clinic: 180/110 +

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10
Q

gangrene

A

tissue death due to ischeamia/ infarction

typically feet

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11
Q

what is amourosis fugax

A

blindness due to lack of blood flow

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12
Q

atrophic skin

- eg of disease its seen in

A

thin skin (eg PAD)

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13
Q

CRP blood test

A

c-reactive protein
detects inflammation, released after tissue injury
quite vague, non-specific but can be used to rule things out (eg claudication)

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14
Q

ESR blood test

A 
erythrocyte sedimentation rate
measure degree of inflammation such as cancer, autoimmune etc
non specific (excludes claudication)
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15
Q

haematoma vs haemorrhage

A

both refer to localised bleeding from a blood vessel. haematoma is associated with clotted bleed whereas haemorrhage implies ongoing bleed

usually large vessels i think

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16
Q

haemoptysis

A

coughing up blood

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17
Q

early diastolic murmur

A

mitral stenosis
opening snap could be considered early diastolic (valves closer together so friction sound when blood is pushed through (diastole = blood moves from a –> v)
then mid diastolic as well

aortic regurgitation

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18
Q

mitral stenosis’ murmur =

A

opening snap (early diastolic)
— valves closer together so friction sound when blood is pushed through (end of diastole)
blood moves from a –> v in disatole

then mid diastolic (rumble) to end of diastole

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19
Q

early systolic click murmu

A

mitral valve replacement (working fine)

click= metal

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20
Q

mitral valve replacement murmur

A

early systolic click

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21
Q

ejection systolic crescendo-decrescendo murmur

A

aortic stenosis

- systole as after aorta is after ventricles. de/crescendo is due to the rise/fall of pressure

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22
Q

aortic stenosis murmur

A

ejection systolic crescendo-decrescendo murmur

systole as after aorta is after ventricles. de/crescendo is due to the rise/fall of pressure

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23
Q

pansystolic murmur

A

mitral /tricuspid regurgitation
-valves flap through ventricular systole blood moving past them

  • maybe also MI/angina
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24
Q

mitral regurgitation murmur

A

pansysolic murmur

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25
ANP raised - suggests - causes what
atrial dysfunction high BP causes kidney to excrete more in order to correct for high BP
26
CK MB = - when
Is a marker of damaged heart muscle raised in MI
27
troponin I elevated when
MI
28
sepsis =
systemic inflammatory response associated with an infection
29
where in the blood vessel does atherosclerosis occur
intima
30
pericarditis ecg
Saddle shaped ST and PR depression
31
Saddle shaped ST and PR depression
pericarditis
32
hyperkalemia ecg
Tall tented T waves + pathological Q waves + flattened - absent p waves
33
Tall tented T waves + pathological Q waves + flattened - absent p waves
hyperkalemia
34
stemi ecg
st elevation
35
st elevation ecg
stemi
36
angina ecg
st depression
37
st depression ecg
angina
38
general heart block ecg
increase PR interval
39
increased pr interval
heart block
40
more than one atria p wave to each QRS block
2nd degree heart block
41
no relation between p and QRS
3rd degree heart block
42
3 rd degree heart block ecg
no relation between p and QRS
43
2nd degree heart block ecg
more than one atria p wave to each QRS block
44
mobitz type 1
pr interval increases gradually until QRS dropped/missing (p wave not conducted)
45
mobitz type 2
pr interval does not increase, it is constant. and then a qrs beat dropped/missing (p wave not conducted)
46
atrial fibrillation
irregularly irregular atrium contracts rapidly irregularly, uncoordinately av node responds intermittently - only some conducted to ventricles (irreg vents)
47
atrial fibrillation ecg
``` absent p wave rapid heart rate irregular QRS jaggedy no isoelectric baseline ```
48
``` absent p wave rapid heart rate irregular QRS jaggedy no isoelectric baseline ```
atrial fibrilation
49
atrial flutter ecg
saw tooth narrow tachycardia flutter waves
50
atrial flutter
regularly irregular | due to re-entry circuit in RA from AV back to sinus
51
atrial fib/ flutter - which is reg?
atiral fib= irregularly irregualr | atrial flut = regularly irregular
52
saw tooth narrow tachycardia flutter waves
atrial flutter
53
p waves
atrial depolarization SAN --> AVN general direction is SE so + on trace
54
PR inteval | - length?
SAN to ventricle muscle including AV node delay | should be 120-200ms (3-5 small squares)
55
QRS
ventricular depolarization AVN to septum and ventricles septum is SE so big postive up to R then negative as goes opposite direction up ventricle walls narrow is good
56
T wave
ventricular repolarization
57
time of ECG square
small square = 0.04s | big square = 0.2s (5 small squares)
58
how long does ECG measure for
10s
59
lead 1
lateral
60
lead 2
inferior
61
lead 3
inderior
62
aVR
not a heart face, it is aorta
63
aVL
lateral
64
aVF
inferior
65
v1
septal
66
v2
septal
67
v3
anterior
68
v4
anterior
69
v5
lateral
70
v6
lateral
71
inferior heart -- vessel?
R coronary | R marginal branch of it
72
lateral hear -- vessel?
L circumflex
73
septal heart -- vessel?
LAD
74
anterior heart -- vessel?
LAD
75
ecg rate calculation
1. ) number of R peaks x 6 (ecg is 10s--> min) - - reg/irreg HR 2) 300 / distance between R peaks in large squares - -- reg HR only
76
IHD race risk facotrs
SE asia | AF-CArib
77
QRISK2 aim for?
risk of CV ecent in next 10 y | aim for <10%
78
ACE i action
Inhibits angiotensin converting enzyme which converts angiotensin 1-2 in the RAAS system. Effect is to less aldosterone so reduce reabsorption of sodium and water in the kidneys so lowers BP, also vasodilates
79
ACE I names
"-pril" | ramipril
80
ACE i side effects
Decreased angiotensin 2 formation - Hypotension - Hyperkalemia (aldosterone blocked aldosterone causes K+ excretion). this is esp bad for bilateral renal artery stenosis) - Acute renal failure (less kidney perfusion due to efferent arteriole constriction) Increased (brady)kinin production (normally ACE converts kinin to inactive peptides-- metabolism) - not with ARB as doesn't stop ACE’s other action (brady(kinin) causes)-- - Cough ! - rash - allergic reaction
81
contraindications for ACEi
- Pregnancy (teratogenic) - Hyperkalemia - Renal dysfunction (hyperkalemic S/E esp bad for bilateral renal artery stenosis) - Afro-carribean patients - ---- Have Salt sensitivity so less renin - ----- means lower angiotensin 1 so already repressed RAAS so medication is less effective for other patients - asthma? cos of cough side effect?
82
ARB action
Stops angiotensin 2 binding to peripheral AT1 receptor | does not stop ACE's other function of bradykinin metabolism, so no high bradykinin so no cough
83
ARB names
" -sartan"
84
ARB side effects
- painful breast tissue - Breast tissue increase in males - Hypotension (esp volume depleted patients) - Hyperkalemia (aldosterone causes K+ excretion). this is esp bad for bilateral renal artery stenosis - Renal dysfunction - Rash - Angio -oedema No cough as ACE still able to do other function : convert kinin to inactive peptides so no (brad)kinin hanging about
85
ARB contraindications
Pregnancy Renal issue Hyperkalemia postural hypotension
86
alpha blockers example
doxazosin
87
alpha blockers action
block adrenoreceptors - which act on smooth muscle so decreases preripheral resistance (vasodilation)
88
clopidogrel =
antiplatelet
89
ticagrelor=
antiplatelet
90
B blocker name
"-onol" "-olol" "-llol" metoprolol bisoprolol
91
B blocker action
Block noradrenaline attaching to B adrenoceptors by continued binding to them Decreases cardiac output (less oxygen demand for the heart) Decreased HR (chronotropic) Decreased heart contractility (inotropic) Lower HR means better oxygen distribution (beta1 receptors) (beta 2 receptors -- vasodilation)? Block reflex sympathetic responses which stress heart in HF Propanolol best B blocker for post MI arryhtmia as also blocks sodium channels (also in class 1 = soidum channel blockers , as well as b blocker class 2 )
92
B blocker contraindications
Asthma !!!!!! (bronchospasm) COPD PVD - peripheral vascular disease
93
B blocker side effects
``` Fatigue Headache Sleep disturbances inc nightmares Bradycardia Hypotension Cold peripheries Erectile dysfunction ```
94
calcium channel blockers types with examples
all = L type CCB 1) phenylalkyonines (verapamil, diltiazem) 2) dihydropiridines -“dipine”. (amlodipine) 3) benzothiazapines * in maudative- dihy. . = multi purpose - including hypertension (amlodipine) Non-dihy.. = specific to heart, not hypertension (diltiazem)
95
CCB action
Increase cGMO and reduces intracellular Ca2+ concentration inhibits opening of voltage gated Ca channels (L type) in vascular smooth muscle), so lower calcium entry so less Ca available for contraction so decrease in peripheral resistance vasodilation prevents artery and heart hardening 1)phenylalkyonines (verapamil) cardiac: Decreases CO- negatively chronotropic (decrease HR) Negatively inotropic (reduce force of contraction) Doesn’t act on calcium channel at rest (more effective) type 4 anti arrythmia drugs 2) dihydropiridines (class 1 ?) -“dipine”. (amlodipine) - vascular: Vasodilates peripheral arteries so decreases peripheral resistance Acts on calcium channel at rest (less effective) - good for coronary spasm angina (not sure why) 3) benzothiazepines - both heart and vascular effects - between 1 and 2
96
corticosteroid 2 examples
prednisolone | hydrocortisone
97
corticosteroid action
Dampens immune system | - Suppress prostaglandin and leukotryin mediators
98
digoxin action
inhibit Na/K pump (blocks Na out and K in action) So more Ca in heart -- Increased force of contraction (ionotropic) Increased vagus (parasympathetic supply increased) stimulation ACh released (increases) - - Bradycardia (chonotropic) - - Slows AV node conduction this is a cardiac glycoside (class 5 ) antiarrythmia drug
99
digoxin side effects
More ectopic activity (extra beats) Narrow therapeutic range - Vom - Nausea - Diar - confusion
100
diuretics types and names
1) thiazides - distal tube “-thiazide” 2) loop diuretics- loop of Henle”-mide” 3) k (spironolactone)
101
diuretics action
Pass more urine, more electrolytes lost Decrease blood pressure 1) thiazides = block sodium and chloride reabsorption at the Na/Cl luminal co transporter 2) loop diuretics block Na / K/ 2Cl transporter (moving Na, K, 2 Cl into cells from urine via Na movement). This then reduces water outflow
102
nitrates action
Arterial and venous vasodilators Reduce preload and afterload (it’s the reduced preload that reduces anginal pain as less heart demand) Lowers BP for IHD/ heart failure (not hypertension)
103
statins action
Lowers serum LDL cholesterol by reducing production in the liver
104
lidocaine action
sodium channel blocker (decrease Na) class1 antiarrythmia drug
105
amiodarone action
prolong duration of action potential (by decrease K + ) type 3 antiarrythmia drug amiodarone has long half life and is selective for long action potential
106
thiazides SE
hypokalaemia (increased K+ secretion)
107
chlorthalidone =
non thiazide drug (but still antihypertensive) acts on DCT (reduce reabsorption) for longer duration
108
indapamide =
non thiazide drug (but still antihypertensive) acts on DCT (Reduce reabsorption) also vasodilator
109
what effect do beta blockers have on RAAS
reduce plasma renin
110
spironolactone effect on RAAS
aldosterone antagonist
111
when is CCB contraindicated / cautioned
heart failure as in cardiac muscle - negatively inotropic (contractility)
112
hypocalceamia ECG looks like? | - other causes for same ecg?
long QT (QT syndrome) ``` hypokalemia MI DM drugs - amiodarone, antidep congenital - romano-ward, jervell-large-neilson ```

phase 2a mine (38 decks)

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